Delicious ambiguity? Organizational, interpersonal, and personal communication about spirituality at Hospice

While a great deal of theoretical work affirms the importance of spirituality in hospice care, the manner in which organizational members communicate about spirituality in hospice organizations, and most other health care organizations, remains under-explored and under-theorized. The purpose of this dissertation is twofold. First, this dissertation seeks to understand how hospice members talk about spirituality with one another and with care recipients. Second, this dissertation explores the antecedents and consequences of hospice members' communication strategies. To explore these issues, an ethnographic study was conducted in two branches of a mid-sized hospice. Over 200 hours of participant observation and 42 interviews were completed. Results showed that organizational discourse about spirituality was strategically ambiguous in response to multiple internal and external demands. Strategically ambiguous communication was successful in allowing for a wide range of actions and interpretations; however, it was also problematic in that it served as a source of discomfort and disconnection for some organizational members. Further, results demonstrated that communication about spirituality in interactions between care providers and care recipients was influenced by both organizational discourse and personal understandings of spirituality. Organizational and professional discourse and personal understandings created dialectical tensions between leading and following in care provider-care recipient interactions. Further analysis demonstrated five different strategies for managing the leading-following dialectic. Finally, results suggested that organizational discourses affected the personal identity and outcomes experienced by hospice workers. The preferred organizational identity of the "Gracious Servant" required hospice workers to perform spiritual labor which increased the care providers' propensity to experience stress and burnout. In total, these results demonstrate the importance of examining spirituality from an ecological perspective that considers community, organizational, and interpersonal discourse about spirituality.