Governing nursing through reflection: a discourse analysis of reflective practices

The governmentality of nursing professionalization in advanced liberal societies

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.

Adopting a socio-technical perspective to rethink the use of ICT in VNFIL

Purpose

This paper aims to draw on a socio-technical perspective to explore how information and communication technology (ICT) supports the validation of non-formal and informal learning (VNFIL) in specific practices and arrangements.

Design/methodology/approach

The authors use qualitative content analysis to analyse 43 country reports of the “European inventory on validation” published by the European Centre for the Development of Vocational Training (Cedefop) in 2019.

Findings

This study conceptualises ICT supported VNFIL practices and arrangements from a socio-technical perspective. Given this, the paper finds that ICT is used mainly to provide information on validation practices and arrangements, store qualification registers online and identify and document learning outcomes. The use of ICT to assess and certify learning outcomes remains limited.

Originality/value

VNFIL is very rarely seen in a technical context. This paper contributes to a theoretical perspective and highlights the mutual interdependence of social and technical components. Furthermore, this study provides an overview of inasmuch ICT is currently used to support VNFIL practices and arrangements. Based on the results, validation researchers and practitioners can get inspiration on how to develop ICT supported VNFIL practices and arrangements further.

The relationship between perceived difficulty and reflection in the practice of discharge planning nurses in acute care hospitals: A nationwide observational study

AIMS AND OBJECTIVES

To clarify the characteristics and practice of discharge planning nurses in acute care hospitals and to elucidate the relationship between subjective difficulty perceived in practice and reflection.

BACKGROUND

The importance of discharge planning for an effective transition from the hospital to a care facility is increasing. In acute care hospitals, however, it is not clear what discharge planning nurses are doing for patients who are highly dependent on medical treatment, the subjective difficulties they perceive in practical activities, and whether reflection by nurses can be expected to mitigate those difficulties.

DESIGN

Cross-sectional survey.

METHODS

This survey was conducted in 2,379 acute care hospitals in Japan from 1 June-30 June 2018. The survey of discharge planning practice activities examined nine factors. A nurse who answered that he/she did reflect on his/her practices was defined as a self-reflecting nurse. The STROBE statement checklists were completed.

RESULTS

Questionnaires were collected from 760 respondents (response rate = 32.1%). The discharge planning nurses had fewer than 36 months of experience with discharge planning. Among the nurses who had been involved in hospital discharge support for 13 months or more, the self-reflecting nurses had fewer perceived difficulties in their practice activities than the non-self-reflecting nurses did.

CONCLUSIONS

It was shown that discharge planning nurses with 13 months or more of experience and who practiced reflection on their practical activities perceived less subjective difficulty. Reflection in daily practice may mitigate the subjective difficulty of practical activities experienced by discharge planning nurses, and the establishment of an effective training method that promotes such reflection is required.

RELEVANCE TO CLINICAL PRACTICE

In the future, it will be necessary to construct and evaluate an effective education programme for discharge planning nurses that includes self-reflection on practice cases.

Bounce back- bounce forward: Midwifery students experience of resilience

Resilience is considered a vital characteristic and has gained attention in midwifery practice and education. In particular, midwifery students face challenges during their education in both academic and clinical components of the program. There is need for greater understanding and strategies to develop resilience in the midwifery student population. The aim of this study is to gain insight into how midwifery students conceptualise resilience, and explore how education might support the development of resilience. A focus group was conducted as part of a broader study underpinned by a concept analysis methodology to explore the students understanding of resilience. Participants included six third year midwifery students from one university. Thematic analysis was used to analyse the data. Four key themes were identified. Resilience contextualised to midwifery was triggered by exposure to adversity; resilience was identified as the ability to bounce back and move forward, and was seen to be important for midwifery students. The concept of resilience appears to play an important role in student success. Evidence suggests resilience can be developed and education providers have a role to foster student's resilience. Findings offer strategies to strengthen resilient behaviour for the midwifery student population and provide a basis for further research.

