The Development of Ethnographic Drama to Support Healthcare Professionals

Lisen Dellenborg and Margret Lepp

ABSTRACT: This article describes the development of ethnographic drama in an action research project involving healthcare professionals in a Swedish medical ward. Ethnographic drama is the result of collaboration between anthropology and drama. As a method, it is suited to illuminating, addressing and studying professional relationships and organisational cultures. It can help healthcare professionals cope with inter-professional confl icts, which have been shown to have serious implications for individual well-being, organisational culture, quality of care and patient safety. Ethnographic drama emerges out of participants’ own experiences and off ers them a chance to learn about the unspoken and embodied aspects of their working situation. In the project, ethnographic drama gave participants insight into the impact that structures might have on their actions in everyday encounters on the ward.

KEYWORDS: action research, collaboration, confl icts, ethnographic drama, hospital ethnogra- phy, inter-professional relations, professional development

The Problem: Inter-Professional Confl ict ception of good care, which included marginalised Infl uencing Quality of Care nursing perspectives. … In the example of the ter- minally ill patient who died during the morning Healthcare professionals are involved in confl icts routines, the nurses tried to squeeze in care of the dying patient with all of the other routines and the and ethical dilemmas that call for their judgement medical rounds. … They struggled with their con- in their everyday work. Complicating the situation, science, knowing that the inevitable event of death these confl icts and dilemmas are oft en related to seldom gives way to the routines. … Because of the hierarchies and power relations within and between stress and importance att ached to routines, two RNs professional groups. The confl icts have serious impli- prioritised morning routines over palliative care. cations for individual well-being, inter-professional (Wolf et al. 2012: 7–8) relations, organisational culture, quality of care and patient safety (Kim et al. 2016). In the ward under A problem in the healthcare literature is that the sub- study, we could clearly see that confl icts due to ject of power that permeates both care environments organisational culture had a negative infl uence on and inter-professional relations in various ways has individual well-being and quality of care: not been suffi ciently addressed (Kim et al. 2016). Fur- thermore, research on healthcare confl icts generally The care environment suppressed multi-profession- lacks theoretical grounding and a conceptual frame- alism … by creating demarcated routines rather than holistic care. … In particular, the RNs [the nurses] work (Paradis and Whitehead 2015). Consequently, reacted to the restriction of choice with feelings of these confl icts need to be studied and addressed by guilt and inadequacy. They felt trapped in an am- further research on how to support healthcare pro- bivalent state between a desire for status achieved fessionals in their work, the aim being to improve through biomedical knowledge, technical skill and inter-professional relations, cooperation, and quality adherence to routines, and their professional per- of care, and to contribute to theory-building.

Anthropology in Action, 25, no. 1 (Spring 2018): 1–14 © Berghahn Books and the Association for Anthropology in Action ISSN 0967-201X (Print) ISSN 1752-2285 (Online) doi:10.3167/aia.2018.250102 This article is distributed under the terms of the Creative Commons Att ribution Noncommercial No Derivatives 4.0 International license (htt ps://creativecommons.org/licenses/by-nc-nd/4.0/). For uses beyond those covered in the license contact Berghahn Books. AiA | Lisen Dellenborg and Margaret Lepp

This article provides an example of how drama Finkler 2004). It is thus a research area that describes and ethnography can be combined into ethnographic and analyses hospitals as culturally constructed drama and introduced into healthcare sett ings for domains that need to be understood in their wider research on how to support healthcare professionals social, cultural, historical and political contexts. in their everyday work. Kirsten Hastrup (2017: 316) Ethnography is defi ned in diverse ways and used suggests that collaboration between anthropology in other disciplines than anthropology. For instance, and other disciplines ‘may potentially aff ect and ex- it is used in education (Hammersley 2017) and nurs- pand the anthropological fi eld, and hence anthropo- ing (Roper and Shapira 2000). Common to the vari- logical knowledge’. We show in this article how the ous defi nitions is the objective of understanding the collaboration between anthropology and drama may phenomenon studied from the local point of view expand knowledge-making within anthropology as in its wider sociocultural context using participant well as within drama. Furthermore, in using James observation as the main method and fi eldwork as McCalman and David Pott er’s (2015: 216) metaphor the main strategy. This implies deep involvement of cultivation for organisational transformation, eth- in people’s daily life over a period of time (Borne- nographic drama may present anthropologists with man and Hammoudi 2009; Dellenborg 2013; Nässén the possibility of observing events in which seeds 2013). Ethnography is thus particularly apt for the are sown that may eventually sprout change. How- study of people’s everyday lives, that is, the study ever, for them to fl ourish in the future they will need of human interactions and experiences (Turner and ‘everyday reframing’ (see Alvesson and Svenings- Bruner 1986). son 2008), and they will not reach their full poten- tial if the care context remains the same (Wolf et al. Drama 2012). Drama as pedagogy can stimulate life-long learning skills that enhance the personal development and professional att itudes of students and healthcare The Approaches: Hospital Ethnography professionals (Arveklev et al. 2015). Both drama and and Drama ethnography concern lived experience and take the participants’ own views as their starting point. Fur- Hospital Ethnography thermore, drama can be understood as the pedagogy Increasingly since the fi ft ies and the development of of experience, and can thus be related to experiential Max Gluckman’s Manchester school, research inter- learning (Morrison et al. 2013). David A. Kolb (1984: est within anthropology has widened from mostly 38) describes experiential learning as ‘a process being concerned with people living in rural, typically whereby knowledge is created through the transfor- non-European sett ings, to people living in an urban, mation of experience’. Central to learning through Western sett ings (Messerschmidt 1981; Skott 2013). drama is refl ective thinking; in drama, learning is not Importantly, there is now critical awareness within only the experience itself, but the refl ection related to anthropology of the biases that have shaped the that experience (Bagshaw et al. 2007). Importantly, discipline and led to studies of ‘others’ as ‘cultural’ emotions and cognition are understood as equally beings, and to its overlooking of its own ‘cultural important for this refl ection. Drama and its content foundations and cultural dimensions at home’ (Za- and process can thus be described as follows: man 2008: 143). Anthropological fi eld sites now include global phenomena such as media consump- The content of Drama is human relationships, inter- tion (Gemzöe 2004), indigenous people’s political actions containing both confl ict and power. Drama operates through invoking both cognitive under- identity-building on the Internet (Landzelius 2006), standing and emotional empathy, where participants refugee camps (Gren 2009), theme parks (Appel- imitate and refract life through improvised, fi ctional gren 2007) and various contemporary Western and contexts and situations, integrating thoughts, actions non-Western organisational sett ings (Garsten and and feelings. (Burton et al. 2015: 3) Nyqvist 2013) such as hospitals and hospital wards (Zaman 2008; Wolf et al. 2012). The eff ectiveness of drama for professional develop- Hospital ethnography has grown out of a concern ment is documented. For example, forum theatre was to understand the ways that wider social and cultural shown to be a useful learning medium with regard processes in a certain society are played out in its to promoting teamwork and collaboration in the ra- hospital sett ings (Long, et al. 2008; Rapport 2009; Rice diological intervention fi eld (Lundén et al. 2017). In 2003; Street and Coleman 2012; Van der Geest and addition, drama has been used in nursing education

