"I can't be the nurse I want to be": Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving.

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.

Ambivalent complicities and knowledge production: Researching migrant women farmers' reproductive health experiences in the middle belt of Ghana.

Using a critical reflexive process (An Invitation to Reflexive Sociology, 1992; Theory, Culture & Society, 13, 1996, 17), this article identifies and examines issues of power, complicity and knowledge production as they emerged in the first author's master's research on migrant women farmers' economic and reproductive health experiences in the middle belt of Ghana. We examine the ambivalent positionality of the international graduate student researcher as "other of the other" (Signs: Journal of Women in Culture and Society, 30, 2005, 2017, p. 2025), and how diverse fields of power, including the researcher's educational institution and cultural norms regarding gender relations, mediated interactions among various actors in the research process. Specifically, we examine how the student researcher was complicit in reinforcing patriarchal standards, perpetuating western saviourism and committing symbolic violence. Situating these reflexive findings in relation to insights from feminist postcolonial theories, we highlight how power relations, gender and social class informed these ambivalent complicities. Rather than erase/silence these tensions in the research process, we argue that such ambivalences may be an inevitable dimension of transnational knowledge creation, and thus, it is imperative that researchers consider how their ambivalent positionalities and complicities may be navigated and leveraged most productively and with the least harm to research participants.

The power of potential: Assisted reproduction and the counterstories of women who discontinue fertility treatment.

Despite their low and inconsistent rates of success, assisted reproductive technologies (ARTs) are presented by fertility clinics and constructed in media and popular culture as an effective treatment for infertility. The ways in which such technologies medicalize women's health and bodies have been well documented by social scientists and feminist health researchers. However, little is known about the struggles women face in cases of "failure"; that is, when ART does not achieve its purported potential to assist women in their attempts to conceive and have the desired outcomes of conception and birth. Using a post-structural feminist interpretive framework combined with a narrative methodology, this paper critically examines the ways in which social and cultural narratives about gender and biotechnology shape women's accounts of discontinuing ART. Thirty-six interviews were conducted with twenty-two women across Canada who were at various stages of discontinuation and who utilized a variety of treatment types. Three inter-related narrative themes were developed to categorize the stories of struggle: (i) a growing desperation to be pregnant; (ii) confronting paternalistic medical expectations; and (iii) internalizing and resisting blame for treatment failures. These themes highlight both the explicit and subtle ways in which restrictive social and cultural narratives about womanhood and motherhood were perpetuated in clinical interactions, which ultimately made ending treatment more difficult. Our analysis illustrates how women navigated and resisted such narratives, through pausing or ending treatment despite provider recommendations and clinical messages. We suggest that fertility providers critically reflect on the potentially harmful language used during interactions with patients and recommend that discontinuation discussions become a recurring, normalized component of treatment protocols and patient-provider conversations so that women feel better supported to end treatment when they believe it is financially, emotionally, and physically beneficial for them to do so.

Emotional labour and cord blood collection: frontline perspectives.

PURPOSE: This paper aims to examine emotional labour in the work of frontline staff (FLS) of the Canadian Blood Services' Cord Blood Bank (CBB), contributes to understandings of emotional labour by allied healthcare workers and suggests implications for healthcare managers. DESIGN/METHODOLOGY/APPROACH: Qualitative interviews with 15 FLS were conducted and analyzed as part of a process evaluation of donor recruitment and cord blood collection in Canada. FINDINGS: Emotional labour with donors and hospital staff emerged as a vital component of FLS' donor recruitment and cord blood collection work. Emotional labour was performed with donors to contribute to a positive birthing experience, facilitate communication and provide support. Emotional labour was performed with hospital staff to gain acceptance and build relationships, enlist support and navigate hierarchies of authority. RESEARCH LIMITATIONS/IMPLICATIONS: The results indicate that FLS perform emotional labour with women to provide donor care and with hospital staff to facilitate organizational conditions. The findings are based on FLS' accounts of their work and would be enhanced by research that examines the perspectives of donors and hospital staff. PRACTICAL IMPLICATIONS: Attention should be paid to organizational conditions that induce the performance of emotional labour and may add to FLS workload. Formal reciprocal arrangements between FLS and hospital staff may reduce the responsibility on FLS and enable them to focus on recruitment and collections. ORIGINALITY/VALUE: This paper addresses a gap in the healthcare management literature by identifying the emotional labour of allied healthcare workers. It also contributes to the cord blood banking literature by providing empirically grounded analysis of frontline collection staff.

