| Summary: | Strategic drives and policy initiatives position mobile technology – or mHealth - as a means of addressing current healthcare challenges. However, mobile phones differ from other health technologies due to their ‘ground-up’ adoption, personal ownership and multiplicity of purpose. Prevailing paradigms in mHealth research cannot account for the range of ways mobile phone use is enacted in the hospital setting and therefore cannot support the level of enquiry required to explore new possibilities for care and learning. By adopting a ‘practice’ approach that draws focus to how mobile phone use is enacted in situ, this research reconceptualises care and phone use as sociomaterial practice, enabling the mutual shaping of mobile phones and social practices to be described. To achieve this end, the ward round was selected as a ‘case’ through which the mobile phone use of patients, clinical staff and students could be observed. Ethnographic methods of observation were combined with interviews to collect data from two different wards within the same hospital trust over a six month period in 2013. The primary research question addressed was “How are mobile phones being integrated into healthcare practices in the hospital setting?” Findings from this research show that phones are enacted as transient members of the ward round; visible at moments, then hidden from view. They contribute to the distributed and shared nature of care, loosening the constraints of time and space that are so critical to the ward round whilst simultaneously reproducing them. As such they play an important role in boundary work and in enabling and constraining boundary ‘spillover’. Participants using mobile phones on the ward found ways to benefit from the potentialities of mobile phone use but also had to engage with the complexities of spillover, how to ‘be’ on the ward and how to use phones appropriately. This research shows that the spaces and rhythms within which care is enacted on the ward produce ‘boundary work’ which mobile phone users learn to negotiate. Each episode of use is distinct, contingent and requires nuanced judgements that balance possibilities with safety and ethics. The thesis concludes by arguing top-down hospital safety and quality efforts are likely to struggle to address all the variables of situated practice relevant to mHealth. Nonetheless, working with, rather than against mobile phones in care practice requires an appreciation of empirical ethics and open discussion to allow new practices to emerge whilst safeguarding the interests of all involved.
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