2 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA to prepare students in both the fi rst and second cycle subaltern [and] move people to action’ – the main for their future nursing roles (Arveklev 2017). goal being the use of ethnography for social change, justice and democracy. Many social scientists and Forum-Play performance artists have since then been infl uenced The term forum-play, which we used in the project, by both Turner and Denzin (see, e.g., Harrop and is inspired by Augusto Boal’s (1992) concept of forum Njaradi 2013). Tara Goldstein (2010), for example, theatre. Forum theatre was developed explicitly as a developed performance ethnography as a pedagogi- medium for social change. It is a pedagogical form cal means to experiment with various stereotypical of applied theatre in which the audience members, understandings in order to counteract racism and ho- who are referred to as the ‘spect-actors’ because they mophobia among high school students. The strength are both actors and spectators, are asked to enter of her variation, called performed ethnography, lies in the performance and explore alternative interactions ethnographic research and active participation (Gold- by taking over the roles of the actors. These interac- stein 2008); the students’ active participation in the tions may lead to a more positive outcome than the performance and the following discussion provoked one presented in the original scenario (Boal 1992). critical analysis among the students and created the In the forum-play, situations are drawn from the possibility for them to change their att itudes and participants’ own stories, views, and real lives. The behaviours. situations are improvised and illustrated to discuss Other variations of combining drama and eth- confl icts or ethical dilemmas. The forum-play utilises nography have had the aim of counteracting social an open-ended dramatised story to invite partici- injustice and the stigmatisation of people suff ering pants’ reactions so that they can help the participants from various forms of illness are called ethnodrama change the process of a confl ict, or explore and pos- (Mienczakowski 2001) and ethnotheatre (Saldaña sibly reduce the level of a confl ict through various 2008). These approaches have been used as innova- alternative actions (Burton et. al. 2015). tive ways of reporting and sharing research results. An important diff erence from the above-mentioned variations is that the people concerned, for instance Ethnography and Drama healthcare professionals, are spectators only and not participants in the play (Mienczakowski 2001; There are many variations of the combination of eth- Saldaña 2008). Other forms of ethnotheatre (e.g. Bel- nography and drama. Common to the various forms liveau and White 2010) are more purely pedagogical, is the objective of using ethnographic knowledge for aiming at fi nding new ways for students to learn. In a contextualised understanding of the scenarios. The carrying out this action research project, we were, as various combinations oft en sound the same, which mentioned above, inspired by Augusto Boal, as well might be confusing. For instance, the anthropologist as by Turner (1982) and Denzin (2003). Victor Turner together with Edith Turner developed performance ethnography as a medium for learning. They conducted drama workshops with students, Anthropology and Social Change in which they dramatised life-cycle rituals in order to teach ethnography and develop an inner under- As a discipline, anthropology with its premise of standing of the people for whom these rituals are relativism has generally had a problematic relation- meaningful (Turner and Turner 1982). In particular, ship with the issue of anthropologists becoming Victor Turner (1986) explored the relationship be- engaged in social change. The pertinent questions tween theatre, everyday life, and embodied knowl- here have to do with in whose interest social change edge. Everyday life, according to Turner (1982), is a is supposed to be and from what position we are to form of theatre, not in a metaphorical sense but as a “identify what is good and what is bad and to allo- series of performances of which the body has knowl- cate reward and punishment” (D’Andrade 1995: 399; edge. He emphasised that learning from everyday see also Strathern 1987). The diffi culty of reconcil- life therefore demands bodily engagement and ac- ing informants’ cultural understandings of certain tion: ‘One learns through performing, then performs practices – such as headhunting and female genital the understanding so gained’ (1982: 94). cutt ing – with Western understandings of those prac- Norman K. Denzin (2003: 14) has profoundly de- tices (Rosaldo 2000; Dellenborg 2004) has led many to veloped performance ethnography together with criti- criticise anthropologists for their cultural relativism cal pedagogy as political tools to ‘give a voice to the (Edgerton 1992; Shestack 2000). Cultural relativism is

| 3 AiA | Lisen Dellenborg and Margaret Lepp not, however, the same as moral or ethical relativism: that development organisations have anthropolo- searching for the meanings that practitioners att ach gists who are already specialists – having previously to a ritual and practice does not by defi nition imply undertaken long-term studies of the region – make acceptance or refusal to take a stance on said ritual brief evaluations instead of lett ing an expert who is or practice (Geertz 1984; Gordon 1991; Rosaldo 2000). unfamiliar with the region use PRA. ‘Anthropology’, Importantly, engagement for social change should he says, ‘can help action only if it maintains high stan- be carried out together with those whom it concerns dards of quality’ (2005: 211). Signifi cantly, the action and be based on a thorough understanding of ‘how research project is based on long-term ethnographic things work’ (D’Andrade 1995: 408), that is, on fi eldwork at the ward, and the identifi cation of prob- knowledge of the local context, the diverse social ac- lems and solutions for change to occur was developed tors’ voices, and power positions (Dellenborg 2007; in a collaboration between the researchers and those Dellenborg and Malmström 2013). However, many whom their research concerned: the healthcare pro- anthropologists are indeed engaged in the struggles fessionals and their management. for improved life conditions and social justice among the people in their fi eld (see, e.g., Cowan et al. 2001 and Kulick and Rydström 2015; see also Denzin The Project 2003 and Goldstein 2008 already mentioned above). Medical anthropologists have been important actors Description of The Forum Project for research on fi nding culturally accepted ways to The action research project that developed from the improve health in poorer parts of the world (Kiefer hospital ward management leaders’ invitation to 2006). International development aid organisations the research group to support them in improving have an expressed interest in anthropology, with its communication in the ward was named The Forum thorough understanding of the milieus and the con- Project. The development of ethnographic drama texts of the implementation projects that it may off er. in this project thus started within an ongoing eth- However, knowledge about the fi ner aspects of nographic research project that was a collaboration social life and its complexity requires time to acquire, between health care professionals on a medical ward time that development experts seldom seem to have. in a hospital in Sweden and a research group from Att empts at synthesis have been made in the form of a Swedish university. The project’s intention was KAP (knowledge, att itudes, practices), RRA (rapid ru- to create a forum for refl ection and change for bet- ral appraisal) and PRA (participatory rural appraisal). ter communication in the ward using ethnographic Yet these methods are problematic, as they bear ‘a re- fi eldwork and drama in the form of a forum-play. mote resemblance to anthropology but simplifi ed into The Forum Project comprised four action research a kit’ (de Sardan 2005: 210). A professor in anthropol- cycles: Cycle 1 in 2008, Cycles 2 and 3 in 2011, and ogy with a great deal of experience in development fi nally Cycle 4 in 2012. The activities of each cycle are work, Jean-Pierre Olivier de Sardan recommends described in Table 1.

