In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses’ wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence (...) about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses’ wound work as it arises within the established uptake of scientific evidence. (shrink)

This paper challenges nurses to join together as a collective in order to facilitate ongoing analysis of the issues that arise for nurses and patients when nursing care is harnessed for health care efficiencies. It is a call for nurses to respond with a collective strategy through which we can ‘talk back’ and ‘act back’ to the powerful rationality of current thinking and practices. The paper uses examples from an institutional ethnographic (IE) research project to demonstrate how dominant approaches to (...) understanding nursing position nurses to overlook how we activate practices of reform that reorganize how we nurse. The paper then describes two classroom strategies taken from my work with students in undergraduate and graduate programs. The teaching strategies I describe rely on the theoretical framework that underpin the development of an IE analysis. Taken into the classroom (or into other venues of nursing activism) the tools of IE can be adapted to inform a pedagogical approach that supports nurses to develop an alternate analysis to what is happening in our work. (shrink)

Within the literature that circulates in the discourses organizing nursing education, there are embedded assumptions that link student performance on maths examinations to safe medication practices. These assumptions are rooted historically. They fundamentally shape educational approaches assumed to support safe practice and protect patients from nursing error. Here, we apply an institutional ethnographic lens to the body of literature that both supports and critiques the emphasis on numeracy skills and medication safety. We use this form of inquiry to open an (...) alternate interrogation of these practices. Our main argument posits that numeracy skills serve as powerful distraction for both students and teachers. We suggest that they operate under specious claims of safety and objectivity. As nurse educators, we are captured by taken‐for‐granted understandings of practices intended to produce safety. We contend that some of these practices are not congruent with how competency actually unfolds in the everyday world of nursing practice. Ontologically grounded in the materiality of work processes, we suggest there is a serious disjuncture between educators' assessment and evaluation work where it links into broad nursing assumptions about medication work. These underlying assumptions and work processes produce contradictory tensions for students, teachers and nurses in direct practice. (shrink)

‘Patient satisfaction’: Knowledge for ruling hospital reform — An institutional ethnography Driven by funding restraint, Canadian health‐care has undergone over a decade of significant reform. Hospitals are being restructured, as text‐based practices of accountability bring a new business‐orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance (...) of text‐based management. I analyse information about ‘patient satisfaction’ as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about ‘what actually happened’ as a professional caregiver would have known it. On this basis, I contend that this sort of taken‐for‐granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations (...) with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently (...) in the analysis as a high‐level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health‐care providers in spaces called ‘wait times’, where it is systematically rendered ‘unknowable’. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. (shrink)

This new book integrates material drawn from a variety of sources – feminist theory, cultural and literary analysis, sociology and art history – in an original discussion of women′s relationship to modern and post–modern culture. The essays in the book challenge the continuing separation of sociological from textual analysis in cultural (and feminist) theory and enquiry. They address critically the question of women′s writing, exploring the idea that women may begin to define their own lives and construct their identities in (...) a patriarchal culture through the very process of writing. They also present a cogent defence of a feminist cultural politics, including a politics of the body. (shrink)

Feminism, poststructuralism, postcolonialism, and Marxism, among other critical approaches, have undermined traditional notions of aesthetics in recent decades. But questions of aesthetic judgment and pleasure persist, and many critics now seek a "return to aesthetics" or a "return to beauty." Janet Wolff advances a "postcritical" aesthetics grounded in shared values that are negotiated in the context of community. She relates this approach to contemporary debates about a committed politics similarly founded on the abandonment of certainty. Neither universalist nor relativist, (...) the "aesthetics of uncertainty" provides a discourse on beauty that contemporary critics can engage with and offers a basis for judgment that is committed to assigning value to works of art. Wolff explores her position through a range of topics: the question of beauty in relation to feminist critique; the problematic status of twentieth-century English art, visual representations of the Holocaust, Jewish identity as portrayed by the artist R. B. Kitaj, refugee artists and modernism in 1940s Britain, and the nature and appeal of imagistic thinking in sociology. She addresses the desire for certainty and the timeliness of doubt and concludes with a meditation on the intersection of aesthetics and ethics, arguing that ethical issues are very much implicated in aesthetic discourse. (shrink)

