Institutional Ethnography (IE) is a method of inquiry into the social organisation of knowledge. It begins with a disjuncture/troubling experience impacting a specific group of workers and adopts their standpoint/subject positon to look out into the wider institution and trace the work and textual practices that organised (and produced) the disjuncture under investigation. The study took the standpoint of Senior Social Care Workers (SSCWs) from one RCH in Scotland to uncover the complex social organisation of “abandonment” SSCWs described when there was insufficient support from NHS services to care appropriately for sick and dying residents. The focal point of inquiry was on SSCWs descriptions of being “pushed” into “difficult” decision-making conversions with family members about “serious illness” andthe Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) – without the support of doctors (or nurses).To inquire into how SSCWs work had become tied into the medical, legal and bureaucratic practices that rule death, dying and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision making in Scotland's RCHs the study drew on ten open-ended interviews (SSCWs, n= 4 and others whose work influenced SSCWs working practices, n= 6). Interview transcripts were examined to uncover SSCWs accounts of their knowledgeable work related to managing illness, death and dying - along with the characteristic tensions,frustrations and contradictions embedded in those accounts. The study traced how doctors and nurses were routinely, and systematically, absent from RCHs - leaving residents systematically excluded from the level of care that they needed. It also traced how SSCWs work with “serious illness” and “difficult” conversations was co-ordinated in disquieting ways in an apparent commitment to high quality “palliative care”.What was discussed between SSCWs and family members during conversations about “serious illness” and the DNACPR form was out of step with the DNACPR policy, the rhetoric of palliative care, and the actual needs of SSCWS, family members, and residents for medical support. However, the study shows that what happened in the RCH was not simply an error of practice. This is becauseit was textually planned, organised, and co-ordinated across healthcare institutions, professional groups, the regulatory body acting on behalf of the Scottish Government and the management and care staff of the RCH itself. SSCWs - and others – were organised to take up the powerful ruling discourse of palliative care in ways which treated residents and family members withincreasing objectivity, where institutional needs to reduce NHS spending and to protect the income generating potential of the care home as a business ruled over individual needs. In taking up and enacting the powerful ruling discourse of palliative care, SSCWs – and others- (intentionally but unknowingly) took up the very tools of oppression that dominated and overpowered their own and others lives. The knowledge generated by this research can be used to show SSCWs and others how they unknowingly participate in taking up actions that are not in their own or others interests. This is the basis of changing the conditions of SSCWs and others lives thereby advancing anti-oppressive work.

How we come to know about social phenomena is an important sociological question and a central focus of this thesis. How knowledge is organised and produced and becomes part of ruling relations is empirically interrogated through an institutional ethnography. I do this in the context of explicating the construction of a public history concerning Aboriginal Australian child separations over the 20th century, and in particular as it arose in the 1990s as a social problem. Particular attention is given to knowledge construction practices around the Australian National Inquiry into the Separation of Aboriginal Children from Their Families (1996-1997) and the related Bringing Them Home Oral History Project (1998-2002). The once separated children have come to be known as The Stolen Generation(s) in public discourse and have been represented as sharing a common experience as well as reasons for the separations. Against the master narrative of common experience and discussion of the reasons for it, this thesis raises the problematic that knowledge is grounded in particular times and places, and also that many people who are differently related and who have experiences which contain many differences as well as similarities end up being represented as though saying the same thing. Through an institutional ethnography grounded in explicating the social organising activities which produced the Bringing Them Home Oral History Project, I examine how institutional relations coordinate the multiplicity and variability of people’s experiences through a textually-mediated project with a focused concern regarding the knowing subject, ideology, accounts, texts and analytical mapping. Through this I show how ruling relations are implicated in constructing what is known about the Aboriginal child separation histories, and more generally how experience, memory, the telling of a life and the making of public history are embedded in social organising practices.

Sexual harassment in the workplace is both illegal discrimination under human rights law and a part of the everyday experiences of women working in the full-service restaurant industry in British Columbia (BC). This dissertation is a feminist, institutional ethnographic inquiry into how women’s unwanted or uncomfortable sexual experiences with managers, co-workers, and customers within the context of full-service restaurant work in BC are still happening more than three decades after sexual harassment was first named sex discrimination in Canada. I argue that restaurant work is organized in such a way that uncomfortable or unwanted sexual experiences at work are made normal. My dissertation tells the story of how law is implicated in the construction of such restaurant workplaces within which sexual harassment and unwanted sexual experiences are normalized. The complicated interaction between the social context of restaurant work, workplace practices in restaurants, and inadequate employment standards legislation constructs precarious work environments wherein workers have little economic or job security and rely on customers for tips. Tipping, a practice legally legitimized and reinforced with lower minimum wages for alcohol servers, means workers endure sexualized and discriminatory behaviour at work in exchange for tips. Moreover, gendered social relations, reflected in managerial hiring practices and restaurant dress codes, lead women workers to associate femininity and a sexualized presentation of their self with their employment. Sexual harassment law is implicated in the problem as well. Sexual harassment law in BC (re)produces the gendered social relations of work through an individualized human rights framework and a jurisprudential notion of “unwelcomness” that both place the burden for addressing discrimination on the shoulders of workers. / Graduate / 2019-05-06

