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Ethnography and Practice Theory

This chapter outlines the ethnographic basis for the book, and develops particular arguments linking ethnographic approaches with practice-based and sociomaterial perspectives. Details of the fieldwork undertaken at Karitane are then provided, framing the account in practice theoretical terms by describing fieldwork practices and the site of research. Issues of participation, observation and intimate outsidership are then discussed. The ethnographic approach taken in this study is located within a contested methodological terrain, and links are made to Baradian notions of diffraction , before questions relating to the role of theory in ethnography are considered. Relationships with other ethnographies in similar health settings are explored, before a final section that accounts for the ethnographic work underpinning this book as both a solo and joint endeavour.

This book is based on an ethnographic study where the fieldwork and analysis were informed by sociomaterial, specifically practice theoretical perspectives. One important reason for the adoption of an ethnographic approach is simply that it is one in which I find joy and have experience. It was also made possible by the conditions under which this research was undertaken: a funded Fellowship that allowed long periods of time to be spent in the field.

However, there are also important synergies between theory and methodology that should not be overlooked. Fenwick et al. (2011) note that studies informed by a range of sociomaterial theories have stimulated and drawn upon diverse empirical approaches, but that they tend to ‘begin from the local and the singular, following details of everyday interactions to understand practice in situ’ (p. 177). There are many approaches to doing this, including ethnography , spatial mapping, and visual narrative. Interviews have been used, often to supplement observation where resources, practicalities and ethics make observation difficult. The emerging use of the ‘interview to the double’, asking a participant to describe what someone taking her place would need to know and do in order to perform a particular job or practice without others noticing the switch (Nicolini 2009, 2011; Nicolini and Roe 2014).

There are many obvious reasons why a practice-focused, sociomaterial study would deploy an ethnographic approach. Ethnography is well established as a means to describe and understand phenomena in situ. Its attention to material artefacts has an immediate resonance with a sociomaterial perspective. Hager et al.’s (2012) edited volume captures the breadth of commitment to ethnographic methods in studies that seek to get close to practices, attending to issues of materiality, embodiment , time and space (see in particular Johnsson 2012; Lee et al. 2012; Manidis and Scheeres 2012; Zukas and Kilminster 2012). A group of Italian researchers has developed ethnographic methods in response to the changing (e.g. digitalised, globalised) nature of organisational and pedagogic practices (Gherardi 2006; Gherardi and Nicolini 2002; Landri 2007, 2012, 2013; Strati 2003, 2007). Czarniawska’s (2004, 2012) work, informed by actor-network theory , further illustrates innovative use of ethnographic sensibility and methods. She captures the fuzzy relations between bodies, artefacts and knowing , exploring how times and spaces are woven together, often from a position in the field behind a worker at a desk.

Schatzki (2012) offers a strong, theorised rationale for ethnography in research informed by practice theory. He writes of anthropologists and educational sociologists who go into the field, and combine fieldwork with knowledge gained from books and other resources beforehand:

With the knowledge thereby gained, both about their subjects and about types of people more broadly, they can, when encountering their subjects, decently well identify the activities and practices these people carry on, as well as the material entities and arrangements thereof amid which do so. Nonetheless, much about the organizations and temporalspatial infrastructures of these practices and bundles, about how the practices and arrangements hang together and connect to others of their own ilk, about the contexts in which activities take place, and about the histories of the bundles and how they might develop in the future in what contexts, will be unknown. This is detailed information that no one, including the subjects, possesses; at best, the knowledge that is distributed among the subjects and those who have studied them might, if pooled, cover much of these matters. Despite this, understanding these things is essential to understanding the subjects’ lives and worlds and to anticipating and attempting to shape their future.

To acquire this knowledge, the investigator has no choice but to do ethnography , that is, to practice participant-observation. (p. 23, my emphasis)

While he also acknowledges the value of oral history, the point he makes is crucial: many of the things that we are interested in as sociomaterial researchers of practice are unlikely to be seen as interesting to, or even in the realm of explicit awareness for the people performing those practices. As sociomaterial researchers we are seeking to give accounts of the world that are valuable precisely because they differ from those that practitioners would instinctively give, and indeed because they differ from those that academic researchers have historically tended to give, too. The interview to the double (Nicolini 2011) has proved highly effective in nudging participants to pay attention to and describe features of their working lives that would otherwise be overlooked, deemed too boring to be of interest. Without diminishing the value of the interview to the double and other approaches, I maintain that ethnography does offer something valuable and distinctive in face of the challenges raised by Schatzki.

