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Wising J, Ström M, Hallgren J, Rambaree K. Certified Registered Nurse Anaesthetists' and Critical Care Registered Nurses' perception of knowledge/power in teamwork with Anaesthesiologists in Sweden: a mixed-method study. BMC Nurs 2024; 23:7. [PMID: 38163862 PMCID: PMC10759417 DOI: 10.1186/s12912-023-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024] Open
Abstract
Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists' (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES.Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23.Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR.Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes.
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Affiliation(s)
- Jenny Wising
- School of Health Sciences, University of Skövde, Skövde, Sweden.
| | - Madelene Ström
- Region Västra Götaland, Skaraborgs Hospital Skövde, Dept of Anesthesia, Skövde, Sweden
| | - Jenny Hallgren
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Komalsingh Rambaree
- Department of Social Work and Criminology, University of Gävle, Gävle, Sweden
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Miller GE, Holmes D. Self-Deception in Clinical Nursing Practice: A Concept Analysis. Clin Nurs Res 2024; 33:114-122. [PMID: 37872731 PMCID: PMC10731826 DOI: 10.1177/10547738231206610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
In this paper, we explore the phenomenon of "self-deception" within the context of nursing, focusing on how nurses employ this coping mechanism when faced with dissonance, distress, and conflicting situations in clinical settings. Our primary objective is to examine the phenomenon of self-deception using Rodgers' evolutionary method of concept analysis. Focusing on nurses' experiences in challenging situations, our analysis highlights how self-deception is often employed as a coping strategy. According to our conceptual analysis, self-deception in nursing clinical practice highlights tensions between different paradigms and expectations in healthcare settings. These tensions stem from the power dynamics and subservience that nurses often face, which can hinder their ability to advocate for themselves, their patients, and the nursing profession.
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Rudberg I, Olsson A, Thunborg C, Salzmann-Erikson M. Interprofessional communication in a psychiatric outpatient unit - an ethnographic study. BMC Nurs 2023; 22:286. [PMID: 37626326 PMCID: PMC10463438 DOI: 10.1186/s12912-023-01446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit. METHOD During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection. RESULTS We found that a workplace's history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit's code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks. CONCLUSION Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication.
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Affiliation(s)
- Ingela Rudberg
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, SE-801 76, Sweden.
| | - Annakarin Olsson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, SE-801 76, Sweden
| | - Charlotta Thunborg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Welfare, Mälardalen University, Västerås, Sweden
| | - Martin Salzmann-Erikson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, SE-801 76, Sweden
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Patel G, Phung VH, Trueman I, Orner R, Siriwardena AN. Common hierarchies, varied rules - the problem of governing community first responders in prehospital care for quality standards: documentary discourse analysis. BMC Health Serv Res 2023; 23:38. [PMID: 36647122 PMCID: PMC9841939 DOI: 10.1186/s12913-022-08960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
A key focus is placed on engaging communities to become involved in making decisions to support health and care services in healthcare policies in England, UK. An example is the deployment of volunteers such as community first responders (CFRs), who are members of the public with basic life support skills, trained to intervene in emergency situations prior to the arrival of ambulance services. CFR policies have been devised by National Health Service (NHS) Trusts as a way of governing these and related activities. This paper critically examines the discourse around CFR policies to understand how CFR roles are organised and monitoring governance mechanisms are delineated in ensuring quality care delivery. We collected ten CFR policies from six ambulance services. Inductive analysis, guided by Foucault's theory, enabled the identification of themes and subthemes. We found that Trusts have a common goal to make care quality assurances to regulatory bodies on CFR roles, and this is depicted in common hierarchies of individual responsibilities across Trusts. However, policies that govern approaches to CFRs activity vary. Firstly, the paper highlights institutional approaches to ensuring public safety through the application of organised surveillance systems to monitor CFR activities, and draws parallels between such surveillance and Foucault's docile bodies. Secondly, the paper discusses how varying rules in the surveillance system compromises safety by decentralising knowledge to regulatory bodies to whom NHS Trusts must make safety assurances. We suggest that stronger interrelationships between Trusts in considering the CFR role has potential to increase public safety and outline a clearer direction for CFRs.
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Affiliation(s)
- Gupteswar Patel
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Viet-Hai Phung
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Ian Trueman
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Roderick Orner
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Aloysius Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK ,grid.36511.300000 0004 0420 4262LMS 3006, Lincoln Medical School, University of Lincoln, 3006, LN6 7TS Lincoln, UK
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Purvis JK. Applying a Foucauldian lens to the Canadian code of ethics for registered nurses as a discursive mechanism for nurses professional identity. Nurs Inq 2022; 30:e12536. [PMID: 36260285 DOI: 10.1111/nin.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
This study examines the Canadian Code of Ethics for Registered Nurses as a discursive mechanism for shaping nurses' professional identity using a Foucauldian lens. Nurses are considered essential in healthcare, yet the nursing profession has struggled to be recognized for its discipline-specific knowledge and expertise and, as such, has remained the subject of and subject to the dominant discourses within healthcare and society generally. Developing a professional identity in nursing begins after the necessary education and training are achieved and embodies the profession's history, values, code of ethics, and expectations of the profession that distinguish it from other professions. Since nurses' professional identity is shaped through discourse, it raises the question of whether there are spaces to reconceptualize nurses' subject position within health care. Since professional identity is considered the embodiment of knowledge and practice, the code of ethics bears examination both for its effect on nurses' professional identity and as a potential site from which to challenge hegemonic assumptions. This article discusses the concept of professional identity in nursing and its development through the discursive formations in the code of ethics. The sources of power/knowledge are examined as both mechanisms of control and as spaces for change.
