Deleuzians of patient safety : a video reflexive ethnography of end-of-life care

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This thesis explores healthcare space(s) towards the end of life. It critically examines the links between the places/spaces where dying people find themselves, and how spaces enable or constrain their agency and contribute to the quality of the care they receive. There is a dearth of research that is concerned specifically with end of life care space(s) and patient safety. This thesis addresses this gap. It draws on several theoretical approaches. Principally concerned with the concept ‘space’, the theoretical lens of the research is inspired by French philosophers Deleuze and Guattari. This thesis differs from previous studies by positioning dying people centrally in the research. Using an indigenous ethics research framework of relationship and reciprocity, the study challenges current positioning of dying patients as vulnerable research subjects. In so doing, it searches out alternatives to conventional methods in order to give recognition to agency. Comprising a written dissertation and a video component, this thesis integrates the visual with the written text providing a platform for the reader to process it somaesthetically. This research study found that the field of patient safety does not presently address the care quality and safety needs of dying people. Habitual care patterns expose dying patients and their families to harm along with those healthcare workers caring for them. Visual methods provide a disruptive innovation that challenges these normative and habitual rhythms of inattentiveness to healthcare (un)safeties. This thesis finds that safety and ‘healing’ reside within dynamic assemblages arising from bodies affecting and being affected by others. When healthcare workers ‘learn to be affected’ and thus become attuned to the implications of safety and dying, healthcare safeties become possible. Healthcare safeties are contingent on weaves of commitment netting in relationships of trust by bringing together healthcare worker expertise and the expertise of patients and their families to co-produce safety. This thesis contends that rather than a place where interventions happen, healthcare settings are clinical interventions. Lastly, researcher stances and research methods are, therefore, not to be formed separately from the healthcare setting but to be articulated through and in the setting, and become a part of it. This methodological conclusion indicates that we as researchers need to move away from our conventional and habitual patterns maintained by disciplinary status and constraint, in order to become part of open-ended, collaborative communities unfolding research and lived change together.
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