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PhD Thesis by Jensine Ingerslev Nedergaard: Skin as a Communicative Boundary - Semiotic Dialogue in Danish Healthcare System

In this PhD thesis, the researcher answers the following questions: How is it possible to understand communication and meaning-making through the skin? / How does this embodied understanding of the skin as a physical and psychological boundary hold the ability to control and/or integrate communication and meaning making? / How can we develop a new approach of educating communicative aspects in the Danish healthcare system?

Skin as a Communicative Boundary Semiotic Dialogue in Danish Healthcare System

by Jensine Ingerslev Nedergaard

In the process of conducting this thesis, it very early became evident that the already known theories of human relating and communicating in asymmetrical aspects, were somewhat simplified to an extent, it became difficult to fully grasp what it encompasses. It is not just the oral gesture, the bodily performance, the culture or even the individual identities. It is all of them at the same place and time.

Understanding how feelings and identities can be represented through and via the body, with the skin as the immediate connecting device for a person’s inner reflections and metabolism, exposed and played out on the outside connecting with other persons – calls for a new theory. This theory has to be able to contain all these different aspects and processes. The very first (and not finished) endeavours to develop this theory is the Semiotic Skin Theory, in which a police officer who got shut in duty is a major contributor of understanding how identity can be contained and negotiated in and through the skin as to be able to further investigate how this flux of negotiation through the layers of semiotic skin can be the foundation of developing new strategies in creating partnerships in asymmetrical communications (as in the healthcare system).

Dialogues in healthcare systems all over the world operate with a theory of Shared Decision Making, which in theory is nicely conducted. Unfortunately, a tremendous amount of research has been done in the field of investigating the effect of this approach and it shows differing results. This must indicate that there is a simplification of an extremely complex phenomenon that cannot be implied in practice.

To solve this problem of simplicity to a multifaceted and complex phenomenon in the Danish healthcare system, a cooperation between the pediatric area of specialization and the oncological wards at Aalborg University Hospital were established. In this process the two terms of collective doctors and collective patients were developed and introduced as to display the complexity in the communication as well as the complexity in reflecting and negotiating identities in these asymmetrical dialogues.

In the area of a pediatric contact with the child as a patient it was evident that the body and the contact with this body became the media of communication. This non-verbal area of communication and relating is described and performed with accuracy and refinement in the area of classical music via musicians’ and conductors’ performance of creating good music.

Implementing all these aspects in the development of a communication course for doctors and nurses at Aalborg University Hospital seemed necessary as to contain all the different nuances of an asymmetrical communication. Therefore, it is also necessary to work in the fields of theories of borders and boundaries, which are as complex and multifaceted as the asymmetrical communication is itself. Each time the theory develops in connecting areas of cross-disciplinary research, the borders are crossed and boundaries are extended in this theoretical work and further boundarycrossing is detected in the area of human communication.

As a result of connecting cross-disciplinary theoretical areas, the courses in communication at the University Hospital have developed into continual lectures for the employees - and a new longitudinal project is established with one of the oncological wards, as to gain better contact with the patients, so they keep a general health condition stabile.

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