Tacit knowledge, time and practice in two dementia services: an ethnography

Abstract

This inquiry considers the importance of tacit knowledge, and how it might be characterised in an NHS memory service and a local authority day-care and respite service for people with dementia. When investigating the sorts of knowledge that might be valuable in helping individuals affected by dementia-type memory problems, service settings offer good prospects for locating empirical enquiry. Interactions between people with dementia, practitioners and carers invariably occur at points such as assessment, diagnosis and care-giving. Through in situ observations of interactions between health and care practitioners, people with dementia and carers, the knowledge repertoires of each were considered. This thesis explores how these knowledge repertoires differ, yet when they come together in practice situations it becomes apparent that each individual's knowledge is potentially valuable for making sense of the situation. In the memory service knowledgeable accounts from individuals and carers regarding when and how memory problems first appeared are imparted to the clinician. This knowledge, along with the clinician's knowledge, is brought to bear in determining memory status. In the social care setting 'getting to know' individuals - whose abilities to articulate their own accounts may be fading - requires spending time together during which a sense of the individual can be gained. The explicit-tacit knowledge mix in any practice situation is unproblematic unless an account of, or justification for practice is required. Qualities of knowledge that render this impossible are that tacit knowledge is inarticulable linguistically; and, in any given instance there are no known means of differentiating between the involvement of either tacit or explicit knowledge.
To attend to these difficulties an alternative way of seeing tacit knowledge is explored, whereby different understandings of tacit knowledge are surfaced when its relatedness to 'time' and 'practice' is considered. A set of notional knowledge-time-practice convergences are put forward.