Programme full

Thursday 16 April 2015 11:00 - 12:30
PAPER SESSION 4
Medicine, Health and Illness 2
W823, HAMISH WOOD BUILDING
Body Work in Early Medical Abortion
Harden, J., Purcell, C., Lawton, L., Cameron, S., Glasier, A.
(University of Edinburgh)
Abortion provision has seen significant shifts in the last 25 years in the UK and worldwide. Developments in medical
methods of abortion have enabled a higher proportion to take place earlier (with the percentage in the NHS Health
Board area of the present study having risen from 55% to 74% since 2009). They have also created the possibility of
women returning home to pass the pregnancy. These changes raise questions of how the work of medical abortion is
conceptualised by those who do it and it is the impact of these changes on staff working in abortion provision which
this paper explores. To do this it applies the conceptual lens of 'body work' to healthcare workers' accounts of 'early
medical abortion' (EMA) work, in order to draw out the peculiarities, constraints and challenges associated with EMA
work. We draw on data from in-depth interviews with 37 nurses, clinical support workers, sonographers and doctors
working in one area of urban Scotland, conducted between October 2013 and April 2014. Thematic analysis
highlighted three key issues in the body work of EMA relating to: temporal dimensions of the work; the
'dematerialisation' brought about by the option of women returning home to pass the pregnancy; and that which
replaces hands-on abortion work, which we suggest can be conceptualised as 'body work-by-proxy'. This paper
contributes to understandings of contemporary abortion provision and to debates regarding the utility of the concept of
body work.
Choice as Part of Care: Nurses Navigating Patient Preferences towards the End of Life
Borgstrom, E.
(University of Cambridge)
Choice – in the form of advance care planning – is a key element of English end-of-life care since 2008. It postulates
that knowing patient preferences about death and dying, such as preferred place of death, enables better co-ordinated
and personalised health care. It is assumed that this will ultimately ensure a good death through awareness and
preparedness. Tools like the Preferred Priorities for Care (PPC) document have been created to facilitate the process
of discussing and capturing patient choice. The underlying theory is that choice is empowering to all involved – the
patient, their family and carers, and the healthcare professionals. Mol has suggested that the logic of choice cannot
align with a logic of care. Using ethnographic examples from long-term fieldwork, I will demonstrate how ascertaining
patient choice has become part of nurses' work. In doing so, nurses risk treating choice as a task to be completed
rather than as a relational aspect of care. Consequently, staff navigate how and when they 'do choice' with patients in
order to maintain what they view as a caring disposition. In this context, choice and care are simultaneously conceived
of as objects and practices. I will argue that whilst choice and care may have different underlying logics in terms of the
amount and kind of relationality, using patient choice as a driver for end-of-life care blurs this theoretical distinction
and challenges us to rethink what these terms can mean in everyday practice.
The Role of Ethnography in the Sociology of Healthcare Quality and Safety: The Case of High-volume, Safetycritical
Routines in UK General Practice
Grant, S.
(University of Dundee)
Within the sociology of healthcare quality and safety, ethnographic methods have been increasingly employed to
examine the nature of risk and safety across a range of healthcare organisational settings (e.g. Dixon-Woods et al.
2009; Mesman 2008; Swinglehurst et al. 2011). Drawing on ethnography's ability to provide rich, holistic insights of
everyday practices, these studies have highlighted the complexity of socio-technical systems and the importance of
socio-cultural and infrastructural contexts on how safety is understood and performed in everyday practice (Allen
2013; Iedema 2009; Rowley & Waring 2011). The aim of this paper is to reflect on the role of ethnography within the
sociology of healthcare quality and safety by examining its application to high-volume, safety-critical routines within
UK general practice. It then goes on to explore ways in which ethnography can be further developed as a safety
improvement methodology within healthcare organisations. This paper will reflect on ethnographic fieldwork conducted
across eight UK general practices from 2010-2014 involving 1,787 hours of observation of high-volume, safety-critical
routines (e.g. repeat prescribing, test results handling, medicines reconciliation), 62 interviews with clinical,
administrative and managerial staff, and documentary analysis of key practice documents. Reflecting on the data
collection and analysis processes for this research, this paper seeks to contribute to current methodological
BSA Annual Conference 2015 154
Glasgow Caledonian University