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Affiliation(s)
- Janet K Purvis
- Rankin School of Nursing, St Francis Xavier University, Antigonish, Canada
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Hoff JL, Kuiper M. The governmentality of nursing professionalization in advanced liberal societies. JOURNAL OF PROFESSIONS AND ORGANIZATION 2021. [DOI: 10.1093/jpo/joaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
In Western countries, the occupational discipline of nursing is undergoing processes of professionalization. Although professionalization offers an appealing perspective on occupational advancement, it is an ambiguous process, especially in the context of ongoing reforms of advanced liberal states. More specifically, there is a confusing relationship between the professionalization of nursing and the state. This relation is underexamined in theories of nursing professionalization. Instead of seeing the state and professions as two distinct spheres, this article highlights their interconnectedness. It argues that nursing professionalization can be understood as a strategy of advanced liberal governmentality. Through an empirical analysis of the professionalization of Dutch nursing from a Foucauldian perspective, it shows how the appeal to ‘professionalism’ functions as a disciplinary mechanism that produces forms of advanced liberal ‘(bio)power’. This generates academic and practical questions, since nurses—the largest group of healthcare professionals—have distinctive relations with their patients, who regard them as ‘independent’ and ‘caring experts’. Furthermore, it sheds light on the academic debate about the reconfiguration of professionalism by showing how certain ‘professional’ reconfigurations are not only unavoidable but unavoidably (bio)political as well.
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Affiliation(s)
- Jan-Luuk Hoff
- Utrecht University School of Governance, Utrecht University, 3511 ZC Utrecht, the Netherlands
| | - Marlot Kuiper
- Utrecht University School of Governance, Utrecht University, 3511 ZC Utrecht, the Netherlands
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The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time. ANS Adv Nurs Sci 2020; 43:102-113. [PMID: 32345799 DOI: 10.1097/ans.0000000000000290] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The remnants of colonialism manifesting as structural violence, racism, and oppression continue to plague our society as evidenced by the persistence of health inequities, particularly for minority populations in the United States. As a profession bound by moral and ethical mandates, nursing must resist and deconstruct oppression in all its forms. Nurses, informed by critical race theory, intersectionality, and historical trauma, can become formidable allies with marginalized populations in the fight for social justice and health equity.
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Benbow S, Forchuk C, Berman H, Gorlick C, Ward-Griffin C. Spaces of Exclusion: Safety, Stigma, and Surveillance of Mothers Experiencing Homelessness. Can J Nurs Res 2019; 51:202-213. [PMID: 31282752 DOI: 10.1177/0844562119859138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lack of affordable housing, poverty, and intimate partner violence are among the most common reasons for homelessness among mothers and their children in Canada. Mothers experience social exclusion in compounding and debilitating ways. In the literature on social exclusion and health, rarely is safety recognized as a prominent component of social exclusion. The purpose of this critical narrative study was to better understand the unique narratives of social exclusion for mothers experiencing homelessness in Ontario. A critical narrative methodology with an intersectional lens was used. Twenty-six ( N = 26) mothers participated in the study. The overarching finding of unsafe spaces represents the unique forms of exclusion from safety participants experienced in public and private spaces. Emerging out of this overarching category are two intertwined subcategories of (a) exclusion from safety and (b) stigma: public surveillance and discrimination. Participants’ narratives of exclusion from safety signify an ecosystem of unsafe spaces. The findings illuminate and reiterate the imperative for nurses to recognize that safety is a human right and is foundational for health. Nurses can use critical self-reflection and challenge the inherent “nursing gaze” to promote spaces of support rather than surveillance and engage in political advocacy to address structural inequalities, such as gender-based violence.
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Affiliation(s)
- Sarah Benbow
- 1 School of Nursing, Faculty of Health, Community Studies, and Public Safety, Fanshawe College, London, ON, Canada
| | - Cheryl Forchuk
- 2 Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Helene Berman
- 2 Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Carolyne Gorlick
- 3 School of Social Work, King's College, Western University, London, ON, Canada
| | - Catherine Ward-Griffin
- 2 Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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9
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Dillard-Wright J. Electronic health record as a panopticon: A disciplinary apparatus in nursing practice. Nurs Philos 2019; 20:e12239. [PMID: 30821896 DOI: 10.1111/nup.12239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
Abstract
The specific arrangements of power/knowledge that characterize nurse interactions with the electronic health record form a panopticon. As health care moves into the 21st century, sophisticated technologies like the electronic health record shape the terrain of professional possibilities. The longer it is in use, the more it is possible to excavate the inherent disciplinary function of electronic health record. A panopticon is a generalizable, replicable apparatus of power that cultivates discipline when similar behaviours are desired from a group of people. This paper traces the arrangements of power/knowledge that characterize nurse interactions with the electronic health record rooted in a trauma critical care setting. Examining the apparatuses of power/knowledge enforced through panopticism in nursing makes the invisible visible. This in turn enables nurses to address the intended and unintended consequences of the electronic health record. If nurses are to effectively shape the direction of their own futures and the future of health care, nurses will need to unpack the invisible techniques of power such as the electronic health record as a panopticon. In the process of building a visible identity, contextualizing nursing knowledge to better care for patients on the one hand and understand the relationships of power that limit us on the other, nurses are neither apolitical nor powerless. Considering the dialectic of power/knowledge in the healthcare setting helps to illuminate spaces to recharacterize nursing, reveal the contributions and knowledge of nurses, and consolidate the professional power of nurses to affect meaningful change and self-governance in the healthcare setting.
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10
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Mkandawire-Valhmu L, Weitzel J, Dressel A, Neiman T, Hafez S, Olukotun O, Kreuziger S, Scheer V, Washington R, Hess A, Morgan S, Stevens P. Enhancing cultural safety among undergraduate nursing students through watching documentaries. Nurs Inq 2018; 26:e12270. [PMID: 30506988 DOI: 10.1111/nin.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022]
Abstract
The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students' written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students' understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care.
