AGENTIVE FUTURE-MAKING IN MUNDANE INTERACTIONS: CRITICAL ENCOUNTERS AS SITES OF CONCEPT FORMATION

AGENTIVE FUTURE-MAKING IN MUNDANE INTERACTIONS: CRITICAL ENCOUNTERS AS SITES OF CONCEPT FORMATION Yrjö Engeström CRADLE University of Helsinki LECTURE 2 JOHN DEWEY LECTURES 2013: Concept Formation in the Wild as Educational Challenge: An Activity-Theoretical Research Program CREAD – Research Center on Education, Learning and Didactics Brittany Institute of Education University of Western Brittany, Rennes, France November 2013

TWO FOUNDATIONAL MECHANISMS OF FUTURE-MAKING • (1) VOLITIONAL ACTION TO ACHIEVE CHANGE = TRANSFORMATIVE AGENCY • (2) FORMATION OF CONCEPTS THAT EXPLICATE AND STABILIZE THE DIRECTION OF THE ENVISIONED CHANGE THE TWO MECHANISMS ARE CLOSELY INTERTWINED IN LIFE

CRITICAL ENCOUNTER • For Vygotsky, a conflict of motives was the starting point of the emergence of volitional action; conflicts of motives typically burst into the open in interactions between people • Such interactions often involve joint decision making or problem solving between participants who represent different positions and perspectives on the issues at hand • A conflict of motives is triggered or actualized by the tension between the parties, but it is not reducible to a disagreement; aconflict of motives is genuinely an inner conflict for the subject • In many work activities and institutions we can identify regularly occurring interactional situations which engender conflicts of motives; we call such recurring situations critical encounters

THE STRUCTURE OF A CRITICAL ENCOUNTER CONCEPTUALIZATION EFFORT VOLITIONAL ACTION SOURCE DOMAIN SOURCE DOMAIN COMPLEMENTARITY

DOUBLE STIMULATION IN CRITICIAL ENCOUNTERS • IN A CRITICAL ENCOUNTER, ONE OR BOTH SUBJECTS MAY EMPLOY AN ARTIFACT AS A SECOND STIMULUS TO TRANSFORM THE SITUATION AND TAKE VOLITIONAL ACTION TOWARD A NEW, EXPANDED PRACTICE • TO IDENTIFY AND ANALYZE SUCH SEQUENCES OF DOUBLE STIMULATION, WE NEED TO PUT SPECIAL FOCUS ON THE ARTIFACTS EMPLOYED AND ON THE VOLITIONAL ACTIONS THAT THEY TRIGGER

FOCUS ON DOUBLE STIMULATION IN CRITICAL ENCOUNTERS CONCEPTUALIZATION EFFORT VOLITIONAL ACTION SOURCE DOMAIN SOURCE DOMAIN COMPLEMENTARITY

HOME CARE VISITS AS CRITICAL ENCOUNTERS • 26 VIDEOTAPED HOME CARE VISITS IN THE MUNICIPAL HOME CARE SERVICE OF THE CITY OF HELSINKI • CLIENTS ARE ELDERLY PEOPLE (TYPICALLY OVER 75 YEARS OF AGE) WITH MEDICAL CONDITIONS THAT REQUIRE CONTINUOUS MONITORING • HOME CARE WORKERS ARE TYPICALLY LOWER LEVEL PRACTICAL NURSES • IN THE VISITS, ALSO A RESEARCHER WAS PRESENT TO DOCUMENT THE ENCOUNTER

MOBILITY AGREEMENT AS CHALLENGE • IN THE VISITS, THE HOME CARE WORKER WAS SUPPOSED TO IMPLEMENT THE NEW TOOLKIT OF MOBILITY AGREEMENT • IT IS AIMED AT INTEGRATING REGULAR PHYSICAL MOBILITY EXERCISES INTO THE HOME CARE VISITS AND IN THE EVERYDAY LIFE OF THE CLIENTS • IMPLEMENTATION IS DIFFICULT BECAUSE THE DOMINANT STANDARD SCRIPT OF A HOME CARE VISIT FOCUSES ON NECESSARY MEDICAL TASKS (DISPENSING MEDICATIONS, MONITORING BLOOD PRESSURE) AND PRACTICAL CHORES OF HYGIENE AND NUTRITION – FACILITATING PHYSICAL MOBILITY IS NOT A PART OF THE STANDARD SCRIPT • THUS, THESE VISITS ARE RIDDLED WITH THE TENSION BETWEEN MAINTAINING THE STANDARD SCRIPT (AVOIDING EXTRA EFFORT) AND EXPANDING THE SCRIPT BY INCLUDING THE MOBILITY AGREEMENT

TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER WE FOUND FIVE BROAD TYPES OF ENCOUNTERS… F % 6 23 4 15 5 19 6 23 5 19 TOTAL 26 100

…WHICH CORRESPOND TO FIVE DIFFERENT TYPES OF FUTURE ORIENTATION QUALITY OF FUTURE ORIENTATION TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER Nurse assumes that the client’s condition will get worse, aims at keeping up the regular script as long as the client stands on her/his own feet Nurse lets the client talk and dream about the future but stays out of it herself Nurse begins to conditionally consider possible changes in the standard script Nurse instructs or obliges the client and other workers to make changes Nurse and client envision and plan changes jointly

…WE ALSO FOUND FIVE TYPES OF VOLITIONAL ACTIONS VOLITIONAL ACTIONS JOINT NOVEL PHYSICAL ACTION CLIENT’S ONE-SIDED EXPRESSION OF WILL NURSE’S INSTRUCTION OR ENCOURAGEMENT JOINT COMMITTMENT CLIENT’S NOVEL PHYSICAL ACTION TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER 1 3 - 2 - 3 - - 1 - 1 2 1 1 - - 4 1 1 1 - 1 1 2 TOTAL 5 (19%) 10 (38%) 3 (12%) 5 (19%) 3 (12%)

…AND FIVE COMPONENTS OF THE EMERGING CONCEPT OF SUSTAINABLE MOBILITY • 1. MOVING OUT BEYOND THE HOME • 2. REGULARITY OF PHYSICAL MOVEMENT • 3. CONDUCTING MOVEMENT TOGETHER • 4. STANDING UP FROM THE CHAIR OR BED • 5. INTEGRATING MOVEMENT INTO DAILY CHORES

CONCEPTUALIZATION EFFORTS INTEGRATING MOVEMENT INTO DAILY CHORES MOVING OUT BEYOND THE HOME REGULARITY OF MOVEMENT CONDUCTING MOVEMENT TOGETHER STANDING UP FROM THE CHAIR OR BED TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER 3 1 - 4 - 2 2 - 2 - 1 4 - 4 - 3 2 2 6 4 3 2 4 4 2 TOTAL 12 (46%) 11 (42%) 6 (23%) 20 (77%) 6 (23%) (26 encounters = 100%; multiple different conceptualization efforts may occur in one encounter)

CONCEPTUALIZATION EFFORTS INTEGRATING MOVEMENT INTO DAILY CHORES MOVING OUT BEYOND THE HOME REGULARITY OF MOVEMENT CONDUCTING MOVEMENT TOGETHER STANDING UP FROM THE CHAIR OR BED TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER 3 1 - 4 - 2 2 - 2 - 1 4 - 4 - 3 2 2 6 4 3 2 4 4 2 TOTAL 12 (46%) 11 (42%) 6 (23%) 20 (77%)6 (23%) (26 encounters = 100%; multiple different conceptualization efforts may occur in one encounter)

THESE FINDINGS SUPPORT OUR EARLIER CLAIM THAT STANDING UP FROM THE CHAIR IS THE GERM CELL OF AND GATEWAY TO THE NEW CONCEPT OF SUSTAINABLE MOBILITY (see Engeström, Nummijoki & Sannino, 2012)

THE VOLITIONAL ACTIONS AND CONCEPTUALIZATION EFFORTS WERE GENERATED WITH THE HELP OF ARTIFACTSWE FOUND SEVEN TYPES OF ARTIFACTS-IN-USE

