An aim of all of the management of healthcare systems is the smooth provision of services. A great deal of effort is put into ensuring processes will obtain this ideal – the well‐run system. The central argument in this paper is that these processes result in a system that perpetrates violence and coercion on its clients and workers. This violence is structural and personalizing in its effects. Moreover, time and effort is taken away from the actual work of the system (...) for its management. Under such managerialist control, the idea of chaos and the need to ensure order are used to fuel an apparatus that takes the focus from other aspects of the system such as the power relations that keep the system as it is. In such an ordering, the clinical audit is promoted as a method to ensure order by keeping ahead of, or removing the potential for chaos. In using Žižek's ideas about violence it is possible to identify how efforts and attempts to correct the system are doomed to fail just as they hide how nurses' enrolment in the service of the system leads to alienation and subjectification. A central aim of this paper is to rethink how power and implicit violence are practised in such processes. To overcome the inherent violence of the audit culture, this paper suggests an interruption of audit cultures with a promotion of more radical positions for nursing practice and clinically based research. The hope is to recalculate and interrupt how nurses are to operate in the management structures that organize healthcare. (shrink)

MAPEDZAHAMA V, RUDGE T, WEST S and PERRON A. Nursing Inquiry 2012; 19: 153–164 [Epub ahead of print]Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplaceThis article presents an analysis of data from a critical qualitative study with 14 skilled black African migrant nurses, which document their experiences of nurse‐to‐nurse racism and racial prejudice in Australian nursing workplaces. Racism generally and nurse‐to‐nurse racism specifically, continues to be under‐researched in explorations of these workplaces; when (...) racism is researched, the focus is nurse‐to‐patient racism and racial prejudice. Similarly, research on the experiences of migrant nurses from a variety of ethnicities in Australia has tended to neglect their experiences of the social dynamics of the workplace, thus reinforcing their racialisation. When racialised, the migrant nurse becomes ‘the problem’ through a focus on English language competency and ensuing communication barriers. This paper applies Essed’s framework of ‘everyday racism’ to theorise narratives of racism by black African migrant nurses in Australia. In so doing, it not only brings to the fore silenced discussions of nurse‐to‐nurse racism in Australia, but also exposes the subtle, mundane nature of contemporary racism. For this reason, while the data we present must be read within their context, that is, the Australian nursing workplace, it has significance for advancing a critical analysis of racialised minority groups’ experiences of racism within seemingly ‘race‐less’ nursing workplaces internationally. (shrink)

The purpose of this paper is to explore how nurses are enrolled into and take part in programmes of efficiency and effectiveness. Using the philosophical theorizing about desire as a force or power, I focus specifically on what is understood as relations between desire and productivity in current Westernized health‐care systems. Use is made of the idea from Spinoza that human emotions consist only of pleasure, pain, and desire as these act as a motive force. This is then linked with (...) more contemporary work on the politics and discourses of desire. A report on the implementation of a productivity programme in the United Kingdom, The Productive Ward: Releasing time to care™, is explored for the ways its developers set about motivating nurses to endorse and enact the programme. In exploring the mechanics of desire in these processes, a view of desire as productive is promoted. Looking at desire as assembling actions, and an assemblage, moves the analysis to an interrogation of actions and practices used to enable and bring nurses to the process. Moreover, in working through the various modalities and operations of desire, the potential and limits of such projects are abstracted. Such potentials and limits are necessarily set by the intensification of power and desire in the capitalist economy, saturating areas of nursing, and health‐care provision. (shrink)

Skin as cover: the discursive effects of 'covering' metaphors on wound care practicesThis paper outlines a Foucauldian analysis of interactions between nurses and patients during wound care procedures in a burns unit. It explores the use of Kristeva's psychoanalytic concepts of abjection and the abject body to illuminate the emotional affects of wounds on nurse and patient. In this process, I identify how cultural metaphoric understandings about skin influence and organise the care of burns patients. Such analysis suggests the import (...) of the complete skin, the medical scientific control over the definition of this work, and the emotional forces that resist such control. (shrink)

Positivist ethnographic research situates the participant observer in an objectivist position towards the field. Using poststructural perspectives to analyse the field challenges and unsettles objectivist assumptions underpinning ethnography. Neither is merging of the two approaches completely unproblematic. A crucial element in a coherent amalgam centres around resolution of potential contradictions emanating from the place of field notes in ethnographic research, and the position of the researcher (author) vis‐a‐vis such notes. Contemporary approaches to field notes maintain that such notes are not (...) an objective description of the field, unaffected by the voice of the researcher. Rather, observational records are to be regarded as text, with characteristics in common with all texts. The ethnographic record is constituted as much by the positionality of the researcher as by the research participants. The nurse researcher can be viewed as participant in the constitution of the field. In unsettling and challenging taken‐for‐granted understandings about nursing practice, I am affirming the centrality of the position of the nurse in nursing research. (shrink)

