Care At A Distance

Often the switch to telecare--technology used to help caretakers provide treatment to their patients off-site--is portrayed as either a nightmare scenario or a much needed panacea for all our healthcare woes. This widely researched study probes what happens when technologies are used to provide healthcare at a distance. Drawing on ethnographic studies of both patients and nurses involved in telecare, Jeannette Pols demonstrates that instead of resulting in less intensive care for patients, there is instead a staggering rise in the frequency of contact between nursing staff and their patients. Care at a Distance takes the theoretical framework of telecare and provides hard data about these innovative care practices, while producing an accurate portrayal of the pros and cons of telecare.

World-wide migration has an unsettling effect on social structures, especially on aging populations and eldercare. This volume investigates how taken-for-granted roles are challenged, intergenerational relationships transformed, economic ties recalibrated, technological innovations utilized, and spiritual relations pursued and desired, and asks what it means to care at a distance and to age abroad. What it does show is that trans-nationalization of care produces unprecedented convergences of people, objects and spaces that challenge our assumptions about the who, how, and where of care.

Psychotherapy across distance and time, from Freud’s treatments by mail to crisis hotlines, radio call-ins, chatbots, and Zoom sessions. Therapy has long understood itself as taking place in a room, with two (or more) people engaged in person-to-person conversation. And yet, starting with Freud’s treatments by mail, psychotherapy has operated through multiple communication technologies and media. These have included advice columns, radio broadcasts, crisis hotlines, video, personal computers, and mobile phones; the therapists (broadly defined) can be professional or untrained, strangers or chatbots. In The Distance Cure, Hannah Zeavin proposes a reconfiguration of the traditional therapeutic dyad of therapist and patient as a triad: therapist, patient, and communication technology. Zeavin tracks the history of teletherapy (understood as a therapeutic interaction over distance) and its metamorphosis from a model of cure to one of contingent help. She describes its initial use in ongoing care, its role in crisis intervention and symptom management, and our pandemic-mandated reliance on regular Zoom sessions. Her account of the “distanced intimacy” of the therapeutic relationship offers a powerful rejoinder to the notion that contact across distance (or screens) is always less useful, or useless, to the person seeking therapeutic treatment or connection. At the same time, these modes of care can quickly become a backdoor for surveillance and disrupt ethical standards important to the therapeutic relationship. The history of the conventional therapeutic scenario cannot be told in isolation from its shadow form, teletherapy. Therapy, Zeavin tells us, was never just a “talking cure”; it has always been a communication cure.

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

World-wide migration has an unsettling effect on social structures, especially on aging populations and eldercare. This volume investigates how taken-for-granted roles are challenged, intergenerational relationships transformed, economic ties recalibrated, technological innovations utilized, and spiritual relations pursued and desired, and asks what it means to care at a distance and to age abroad. What it does show is that trans-nationalization of care produces unprecedented convergences of people, objects and spaces that challenge our assumptions about the who, how, and where of care.

Online Distance Education: Towards a Research Agenda offers a systematic overview of the major issues, trends, and areas of priority in online distance education research. In each chapter, an international expert or team of experts provides an overview of one timely issue in online distance education, summarizing major research on the topic, discussing theoretical insights that guide the research, posing questions and directions for future research, and discussing the implications for distance education practice as a whole. Intended as a primary reference and guide for distance educators, researchers, and policymakers, Online Distance Education addresses aspects of distance education practice that have often been marginalized, including issues of cost and economics, concerns surrounding social justice, cultural bias, the need for faculty professional development, and the management and growth of learner communities. At once soundly empirical and thoughtfully reflective, yet also forward-looking and open to new approaches to online and distance teaching, this text is a solid resource for researchers in a rapidly expanding discipline.

Is it ethical for psychiatrists to call a president a narcissist? From Goldwater to Trump, Martin-Joy reviews the debate.