Trowler (2013) makes a strong case for the fit between practice theory and ethnography , echoing Miettinen et al.’s sense that practice theory is ‘ethnographic in its sensibility’ (2009, p. 1312). Trowler (2013) highlights how a practice perspective attends to artefacts as they are entangled with humans in the accomplishment of practices.

My ethnographic approach enabled me to notice and attend to things like pens, ink, footsteps and floating gaits, statuesque postures, synchronised nodding, grabbing bubble-wrap from a drawer behind a door while holding a baby. I did ethnographic research because it makes possible accounts of practices, professional learning and partnership that would be very difficult to generate otherwise. Borrowing Ganong’s (1995, 2011) term, and rehearsing a concept I apply substantively in Chap. 9, I argue that ethnography offers a position of intimate outsidership that is precisely what is required in order to produce the detail and distinctiveness that are imperative in sociomaterial, practice theoretical work. I return to this theme below, in discussion of my fieldwork practices.

Overview of Fieldwork

This section provides an account of the fieldwork that provides the empirical foundation for this book. I first approach this from a practice view, conveying a sense of the ethnographic labour involved, but also finessing the notion of the ‘site’ of research in a Schatzkian sense. I then take up questions of participation and observation, and explain the fluid shifts between these that occurred in the accomplishment of a position that I term ‘intimate outsidership’ (borrowing on Ganong 1995, 2011).

Fieldwork Practices, Evidence and the ‘Site’ of Research

The question of ‘What did I do?’ as an ethnographer can be answered in a number of ways. The first focuses on a concrete account of fieldwork labour: where I went, what I did, how long for, whom I followed, and so on. This contributes to establishing a sense of a robust, weighty evidence base consistent with the approach to educational ethnography fold into which I was socialised in my earlier work (see below). However such an account can be conceptualised differently. Focusing on my actions in relation to ongoing (other) practices contributes to describing the site of my research in a Schatzkian sense. Here site is not just the setting as an organisation (Karitane), a service or building (the Residential Unit at Carramar), as described in Chap. 2.Footnote 1 The site of my research is a result of my engagement with this setting—across all hours of day and night and its (sociomaterially produced) spaces, following the bodies of professionals as they support families, and engaging with the material world through touch, reproduction (photocopies and note taking), visual imagery, aesthetics and so on. It is through the bundling of practices and materialities of my ethnographic fieldwork with those of the Unit that the Unit becomes an empirical site, a clearing at which the big questions and themes outlined in Chap. 1 can come into view.

I visited the Residential Unit 60 times, on 29 separate weeks, between March and November 2011. Visits were generally between 5 and 12 hours, sometimes contained within one shift, but also spanning two shifts , or a period from evening through until dawn. Given the weekly rhythm of the Unit, most visits were scheduled to track what happened with particular families over a five day period. I often made three visits in a week, beginning on Monday, and spreading the remaining two visits out over the days and nights between then and Friday lunchtime.

My observations were for the most part loosely structured. I began with a month of very fluid observation, moving around the Unit in order to learn its basic temporal-spatial routines and cycles: what happens, where, and when. After this, the majority of visits involved shadowing a particular member of staff. The choice of which members of staff to shadow reflected empirical aims alongside practical and ethical constraints and opportunities. I shadowed all the nursing staff at least once, more than once if they had multiple roles, such as occasional in-charge duties. I spent time with both playroom coordinators, covering each day of the week in the playroom several times. I observed group activities and individual sessions led by the psychologist and social worker, and sat in on numerous paediatric assessments, and case conferences where many different health disciplines were represented. In total 37 different members of staff were directly observed and gave consent to participate.

Most of the time the choice of who to shadow was linked to the families who gave consent to participate, and whose stories I was following through each week. Typically between one and three families participated each week, and I would begin each visit by finding out who was assigned to work with them and asking their permission for me to shadow them. The process of recruiting families reflected significant input from clinicians, who made judgements about which families it would be appropriate to approach, and who held discussions seeking consent without me being present, so it would be easier for parents to decline if they wished. Given the presence of up to ten families in such a confined space, it was not possible to avoid all contact with other families, but other than basic information (such as how many parents and children were in the playroom or dining room at a particular time), no data relating to families who did not give informed consent were generated. In total 58 families participated formally, of which 18 had two or more children present on the Unit. Parents gave consent on behalf of all children with them. These children ranged in age from six weeks to three and a half years. The socio-economic backgrounds of participating parents reflected the diversity of clients discussed in Chap. 2.

My observations incorporated the full range of activities that take place on the Unit, including meal times, settling , play, all the group activities , intake , admission , discharge , handover , case conference , staff debrief, paediatric assessments, tours of the Unit, staff breaks, and staff meetings. Many of these were observed several times. Every hour of the Unit’s functioning from 8 a.m. on Monday morning, until after the last client departs on Friday afternoon was covered at least once.