Nursing and nursing practice both construct and are in turn constructed by the context in which they operate. Texts play a central part in that construction. As such, nursing and nursing practice can be considered to represent a reality that is textually mediated. This paper explores the notion of nursing as a textually mediated reality and offers the reader the possibility of engaging in reflection on what implications this has for nursing and their own nursing practice. The analyses provided draw (...) on aspects of die work of both Foucault and Derrida. Foucault's notion of discourse provides a vehicle for die exploration of nursing as textually mediated, as does Derrida's concept of binary oppositions. The paper thus illustrates some of die possibilities afforded nursing by poststructural analyses. In particular it does this by exploring one of the central textual constructions, impacting on die way that nursing and nursing practice are conceptualized, the mind/body binary opposition. (shrink)

The use of virtual environments for the provision of health‐care is on the increase, and with each new development brings debates about their impact on care, nursing and nursing practice. Such environments offer opportunities for extending care and improvements in communication. Others believe these developments threaten aspects of nursing they hold sacrosanct. This paper explores the development of an assemblage of computer networks, databases, information systems, software programs and management systems that together work to manage health‐care in Australia, namely casemix. (...) We contend that spatial theories on network society show how this assemblage co‐ordinates and operates to manage care. We discuss how this assemblage affects care and suggest that changes in organisation may be a part of the shift in how bodily organisation occurs more generally, but more specifically in health‐care. We also suggest how nurses are enrolled in and by such networks, leading to transformation in nurses’ practices. Finally, we argue that using spatial forms of analysis allows an interpretation of such assemblages that may account for their strengths and their shortcomings. (shrink)

Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how nurses engage with and interrupt (...) these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection. (shrink)

Motivated by discourses that link early child development and health, nurses engage in seemingly benign surveillance of children. These practices are based on knowledge claims and technologies of developmental science, which remain anchored in assumptions of the child body as an incomplete form with a universal developmental trajectory and inherent potentiality. This paper engages in a critical discursive analysis, drawing on Donna Haraway's conceptualizations of technoscience and figuration. Using a contemporary developmental screening tool from nursing practice, this analysis traces the (...) effects of this tool through production, transformation, distribution, and consumption. It reveals how the techniques of imaging, abstraction, and measurement collide to fix the open, transformative child body in a figuration of the developing child. This analysis also demonstrates how technobiopower infuses nurses' understandings of children and structures developmentally appropriate expectations for children, parents, and nurses. Furthermore, it describes how practices that claim to facilitate healthy child development may inversely deprive children of agency and foster the production of normal or ideal children. An alternative ontological perspective is offered as a challenge to the individualism of developmental models and other dominant ideologies of development, as well as practices associated with these ideologies. In summary, this analysis argues that nurses must pay closer attention to how technobiopower infuses practices that monitor and promote child development. Fostering a critical understanding of the harmful implications of these practices is warranted and offers the space to conceive of human development in alternate and exciting ways. (shrink)

Seeking to answer the question of what it is that nurses do, scholars researching nursing have worked with theoretical approaches ranging from the more abstract to the concrete: from philosophizing the nature of nursing to emphasizing the interpersonal nature of nursing practice to exploring processes of clinical decision‐making. In this paper, we engage with Bourdieu's theory of practice as an alternative approach that helps to understand the finer points of nurses' everyday practices of nursing as being grounded in an ontology (...) of practice. We first outline the foundations of Bourdieu's thinking as he established both a relational philosophy of science and an embodied philosophy of action to develop the theory of practice around notions of habitus, capital and field. Then, using the inter‐relationships of these key elements of the theory of practice as a ‘toolkit to think with’, we explore an instance of nursing in practice in an acute care setting and show how, in taking account of social context, the dialectics between the elements reveal the social interactions that are accomplished in the doing. Moving to the relationships of these three elements with Bourdieu's further notions of illusio, symbolic power and symbolic violence, we uncover an ontology of nursing practices in the everyday. We conclude by summarising what this ontology of practice has to offer investigations into practices of nursing in any social context. (shrink)