ARTIFACTS USED RESTRICTIVELY EXPANSIVELY BLOOD PRESSURE METER FURNITURE, DOMESTIC OBJECTS MOVEMENT-SUPPORTING DEVICES FURNITURE , DOMESTIC OBJECTS FOOD, MICRO- WAVE OVEN MEDICATIONS, DISPENSERS MOBILITY AGREEMENT TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER - - 1 2 1 2 2 1 - 1 1 2 1 1 - - 1 1 - 1 4 - 1 - 1 3 3 6 - - - - 3 1 4 TOTAL 1 (4%) 1 (4%) 3 (12%) 5 (19%) 9 (35%) 8 (31%) 17 (65%) (26 encounters = 100%; multiple different artifacts may be used in one encounter)

RESTRICTIVE AND EXPANSIVE USES OF ARTIFACTS • THE TABLE SHOWS THAT EVEN THE VERY SAME ARTIFACTS (e.g., furniture and domestic objects) MAY BE USED EITHER RESTRICTIVELY OR EXPANSIVELY • BY RESTRICTIVE, WE MEAN USING ARTIFACTS TO SUPPORT THE MAINTENANCE OF THE STANDARD SCRIPT • BY EXPANSIVE, WE MEAN USING ARTIFACTS TO GO BEYOND THE STANDARD SCRIPT, TO ALLOW ACTIONS THAT ARE NOT REQUIRED BY THE STANDARD SCRIPT

ARTIFACTS USED RESTRICTIVELY EXPANSIVELY BLOOD PRESSURE METER FURNITURE, DOMESTIC OBJECTS MOVEMENT-SUPPORTING DEVICES FURNITURE , DOMESTIC OBJECTS FOOD, MICRO- WAVE OVEN MEDICATIONS, DISPENSERS MOBILITY AGREEMENT TYPE OF ENCOUNTER NURSE AND CLIENT FOLLOW THE SCRIPTED ROUTINES NURSE ALLOWS CLIENT TO TAKE NOVEL ACTION WITHOUT ENGAGING HERSELF NURSE JOINS NOVEL ACTION INITIATED BY CLIENT NURSE INSTRUCTS CLIENT TO TAKE NOVEL ACTION, LEAVES IMPLEMENTATION TO OTHERS NURSE AND CLIENT INITIATE AND IMPLEMENT NOVEL ACTION TOGETHER - - 1 2 1 2 2 1 - 1 1 2 1 1 - - 1 1 - 1 4 - 1 - 1 3 3 6 - - - - 3 1 4 TOTAL 1 (4%) 1 (4%) 3 (12%) 5 (19%) 9 (35%) 8 (31%) 17 (65%) (26 encounters = 100%; multiple different artifacts may be used in one encounter)

THESE FINDINGS INDICATE THAT THE MOBILITY AGREEMENT TOOLKIT DOES INDEED SERVE AS A KEY ARTIFACT THAT SUPPORTS ACTIONS THAT EXPAND THE STANDARD SCRIPT

TYPE OF ARTIFACT RESTRICTIVE EXPANSIVE BLOOD PRESSURE METER FURNITURE, DOMESTIC OBJECTS MOVEMENT-SUPPORTING DEVICES FURNITURE , DOMESTIC OBJECTS FOOD, MICRO- WAVE OVEN MEDICATIONS, DISPENSERS MOBILITY AGREEMENT TYPE OF VOLITIONAL ACTION CLIENT’S ONE-SIDED EXPRESSION OF WILL 1 - 1 2 1 1 2 NURSE’S INSTRUCTION OR ENCOURAGEMENT - - - - 2 3 8 JOINT COMMITMENT - - - - 1 1 2 CLIENT’S NOVEL PHYSICAL ACTION - 1 2 2 3 2 2 JOINT NOVEL PHYSICAL ACTION - - - 1 2 1 3 TOTAL 1 (4%) 1 (4%) 3 (12%) 5 (19%) 9 (35%) 8 (31%) 17 (65%) (26 encounters = 100%; multiple different artifacts may be used in one encounter)

