Effective health and wellness systems for rural and remote Indigenous communities: a rapid review

Background: The Canadian healthcare system bares a long legacy of colonisation and assimilation of Indigenous values and approaches to health and wellness. This system often perpetuates social and health inequities through systemic racism, underfunding, lack of culturally appropriate care and barriers to access care. Current funding legislation policies enacted across federal, provincialand territorial governments do not necessarily uphold Indigenous Peoples' rights to self-determination, health and wellness. We summarise literature on promising Indigenous health systems and practices that prioritise and/or improve rural Indigenous Peoples' health and wellness. Objective: The impetus for this review was to provide information on promising health systems, while Dehcho First Nations developed a health and wellness vision. Methods: Documents were gathered from indexed and non-indexed databases to obtain literature from peer-reviewed and non-peer reviewed sources. Two reviewers independently 1) screened titles, abstracts and full texts to ensure they met the inclusion criteria, 2) gathered relevant data from all included documents and 3) identified major themes and sub-themes. Reviewers then discussed and reached consensus on the themes. Results: Thematic analysis revealed six themes for effective health systems for rural and remote Indigenous communities: 1) access to primary care, 2) multi-directional knowledge exchange, 3) culturally appropriate care, 4) training and building community capacity, 5) integrated care and 6) health system funding. Conclusion: Effective health and wellness systems must support Indigenous ways of knowing and doing in healthcare models based on collaborative partnerships with community members, health providers and government agencies.

Children's technologies of the self within neoliberal governmentality at the educational transition to Gymnasium in Zurich

Over the last two decades, research in children's geographies and governmentality studies have contributed significantly to the study of children's experiences in neoliberal educational contexts. This paper furthers this debate by examining the ways children govern and are governed within the neoliberal governmentality at the educational transition to Gymnasium: the only school that offers a direct path to university education within the state-funded school system in Switzerland. Drawing on an ethnography with eight students aged 13-15 during their preparation for the selective entrance examination to Gymnasium in Zurich, this article makes two points: Firstly, it demonstrates how Zurich's education system thrusts students into taking individual responsibility for their educational success at this transition. Secondly, the article draws on Foucault's later work to explore the particular 'technologies of the self' that children adopt coping with this individualized responsibility. This paper argues that these technologies reveal insights into the neoliberal governmentality of this educational transition. Finally, the article argues to critically examine children's technologies of the self to understand their relationships with the education systems they navigate. This line of inquiry serves as a pathway to answer and expand earlier calls to grant children an active voice in research on education.

Credentialing and certification: Overview, science, and impact on policy, regulation, and practice

AIM

To engage the global nursing community in sharing knowledge, experiences, and lessons learned about credentialing of individual nurses to improve nursing practice, patient safety, and quality of care.

BACKGROUND

Although the United States has a long and robust history of credentialing individual nurses, the opportunity exists to expand the dialogue globally, and is supported by globally focused governing bodies who call for increased or expanded investment in nursing certification and credentialing. Foundational work to define and operationalize certification for research purposes and develop an administrative home for stakeholders interested in certification can be leveraged by countries and regions globally. Existing frameworks for credentialing research may be used to drive theory-based research in the future.

SOURCES OF EVIDENCE

PubMed, International Council of Nurses, National Academies of Sciences, Engineering, and Medicine, World Health Organization, American Nurses Association, American Nurses Credentialing Center, and the authors' own experiences.

DISCUSSION

Credentialing as a form of self-governance, as a method for public protection, and as a foundational element in the increasingly new forms of healthcare delivery is intensifying in importance. Credentials provide an opportunity to evaluate relationships between key elements such as nursing practice, environments where nursing care is delivered, and nursing programs with outcomes of interest for the profession such as safety, quality of care, and patient outcomes.

CONCLUSIONS

Establishing rigorous credentials for nurses demonstrates a commitment to excellence. Credentialing frameworks that are universally applied could enable nurses to move seamlessly across geographic boundaries, permit regulators and employers of nurses to have a common set of standards and expectations, and ensure a level of competency for nursing practice that can be interpreted and trusted by various stakeholders.

IMPLICATIONS FOR NURSING POLICY

Policymakers have a pivotal role in advancing credentialing in nursing worldwide. Countries developing credentialing programs in nursing need to study their results to help inform how practice might be required to change over time.

