Embodied Germ Cell at Work: Building an Expansive Concept of Physical Mobility in Home Care

Abstract

This article presents a process of collective formation of a new concept of mobility between home care workers and their elderly clients, who are at risk of losing physical mobility and functional capacity. A new tool called mobility agreement was introduced to facilitate the inclusion of regular mobility exercises in home care visits and in the daily lives of the clients. Our analysis starts with an overview of those visits in 2008 and 2009. We then analyze in detail one visit conducted in 2011, after two years of implementation of the mobility agreement. The analysis brings together the dialectical principle of ascending from the abstract to the concrete with the help of a germ cell, and key ideas from embodied and enactive cognition. During the visits a new concept of mobility began to emerge in the simple movement of standing up from the chair. This new concept transcends and overcomes the contradiction between safety and autonomy. Also it embeds and integrates mobility into necessary everyday actions of the old person. It is accomplished jointly with the nurse and relying on often innovative uses of everyday household artifacts. Finally, the new concept frames physical mobility in terms of sustainability.

Acknowledgments

Research reported in this article has been financially supported by the Finnish Funding Agency for Technology and Innovation Tekes (project “Implementation conditions of integration innovations in health care: Organizational volition and the voice of the client”; PI Yrjö Engeström) and by the Academy of Finland (project “Concept formation and volition in collaborative work”; PI Yrjö Engeström).

We are grateful to the clients, workers, and managers of the home care of the city of Helsinki for their generous participation in our research. We express our gratitude to Anne Edwards, Sten Ludvigsen, Ference Marton, Reijo Miettinen, Marco Pereira Querol, Falk Seeger, and Jaakko Virkkunen for their insightful critical comments.