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 influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

In 1998, the US Supreme Court first held that asymptomatic HIV infection constituted a disability when it ruled on the case of Bragdon v. Abbott. The use of yet another label to identify women living with HIV has been rarely questioned. While we do value the use of this label as an anti-discriminatory strategy, we believe that there is a need to examine how language and more specifically, the use of words such as disability, limitation, and impairment may create new (...) forms of identities for women living with HIV. Using this legal case as a starting point, the goal of this paper is to critically examine the 'fabrication' of asymptomatic HIV infection as a disability. Grounded in a feminist poststructuralist perspective, this paper exposes the relationship between language, social institutions, subjectivity, and power in the construction of difference. By doing so, it addresses the identification of women living with HIV/AIDS as disabled and the self-differentiation process that they must go through in order to live as normally as possible. (shrink)

This paper analyzes and explores varying discourses within the talk of new practitioner direct entry (DE) midwives in Aotearoa/New Zealand. In Aotearoa/New Zealand, midwifery is theorized as a feminist profession undertaken in partnership with women. Direct entry midwifery education is similarly based on partnerships between educators and students in the form of liberatory pedagogies. The context for the analysis is a large ethnographic study undertaken with a variety of differently positioned midwives based mainly in one city in New Zealand. I (...) interviewed and observed over 40 midwives in their different practice settings in 2003. Complex and contesting forms of knowledge production are analyzed in this paper drawing on methodological insights from Foucauldian discourse analysis. New practitioners engage in techniques of self‐monitoring and surveillance as they move towards becoming established practitioners. New midwifery subjectivities and forms of knowledge production which contest authoritative forms of knowledge are produced. Midwives in New Zealand are seen to inhabit a complex and liminal space of midwifery praxis. Paradoxically, they are exhorted to remain the ‘guardians of normal birth’ in a time of increasing interventions into birth both locally and internationally. Paradoxes encountered by new midwifery practitioners in New Zealand as they struggle to maintain ideals of ‘normal’ birth may be paralleled by the constraints inadvertently produced through governing discourses of emancipatory or liberatory pedagogies. The relevance of this is also highly critical for midwifery and birth practices internationally. (shrink)

FADYL JK and NICHOLLS DA. Nursing Inquiry 2013; 20: 23–29 Foucault, the subject and the research interview: a critique of methodsResearch interviews are a widely used method in qualitative health research and have been adapted to suit a range of methodologies. Just as it is valuable that new approaches are explored, it is also important to continue to examine their appropriate use. In this article, we question the suitability of research interviews for ‘history of the present’ studies informed by the (...) work of Michel Foucault – a form of qualitative research that is being increasingly employed in the analysis of healthcare systems and processes. We argue that several aspects of research interviewing produce philosophical and methodological complications that can interfere with achieving the aims of the analysis in this type of study. The article comprises an introduction to these tensions and examination of them in relation to key aspects of a Foucauldian philosophical position, and discussion of where this might position researchers when it comes to designing a study. (shrink)

The challenges posed by postmodern and poststructural theories profoundly disrupt the certainties of feminist and nursing research, yet at the same time offer possibilities for developing new epistemologies. While there are an increasing number of accounts discussing the theoretical implications of these ideas for nursing research, I wish to discuss the practical and the methodological implications of using postmodern feminist theories within empirical research. In particular, I identify the challenges I encountered through an examination of specific aspects of the research (...) process and through examples drawn from empirical research. I conclude that using postmodern feminist theories requires a continuous engagement with, and interrogation of, the modern epistemological and ontological assumptions of qualitative, feminist nursing research and, in so doing, presents the possibility for nurse scholars to begin to develop a ‘passionately interested’ methodological approach to nursing inquiry. (shrink)

