This thesis is a study of telecare in nursing care practices. The use of technology will change care, in both expected and unexpected ways. Of course, care professionals will not physically be with patients when care is given at a distance. But there are also more subtle changes, like patients who use the technology on their own terms, and nurses’ improvised solutions to work around hindrances. All of these adjustments turn telecare practices into construction sites, where nurses and patients work to achieve good care. This thesis examines the way nurses do this construction work, to enhance our understanding of how care changes when it is given at a distance, and to support nursing practices to change in good ways.
In the first chapter, ‘Introducing telecare: from policy to practice’, I set out the framework for my research. Government and care organizations aim to solve the twin problem of increasing care demands and a declining labor pool by introducing technology to care at distance. The introduction of technology is based on hope and expectations and projects are often initiated with quite abstract ideas (like ‘guidance’ or ‘support’) regarding what kind of care can be given at a distance. The economic motivations for telecare overshadow the fact that implementing technologies has to take shape in nurses’ and patients’ daily practice. My research questions explore how they do this:
• What changes occur in care practices when nurses use technology to provide care at a distance and how do these changes come into being?
• How do nurses deal with such changes?
• How can nurses improve their care at a distance-practices and how can researchers contribute to this?
The introduction relates these research questions and my approach to literature concerned with care and technology. The body of research on telecare shows the hopes and fears that are both invested in care at a distance. In the eyes of advocates, like government and care organizations, telecare should lead to care that is more efficient and meshes with the trend of patient self-management. Care professionals, in contrast, fear that by not being physically present when caring at distance, they may miss out on information and their relationships with patients will deteriorate. Scholars point out that technology is seen both as a threat to the nursing profession and as an improver of nurses’ status. This ambiguous meaning of technology in the caring professions, is a recurring issue.
Everything around us can be part of care. Care is not only a professional activity, but also consists of mundane acts. It is not only something nurses do based on protocols and established procedures, but also takes place in unexpected actions by unexpected actors. To look at care this way, I introduce theories that emphasize the importance of things such as homes, other beings and objects in care, best encapsulated as a material-semiotic approach as it includes both humans and non-humans and their relations. The most important non-human in this study is telecare technology. Analyzing the activity of both humans and non- humans allows me to understand the obvious and more subtle changes in care practices when technology is introduced.

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