The image of the hospital is presented to the public as a place of healing. Though the oft‐criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing practices (...) may disrupt the agency of both patients and nurses alike. (shrink)

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) (...) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally. (shrink)

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting (...) upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

Based on our respective research programs (psychiatry, forensic psychiatry, public health, HIV/AIDS, harm reduction) this article aims to use purposely non‐conventional means to present the substantial contribution of poststructuralist perspectives to knowledge development in nursing science in general and in our current research in particular. More specifically, we call on the work of Michel Foucault and Deleuze & Guattari to politicize nursing science using examples from our empirical research programs with marginal and often highly marginalized populations. We discuss the concepts (...) of power, discourse, and resistance to illustrate the essential contribution of poststructuralism to marginal, even “nomadic”, nursing research. (shrink)

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that (...) new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of ‘assemblage’. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs. (shrink)

For decades, nursing as a discipline has tried to establish itself within the socio‐professional and the socio‐political arenas. To date, several theorists have attempted to thoroughly define the essence (ontology) of nursing while others have proposed means (syntax) to achieve this ‘collective’ objective. Considering that this preoccupation, rooted in essentialism, is pervasive in the nursing literature, our claim is that these quests should be criticized because they impede innovative and transdisciplinary approaches to nursing theory. Our criticism includes the perspective supported (...) by the so‐called ‘postmodern nursing theorists’. We argue that the oeuvre of some nursing postmodern scholars is as prescriptive and linear as the ones they critique. Like it was done before, the discourse of these thinkers perpetuates the status quo by excluding alternative forms of knowledge that cross the boundaries of the discipline of nursing. Using the work of Deleuze and Guattari, this paper proposes an alternative way to conceive the development of nursing knowledge, which, we think, could represent an alternative way to explore the discipline of nursing. (shrink)

Working within the tradition of continental philosophy, this article argues in favour of a phenomenological understanding of language as a crucial component of bioethical inquiry. The authors challenge the ‘commonsense’ view of language, in which thinking appears as prior to speaking, and speech the straightforward vehicle of pre-existing thoughts. Drawing on Maurice Merleau-Ponty's (1908–1961) phenomenology of language, the authors claim that thinking takes place in and through the spoken word, in and through embodied language. This view resituates bioethics as a (...) matter of bodies that speak. It also refigures the meaning of ethical self-reflexion, and in so doing offers an alternative view on reflexivity and critique. Referring to the Kantian critical tradition and its reception by Hannah Arendt and Michel Foucault, we advance a position we call ‘critical ethical reflexivity’. We contend that Merleau-Ponty's phenomenology of language offers valuable insight into ethical reflexivity and subject formation. Moreover, his understanding of language may foster new qualitative empirical research in bioethics, lead to more nuanced methods for interpreting personal narratives, and promote critical self-reflexion as necessary for bioethical inquiry. (shrink)

Human enhancement technologies raise serious ethical questions about health practices no longer content simply to treat disease, but which now also propose to “optimize” human beings’ physical, cognitive and psychological abilities. These technologies call for a reassessment of our relationship to health, the human body and the body's organic, identity and social functions. In nursing, such considerations are in their infancy. In this paper, we argue for the relevance of critical phenomenology as a way to better understand the ethical issues (...) related to human enhancement technologies (HET). In so doing, we seek to problematize HET and assess their influence on the future development of nursing science and practice. It is difficult to anticipate the concrete effects of HET, we suggest, because these practices reconfigure the meaning of normativity and disorient our conventional ethical landscape. In this context, we argue that the later work of Martin Heidegger and Michel Foucault invites a critical perspective into how techno‐scientific discourses modify our relationship to care, to health and to our own social and corporeal identities. Despite the traditional philosophical opposition between phenomenology and critical theory, we maintain that a hybrid critical phenomenological approach opens new ways to assess the integration of technology and practice. Our analysis understands HET as a process of “hybridization” between technological objects and human subjects. Critical phenomenology thus effectively questions anthropocentric definitions of technology, challenges the dichotomy between curative treatment and enhancement and, finally, prompts valuable reflection on the implications of HET for nursing theory and practice. (shrink)

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are (...) fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. (shrink)