Critical discursive analyses offer possibilities for equity‐oriented research, and are a resource for addressing resistant social problems, such as child neglect and abuse (CN&A). A key challenge for discourse analysts in health disciplines is the tensions between materiality and social constructions, particularly at the site of the body. This paper describes how Donna Haraway's ideas of figuration and technobiopower can augment critical discourse analysis to address this tension. Technobiopower, an intensification of biopower in the context of technoscience, is seen as (...) underpinning the melding of material and semiotic practices. The subject is no longer a material body, but a hybrid body that exists in tropic figuration between the real and unreal. This paper uses an analysis of the figuration of The Monstrous Perpetrator from a study of nursing responses to CN&A to illustrate how Haraway's figuration aligns with and provides an analytical tool to extend critical discursive analyses. Specifically, this methodology offers new ways to identify the discursive qualities of bodies, and how material aspects of bodies are exaggerated, concealing their hegemonic ideologies and discriminatory effects. By identifying discourses within or inscribed upon the body, they can be disrupted, opening new possibilities for social change. (shrink)

Immigrant nurses make up a large percentage of the Australian nursing workforce. Since the support in the workplace is expected to be inclusive for all nurses, the aim of this article is to explore how support and opportunities for professional growth, learning and development are distributed across different categories of nurses working in a neonatal intensive care unit (NICU). An ethnographic approach has opened an examination of the everyday workplace practices in the NICU to gain insight into how nurses made (...) sense of the social and power relations occurring between themselves and their senior colleagues and how they experienced the support and opportunities they received in their workplace. As today's workplaces such as the NICU are diverse in races, culture and experiences, the concepts of intersectionality and cultural safety assisted in identifying inequality and injustice related to such diversity. The results showed how patronage relations rendered nurses with immigrant status with major disadvantage and left them clinically and culturally vulnerable. Such inequity defeats the reasons for encouraging skilled migration of nurses and poses questions on the cultural competency of recruiting organisations. Considering how cultural safety might guide staff development offers opportunities for authentic support to culturally diverse nurses. (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)

This paper scrutinises the many ways in which ‘success’ is portrayed in representing assisted reproductive technology (ART) services and illuminates how these definitions differ from those held by participant couples. A qualitative approach informed by feminist perspectives guided this study and aimed to problematise the concept of ‘success’ by examining literature from ART clinics, government reports on ART, and by analysing narratives of couples who have accessed ART services. As many ART services have varying definitions of ‘success’ and as statistics (...) are manipulated to promote further patronage of ART services, the likelihood of ‘success’ is often overstated. This paper is concerned with the effects this promotion has on the participants. We suggest that this very mobilisation of statistical success changes the ability of those who access ART services to make productive decisions about themselves inside these treatment regimes, as the basis for decision‐making is hidden by the way numbers, objectivity and clinical reasoning operate to maintain participation in the program. In such an operation, the powerful mix of hope and technology kept participants enrolled far longer than they originally planned. Moreover, how success rates are manipulated raises ethical issues for all involved: clients, counsellors, and nursing and medical professionals. (shrink)

Procedure manuals and textually mediated deathThe procedure manual as a document represents the practice of nursing care. Analysis of such manuals allows us to explore discourses of nursing and the ways in which they frame nursing practice. A critical analysis of a hospital procedure manual using discourse analysis was undertaken. A specific excerpt concerning ‘Last offices’ is used as an example of the institutionalisation of organisational values and beliefs as these influence nursing care. ‘Last offices’ directs nursing practices related to (...) the death of a patient, and the laying out as preparation for the funeral director or coroner. The analysis shows that procedure manuals reproduce hegemonic ideologies of nursing. The analysis also shows how nursing practices are constituted by intersecting forces of differing locations such as the hospital as an organisation, the healthcare system and the wider society within which these function. (shrink)

WEST S, MAPEDZAHAMA V, AHERN M and RUDGE T. Nursing Inquiry 2012; 19: 177–187 [Epub ahead of print]Rethinking shiftwork: mid‐life nurses making it work!Many current analyses of shiftwork neglect nurses’ own voices when describing the dis/advantages of a shiftworking lifestyle. This paper reports the findings of a critical re‐analysis of two studies conducted with female mid‐life Australian nurses to explore the contention that the ‘problem‐centred’ focus of current shiftwork research does not effectively address the ‘real’ issue for mid‐life nurses, (...) that is, how to develop and maintain shiftwork tolerance. Participants used shiftwork to: (i) manage, navigate and negotiate various aspects of their nursing work and the workplace itself; (ii) facilitate more manageable work/life negotiations; and (iii) self‐identify opportunities to engage in their own self‐care (body work and mind work). The findings thus went beyond simply exposing what nursing bodies do in time and space by bringing to the fore discussions of ‘time‐body’ relationships, the embodiment of time and nurses re/configuration of that time demonstrating that the frequently unacknowledged positive aspects of shiftwork, when centred in discussions, give voice to other ways to think about shiftwork and a shiftworking lifestyle. Thus, our contention is that the ‘problem‐centred’ focus of current shiftwork debates does little to address the ‘real’ issue for shiftworking mid‐life female nurses – the development and maintenance of shiftwork tolerance. (shrink)

