Floersch, J. (2004). "Ethnography:
A case study of invented
clinical knowledge," edited by Deborah K. Padgett, in
The Qualitative Research Experience. Pp. 76-96. Belmont, CA: Wadsworth/Thomson Learning.
A. Practice
Ethnography: A Case Study of Invented Clinical Knowledge
The use of ethnography to understand practice-in-action offers rich interdisciplinary
opportunities for occupational therapists, anthropologists, sociologists, nurses and social
workers. Wherever there is a practice relationship, there are opportunities to study helping in
everyday contexts. Within and among the various disciplines there are manifold understandings of
the principles and practices of ethnographic techniques, but there is general agreement on the
central features: ethnography is holistic, inductive, and naturalistic (Creswell 1994; Lincoln and
Guba 1985).
Tanya Luhrmann (2000), Deborah Connolly (2000), Norma Ware (1999), Michael Rowe (1999),
Elizabeth Townsend, (1998), David Wagner (1993), Geoffrey Skoll (1992), and Lorna Rhodes (1991)
have used ethnography to examine occupational therapists, social workers, drug abuse counselors,
psychiatric nurses, and psychiatrists. Gerald A.J. de Montigny (1995) studied child welfare
workers and used both oral and written narratives. Dorothy Smith (1987) offers specific
methods for institutional ethnography in the study of everyday life that if adapted, could be what
I am calling practice ethnography. Townsend (1998) and de Montigny (1995), for example, made
significant contributions using Smith's method.
In contrast to institutional ethnography, I propose practice ethnography. It does not focus on
the institutional or organizational determinants of practice, although these matter.
Instead, practice ethnography examines the process of practice and investigates how practitioners
use theory in practice. See, for example, Gubrium's (1992) comparative ethnographic
study of family therapy. The setting for this study was a suburban community mental health
center in the Midwest . The center served 400 clients and was fortunate to have abundant
state and local funds to provide the myriad case management, medication, housing, vocational, and
social support services that severe mental illness often requires. For nearly a year,
I followed and observed case managers who worked in five teams. The data for this chapter
are from a case study of a client and associated team. In
Meds, Money, and Manners, (Floersch, 2002) I provided an in-depth historical-sociological
and ethnographic analysis of the practice called strengths case management.
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