I took 338 photographs of architectural spaces, walls, objects, and people. Those of people were taken as aides-memoire to accompany written descriptions of bodily postures and relationships between human bodies, and between those bodies and things such as toys , tables, clipcharts , and pens. These have provided the basis for line drawings that de-identify the people involved and highlight certain features that I wish to draw attention to. These drawings are scattered throughout this book. They reflect complex processes of analysis and re-presentation that I will not discuss further here (see Hopwood 2014). A number of loose sketches were also made and incorporated within field notes (for example, hand-drawn maps of the layout of the playroom ).

I also collected or copied 119 documents, including thank-you cards from parents , leaflets given to parents, blank copies of proformas such as forms used in admission interviews, measurement tools (Edinburgh Postnatal Depression Scale, Karitane Parent Confidence Scale), workflow checklists such as the Welcome Group guide, anonymised versions of the clients in residence sheets capturing informal notes made on them by staff, pages from the staff communication book, notices for staff (such as a message about amber necklaces on children), resources used in group activities , meeting agenda, and anonymised behaviour charts (records of children’s sleep , eating and behaviour). Copies of documents relating to clients, such as progress notes, admission records etc. could not be made, but I was given permission to read and make notes on a selection of these, in order to capture the kinds of things that are written down.

A small number of interactions were audio-recorded, focussing on those where a verbatim record of speech was important. Over a two week period, most handover discussions (except those including parents ) were recorded, and in addition I was able to record an intake phone call, and a counselling session between a social worker and a mother. During one week a video camera was used as part of a related methodological exercise (see Hopwood 2014). However the 77 video clips (ranging from a few seconds to 40 min) were included in the general dataset analysed for this book.

Finally, I also collected a significant amount of quantitative data that had already been generated as part of routine practice on the Unit. This included anonymised records of depression assessments (EPDS score on admission ), parent confidence measures (KPCS scores on admission and discharge ; see Chap. 2), results of domestic violence screenings (positive or negative), and the number of referrals to allied health. These data were collected for the period of study, and gave several pieces of information about 250 parents. Results of the client satisfaction surveys (again anonymised) for the same period were made available to me, out of which I entered 280 responses to nine items (those of most relevance) into a separate database. In total over 5000 datapoints comprising scores, binary indicators, and likert scales were analysed. Furthermore, existing data in the form of responses to evaluation forms relating to group activities , largely in the form of likert scales and open-ended comments, were incorporated into the dataset and analysed.

Participation, Observation, and Intimate Outsidership

In this section I will describe how my approach to fieldwork accomplished, in a shifting and emergent way, my position of ‘intimate outsider’ (Ganong 1995, 2011) in relation to the professionals and families on the Unit. Ethnographic observation is often characterised by a position along a continuum from detached observation to full participation. However, I have previously argued that this is often an inadequate basis for capturing the fluid ways of being among and doing (with) as an ethnographer (Hopwood 2007b). There, I used the notion of ‘territories’ to pinpoint patterns in the shifting and emergent performances of the ethnographer, and how they relate to what is happening.

The concept of ‘intimate outsidership ’ complements that of territories, and usefully captures much of what I think is so valuable about ethnography . It is most important in this book in Chap. 9, where I use it to understand the ways professionals learn much that is private and sensitive for families, and yet always stand apart from them too. Ganong (1995, 2011) used the term ‘intimate outsider’ to describe his position as a non-nurse but also researcher of nursing whose role required a close understanding of nursing and an ability to stand back and cast different light on what was happening in the field. In the same way, ethnography enabled me to become intimately involved in the goings on of the Unit (see below for a discussion of the fluid movement between detached observation and participation), while always being apart—noticing features that others may ignore, making the familiar strange by seeing (hearing, touching etc) with different ‘educational researcher’ eyes.

In one instant and space an ethnographer might be highly involved, and yet moments later, quite detached. This was true of my fieldwork on the Unit. I was not a full participant, either as a parent or a professional. But I did step into the embodied practices of both groups. I played with children (getting paint on my hands and face , singing and dancing), held infants in arms, and rocked cots. I joined parents on the floor of the playroom in the relaxation group (making my notes afterwards!), and shed tears with them in the Friday morning reflection activity led by the Sister of Charity. I followed staff, mirroring their movements and postures , joining them in acting calm during toddler tantrums , eating with them in the staff room, and fighting yawns during the night shift. I had a ‘proxy pass’ that opened the doors to the building for me, a locker, and was subject to the regulations and rules applying to employees (wearing closed shoes, demonstrating immunity to specified diseases, completing child protection training etc.). But I never stepped into their role or responsibility in supporting and caring for parents. Often I was present but not near in a practiced sense (see Schatzki 2010, Chap. 3), as in admission and discharge interviews, where I would sit in a suitably visible but unobtrusive place and quietly make notes (see Hopwood 2013, 2015). I would often be seen standing or sitting, scribbling down notes in the corridors, playroom , lounges, dining room or by the nurses’ station . My notebook was small enough to fit in my pocket, so I could suspend writing and join in activity when it was appropriate. Thus my fieldwork was characterised by highly dynamic and responsive shifting between distance and proximity, observation and participation. It is through this fluidity that I felt I accomplished the position of intimate outsidership .