H. B. D. Kettlewell's (1955, 1956) classic field experiments on industrial melanism in polluted and unpolluted settings using the peppered moth, Biston betularia, are routinely cited as establishing that the melanic (dark) form of the moth rose in frequency downwind of industrial centers because of the cryptic advantage dark coloration provides against visual predators in soot-darkened environments. This paper critiques three common myths surrounding these investigations: (1) that Kettlewell used a model that identified crypsis as the only selective force responsible (...) for the spread of the melanic gene, (2) that Kettlewell's field experiments alone established that selection for crypsis was the most important factor in the spread of melanic forms, and (3) that Kettlewell's investigations in an unpolluted wood near Dorset constituted a control for his earlier Birmingham studies (contra Hagen 1993, 1996). This analysis further identifies two features that distinguish manipulative experiments in evolutionary biology from experiments in other contexts. First, experiments in evolutionary biology rest on a wealth of information provided by strictly observational ecological studies; in the absence of such information experiments in evolutionary biology make no sense. Second, there is a trade-off between how much control investigators have over the conditions being studied and how informative the results of the experiment will be with regard to natural populations. (shrink)

We are pleased to publish this WSIA edition of Trudy’s Govier’s seminal volume, Problems in Argument Analysis and Evaluation. Originally published in 1987 by Foris Publications, this was a pioneering work that played a major role in establishing argumentation theory as a discipline. Today, it is as relevant to the field as when it first appeared, with discussions of questions and issues that remain central to the study of argument. It has defined the main approaches to many of those (...) issues and guided the ways in which we might respond to them. From this foundation, it sets the stage for further investigations and emerging research. This is a second edition of the book that is corrected and updated by the author, with new prefaces to each chapter. (shrink)

Dantis, Trudy As a 'definite community of Christian faithful', every parish is called to embody the presence of the church in the wider community. It does this by being a place of living communion and participation that is wholly mission-oriented, an environment conducive to hearing God's word and growing in the Christian life, and one that is engaged in dialogue, proclamation, outreach, worship and celebration. In doing so, a parish becomes 'salt' and 'light' for the community it is located (...) in. Parish vitality can therefore be likened to the 'saltiness' or 'luminosity' of a parish community. It is imperative for every parish community to grow in health and strength if it is to be an effective source of evangelisation and an authentic witness of the Gospel. As Wittberg notes, 'To the extent that their communal "salt" loses its flavor, parishes - are worse than irrelevant, because they no longer image God'. (shrink)

The book also comes with an exhaustive array of study aids that enable the reader to monitor and enhance the learning process.

In 1995, the Dutch Minister of Health proposed that a randomized clinical trial (RCT) with heroin-maintenance for severe abusers be conducted. It took nearly four years of lengthy debates before the Dutch Parliament consented to the plan. Apart from the idea of prescribing heroin, the minister and her scientific advisers had to defend the quite high material and non-material costs that would arise from employing the randomized controlled design. They argued that the RCT represented the truly scientific approach and was (...) the royal way to unambiguous results. In the present article, I question this common dual justification of RCTs. First, I situate the historical origins and the basic assumptions of the ideal experiment in 20th-century economic liberalism. Secondly, using the Dutch heroin experiment as an example, I discuss human-science experimentation as an attempt to create reality rather than merely record it. Finally, I discuss some surprising responses by heroin users. These responses display the assumptions of RCTs discussed in the historical section, and underline the importance of the culture of heroin use. In the epilogue, I suggest that cultural aspects of heroin consumption can best be studied by thorough ethnographic research. (shrink)