Contested discourses and culture sensitivity: Norwegian nursing students' experience of clinical placement in Nicaragua

Aim

The purpose of this study was to gain understanding of Norwegian students' practical experience of “culture sensitivity.”

Design

Using focus‐group interviews and individual written assignments, we draw on a Foucauldian‐inspired approach to analyse nursing students' narratives about their clinical placement in Nicaragua.

Method

Seven third‐year bachelor nursing students enrolled in a clinical placement programme on the Caribbean coast in Nicaragua and participated in focus‐group interviews. Interviews were conducted prior to their departure to Nicaragua and after their return to Norway. Other sources of data included learning objectives for clinical placement, written individual assignments with students' reflections about their experiences and achievement of learning objectives.

Results

Students expressed gradually increased awareness about the nursing discourses and power relations shaping clinical encounters throughout their learning trajectory in clinical placement. They became more aware of the politics of nursing practices through their experiences of clashes between different nursing discourses.

Unmasking the enterprising nurse: migrant care workers and the discursive mobilisation of productive professionals

Public care work organisations in Northern Europe often seek to increase their economic efficiency in ways that care workers criticise for reducing both their professional autonomy and the quality of care. Recently, the ideal of 'enterprising nursing' has emerged as a political belief according to which economic efficiency, care workers' autonomy and the quality of care can be improved in tandem by cultivating care workers' agential abilities. This article examines the reception of this belief among migrant care workers in Finland. Drawing on research interviews, the analysis demonstrates how migrant care workers may have difficulties in aligning themselves with the enterprising ideals but also in protesting them. Ethnicity, and the status of a migrant, can offer resources for both constructing enterprising subjectivities and reframing care workers' agency, and their organisational environment, in more critical terms.

Workplace bullying prevention: a critical discourse analysis

AIM

The aim of this study was to analyse the discourses of workplace bullying prevention of hospital nursing unit managers and in the official documents of the organizations where they worked.

BACKGROUND

Workplace bullying can be a self-perpetuating problem in nursing units. As such, efforts to prevent this behaviour may be more effective than efforts to stop ongoing bullying. There is limited research on how healthcare organizations characterize their efforts to prevent workplace bullying.

DESIGN

This was a qualitative study.

METHOD

Critical discourse analysis and Foucault's writings on governmentality and discipline were used to analyse data from interviews with hospital nursing unit managers (n = 15) and organizational documents (n = 22). Data were collected in 2012.

FINDINGS

The discourse of workplace bullying prevention centred around three themes: prevention of workplace bullying through managerial presence, normalizing behaviours and controlling behaviours. All three are individual level discourses of workplace bullying prevention.

CONCLUSION

Current research indicates that workplace bullying is a complex issue with antecedents at the individual, departmental and organizational level. However, the discourse of the participants in this study only focused on prevention of bullying by moulding the behaviours of individuals. The effective prevention of workplace bullying will require departmental and organizational initiatives. Leaders in all types of organizations can use the results of this study to examine their organizations' discourses of workplace bullying prevention to determine where change is needed.

Framing the implementation process of video conferencing in discharge planning-According to staff experience

Challenges of improving discharge planning have been an area of concern for many years, including problems related to the lack of time for professionals to participate. In a county in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation of the professionals. To examine the implementation process, interviews were conducted with the implementers, who were project leaders, discharge planning coordinators in the hospital, and in home-care. The interviews were analyzed qualitatively, using directed content analysis with a deductive approach to a theoretical framework that was composed from theories about implementation processes to be suitable for the healthcare sector, consisting of the factors: implementation objects; implementation actions; actors; users; inner context and outer context. The results of this study are consistent with the framework but with the addition of a new dimension-time, i.e. time to prepare; time to understand; time to run through and time to reflect. It is suggested that implementation frameworks are useful when IT is introduced in healthcare. Framing the implementation process supports the exposure of factors and highlights relationships and states of dependence between those factors which may affect implementation.