77 % OF ALL THE VOLITIONAL ACTIONS WERE GENERATED IN ENCOUNTERS WITHIN WHICH ARTIFACTS WERE USED EXPANSIVELY

TYPE OF ARTIFACT RESTRICTIVE EXPANSIVE BLOOD PRESSURE METER FURNITURE, DOMESTIC OBJECTS MOVEMENT-SUPPORTING DEVICES FURNITURE , DOMESTIC OBJECTS FOOD, MICRO- WAVE OVEN MEDICATIONS, DISPENSERS MOBILITY AGREEMENT TYPE OF CONCEPTUALIZATION EFFORT MOVING OUT BEYOND THE HOME - - 1 3 4 3 7 REGULARITY OF MOVEMENT 1 - - - 2 5 7 CONDUCTING MOVEMENT TOGETHER - - - - - 2 3 STANDING UP FROM THE CHAIR OR BED 1 1 3 3 4 3 12 INTEGRATING MOVEMENT INTO DAILY CHORES - 1 - - 4 - 3 TOTAL 2 (8%) 2 (8%) 4 (15%) 6 (23%) 14 (54%) 13 (50%) 32 (123%) (26 encounters = 100%; multiple different artifacts and conceptualization efforts may be found in one encounter)

81 % OF ALL CONCEPTUALIZATION EFFORTS WERE FOUND IN ENCOUNTERS WITHIN WHICH ARTIFACTS WERE USED EXPANSIVELY

RESTRICTIVE USES OF ARTIFACTS: EXAMPLES OF MAINTAINING THE STANDARD SCRIPT

EXAMPLE 1: THE ARMCHAIR

The client has a wheelchair but he tries to avoid using it. He experiences getting up from an armchair as a useful mobility exercise but it is challenging for him and he wants to discuss this with the nurse. Client: The armchair is so that I struggle a little to get up from there. (turn 204) Client: It's good, yes, yes! I did not ever avoid it [the armchair] either. In the beginning when the chair arrived, I thought I cannot go there. (turn 207) The nurse carries out the normative script and turns the armchair into a restrictive artifact, to be esthetically enjoyed but not expansively used. Nurse: Yes, it is a nice chair. (turn 208) Nurse: Colorful, you like colors. (turn 211)

EXAMPLE 2: BREAKFAST

The nurse encourages the old lady to manage her breakfast eating. Focusing on breakfast allows her to avoid the implementation of the mobility agreement. Breakfast becomes a restrictive artifact that permits the maintenance of the standard script. Client: Coffee! Nurse: Coffee is coming. But would you like some bread with the coffee and …? Usually you take some yoghurt… Client: Yes, well, what usually is there.” (turns 330-332)

EXAMPLE 3: MEDICINE DISPENSERS

The nurse concentrates on distributing medicine to the client’s medication dispenser (dosette). The client, on the other hand, expresses a will to walk down the stairs and to get better to be able to participate in her granddaughter’s graduation party. The nurse starts to hand different kinds of medication jars to the client and the client places medicine to the dispenser. Nurse: Yes, it is a dosette … Let’s place there the night medication. Client: There at the end [of the dosette]should be more of those [pills](turns 89-90). Nurse: Yes, there they are, and what about your daytime medication? Client: They are safely there. They [another home care employee or the daughter] have filled in morning pills, daytime pills, afternoon pills. Here is an iron medication, there in the morning section, down there, the last one is the one for the night. (turns 93-94)

EXAMPLE 4: BLOOD PRESSURE METER

The visit begins with the nurse wanting to measure the client’s blood pressure. Nurse: I will take the blood pressure first. How have you been? Client: Moderate, quite good actually. Nurse: Has your arm been sore? Client: Yes, my arm, last night it was pretty sore but I did not take additional pain relief. (turns 4-8) The nurse then speculates that perhaps the client has moved too much and the arm was thus sore. The client quite proudly tells that she made her personal record by walking around the table with her rollator22 rounds, her average number of rounds being 12. The nurse interrupts her talk and again wants to take the client’s blood pressure. Nurse: Yes, right. Now remain still and do not say anything. I will put the [blood pressure] meter in its place. (turn 17) The client tries to tell the nurse about the improvement in the condition of her legs. Client: They [the legs]are so fantastic that I am feeling really great. Nurse: Yes, OK, and now I will measure your blood pressure again. Client: Yes. Nurse: Please be quiet in the meantime. (turns 42-45)