Table 1. The Project’s Four PAR Cycles

Cycle 1 • Aim: To improve communication and understanding for transcultural healthcare encounters on the ward. • Activities: Inter-professional group discussions. • Participants: RNs, NAs and physicians. • Analysis: The complexity in healthcare encounters and the diversity represented by patients in terms of language spoken, cultural understandings, religious belonging, age and gender left the healthcare professionals confused as to what kind of knowledge they needed to increase their transcultural understanding and communication competence. It was clear that communication patt erns were infl u- encing patient encounters in general in a negative way. The results are described in a study by Dellen- borg and colleagues (2012). • Outcome: The researchers recommended that the ward’s management arrange for regular sessions to be held between staff and researchers with the aim of improving encounters in the ward through critical self-refl ection and elaborated discussions on the meaning of diversity and diff erence. It was decided to organise opportunities for staff to refl ect on these issues in the form of drama workshops.

4 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA

Cycle 2, step 1 • Aim: To improve communication between healthcare professionals and patients and their families. • Activities: Drama workshops – seven drama workshops of three hours each in groups of approxi- mately 12 participants. A total of 15 forum-plays were performed. • Participants: RNs and NAs. • Analysis: The staff strove to ‘do the right thing’ according to their values and competencies, but were hindered from doing this by stress, routines, language diffi culties, misunderstandings, poor commu- nication, and hierarchies related to the diff erent healthcare professions. • Outcome: The ward’s management and the researchers planned for professional group discussions on themes that had been produced in the forum-plays: inter-professional relations and communication; how to be fl exible in relation to routines; and how to make the patient’s voice heard and establish good relations with patients’ families.

Cycle 2, step 2 • Aim: To improve communication and relations with patients and their families on one hand, and within the staff group on the other. • Activities: Staff conference with inter-professional group discussions. • Participants: RNs, NAs and physicians. • Analysis: There was a need for more knowledge about and understanding of each other’s everyday work; time for refl ection within the team; suggestions for modifi cation of routines to meet patients’ needs and save healthcare professionals’ time; and the creation of structures improving the medical round for staff ’s and patients’ well-being and communication. • Outcome: A second series of drama workshops that would include physicians was arranged.

Cycle 3 • Aim: To improve inter-professional communication, healthcare encounters and teamwork. • Activities: Drama workshops. Five workshops of three hours each in groups of approximately 12 participants. In total, 11 forum-plays were performed. • Participants: RNs, NAs and physicians. Physicians participated in three out of fi ve workshops. No senior physicians participated. • Analysis. There is a need to improve inter-professional relations and teamwork. • Outcome: The researchers’ ethnographic knowledge of the ward indicated that the professional groups easily ended up in accusations and defensiveness while discussing team-related problems in inter- professional groups. The researchers therefore recommended that the ward’s management arrange for intra-professional group discussions on teamwork in a staff conference.

Cycle 4 • Aim: To refl ect on the aim of the healthcare team, the professionals’ view of their roles in the team, and obstacles to and possibilities for implementing these roles. • Activities: Intra-professional group discussions at a staff conference. • Participants: RNs, NAs and physicians (senior and junior physicians discussed in separate groups, as they had diff erent roles in the team and their relations were marked by hierarchy). • Analysis: The expressed aim of the team (‘to give patients the best care using all professions’ compe- tencies’) was diffi cult to fulfi l due to hierarchical order in the team and organisational factors. Nurses diff ered from physicians in their wish to see patients as part of the team. At the time of the study, patients were generally informed about, rather than made partners in, the creation of a care plan. • Outcome: As in every cycle, the ward’s management was given a writt en report from which they were to continue working to improve teamwork and healthcare encounters on the ward.

| 5 AiA | Lisen Dellenborg and Margaret Lepp

During Cycle 3, the problems that were encountered Context of the Project trying to get physicians to participate in the drama The context was a medical emergency ward at a uni- workshops were unfortunate for the project and the versity hospital in Sweden. The hospital had a catch- development of teamwork on the ward. The nurses’ ment area with over two hundred and fi ft y thousand management leader prioritised the drama work- residents. The healthcare professionals in the project shops as occasions for professional competence de- worked on the medical emergency ward, which was velopment for the nurses. The physicians, however, divided into an emergency care unit for the most were given no time by their management to par- critically ill and an intermediate care unit for patients ticipate in the drama workshops. The reason given who were in rehabilitation or whose condition had for this was the scarcity of physicians. The few who been diagnosed as not critical. However, due to or- managed to participate had to do so parallel to their ganisational changes in the clinic, old and very sick ordinary tasks. In one case, a physician was released patients – even those in need of palliative care – were at the last moment from their ordinary tasks aft er a cared for in the ward as well. call from the anthropologist (LD) to the physicians’ The ward environment was high-tech, and the management leader. We gather that the physicians’ treatment regimen off ered full supervision of the management was not negatively inclined towards patients and preparedness for emergency interven- the workshops, as they had made the decision to tion by the relevant personnel. At the time of this participate in the project workshops, but did not project, the ward had 36 beds. The average stay for consider them important enough to prioritise them. in-patients needing care was 4.4 days. The personnel Looking at this lack of physician participation in the consisted of 60 Registered Nurses (RNs), 40 nursing drama workshops in a wider context, we note that assistants (NAs) and 43 senior and junior physicians. physicians are generally known to be a professional A senior physician is a specialist. A junior physi- group that is diffi cult to engage in organisational cian, called a resident, might be a medical student work (Bååthe 2016). Yet their engagement is critical, practising to gain their licence 18 to 21 months aft er as they are in a powerful position to hinder improve- qualifying as a physician, a newly certifi ed physician ments in organisational work (Bååthe and Norbäck or a physician in specialist training. About 25% of 2013). This has been explained as partly being due the RNs and 60% of the physicians were men. The to physicians’ training and partly due to a traditional overwhelming majority of the RNs and NAs were lack of organisational and collective aspects of the women. The healthcare professionals worked in profession. Primarily, their training focuses on the teams consisting of two RNs and two NAs caring for development of clinical skills (Snell et al. 2011: 952). ten patients together with a senior physician and a Physicians have been trained to think of change in junior doctor . relation to individual patients, medicine and treat- ment, and not in relation to the wider organisation. A fact strengthening this focus is that biomedicine is Methods and Methodology a science and that its epistemology is focused on ‘the solitary body of the individual sick person’, which Participatory Action Research creates diffi culties when advancing the important ef- The project was carried out as participatory action fect of social relations on illness (Kleinman 1995: 37) research (PAR), which meant that problems were and also, we add, in the clinic. Accordingly, it is rare defi ned and solutions sought out by collaboration that physicians’ management supports them in their between the researchers and the healthcare profes- eff orts to take part in work for organisational change sionals. The aims of this research were to improve (Bååthe 2016). In our project, this circumstance was practice and study the eff ects of the actions taken. unfortunate, as physicians’ voices were not heard Action research has a long history and was fi rst de- and the opportunity for important inter-professional scribed by Kurt Lewin (1946: 202) as ‘comparative dialogue was lost. We could see that the lack of phy- research on conditions and eff ects of various forms sician participation in the drama workshops refl ected of social action and research leading to social action’. the ethical dilemmas and communication failures in PAR involves a spiral of cycles (planning – acting the ward as narrated and performed by the nurses in – observing – refl ecting – replanning), with criti- the drama workshops. cal refl ection being an important step in each cycle (Kemmis and McTaggart 2005). As the purpose of PAR is to contribute to change in a particular social

