Body Boundaries and Discursive Practices in Life Threatening Illness: Narratives of the Self

Abstract

This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. The idea of harmonising nursing practice in the patient's local world through contingent and thinking responses, and the recognition of one's own agency as the nurse, are considered in terms of what might constitute ethical practice. The thinking nurse is a specific intellectual, who critically engages with the context of her/his own practice to form new discourses derived from local and contextual 'truths' about illness, suffering and dying. The capacities for vision that are developed through the stories in the thesis, are explored as having the potential to present new possibilities for the practice of professional nursing. Notions of what constitutes ethical practice are negotiated and contested through local conversations, which privilege the capacities of the patient and the nurse in taking up new discursive positionings as alternatives to those prescribed through the sovereignty of expert power. In the local and contextual world of the patient, visions for practice may be negotiated moment by moment through careful exploration of discursive tensions and the critical appraisal of the utility of alternative possibilities. This development of local knowledge relies on the ability of the nurse to explore and trust her/his own judgement and nursing responses in situations where visions for practice may not be clear. The 'un-picking' and 're-sewing' of stories related in the analysis of the discursive production of the cancer patient and the 'private nurse' present new possibilities for the ethical substance of nursing. This ethical substance creates the potential for new conceptualisations of practice, where nurses and other health professionals take responsibility for the effects of their activities with patients. In this 'un-picking' of the stories in the thesis, I am concerned with the discursive positionings that are taken up by the patient and the health professional in the story. I identify the means through which subjects become visible in discursive statements and the effects of these subject positionings on specific moments of practice with the patient. The 're-sewing' of events involves the telling of alternative stories, negotiated between the actors in the events, to produce a more ethically desirable outcome in the specific contexts of nursing practice.