Shifting boundaries in telecare – the nurse-doctor relationship

Abstract

PurposeTelecare 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 study is to provide empirically based knowledge about the organization of the use of ICT and dilemmas of this increasingly common practice in healthcare.Design/methodology/approachThe study draws on observations, interviews and desk research in relation to a large €4.5m 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.FindingsTelecare not only 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”.Originality/valueThe 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 not only exposed to a new responsibility as all-round case managers but they also have less access to clinical decision makers. The notion of “paradoxical accountability” is developed to account for this dilemma.