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Using ethnography to examine health care practice

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... where new work has to be constantly added in & woven into ongoing work. ... Providing an evidence based framework for examining work in situ and developing it. ... – PowerPoint PPT presentation

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Title: Using ethnography to examine health care practice


1
Using ethnography to examine health care practice
  • Dr Maureen Deacon
  • The Manchester Metropolitan University

2
The plan
  • Brief overview of the study
  • The purpose and process of ethnography
  • Some of the advantages and limitations of using
    this method to examine professional practice in
    action
  • Implications for practice development
  • Learning points

3
The study I cant get a thing done
  • An ethnography of AMHN aim was to contribute to
    the body of knowledge in this under researched
    field by developing a systematic analysis of
    their routine occupational activities
  • 3 years episodic participant observation in an
    inner-city MH unit. Ethical approval.
  • A case study (Inclu PICU) setting shared
    problems described nationally
  • Included virtual ward work (eg, ECT trips)

4
The study cont.
  • Worked with the ethnomethodologists attitude of
    wonder concerning the crafting of their work
  • Main finding was that AMHNs enable acutely
    mentally ill people to recover using mundane
    social activity and talk as professional
    resources. They are multi-taskers experts in
    handling multiple realities, needs and demands
    they flexibly accomplish their work by
    manoeuvring around an implicit and explicit
    interpretive background.

5
Findings cont.
  • This is accomplished by endless, open-ended,
    diffuse and contingent activities where new work
    has to be constantly added in woven into
    ongoing work.

6
The purpose and process of ethnography (EG)
  • According to Brewer (200010) EG is the study
    of people in naturally occurring settingsby
    means of methods which capture their social
    meanings and ordinary activities, involving the
    researcher participating directly in the study.

7
Cont.
  • EG, therefore, refers to a style of research that
    is distinguished by its purposes, rather than a
    particular method of data collection.
  • The purpose in my study was to analyse the
    routine work of AMHNs

8
Cont.
  • I used the data collection methods of participant
    observation, opportunistic interviewing and
    carefully listening to naturally occurring talk
    (Silverman, 1997).
  • This was organised through a process called
    theoretical sampling (Silverman, 2001) and
    opportunistic sampling. For example

9
Cont
  • It was this process that led to the specific
    matters that were examined very closely (an
    aspect that I struggled with) importance of
    making defensible decisions.

10
Cont.
  • Focus is on members methods, social action, the
    lived order/detail, the unfolding, contingent
    and temporal nature of social life how this is
    used to make sense of the world.
  • Follows that there is interest in routine,
    mundane aspects of work
  • Accountable features what members take into
    account when orientating to, and sustaining
    interaction, practice and experience in a
    particular setting. The documentary method of
    interpretation

11
Accountable features orientating, implicit
explicit organisational imperatives
  • Discharge patients as quickly as possible
  • Prevent patients disturbance from exposing the
    organisation to criticism
  • Follow organisational rules
  • Fit in with the wider organisation and outside
    agencies

12
The interpretive context
  • You know the case because you know the place
  • Mundane matters are tools for formulating
    patients mental health status and their progress
    towards recovery
  • Conceptual resources deserving cases features
    of absolution

13
Advice to EGs
  • Treat natural facts as accomplishments
    (practitioners find this very odd!). Observe
    lived detail.
  • Analyse accounts and formulations
  • Problematize reasoning
  • Analyse the interpretive framework (general
    local)
  • Look for normal natural troubles

14
Advantages of this method
  • This and that is what the world is made up of
    (Harvey Sacks)
  • Respectful
  • Gain deep, extremely complex understanding.
    Analytic purchase on how one thing unavoidably
    connects to another.
  • Draws attention to invisible work what we do
    most of the time!
  • The analysis of actual work its unfolding,
    contingent nature. Real life, not abstract
    theorising.

15
Disadvantages
  • Findings hard to articulate neatly
  • Time consuming
  • Does not meet canons of traditional scientific
    enquiry (problems influencing stakeholders)
  • In-depth analysis of some things but not others
  • Challenge to make principled choices regarding
    what data to analyse to make the familiar
    strange. You have to be close up but standing
    back simultaneously personally very demanding

16
Some implications for practice development
  • Critical importance of bringing these invisible
    skills in to conscious awareness,
  • Articulating them
  • Providing an evidence based framework for
    examining work in situ and developing it.
  • For example, the management of disturbance.

17
Learning points
  • Practice is messy if researchers do not engage
    with this reality then their research will remain
    largely irrelevant to practitioners.
  • EG respects the work of practitioners and tries
    to understand it, rather than coming for the more
    traditional corrective position
  • EG reveals the huge complexity and accomplishment
    of everyday practice.

18
References
  • Brewer,A.(2000) Ethnography Buckingham OUP
  • Pollner,M. Emerson,R.M. (2001) Ethnomethodology
    and Ethnography. In Atkinson,P. et al. (2001)
    Handbook of Ethnography. London Sage
  • Silverman, D. (1997) Qualitative research.
    Theory, method and practice. London Sage
  • Silverman, D. (2001) Interpreting qualitative
    date. London Sage
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