In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and (...) National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on ‘new public management’, we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning. (shrink)

Values‐based practice is deemed essential for healthcare provision worldwide. In England, values‐based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students’ personal values align with the values of the National Health Service (NHS), which focus on compassion and patient‐centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students’ perceptions of their values over the duration of their education programme as a (...) ‘values journey’. The aim of this hermeneutic longitudinal focus group study was to explore the ‘values journey’ of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this. (shrink)

We consider two issues relating to WH-questions:(i) when you ask aWH-question you already have a description of the entity you are interested in,namely the description embodied in the question itself. You may evenhave very direct access to the entity – see (1) below.In general, what you want is an alternative description of some item thatyou already know a certain amount about.

In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

In this article I argue that Part II of the Family LawAct 1996 gives expression to a new form ofresponsibility. I begin by suggesting thatresponsible behaviour has shifted from prohibiting orrequiring particular actions: we now exhibitresponsibility by our attitude towards our actions. I then examine where this new conception ofresponsibility has come from. Through an examinationof the work of post-liberal theorists, principallyMichael Sandel, I argue that a changing view ofpersonhood within post-liberal theory has led to aquestioning of the possibility of (...) choice, and that theabsence of choice necessitates a shift in thedefinition of responsible behaviour. If we are createdby our decisions then we cannot be held to account forour decisions, but only for the care we have takenover them. Responsibility is therefore measured notby our level of self-control but by our level ofself-awareness. Finally I examine the consequences ofthis shift in the meaning of responsibility. Withinthis framework autonomy is illusory thereforedecisions do not need to be respected. This explainswhy the implementation of Part II of the Family LawAct 1996 has been called into question. Within thisframework responsibility is relative therefore itextends indefinitely. This enables the Family Law Actto be uniquely intrusive and judgmental: everydivorcing couple, on being held up to scrutiny, isfound lacking. (shrink)

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased (...) continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or ‘bounded’ relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship. (shrink)

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

How nursing as a profession is valued may be changing and needs to be explored and understood in a global context. We draw on data from two empirical studies to illustrate our argument. The first study explored the value of nursing globally, the second investigated the experiences of overseas trained nurses recruited to work in a migrant capacity in the UK health care workforce. The indications are that nurses perceive themselves as devalued socially, and that other health care professionals do (...) not give nursing the same status as other, socially more prestigious professions, such as medicine. Organizational and management structures within the NHS and the independent care home sector devalue overseas nurses and the contribution they make to health care. Our conclusions lead us to question the accepted sociocultural value of the global nursing workforce and its perceived contribution to global health care, and to consider two ethical frameworks from which these issues could be discussed further. (shrink)

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity (...) in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice. (shrink)

A ‘good enough’ nurse: supporting patients in a fertility unitIn this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as ‘emotional awareness’ and ‘non‐caring’ as ‘emotional distance’ may be forms of nursing akin to Fabricius’s (1991) arguments around the ‘good enough’ nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach (...) to caring and do not expect an emotionally intimate relationship from nurses. (shrink)

In this paper we comment on the changes in the provision of fertility care in Australia, New Zealand and the UK to illustrate how different funding arrangements of assisted reproductive technologies (ART) shape the delivery of patient care and the position of fertility nursing. We suggest that the routinisation of in vitro fertilisation technology has introduced a new way of managing the fertility patient at a distance, the distal fertility patient. This has resulted in new forms of organisational routines in (...) ART which challenge both traditional forms of nursing and advanced nursing roles. We discuss the consequences of this increasingly globalised approach to infertility through the lens of three national contexts, Australia, New Zealand and the UK to unpack the position of nursing within the new forms of organisational routines. (shrink)

This paper explores the experiences of infertile women who occupy a liminal space in society, and argues that the fertility clinic served as a space to tolerate women's experiences of liminality. It provided not only rituals aimed at transition to pregnancy, but also a space where women's liminal experiences, which are caused by the existential chaos of infertility, could be tolerated. The British experience seemed to differ from the American one identified in the literature, where self‐management and peer group support (...) are described as strategies used by infertile women to manage infertility. The British women in this study did not appear to draw so much on self‐management or peer group support to deal with their experiences of infertility. They appeared to be isolated in their experience. The clinic thus provided a space in which recognition was given to their intensely private experiences of difference from those in the outside fertile world and allowed them to manage these socially unacceptable, culturally taboo and invisible experiences. However, because of its very limited success rate in enabling women to become pregnant, rather than facilitating the transition of status from infertile to fertile woman, the clinic also served to reinforce the liminal experiences of those women who remained infertile. Inadvertently, the clinic offered a way of being in limbo while at the same time reinforcing the liminal experiences of women. (shrink)

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to (...) attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