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Affiliation(s)
| | - Jennifer Weitzel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Tammy Neiman
- College of Allied Health & Nursing, Minnesota State University, Manako, Minnesota
| | - Shahad Hafez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | | | - Suzanne Kreuziger
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Victoria Scheer
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Rosetta Washington
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Alexa Hess
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Sarah Morgan
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Patricia Stevens
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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11
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Delvin ME, Braithwaite S, Camargo Plazas P. Canadian nurse practitioner's quest for identity: A philosophical perspective. Int J Nurs Sci 2018; 5:110-114. [PMID: 31406811 PMCID: PMC6626291 DOI: 10.1016/j.ijnss.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/06/2022] Open
Abstract
The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare settings to the provision of comprehensive care. The context in which the role has been established positions nurse practitioners' practice within medical and nursing paradigms. As the healthcare system evolves, nurse practitioners must define their identity to advocate for roles that reflect their professional values. A historical overview highlighting the context in which the NP role expanded will guide a philosophical discussion regarding role identity. After exposing tensions between the nursing and medicine disciplines, Abbots' theory of profession will be utilized to understand the foundations leading to initial research on nurse practitioner integration within the healthcare system. Feminist philosopher bell hooks' discourse on marginality will serve as a platform to reflect on the nurse practitioner identity within the current social context. Foucault's notions of governmentality, parrhesia and care of the self will then guide reflections regarding ways for nurse practitioners to locate themselves as a profession.
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Affiliation(s)
- Marie-Elaine Delvin
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
| | - Suzanne Braithwaite
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
| | - Pilar Camargo Plazas
- School of Nursing, Queen's University, 82 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
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Molina-Mula J, Gallo-Estrada J, Perelló-Campaner C. Impact of Interprofessional Relationships from Nurses’ Perspective on the Decision-Making Capacity of Patients in a Clinical Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017. [DOI: https://doi.org/10.3390/ijerph15010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Molina-Mula J, Gallo-Estrada J, Perelló-Campaner C. Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:E49. [PMID: 29286342 PMCID: PMC5800148 DOI: 10.3390/ijerph15010049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 02/05/2023]
Abstract
Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.
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Affiliation(s)
- Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma de Mallorca, Spain.
| | - Julia Gallo-Estrada
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma de Mallorca, Spain.
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Ballard A, Khadra C, Le May S, Gendron S. Différentes traditions philosophiques pour le développement des connaissances en sciences infirmières. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.124.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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Buus N, Hamilton BE. Social science and linguistic text analysis of nurses' records: a systematic review and critique. Nurs Inq 2015; 23:64-77. [PMID: 26109278 DOI: 10.1111/nin.12106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2015] [Indexed: 11/28/2022]
Abstract
The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in this emerging area of research. Systematic searches in reference databases and in citation indexes identified 12 articles that included analyses of the social and linguistic features of records and recording. Two reviewers extracted data using established criteria for the evaluation of qualitative research papers. A common characteristic of nursing records was the economical use of language with local meanings that conveyed little information to the uninitiated reader. Records were dominated by technocratic-medical discourse focused on patients' bodies, and they depicted only very limited aspects of nursing practice. Nurses made moral evaluations in their categorisation of patients, which reflected detailed surveillance of patients' disturbing behaviour. The text analysis methods were rarely transparent in the articles, which could suggest research quality problems. For most articles, the significance of the findings was substantiated more by theoretical readings of the institutional settings than by the analysis of textual data. More probing empirical research of nurses' records and a wider range of theoretical perspectives has the potential to expose the situated meanings of nursing work in healthcare organisations.
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Affiliation(s)
- Niels Buus
- University of Southern Denmark, Odense C, Denmark
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Foth T. Understanding 'caring' through biopolitics: the case of nurses under the Nazi regime. Nurs Philos 2014; 14:284-94. [PMID: 24034159 DOI: 10.1111/nup.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
These days, discussions of what might be the 'essence' or the 'core' of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the 'newer' nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of 'life unworthy of living'. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; 'goodness' that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.
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Affiliation(s)
- Thomas Foth
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Nicholls DA, Holmes D. Discipline, desire, and transgression in physiotherapy practice. Physiother Theory Pract 2012; 28:454-65. [DOI: 10.3109/09593985.2012.676940] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Koehne K, Hamilton B, Sands N, Humphreys C. Working around a contested diagnosis: Borderline personality disorder in adolescence. Health (London) 2012; 17:37-56. [DOI: 10.1177/1363459312447253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This discourse analytic study sits at the intersection of everyday communications with young people in mental health settings and the enduring sociological critique of diagnoses in psychiatry. The diagnosis of borderline personality disorder (BPD) is both contested and stigmatized, in mental health and general health settings. Its legitimacy is further contested within the specialist adolescent mental health setting. In this setting, clinicians face a quandary regarding the application of adult diagnostic criteria to an adolescent population, aged less than 18 years. This article presents an analysis of interviews undertaken with Child and Adolescent Mental Health Services (CAMHS) clinicians in two publicly funded Australian services, about their use of the BPD diagnosis. In contrast with notions of primacy of diagnosis or of transparency in communications, doctors, nurses and allied health clinicians resisted and subverted a diagnosis of BPD in their work with adolescents. We delineate specific social and discursive strategies that clinicians displayed and reflected on, including: team rules which discouraged diagnostic disclosure; the lexical strategy of hedging when using the diagnosis; the prohibition and utility of informal ‘borderline talk’ among clinicians; and reframing the diagnosis with young people. For clinicians, these strategies legitimated their scepticism and enabled them to work with diagnostic uncertainty, in a population identified as vulnerable. For adolescent identities, these strategies served to forestall a BPD trajectory, allowing room for troubled adolescents to move and grow. These findings illuminate how the contest surrounding this diagnosis in principle is expressed in everyday clinical practice.