The following three papers focus on compassion, an issue well worth our consideration in our contemporary age, and most especially during our recent national tragedy. It is hoped that these philosophical discussions of compassion may help us as we, on personal and societal levels, come to grips with immense human suffering. The topic of compassion brings us into an exploration of a cluster of related philosophical issues and is thus a good stepping off point for inquiry. The role of the (...) first paper is that of stage setting, to simply layout an approach to compassion presented by Aristotle and developed by Martha Nussbaum. This approach served as the introductory consideration in a course on compassion, taught by the first two commentators. Initially we wondered if we could sustain discussion on this narrow topic over fourteen weeks, but found the course left students with numerous questions worth their further consideration. So too in these papers, a number of issues will remain untouched, such as the relation of compassion and public policy and specific approaches to the cultivating of compassion, both of which are explored at length by Martha Nussbaum. This first paper frames our discussion, by presenting in outline form key points addressed in Martha Nussbaum’s Aristotelian discussion of the emotion of compassion, and touches upon issues developed in the next two papers. (shrink)

The following three papers focus on compassion, an issue well worth our consideration in our contemporary age, and most especially during our recent national tragedy. It is hoped that these philosophical discussions of compassion may help us as we, on personal and societal levels, come to grips with immense human suffering. The topic of compassion brings us into an exploration of a cluster of related philosophical issues and is thus a good stepping off point for inquiry. The role of the (...) first paper is that of stage setting, to simply layout an approach to compassion presented by Aristotle and developed by Martha Nussbaum. This approach served as the introductory consideration in a course on compassion, taught by the first two commentators. Initially we wondered if we could sustain discussion on this narrow topic over fourteen weeks, but found the course left students with numerous questions worth their further consideration. So too in these papers, a number of issues will remain untouched, such as the relation of compassion and public policy and specific approaches to the cultivating of compassion, both of which are explored at length by Martha Nussbaum. This first paper frames our discussion, by presenting in outline form key points addressed in Martha Nussbaum’s Aristotelian discussion of the emotion of compassion, and touches upon issues developed in the next two papers. (shrink)

Forgiveness and Revenge is a powerful exploration of our attitudes to serious wrongdoings and a careful examination of the values that underlie our thinking about revenge and forgiveness. From adulterous spouses to terrorist factions, we are surrounded by wrongdoing, yet we rarely agree which response is appropriate. The problem of how to respond realistically and sensitively to the wrongs of the past remains a perplexing one. Trudy Govier clarifies our thinking on this subject by examining the moral and practical (...) impact of revenge and forgiveness, both personal and political. Forgiveness and Revenge offers much-needed clarity and reason where emotions often prevail. It is essential reading for anyone interested in the ethics of attitudes to wrongdoing. (shrink)

Most characters that distinguish one individual from another, like height or weight, vary continuously in populations. Continuous variation of these ‘quantitative’ traits is due to the simultaneous segregation of multiple quantitative trait loci (QTLs) as well as environmental influences. A major challenge in human medicine, animal and plant breeding and evolutionary genetics is to identify QTLs and determine their genetic properties. Studies of the classic quantitative traits, abdominal and sternopleural bristle numbers of Drosophila, have shown that: (1) many loci have (...) small effects on bristle number, but a few have large effects and cause most of the genetic variation; (2) ‘candidate’ loci involved in bristle development often have large quantitative effects on bristle number; and (3) alleles at QTLs affecting bristle number have variable degrees of dominance, interact with each other, and affect other quantitative traits, including fitness. Lessons learned from this model system will be applicable to studies of the genetic basis of quantitative variation in other species. (shrink)

It is rare to find honest accounts of the difficulties and dilemmas encountered when conducting sensitive research with vulnerable research populations. This account explores some of the ethical issues raised by a qualitative interview study with lesbians and gay men about their experiences of nursing care. There is tension between the moral duty to conduct research with vulnerable and stigmatized groups in order to improve care, and the inevitable lack of resources that go with such a venture. This increases the (...) risk of harm during the process of research. The risk of harm to both the researchers and the researched is explored and the need for a support structure for both groups is raised. There is a pressing need to develop further understanding about the ways in which the dissemination of research can potentially harm already vulnerable research populations. (shrink)

: Bayesians and error statisticians have relied heavily upon examples from physics in developing their accounts of scientific inference. The present essay demonstrates it is possible to analyze H.B.D. Kettlewell's classic study of natural selection from Deborah Mayo's error statistical point of view (Mayo 1996). A comparison with a previous analysis of this episode from a Bayesian perspective (Rudge 1998) reveals that the error statistical account makes better sense of investigations such as Kettlewell's because it clarifies how core elements (...) in the design of experiments are used to minimize erroneous inferences rather than dwelling on whether the strategies used are reasonable. (shrink)