Media Do Not Exist: Performativity and Mediating Conjunctures by Jean-Marc Larrue and Marcello Vitali-Rosati offers a radically new approach to the phenomenon of mediation, proposing a new understanding that challenges the very notion of medium. It begins with a historical overview of recent developments in Western thought on mediation, especially since the mid 80s and the emergence of the disciplines of media archaeology and intermediality. While these developments are inseparable from the advent of digital technology, they have a long history. The authors trace the roots of this thought back to the dawn of philosophy. Humans interact with their environment – which includes other humans – not through media, but rather through a series of continually evolving mediations, which Larrue and Vitali-Rosati call ‘mediating conjunctures’. This observation leads them to the paradoxical argument that ‘media do not exist’. Existing theories of mediation processes remain largely influenced by a traditional understanding of media as relatively stable entities. Media Do Not Exist demonstrates the limits of this conception. The dynamics relating to mediation are the product not of a single medium, but rather of a series of mediating conjunctures. They are created by ceaselessly shifting events and interactions, blending the human and the non-human, energy, and matter.
MULTIFILE
Background: Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods: We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n=4). Results: The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions: The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment.