6 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA context, the combination of drama with ethnographic participants sitt ing in a circle and sharing presenta- methods and methodology is well suited. Our project tions and expectations; this was followed by warm- consists of four PAR cycles. up games that included participants sharing their names and life histories (in pairs) and improvising Ethnographic Fieldwork work scenes using role reversal. The warm-up games In parallel with the four PAR cycles, ethnographic were followed by the preparations for forum-plays. fi eldwork with participant observation was conducted In pairs, participants exchanged a story of confl ict on the ward by the fi rst author, LD. The purpose from their everyday work on the ward. In groups of of the fi eldwork was to understand the healthcare three to fi ve, the participants were then given 30–45 environment from the perspective of the healthcare minutes to prepare a scenario for a forum-play. Each professionals – physicians, RNs, and NAs – and the workshop entailed two, or at most three, forum- patients. Participant observation was also conducted plays. Staff members were given opportunities to in- during the drama workshops by three anthropolo- tervene actively in each of the plays performed (Lepp gists in the research group (LD, KN [Dr Kristina and Dellenborg 2013). Nässén] and CS [Dr Carola Skott ]), the last two also having professional experience as RNs. The methodology of the ethnographic approach Ethical Considerations includes refl exivity, description, comparison and interpretation, an inner perspective, and a relativ- Permission to conduct the study was obtained from istic stance (Scott -Jones and Watt 2010; Skott 2013). the Regional Ethical Review Board in Gothenburg, Refl exivity implies a demand on the researchers to Sweden (046-08). The investigation conforms to the be aware of their own pre-understandings as well principles outlined in the Declaration of Helsinki as positionality, including sex and gender identity, developed by the World Medical Association. Con- age, socio-economic class and ethnicity, lest the cerning participant observation during the drama researchers risk reproducing their own understand- workshops, the participants were informed orally ing of the phenomenon. Awareness of positionality that participation was voluntary, that an ethnogra- proved critical, as the fi rst author needed to draw pher would be taking fi eld notes during the work- on diff erent aspects of her identity in order to build shops to be used for scientifi c articles and that their confi dence with the various healthcare professional identities would be protected. On the ward, the staff groups in the project: the physicians, the RNs and the and the patients received writt en and oral informa- NAs (Dellenborg 2013). tion about the fi eld study on numerous occasions in Being the fi eldworker, LD was in charge of pre- an att empt to reach them all. Being aware of the ethi- senting research fi ndings, leading group activities cal sensitivity that accompanies observational studies at the healthcare staff conferences and ensuring the in hospital wards, at the slightest apprehension that a transparency of the research process. Important for staff member or patient might feel uneasy about her the action research process as well as the develop- presence LD changed for another unit in the ward. ment of ethnographic drama was that the research At the time of the drama workshops, the participants group (LD, ML, KN, CS) carried out all analyses col- were familiar with LD. Although some expressed an lectively, which resulted in group ethnography as de- uneasiness about drama, no one expressed any ap- scribed by Gemzöe (2004) and documented by Skott prehension about being observed by the researcher. and colleagues (2013).

The Drama Workshop Findings and Refl ections The particular form of drama workshop used in this project built on earlier research in the fi eld of drama The idea of drama workshops was a result of the ac- and confl ict management (Burton et al. 2015). The tivities in Cycle 1. In Cycles 2, 3 and 4, the profession- drama workshop was conducted in a classroom in als were given the opportunity to refl ect back and the hospital, which was cleared of tables, an open forth together with the researchers in drama work- space that provided room for movement and per- shops and professional group discussions. Through formance. Each workshop lasted for three hours and fi eldwork (carried out during Cycles 2, 3 and 4) and was facilitated by ML (an authorised drama teacher, other activities with the healthcare professionals, the RN and researcher). Each workshop started with the researchers acquired rich ethnographic knowledge of

| 7 AiA | Lisen Dellenborg and Margaret Lepp

the ward. This knowledge was central for the devel- These forum-plays also illustrated challenging opment of ethnographic drama. situations related to routines. These situations did not instantaneously point to failing professional The Development of Ethnographic Drama communication. Yet, in the process of staff refl ection The development of ethnographic drama is described it became clear that communication had failed within and presented through the process of: and between teams on the ward. These forum-plays made the participants refl ect on how failed commu- (1) Combining ethnography and drama; nication between professionals may harm patients (2) Using the forum-play as an example; and on how they may actually exert power over (3) Describing the healthcare professionals’ inter- patients when sticking unrefl ectively to routines. pretative process; The interactions and discussions generally went from (4) Describing the researchers’ interpretative pro- accusing counterparts to searching for alternative ac- cess; and tions and, at best, to refl ecting on the problems and (5) Formulating ethnographic drama. coming to an understanding of the complexity of the situations and achieving insight into their own roles (1) Combining Ethnography and Drama in the confl icts. Progressively during the last three cycles of the This is where a forum-play generally ends when Forum Project, the research group discovered that led by drama teachers alone. The co-operation with the combination of drama and ethnography was anthropologists and the combination with ethnog- particularly creative way to produce new knowledge raphy gave the researchers an opportunity to un- about the healthcare context and to support health- derstand the forum-plays in the wider context of care professionals in improving their communica- the hospital environment. This, in turn, gave the tion with patients and each other. Carrying out researchers the means to support the management participant observation at the drama workshops gave and staff bett er in improving communication and researchers the opportunity to share and listen to the co-operation on the ward. We shall now describe participants’ own narratives concerning what was how the combination of ethnography and the forum- important for them in their everyday work. play was developed into ethnographic drama. We Problematic and confl icted situations in encoun- shall also describe the particular kind of knowledge ters between healthcare professionals and patients gained from this combination. and their families were signifi cant, which was ex- pected from the inter-professional group discus- (2) Using the Forum-Play as an Example sions held in Cycle 1. However, as many as half of In order to describe the development of and the the forum-plays concerned communication failures knowledge gained from ethnographic drama, we and confl icts between professionals and also confl icts shall use one forum-play as an example. The forum- related to routines. In fact, confl icting professional play concerned an elderly, severely ill patient and his relations were put forward by participants as a major visiting elderly wife. The ethical dilemma was that a hindrance in their everyday work. This circumstance young nurse, Karin, found herself prohibited by Eva, drew the researchers’ att ention to the need of work- a nursing colleague, from doing what she thought ing on inter-professional relations. would be best for the patient and his wife: Common themes in the forum-plays on confl icting A registered nurse, Karin, 25 years old, comes into inter-professional relations were mutual expecta- a single patient room where the severely ill patient tions that were not fulfi lled or not expressed within Kurt is lying in his bed. Kurt is 87 years old and in a the team, confl icts that were not communicated, palliative phase and very anxious. His wife Ada, 87 discussed or even acknowledged by counterparts. years old, is sad and asks Karin if someone can stay Although there were examples of failed co-operation with them in the room for a while to calm Kurt. The in relations between all professional groups, the RNs registered nurse goes to ask her colleague, Eva, 45 and NAs specifi cally raised experiences of failed years old, who has worked on the ward for a long communication and co-operation with physicians. time, for advice. The answer she gets is that there is The RNs voiced the dilemma of having litt le author- no nurse who can sit with them and that ‘we don’t ity in relation to physicians and yet much responsi- pursue that form of care here’. (Workshop 1, forum- play no. 2, Cycle 2) bility in relation to the patients and their families; in various ways, they expressed feeling pinioned by As stated above, in the forum-play the audience physicians. members intervene in the play with suggestions of