The Undergraduate Medical Radiation Science Students' Perception of Using the e-Portfolio in Their Clinical Practicum

PURPOSE

Portfolios have been discussed in the literature as a method of encouraging health care professionals to reflect on practice and to self-assess. In undergraduate education, it is envisioned as an authentic assessment of the student's development. Readiness to practice for graduates of the joint University of Toronto and The Michener Institute undergraduate Medical Radiation Sciences (MRS) program includes the demonstrated ability to reflect. A study was done to evaluate the learning e-portfolio being used by the MRS radiation therapy students in the clinical practicum. This article discusses student perspectives.

METHODS

In 2010, the undergraduate radiation therapy class (N = 50) was invited to participate in the study after the electronic portfolio was used in their clinical placement for the first time. An online survey and focus group discussions were organized to get their perspectives. This was action research from which descriptive and thematic analyses are presented.

RESULTS

Nineteen students consented to participate in the study. The respondents reported that the e-portfolio helped them to develop a sense of responsibility for their own professional development (88%), to improve their reflective (80%), and self-assessment skills (80%). The themes that emerged are in alignment with other studies for a learning portfolio, although the electronic format posed an additional challenge for the students.

CONCLUSIONS

The e-portfolio was perceived to be an effective tool to enhance professional skills, including their understanding of professional development expectations as future MRS graduates. One of the limitations of this study was it had a small number of participants; however, as a springboard, it provided an important view of the potential of the e-portfolio and the format of support required for the learners in the undergraduate radiation therapy program.

Examining clinical supervision as a mechanism for changes in practice: a research protocol

AIM

This paper describes the research protocol for a study exploring if and how clinical supervision facilitates change in practice relating to psychosocial aspects of care for Health Professionals, who have been trained to deliver a psychosocial intervention to adults with cancer.

BACKGROUND

There is a recognized need to implement care that is in line with clinical practice guidelines for the psychosocial care of adults with cancer. Clinical supervision is recommended as a means to support Health Professionals in providing the recommended psychosocial care.

DESIGN

A qualitative design embedded within an experimental, stepped wedge randomized control trial.

METHODS

The study will use discourse analysis to analyse audio-recorded data collected in clinical supervision sessions that are being delivered as one element of a large randomized control trial. The sessions will be attended primarily by nurses, but including physiotherapists, radiation therapists, occupational therapists. The Health Professionals are participants in a randomized control trial designed to reduce anxiety and depression of distressed adults with cancer. The sessions will be facilitated by psychiatrists experienced in psycho-oncology and the provision of clinical supervision.

DISCUSSION

The proposed research is designed specifically to facilitate exploration of the mechanisms by which clinical supervision enables Health Professionals to deliver a brief, tailored psychosocial intervention in the context of their everyday practice. This is the first study to use discourse analysis embedded within an experimental randomized control trial to explore the mechanisms of change generated within clinical supervision by analysing the discourse within the clinical supervision sessions.

Qualitative research as evidence: criteria for rigour and relevance

This paper is about the nature and construct of evidence and its relation to qualitative research. Using a post-modern lens, we begin by defining evidence, signifying the importance of context, and use discourse as a vehicle for looking at the ways in which qualitative research evidence struggles to achieve the equivalent standing of its quantitative counterpart. In outlining the role of discourse in the creation of research paradigms, we offer a conceptual map that enables a repositioning of qualitative research in the evidence-based genre. In order to best illustrate our standpoint, we then provide two examples of qualitative, transformational research approaches and relate these to the criteria of rigour and relevance, criteria which we would argue when met are examples of high-quality evidence. Having used the examples of discourse analysis and auto-ethnography, we then conclude by exposing and decentralising the myth that surrounds the discourse of evidence-based practice, which continues, albeit unintentionally, to discredit any evidence that falls outside of its parameters.