EMERGENT CONCEPT N: I willleave the (mobility) instructionshere. In the Autumn, onewillchooseyou new movementsthen, oryour new nursewillprobablysee with youother (movements) (turn 112). C: Ok, right. VOLITIONAL ACTION Client independently started to show mobility exercises to the nurse and lifted up her legs (turn 74). The nurse later suggested to the client to go through some mobility exercises. MEDIATING ARTIFACT MEDIATING ARTIFACT N: Yes. Ok, and now I will measure your blood pressure again(turn 43) You do not need to go around the table so many times, you can get worse (turn 9). This one (exercise) is probably not very well suited for you as you do not have so good balance(turn 94). Do not leave the rollator there. Take it with you (turn 108) BOUNDARY PROBLEM WHICH REPRESENTS A POTENTIALLY SHARED OBJECT AND CONFLICT OF MOTIVES The client feels quite good but needs mobility exercises to recover from an operation. Nurse did not seem to trust the client’s ability to move without the supportive devices, silenced the client, and made decisions on her behalf. Client made her personal record by walking by herself around the table with her rollator22 rounds (outside the home care visit) SOURCE DOMAIN C: Moderate, quite good actually (condition). Yes, my arm, last night it was pretty sore but I did not take additional pain relief (turns 4-8) SOURCE DOMAIN N: Measuring the client’s blood pressure and weight and trying simultaneously to superficially check whether the client knew how to do the exercises of the mobility agreement ACTOR 1 NEED STATE AND ANTICIPATORY DIRECTIONALITY C: Butyou know what, my legs are now really good, they do not ache at all! (turn 30). They (legs) are so fantastic that I am feeling really great (turn 42). ACTOR 2 NEED STATE AND ANTICIPATORY DIRECTIONALITY N: Yes right. Now remain still and do not say anything. I will place the (blood pressure) meter. Ok, good, now I will place the plaster which reduces pain (turn 17). TENSION COMPLEMENTARITY

EXPANSIVE USES OF ARTIFACTS: EXAMPLES OF DOUBLE STIMULATION

EXAMPLE 5: BOOK OF WORK HISTORY

The encounter begins with the client getting up from the bed and starting breakfast. The nurse brings to the table a book in which the client’s work history is documented (he got the book as a present after working for 25 years for the city). Nurse: Here is this book. Would you like to show, how you’ve been working in the City of H? (turn 39) The client starts to tell about his work history, with the help of the book. The nurse then suggests that they take a walk outdoors. Nurse: Paul, I will get a sweater for you, then we’ll go out little by little, OK? Client: Yes. (Turns 240-241) The book opens up a wider temporal and spatial perspective on the client’s life. Transition from the book to the walk outdoors happens smoothly. Later, a conceptualization effort is focused on the regularity of exercise: Nurse: How is with you, now when you go out more regularly – have you noticed, has it affected how you sleep? Client: Oh, yes, I sleep like a log! (Turns 365-366)