This paper delineates a postmodern discourse analysis that is positioned within a semiotic theory of language. This theory of language foregrounds the performative aspects of language usage and provides the theoretical space from which to theorize the interrelationship between social organizations or structure and social agents or individuals. Our version of discourse analysis contends that social structure is enacted (production and reproduction) through the employment of various vocabularies: social structure is not something outside of, behind, or underneath these performances, and (...) we argue that social organization is not produced by external structures operating upon or causing people to adopt certain behaviours. Rather, social structure is an effect of taking up practices and reproducing and modifying them. From this perspective, individuals are constituted by being recruited into and reproducing discursive practices. Hence, by looking at the actual employment of language – its tactical, practice dimensions – one can avoid the usual binary of seeing the person as either the autonomous origin of his or her experience or the ideological pawn of social determination. This methodology calls into question how the narratives or stories that individuals recount are imbricated within relational plays of power, and concomitantly, how subjects reauthorize their own positions. We assert that the methodological challenges of research addressing social injustice cannot be reduced to either: (i) interpersonal relationships between researcher and participants, or (ii) relegated to ‘social structures’ acting upon or outside of individuals. (shrink)

MACDONNELL JA. Nursing Inquiry 2011; 18: 313–324 Gender, sexuality and the participatory dimensions of a comparative life history policy studyIn this paper, I explore how a critical feminist lens was a crucial element in creating a participatory policy study which used a qualitative design and comparative life history methodology. This study focused on Canadian nurses’ political practice related to advocacy for lesbian health. Findings show that the combination of the gender lens and life history approach offers potential to create knowledge (...) in ways aligned with health‐promoting and emancipatory outcomes. However, the nature of participation and interaction by researcher and participants is contexualized and contested given complex dynamics of power that shape all aspects of this doctoral study process. The critical feminist lens with its focus on reflexivity informed the content and process of knowledge production in this study and shaped key turning points: the ways in which this policy study was conceptualized, the choice of comparative life history methodology, ethical considerations, data collection and analysis and representation of findings. Life history is unlikely to be the methodology that first comes to mind when undertaking a policy study. Its historical roots are associated with biographical, oral history and narrative approaches, which typically aim to elicit understanding of lived experience. Yet, it was this very aspect, this focus on lived experience, which rendered life history methodology fitting as I contemplated how to examine the relationship between nurses and policy. I was interested in understanding nurses’ political practice, how policy influenced nurses’ capacity to advocate in their everyday lives, as well as nurses’ impacts on policy processes and their larger social worlds. (shrink)

This paper develops a framework for establishing rigour for a discourse analysis of professional transition in midwifery, theorised as a ‘female professional project’. Discourse analysis has gained recognition as a useful approach in nursing and midwifery research. It provides an alternative to those qualitative approaches that propose to reveal a ‘reality’ from the perspective of the individual experience, and that this lived experience can be directly represented in language. There are multiple discourse analytic approaches, and often researchers are not explicit (...) about what type they are employing. Furthermore, to date there are few clear guidelines for what constitutes rigour in a discourse analytic study. Rigour in qualitative research broadly falls into two categories: the replication perspective that argues for the maintenance of criteria of validity and reliability, usually with an underpinning assumption (often unquestioned) that a ‘truth’ can be revealed. The second is the parallel perspective that questions the ontological and epistemological assumptions of the replication perspective and argues for the development of criteria that reflect the assumed questionable nature of truth and reality. Transferring these criteria to a discourse analytic study revealed some problems. A common challenge identified in achieving rigour in discourse analysis is the maintenance of congruity between the epistemological and ontological basis of a piece of research and the actual analysis conducted or reported. A framework is proposed to address these incongruities and includes six elements. As nurses and midwives increasingly employ discourse analysis in their research, attempts to clarify how rigour will be determined are important if the outcomes of such research are to be seriously considered for their implications for theory, policy and practice. (shrink)