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Bender A, Peter E, Wynn F, Andrews G, Pringle D. Welcome intrusions: An interpretive phenomenological study of TB nurses’ relational work. Int J Nurs Stud 2011; 48:1409-19. [DOI: 10.1016/j.ijnurstu.2011.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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Miró M, Gastaldo D, Nelson S, Gallego G. Spanish nursing under Franco: reinvention, modernization and repression (1956-1976). Nurs Inq 2011; 19:270-80. [DOI: 10.1111/j.1440-1800.2011.00565.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong JPH, Poon MKL. Bringing translation out of the shadows: translation as an issue of methodological significance in cross-cultural qualitative research. J Transcult Nurs 2011; 21:151-8. [PMID: 20220035 DOI: 10.1177/1043659609357637] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Translation is an integral component of cross-cultural research that has remained invisible. It is commonly assumed that translation is an objective and neutral process, in which the translators are "technicians" in producing texts in different languages. Drawing from the field of translation studies and the findings of a translation exercise conducted with three bilingual Cantonese-English translators, the authors highlight some of the methodological issues about translation in cross-cultural qualitative research. They argue that only by making translation visible and through open dialogue can researchers uncover the richness embedded in the research data and facilitate multiple ways of knowing.
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O'Byrne P, Holmes D. The politics of nursing care: correcting deviance in accordance with the social contract. Policy Polit Nurs Pract 2009; 10:153-162. [PMID: 19696087 DOI: 10.1177/1527154409344347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Despite numerous theories, models, and philosophies describing what nurses are and what they do, nursing care is often presented as an apolitical process which primarily focuses on patient needs and priorities. However, it is our position that nursing practice-in all regards-is political. To support this argument, we have drawn on works describing of soft/hard power, pastoral power, stigma, deviance, and governmentality, in addition to explaining our institutional social contract conceptualization of politics. In using these concepts, our political perspective reframes nursing practice as a means by which an individual's potential or actual deviance (meaning a deviation from social norms) can be identified and then corrected.
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Costa R, Souza SDSD, Ramos FRDS, Padilha MI. Foucault e sua utilização como referencial na produção científica em enfermagem. TEXTO & CONTEXTO ENFERMAGEM 2008. [DOI: 10.1590/s0104-07072008000400002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O trabalho teve como objetivo evidenciar a incorporação do referencial foucaultiano na produção científica do Programa de Pós-Graduação em Enfermagem da Universidade Federal de Santa Catarina. É um estudo qualitativo que utiliza a pesquisa documental. A fonte de pesquisa foi o Banco de Teses e Dissertações do programa. Foram identificados 13 estudos que utilizaram Michel Foucault. A análise dos estudos foi feita em duas etapas: classificação dos trabalhos em relação aos objetos de investigação e organização do material a partir dos dados dos estudos, dando lugar às categorias: Por que Michel Foucault?; A questão do poder nos estudos da enfermagem e, Arqueologia e genealogia nos estudos foucaultianos. Este referencial aponta um novo olhar para os diversos campos de pesquisa em enfermagem.
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Carvalho SR, Gastaldo D. Promoção à saúde e empoderamento: uma reflexão a partir das perspectivas crítico-social pós-estruturalista. CIENCIA & SAUDE COLETIVA 2008; 13 Suppl 2:2029-40. [DOI: 10.1590/s1413-81232008000900007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 07/03/2007] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho, descrevemos o arcabouço teórico e as estratégias centrais da Promoção à Saúde, seguidos de uma análise crítica tanto intra como extra-paradigmática ao ideário do referido movimento. A partir de uma perspectiva intra-paradigmática, privilegiamos o enfoque ao qual se filia a Promoção à Saúde, as teorias crítico-sociais, para analisar um dos seus conceitos estruturantes - o conceito de empoderamento -, explorando seu potencial para a transformação das práticas comunitárias e profissionais em saúde. A seguir, refletimos sobre a Promoção à Saúde a partir de uma perspectiva extra-paradigmática, buscando nas teorias pós-estruturalistas novas possibilidades analíticas para entender as relações de poder que se estabelecem a partir das práticas e políticas de Promoção à Saúde. Ao longo deste artigo, articulamos os princípios teóricos explorados a questões contextuais e a debates atuais na área da saúde no Brasil.
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Gagnon M, Holmes D. Governing masses: routine HIV testing as a counteroffensive in the war against HIV-AIDS. Policy Polit Nurs Pract 2008; 9:264-273. [PMID: 18981058 DOI: 10.1177/1527154408323931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created.
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Abstract
AIM This paper is a report of a study to analyse reflection as discourse and a technology of confession which produces a certain desirable subjectivity within nursing practice. BACKGROUND Reflection and reflective practice are common themes in nursing practices and in the literature on nursing. These practices are often construed as positive and empowering, and more critical analyses of them are needed. METHOD A Foucauldian-inspired discourse analysis based on the concepts of governmentality and technologies of the self was conducted. Transcripts of interviews conducted in 2006-07 with 42 managers, supervisors, teachers and participants in an in-service programme to prepare healthcare assistants to become Licensed Practice Nurses in the elder care sector were analysed. FINDINGS Reflection as confession operates as a governing technology within the nursing practice analysed. Programme participants are encouraged to reflect and scrutinize themselves about their work as a way to improve their competencies and practice. Through appraisals, they are invited to reflect about themselves as way to achieve their desires. In this way, active, responsible, problem-solving, self-governing practitioners are constructed. CONCLUSION Through a Foucauldian reading of reflective practices it is possible to illustrate that reflection is not a neutral or apolitical practice. Instead, it is a governing practice that does something, in discursive terms, to nursing subjectivity - something that can create a space for reflection about what reflection discursively does to subjectivity.
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Affiliation(s)
- Andreas Fejes
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
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Hamilton B, Manias E. The power of routine and special observations: producing civility in a public acute psychiatric unit. Nurs Inq 2008; 15:178-88. [DOI: 10.1111/j.1440-1800.2008.00406.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matthews A, Scott PA. Perspectives on midwifery power: an exploration of the findings of the inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland. Nurs Inq 2008; 15:127-34. [PMID: 18476855 DOI: 10.1111/j.1440-1800.2008.00402.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio-political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency-structure interaction and stresses the centrality of agents' roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives' relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report.
