Fitting in or standing out: what will change in nursing education over the next five years?
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Canada↗
Biomedical subjects
M E Purkis
Publications and source records attributed to M E Purkis.
Managing home nursing care: visibility, accountability and exclusion.
The paper examines managerial practices shaping contemporary home nursing care. Foucault's writings on governmentality are used to appraise managerial and nursing practices understood as exemplars of forms of government of people's health. An ethnographic study of organizational practices shaping contemporary home nursing care reveals that the everyday work of managers involves making particular forms of nursing practice visible. Through careful scripting of these visible forms of practice, managers and nurses together work to exclude the local knowledge of patients and of nurses regarding experiences of living with chronic illness. Recommendations are offered for managers and nurses who seek to develop more autonomous roles for nurses: roles that require the inclusion of people's own knowledge of how they live at home with their chronic illness.
Attitude of Health Personnel↗
Embracing technology: an exploration of the effects of writing nursing.
Contemporary societal factors influencing the delivery of healthcare in Canada include loud and persistent demands for accountability around the use of public funds. Interests in fiscal accountability are not only held by managers and politicians. Practitioners too hold interests in this domain, particularly where 'interest' means having a reserved seat at the table where discussions regarding resource allocation will take place. In this light, practitioners are also interested in enrolling forms of technology that enable them to make visible their 'unique contribution' to the care delivery enterprise. Latour's writings on 'technology' as durability offer methods for describing socio-technical processes that contribute to the appearance of domination. Challenging the prevailing view that order results from powerful domination, Latour argues that domination is an effect of contingent processes. A case study is presented where multiple interests in developing a form of nursing that is visibly 'autonomous' and 'cost-effective' are brought together with technological forms that promise such visibility. Costs associated with purchasing visibility are critically examined.
Canada↗
Response to Marie-Francoise Colliere: using anthropology toanalyse healthcare situations.
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Anthropology, Cultural↗
The Comox Valley Nursing Centre.
With today's emphasis on health care reform across Canada, many individuals, groups and governments are seeking new approaches to the delivery of health care. Nursing organizations have argued for approaches that make better use of nurses' experience and expertise. Thus, a project in British Columbia, the Comox Valley Nursing Centre, warrants interest from nurses and policy makers for the way it broadened the nursing role to provide high quality, effective health care in specific community.
Adult↗
The "social determinants" of practice? A critical analysis of the discourse of health promotion.
Developments in the practice of health promotion have centred on considerations of what clients bring to their encounters with professionals. This changes in the provider-client relationship marks a significant departure from practice models that relied on the professional giving the client expert health instructions. The literature that seeks to illuminate these more contemporary relationships with clients tends to ignore what practitioners bring to the health promotion encounter and, significantly, the social conditions that underlie the encounter. This paper, drawing on research gathered during an ethnographic study of practice in a public health clinic, critically analyzes health promotion with a view to challenging researchers, educators, and practitioners concerning the health-promoting possibilities in existing practice settings.
Adult↗
Nursing in quality space: technologies governing experiences of care.
This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse-patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practice in ways prescribed by nursing theories. Set aside in this approach to the so-called 'problems' of nursing practice has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but are social spaces through which particular meanings about nursing care can be conveyed.
Health Facility Environment↗
The configuration of nurse-patient relationships: a critical view.
This paper sets out the grounds on which a reconfiguration of the ideas currently employed to conceptualize nurse-patient relationships might be founded. It is apparent that much of the rhetoric on which education for nursing practice is founded is difficult to relate to the realities of everyday nursing work. We explore the production of the nurse-patient relationship, in theory and practice as a therapeutic relationship. The paper moves beyond outlining yet again disparities between theory and practice. We argue that a more productive direction for research and analysis aims at understanding conditions that support sustained conduct characteristic of nursing practice in everyday work settings. We demonstrate some of the central conflicts operating between the professionalizing aims of nurses and the establishment of equitable positions for doing the work of nursing.
Canada↗
Entering the field: intrusions of the social and its exclusion from studies of nursing practice.
In this paper the exclusion of 'the social' from studies of nursing practice is addressed with regard to two important pieces of empirical fieldwork. The claim advanced in this paper is that methods currently advanced in the nursing literature for gathering and analyzing data, are constituted by theoretical notions which themselves exclude the social from understandings of nursing practice. Drawing on structuration theory, the paper advances an understanding of the research process as one parallel to nursing or that of any other practice-based discipline. Accounts arising from the research projects of Field and Benner are examined critically in this paper. The examination is informed by wider social theory, but with particular reference to Giddens' (1984) theoretical formulations. It is concluded that unless the knowledgeability of social actors is accounted for, both in the planning of empirical research studies and in interpreting the findings of such studies, crucial aspects of social conduct organized through nursing practice and organizing nursing practice are excluded from considerations of practice. The implications of such exclusion are addressed.
Clinical Competence↗