Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the (...) controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)

Increasing recognition of adverse events in health care is wide spread. Implementing improved system arrangements, which prevent adverse events taking place rather than focussing on individual culpability is increasingly being recognised as a more effective preventative strategy. But does such a perspective mean individual health practitioners remain accountable for their practice? This article explores the philosophical, psychological and professional contradictions inherent in attempting to understand where the responsibility for our actions lies and concludes by arguing that while the case for (...) the system approach to adverse event reduction is strong, the notion of individual professional culpability needs to be maintained. (shrink)

Chile's ‘Indigenous Peoples Legislation’ goes back to Colonial time, when the Catholic Church and the Spanish Crown sought to ensure access to Indian souls and labour. This chapter offers an analysis of the processes that led to changes in Chile's Indigenous Peoples Legislation, which finally granted legal recognition to the Chilean indigenous population. Focusing on the Aymara of Arica, the ethnographic analysis reveals how a dominant group has tried to impose itself as the core of the newly born state, by (...) formally denying the ethnic heterogeneity of the population. The chapter analyses the Aymara's leaders' struggle for the assertion of their Indian identity, by looking at their participation in the political processes that eventually led to the 1993 Indigenous law. Finally, it examines the consequences of the implementation of the law for present-day Aymara leadership in North Chile. (shrink)

This thesis seeks to provide an overview and examination of the thought of the significant contemporary sociologist, Peter L. Berger. Berger is concerned with the issue of how meaning is constructed in modern, secular, bureaucratic society. Furthermore, this thesis seeks to outline, and trace the development of, Berger's thought. To achieve this the thesis examines Berger's use of the disciplines of the sociology of knowledge and religion, along with contemporary studies in religion and theology. Berger, by linking the function of (...) a theodicy with that of making meaning, allows for theodicies to be conceived of in the broader context of making meaning in contemporary society. As such, a contemporary theodicy needs to include (indeed, it needs to be inclusive, rather than exclusive) such factors as the relationship between self, others, the world, and the transcendent so as to provide some basis for an authentic and meaningful existence. There is a need for a more inclusive theodicy (other than the traditional individualistic type) which has hermeneutic concern for the 'whole' (wholeness of self, wholeness in relationships with others, wholeness with the world/environment, and wholeness with the transcendent). However, this 'wholeness' will not be provided by over-arching, public, structures or systems; it will need to be through chosen, private means which reflect the Post-Modernist situation where 'closure' on a grand scale is unobtainable (Marshall, 1992, pp. 192 -193). Berger's work provides the possibility for this legitimation of a theodicy (or theodicies) which will provide meaning in Post-Enlightenment society. The construction of meaning in contemporary society needs an ability to cope with complexity, it needs to be reasonable, as well as contemporary (to cope with the plurality in modern society), and it is on the way (that is, not given to closure). Therefore any contemporary theodicy, or system of meaning, must be able to be historically concerned (that is, conscious of its origins and open to the future), empirical (that is, open to scrutiny and review), inductive (that is, dealing with concrete reality, not abstract theory), and concerned with people's lived experience. Berger's signals of transcendence allow for the legitimation of this private, deinstitutionalized religion; that is, they legitimate a meaningful theodicy for contemporary humanity. This theodicy, which is able to accommodate the wider view current in modern society provided by the ecological movement, interaction between the various religious traditions, the feminist movement, the reality of multi-culturalism, and the resulting pluralism from the above factors, can provide some basis for a meaningful and authentic existence in contemporary society. The signals of transcendence are able to correlate people's lived experience (their 'natural reality') to a reality which is "in, with and under" that natural reality (Berger, 1992, p. 155). (shrink)