Negotioating professional knowledge and responsibility in telecare: inter-professional cooperation across sectors

As part of ongoing efforts of rationalization and retrenchment in the healthcare sector, tasks are increasingly moved from costly specialized hospital departments to the primary healthcare sector, where less specialized personnel take on these tasks. Telecare plays an important role in facilitating local access to specialized competences at central hospitals through ICT-systems. Telecare thus establishes new virtual spaces for inter-professional cooperation between hospital- and municipal healthcare workers. This paper presents a study of how telecare contributes to transforming profes-sional identities and inter-professional relations. In an ethnographic study of local telecare nurses’ interactions with a specialized hospital department concerning the treatment of ulcers, we show how the ‘tele-ulcer’-technology gives rise to a negotiation of legitimate professional knowledge, as well as to a redistribution of professional responsibilities. The tele-ulcer-technology allows local nurses to access specialized knowledge of ulcer-treatment, which contributes positively to their pro-fessional development. However, the system also leads to a subordination of their contextualized knowledge to an abstract, standardized knowledge. While the tele-ulcer technology allows local nurses to expand their professional responsibility in a meaningful manner, acting as coordinating case-managers for their patients in a fragmented healthcare system, this expanded responsibility may also become a burden in urgent cases where the resources of the tele-ulcer system are not accessible.