Ecologies of care: a posthuman institutional ethnography of nursing

Abstract

The value of nursing and nurse work in the UK is unclear. Changes in nursing within contemporary social, economic and political systems have renegotiated the power structures that produce the meaning and value of nurse work. An increasing amount of research addresses nursing and nursing practice, however there is a scarcity of research about fundamental care and nurse work in contemporary frameworks of nursing. This PhD project explores how the value and meaning of nurse work is created within contemporary institutions.

This project was a posthuman institutional ethnography (PIE) conducted at a large acute NHS hospital in Scotland. The mixed method design involved workforce demographic data, documentary analysis of the NMC Code of Conduct, participatory ethnography at an acute ward as well as three-week long multimedia diaries and semi-structured interviews from 10 practicing nurses. This heterogeneous data was examined using multiple analytical tools grounded in critical feminist and posthuman theoretical approaches. The project mapped each of the tools used onto the supporting principles of PIE and situated the findings from this perspective.

This thesis contributes to nursing research theoretically and methodologically. First, it suggests understanding fundamental care as an ecology created by people, place and structure. Second, it positions nursing in the theoretical framework of critical posthumanities as a (new)materialist practice. Third, it suggests that the obscure valuation of nurse work makes it difficult for institutions to value nurse work. Fourth, it develops the Posthuman Institutional Ethnography research method, developed in educational studies by (Taylor & Fairchild, 2020) as a research method in healthcare for the first time.