Through its social and political activism goals, postcolonial feminist theoretical approaches not only focus on individual issues that affect health but encompass the examination of the complex interplay between neocolonialism, neoliberalism, and globalization, in mediating the health of non-Western immigrants and refugees. Postcolonial feminism holds the promise to influence nursing research and practice in the 21st century where health remains a goal to achieve and a commitment for humanity. This is especially relevant for nurses, who act as global citizens and (...) as voices for the voiceless. The commitment of nursing to social justice must be further strengthened by relying on postcolonial theories to address issues of health inequities that arise from marginalization and racialization. In using postcolonial feminist theories, nurse researchers locate the inquiry process within a Gramscian philosophy of praxis that represents knowledge in action. (shrink)

PORTER S and O’HALLORAN P. Nursing Inquiry 2012; 19: 18–28 The use and limitation of realistic evaluation as a tool for evidence‐based practice: a critical realist perspectiveIn this paper, we assess realistic evaluation’s articulation with evidence‐based practice (EBP) from the perspective of critical realism. We argue that the adoption by realistic evaluation of a realist causal ontology means that it is better placed to explain complex healthcare interventions than the traditional method used by EBP, the randomized controlled trial (RCT). However, (...) we do not conclude from this that the use of RCTs is without merit, arguing that it is possible to use both methods in combination under the rubric of realist theory. More negatively, we contend that the rejection of critical theory and utopianism by realistic evaluation in favour of the pragmatism of piecemeal social engineering means that it is vulnerable to accusations that it promotes technocratic interpretations of human problems. We conclude that, insofar as realistic evaluation adheres to the ontology of critical realism, it provides a sound contribution to EBP, but insofar as it rejects the critical turn of Bhaskar’s realism, it replicates the technocratic tendencies inherent in EBP. (shrink)

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, (...) poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care. (shrink)

In the past 20, years the impact of progressive educational theories have become influential in nurse education particularly in relation to partnership and empowerment between lecturers and students and the development of student autonomy. The introduction of these progressive theories was in response to the criticisms that nurse education was characterized by hierarchical and asymmetrical power relationships between lecturers and students that encouraged rote learning and stifled student autonomy. This article explores how the work of Michel Foucault can be mobilized (...) to think about autonomy in three different yet overlapping ways: as a historical event; as a discursive practice; and as part of an overall strategy to produce a specific student subject position. The implications for educational practice are that, rather than a site where students are empowered, nurse education is both a factory and a laboratory where new subjectivities are continually being constructed. This suggests that empowering practices and disciplinary practices uneasily co‐exist. Critical reflection needs to be directed not only at structural dimensions of power but also on ourselves as students and lecturers by asking a Foucauldian question: How are you interested in autonomy? (shrink)

The past decade has seen the gradual emergence of what might be called a postmodern perspective on nursing research. However, the development of a coherent postmodern critique of the modernist position has been hampered by some misunderstandings and misrepresentations of postmodern epistemology by a number of writers, leading to a fractured and distorted view of postmodern nursing research. This paper seeks to distinguish between judgemental relativist and epistemic relativist or ironist positions, and regards the latter as offering the most coherent (...) critique of modernist/(post)positivist nursing research. The writings of poststructuralist philosophers, including Barthes, Lyotard, Derrida, Foucault and Rorty are examined, and a number of criteria for a postmodern ironist concept of research validity or trustworthiness are suggested. Whilst these writers reject the idea of Method as a guarantee of valid research, they nevertheless believe that value judgements can and must be made, and turn to notions of ironism, différance, and the differend. Ultimately, the postmodern ironist reader of the research report must make a judgement without criteria, based on her own practical wisdom or ‘prudence’. (shrink)

