An interview with Klaartje Klaver about her PhD thesis Dynamics of Attentiveness (2016)
In January during an interview with Tessa Smorenburg, Klaartje Klaver discussed her PhD research Dynamics of Attentiveness (2016). Klaartje spoke about attentiveness in care practices at a Dutch oncology ward, she asserted that attentiveness is political, and explained the value of her study in her present practice.
Attentiveness, an optional extra?
The research of Klaartje Klaver was part of a strategic program called Professional Loving Care. This program was a collaboration between the research group of Ethics of Care of Tilburg University and the St. Elisabeth Hospital in Tilburg(NL). The program Professional Loving Care ran from 2009 to 2014 and aimed to discover, define and to study Professional Loving Care in a general hospital. The program was named after a book by the Dutch care ethicist Annelies van Heijst (2011). Klaartje Klaver was a member of the Research Group Care and Contested Coherence. Klaver presented her PhD thesis Dynamics of Attentiveness- in care practices at a Dutch oncology Ward in 2016. Earlier we published on this website an article, similar to this subject, by Professor Frans Vosman The moral relevance of lived experience in complex hospital practices (2018). Attentiveness is an important concept in the Ethics of Care, but the meaning of it in daily practice is unknown. Attentiveness is mostly seen as a romantic value; an optional extra to good care. “Theoretically there are different opinions about the meaning of attentiveness. During my research I heard various reactions from care professionals of different disciplines on the subject”, Klaver says. “For example: ‘Attentiveness means more hands at the bedside!’ Or ‘It is the most important part of the job’ or ‘Yeah sure, but we have to deal with cutbacks’.”
The practice of attentiveness
Being educated as an anthropologist, Klaartje Klaver used ethnographic research methods. She took part in the practices of the nurses and doctors in their contact with patients; she observed the talk in the hallway between doctors and connected with care professionals biking home after a day of work in the hospital. Daily Klaver documented her experiences, feelings and observations in her notebook. “In the beginning I was quite naïve, I have no medical background and was not aware of the hospital’s daily practice culture.” The method of research requires reflecting on her own observations changing over time. “There were actions in care practices that shocked me at first, but at a certain point they became a normality. For example: during a meeting between a doctor and a patient, the doctor’s phone started ringing. I was particularly surprised when he answered at this moment, given the vulnerability of the situational context. A few weeks later, I understood the complexity of the context better; for the doctor, there was more at stake than this individual patient, matters of life and death are a daily practice in the hospital”, Klaver describes. She was challenged with asserting her position between the nurses and the doctors. Slowly but surely Klaver managed to adjust to their culture and daily practice. This transition duly necessitated a personal change in her perspective when regarding the patients. She was able to witness first-hand the difficulty that doctors and nurses face in remaining attentive to their patients subjective experience .
The dynamics of attentiveness
In her research Klaver makes the distinction between several meanings of attentiveness: instrumental –that what is needed– and moral –that what is regarded as good care in the relationship between caregiver and carereceiver –. She explains that being attentive is not an autonomous action, as often thought, but is largely defined by the context of the specific situation. In the video Klaver describes the complexity of attentiveness and why she understands it to be political. She shares with the viewer a specific case: she shadows a doctor, the doctor needs to perform a rectal examination on a patient without prior notice. After the medical intervention, the patient tells the doctor that the procedure was as painful as giving birth, the doctor dismisses with disbelief the patient’s feedback disregarding her experience.
Furthermore, in the interview, Klaver discusses that this template of hospital culture also has a function in itself. For care professionals to provide the best care, there is a need for a systematic structure in which they can excel, but this template is focused mainly on cure, and that there within lies the potential risk of prejudicially labelling patients.
Being attentive: confronting, painful and shocking
Attentiveness is mostly pictured as a romantic aspect of care, a caring hand on the bed, empathizing with the perspective of the other; but a striking conclusion from Klaver’s empirical research is that being attentive can also be shocking, painful, and confronting. In the example of the doctor presented, he is aware that the intervention is painful, definitely not nice, but a necessity to obtain more medical information. It is understandable that the feedback of the patient ‘it is as painful as giving birth’ doesn’t enter the doctor’s framework. Attentiveness is about empathizing with the person in front of you, and the fact that you are responsible for their suffering can be very confronting. The idea of ‘what if that was me in that situation’ is painful. “To deal with that information, and relate to this situation, casts another light on the concept of attentiveness. It is this awareness of the complexity of attentiveness, which is important when thinking about good care”, Klaver states.
At the moment Klaver works at CCE (Centre for Consultation and Expertise), a Dutch organization in the healthcare system which provides advice and can be consulted when the care for an individual client is (too) complex. In Klaver’s daily practice as a researcher at CCE, she notices in the care situations that the challenging behaviour of clients is often largely determined by the context in which clients and their caregivers find themselves. Her research Dynamics of Attentiveness clarifies that attentiveness is complex and political. Klaver hopes to contribute in her daily work to this awareness.