Group sex among men who have sex with men may be understood as a ‘radical’ practice insofar as it transgresses dominant social discourses around appropriate sexual relations—prioritizing heteronormative, monogamous and risk‐averse sex. These practices are generally defined as steeped in risk, most commonly due to the potential for transmitting human immunodeficiency virus and sexually transmitted infections and accompanied by the possibility of legal and social repercussions. Our ethnographic research study explored the desires, practices and contexts of group sex participants (n (...) = 10) within a popular group sex party destination located in the United States. We employ a poststructuralist perspective (utilizing the work of Deleuze and Guattari) to understand group sex events with the pretext that bodies have no inherent ethics, meaning or essence: they are ‘bodies without organs’. We identify group sex as a form of boundary play, in which participants pursue new limits to what their bodies can do but within a carefully constructed environment that establishes norms of interaction meant to secure trust and safety between participants. A variety of risk reduction practices are shown to be promoted and honoured within these eventful sexual(ized) spaces. The application of poststructuralist concepts of ‘boundary play’ and ‘bodies without organs’ helped to depict the construction and navigation of pleasure, safety and risk among group sex participants. (shrink)

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients (...) who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

Since the era of deinstitutionalisation, many clinical approaches have emerged to enable the care and treatment of people suffering from mental illness. In recent years, the use of coercive approaches in the community (e.g., outpatient commitment or community treatment orders) has also increased internationally. Although nurses' role regarding these coercive approaches is central and significant, few empirical and theoretical writings have tackled this controversial nursing practice. The purpose of this paper is to analyse coercive nursing care through the lens of (...) French philosopher Gilles Deleuze's concept of ‘societies of control’. Taking up Michel Foucault's work on disciplinary power, Deleuze explores how the move from the striated spaces of closed institutions to the smooth spaces of societies of control took place since the middle of the 20th century. According to Deleuze, the overall objective of ‘societies of control’ is no longer simply to govern deviant behaviour in closed environments (e.g., psychiatric hospitals and prisons) but to ensure a regime of unrelentless surveillance in the open spaces of our communities. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, (...) and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork as an application of (...) healthcare professionals’ skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. (shrink)

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. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews (...) constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

The view from inside : gendered embodiment and the medical representation of sex / Shelley Wall -- The politics of medico-legal recognition : the terms of gendered subjectivity in the UK Gender Recognition Act / Sarah Burgess -- Journeys of choice? : abortion, travel, and women's autonomy / Christabelle Sethna and Marion Doull -- The code of ethics in medicine : intertextuality and meaning in Plato's Sophist and Hippocrates' oath / Twyla Gibson -- Sleeping ethics : gene, episteme, and the (...) body politic / Deborah Lynn Steinberg -- The last temptation of Marion Woodman : the anorexic remainder in bone : dying into life / David L. Clark. (shrink)

The human body has come to be seen as forever susceptible to both external and internal hazards, which in many circumstances require immediate, heroic, and expensive intervention. In response to this, there has been a shift from a treatment‐based healthcare model to one of prevention wherein nurses play an integral role by identifying and assessing risks for individuals, communities, and populations. This paper uses Deborah Lupton’s outline of the spectrum of risk and applies the theoretical works of Foucault and Plato (...) to demonstrate the means by which nurses maintain social order by identifying and counselling risk takers. It also utilizes the work of Deleuze and Guattari to illustrate how Plato’s framework for creating social order through the creation of the good citizen can be viewed as a micro‐fascist system, which has been adopted wholeheartedly by preventative health professionals. The goal of this paper is to present an alternate understanding of risk to provide nurses and other healthcare professionals with a non‐traditional appreciation of certain aspects of their practice as researchers and clinicians. (shrink)

The aim of this article is to critique health policy discourses that are taken for granted. This perspective will allow for the identification of ‘exclusionary’ health policies, which we define as policies that are thought to offer universal benefit, despite yielding adverse effects for significant groups of people in society. As such, policies that are said to be designed ‘for all’ frequently benefit only a subset of the population. Our intent is to highlight the distributional consequences of certain health policies (...) that are largely institutionalized in contemporary society. We believe that these distributional effects are explicit representations of power in society and that institutions may provide individual ‘choice’ and ‘freedom’ that, in turn, yields separation as an outcome, a separating equilibrium. Specifically, if those who benefit from policies of partition are numerous and are to obtain significant advantage or incur limited costs, or if those who are adversely affected are scarce (or hidden), or the size of these adverse effects are small (or perceived to be minor), then partition becomes more likely as a ‘legitimate’, but exclusionary, instrument of public policy. (shrink)

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV‐status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV‐positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, (...) including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice. (shrink)

