Of bedpans and ivory towers? Nurse academics’ identities and the sacred and profane: A Bernsteinian analysis and discussion paper

Constructing the advanced nurse practitioner identity in the healthcare system: A discourse analysis

AIMS

To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs' identities and how they both enable and constrain their roles.

BACKGROUND

Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers.

DESIGN

A qualitative discourse analysis using Gee's Tools of Inquiry.

METHOD

Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals.

FINDINGS

Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs' identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other.

CONCLUSION

This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs' identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals' roles.

IMPACT

By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role.

Revealing how language builds the identity of the advanced nurse practitioner

AIMS AND OBJECTIVES

To explore how language works to enable and constrain the role of the advanced nurse practitioner (ANP) in the health system.

BACKGROUND

Nurses and doctors are produced within historically established disciplinary boundaries. These boundaries are becoming more porous, offering the possibility of a more liberated identity for ANPs that will allow them to reach their full potential. Current uncertainty and confusion about ANPs' identity result in their role being underutilised.

DESIGN

A critical discourse analysis design was used to explore participants' language-in-use. Findings are reported according to the COREQ research checklist.

METHOD

Data were collected through seven in-depth interviews and four focus groups and analysed using Gee's (2010) Identity Building Tool. Participants included ANPs, nurses (including nurse managers), doctors and allied healthcare professionals.

RESULTS

Four discourses were revealed. Participants' language-in-use worked to privilege the ANP's uniquely holistic identity. However, this aspect is also associated with a controlled identity, predominantly constrained by medics and restricted from advancing. The third discourse, the medicalised identity builds an identity that positions ANPs as medical replacements who are assigned trivial medical tasks. The final discourse constructs an independent powerful identity for the ANP that is influential and autonomous.

CONCLUSIONS

Circulating discourses and conversations can influence and shape the construction of the ANP identity. Healthcare professionals need to identify and counter discourses and conversations that construct ANPs' ways of knowing and knowledge as inferior and their role as subservient. Otherwise, ANPs' identity will continue to be controlled and their advancement restricted.

RELEVANCE TO CLINICAL PRACTICE

Confusion concerning the role and identity of the ANP can limit their contribution to the healthcare system. Healthcare professionals need to be aware of how language-in-use can prevent the role from developing and reaching its full potential in enhancing healthcare provision and delivery. Reporting follows the COREQ criteria.

Disposable single-use receptacles in a tertiary hospital: A large survey of staff after a hospital-wide implementation

In March 2014, our 1,100-bed tertiary hospital fully converted from a traditional system of reusable receptacles to a single-use disposable pulp receptacle system. Almost 12 months later, in February 2015, we undertook a large survey questionnaire to investigate user acceptance, perceptions, and any areas for improvement. The disposable pulp receptacle system was seen to be more convenient, more hygienic, and less of a risk in spreading infectious diseases. Occasional human error in its use was featured in the rare negative feedback.

Using Bourdieu's theory of practice to understand ICT use amongst nurse educators

BACKGROUND

Implementing changes in practice in either clinical or educational settings remains challenging. In the context of Information and Communication Technologies (ICT) adoption, the literature focuses either on organisational factors influencing its implementation, or on individual factors influencing its adoption into practice. Separately both fail to examine the issue holistically. Bourdieu's theory of practice provides a method for reconciling the two.

OBJECTIVE

To provide a practical example of how Bourdieu's theory of practice can be employed to better understand nurse educators' responses to ICT.

DESIGN

Exploratory descriptive design, using a Bourdieusian case-study to guide a documentary analysis.

METHODS

In 2009 a two-part study was conducted within a Department of Nursing (DON) in higher education (HE) in England. First Bourdieu's theory of practice was used to develop a case-study; then nurse educators were recruited for a Q-methodology (Q) study. This paper focuses exclusively on the case study and the use of the theory of practice to interpret the findings from the Q-study.

RESULTS

Nursing's transition into academia, promotions criteria in HE and the value placed on research over teaching have influenced educators' responses to technology.