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Affiliation(s)
- Anne Matthews
- School of Nursing, Dublin City University, Dublin, Ireland.
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Andrews GJ, Shaw D. Clinical geography: nursing practice and the (re)making of institutional space. J Nurs Manag 2008; 16:463-73. [PMID: 18405263 DOI: 10.1111/j.1365-2834.2008.00866.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To present a geographical study that highlights the wide ranging spatial features of nursing agency. In turn, illustrate the further potential for geographical research to describe, support, challenge and guide clinical practice - particularly with regard to those 'everyday' activities and actions undertaken on a frequent basis. BACKGROUND To provide a focus, and to anchor the study in existing clinical knowledge and debates, the role of nursing in the (re)making of institutional experiences and life is specifically explored. METHODS In-depth semi-structured interviews were conducted with 15 nurses working in Buckinghamshire and West London, UK. The following specialties were represented: acute care including emergency (n = 3), midwifery (n = 3), children's nursing (n = 2), elderly care (n = 1), rehabilitation (n = 2), mental health (n = 3) and palliative care (n = 1). RESULTS Nurses claimed to actively manipulate, normalize and recreate clinical spaces as part of their everyday therapeutic practice. Specifically, the range of agency employed by them falls under the following six categories: adjusting social composition; introducing 'normal' activities; providing private spaces; seeking private spaces; explaining clinical spaces; spaces for personal escape and wellbeing. IMPLICATIONS FOR NURSING MANAGEMENT It is recommended that nurse leaders - including researchers, managers and clinical educators - explore geography as a source of social scientific evidence that sheds light on the complex nature of everyday professional practice. In this regard, some important disciplinary and structural issues are noted.
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Affiliation(s)
- Gavin J Andrews
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada.
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St-Pierre I, Holmes D. Managing nurses through disciplinary power: a Foucauldian analysis of workplace violence. J Nurs Manag 2008; 16:352-9. [PMID: 18324995 DOI: 10.1111/j.1365-2834.2007.00812.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper describes discipline as a specific technique of power which constitutes, in our view, a form of institutional violence. BACKGROUND The need to create and maintain safe and healthy work environments for healthcare professionals is well documented. EVALUATION Foucault's concept of disciplinary power was used to explore institutional violence from a critical perspective. KEY ISSUE Violence is identified as an important factor in the recruitment and retention of healthcare professionals. Given the shortage of such professionals, there is an urgent need to take a fresh look at their working environments and working conditions. CONCLUSION Power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs. IMPLICATIONS FOR NURSING MANAGEMENT By associating common workplace practices with institutional violence, employers who have a policy of zero tolerance toward workplace violence will need to re-examine their current ways of operating.
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Affiliation(s)
- Isabelle St-Pierre
- Faculty of Medicine, School of Nursing, McGill University, Montreal, Canada
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Abstract
Mixed method study designs are becoming increasingly popular among nurse researchers. Mixed studies can have advantages over single method or methodological investigative designs. However, these advantages may be squandered where researchers fail to think through and justify their theoretic decisions. This paper argues that nurse researchers do not always pay sufficient heed to the philosophic and theoretic elements of research design and, in consequence, some mixed study reports lack argumentative coherence and validity. It is here suggested that Hempel's concept of equivalence can be stretched to usefully illustrate one of the main threats to argumentative coherence in mixed study design. The critical realist theory of Roy Bhaskar is then introduced and this, it is proposed, offers one means by which Hempel's equivalence dilemma can be overcome. Critical realists recognize the existence of logical connections between the ontological, epistemological, and methodological premises that underpin their work. They are therefore more likely to produce coherent studies than uncritical pragmatists who ignore such linkages and, paradoxically, critical realists can be epistemological pluralists because, in re-conceptualizing the ontological basis of inquiry, problems associated with the mixing of alternative metaphysics are circumvented.
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Affiliation(s)
- Martin Lipscomb
- University of the West of England, Faculty of Health and Social Care, Gloucester Centre, Gloucester, UK.
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Hunter B, Segrott J. Re-mapping client journeys and professional identities: a review of the literature on clinical pathways. Int J Nurs Stud 2007; 45:608-25. [PMID: 17524406 DOI: 10.1016/j.ijnurstu.2007.04.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/26/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the growing use of clinical pathways by nurses and midwives, their impact on client care, and the potential consequences of widespread pathway utilisation for the professional identity and knowledge base of nursing and midwifery. METHODS A keyword search was performed within CINAHL and PubMed for the period 1995-2006 to identify relevant material, and article bibliographies were examined to identify relevance references. Thirty-nine publications were selected for inclusion in the analysis on the basis that they offered the most original account of the development of pathways or their effectiveness, or because they provided useful theoretical concepts. A thematic analysis of the selected articles was undertaken. RESULTS The review identified four main themes: the multiple aims of clinical pathways; the process of initial development; pathway implementation in practice, and the impacts of pathways on client care, professional identities, and the nature of written documentation. Clinical pathways have multiple aims, including standardising practice, levering external evidence into local health care work, and improving interprofessional co-ordination. The review found limited evidence of pathways' impact on client care, but the existing research suggests that they may be most suitable for predictable, routinised surgical procedures. Key concepts, such as variance and audit were found to be poorly defined. Clinical pathways appear to achieve many of their effects at the development stage and the reshaping of professional interactions. CONCLUSIONS Given their widespread adoption and valorisation as tools of evidence-based practice, the dearth of evidence for clinical pathways should raise concerns. Clinical pathways may have significant impacts on nursing and midwifery as professions, both through redrawing professional identities and boundaries, and transforming the ways in which nurses and midwives document care. The impact of standardised pathways on professional ideologies which emphasise individualised care, and clinical autonomy will require long-term programmes of research.