There is an enduring debate in nursing regarding the art–science dualism, involving an articulation of two distinct ‘kinds’ of disciplinary knowledge: objective/scientific and subjective/artistic. Nursing identifies both as necessary, yet unbridgeable, which creates problems in constructing a coherent disciplinary knowledge base. We describe how this problem arises based on an ontological assumption of two different kinds of ‘stuff’ in the world: that with essential determinate properties and that without essential properties. We experiment with a solution by ontologically understanding the world (...) as made from a single kind: That the most irreducible element of the world is process, in that reality is a continuous construction whereby subject and object are products, not independent constituents, of reality. Process philosophy overcomes nursing's ontological bifurcation and enables nursing's art–science dualism to be re‐conceptualized as a cohesive logic of skilled reality production. An unavoidable implication of a process turn in nursing philosophy is that the disciplinary goal no longer becomes a privileged ‘body of knowledge’ that authorizes, which has always been a defining challenge in nursing. Rather, and more productively perhaps, the aim is for greater sophistication and plurality in its ongoing commitment to attuning to reality in ways that shape disciplinary attainment. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity (...) through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the ‘person’ or ‘patient’ that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken‐for‐granted definitions and assumptions of the ‘person’ from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the ‘person’ in nursing and beyond. Cronenberg's work explores bodily transformation and (...) mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of ‘the person’. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming‐mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles. (shrink)

This paper seeks to analyze the construction of ethics in sexuality research in which qualitative methods are employed in the field of social sciences. Analyses are based on a bibliographic review of current discussions on research methods of queer theory and on the authors' own experiences of past research on sexuality. The article offers a theoretical perspective on the ways ethnography and in‐depth interviews become methods that can rely on a consensual method and create a politics of intimacy between the (...) researchers and research participants. The politics of intimacy may contribute to the production of a politically engaged knowledge while escaping from the moral matrix that usually governs the relationship between researchers and research participants. It is argued here that the researcher's sexed and gendered body matters for fieldwork; that the consensual method among participants may be employed in sexuality research as a fruitful tool; and that the relationships created among researchers and participants can pose a challenge to predetermined ethical guidelines in research. As a result, discussions problematize the existence of a politics of intimacy in sexuality research that is characterized by ethical relations among research participants. (shrink)

The provision of “closer-to-patient” services has increased in most industrialized countries. However, the migration of services in non-traditional health care settings implies redefining the role of technical and human entities and transforming the nature and use of technologies and places. Drawing on various scholarly efforts to conceptualize space, place, and technology, this paper compares and contrasts satellite and mobile dialysis units implemented in two regions in the province of Quebec, Canada. The satellite units were hosted in two small, local hospitals (...) where nursing staff had been recently trained. The mobile unit was a bus adapted to host five dialysis stations; nurses traveled back and forth between a university teaching hospital and two sites located within a radius of 7.6 miles. In both projects, nephrologists supervised from a distance via a videoconferencing system. Our aim is to illustrate the ways in which the displacement of technical and human entities gives shape to new forms of emplacement in non-traditional health care settings. The satellite and mobile units contributed to the culture of dialysis care and transformed the identity of nurses, doctors, patients, and technologies. By contrasting two projects involving different spatial and clinical logics, we analyze in what ways certain forms of recombination of human and technical entities can prove incomplete but nevertheless acceptable to providers and project managers. (shrink)

Inspirée d’un cadre poststructuraliste, cette étude qualitative de « réception d’un médium » nous a permis de mettre en lumière les « lectures » que font une vingtaine de consommateurs de pornographie des notions de masculinité, de race et ethnicité, du milieu gai et du genre en lien avec la pornographie qu’ils consomment. Les résultats qui émergent de notre analyse critique de discours sont à l’effet que les lectures des consommateurs sont majoritairement dominantes, reproduisant ainsi les stéréotypes présents en société (...) et qui sont re/produits et véhiculés dans la pornographie qu’ils consomment. Les récits des participants attestent du fait que ces derniers remettent peu en question ce qu’ils voient dans le matériel pornographique ; matériel pouvant avoir certaines répercussions sur des indicateurs de santé mentale en accentuant et perpétuant certaines formes de stigmatisation chez certains groupes sociaux. Inspired by a poststructuralist perspective, our qualitative exploratory media reception study offers a critical discourse analysis of 20 male pornography consumers, focusing on their readings of masculinity, race/ethnicity, the gay world, and gender in relation to the pornography they consume. For the most part, results show dominant readings of these categories, which suggests that social stereotypes are produced, reproduced, and transmitted through the medium of pornography. Participant narratives reveal individuals who rarely question what is shown in pornographic material; the latter having potential implications for certain mental health indicators, as well as perpetuating and accentuating forms of stigmatization among specific social groups. (shrink)