There are many ways to understand the movement and tension between emic (insider) and etic (outsider) perspectives in ethnography . These include Dhand’s (2007) account of legitimate peripheral participation among recovering drug users in Delhi—of interest to me because of its deployment of a theory of learning to understand ethnographic presence and practice. Todres’ (2007, 2008) notions of ‘being with’, and a range of accounts focusing on the embodied nature of ethnography and auto-ethnography (e.g. Denshire 2015; Ellingson 2015) all offer valuable enrichments to discussions of the position of the ethnographer in relation to the practices under scrutiny. For me, the concept of intimate outsidership conveys important features of my approach to fieldwork, and gives meaning to those features within the broader sense of the distinctive value that ethnography offers and its fit with the theoretical underpinnings of this book. In the next section I situate my ethnographic approach within a broader, contested domain, and make tentative connections between the idea of intimate outsidership and a diffractive (Barad 2007) approach.

Contested Ethnographies

So far I have described what I have done in terms of fieldwork practices, and the intimacy of broadly non-participant observation. The question of ‘What did I do’ with respect to my empirical approach can be answered in a different way, locating my practices within a wider and contested field of ethnographic research. What it means to do ethnography, or to do it well, is not universally agreed upon: there never was a hegemonic ethnographic order (Atkinson et al. 2001b). As Mills and Ratcliffe (2012) explain, the meaning attached to (good) ethnography is not dissociated from historical, geographical and (post-) disciplinary contexts; nor does it map neatly or exclusively onto these, as reflected in debates between British and American anthropologists (Marcus 2007a, b; Okely 2007a, b). I will now locate my approach within this contested terrain, while acknowledging the messiness involved in any attempt to pin down or badge a particular version of or way of doing ethnography. I do this first by taking up Mills and Ratcliffe’s (2012) historical-disciplinary mapping, then by focusing on ethnographies of practices and Barad’s (2007) diffractive approach. I explain my (current) sense of the role of theory in ethnography, before clarifying the relationship between this (educational ) work and other ethnographic research in health-related settings.

My approach to ethnography reflects an initial enculturation into a British educational guise. This stemmed from studies of schooling in the 1960s and 1970s, through which was fashioned an approach that contrasted strongly with anthropological ethnography of the day (Mills and Ratcliffe 2012). I was profoundly shaped by the accounts of ethnography I read during the early days of my postgraduate study. These included Hargreaves’ (1967), and Willis’ (1977) intimate explorations of schools in relation to big questions about reproduction of social class, schools as social systems, and professional work of teachers (Atkinson et al. 1993; Ball 1981; King 1978; Lacey 1970), and ethnographies that looked at schooling as a site to understand issues such as gender (Mac an Ghaill 1994). I was taught by Walford (see 1991a, b, 1996, 1998, 2001, 2009), and shaped by the way he approached questions of policy and privilege through studies of sites that were in some ways ‘special’—such as British ‘public’ schools (1986, 1987), or the first City Technology College (1991a, b; Walford and Miller 1991).

Among many of these texts is a connection to what Mills and Ratcliffe (2012) identify as an approach to ethnography reflective of a particular historical and disciplinary moment: the take-up of ethnography among British scholars and its application in schools as a means to explore larger social issues. Notwithstanding the diversity within this body of work, and the inadequacy of any attempt to collate and badge them (acknowledged by Mills and Ratcliffe), there are meaningful connections that can be made between this tradition, the way I did my first ethnography (see Hopwood 2004, 2007a, b, 2008, 2009, 2011, 2012), and the approach I took for this study. The traits of this approach that capture my way of doing ethnography include the serious attention to and concern for evidence, and the relationship between claims made and the evidence upon which they are based (see Atkinson et al. 2001a, 2007; Hammersley 1998; Hammersley and Atkinson 2007; Walford 2001, 2009); this sentiment is reflected in the quotation from Willis (2004) below. This approach does not imply a naïve sense of researcher as tabula rasa upon which the world makes direct impressions (see Hammersley 2005), but does bring with it a distinct sense of ethnography as embroiled with questions of data, evidence, and claim-making, rather than notions of deep hanging out, or extended fieldwork as rite of passage that reflect a Malinowskian imaginary (see Marcus 2006). It also offers some resistance to what is perceived by some as a devaluation of systematic fieldwork and analysis.