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Affiliation(s)
- Billie Hunter
- School of Health Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
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Davies B, Allen D. Integrating ‘mental illness’ and ‘motherhood’: The positive use of surveillance by health professionals. A qualitative study. Int J Nurs Stud 2007; 44:365-76. [PMID: 16473357 DOI: 10.1016/j.ijnurstu.2005.11.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 11/27/2005] [Accepted: 11/29/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sociologists have long recognised the social control functions of different social institutions. Nurses, however, often appear more comfortable with formulating their roles in altruistic terms. OBJECTIVES In this paper, we examine the relevance of Foucauldian concepts, in particular that of surveillance, to an understanding the relationship between healthcare professionals (especially nurses) and their patients. DESIGN We use the concept of 'interactional frames' to analyse data from qualitative interviews with mothers who have a mental illness. SETTINGS The research, from which the data in this paper were taken, was carried out in a largely urban area of south-east Wales, in the UK, during 2001 and 2002. PARTICIPANTS The participants were 11 women, each with one or more children, all of whom were under the care of their local Community Mental Health Team. METHODS The paper draws on findings from a wider study of the influence of child-care responsibilities on access to services for women with mental health problems. Data were generated through individual, semi-structured interviews, carried out and transcribed by one of the authors (BD). RESULTS Women produced accounts of their mothering practices which acknowledged the norms of 'good' mothering. They spoke about the need for 'impression management' in their clinical encounters, both those in which they were the patient and those undertaken on behalf of their children. The data showed health professionals moving between frames in which the woman was a mother and in which she was a person with a mental illness, and integrating the two frames to the woman's benefit. CONCLUSIONS Women who are mothers and who are also users of mental health services face particular challenges in managing the contradictory aspects of their dual identity. Health professionals can use their disciplinary power in a positive way, to help women in this task.
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Holmes D, Perron AM, Savoie M. Governing therapy choices: power/knowledge in the treatment of progressive renal failure. Philos Ethics Humanit Med 2006; 1:12. [PMID: 17144913 PMCID: PMC1693913 DOI: 10.1186/1747-5341-1-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 12/04/2006] [Indexed: 05/12/2023] Open
Abstract
This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed.
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Affiliation(s)
- Dave Holmes
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Amélie M Perron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Marc Savoie
- Renal Division, Baxter Corporation, Montréal, Canada
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Nicholls DA, Cheek J. Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage scandals of 1894. Soc Sci Med 2006; 62:2336-48. [PMID: 16253409 DOI: 10.1016/j.socscimed.2005.09.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Indexed: 11/29/2022]
Abstract
In 1894 the Society of Trained Masseuses (STM) formed in response to massage scandals published by the British Medical Journal (BMJ). The Society's founders acted to legitimise massage, which had become sullied by its association with prostitution. This study analyses the discourses that influenced the founders of the Society and reflects upon the social and political conditions that enabled the STM to emerge and prosper. The founders established a clear practice model for massage which effectively regulated the sensual elements of contact between therapist and patient. Massage practices were regulated through clearly defined curricula, examinations and the surveillance of the Society's members. A biomechanical model of physical rehabilitation was adopted to enable masseuses to view the body as a machine rather than as a sensual being. Medical patronage of the Society was courted enabling the Society to prosper amongst competing organisations. Using Foucault's work on power we explore the contingent nature of these events, seeing the massage scandals in context with broader questions of sexual morality, professionalisation and expertise in the late nineteenth century society. We argue that many of the technologies developed by the founders resonate with physiotherapy practice today and enable us to critically analyse the continued relevance of the profession to contemporary healthcare.
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Ebbeskog B, Emami A. Older patients’ experience of dressing changes on venous leg ulcers: more than just a docile patient. J Clin Nurs 2005; 14:1223-31. [PMID: 16238768 DOI: 10.1111/j.1365-2702.2005.01194.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE The aim of this paper was to describe the lived experiences of older patients with venous leg ulcers, during dressing changes as out patients with a focus of their concerns about care interventions. Research on wound care management has focused on treatment of venous leg ulcer, wound assessments and the choice of dressing material. Few studies have focused on the patients' experience of dressing changes. DESIGN Fifteen older people with verified venous leg ulcers were recruited in a metropolitan area of Sweden. Data were collected with research interviews in the form of dialogue. METHOD Data were analysed with an interpretative phenomenological method developed by Benner. RESULTS Twelve women and three men participated. The themes were: 'being cared for with a skillful touch', 'feelings of belonging, continuity and affinity', and 'being suppressed into a state where one loses control, leading to feelings of discomfort'. The participants' experiences varied. Some were satisfied and felt that there was a mutual understanding between caregivers and patients, while others were dissatisfied and felt objectified. Understanding the patients as human beings and considering illness as lived experience helped the care providers to perform skillful wound care, in an atmosphere of mutual understanding. CONCLUSION The patients suffering from venous leg ulcers wanted to feel worthy of wound treatment and to meet skillful, confident and gentle nurses in a sharing atmosphere. Nurses must be perceptive to the individual's bodily experience of the leg ulcer. RELEVANCE TO CLINICAL PRACTICE Wound care requires a multidimensional clinical approach that involves not only medical and technical care strategies of dressings and bandages, but also aspects that concern the situated-based illness experience that persons suffering from leg ulcers may face.
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Affiliation(s)
- Britt Ebbeskog
- Neurotec Department, Clinical Geriatrics, Division of Gerontological Caring Science, Karolinska Institutet, Stockholm, Sweden.