As the population ages and income disparities increase, issues affecting older adults and marginalized individuals are examined more frequently. Despite this, little attention is paid to the community experiences of women over the age of fifty who face marginalization, criminalization and homelessness. This study is an institutional ethnography of older marginalized women in Ottawa, focusing on their identities, lives and their experiences of community life. Its findings are based on ethnographic fieldwork as well as interviews with 27 older marginalized women and 16 professionals working with this group. The women described their identities, social networks, daily activities and navigations of their communities as well as the policy and discursive framework in which their lives are situated. Regardless of whether the women had housing or were staying in shelters, upheaval, uncertainty and change characterized their experiences in the community, reflecting their current circumstances, but also their life courses. Their accounts also revealed how, through social support, community services, and personal resilience, older marginalized women negotiate daily life and find places and spaces for themselves in their communities. As an institutional ethnography, this research foregrounds participants’ responses, framing these with theoretical lenses examining mobilities, identity, social capital, governmentality, and stigma. Specifically, it uses the lenses of mobilities and identities to understand the nature of their community experiences, before moving outward to examine their social networks and the world around them. Governmentality theory is also used to describe the neoliberal context framing their community experiences. The study concludes with a reflection on the research and a set of policy recommendations arising from the study.

Higher education globally is characterised by persistent inequality, which is particularly acute in South Africa. Due to the enduring legacy of colonialism and apartheid, students from certain categories of identity are marginalised, whereas others are privileged. An essential element of these dynamics of power is space. Intersections of identity such as race, class, ability and gender are axes of power in differential experiences of space. Despite this, space is often neglected in research into higher education transformation in South Africa. Through an institutional ethnography, this study examines the dynamics of space and identity at the University of Cape Town (UCT). The study involved a photovoice project, roving interviews and surveys with students; the collection of multimodal data in which space is documented; campus observations; and semi-structured interviews with staff and policymakers. The first analysis chapter involves a multimodal discourse analysis of the identity discourses produced for the Jameson Plaza by the students in the study, specifically as a place of belonging and connection and a place of alienation and discomfort. The second analysis chapter examines the institutional power geometries at play at the UCT across three specific dimensions: 1) spatial memory and material familiarity; 2) material campus symbolism; and 3) spatialised social practices and relations. The findings illustrate how space and power across these dimensions engender experiences of spatialised belonging or spatialised alienation on campus. The affective potentialities of campus, in turn, influence the types of identities students construct for themselves across campus space. Emerging from these considerations, the final analysis chapter explores what student do across, within and through campus spaces. The chapter focuses on everyday use of space by students at the individual level, and specifically spatial coping strategies students use to negotiate and manage their daily lives on campus.