12N: ”Is it fine to go to toilet, first? And then let´s change dry clothes on, and start morning activities.” 13C:”Yes.” 14N: “Like this” (the old man gets up from the bed beside the bed) Like that! Straighten your posture! Take hold of the support aid, grap! And now straighten your back! Like that- good”! 15C: “Yes.” (old man walks with rollator ...) 22N: “Now come here, please”! 23C:” I´ll wash my hands.” 24N: “Yes, wash the hands, wash”! 201N2: (nurse comes to sit beside the client): “ Okay, how do you feel now after the breakfast?” 202C: “Well, quite fine.” 203N: “Quite fine – You feel good to go out then?” 204C: “Yes”. 205N: “Good”! - Do you want have more coffee? 206C: “It is enough now – this time.” 302N: “How do you like this outing?” 303C: “Yes, its is good.” 304N:”Yes.” 305C: “It is just so seldom I come out.” 306N: “Yes, it is once per week like this during the summer.” 310N: “Hey, do you go out during winter?” 311C: “Yes.” 312N: “Very seldom. Then we usually go somewhere.” 365N: How is with you, now when you go out more regularly – have you noticed, has it affected how you sleep?” 366C: Oh, yes, I sleep like a log! 367N: Like a log – yes” 572C: “Here I really have got better with this not falling down anymore. I have not fallen during this year at all! 573N: “Exactly, you have not.” 574C: “There was the time when I felt down couple of times every month – just like that .” CONCEPTUALIZATION EFFORTS 240N:..”I`ll get your pullover now, so we can slowly start to go out, yes?” 241C: “Yes.” 270N: “Okay, like that slowly! (the old man gets up from the chair, starts to walk with rollator). I`ll take the key. (walking together to the lift). 271N:”Now press the P-button. Push the button P! He has a bit problems with his eyesight.” 361N: “… Okay, which direction you would like to go now?” 362C: “Should we go that way?” 363N: “Yes. let´s go there! You are in a very good shape now.” 364C: “Yes”! VOLITIONAL ACTION MEDIATING ARTIFACT MEDIATING ARTIFACT 212C: “Introduce the book, now” 213N: “Look at this, Paul has been working 25y. there…you can introduce it by yourself, it is your work history – it has become important lately.” 390N: “ You were able to walked long with brisk steps. Do you feel pain anywhere?”391C:”Oh yes, here in thighs.” 392N: “Thigh muscles!” 41N: “Here is this book. Would you like to show, how you been working in the City of H?” 42C: “Yes! 85N: “I think , outing is important.” 167N: “when it is summertime, if we have time, we should take clients out.” BOUNDARY PROBLEM WHICH REPRESENTS A POTENTIALLY SHARED OBJECT AND CONFLICT OF MOTIVES SOURCE DOMAIN The nurse interprets new home care script, ”doing with the client” naturally SOURCE DOMAIN 111N: ”What are you thinking now? What kind of thoughts you have now when we bustle around like this?” 112C: “Old age has become.” 113N: “Well, how do you feel about it, Paul?” 114C: “Well, it seems to be natural thing.” 115N:”Yes, but how do you feel about getting old?” 116C:”.. Effects to physical condition and so on.” 117N:”Yes, and anything else?”…118C: “Well, this is for me that you come and see me.” 119N: “That´s how.” 5N: ”Okay! Now we will go and start morning chores, but first I would like to install your hearing aid – does it suit to you? Is it ok to you first to go and eat before we put the pullover on?” 37C: “Yes.” 38N: “Okay, now we will put the trousers on (the old man gets up and nurse helps trousers up. Like that, good! Straighten your back up, I´ll help you and now we can go there . ACTOR 1 NEED STATE AND ANTICIPATORY DIRECTIONALITY ACTOR 2 NEED STATE AND ANTICIPATORY DIRECTIONALITY 121C: “You help a little bit me” 122N: ”well where do you think we are helping you? – Where do we help you?” 123C “Well like in everything” 124N: “Oh, yes we must help you quite a lot. You we more independent earlier.” 578C:”Yes, now I have to try to stay out.” 7N: “ Okay, take the good posture, when you come to sit here! … Does it suite for you to go for outing after the morning chores – okay?” 8C: “Yes”! 44N: “here starts our morning” 75N: “Oh, now he starts to pick up, okay.” 97N: “I think like this, that it would be so important for all the nurses to obey it (Mobility Agreement), because then we are helping and supporting old person´s independence and ability to stay active…” TENSION COMPLEMENTARITY

EXAMPLE 6: THE ROLLATOR

Atension emerges when it turns out that the client’s movement-supporting device, the rollator, has not been in use. The client was supposed to use it twice a week with assistance of a home care employee. Despite her good physical condition, the client did not move or do exercises regularly in her daily life and knew that she needed more exercise. The home care nurses had not kept the agreement to help the client use the rollatorduring home visits. Nurse: Could you show me how… [the client immediately walks to the electric rollatorto turn it on and show how she uses it] Client: Yes, of course I can show. (turns 58-59) Nurse: It seems to have been agreed that when a nurse visits you every Monday and Thursday, then every time there will be a moment for a mobility exercise with this rollator. Has this taken place? Client: No, it has not. I sometimes use it on my own. When I remember. Nurse: Yes, our nurses need to improve their practice, they should always remind you. Client: Yes. Nurse: I will give them a message that they should remind you. It is so good for your feet and back in particular to keep it in good shape. Client: Yes, my back. (turns 72-79)