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Pellatt GC. Redefining rehabilitation from spinal cord injury: A process–outcome model. ACTA ACUST UNITED AC 2005. [DOI: 10.12968/bjnn.2005.1.2.18250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Glynis Collis Pellatt
- Faculty of Health and Social Science, University of Luton, Aylesbury Vale Education Centre, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL
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Zaforteza C, Gastaldo D, de Pedro JE, Sánchez-Cuenca P, Lastra P. The process of giving information to families of critically ill patients: a field of tension. Int J Nurs Stud 2005; 42:135-45. [PMID: 15680612 DOI: 10.1016/j.ijnurstu.2004.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 05/10/2004] [Accepted: 05/20/2004] [Indexed: 10/26/2022]
Abstract
We conducted research to study nurses' views on factors that influence their relationship with patients' relatives in intensive care units in three hospitals in Mallorca (Balearic Islands, Spain). This article focuses on the findings related to the process of giving information to the family. We used a post-structuralist theoretical framework and data were collected through observations and interviews. The analysis revealed that nurses thought information eases relatives' worries, but they felt that in order to avoid conflicts with physicians they should restrain themselves from providing it. We propose that the existing power relationships in intensive care units should be challenged if we expect health care professionals to offer patients' relatives a planned information process.
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Affiliation(s)
- Concha Zaforteza
- Department of Nursing and Physiotherapy, University of Balearic Islands, Spain
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Abstract
BACKGROUND Much has been written about nursing as a predominantly female profession whose members display passivity, submission, obedience and powerlessness. Alternatively, some authors have presented evidence of nurses' capacity to exercise power, revealing the possible relationship between powerlessness and ethical compromise. Thus, empowerment strategies for nurses can yield ethical action. AIM The aim of this paper is to use analysis of the literature to demonstrate how the actions and responses of nurses to ethical concerns are examples of nurses exercising power. METHOD Empirical studies published in the nursing literature between 1990 and 2003 have been analysed to illustrate how nurses' actions of resistance can ensure that moral values are realized in practice. Foucauldian notions of power relations and feminist ethics provide the theoretical framework. CONCLUSIONS Nurses were found to resist in situations where they experienced moral conflicts in relation to the actions of health professionals; however, instances were cited where they did not. Consequently, strategies for nursing education and management are proposed to increase nurses' understanding of the potential acts of resistance that they could employ in situations of moral conflict or concern.
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Affiliation(s)
- Elizabeth Peter
- Joint Centre for Bioethics, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Vahabi M, Gastaldo D. Rational choice(s)? Rethinking decision-making on breast cancer risk and screening mammography. Nurs Inq 2004; 10:245-56. [PMID: 14622371 DOI: 10.1046/j.1440-1800.2003.00190.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women who refrain from undergoing breast cancer screening are believed to be uninformed about risks and usually labeled as irrational. Our purpose in writing this paper is to challenge the traditional notion of rational behaviour, illustrating with qualitative data that people's rationality is influenced by their socio-cultural and political identities. We explore three major themes: (1) cultural explanations regarding intention to use screening mammography (2) (dis)trust in science and expert opinion, and (3) self-responsibility and self-surveillance in caring for one's body. Understanding that women rely on different risk discourses to make decisions about their health should aide researchers, health professionals, and the community in better understanding alternative ways of conceptualizing people's health-related behaviours when they do not coincide with health authorities recommendations.
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Affiliation(s)
- Mandana Vahabi
- Toronto District Health Council, Faculty of Nursing, University of Toronto, 41412 Yonge Street, Suite 2001, Toronto, Ontario, Canada M2P 2A8.
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Ellefsen B. Frames and Perspectives in Clinical Nursing Practice: A Study of Norwegian Nurses in Acute Care Settings. Res Theory Nurs Pract 2004; 18:95-109. [PMID: 15083664 DOI: 10.1891/rtnp.18.1.95.28058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the nature of nurses’ clinical practice in terms of what guide their clinical engagement and clinical constructions. Schön (1983) and Argyris, Putnana, and Smith (1985) have demonstrated that practitioners “see” situations differently depending on how they frame the situation. In nursing, there is a lack of knowledge regarding what kinds of frames nurses are using in their clinical work. The research question was: What frames and perspectives guide nurses’ clinical constructions? The study was based on a descriptive design using a clinical field approach in an acute care setting in Norway. A theoretical sample consisted of 6 registered nurses, 3 from medical wards and 3 from surgical wards. Data were collected through participant observation and in-depth interviews with the nurses, as well as nursing documents about the patients. The results showed that the nurses’ frame of reference emerged as normality, health, need, trajectory, and action. These are structured on 3 themes: (a) the patient status dimension with a set of 3 frames that are used to consider patients’ current status and condition in terms of normality, health, and needs; (b) the dimension with a frame for judging patients’ situational experiences in relation to hospitalization, (illness trajectory); and (c) the nurses’ action referring to the frame with which nurses consider their actions. These 5 frames form a complex template with which nurses come to arrive at meanings of clinical situations and “design” or engage in their practice. The nurses are moving back and forth between these different perspectives, circulating around the individual patient or patients as a group. The nurses’ practice in this setting tells about the complexity and diversity permeating the assessment, decisions, and performance of nursing care.
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Affiliation(s)
- Bodil Ellefsen
- Institute of Nursing Science, University of Oslo, P.B. 1120, Blindern, N-0317 Oslo, Norway.
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Brown B, Crawford P. The clinical governance of the soul: 'deep management' and the self-regulating subject in integrated community mental health teams. Soc Sci Med 2003; 56:67-81. [PMID: 12435552 DOI: 10.1016/s0277-9536(02)00008-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Health professionals have often been described as if they were in conflict with the new managerialist spirit in health care. However, because of their distributed and mobile sites of intervention, the work of community teams presents particular problems for traditional notions of management. In this UK study we identify how mental health team members are regulated by means of a subtle 'deep management'. Team members point to a lack of management direction from senior colleagues, even though some of them participate in the management process themselves. However, the lack of overt management leads them to prioritise clients and foreground professional identities in performing their duties and much additional administrative work besides. This also meant that the organisational structure-the team-was defined in subjective terms. Participants had become self-regulating 'deep managed' subjects under a largely hands-off management regime.