8 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA alternative ways to manage the situation so as to the ward’. In the silence that followed, the others fi nd constructive solutions together. The play was slowly nodded their heads in agreement. run again and now, as the fl oor was opened for the audience members to intervene, several voices in the (3) Describing the Healthcare Professionals’ audience protested loudly when Karin was hindered Interpretative Process by Eva from solving the situation by searching for At fi rst glance, the professionals interpreted the prob- a nurse to support the elderly couple with some lem as being about the status of the two RNs and who company: ‘We can’t leave the patient, can we?’ ‘We had the right to decide what form of care the patient should call for support from another nurse to come should get. The audience then refl ected on various and stay with the couple!’ aspects of power relations that coincided in the play: A nurse in the audience went on scene and took the the length of time that these nurses had worked on role of Karin. She tried to change the scenario by call- the ward and the age diff erence between them. In the ing Eva back into the patient room, and she tried to initial narrative, the younger nurse did not dare to convince her to let a nurse stay with the couple. Eva contradict the older nurse, who was forthright about still did not agree and instead proposed morphine her view of how things were done on the ward: ‘We for the patient. Her proposal induced much ten- don’t pursue that form of care here’, meaning that the sion in the group. ‘Why would you give the patient ward did not undertake palliative care. She thereby morphine?’ someone in the audience asked Eva in an claimed the privilege of interpretation. With her indignant tone, supported by others’ humming. The body language, Karin, the younger nurse, dramatised person who played Eva answered that she intended the hesitation that she felt in this situation, being to reduce the patient’s anxiety. The audience was not hindered from doing what she thought was best for relieved by this answer and heavily criticised her the patient and the couple; she was silent, as though suggestion to give morphine as an alternative. They frozen by the shock of her colleague’s words. She did suggested that Eva might have responded diff erently not go into the patient’s room to deliver this answer. had Karin not been a newly registered and newly The audience later confi rmed that it is diffi cult to employed young nurse. The participants reasoned introduce new ideas on the ward. They refl ected on that it was diffi cult to make way for new thinking on the power relations between healthcare professionals the ward. The drama leader asked Karin what she and patients and their families, and that the latt er felt about being new on the ward. Karin, in charac- are dependent on the professionals. Together, the ter, pondered on the diffi culty of acting without the audience and the nurse acting as Karin suggested support of experienced colleagues, which in this case a practical solution: to ask staff in other parts of the was deciding to fi nd a nurse to support the couple. ward for help. Karin, in character, tried this and came The play continued, and Karin now tried to act back with an extra nurse, who was able to keep the on her own and so to speak go behind the back of elderly couple company for a while. They were con- her colleague. She asked the staff in the other part tent with having found an alternative way to handle of the ward for help, and thus managed to solve the an ethically diffi cult situation, a way that seems to situation. Eva, in character, stood silently and did not have suited everyone. However, as the discussion react negatively to Karin’s action. A voice in the audi- continued they detected that the forum-play, rather ence remarked with approval: ‘The most experienced than being just about the status of two nurses, actu- person does not always know best!’ This remark was ally concerned the wider issue of biomedicine contra followed by relieved laughter in the audience. The care-giving on the ward. They considered the ‘nar- drama leader then asked the ‘actors’ how they had row medical thinking’ on the ward and the strong felt taking on the diff erent roles. The one who had medical orientation of their practice. They were played Ada said cautiously that she had just wanted discontent with the fact that medicine had priority help for her husband and herself. The one who had over care-giving. Upon refl ection, they saw that the played Kurt said: ‘I got more worried and uneasy … forum-play illustrated this precedence as being at the [as the nurses disputed with each other]’. The partici- expense of a holistic understanding of the patient as a pants were all concerned about this situation and up- person with more than just medical needs. set by the narrative. Collectively, they wondered how a colleague would even consider leaving two elderly (4) Describing the Researchers’ Interpretative persons in need alone in the room. However, in the Process round of refl ections one of the participants thought- Interpreting the forum-play in relation to the knowl- fully observed: ‘We are very medically oriented on edge gained from fi eldwork on the ward, the re-