Feminism, poststructuralism, postcolonialism, and Marxism, among other critical approaches, have undermined traditional notions of aesthetics in recent decades. But questions of aesthetic judgment and pleasure persist, and many critics now seek a "return to aesthetics" or a "return to beauty." Janet Wolff advances a "postcritical" aesthetics grounded in shared values that are negotiated in the context of community. She relates this approach to contemporary debates about a committed politics similarly founded on the abandonment of certainty. Neither universalist nor relativist, (...) the "aesthetics of uncertainty" provides a discourse on beauty that contemporary critics can engage with and offers a basis for judgment that is committed to assigning value to works of art. Wolff explores her position through a range of topics: the question of beauty in relation to feminist critique; the problematic status of twentieth-century English art, visual representations of the Holocaust, Jewish identity as portrayed by the artist R. B. Kitaj, refugee artists and modernism in 1940s Britain, and the nature and appeal of imagistic thinking in sociology. She addresses the desire for certainty and the timeliness of doubt and concludes with a meditation on the intersection of aesthetics and ethics, arguing that ethical issues are very much implicated in aesthetic discourse. (shrink)

Originally presented as the author's thesis, University of Birmingham, 1972. Bibliography: p. 139-146. Includes index.

Rosamond Kent Sprague’s translations of the _Laches and Charmides_ are highly regarded, and relied on, for their lucidity and philosophical acuity. This edition includes notes by Sprague and an updated bibliography.

Crisis demands -- Crisis narratives -- Crisis: refrain!

A feminist primer for philosophers of science -- The legacy of twentieth century philosophy of science -- What feminist science studies can offer -- Challenges from every direction -- The prospects of twenty-first century philosophy of science.

To be truly provocative and outrageous the superior philosophical sophistry will commonly possess four somewhat adventitious features. I shall rate it as classic if it has all four. First, and least adventitiously, the argument will be crisp and initially seductive. Second, by the standard the sophistry sets direct rebuttal will be laborious and diffuse. Third, the recipe for the latter will prescribe that we pick out some hitherto unarticulated logical principle such that if the principle be true then the sophistical (...) argument must be invalid, and then, on the strength of that consequence assume the principle to be true. Consequently and fourth, as an antidote parody is supreme. With a persuasive absence of fuss and bias we can turn the tables if we show that, if the sophistical argument were really valid, then some structurally similar argument would prove just as consummately far too much. In short, from the rhetorical point of view at least, Gaunilo is more lethal than Kant. Even if the similarity is defective, the sophist will lose some of his adventitious and insufferable poise, if he ventures to show why. (shrink)

Is it time to take a break from feminism? In this pathbreaking book, Janet Halley reassesses the place of feminism in the law and politics of sexuality. She argues that sexuality involves deeply contested and clashing realities and interests, and that feminism helps us understand only some of them. To see crucial dimensions of sexuality that feminism does not reveal--the interests of gays and lesbians to be sure, but also those of men, and of constituencies and values beyond the (...) realm of sex and gender--we might need to take a break from feminism. Halley also invites feminism to abandon its uncritical relationship to its own power. Feminists are, in many areas of social and political life, partners in governance. To govern responsibly, even on behalf of women, Halley urges, feminists should try taking a break from their own presuppositions. Halley offers a genealogy of various feminisms and of gay, queer, and trans theories as they split from each other in the United States during the 1980s and 1990s. All these incommensurate theories, she argues, enrich thinking on the left not despite their break from each other but because of it. She concludes by examining legal cases to show how taking a break from feminism can change your very perceptions of what's at stake in a decision and liberate you to decide it anew. (shrink)

In 1978, as the protests against the Shah of Iran reached their zenith, philosopher Michel Foucault was working as a special correspondent for _Corriere della Sera_ and _le Nouvel Observateur_. During his little-known stint as a journalist, Foucault traveled to Iran, met with leaders like Ayatollah Khomeini, and wrote a series of articles on the revolution. _Foucault and the Iranian Revolution _is the first book-length analysis of these essays on Iran, the majority of which have never before appeared in English. (...) Accompanying the analysis are annotated translations of the Iran writings in their entirety and the at times blistering responses from such contemporaneous critics as Middle East scholar Maxime Rodinson as well as comments on the revolution by feminist philosopher Simone de Beauvoir. In this important and controversial account, Janet Afary and Kevin B. Anderson illuminate Foucault's support of the Islamist movement. They also show how Foucault's experiences in Iran contributed to a turning point in his thought, influencing his ideas on the Enlightenment, homosexuality, and his search for political spirituality. _Foucault and the Iranian Revolution_ informs current discussion on the divisions that have reemerged among Western intellectuals over the response to radical Islamism after September 11. Foucault's provocative writings are thus essential for understanding the history and the future of the West's relationship with Iran and, more generally, to political Islam. In their examination of these journalistic pieces, Afary and Anderson offer a surprising glimpse into the mind of a celebrated thinker. (shrink)

This study investigated effects of codes of ethics on perceptions of ethical behavior. Respondents from companies with codes of ethics (n = 465) rated role set members (top management, supervisors, peers, subordinates, self) as more ethical and felt more encouraged and supported for ethical behavior than respondents from companies without codes (n = 301). Key aspects of the organizational climate, such as supportiveness for ethical behavior, freedom to act ethically, and satisfaction with the outcome of ethical problems were impacted by (...) the presence of an ethics code. The mere presence of a code of ethics appears to have a positive impact on perceptions of ethical behavior in organizations, even when respondents cannot recall specific content of the code. (shrink)

A mirror image is not an image of a thing seen, but that thing seen in a different perspective.