Contextual factors influencing donor recruitment and cord blood collection: perspectives of frontline staff of the Canadian Blood Services' Cord Blood Bank.

BACKGROUND: Umbilical cord blood (CB) is an important source of hematopoietic stem cells that are used to treat blood- and immune-system disorders. Public CB banks aim to build inventories with high-quality CB units to meet healthcare needs. While research has noted the influence of broader contextual factors on donor recruitment and CB collection processes, to date, no published study has identified the specific contextual factors and challenges to donor recruitment and CB collection. This paper addresses this gap in the literature. STUDY DESIGN AND METHODS: A qualitative case study focusing on donor recruitment and CB collection processes was conducted to identify the contextual factors influencing these processes. This paper reports the findings from in-depth, semi-structured interviews conducted with 15 frontline staff of the Canadian Blood Services' Cord Blood Bank. Interview data were analyzed using inductive interpretive methods to identify the contextual conditions and factors that influence recruitment and collection. RESULTS: Frontline staff described various social factors that influenced and challenged the processes of donor recruitment and CB collection. These were categorized into four overlapping contexts: birthing context, hospital context, CB bank organizational context, and sociocultural context. CONCLUSION: Consideration of social context is necessary in order to effectively address the factors and challenges that influence the successful development of high-quality CB inventories, and to guide resource allocation. Further examination of contextually-rooted factors and their interactions is necessary to optimize donor recruitment and CB collection processes.

HPV vaccination discourses and the construction of "at-risk" girls.

RéSUMé: OBJECTIF: L'objectif était d'étudier le déploiement des discours sur la vaccination contre les VPH (VVPH) et leur impact sur les filles, les parents, les infirmiers/infirmières et les médecins canadiens. MéTHODES: Des entrevues ont été réalisées avec des participant(e)s (n = 146) de quatre provinces canadiennes. Une analyse poststructuraliste du discours a permis d'examiner les campagnes de VVPH et les transcriptions d'entrevues pour documenter la façon dont les participant(e)s interprètent les VVPH et se positionnent comme sujets au sein des discours de l'industrie ou des agences de santé publique. RéSULTATS: Les campagnes de VVPH sont sexistes, hétéro-normatives et trompeuses. Émergeant de l'analyse des entrevues est le manque d'information des filles et des parents en ce qui a trait à la VVPH. Les mères se construisent en tant que bio-citoyennes responsables, mais au prix de l'impuissance, de l'anxiété et de la peur ressenties parallèlement à l'impératif d'agir pour minimiser le risque de cancer de leur fille. Quant aux professionnel(le)s de la santé, ils s'approprient les discours dominants sur la VVPH et utilisent la peur comme stratégie pour fabriquer le consentement pour la VVPH. Les occasions de dialogue sur la VVPH et la santé sexuelle des filles sont perdues et les positions en tant que sujets sont problématiques pour tous les types de participant. CONCLUSIONS: Nous nous questionnons à savoir si la santé publique est bien servie quand les discours sur la VVPH transforment des corps en santé en corps « à risque ¼ et quand la peur du cancer est instrumentalisée pour la pharmacologisation de la santé publique.

Preparedness as a technology of (in)security: Pandemic influenza planning and the global biopolitics of emerging infectious disease.

This article takes as its starting point the idea that re-emerging infectious disease has become a paradigmatic way of thinking about disease. The framing of infectious disease as a threat to global public health and economic security coincides with preemptive forms of control. A particular type of preemptive regulation is global pandemic influenza planning that entails the governing of an imminent, albeit uncertain, global health event. We examine the discourse of 'preparedness' within pandemic planning documents produced by the World Health Organization from 1999 to 2009. We present key findings on: the construction of the influenza virus in terms of its potential to transform and expand across corporeal and territorial boundaries; and the integration of pandemic preparedness into everyday practices. Our analysis illustrates how the discourse of preparedness links the justification for population-level preemptive approaches to discursive constructions of the virus. By articulating this relationship, this article contributes to understandings of the implications of 'molecular' constructions for the biopolitical regulation of the global population.

From desire to disease: human papillomavirus (HPV) and the medicalization of nascent female sexuality.