The precarious rights of senior citizens, especially those who are highly educated and who are expected to counsel and guide the younger generations, has stimulated the creation internationally of advocacy associations and opinion leader groups. The strength of these groups, however, varies from country to country. In some countries, they are supported and are the focus of intense interest; in others, they are practically ignored. For this is reason we believe that the creation of a network of all these associations (...) is essential. The proposed network would act as a support for the already-existing policies of the United Nations’ High Commission for Human Rights, of independent experts, and of the Global Alliance for the Rights of Older People. All three have long ago recommended the creation of a recognized instrument for uniting presently scattered efforts. The proposed network, therefore, will seek to promote the international exchange of relevant expertise, and it will reinforce the commitments and actions that single countries are currently taking to meet these objectives. For example, informative public events can be organised to promote particular support initiatives and to provide an opportunity for new members of the network to be presented. The network will promote health for senior citizens, disease prevention, senior mobility, safe free time for seniors, alimentary education, protection against new risks and dangers, as well as equity in the services necessary for seniors to adopt new information and communication technologies. In the case of retired academic members, the network will promote equality with respect to continuing use of digital technologies (particularly email), continuing access to research libraries, and the guaranteed ability for seniors to fund their own research programs and to deliver free seminars. (shrink)

BackgroundFear of cancer recurrence is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research.MethodsMembers of the International Psycho-oncology Society Fear of Cancer Recurrence Special Interest Group were invited to participate in an online Delphi study. Research domains identified in Round (...) 1 were presented and discussed at a focus group to consolidate the domains and items prior to presentation in further survey rounds aimed at gaining consensus on research priorities of international significance.ResultsThirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified.ConclusionThe findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need. (shrink)

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non‐European Union (EU) and non‐White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory (...) due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 30.3 (2000) 40-52 [Access article in PDF] Hugo's le Dernier Jour d'un Condamné The End as Contamination Allan Stoekl How does one end a story? What does it mean to end a story? What is the relationship between the end of a story and that which precedes it? These, in many ways, are among the central concerns of nineteenth-century fiction, for this period saw extensive experimentation not (...) only in the areas of narration, point of view, and style, but in the realm of what is often called narrative "closure."This term, one we are all familiar with from television news accounts—everyone wants closure nowadays, whatever that is—is already contested in much of nineteenth-century fiction. The happy certainties of, say, a Sherlock Holmes story are hardly corroborated by the dismal fates of Emma Bovary or Thérèse Raquin. Indeed, one of the goals of much "realism" of the period can be seen as a desire to formulate another type of ending, one that provides not happy consolation—closure in the contemporary sense of the term—but simply an ending as cessation, a hanging-fire that offers only the silence, and emptiness, of the tomb. And even the emptiness of the character: after all, when Charles Bovary is opened up in order to determine the cause of his death, the doctors "find nothing": he was as empty as the ending of his wife's story. Indeed the discovery of that emptiness is the end (such as it is). Charles's emptiness has opened the story, it closes it, and in between there are only episodes that make obvious the end to come: disillusionment in the power of stories, the death-in-life of a life that tries to ape adventures. The end, the end of stories in general, comes to occupy and reconfigure (in its own nonimage) the entire story.As Montaigne put it, there is only a bout rather than a but: an end as mere cessation rather than as goal or conclusion.1 This endlessness of the end—as simple extinction—suffuses all that comes before it: it is not so much that events lead up to an end, but rather that the end casts back on the events that precede it its own void, its fundamental unknowability.Sartre, of course, was eager to continue this Flaubertian critique (as he continued so much else started by Flaubert); in La nausée (Nausea) his hero, Roquentin, refuses any belief in the reality of "adventures"—his own or anyone else's—because they are essentially false: they are stories, with beginnings and endings selected to provide an illuminating or pleasurable experience. They are no more "real" than are the objects [End Page 40] around us, which are fabricated and chosen with a subjective, and selfish, end in view. In lived adventures, as in stories in novels or films, it is the end that gives sense to what comes before it: the economy of narrative, so to speak, requires that everything that figures in a story be of use in contributing to a satisfying and totalizing end (a but). In his diary, Roquentin writes:And in reality you have started at the end. It was there, invisible and present, it is the one which gives to words the pomp and value of a beginning. "I was out walking, I had left the town without realizing it, I was thinking about my money troubles." This sentence, taken simply for what it is, means that the man was absorbed, morose, a hundred leagues from an adventure, exactly in the mood to let things happen without noticing them. But the end is there, transforming everything. For us, the man is already the hero of the story. [...] And the story goes on in reverse: instants have stopped piling themselves up in a lighthearted way one on top of the other, they are snapped up by the end of the story which draws them and each one of them in turn, draws out the preceding instant: "It was night, the street... (shrink)