This study explores the effect of individuation training on the acquisition of race-specific expertise. First, we investigated whether practice individuating other-race faces yields improvement in perceptual discrimination for novel faces of that race. Second, we asked whether there was similar improvement for novel faces of a different race for which participants received equal practice, but in an orthogonal task that did not require individuation. Caucasian participants were trained to individuate faces of one race (African American or Hispanic) and to make (...) difficult eye-luminance judgments on faces of the other race. By equating these tasks we are able to rule out raw experience, visual attention, or performance/success-induced positivity as the critical factors that produce race-specific improvements. These results indicate that individuation practice is one mechanism through which cognitive, perceptual, and/or social processes promote growth of the own-race face recognition advantage. (shrink)

This study investigated effects of codes of ethics on perceptions of ethical behavior. Respondents from companies with codes of ethics (n = 465) rated role set members (top management, supervisors, peers, subordinates, self) as more ethical and felt more encouraged and supported for ethical behavior than respondents from companies without codes (n = 301). Key aspects of the organizational climate, such as supportiveness for ethical behavior, freedom to act ethically, and satisfaction with the outcome of ethical problems were impacted by (...) the presence of an ethics code. The mere presence of a code of ethics appears to have a positive impact on perceptions of ethical behavior in organizations, even when respondents cannot recall specific content of the code. (shrink)

This article reports the results of an exploratory investigation of a particular area of moral tension experienced by MBA students in a graduate school of business. During the first phase of the study, MBA students'' own perceptions about the moral climate and culture of the business school were examined. The data gathered in this first part of the study indicate that the students recognize that a central part of this culture is constituted by a shared familiarity with a set of (...) institutionally reinforced premises about human behavior and motivation including the ideas that: 1) people are self-interested utility-maximizers, 2) individuals should be unimpeded in their pursuit of their own self-interest through economic transactions, and 3) virtually all human interactionsare economic transactions. The data further indicated that the business students experience a degree of tension between this ethic of self-maximizing and the everyday ethics prevalent in our broader culture, in which altruism and selflessness are central elements. The final section of the study was an effort to see whether and how these institutionally sanctioned premises were integrated into the students'' arguments about the relationship between self-interest and social responsibility. (shrink)

This collection of contributions from both linguists and lawyers brings a pragmatic perspective to the linguistic basis for legal meaning and for finding a norm by which to decide a case. That is, it turns from notions of linguistic meaning as residing in the text, as literal meaning waiting to be dug out, to focus instead on how readers infer pragmatic meaning, and on the kinds of inferencing that characterise legal discourse.

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising (...) from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience. (shrink)

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

Posthuman affirmative ethics relies upon a fluid, nomadic conception of the ethical subject who develops affective, material and immaterial connections to multiple others. Our purpose in this paper is to consider what posthuman affirmative business ethics would look like, and to reflect on the shift in thinking and practice this would involve. The need for a revised understanding of human–animal relations in business ethics is amplified by crises such as climate change and pandemics that are related to ecologically destructive business (...) practices such as factory farming. In this analysis, we use feminist speculative fiction as a resource for reimagination and posthuman ethical thinking. By focusing on three ethical movements experienced by a central character named Toby in Margaret Atwood’s MaddAddam trilogy, we show how she is continually becoming through affective, embodied encounters with human and nonhuman others. In the discussion, we consider the vulnerability that arises from openness to affect which engenders heightened response-ability to and with, rather than for, multiple others. This expanded concept of subjectivity enables a more relational understanding of equality that is urgently needed in order to respond affirmatively to posthuman futures. (shrink)

