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”No space for old women!”Technological transformations in healthcare work
Ann Therese LotheringtonProfessorUniversity of Nordland, Norwayatl@uin.no
Work Futures in the Digital Economy Symposium Chilworth Manor Hotel, Southampton, 22nd-23rd March, 2012
Structure of presentation
1. Feld of research2. Interview with Anna3. My private story4. The movie5. Analysis 6. Conlusion
1. Field: The modern hospital
2. Interview with Anna
”It’s cracy what they are doing! To be honest, for me it is just a question of keeping up. One more year and I’ll be 62.”
”This job is not for old women. It doesn’t fit.”
”I think I’ve said all I wanted to say. I’m thinking about that movie ”No Country for Old Men.””
3. My private story
No Country for Old Men (2007) Joel and Etan Coen
Blogg: A somewhat complete analysis http://toomanycupcakes.blogspot.com/2
008/03/no-country-for-old-men-somewhat.html
4. The movie
The apparent law and orderof our times
The ultimate badass outlaw Anton Chigurh
”I do not want to go out and meet something I do not understand.”
Ed Tom Bell:
“A man cannot escape what’s coming to him”
Ed Tom Bell
Dreamed of his father who died when he was 20 years younger than Bell is now.
5. The analysis: Towards a new era
The shirts as a metaphor for the health care system
”health care bought by money with no solution”
• September 22, 2009 12:08 AM, p7
”So the shirts healed, covered and diverted attantion so the healing could begin. He (Chigurh) also applied sutures like a doctor so here seems to be an analogy with the health care system”
• February 9, 2011 4:21 PM, p19
Our story’sEd Tom Bell
Karin (65)Rønnaug (62)Randi (76)Solveig (63)(random order)
discussing changes in health care work with reseachers
Operating theatre, 1970ies
”Housewife school”
compulsory before
attending nursing school
Nursing work in an operating theatre
”It was such all-around-work, but we did at least learn to labour”
• Rønnaug (62)
”We had the responsibility for everything”
• Randi (76)
PREPARATIONS
"The instruments were our responsibility. All instruments were non-sterile. We had to find out what was needed for surgery and sterilize and pack. We had to know what to use for the different operations.”
P
Preparations
"And then we had such a table with suture threads that we used for suturing (surgical stitching). They were bottled in sterile. And there we were pulling up the sutures, threading them on the needles - thin needles, small eyes, when we were about to suture something thin. What a change when we got swaged needles! Then we didn’t have to do that. "
"It was a lot of work with the swabs. We counted stacks of tens and folded them. We got some saline that we used for wet swabs - now you get everything ready - we did it ourselves. We washed, dried, powdered and packed the used ones. We did even patch them if necessary."
“We made plaster, did you?”"Yes, and we sharpened the needles. As a nursing student, we learned to sharpen needles, wash them and put them in formaldehyde. ”
"But worst of all was the calculation of drugs - it was awful!”
During the operation
“ You must know what to hand over to the surgeon - preferably before he knows it himself.”
During the operation
"During the operation we had to ensure that nothing was forgotten in the patient. We counted the swabs - 100 times - before and after and during. We still do that. It is very much to remember.”
"But in those times there were real operations - open the stomach and stuff - and we took active part in the operation. It requires experience to avoid fumbling.”
"It was the surgical nurse who had to be in it all the time – sterile. Assistant nurses could not support us, because they didn’t have enough education - to do sterile work. The assistant nurses were very skilled, but they could not assist surgery. So it was better with two nurses. Then we could relieve each other.”
Follow up
"We had to clean the operation theatre between patients. There was no one else who cleaned. We shared the work so that one cleaned the operating theater, while the other took the instruments. Then we were ready for the next patient.”
Follow up
"And the report was written with pen on paper.”
"It was enough to do in quiet periods as well, such as packing equipment and cleaning cabinets, and see to that things were not expired and such. I remember one who didn’t like this, and said she had not become a surgical nurse to clean cabinets. Then we were shocked! But she cleaned the cabinet that day."
Technological change
"Acute and emergency operations have become much, much better! It cannot be compared - it's about safety. That’s very good. Now we receive a paper package that contains everything we need: coats, swabs, knifes, washing sets, drapes and everything. So we have a small tray with everything we need for the operation. Don’t have to spend time on packing. It's all in one package. So it’s much faster. We do not even have to do the calculation of drugs! It comes ready to use."
Digitisation
"Computers came into the theatres. We got the X-ray images on screens and reports should be written on the screen. That computer is, I’m sure, good for those who use it a lot, but for us who don’t it’s more ... a nuisance.”
New surgery technology
"The good old operations disappeared. It’s (endo)scopy now. A lot of standing - for hours - a much more passive and stagnant job.”
Give me a real belly!
“You hang around and watch. It has become a different and more boring job. Moreover, it is tiring with (endo)scopy because you have nothing to do – you just stand there. When you have a lot to do you forget that you are tired. If you are in a hurry you run, you know, even if you’re not supposed to.”
Adapting to a new era
"We just had to jump into it, without much training. They showed us in the Thursday meeting when we got the new rack. Everybody knew the old one, so of course we got a new one. And when we were standing there and did not know, we had to see if the nurse who had been trained, and more or less mastered it, was free and could come and help."
”You have to be young to keep up today!”
“Orthopedic surgery has changed a lot, and very rapidly. Just think about all the instruments!”
“That’s where I jumped off! It was only two years until I was about to be retired - and when I saw all the gadgets and all that was needed for a prosthesis, I felt ... one should not feel that as long as one is working, but ... now, now I start to feel old.”
“And the constant changing of the computer systems!”
“Sighs and groans! New programmes again - without training! I felt we got very little training in computer use, really. It was more like asking there and then, and then someone helped you. And those who used it most were good at it, while the rest of us made it in a way.”
"But I've said that I will not use it, because I'm hardly there. I'd rather spend time on something else - useful - instead of sitting in front of a screen.”
"That was not why we became surgical nurses!”
”A man cannot escape what’s coming to him.”
”I didn’t want to learn more!”
Our story’s metaphor for death:
Three about the new era:
Karin: •"The surgical nurse is most likely about to disappear - the function is gone."
Ed Tom: •”What’s going on is overwhelming. I feel overmatched. This country is hard on people, it’s not an easy place to live in.”
Anna: •“This job is not for old women. It doesn’t fit. I’ll just keep up till I’m 62.”
Exclusion mechanisms:
The villain
1) Chigurh doesn’t come from the place where the story is set. He comes from elsewhere and looks different - more modern.
2) We do not really get to know Chigurh but he doesn’t need to be explained. He is just there.
3) Chigurh is unstoppable in his brutality and without morals. He just moves on without looking back.
4) Chigurh is described as ”A ghost – pretty much”
Catch the villain?
6. Conclusion
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