However, there are features of my approach to ethnography in this project that emphasise aspects that are not foregrounded so centrally in what I outlined above. These include some of the more evocative, personal and embodied dimensions . While the embodied nature of ethnography has been addressed by scholars who work within that tradition (Stephens and Delamont 2006), the body and senses have been given greater attention in other approaches to ethnography. Distinctive embodied senses and sensibilities and their connections with practice, spatiality and temporality are emerging (e.g. Ellingson 2006, 2015; Hockey 2006; Seymour 2007; Todres 2007, 2008). Elsewhere I have drawn on this trend, giving an account of my ethnographic practices as embodied, material practices (Hopwood 2013, 2015). Pink’s (2005, 2008, 2009) account of sensory ethnography inspired and captures much of my deliberate attempt to engage fully with senses of sound , smell, touch, and taste, and to resist over-privileging sight and the visual (see also Mason and Davies 2009). Within a sociomaterial fold, Strati (2003, 2008) refers to this as an aesthetic dimension of ethnography, drawing on impressions, and sense-based judgements that may provoke questions as much as they provide answers, drawing on an empathic-evocative understanding in contrast to a logical-analytic one. Such a sensibility is reflected in the account of times, spaces, bodies and things in Part II, the continuation of these threads through Part III, and the aesthetic appreciation of professional practice and learning that this affords. In the next section I continue to describe the approach to ethnography in my work on the Residential Unit, linking back to the theoretical terrain of practice and diffraction .

Ethnography, Practices and Diffraction

At this point the assumptions, ontological position, and concepts discussed in Chap. 3 are brought into closer connection with methodological questions. In particular I consider the idea of ethnography as a study of practices, and connections between my approach and Barad’s (2007) notion of diffractive research .

The specific ethnographic focus on practices, rather than cultures, or organisations brings distinctive qualities to my ethnography . Many ethnographies, of course, describe what people do and say, and the things involved with these doings and sayings . But I base the work in this book on a site ontology (Schatzki 2003; see Chap. 3). This assumes practice-arrangement bundles to be the fundamental unit of social life, making them the primary unit of analysis. Through this approach, ethnography ventures into frontier territory. In this respect I follow in some ways the wonderful example set by Mol (2002) in The Body Multiple. Mol describes how medicine enacts the objects if its concern and treatment (drawing on actor-network theory). Similarly I explore pedagogy, learning and partnership , as well as times, spaces, bodies and things, with reference not to what they are, but how they are done.

In furnishing the term ‘ethnography ’ with richer and more specific meaning as it applies to my work for this book, I wish to make some guarded connections with Barad’s (2007) notion of diffraction (see also Barad 2003; Nicolini and Roe 2014 offer a much deeper and more sophisticated account linking to interview methodology). Barad challenges and undermines established ontologies, epistemologies and notions of reflection, writing of…

… shifts that are at issue in moving away from the familiar habits and seductions of representationalism (reflecting on the world from outside) to a away of understanding the world from within and as part of it, as a diffractive methodology requires. (2007, p. 88)

There are elements of my work that echo a diffractive approach, although I wish to be clear that I am not claiming the work presented in this book in any way does justice to the complexity and commitments of Barad’s (2007) ideas. Nonetheless, it is worth noting a number of points of resonance. One is that diffractive research is not about a view from a distance, but about patterns that emerge from entanglement with the phenomena of interest. Here I refer back to my discussion of participation and observation, and suggest that the concept of intimate outsidership conveys something of the entanglements that Barad has in mind.

Diffractive research is performed and emerges through intra-actions , rather than representing pre-existing boundaries between subject and object (Barad 2007). The account of the site of my ethnography above did not take the site as an a priori entity or container for research, but as something produced through relationships between the practices and materialities of fieldwork on one hand, and those of professional work on the other. These relationships are not defined outside of the research, nor outside of the practices being investigated. Hence, I see a diffractive quality here, too.