CONCLUSION

The use of Bourdieu's framework provides a rich and contextual backdrop for understanding how organisational factors interact to influence individuals' responses to technology adoption.

Nurse to educator? Academic roles and the formation of personal academic identities

This aim of this research was to investigate the academic role of the nurse educator and its contribution to the formation of personal academic identity. Data was gathered using in-depth interviews (n=14) with experienced nurse educators employed within pre-1992 and post-1992 universities. Prolonged analysis, reflection and theorisation of the findings indicated that participants experienced multiple challenges when seeking to assimilate personal academic identity, adopting, and adapting a variety of identities over time. A conceptual model of identity transformation encompassing five stages: pre-entry, reaffirming, surmounting, stabilising and actualising, provides a useful analytical framework to inform and shape the professional development of nurse educators.

What lies beneath? The underlying principles structuring the field of academic nursing in Ireland

This article reports the findings of a structural analysis of the field of academic nursing in Ireland and considers the implications of the field's current structure for its present status and future trajectory in the academy. Six years after preregistration nursing education transferred to the higher education sector, tensions continue to exist concerning the status and legitimacy of academic nursing and of those who profess to profess it. The languages of legitimation of senior nursing academics and national nursing leaders (n = 16) were elicited and subjected to a critical discourse analysis. Respondents' languages were analyzed in terms of the settings of four underlying structuring legitimation principles: autonomy, density, specialization, and temporality. Academic nursing in Ireland was found to be structured by low autonomy, high density, and weak specialization. I conclude that academic and professional leaders in Irish nursing need to urgently consider how academic nursing can reconfigure its relationships with clinical nursing, increase its intellectual autonomy, enhance its internal coherence and cohesiveness, strengthen the epistemic power of its knowledge base, and critically evaluate the ways in which past practices inform its present and whether and to what extent they should shape its future.

A socio-cultural approach to learning in the practice setting

Practice learning is an essential part of the curriculum and accounts for approximately 60% of the current pre-registration nursing programmes in the Republic of Ireland. The nature and quality of the clinical learning environment and the student nurses' experience of their practice placements is recognised as being influential in promoting the integration of theory and practice. However, the problem experienced by many learners is how to relate their theoretical knowledge to the situation-at-hand within the practice setting. Socio-cultural or activity theories of learning seek to explain the social nature of learning and propose that knowledge and learning are considered to be contextually situated. Lave and Wenger (1991) argue that learning is integrated with practice and through engagement with a community of practice, by means of sponsorship; students become increasingly competent in their identity as practitioners. This paper examines the changes which have occurred within the pre-registration nursing curriculum in the Republic of Ireland with the transition from the apprenticeship system to the graduate programme, and the resulting reduction in clinical learning hours. It also examines the potential impact on the development of student learning with the implementation of the concepts proposed by Lave and Wenger to learning in the practice setting.

Developing professional identity in nursing academics: the role of communities of practice

This paper analyses the current standing of nursing within the wider United Kingdom (UK) higher education (HE) environment and considers the development of academic identity within the sector, introducing a technology mediated approach to professional learning and development. A community of practice (CoP) is a way of learning based on collaboration among peers. Individuals come together virtually or physically, with a common purpose, defined by knowledge rather than task [Wenger, E., 1998. Communities of Practice: Learning, Meaning and Identity, sixth ed. Cambridge University Press, Cambridge]. In 2008, a small team of academics at Glasgow Caledonian University, School of Nursing, Midwifery and Community Health created and implemented iCoP, a project undertaken to pilot an international CoP, where novices and expert academics collaborated to debate and discuss the complex transition from clinician to academic. Although not intended as a conventional research project, the developmental journey and emerging online discussion provide an insight into the collective thoughts and opinions of a multi-national group of novice academics. The article also highlights the key challenges, problems and limitations of working in an international online arena with professionals who traditionally work and thrive in a face to face, real time environment.