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Affiliation(s)
- Brian Brown
- Faculty of Health and Community Studies, De Montfort University, Milton Keynes, UK.
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Zaforteza Lallemand C, de Pedro Gómez JE, Gastaldo D, Lastra Cubel P, Sánchez-Cuenca López P. ¿Qué perspectiva tienen las enfermeras de unidades de cuidados intensivos de su relación con los familiares del paciente crítico? ENFERMERIA INTENSIVA 2003; 14:109-19. [PMID: 14499102 DOI: 10.1016/s1130-2399(03)78115-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction and aim. Nursing professionals in intensive care units (ICU) face situations of uncertainty and anxiety, above all in patients' relatives. In the literature, we find that the way in which the family and their needs are valued by professionals in the unit is not very systematical, even though there are instruments that have been validated for this purpose. Therefore, we decided to value what perspective ICU nurses have of the relationship they establish with patients' relatives, in order to find possible explanations for this situation. Material and methods. A qualitative study with a critical-social orientation. This was carred out in three ICUs in three state hospitals in Mallorca. Research techniques: 8 observations of the visit of relatives to the unit and 6 semi-structured interviews with nurses from the three hospitals. The transcripts of the interviews were analysed and codified in significance units. Sources and methods were triangulated.Results. Categories of the relationship process: 1) who the social actors are; 2) what the actions of the nurses with respect to the relatives are; 3) what the relationships are like between both; and 4) expectations of the nurses regarding this relationship.Conclusions. a) It is necessary to establish quality standards for attending the relatives of critical patients. b) Continuous nursing training is necessary in order to provide emotional support to families and to protect nurses from the added stress involved in providing this emotional support.
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Abstract
BACKGROUND This paper conceptualizes nursing as a health profession in transformation at the beginning of the 21st century. We frame our analysis using Michel Foucault's concept of governmentality. While extensively quoted and used in other disciplines, the work of the late French philosopher has been cited infrequently in the nursing literature. Yet a closer look at his work reveals how Foucault offers a relevant entry point for revisiting nursing theory and nursing practice. AIM OF THE PAPER aim of this paper is to reflect on nursing practice as it is inscribed within the state's modus operandi. We discuss the prevalent notion that nurses are powerless and suggest they do exercise power in many ways and that they are a powerful group. RESULTS In this paper we show how nursing is a means of governmentality of individuals and of the population because its practices contribute to the management of society through a vast range of power techniques. These techniques range from disciplining individuals to promoting discourses that construct desirable subjectivities. Within this perspective, the emergence of political aspects of nursing theory and nursing practice are made explicit. CONCLUSION We explore the limits and potentials of the concept of governmentality to the understanding of nursing as a health profession. This concept can generate a form of critical immobilism, but also promotes a more politically complex understanding of nursing practice.
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Affiliation(s)
- Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power - sovereign, disciplinary and pastoral - which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis.
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Affiliation(s)
- Dave Holmes
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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Gastaldo D, Mercado-Martinez FJ, Ramasco-Gutierrez M, Lizardi-Gomez A, Gil-Nebot MA. Qualitative health research in Ibero-America: the current state of the science. J Transcult Nurs 2002; 13:90-108. [PMID: 11951720 DOI: 10.1177/104365960201300202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Qualitative health research (QHR) comprises a field that has spread and consolidated in Ibero-America (Iberian and Latin American countries) during the 1990s. Until now, however, no systematic evaluation has been made of the qualitative health research published in the region. The aim of this article is to discuss four aspects of QHR: the capability and limitations of using international databases to identify Ibero-American qualitative health studies; the principle health topics studied in Latin America using QHR methodologies; the development of QHR in Spain; and the theoretical perspectives that guide studies in Latin America. A bibliographic search was conducted to identify QHR studies listed in 17 international and/or regional databases. A parallel search was conducted by contacting research centers, academic institutes, and key researchers in several countries.
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Delgado Hito P, Sola Prado A, Mirabete Rodríguez I, Torrents Ros R, Blasco Afonso M, Barrero Pedraza R, Catalá Gil N, Mateos Dávila A, Quinteiro Canedo M. [Modification of nursing practice through reflection: participatory action research]. ENFERMERIA INTENSIVA 2001; 12:110-26. [PMID: 11674947 DOI: 10.1016/s1130-2399(01)78029-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Technology and complex techniques are inevitably playing an increasing role in intensive care units. They continue to characterize nursing care and in some cases dehumanize it. The general aim of this study was to stimulate reflection on nursing care. The study was based on the participation of the investigators with the goal of producing changes in nursing practice. Qualitative methodology in the form of participatory action research and the Kemmis and McTaggart method were used. Data were collected through systematic observation, seven group meetings and document analysis. Eight nurses took part in the study. The meetings were recorded and transcribed verbatim into a computer. This process and the meaning of the verbatim transcription (codification/categorization process and document synthesis cards) were analyzed. The results of this study enabled exploration of the change in nursing practice and showed that the reflection in action method stimulates changes in practice. The new way of conceiving nursing action has increased nursing care quality and its humanization since it shows greater respect for the patient, provides families with closer contact and greater support, improves coordination of nursing care acts and increases collaboration among professionals.In conclusion, participatory action research is a valid and appropriate method that nurses can use to modify their daily practice.
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Affiliation(s)
- P Delgado Hito
- Profesora Colaboradora de la Escuela Universitaria de Enfermería del Hospital de la Santa Creu i Sant Pau. Licenciada en Enfermería por la Universidad de Montreal, Canada
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El reto de investigar en enfermería: una reflexión sobre las universidades españolas y el contexto internacional. ENFERMERIA CLINICA 2001. [DOI: 10.1016/s1130-8621(01)73719-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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