Enfoque cognitivo

Instead of explanations that rely on ‘social ideas’, the third analytic consideration for ANT is its use of rich descriptions. While I knew the term rich description to originate in ethnography, it has a privileged place in ANT as a method reflective of modesty and openness. During my project, I challenged myself to write reflective memos that paid close attention to how labels, signs, notes, slides, posters, blueprints, charts, articles, white papers, policy briefs, and physiological objects—like fluid— provided descriptions of actor-networks. Following Latour (1996) and Mol (2002a), I looked at the ways these objects transferred knowledge and disseminated networks by way of interviews with patients, caregivers and health care providers.

I’m an HPE researcher, but Latour and Mol are anthropologists. ANT’s roots are in the ethnographic tradition characteristic of anthropology and the later ethnomethodological tradition of sociology. Ethnography was the approach used by the classic anthropologists who traveled to remote cultural communities in order understand other cultures and our own, for example, Margaret Mead’s canonical Coming of Age in Samoa (Mead, 1928). Ethnomethodology uses ethnographic methods, but instead of applying these methods in remote locations it applies them to ‘everyday’ settings. It describes the local practices of groups and organizations using a combination of interview methods and informal, incidental observations.

Ethnographic methods were not feasible for my study, despite the fact that in a perfect world I would have preferred to use them. My work took place within the context of a broader study

7.1. METHODOLOGICAL REFLECTIONS 125 using constructivist grounded theory. At the time of this research my position as a researcher was much different than an ethnographer. My research collaborators were well aware that ethnographic methods would not be appropriate in the spaces in which we conducted our work—primarily outpatient clinics and primary care clinics. My data, therefore, were primarily composed of interview transcripts as well as incidental observations that were written after each interview in the form of reflective memo.

This raises the question of whether interview transcripts can effectively document the actor-networks in which I was interested. I would argue that they can, because they were not simply text documents analyzed out of context. As I have described in Chapter 3, I was tasked with coordinating the larger study within which my work takes place. I was involved in planning the study, acquiring ethical approval from five research ethics boards across Canada, collaborating with our clinical stakeholders, presenting our study to the clinics where we were recruiting, and participating in grand rounds presentations. Most importantly, I went to heart function clinics, I met patients there, I met their companion caregivers, I interviewed patients in their homes, I observed the way they lived, I observed the structure of the clinics, I observed the material arrangements in patients’ homes. I debriefed with mentors and collaborators throughout the process, discussing the role and agency of fluid with various physicians before deciding it would be my focus. Therefore, I would argue that, like the other materials in my study, interviews are networks. They can be seen as translations in a chain of activities that compose the research process. They did not begin as text documents and they did not end there. Instead they represent artifacts of numerous activities in which I was directly engaged and where various materials influenced my study.

Notwithstanding this defense of interviews as a primary data source for my inquiry, I would endeavor to design this study to allow for ethnographic methods were I to do it again. My data collection took place in fascinating environments filled with human and nonhuman actor-networks. I would have liked to have the ability to not only observe health care providers at work but also patients as they engaged in fluid management techniques at home or at the

126 CHAPTER 7. DISCUSSION

clinic. Ethnographic research also affords the opportunity for researchers to conduct short, ad hoc interviews in real time. I would have used these to enquire about the agency of nonhumans and the network and material effects relating to the people I was observing. The collection and analysis of artifacts is another important factor that often plays a role in ethnography. I would have liked to use photography and document analysis to bring to light otherwise invisible aspects of the networks I was observing.

The primary methodology informing my work required recruiting patients and asking them to identify who they considered to be on their care teams (Lingard, McDougall, Schulz, et al., 2013). During interview analysis I endeavored to compose rich descriptions that depicted the ways my participants traced their care networks. And while ethnographic methods could have added important dimensions to the study, I believe that my interviews allowed me to explore in useful ways how these actors define the actors within a given network and their relationship to one another.