To analyze which ethically relevant biases have been identified by academic literature in artificial intelligence algorithms developed either for patient risk prediction and triage, or for contact tracing to deal with the COVID-19 pandemic. Additionally, to specifically investigate whether the role of social determinants of health have been considered in these AI developments or not. We conducted a scoping review of the literature, which covered publications from March 2020 to April 2021. ​Studies mentioning biases on AI algorithms developed for contact (...) tracing and medical triage or risk prediction regarding COVID-19 were included. From 1054 identified articles, 20 studies were finally included. We propose a typology of biases identified in the literature based on bias, limitations and other ethical issues in both areas of analysis. Results on health disparities and SDOH were classified into five categories: racial disparities, biased data, socio-economic disparities, unequal accessibility and workforce, and information communication. SDOH needs to be considered in the clinical context, where they still seem underestimated. Epidemiological conditions depend on geographic location, so the use of local data in studies to develop international solutions may increase some biases. Gender bias was not specifically addressed in the articles included. The main biases are related to data collection and management. Ethical problems related to privacy, consent, and lack of regulation have been identified in contact tracing while some bias-related health inequalities have been highlighted. There is a need for further research focusing on SDOH and these specific AI apps. (shrink)

ABSTRACT Previous research has consistently highlighted the importance of stakeholder engagement in identifying and developing solutions to ethical challenges in genomic research, especially in Africa where such research is relatively new. In this paper, we examine what constitutes good ethical practice in research, from the perspectives of genomic research participants in Uganda. Our study was part of a multi-site qualitative study exploring these issues in Uganda, Ghana and Zambia. We purposively sampled various stakeholders including genomic research participants, researchers, research ethics (...) committee members, policy makers and community members. This paper presents the findings from in-depth interviews with 27 people with diabetes who had participated in a diabetes genomic study. Data were collected using semi-structured interviews. Manual thematic content analysis was conducted using a framework approach. Findings indicate three key requirements that research participants see as vital for genomic research to be more responsive to research participants’ needs and contextual realities: (1) de-emphasising the role of experts and institutions in the consenting process, (2) clarity about the timing and nature of feedback both of findings relevant to the health of individuals and about the broad progress of the study, and (3) more effective support for research participants during and after the study. (shrink)

We suggest that policies will be less popular when individuals personally have to pay for them rather than when others have to pay (i.e., a Not Out of My Bank Account or NOMBA effect). Dual process models of persuasion suggest that personally having to pay would motivate scrutiny of persuasive messages making it essential to use effective science communication tactics when using climate science to support climate change policies. A pilot experiment (N = 186) and main study (N = 758) (...) support a NOMBA effect with less policy support (Pilot study) and lower recommended fees (Main study) for a policy that would require participants, rather than another group, to pay a fee for community solar panels. Consistent with dual process models and suggesting systematic processing, only when participants would have to pay the fee, messages using strong (vs. weak) science communication tactics increased support for policies (Pilot study), increased the favorability of thoughts about the policy (Main study) and these thoughts subsequently predicted policy support (Main study). Inconsistent with propositions that information about expert sources would be a heuristic or bolster science messages, expert consensus information did not influence thoughts or policy support in any study condition. Efforts to understand climate change policy support would benefit from attending to research on dual process models of persuasion, including understanding how different types and degree of outcome relevance can alter how people process science information used to bolster support for climate change policies. (shrink)

This book attempts to understand regret, an emotion that bridges the actual and the possible, the past and present. Through a wealth of sources it takes up questions of the meaning of regret and how it differs from similar experiences such as remorse and guilt; what sorts of things people most often regret; and the roots of regret in circumstances and in who we are. It takes issue with the view common both in this culture and in leading theories of (...) decision that regret is irrational and dysfunctional - specifying the surprising benefits of regret, its great and good sense. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant (...) consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)

Functionalism in the philosophy of mind is the doctrine that what makes something a mental state of a particular type does not depend on its internal constitution, but rather on the way it functions, or the role it plays, in the system of which it is a part. This doctrine is rooted in Aristotle's conception of the soul, and has antecedents in Hobbes's conception of the mind as a “calculating machine”, but it has become fully articulated (and popularly endorsed) only (...) in the last third of the 20th century. Though the term ‘functionalism’ is used to designate a variety of positions in a variety of other disciplines, including psychology, sociology, economics, and architecture, this entry focuses exclusively on functionalism as a philosophical thesis about the nature of mental states. (shrink)

Recent research on the cognitive abilities and emotional capacities of animals has fueled the animal rights movement and renewed debate over the differences between human and non-human animals. This debate has not been central to sociology, although George Herbert Mead drew a very hard line between humans and animals by asserting that the latter were not capable of symbolic interaction. Sociologists are now beginning to question this assumption, and this article falls within this new line of research. We begin by (...) presenting alternative interpretations of symbolic interaction that allow for the possibility of such activity in non-human animals. We review recent research on symbolic interaction between humans and dogs, and we present our own research findings on human-feline interaction. We conclude that there is growing evidence that symbolic interaction is widely distributed throughout the animal kingdom, and that it enables animals to survive more effectively in a wide variety of environments. (shrink)