Mixed method study designs are becoming increasingly popular among nurse researchers. Mixed studies can have advantages over single method or methodological investigative designs. However, these advantages may be squandered where researchers fail to think through and justify their theoretic decisions. This paper argues that nurse researchers do not always pay sufficient heed to the philosophic and theoretic elements of research design and, in consequence, some mixed study reports lack argumentative coherence and validity. It is here suggested that Hempel's concept of (...) equivalence can be stretched to usefully illustrate one of the main threats to argumentative coherence in mixed study design. The critical realist theory of Roy Bhaskar is then introduced and this, it is proposed, offers one means by which Hempel's equivalence dilemma can be overcome. Critical realists recognize the existence of logical connections between the ontological, epistemological, and methodological premises that underpin their work. They are therefore more likely to produce coherent studies than uncritical pragmatists who ignore such linkages and, paradoxically, critical realists can be epistemological pluralists because, in re‐conceptualizing the ontological basis of inquiry, problems associated with the mixing of alternative metaphysics are circumvented. (shrink)

MIRÓ M, GASTALDO D, NELSON S and GALLEGO G. Nursing Inquiry 2012; 19: 270–280 Spanish nursing under Franco: reinvention, modernization and repression (1956–1976)This article examines Spanish nursing during a critical 20‐year period (1956–76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state‐run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS–Ayudante Técnico Sanitario (...) (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women’s Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid‐twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first‐year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender‐related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women’s branch of the ruling Falangist Party in mid‐twentieth century Spain. (shrink)

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in (...) this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio‐political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency‐structure interaction and stresses the centrality of agents’ roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives’ relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report. (shrink)

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students’ written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine (...) how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students’ understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care. (shrink)

These days, discussions of what might be the ‘essence’ or the ‘core’ of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the ‘newer’ nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. (...) These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of ‘life unworthy of living’. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; ‘goodness’ that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice. (shrink)

This study examines the Canadian Code of Ethics for Registered Nurses as a discursive mechanism for shaping nurses' professional identity using a Foucauldian lens. Nurses are considered essential in healthcare, yet the nursing profession has struggled to be recognized for its discipline‐specific knowledge and expertise and, as such, has remained the subject of and subject to the dominant discourses within healthcare and society generally. Developing a professional identity in nursing begins after the necessary education and training are achieved and embodies (...) the profession's history, values, code of ethics, and expectations of the profession that distinguish it from other professions. Since nurses' professional identity is shaped through discourse, it raises the question of whether there are spaces to reconceptualize nurses' subject position within health care. Since professional identity is considered the embodiment of knowledge and practice, the code of ethics bears examination both for its effect on nurses' professional identity and as a potential site from which to challenge hegemonic assumptions. This article discusses the concept of professional identity in nursing and its development through the discursive formations in the code of ethics. The sources of power/knowledge are examined as both mechanisms of control and as spaces for change. (shrink)

Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his (...) fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power — sovereign, disciplinary and pastoral — which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis. (shrink)

The power of routine and special observations: producing civility in a public acute psychiatric unit This study directly addresses controlling aspects of psychiatric nursing practice, which are currently marginalised in practice and research. We first consider the discursive tensions surrounding the mandated goal of social control in public acute psychiatric units, particularly referring to those units located within medical hospitals. We attest to the enduring social control mandate in psychiatric nursing and explore ways in which it is enacted.Specific nursing practices (...) of ‘doing the obs’ while scanning the ward and ‘special observations’ are investigated as important activities of social control, based on findings from an ethnographic study in one acute psychiatric unit in Australia. These practices are acknowledged as key modes of nursing surveillance. Contrary to past work, they are regarded as productive for engendering civil conduct among patients in acute psychiatric settings. We reframe these activities of surveillance as liberal therapeutic practices in themselves, to the extent that they assist patients to achieve treatment goals and promote self‐surveillance and self‐control. Instead of effacing practices of control, we encourage nurses to discriminate between more and less liberal modes of control in everyday practice and to build their skills in liberal controlling strategies. (shrink)

The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in this emerging area of research. Systematic searches in reference databases and in citation indexes identified 12 articles that included analyses of the social and linguistic features of records and recording. Two reviewers extracted data using established criteria for the evaluation of qualitative research papers. A common characteristic of nursing records was the economical (...) use of language with local meanings that conveyed little information to the uninitiated reader. Records were dominated by technocratic‐medical discourse focused on patients’ bodies, and they depicted only very limited aspects of nursing practice. Nurses made moral evaluations in their categorisation of patients, which reflected detailed surveillance of patients’ disturbing behaviour. The text analysis methods were rarely transparent in the articles, which could suggest research quality problems. For most articles, the significance of the findings was substantiated more by theoretical readings of the institutional settings than by the analysis of textual data. More probing empirical research of nurses’ records and a wider range of theoretical perspectives has the potential to expose the situated meanings of nursing work in healthcare organisations. (shrink)