The body of the one deemed mad often remains a sexual body with sexual needs. Mental health services respond to these demands of the body in various ways, including constructing rules around physical movement. In this context, we were interested in how mental health clinicians problematized the sexual needs and practices of residents of a long‐stay mental health rehabilitation facility and how solutions were constructed in relation to the residents’ sexual desires. This paper reports findings from mental health clinicians, as (...) part of a case study where we addressed this question. Mental health clinicians responded to residents’ sexuality from a discourse of risk. The notion of the engagement with each resident as a sexual subject was subordinated to the paternalistic notion of protecting the patient from risk. The resident became an object to be monitored and protected rather than a subject with sexual desire and agency. This paternalism also showed itself in relation to a ‘no‐sex on‐site’ rule that allowed for a shift of risk from the organization to the resident. Residents, rather than having a relatively safe place to have sexual relations, were required to find a place elsewhere, potentially unsafe, outside the facility. (shrink)

The idea of the Guantánamo detainee as a Muselmann , the lowest order of concentration camp inmates, contains within it important implications for the new understanding of sovereignty in the era of Guantánamo, in an age of exception. The purpose of this article is to explain the status of those who are detained at Guantánamo Bay. Stated broadly, in assessing that status, we will emphasize the connection between the altered meaning of sovereignty that has accompanied the placing of prisoners in (...) an American penal colony in Cuba and the biopolitical status of the prisoners who reside there. More particularly, we will locate the points of convergence among the factors (the war on terror, sovereignty, and the media) that have produced and reconstituted the legal and ethical status of Guantánamo detainees. (shrink)

This comprehensive collection offers a unique look at nursing practice, theory, research and nursing history from various critical theoretical perspectives. It aims to initiate an international discussion among scholars from diverse countries, particularly Germany and Anglo-American countries, coming from distinctive schools of thought, e.g. German Critical theory and Post-structural approaches, and influenced by their respective histories of sciences. This book analyzes and criticizes nursing theory, nursing research and practice along several dimensions: Nursing Ethics, Subjectivity, Body and Flesh (Leib), Technology, Power, (...) History, and Education. (shrink)

In 1974, the Liberal government of Pierre Trudeau released a “green paper” known as the Lalonde Report, after the health minister at that time. The report formulated perspectives on health and the main concepts and ideas developed in it, particularly the concept of “lifestyle,” which became the foundation of public health policies in many different European countries and the United States. The concept of “lifestyle” connected personal behaviour and habits to the individual health condition; people were not dying due to (...) a lack of access to medical care but because they lived a life prone to personal risk taking. Furthermore, what is seldom discussed is that this report not only propagated the (neo)liberal view of citizens as autonomous rational actors (homo oeconomicus), with personal responsibility for their health, but it was a first step in the transformation of Medicare and went far beyond the question of health promotion. Health was no longer something that happened to a person but was created through personal choice and, therefore, one had to assume responsibility for one's behaviour. Using Foucault's definition of government as the “conduct of conduct,” we will demonstrate that the Lalonde report must be understood as a specific “technology of government” and contributed to a neoliberal transformation of health care despite the fact that the Canadian system of Medicare was based on the idea of universality, meaning citizens had equal access to health care independent of their socio‐economic situation. As we will demonstrate, the Lalonde report undermined this foundation and initiated a profound reorientation, not only of the healthcare system, but even more importantly, it radically changed the way we think about our behaviour around health‐related issues. We will also discuss how the making of the report contributed to the redefinition of politics and demonstrated a lack of concern with liberal‐democratic decision‐making processes. (shrink)

On 18 November 2014, the United Nations launched an urgent new campaign to end AIDS as a global health threat by 2030. With its proposed strategy, the UN follows leading scientists who had declared the failure of former prevention strategies and now were promoting a ‘Seek and Treat for Optimal Prevention’ (STOP) approach as the most cost‐effective response to the pandemic to meet the goal of ‘an AIDS‐free generation’. STOP combines antiretroviral therapy and routine HIV screening to find persons unaware (...) that they are HIV‐positive, because research has shown that people consistently change their behaviour (i.e. increase condom use, have fewer partners) after an HIV diagnosis. AIDS activists have broadly criticized this strategy on different levels. In this article, we go beyond these criticisms and try to analyse the political rationalities behind this ‘new’ strategy. We believe that it is necessary to put the rationale underpinning the STOP programme into the context of broader societal transformations that can best be captured as the development of advanced liberal societies and the new emphasis on self‐controlling or self‐responsibility rather than on disciplining behaviour. (shrink)