Biometrics and citizenship: Measuring diabetes in the United States in the interwar years

In 1936, the journalist Hannah Lees published "Two Million Tightrope Walkers," drawing attention to the significant number of people in the United States estimated to have diabetes. Focusing on how people with diabetes should live, she emphasized the importance of recording the exact values of everything they ate and avoiding all "riotous living" lest they be unable to keep careful measurements of calories, insulin, and sleep. Employing two meanings of measured - as counted and as moderate - Lees was doing more than communicating how someone might control their disease; she was also calling for a "controlled and self-reliant citizenry." Indeed, Lees insisted that diabetics who followed a regime of measurement "make a good deal better citizens than the average." Drawing on the writings of Lees and other social commentators, I explore the link between biometrics, citizenship, and diabetes in the United States in the interwar years. In particular, I look at how this disease came to symbolize both the regimes of discipline thought to be necessary in a society moving to consumption as its economic motor, and the fears of what could happen if consumption ran amok. Biometrics, I argue, offered clinicians and patients a potent tool for measuring deviance and, potentially, for restoring a person to the "norm."

Transitions to adulthood: self-governance and disciplining in the making of patient citizens

Young people develop new behaviours and redefine their identities during health transitions when they move from paediatric to adult healthcare environments. Their identities help to guide their health-related actions in response to life changes. Young people's health is increasingly recognised as important, yet we lack understanding of how health transitions shape identities and how they relate to other transitions to adulthood. We conducted a longitudinal interview study with young people with sickle cell disease to explore how young people define new identities as they transition to adulthood. We show how 'disciplining at a distance' via healthcare self-management discourses and neoliberal norms governing adolescence play out in the tensions participants encounter when they are crafting new identities. Health transitions involve struggles to negotiate competing demands for self-discipline. It is crucial to create enabling spaces for young people to protect their health while still developing identities that help them achieve life goals.

How Bioethics and Case Law Diverge in Assessments of Mental Capacity: An Argument for a Narrative Coherence Standard

Clinical assessments of mental capacity have long been guided by four basic cognitive criteria (understanding, appreciation, ability to reason, communication of decision), distilled directly from widespread legal precedent in common law cases of informed consent and refusal. This article will challenge the sufficiency of these legal criteria at the bedside on the assertion that clinicians and bioethicists who evaluate decisional capacity face questions far deeper than the mere presence or absence of a patient's informed consent. It will then present an additional standard beyond the existing cognitive criteria - to be called the Narrative Coherence Standard - that may begin to bridge the gap between the existing legal standards and higher-order bioethical priorities. This standard will be treated with a philosophical argument for its use, as well as a detailed exploration of its technical components and conceptual underpinnings.

Developing Autonomy and Transitional Paternalism

Adolescents, in many jurisdictions, have the power to consent to life saving treatment but not necessarily the power to refuse it. A recent defence of this asymmetry is Neil Manson's theory of 'transitional paternalism'. Transitional paternalism holds that such asymmetries are by-products of sharing normative powers. However, sharing normative powers by itself does not entail an asymmetry because transitional paternalism can be implemented in two ways. Manson defends the asymmetry-generating version of transitional paternalism in the clinical context, arguing that it maximizes respect for adolescent autonomy. This article offers an alternative argument in favour of the asymmetry-generating form of transitional paternalism, one that makes appeal to obligations that individuals have to develop self-governance in others. We should share normative powers asymmetrically in the clinical context for three reasons. First, the asymmetric version of transitional paternalism takes seriously duties to support adolescents' developing autonomy, alongside other duties that adults have to young people. It does so by enabling young people to be involved in important decisions that they would otherwise be excluded from. This is of value because participation of this sort is central to the cultivation of their self-governance. Second, only the asymmetric version gives young people a voice in respect of all clinical actions, and only the asymmetric version leaves open the possibility that the coarse lines of legislation might be 'fine-tuned' in individual cases. Third, the asymmetric sharing of normative powers is consistent with the kind of social arrangements that best support autonomy.

Resilience 2.0: social media use and (self-)care during the 2011 Norway attacks

Departing from the understanding that resilience is a technique of self-organization during emergencies, this article provides a study on the way in which the use of social media influenced and engendered societal resilience practices during the 2011 Norway attacks. It builds on the concepts of governmentality and mediality to discuss how the interplay between social media and its users created new forms of self-initiated and mediated emergency governance. Empirically, it draws on material from 20 in-depth interviews with Norwegians who explained and reflected upon their social media use during the attacks. The article presents an overview of the different functions that social media assumed in the process of dealing with the attacks and discusses these vis-à-vis their related challenges. It draws conclusions about the way in which resilience practices and the resilient subject are influenced by the networked character of 2.0 technologies.