| 9 AiA | Lisen Dellenborg and Margaret Lepp

searchers were able to see that the play about Karin interests. These situations oft en led to moral stress and Eva and the couple was characteristic for that (Wolf et al. 2012). There were also stories of individ- particular healthcare environment and did not just ual care-givers striving to fi nd ethical solutions, as illustrate a single exceptional event. The participants’ Karin fi nally did in the forum-play. In so doing, they process of refl ection resulted in an understanding had to challenge the care environment and organisa- of Eva’s actions, an important insight that was not tional prioritisations (Dellenborg 2013). spoken aloud and did not imply acceptance, but Signifi cant for this play was that it was not until the one that helped them to make sense of her behaviour, nurses had become engaged on various levels, most as illustrated by the comment: ‘We are very medi- importantly on an emotional level, and had made this cally oriented at the ward’. Throughout the main narrative into an embodied experience that they were part of the play, Eva was criticised heavily for acting able to recognise the impact of structures on their ac- strangely. However, towards the end of the play the tions and not simply blame the individual nurse Eva. care-givers gradually shift ed their focus from Eva as In this healthcare environment, there was a strong an odd individual ‘wrong-doer’ towards self-critical tendency to blame individual care-givers rather than refl ection concerning the strong medical orientation to see how organisational and structural factors re- on the ward. The use and form of the forum-play sult in confl ict on the ward, such as the prioritisation became a catalyst for issues that needed to be raised of biomedical knowledge and the organisation of but that would normally be avoided, such as the risk routines and working schedules (Dellenborg 2013; of routines taking precedence over patients’ needs. Wolf et al. 2012). The predominant goal of the Forum In the process, existing hierarchies in the ward were Project was precisely to support management and made visible. The participants gained insight into the healthcare professionals in their understanding the impact that structures might have on their own of the lack of communication and the relational con- actions in everyday encounters, actions counteract- fl icts in this wider sociocultural context. ing patients’ as well as professionals’ well-being on the ward. (5) Formulating Ethnographic Drama Participant observation on the ward confi rms The researchers found that the forum-play combined this picture; there was a strong focus on biomedical with ethnography gave them unexpected possi- knowledge and routines as described in the lengthy bilities to learn about the unspoken and embodied block quotation from Wolf and colleagues presented aspects of life on the ward, the aspects that are dif- at the beginning of this article. Signifi cantly, these fi cult to put into words and those that are taken for perspectives took precedence in multi-professional granted (Bourdieu 1977). The use of the forum-play dialogue and left litt le room for other perspectives, makes it clear that the drama leader’s, the ethnog- such as care-giving perspectives and the patient’s raphers’ and the participants’ pre-understandings perspective (Wolf et al. 2012). Since the geriatric were challenged and transformed. Through bodily ward in the hospital had been closed, most of the acting in the forum-play, the participants co-created emergency ward’s patients were (and still are to this a common narrative ‘as if’ the situation were real and day) old and very ill, and some indeed palliative. happening again – and at the same time diff erent However, neither the care, the number of care-givers from the original event because all participants con- nor the physical milieu were in any way organised so tributed with their experiences and interpretations. as to enable care-givers to support patients in need of The forum-play provides a unique opportunity to palliative care. turn personal experiences into cultural narratives. Understood in this context, Eva’s statement that The interveners improvised according to their expe- palliative care was not pursued on the ward and her riences of the ward and together created a situation suggestion to give morphine rather than to support that they could all recognise as ‘their ward’. In the the couple with her presence do not appear that odd. project, the ethnographic knowledge produced was The character Karin’s experience of not being able to broadened by every forum-play. The drama leader act according to her values about good care was an and the anthropologists thus became increasingly experience described by many RNs in informal con- skilful in contextualising the participants’ narratives versations, interviews and forum-plays. The fi eld- and thereby in supporting them to learn to see their working anthropologist heard many stories about own actions as producing and reproducing the socio- restricted choice due to structures in the ward and cultural structures on the ward. This insight enabled challenges that the RNs met in the contest between them to act diff erently and thereby, taking small medicine and care, routines and the patient’s best steps, actually to contribute to change.

10 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA

Turner (1982: 94) underscored that ‘there must be In this way, drama is enriched by the ethnographic a dialectic between performing and learning. One practices of fi eldwork and participant observation learns through performing, then performs the un- and the possibility to interpret the drama in a wider derstanding so gained’. This quotation explains how context. Likewise, ethnography is enriched by drama forum-play and drama are eff ective in the learning and forum-play as the participants enact dilemmas of alternative ways of acting. Through their engage- ‘as if’ they were happening again. Combining drama ment in the play, the participants were touched and and ethnography into ethnographic drama thus cre- moved, and thus gained a unique opportunity for ates opportunities for learning in both research and learning. In Goldstein’s study (2008), the participants’ healthcare practice. active participation in the performance and the fol- lowing discussion triggered their critical analysis, which potentially led to change. In ethnographic Acknowledgements drama, as constructed by our research group, it is es- sential that the participants involved are those who We wish to thank the hospital and the ward man- enact the play, but it is also important that the narra- agement leaders and the healthcare professionals tives enacted represent the participants’ own experi- on the emergency ward for the opportunity to work ences. By acting out their narratives, the diffi culties, together in this action research project. We also wish problems, communication failures and dilemmas to thank The Swedish Institute for Health Sciences experienced by the healthcare professionals in their [Vårdalinstitutet] at Lund University, the University daily work thus became concretised. Through ethno- of Gothenburg, and the Institute for Health and Care graphic drama research and supervision, a process Sciences, University of Gothenburg, which, at the emerged that enabled the participants to gain new time of this project, collaboratively granted the fi rst understanding. They learnt how to communicate author a position as a research assistant. This made and act in bett er ways, so that usually confl icted situ- the long-term ethnographic fi eldwork on the ward ations could be transformed into decent healthcare possible. Warm thanks are owed to our research team encounters with patients and their families on one colleagues, Dr Carola Skott and Dr Kristina Nässén. hand and professionals on the other.

Conclusion LISEN DELLENBORG holds a doctorate in social anthro- pology and is employed as a university lecturer and Ethnography and drama combined in the form of researcher at the Institute of Health and Care Sci- a forum-play is what we call ethnographic drama. ences at the Sahlgrenska Academy, University of Go- Ethnographic drama turned out to be well suited to thenburg, Sweden. She has extensive experience with illuminating, addressing and studying relations in ethnographic research, having worked in Senegal healthcare within and between professional groups on female genital cutt ing and in Sweden where she and also between professionals and patients and is currently engaged in hospital ethnography. Her their families. The method is particularly appropriate areas of expertise are hospital ethnography; inter- for research on and the support of healthcare profes- professional communication and relations within the sionals in their everyday work, in which confl icts Swedish healthcare system; female gential cutt ing; turned out to be signifi cant for inter-professional re- gender; sexuality; ethnicity and religion. lations and for the care that was being given. Forum- E-mail: [email protected] play as one of the method’s two cornerstones is thus particularly apt for helping healthcare professionals MARGRET LEPP is a registered nurse (RN), a doctor of improve inter-professional relations, co-operation philosophy and a professor at the Institute of Health and quality of care. The method contributes knowl- and Care Sciences at the Sahlgrenska Academy, Uni- edge about the specifi c context and the participants’ versity of Gothenburg, Sweden, with a focus on caring perspectives when acting as patients, relatives and pedagogy. She is also an adjunct professor at Griffi th healthcare professionals. Distinctive for this version University, South East Queensland, Australia. Her of ethnographic drama is that it is based on the par- areas of research include students’ and healthcare ticipants’ own experiences and narratives, and not on professionals’ learning; educational drama; interna- the ethnographers’ interpretations of the same, as is tionalisation and confl ict management. otherwise typical. E-mail: [email protected]