Many men who have sex with men (MSM) express feeling marginalized by discourses within public health and sexual health nursing that determine bareback sex is deviant and unsafe. Their resistance to risk‐based discourses can be seen within radical sex practices such as deliberately becoming‐infected with HIV (bug‐chasing) and breeding‐infection (gift‐giving). The metaphors of bug‐chasing and gift‐giving, particularly those spread across global online spaces, can influence the sexual experiences and practices of MSM. A metaphor analysis was conducted of Internet forums discussing (...) HIV chasing and gifting metaphors, and showed a variety of discursive meanings, tactics and effects to the radical sex practice. A radical research approach was used to explore the processes of becoming‐infected and breeding‐infection as determinant steps in the symbolic resistance of risk‐based discourses, as well as the creation of new forms of life and community among MSM. Our analyses demonstrate how the gifting/chasing metaphors express MSM's marginalization as well as their lines of flight from having their practices captured within public health discourses. We hope to offer alternative nursing approaches for thinking through and engaging with transgressive and queer sexual practices. (shrink)

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. (shrink)

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims: to gain access to the bodily phenomenon of being placed in mechanical restraints; to give voice to the intimate experiential (...) understanding of this experience; and through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses and patients we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: context of care, meaning of quality of care, emotional reactions and nurse–patient relationship, meeting the needs and need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice. (shrink)

Humanism in forensic psychiatry: the use of the tidal nursing model The humanist school of thought, which finds resonance in many conceptual models and theories designed to guide nursing practice, needs to be understood in the context of the total institution, where the individual is subjected to a mortification of the self, and denied autonomy. This article will engage in a critical reflection on how humanism has influenced nursing theorists and the subsequent production of conceptual models and theories, especially as (...) they relate to the field of forensic psychiatric nursing. Although humanism provides optimism for nurse–patient relations, this article explores the incapability of such a philosophy to acknowledge the power relationships between individuals and its inability to explain the day‐to‐day realities experienced in forensic nursing, where the possibility of interpersonal violence reshapes nursing care. The tidal model will be discussed in detail as an example of a recently developed humanistic nursing model. Viewed from this perspective, it is clear that humanistic philosophy and its subsequent models of care are in discordance with the highly specialized field of forensic nursing. (shrink)

Chemicals have penetrated everyday lives of men who have sex with men as never before, along with new online and mobile technologies used to seek pleasures and connections. Poststructuralist (including queer) explorations of these new intensities show how bodies exist in the form of (political) surfaces able to connect with other bodies and with other objects where they may find/create a function (e.g., reproduce or disrupt hegemonies). This federally funded netnographic study explored how a variety of chemicals such as recreational (...) drugs, pharmaceuticals and steroids are contributing to the construction of gay, bisexual and other men having sex with men (GBMSM) communities and their interactions with idealized masculinities in the age of increasing technology. Five major thematic categories emerged from our analysis: (1) assembling bodies and technologies, (2) becoming orgiastic, (3) experiencing stigma, (4) becoming machinic and (5) negotiating practices. Our analysis explores how and why GBMSM pursue excesses of pleasure and connection through the assemblages they make with sexualized drug use, online platforms and other men. (shrink)

According to the literature, the family is now considered to be the most important resource for the care and support of a sick family member. Families are being increasingly invited and trained to play a utilitarian role, not just as family caregivers, but as healthcare agents. Healthcare institutions, based on neoliberal health policies, are encouraging them to perform increasingly complex and professionalized tasks. The burden associated with this expanded healthcare function, however, is significant (fatigue, emotional distress and exhaustion). The aim (...) of this article was to present French sociologist Jacques Donzelot's theoretical perspective on governing through the family. According to Donzelot, such a government is exercised through various power techniques, including the instrumentalization of the family role and the transfer to families of the responsibility for health care. This author describes how healthcare institutions call on the family to perform hospital and biomedical practices within the home. A spin‐off of neoliberalism, the practices of governing through families specifically target women, who are considered to be the pillar of the family. Donzelot's perspective is very relevant to nursing, but is still rarely mobilized in the discipline. His critical perspective allows for a re‐reading of relations of power and mechanisms of surveillance and control of families, issues that are often overlooked in nursing research. (shrink)

The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's concept (...) of governmentality is helpful in understanding the production of the citizen subject, its location within the 'art of government', as well as the ethical and political implications of citizenship in the context of mental health. (shrink)

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts – including health care systems and research institutions – perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two‐spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter‐spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us (...) the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter‐spaces, thereby instigating counter‐institutional practices, for those who experience otherness. (shrink)