EXAMPLE 7: THE MOBILITY AGREEMENT AND THE RUBBISH BAG

The client has done regular physical exercises based on the mobility agreement. In this encounter, they employ the rubbish bag as a specific second stimulus, triggering the volitional action of taking out the rubbish together. Nurse: If I take this heavier, and you take the lighter rubbish bag. (Turn 27) After taking out the rubbish, they engage in a conceptualization effort triggered by the volitional action. Nurse: So, and then do you take the rubbish always out with us – home care workers? I mean, do you always get out when home care visits you? Client: No, not always – they´ve taken them without me. Nurse: Aha, somebody has taken the rubbish out without you? Client: Yes. […] Nurse: But it would be very good for you to take the rubbish always out with us? Client: Yes, okay, sometimes I have done that, gone out with them to take the rubbish out. Nurse: … it would be very important to agree that to be a regular habit. It would not matter if somebody suggested to take the rubbish out – you should always respond “let´s go together!” Client: Yes, that´s the point! (Turns 253-264)

RESTRICTIVE AND EXPANSIVE USES OF ARTIFACTS • RESTRICTIVE USE OF ARTIFACTS TOOK THE FORMS OF TRIVIALIZING CLIENT’S INITIATIVES (Example 1), AVOIDING NOVEL ACTIONS (Example 2), AND CONVERTING OR INTERRUPTING CLIENT’S INITIATIVES (Examples 3 and 4) • EXPANSIVE USE OF ARTIFACTS TOOK THE FORMS OF WIDENING THE PERSPECTIVE ON CLIENT’S LIFE (Example 5), REVIVING AGREED-UPON NOVEL ACTIONS (Example 6), AND TRIGGERING A PHYSICAL ACTION THAT LED TO CONCEPTUALIZATION (Example 7)

DOUBLE STIMULATION IN CRITICAL ENCOUNTERS • IN EXAMPLE 6, THE ROLLATOR FUNCTIONED AS AN EFFECTIVE SECOND STIMULUS THAT LED TO AN EXPANSIVE RECONCEPTUALIZATION OF THE AGREED-UPON NOVEL PRACTICE • IN EXAMPLE 7, THE RUBBISH BAG FUNCTIONED AS AN EFFECTIVE SECOND STIMULUS THAT LED TO AN EXPANSIVE CONCEPTUALIZATION • IN BOTH CASES, THE FIRST STIMULUS (THE REAL PROBLEM) WAS IDENTIFIED AND OPENED UP ONLY AFTER THE SECOND STIMULUS WAS GRABBED AND A VOLITIONAL PHYSICAL ACTION HAD BEEN TAKEN WITH THE HELP OF THE SECOND STIMULUS

CONCLUSIONS • FUTURE-MAKING HAPPENS IN CRITICAL ENCOUNTERS THAT ARE DISPERSED IN SPACE AND TIME; VOLITIONAL ACTIONS AND CONCEPT FORMATION EFFORTS IN A SINGLE ENCOUNTER ARE TYPICALLY SMALL – BUT WOVEN TOGETHER OVER SPACE AND TIME THEY MAY LEAD TO SEA CHANGE • THE EXPANSIVE USE OF ARTIFACTS TO ACCOMPLISH DOUBLE STIMULATION IS OF CRUCIAL IMPORTANCE FOR THE QUALITY AND CONTINUITY OF FUTURE-MAKING IN CRITICAL ENCOUNTERS; ARTIFACTS USED AS SECOND STIMULI INCLUDE THE DELIBERATELY INTRODUCED MOBILITY AGREEMENT TOOLS, BUT ALSO OTHER ARTIFACTS GRABBED BY THE SUBJECTS • ARTIFACTS ARE NOT AUTOMATICALLY USED EXPANSIVELY; THEY ARE OFTEN ALSO USED RESTRICTIVELY, TO MAINTAIN THE OLD • THE MODEL OF CRITICAL ENCOUNTER SERVES AS A REASONABLE APPROXIMATION OF THE KEY FACTORS AT PLAY IN FUTURE-MAKING; IT NEEDS TO BE TESTED FURTHER

AGENTIVE FUTURE-MAKING IN MUNDANE INTERACTIONS: CRITICAL ENCOUNTERS AS SITES OF CONCEPT FORMATION