| 11 AiA | Lisen Dellenborg and Margaret Lepp

References D’Andrade, R. (1995), ‘Moral Models in Anthropol- ogy’, Current Anthropology 36, no. 3: 399–408. Abu-Lughod, L. (1991), ‘Writing Against Culture’, in Dellenborg, L. (2004), ‘A Refl ection on the Cultural R. G. Fox (ed.), Recapturing Anthropology – Working Meanings of Female Circumcision: Experiences in the Present (Santa Fe, NM: School of American from Fieldwork in Casamance, Southern Senegal’, in Research Press). S. Arnfred (ed.), Rethinking Sexualities in Africa (Up- Alvesson, M. and S. Sveningsson (2008), Organizational psala, Sweden: The Nordic Africa Institute), 79–96. Culture: Cultural Change Work in Progress (London: Dellenborg, L. (2007), ‘The Multiple Meanings of Fe- Routledge). male Initiation: “Circumcision” among Jola Women Appelgren, S. (2007), ‘Huis Ten Bosch: Mimesis and in Lower Casamance, Senegal (PhD Diss., Univer- simulation in a Japanese Dutch Town’ (PhD diss., sity of Gothenburg, Sweden). University of Gothenburg, Sweden). Dellenborg, L. (2013), ‘Fältarbetets betydelse och Arveklev, S. H. (2017), ‘Drama and Learning in Nurs- villkor’ [Fieldwork: Meaning and Circumstances], ing Education: A Study in First and Second Cycle’ in C. Skott , L. Dellenborg, M. Lepp and K. Nässén (PhD Diss., University of Gothenburg, Sweden). (eds.), Människan i vården: Etnografi , vård och drama Arveklev, S. H., H. Wigert, L. Berg, B. Burton and [The Person in Healthcare: Ethnography, Care and M. Lepp (2015), ‘The Use and Application of Drama Drama] (Stockholm: Carlssons). in Nursing Education – An Integrative Review Dellenborg, L., C. Skott and E. Jakobsson (2012), of the Literature’, Nurse Education Today 35, no. 7: ‘Transcultural Encounters in a Medical Ward in 12–17. Sweden: Experiences of Health Care Practitioners’, Bååthe, F. (2016), ‘Physicians’ Engagement: Qualitative Journal of Transcultural Nursing 23, no. 4: 342–350. Studies Exploring Physicians’ Experiences of Engag- Dellenborg, L. and M. Malmström (2013). ‘Att äga sin ing in Improving Clinical Services and Processes’ förändring: Kvinnlig omskärelse/könsstympning (PhD Diss., University of Gothenburg, Sweden). och mänskliga rätt igheter’ [To Own the Processes Bååthe, F. and L. E. Norbäck (2013), ‘Engaging Physi- of Change: Female Circumcision / Female Genital cians in Organisational Improvement Work’, Journal Mutilation and Human Rights] in P. de los Reyes, of Health Organisation and Management 27, no. 4: M. Eduards and F. Sundevall (eds.), Internationella 479–497. relationer: könskritiska perspektiv [International Bagshaw, D., B. Burton, M. Friberg, A. Grünbaum, Relations: Gender-Critical Perspectives] (Stockholm: M. Lepp, J. O’Toole and J. Pillai (2007), Bridging the Liber), 218–234. Fields of Drama and Confl ict Management in DRACON Denzin, N. K. (2003), Performance Ethnography: Critical International, Empowering Students to Handle Confl icts Pedagogy and the Politics of Culture (Thousand Oaks, through School-Based Programmes (Studia Psycho- CA: SAGE). logica et Paedagogica, Series Altera CLXX) (Malmö: de Sardan, J.-P. O. (2005), Anthropology and Development, Malmö University Electronic Publishing). htt p:// (trans.) A. Tidjani Alou (London: Zed Books). dspace.mah.se/bitstream/2043/5975/1/drac06nov.pdf. de Wit F. R., C. Lindred, L. Greer and K. A. Jehn. Belliveau, G. and V. White (2010), ‘Performer and (2012), ‘The Paradox of Intragroup Confl ict: A Meta- Audience Responses to Ethnotheatre: Exploring Analysis’, Journal of Applied Psychology 97, no. 2: Confl ict and Social Justice’ Arts Praxis 2. htt ps:// 360–390. steinhardt.nyu.edu/music/research/artspraxis/2. Edgerton, R. B. (1992), Sick Societies: Challenging the Boal, A. (1992), Games for Actors and Non-Actors (Lon- Myth of Primitive Harmony (New York: The Free don: Routledge). Press). Borneman, J. and A. Hammoudi (eds.) (2009), Being Garsten, C. and A. Nyqvist (eds.) (2013), Organisational There: The Fieldwork Encounter and the Making of Truth Anthropology: Doing Ethnography in and among Com- (Berkeley: University of California Press). plex Organisations (London: Pluto Press). Bourdieu, P. (1977), Outline of a Theory of Practice (Cam- Geertz, C. (1973), The Interpretation of Culture (New bridge: Cambridge University Press). York: Basic Books). Burton, B., M. Lepp, M. Morrison and J. O’Toole (2015), Geertz, C. (1984), ‘Anti Anti-Relativism’, American An- Acting to Manage Confl ict and Bullying: Eff ective Evi- thropologist 86, no. 2: 263–278. dence-Based Strategies (London: Springer). Gemzöe, L. (2004), Nutida etnografi : refl ektioner från me- Cowan, J. K., M. B. Dembour and R. A. Wilson (eds.) diekonsumtionens fält [Contemporary Ethnography: (2001), Culture and Rights: Anthropological Perspectives Refl ections from the Field of Media Consumption] (Cambridge: Cambridge University Press). (Nora, Sweden: Nya Doxa).

12 | The Development of Ethnographc Drama to Support Healthcare Professionals | AiA

