Emotions and mindlines : a palliative care perspective

Abstract

This thesis explores the relationship between emotion and mindlines in palliative care. This contributes to the processual turn in organisational studies by using Deleuze and Guattari's (1987) notion of the assemblage to illuminate the processual nature of knowledge translation in palliative care. The processual perspective of organisational theory clarifies the mutual shaping between the 'material' and the 'social' when considering how emotion affects knowledge and practice. An emerging paradigm of evidence-based practice privileges the socially-constituted nature of knowledge, predicated on interaction and subjectively experienced by individuals. This follows the contention that clinicians do not consistently consult explicit forms of evidence, often in the form of clinical practice guidelines, to inform their practice. Gabbay and le May's (2004) concept of mindlines attends to this paradigmatic shift. The concept focuses on collectively-reinforced, internalised tacit guidelines informed largely by clinician interactions with networks of trusted sources. The importance of mindlines in palliative care is evident in extant literature as it accounts for the translation of tenuous and fluid practices that are vital in end-of-life care. However, scholars are yet to elucidate the ways emotions affect the development and shaping of mindlines. This study employed a 12-month ethnography within a public community health centre that offered palliative care to patients living at home. I collected qualitative data while shadowing and observing nurses as they delivered, planned, and/or discussed palliative care (and related matters), focusing specifically on critical incidents. This thesis contributes to organisational scholarship by applying the assemblage to describe the observable social organisational forms, and the forces of stabilisation and transformation in health organisations. The findings suggest greater attention needs to be given to emotion in the context of knowledge translation by researchers, policymakers, managers, and practitioners by accounting for emotions within explicit assemblages of practice and allowing for interpretative, flexible, and relative ideas of care within emotional contexts. This study provides a conceptual and methodological foundation for further study on mindlines as assemblages, which should be taken up by scholars working within the broad field of knowledge translation. For managers and clinicians, this study suggests greater opportunities should be provided to clinicians to reflectively and reflexively examine how they are moved by patients, carers, colleagues, and managers. In concert with extant research, this study underscores the significance of a model of care that enables transdisciplinary communication, or a globalisation of specialisations and disciplines.

Date of Award	2019
Original language	English