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Niels Christian M Nickelsen

Shifting boundaries in telecare: the nurse-doctor relationship

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Telecare is a growing practice defined as diagnosis, treatment and monitoring among doctors, nurses and patients, which is mediated through ICT and without face-to-face interaction. The purpose of this article is to provide empirically based knowledge about the organization of the use of ICT and dilemmas of this increasingly common practice in healthcare.

Telecare embraces new standards and possibilities for professional responsibility and accountability for nurses, but also alters the relationship between doctors and nurses. This leads to a dilemma we characterize as ‘paradoxical accountability’.

The study draws on observations, interviews and desk research in relation to a large 4.5 million euro pilot project at four hospitals in Copenhagen regarding care of 120 patients with chronic obstructive pulmonary disorder (COPD). The empirical study was carried out over four months. Online video consultations were observed alongside workshops focusing on nurses’ photo elucidation of the telecare practice. The analytical ambition was to start the study in the middle of things and explore the emergent design of telecare.

The study draws on Star’s notion of ‘infrastructure’. In this perspective, infrastructure comprises human and non-human conduct embedded in organizational conventions, relations and sites. The analysis demonstrates that nurses are exposed to a new responsibility as all-round case managers, but also have less access to clinical decision makers. The notion of ‘paradoxical accountability’ is developed to account for this dilemma.

Keywords (max 8)
Telecare, infrastructure, practice oriented analysis, healthcare professionals, accountability, boundaries

Paper type
Case study
Original languageEnglish
JournalJournal of Workplace Learning
Pages (from-to)588-600
Number of pages14
Publication statusPublished - 21 Nov 2017

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