Goldstein, T. (2008), ‘Performed Ethnography: Pos- grafi , vård och drama [The Person in Healthcare: Eth- sibilities, Multiple Commitments and the Pursuit of nography, Care and Drama] (Stockholm: Carlssons). Rigor’, in K. Gallagher (ed.), The Methodological Di- Lewin, K. (1946), ‘Action Research and Minority Prob- lemma: Creative, Critical and Collaborative Approaches lems’, Journal of Social Issues 2, no. 4: 34–46. to Qualitative Research (New York: Routledge), Long, D., C. L. Hunter and S. van der Geest (2008), 85–120. ‘When the Field Is a Ward or a Clinic: Hospital Eth- Goldstein, T. (2010), ‘Snakes and Ladders: A Performed nography’, Anthropology & Medicine 15, no. 2: 71–78. Ethnography’, International Journal of Critical Peda- Lundén, M., I. Lundgren, M. Morrison-Helme and gogy 3, no. 1: 68–113. M. Lepp (2017), ‘Professional Development for Gordon, D. (1991), ‘Female Circumcision and Genital Radiographers and Postgraduate Nurses in Ra- Operations in Egypt and the Sudan: A Dilemma diological Interventions: Building Teamwork and for Medical Anthropology’, Medical Anthropological Collaboration through Drama’, Radiography: Inter- Quarterly 5, no. 1: 3–14. national Journal of Diagnostic Imaging and Radiation Gren, N. (2009), ‘Each Day Another Disaster: Politics Therapy 23, no. 4: 330–336. and Everyday Life in a Palestinian Refugee Camp McCalman, J. and D. Pott er (2015), Leading Cultural in the West Bank’ (PhD diss., University of Gothen- Change: The Theory and Practice of Successful Organiza- burg, Sweden). tional Transformation (London: Kogan Page Limited). Hammersley, M. (2017), ‘What Is Ethnography? Can It Messerschmidt, D. A. (ed.) (1981), Anthropologists at Survive? Should It?’ Ethnography and Education 13, Home in North America: Methods and Issues in the no. 1: 1–17. Study of One’s Own Society (Cambridge: Cambridge Harrop, P. and D. Njaradi (eds.) (2013), Performance and University Press). Ethnography: Dance, Drama, Music (Newcastle upon Mienczakowski, J. (2001), ‘Ethnodrama: Performed Tyne, UK: Cambridge Scholars Publishing). Research – Limitations and Potential’, in P. Atkinson Hastrup, K. (2017), ‘Collaborative Moments: Expand- (ed.), Handbook of Ethnography (London: SAGE). ing the Anthropological Field through Cross-Disci- Morrison, M., E. Nilsson and M. Lepp (2013), ‘Bringing plinary Practice’, Ethnos 83, no. 2: 316–334. the Personal to the Professional: Pre-Service Teach- Kemmis, S. and R. McTaggart (2005), ‘Participatory ing Students Explore Confl ict through an Applied Action Research’, in N. K. Denzin and Y. S. Lincoln Drama Approach’, Applied Theatre Research 1, no. 1: (eds.), The SAGE Handbook of Qualitative Research 63–76. (Thousand Oaks, CA: SAGE), 559–604. Nässén, K. (2013), ‘Deltagande observation’ [Partici- Kiefer, C. W. (2006). Doing Health Anthropology: Research pant Observation], in C. Skott , L. Dellenborg, Methods for Health Scientists. (New York: Springer). M. Lepp and K. Nässén (eds.), Människan i vården: Kim, S., E. Butt rick, I. Bohannon, R. Fehr, E. Frans and Etnografi , vård och drama [The Person in Health- S. Shannon. (2016), ‘Confl ict Narratives from the care: Ethnography, Care and Drama] (Stockholm: Health Care Frontline: A Conceptual Model’, Con- Carlssons). fl ict Resolution Quarterly 33, no. 3: 255–277. Rapport, N. (2009), Of Orderlies and Men: Hospital Por- Kleinman, A. (1995), Writing at the Margin: Discourse ters Achieving Wellness at Work (Durham, NC: Caro- between Anthropology and Medicine (Berkeley: Univer- lina Academic Press). sity of California Press). Rice, T. (2003), ‘Soundselves: An Acoustemology of Kolb, D. A. (1984), Experiential Learning: Experience as Sound and Self in the Edinburgh Royal Infi rmary’, the Source of Learning and Development (Englewood Anthropology Today 19, no. 4: 4–9. Cliff s, NJ: Prentice-Hall). Roper, J. M. and J. Shapira (2000), Ethnography in Nurs- Kulick, D. and J. Rydström (2015), Loneliness and its ing Research (Thousand Oaks, CA: SAGE). Opposite: Sex, Disability, and the Ethics of Engagement Rosaldo, R. (2000). On Headhunters and Soldiers. (Durham: Duke University Press). Separating Cultural and Ethical Relativism. Issues in Landzelius, K. (2006), Going Native on the Net: Indig- Ethics 11(1): 2-6. enous Cyberactivism and Virtual Diasporas over the Saldaña, J. (2008), ‘Ethnodrama and Ethnotheatre’, in World Wide Web (London: Routledge). J. G. Knowles and A. L. Cole (eds.), Handbook of the Lepp, M., and Dellenborg, L. (2013). Workshop med Arts in Qualitative Research: Perspectives, Method- forumspel – framväxten av etnografi skt drama. ologies, Examples, and Issues (Los Angeles: SAGE), [Workshop with Forum-Play – the Development of 195–207. Ethnographic Drama], in C. Skott , L. Dellenborg, M. Scott -Jones, J. and S. Watt (eds.) (2010), Ethnography in Lepp and K. Nässén (eds.), Människan i vården: Etno- Social Science Practice (London: Routledge).

| 13 AiA | Lisen Dellenborg and Margaret Lepp

Shestack, J. J. (2000), ‘The Philosophical Foundations of Street, A., and S. Coleman (2012), ‘Introduction: Real and Human Rights’, in J. Symonides (ed.), Human Rights: Imagined Spaces’, Space and Culture 15, no. 1: 4–17. Concepts and Standards (Aldershot, UK: UNESCO Turner, V. (1982), From Ritual to Theatre: The Human Publishing), 31–66. Seriousness of Play (New York: PAJ Publications). Skott , C. (2013), ‘Beskriva, tolka och förstå – etnogra- Turner, V. & Turner, E. (1982). Performing ethnogra- fi ns metodologi’ [Description, Interpretation and phy. The Drama Review 26(2):33-50. Turner, V. (1986). Understanding – The Methodology of Ethnogra- The Anthropology of Performance. (New York: PAJ phy], in C. Skott , L. Dellenborg, M. Lepp and K. Publications). Nässén (eds.), Människan i vården: Etnografi , vård och Turner, V. and E. M. Bruner (eds.) (1986), The Anthro- drama [The Person in Healthcare. Ethnography, Care pology of Experience (Urbana: University of Illinois and Drama] (Stockholm: Carlssons). Press). Skott , C., L. Dellenborg, M. Lepp and K. Nässén van der Geest, S. and K. Finkler (2004), ‘Hospital Eth- (2013), Människan i vården: Etnografi , vård och drama nography: Introduction’, Social Science and Medicine [The Person in Healthcare. Ethnography, Care and 59, no. 10: 1995–2001. Drama] (Stockholm: Carlssons). Wolf, A., I. Ekman and L. Dellenborg (2012), ‘Everyday Snell, A. J., D. Briscoe and G. Dickson (2011), ‘From Practices at the Medical Ward: A 16-Month Ethno- the Inside Out: The Engagement of Physicians as graphic Field Study’, BMC Health Services Research Leaders in Health Care Sett ings’, Qualitative Health 12, no. 184: 1–12. Research 21, no. 7: 952–967. Zaman, S. (2008), ‘Native among the Natives: Physi- Strathern, M. (1987), ‘An Awkward Relationship: The cian Anthropologist Doing Hospital Ethnography at Case of Feminism and Anthropology’, Signs 12, no. Home’, Journal of Contemporary Ethnography 37, no. 2: 276–292. 2: 135–154.

14 |