The site ontology (Schatzki 2003, see Chap. 3) underpinning this research also has substantial, meaningful, common ground with elements of Barad’s diffractive approach. Most specifically, her rejection of notions of knowing at a distance, in favour of ontologies in which knowing is viewed as material practice . I take up Gherardi’s (2006) notion of knowing in practice as a key concept in the chapters that follow. This ‘materialises’ the notion of knowing in the sense that it is tied, fundamentally, to ideas of embodied action, performances that are always accomplished through a material body, amid, attuned to, towards (etc.) other features of the material world. Barad holds that diffraction is fundamentally about accounting for ‘how practices matter’ (2007, p. 90), and I assume the ‘matter’ here is deliberately rich and multi-layered in its meaning: matter in ethical, material, contingent ways, as established through entanglement rather than objective reflection from a distance. The sense of how and why practices of the Residential Unit matter is central to this book—it is why the professional practices and learning emerging there are worthy of our attention. Chapter 2 began the work of telling this story, and (more or less explicitly) all the remaining chapters unravel and unfold this further, through stories of change for families with young children, and professional expertise , practices and learning helping to create effective partnerships with parents . We may note echoes here of the discussion in Chap. 1, of critique and its present and absent forms in this book.

For now, I wish to lay one final marker in terms of ethnographic territory, and this is to clarify something this ethnography is not. The study discussed here is of one (part of) one institution, but it is not an institutional ethnography of the kind proposed by Smith (1990), despite the obvious links between this approach and mine, in terms of its emphasis on practices (see Grahame (1998), or McGibbon et al. (2010) for an example relating to nursing). A Smithian institutional approach would doubtless reveal much of interest and value about what happens at Karitane and how this happens, and it would bring different and important questions about power, exclusion and ruling relations. This lies outside the scope and purpose of what I undertook and present in this book. However, questions of the role of theory in ethnography are highly pertinent, and form the focus of the next section.

Ethnography, Theory and Analysis

In this section I focus more sharply on questions of theory and its relationship to my ethnographic approach. I reconnect with the contested terrain and (post-) disciplinary traditions discussed above, and touch briefly upon processes of analysis that might justifiably be viewed as taking on a diffractive hue, although certainly not proceeding in a full Baradian (2007) sense. This section continues to weave together some of the foundations and assumptions outlined in Chap. 3, now from a methodological viewpoint.

The relationship between theory and ethnography is contested (Mills and Ratcliffe 2012). It has changed in my own history of ethnographic research—from earlier work that was much ‘lighter’ on theory (Hopwood 2004, 2007a, b, 2008, 2009, 2011, 2012), to the current study which is infused with theory, and has both theoretical and substantive agendas at its core (see Chap. 1). In response to an early draft of some of the material presented later, a colleague (with an anthropological background) commented:

I get a bit of a sense that you’ve been forced to genuflect in front of theory – the piece foregrounds theory in a big way.

This touched upon my wariness of over-theorising or theoretical over-determination. I want theory to shape my questions and enhance my answers. But it should not sew up what might be asked or found. I share Clegg’s (2012) sense of the danger in insisting too loudly on ‘theory’. I do ethnography because I feel I have something to learn from the world, by watching, listening, touching, being with, sensing. The point of collecting data is because one doesn’t understand something as well as one would like to. But there has to theoretical rigour as well as empirical rigour when we engage with evidence or data (Clegg 2012). If theory doesn’t speak to data, the data are not at fault, and one must look elsewhere to find a means to engage with one’s empirical material. Hence the value I find in Nicolini’s (2009) notion of zooming in and zooming out, being agile in the application of theory in order to enrich the engagement with empirical material.

The theoretical literature and concepts I referred to in Chap. 3, and those I mobilise in the remainder of this book, are highly selective. This selection is governed chiefly by what I have found most productive in generating and working with my data. One doesn’t have to revert to naïve realism or empiricism to note that good data (whatever the processes of its construction), both enable and limit what we can say about the world. The infinite range of things I might have written about Karitane was radically reduced by what I was able, and chose, to notice as an ethnographer. Data were generated on the basis of this. The crisis of representation need not, in my view, create an ambivalence about data or evidence. Yes, I have concern for my role as a researcher and issues of ontology, epistemology , and representation: What am I noticing? How? Why? How am I capturing that in my notes, pictures? How do I account for the embodied legacy of fieldwork in my memory, senses of touch and smell? Yes, there are more than accidential and surface resonances between my work and a diffractive approach in a Baradian (2007) sense. Willis writes:

In one way I am a simple empiricist: Write down what happens, take notes about what people do and say, how they use objects, artefacts, and symbolic forms in situ. Do not worry too much about the endless debates concerning ethnographic authority and the slippages of discursive meaning understood from an abstract poststructuralism. Tell me something – I know all the method problems – tell me, tell your readers, something about the world… rather than endless methodological discussions where we learn everything about the sacred bourgeois formation of the writer and nothing about the profane formation of the subject. I seem to hear subjects screaming silently from the margins of the page, ‘but what about us?’. (Willis 2004, p. 169)

