Safety Matters: The relations of safety in anaesthesia

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Copyright: Warner, Kerry
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Abstract
This thesis investigates the relations of safety in anaesthesia by examining how safety emerges in the course of everyday working practices. The purpose of this research is to describe the phenomenon of working safely in anaesthesia, its constitutive relations, and how anaesthetists’ repertoires of action both afford and address their concerns about what is safe and unsafe in everyday work. By drawing on practice theory and sociomateriality, this dissertation provides an original contribution to safety research by describing how the dynamic ordering of safety in anaesthesia arises from connections-in-action enacted in everyday practices. It challenges the paradigmatic systems approach to patient safety by highlighting matters excluded from it, namely working bodies (including human-nonhuman hybrids), spatiality, temporality, and affect. An ecological praxiography, attending to the specificities of situated action and receptive to post-qualitative inquiry, was employed to trace the connections-in-action formed as anaesthetists work safely. Empirical material was provided by anaesthetists’ stories collected in interviews and by Australian anaesthetic guidelines. This study has elicited how safety in anaesthesia is enacted within a fluid dynamic that remains open to change in ways that are flexible enough to sustain safety resiliently in everyday working life. Phenomenographic analysis has uncovered how safety in anaesthetic work is ordered by a schema of vigilance constituted by repertoires of action, which are labelled the logics of risk and care. Praxiographic analysis has revealed when the logics of risk and care reinforce each other, the relational dynamics of practice stabilise safety. When these logics are opposed in practice, safety is destabilised, and unsafety may instead emerge from the sociomaterial relations of practice. This thesis demonstrates how the logic of care is enacted in intersubjective relations and also performed by human and nonhuman relations configured within affective and spatial dimensions of practice. It advances praxiographic methodology by researching affect as a dimension of practice This research extends current understandings of patient safety beyond those centred on risk and error. It highlights the importance of how the logic of care enacts meaningful ways of working safely in anaesthesia. This is an innovative, nondualist and practice-based approach to studying patient safety.
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Author(s)
Warner, Kerry
Supervisor(s)
Healy, Stephen
Miller, David
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Publication Year
2018
Resource Type
Thesis
Degree Type
PhD Doctorate
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