This thesis is an institutional ethnography (IE) examining the social organization of Community Care Access Centre School Health Support Services (CCAC SHSS) for children with diabetes in Ontario schools. More specifically, it explicates the social relations embedded in, and coordinating the work organization of mothering (parenting) and nursing in the school setting. The inquiry begins in my personal experience as a mother of a child with diabetes starting kindergarten, and the troubles I encountered in getting the care and attention needed to keep my child safe at school. Starting from experience, a place outside of theory and institutionalized categories and discourse, I set out on a journey to discover the social organization that coordinates my experience, and to seek answers to my query: how are school health supports put together in such a way that I, as a parent, am left feeling worried about my child’s safety when she is at school, have had to fight to secure the much needed ‘diabetes care’, and even then, am often called upon to provide voluntary supplementary healthcare work to ensure her safety at school? I have structured this thesis into two main parts. The first part provides the set-up for this thesis. First, I orient readers to this distinctive way of doing an IE, directing their attention to how I used the core IE concepts in this research and calling upon them to read the remainder of the thesis taking up this distinctive theoretical and conceptual lens. Indeed, what we know and how we know it has much to do with how knowledge is socially organized. Then, I go on to examine the different ways of knowing about ‘diabetes care’, how these distinctive ways of knowing create a disjuncture for me as a parent and how this disjuncture is used to establish the research standpoint to begin and direct the explication. The last chapter in this part situates health supports for children with diabetes within the services provided by public-funded home care. I sketch three decades of the history of reform and organizational restructuring of home care in Ontario, in particular, the introduction of privatizing relations into the local practices of community nursing and the creation of CCACs. These relations of privatization reorganized the home care sector, the workforce, and the relation between the ‘state’ and its citizens. What went on before sets the groundwork for what can happen next, and it is under this context and conditions in which my inquiry is set. The second part consists of four academic journal manuscripts. They are the descriptive analysis for this IE. These four chapters describe what I have learned and discovered in doing this research, and three of them in particular provide an empirical analysis showing how school health supports for children with diabetes are put together such that the troubles I experienced came into being. These four chapters are conventionally referred to as research ‘findings’ in traditional qualitative research methodology. Each of these chapters speaks to a particular way of knowing about ‘diabetes care’. One focuses on parents’ experiential ways of knowing based on the actualities of their daily and nightly everyday world to show the amount of work and knowledge required to care for and to keep their children with diabetes alive; while the other three underscore the CCACs’ institutional ways of knowing about ‘diabetes care’ in the school setting. I show how these objectified ways of knowing derived from institutional texts (Standardized CCAC Medial Orders, information technology software and the Diabetes Checklist for Independence) are used to determine a child’s eligibility to receive health supports at school. These objectified textual forms of knowing are removed from the actualities of people’s real life circumstances, and differ significantly with how and what parents know is needed for their children with diabetes to stay well and safe at school. It is precisely this form of text-mediated social coordination that leaves parents feeling worried and draws them in to doing voluntary healthcare work at school, without which the child’s safety and the continuity of care is not possible. Tracing the institutional relations organizing how health support services for children with diabetes actually happen in the classroom, I show the kind of work expected of parents, and demonstrate that the CCAC SHSS policy and practices only ‘work’ as they should with the incorporation of parents’ ‘unauthorized’ knowledge and their ongoing voluntary complementary healthcare work. While it is in parents’ interests to ensure their children’s safety and well-being at school, there are differences between parents in how, and if, they can deliver their knowledge and resources. / Thesis / Doctor of Philosophy (PhD) / Diabetes is a chronic health condition that requires individuals with diabetes or their families to maintain a daily well-coordinated and intensive diabetes self-care routine. Lapses in this complex daily regimen can have devastating immediate and long-term consequences. How children’s diabetes, that is children’s health and well-being, are cared for at school is of concern for parents. The inquiry begins in my personal experience as a mother of a child with diabetes starting kindergarten, and the troubles I encountered in getting the care needed to keep my child safe at school. Starting from experience, this thesis examines how the institutional context and routine practices of diabetes care in school affects the care children actually receive. Despite legislation that requires accommodations for students with disabilities, what I found in this study is that parental involvement (which is inequitably available) is essential to ensure diabetes care is adequate for children in schools.

This PhD thesis argues that accounts are influenced by culture, are a fundamental form of social practice by which interaction is accomplished, and thus a central sociological concept. The focus of the thesis is that accounts of time and money are affected by religious belief. It examines and (re)conceptualises the concept of an account. Accounts are re-theorised as taking two forms: rational and rhetorical, with their mediation emphasised as the feature that makes them empirically different. Studies of accounting in religious institutions are critically examined and complemented using research from a neglected (in 'financial' accounting studies) branch of sociological research about accounts as ubiquitous social practices. Time and money are appropriate phenomena to research sociologically because they are relevant to sociological and financial conceptions of an account as numerically accountable phenomena that also have socially meaningful features. Ethnomethodology and institutional ethnography are deployed as two mutual methodological frameworks for researching the social accomplishment of accounts in small-scale interaction and ways in which a complex of wider ruling relations, through institutional discourses, are implicit in accounting interactions, especially in institutional settings. The thesis forwards a set of theoretically derived propositions to provide an explanation of accounts that explores their social embeddedness more closely than previous work. Briefly, these are that accounts generally, and particularly as applied to time and money, are a key means to make actions visible; are an attempt to promote a morally worthy self; are culturally relative; give information about the social norms of the social collective; always occur at moral and sometimes institutional interfaces; and are ubiquitous social practices. To provide and interrogate an applied example of these theoretically and methodologically derived propositions about accounts of time and money and how these are affected by culture and beliefs, I use observation, participant observation, analysis of community produced literature, and semi-structured interviews in a critical case study of the Findhorn Foundation. Therein time and money are rhetorically accountable; are indicative of the spiritually influenced moral code of the Findhorn Foundation; and the moral code provides for a vocabulary of motives that members use in order present morally worthy selves. The ideal moral self is culturally relative to the Findhorn Foundation and sets itself in opposition to an ideal type of capitalist production, consumption and generally dominant ways of knowing, being, and organising in industrialised western societies. Rhetorical accounts of time and money pervade rational ones at the organisational level and spiritual principles are blended with business acumen. However, although spiritual principles have epistemological and ontological differences (from dominant ways of doing business in the wider society), they need to be commensurable with the extra-locally produced discourses found within the wider society in order to remain legally viable. Furthermore, tensions around inefficient decision-making processes exist. Accounts are tied to multiple (at times competing) moral codes within Findhorn, and also operate within pragmatically set limits involving disposable resources. This thesis is argued to be a valuable contribution to sociological literature around social accounting in general, and in religious institutions in particular, and contributes to the literature concerning social actors' accounts of their social actions, regardless of the specific setting. That is, these findings are 'about social practices' in general. Succinctly, my thesis puts forward a strong case for seeing accounts as a central sociological concept.