In their own words: nurses’ discourses of cleanliness from the Rehoboth Mission For nurses of the nineteenth and early twentieth centuries, cleanliness was often seen as a virtue next to godliness. For missionary nurses, this analogy took on multiple meanings. This study focuses on discourses of cleanliness at one site of missionary nursing in the early twentieth century: the Rehoboth Mission and its hospital, which provided health‐care to the Navajo in the southwestern USA from 1903 to 1965. Data sources included (...) denominational publications, institutional records, correspondence, questionnaires and interviews of the Dutch–American missionary nurses who practiced at the Rehoboth Mission. Discourse analysis was conducted on references to cleanliness, hygiene and sanitation in these texts. Secondary discourses of embodiment in daily practice, initiation and assimilation, caring, ignorance, environmental factors and gendered work were identified and analyzed. The study interrogates the whiteness of the nurses’ dominant culture and sheds light on nurses’ relationships with normative discursive frames that reflect and perpetuate inequalities, discredit non‐dominant practices, and leave little room for competing discourses. It also illustrates a blurring of religion and health‐care, and the need for a reflective and informed stance as a basis for cultural competence. (shrink)

Breastfeeding policies and the production of motherhood: a historical–cultural approach This paper revisits some of the aspects that allow us to situate historically the process that has been called the ‘politicization of women's breasts’. It is part of a broader research project being undertaken in Rio Grande do Sul, Brazil, which is studying information from the educational material used in the National Campaign for the Incentive of Breastfeeding. The methodological approach used is cultural analysis, and its theoretical basis is informed (...) by feminist studies and cultural studies, from a poststructuralist perspective. Knowledges and practices that produce notions of maternity are problematized to argue that current political and economic arrangements have necessitated a redefinition of motherhood. This re‐signification of motherhood has transferred to women the duty of solving an array of problems that were previously considered government's responsibility, in particular those related to the physical and emotional development of infants. (shrink)

Clerical frames for nursing practice: missionary nurses at Rehoboth This paper presents a discourse analysis of publications of the Christian Reformed Church regarding its Rehoboth Mission near Gallup, New Mexico, among the Navajo. All issues of The Banner, Acts of Synod of the Christian Reformed Church, the Rehoboth Hospital Bulletin, and the Annual Report of the Rehoboth Mission from 1880 to the present were reviewed for references to health‐care at Rehoboth from 1903 to 1943. Four religiously framed discourses were identified: (...) discourses justifying provision of health‐care at the mission, discourses of the Navajos as immature and potentially dangerous, needing to be civilized, discourses of cleanliness, and discourses of calling. This paper adds to a growing body of knowledge about religious frames within which nurses have practiced in North America. (shrink)

The article draws attention to the unexploited potentials in using visuals within nursing research and especially in using visuals as data. Initially, the authors give a brief description of what is meant by visual research methods and present a short overview of the different approaches that are possible. Visual methodologies are situated within different theoretical frames, often within a postmodern framework. We present a study using a postmodern approach inspired by the works of Foucault. The study demonstrates the possibilities inherent (...) in using visuals as data by exemplifying how illustrations from health journals from Scandinavia reflect otherwise veiled and/or unconscious gendered attitudes on user participation. (shrink)

Public health nurses (PHN) have had a long history of working with new mothers in the community. Their practice includes collaboration, building therapeutic relationships, mutual goal setting, establishing trust, supporting clients’ strengths, empowerment and social justice. The wealth of information that new mothers receive both solicited and unsolicited may come from many different sources such as medicine, midwifery and those created personally by families. Although much of the information on mothering is presented with the intent of helping, it can also (...) be hegemonic and oppressive depending on different discourses, stereotypes and myths of mothering and therefore may cause confusion, guilt and uncertainty. Public health nurses often address conflicting social, cultural and personal discourses about mothering practices in order to support an empowering mothering experience. The term ‘social mediator’ was purposefully created in an attempt to describe the unique work of PHNs that this author has witnessed through her own research and practice as a PHN. This paper will present a discussion of the author's own work and research findings that will suggest how feminist poststructuralist theory may be used to guide and understand information exchange between PHNs and mothers as they mediate different social, cultural and personal discourses on mothering. (shrink)