I expect that readers will sense a tension between Willis’ stance above, and Barad’s (2007) notion of diffraction . There are certainly important differences in their views. However my reading of Barad, and I admit it is likely a naïve one, is that she is also seeking to undermine approaches that have elevated the notion of reflection or reflexivity beyond their station. In her sense of accounting for how practices matter, I hear echoes of Willis’ ‘but what about us?’. While Willis’ subject-object distinction may be too coarse for a Baradian reading, not entangled enough, both are urging a stance that is engaged, that accounts for the world in a way that matters, that conveys what matters. I retain a sense of ethnography having a remit to tell a story about the world. I follow Walford (2009) in writing this book as an ethnographic account that attempts to construct a text where the evidence generated and shared enables and constrains what can I can say about a certain feature of the world. This still leaves space for multiple interpretations of the same phenomenon, and the indeed same data.

So I have a strong commitment to data and acknowledge its heavy presence in the research process. But there is a heavy presence of theory too. What data are evidence of, what they mean, can be greatly enriched through theory. Theory adds to the number of useful and valid interpretations we can make of data. Theory in some ways came before my data. How could it not? In this ethnography , compared to my previous studies (Hopwood 2007a, b, 2012), theory played a much stronger role from the start. My interest in questions of practice, bodies, materiality and so on stemmed partly from reading of sociomaterial literature, in particular Schatzki. My observations thus reflected an ethnographic sensibility that was purposefully attuned to times, spaces, bodies, and things . No radical stretch for ethnography, perhaps, but nonetheless an a priori theoretical shaping of what I noticed and thus the data that were generated.

What of analysis? Srivastava and Hopwood’s (2009) framework for analysis captures a shifting balance between the empirical and theoretical, the grounded and the purposefully selective. The questions ‘What are the data telling me?’, ‘What do I want to know?’ and ‘What is the relationship between these two?’ provided an overarching basis for how I engaged with my data, both as fieldwork was in progress, and in the more detailed analysis that followed. Theory and data spread across both of the first two questions: theory led me to the field and shaped my presence in the field; the field and the data shaped the material with which that theory was engaged, and laid out terms upon which theory became relevant and useful.

Furthermore, I suggest that there are some resonances between this iterative analytical approach, and the diffractive qualities I outlined above, particularly in terms of how they have been taken up in practices of data analysis. Lenz Taguchi (2012) takes up Barad’s (2007) work (and that of other feminist scholars including Haraway), understanding diffractive analysis as a ‘becoming-with’ the data as researcher, as proceeding in non-linear fashion through shifting entanglements between the researcher and the data. This certainly captures the sense of shaping and being shaped by meanings that emerged as I analysed the data for this book.

An Educational Ethnography in a Health-Related Setting

I wish, briefly, to further clarify the intellectual location of my ethnography at Karitane, and to acknowledge some of its looser connections. In the preface and above I have positioned this work as an educational ethnography: an in-depth empirical study, based centrally on observation, driven by questions about practices and learning. It is ‘educational ’ in the sense that issues of knowledge (or knowing ), expertise , learning, and at times pedagogy too, are in sharp focus. As an academic I feel I belong to the discipline of education, and as I explained above, the tradition of educational ethnography (particularly its British guise, crude as such a badging inevitably is) is the one that shaped my early formative years as an ethnographer.

But this is an ethnography in a setting not traditionally viewed as an educational. Yes, Karitane and many similar organisations describe their role as including parent education, but there are other things going on too: care, therapy, even treatment (insofar as medications are at times prescribed and administered). The Residential Unit at Carramar is technically a hospital. It is staffed by professionals whose qualifications are in fields such as nursing, social work, medicine, and so on (see Chap. 2). As an educational researcher, I therefore notice and interpret what goes on with strange eyes. As I explained in Chap. 1, the idea of framing practices in such settings as pedagogical is fundamental to the fresh insights this book offers in terms of rethinking professional practice, expertise and learning, and how these connect with notions of partnership and coproduction . The educational perspective is another way in which I always remained an outsider: I never had the intimacy of shared professional backgrounds with the staff of the Unit.

This said, it is important to acknowledge that the worlds of nursing and health care more generally are, of course, familiar sites of ethnographic enquiry. Lawler’s (1991) Behind the screens, for example, offers an intimate insider’s account of nursing life (in a more traditional setting of hospital care), followed up by descriptions of the embodied work of nursing, again highly inflected with connections between empirical material and personal professional experience (Lawler 1997a, b). Some focus on very specific care practices, such as communication (Osterlund 2007; The et al. 2000), or end of life care (Costello 2001), while others take up wider issues such as relationships between health disciplines (Allen 1997). The field of medical anthropology draws heavily on ethnographic approaches (inflected with anthropological disciplinary histories and sensibilities as well as influences derived from the medical context). This is a diverse field, and includes studies that explore cultures and meanings in particular sites such as community mental health centres (e.g. Ware et al. 2000), and others that take a higher-resolution focus on patient-practitioner interactions (e.g. Kingfisher and Millard 1998).