When the Swedish National IT Strategy for Health and Social Care was introduced in 2006, intensive work started in implementing Information Systems (IS) in Swedish healthcare organizations. To follow up on the requests for more research with a combined socio-technical focus on challenges, the overall aim of this thesis was to identify social challenges when implementing IS in a Swedish healthcare organization. Furthermore, the aim was to understand the impact of identified social challenges when implementing IS in this context by putting them in an interdisciplinary Applied Health Technology theoretical framework. Institutional ethnography and phenomenological hermeneutics influenced the study design. Study 1 aimed to investigate different meanings of accessibility when implementing Health Information Technology in everyday work practice. The results indicate that accessibility depends on working routines, social structures and patient relationship. When an IT strategy and interaction in everyday work use the same word in different ways there will be consequences. Study 2 sets out to describe experience-based reflections on discharge planning as narrated by nursing staff in primary healthcare, along with their concerns about how the introduction of video conferencing might influence the discharge planning situation. It was found that there is a need for improvement in communication and understanding between nursing staff at the hospital and in primary healthcare. The aim of study 3 was to explore social challenges when implementing IS in everyday work in a nursing context. Power (changing the existing hierarchy, alienation), Professional identity (calling on hold, expert becomes novice, changed routines), and Encounter (ignorant introductions, preconceived notions) were categories presented in the findings. The aim of study 4 was to explore and obtain a deeper understanding of how identified social challenges have an influence on the implementation process of IS, based on healthcare staff’s experiences on micro, meso and macro levels of Swedish Healthcare organizations. It was found that the challenges were related to the steps of putting into practice, making IS a part of everyday work routine and establishing an identity in the implementation process. In the thesis’s discussion, social challenges when implementing IS in Swedish healthcare organizations and how they might be met and dealt with constructively are further reflected upon in relation to the interdisciplinary theoretical framework and as possible consequences of the modernity-era. This thesis contributes to the starting up of a discussion of how ingrained professional characteristics are important to feel secure of being part of an established profession. If the characteristics are questioned, the whole professional performance is threatened. One consequence of this insight is the reinforcement of the realization that a basic understanding of IS and IS implementation processes in healthcare organizations needs to be integrated in to the construction of professional identity of nurses already from the start in nursing education.

Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 RenataMV_TESE.pdf: 1551134 bytes, checksum: 5241bc9c940147eb3212cc19ebdea324 (MD5) Previous issue date: 2010-02-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema ?nico de Sa?de SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs / O Programa Canguru foi implantado no Brasil em 2000 atrav?s de uma pol?tica p?blica do Sistema ?nico de Sa?de (SUS), sustentado sob a ret?rica da humaniza??o dos servi?os de sa?de. Este programa adota a pr?tica de colocar o beb? prematuro e/ou de baixo peso em contato pele a pele com sua m?e com o intuito de fortalecer o v?nculo afetivo entre m?e e beb?, incentivar o aleitamento materno e promover maior seguran?a nos cuidados com seu filho. As m?es usu?rias do SUS s?o, dessa forma, solicitadas a residirem na maternidade, participando dos cuidados com o beb?, at? sua alta. No entanto, constatou-se, em observa??es pr?vias, que a participa??o no Programa Canguru tem sido geralmente uma imposi??o para essas usu?rias. Assim sendo, procurou-se interpretar os textos que permeiam o desenvolvimento da pr?tica Canguru. Essa pesquisa foi realizada atrav?s de dois estudos: 1) explora??o hist?rica do conceito de maternidade e an?lise de como a maternidade ? apresentada no m?dulo do documento oficial que orienta o programa; 2) an?lise da din?mica institucional que permeia o Programa Canguru, enfatizando o estudo acerca do processo de trabalho dos profissionais da sa?de e a compreens?o da percep??o das usu?rias sobre sua estadia na maternidade e sobre a din?mica de atendimento. Destaca-se que a rela??o entre esses dois estudos permitiu a compreens?o da forma que os discursos podem influenciar o comportamento dos profissionais de sa?de e que implica??es os discursos destes t?m na pr?tica cotidiana do atendimento em sa?de. A pesquisa, fundamentada na metodologia da Etnografia Institucional, considera as pr?ticas e experi?ncias como socialmente organizadas, procurando entend?-las na sua din?mica e interdepend?ncias. A perspectiva adotada para a an?lise documental, como tamb?m para o estudo dos dados qualitativos constru?dos na pesquisa emp?rica, foi a an?lise do discurso. A pesquisa mostrou que embora o Programa Canguru venha demonstrando resultados positivos, tanto em rela??o ? economia de recursos quanto aos aspectos psicol?gicos e biol?gicos do beb?, por outro lado ele falha em considerar a complexidade social, econ?mica e cultural das m?es e as limita??es estruturais do sistema de sa?de p?blica. O documento oficial deste programa apoia-se na racionalidade m?dica e econ?mica, cuja concep??o centra-se no modelo biom?dico hegem?nico e nas condi??es de vida e estrutura??o de fam?lia de uma popula??o que n?o ? usu?ria do Sistema ?nico de Sa?de. Essa disson?ncia dificulta o sucesso do programa, uma vez que suas a??es s?o planejadas e criadas sem considera??o ?s condi??es de vida e experi?ncias das pessoas que fazem uso desse servi?o. Com rela??o ? din?mica institucional, observou-se que, embora alguns profissionais se diferenciem no tratamento com as usu?rias, a maioria deles desconsidera o papel ativo da m?e nesse m?todo de interven??o. Por outro lado, a pesquisa mostrou que as m?es veem o programa como uma obriga??o e n?o uma op??o que implique em momentos prazerosos no ambiente hospitalar. Ressalta-se, assim, que a implanta??o deste programa requer n?o s? a presen?a e o treinamento para o bom atendimento da equipe de funcion?rios, como tamb?m deve ser levado em considera??o a complexa rede de determinantes sociais da sa?de que podem influenciar na participa??o das m?es no programa. Discutir e problematizar o cotidiano de programas como esse se constitui, dessa forma, um exerc?cio de reflex?o sobre cidadania e governan?a, permitindo espa?os para a melhoria dos programas de sa?de p?blica

abstract: This research works from in an institutional ethnographic methodology. From this grounded approach, it describes the dialectic between the individual and the discourse of the institution. This work develops a complex picture of the multifarious ways in which institutional discourse has real effects on the working lives of graduate teaching associates (GTAs) and administrative staff and faculty in Arizona State University's Department of English. Beginning with the experiences of individuals as they described in their interviews, provided an opportunity to understand individual experiences connected by threads of institutional discourse. The line of argumentation that developed from this grounded institutional ethnographic approach proceeds thusly: 1) If ASU’s institutional discourse is understood as largely defined by ASU’s Charter as emphasizing access and academic excellence, then it is possible to 2) see how the Charter affects the departmental discourse in the Department of English. This is shown by 3) explaining the ways in which institutional discourse—in conjunction with disciplinary discourses—affects the flow of power for administrative faculty and manifests as, for example, the Writing Programs Mission and Goals. These manifestations then 4) shape the training in the department to enculturate GTAs and other Writing Programs teachers, which finally 5) affects how Writing Programs teachers structure their courses consequently affecting the undergraduate online learning experience. This line of argumentation illustrates how the flow of power in administrative faculty positions like the Department Chair and Writing Program Administrator are institution-specific, entangled with the values of the institution and the forms of institutional discourse including departmental training impact the teaching practices of GTAs. And, although individual work like that done by the WPA to maintain teacher autonomy and the GTAs to facilitate individual access in their online classrooms, the individual is ultimately lost in the larger institutional conversation of access. Finally, this research corroborates work by Sara Ahmed and Stephanie L. Kerschbaum who explain how institutions co-opt intersectional terms such as diversity and access, and that neoliberal institutions' use of these terms are disingenuous, improving not the quality of instruction or university infrastructure but rather the reputation and public appeal of the university. / Dissertation/Thesis / Doctoral Dissertation English 2019