There are methodological canons of qualitative and ethnographic research specifically addressed to healthcare settings (de Laine 1997; Pope and Mays 1995; Reeves et al. 2008; Savage 2000a). To me these often appear infused with notions of research accountability and validity that seep through from the broader (hard) scientific world of randomised, controlled trials and quantitative evidence; either that or the qualitative approach is somehow positioned as counter to them. Nonetheless, ethnographies within the health field demonstrate features in common with broader methodological trends, including those that highlight the embodied nature of ethnography (Edvardsson and Street 2007; Savage 2000b) and the practices it explores (Hindmarsh and Pilnick 2007).

I have done scant justice to ethnographic research in health fields and medical anthropology. However the shallow contact I’ve made with these bodies of work above suffices for my immediate purpose. This is to clarify that while this book does, I hope, offer something new and distinctive within this body of work, it has not been developed primarily as a contribution to it, and the subsequent chapters do not unfold in close conversation with this work. This chapter is almost complete; it remains now for me to explain the joint and individual nature of the work relating to this book.

A Solo/Joint Endeavour

My work at the Residential Unit of Karitane had two different but linked components. The first was focused on my own fieldwork and analyses, and is described in this book. The second was made possible by a grant that funded a research assistant, Teena Clerke. The aim was to pursue methodological questions relating asymmetrical approaches to joint ethnography , resulting in a book first-authored by Teena (Clerke and Hopwood 2013). Teena made 22 visits to Karitane during the period of study, 6 of which coincided with my visits. Methodological issues cannot be separated from substantive issues—indeed the former become interesting through their reference to substance, and so there was inevitable crossover between the joint and solo aspects. Our methodological questions were primary, but remained linked to substantive questions about partnership and pedagogy. The initial outcomes of our joint substantive analysis are reported by Hopwood and Clerke (2012).

The questions guiding the joint analysis focused on how staff learned from families and each other, how change was brought about for families, and how partnership was accomplished on the Unit. Teena has a professional background as a graphic designer, design academic, and feminist scholar of the discipline of design, but also has postgraduate qualifications in adult education and has published in design education and doctoral pedagogy (Bower et al. 2009; Clerke 2010). This meant that her account was not inflected with the same theories and concepts of practice, learning and pedagogy that I brought to the analysis. Indeed this difference, alongside our different ways of being, relating and noticing in the field (for example, Teena is a parent, I am not), was part of what made our joint work asymmetrical and interesting. However in terms of identifying general patterns and features, the practices that Teena described and identified overlapped considerably with my own account, such that we were able to merge our analyses and proceed together in refining our interpretations and understanding relating to those three questions.

Teena specifically raised the notion of running commentaries given by staff on their work (see Chap. 9)—something that I recognised immediately in my data, but had not previously framed so explicitly. Choreography (Chap. 9) and pedagogies of noticing and distraction (Chap. 10) are examples of concepts we both arrived at through our first, separate, analyses, and proceeded to enrich jointly. Teena’s use of sketching in the field, and her lead role in using images for a staff development event at Karitane, led us to explore the use of line drawings instead of photographs as a means to convey selected visual detail while preserving thee anonymity of people involved. Combined with the account of very similar drawings offered by Michael (2012), these became important features of our joint writing. As noted above, I have continued to create drawings in the process of analysis (see Hopwood 2014), with many of them included in this book.

The analyses and ideas presented in this book reflect work I began independently and continued after our joint project ended. The sociomaterial approach, engagement with temporality, spatiality, embodiment and materiality, and more detailed linking to notions of pedagogy and learning are all features of this project that I have pursued separately. I quote and refer only to data I generated, although my familiarity with Teena’s field notes confirms that there is nothing in those to challenge or undermine my own account. These paragraphs have been written with Teena, and reflect our joint attempt to explain an ethnographic project with two overlapping strands, guided by both shared and separate logics and questions, and producing a mix of jointly authored and single authored accounts.

Conclusion

This chapter has justified ethnography in terms of alignment of methodology with theory. I have presented details of my fieldwork, inflecting this with sociomaterial and practice theoretical concepts discussed in Chap. 3, as well as the notion of intimate outsidership as a means to understand fluid relationships between participation and observation. I have located my approach to ethnography within a contested methodological terrain. I have also taken a clear stance on the role of theory in (this) ethnographic work, pointing to its diffractive features.