This article critically examines the proliferation of information on the human papillomavirus (HPV) vaccination as integral to contemporary processes of medicalization that take the young female body and her nascent sexuality as its primary object and target. We suggest that the recent introduction of voluntary HPV vaccination for girls, in North America and elsewhere, constitutes a form of neomedicalization (Batt & Lippman, 2010 ) that links risks for future disease (cervical cancer) with the transmission of a common, sexually transmitted infection (HPV). Informed by findings from a critical discourse analysis of Canadian English newspapers, magazines, and public information about HPV vaccination, our interest is on how the emergence of sexual relationships becomes constructed as a time fraught with risks to future health, and that must be managed through biotechnological intervention (vaccination). We suggest that this configuration of medicalization, rather than demarcate a new category of abnormality that can be treated with pharmaceutical or medical intervention, positions the emergence of sexuality itself as the basis of risk and pathologization. The article concludes by considering the implications of this form of medicalization for constructions of female sexuality and sexual health education.

"You are free to set your own hours": governing worker productivity and health through flexibility and resilience.

Flexible work is now endemic in modern economies. A growing literature both praises work flexibility for accommodating employees' needs and criticizes it for fueling contingency and job insecurity. Although studies have identified varied effects of flexible work, questions remain about the workplace dimensions of flexibility and how occupational workplace health is managed in these workplaces. This paper presents findings from a qualitative study of how managers in the computer software industry situate workplace flexibility and approach worker health. In-depth interviews were conducted with managers (and some workers) at 30 firms in Ontario, Canada. Using a critical discourse analysis approach, we examine managers' optimistic descriptions of flexibility which emphasize how flexible work contributes to workers' life balance. We then contrast this with managers' depictions of flexibility work practices as intense and inescapable. We suggest that the discourse of flexibility, and the work practices they foster, make possible and reinforce an increased intensity of work that is driven by the demands of technological pace and change that characterize the global information technology and computer software industries. Finally, we propose that flexible knowledge work has led to a re-framing of occupational health management involving a focus on what we call "strategies of resilience" that aim to buttress workers' capacities to withstand intensive and uncertain working conditions.

Workplace injury or "part of the job"?: towards a gendered understanding of injuries and complaints among young workers.

Epidemiological studies have found that teenage workers have higher occupational injury rates than adult workers, and that young males are a particularly high-risk subgroup. However, there have been few studies to date that have explored qualitatively young workers' everyday understandings and experiences of occupational health risks. Based on focus groups conducted with Canadian urban and suburban teenagers aged 16-18 years, this paper explores young workers' understandings and experiences of occupational health risks, and their gendered nature. The respondents were employed in a diverse range of jobs. The findings suggest that young workers experience a number of minor injuries and physical complaints related to their work. These injuries were typically seen as "part of the job" because they happened frequently and were of low severity. Also, the experience of these injuries as "part of the job" was informed by the young workers' perceived lack of control to improve or alter the conditions of their work. Furthermore, young workers' complaints and concerns were systematically discounted and this happened in a gendered fashion. Whereas the females emphasized how their complaints were actively disregarded by their superiors, males (and some females in male-dominated work settings) described how they stifled their complaints in order to appear mature among their (older) co-workers. Comparisons with qualitative studies of adult workers suggest that accepting some risks and injuries as "part of the job" is not peculiar to young workers. The implications of these findings for improving workplace safety for young workers are discussed.

'Working at the margins' or 'leading from behind'? A Canadian study of hospital-community collaboration.

Collaboration between hospitals and community organisations has been promoted over the past 20 years by various levels of government, hospital associations, health promotion advocates, and others at the state/province, national and international levels as a way to improve the 'efficiency of the system', reduce duplication, enhance effectiveness and service coordination, improve continuity of care, and enhance community capacity to address complex issues. Nevertheless, and despite a growing literature on interagency collaboration, systematic documentation and empirical analysis of hospital-community collaboration (HCC) is almost completely lacking in the literature, particularly as regards collaborations that address the determinants of health beyond the hospital walls. In this paper, we describe the methodology and key findings from a research study of HCC. The Hospital Involvement in Community Action (HICA) study undertook detailed qualitative case studies (in four urban, suburban, rural and northern locations) and a telephone survey (of 139 community organisations in a large urban centre) in order to learn about the range of collaborations and working relationships that exist between hospitals and community agencies in the province of Ontario (Canada), and the factors that influenced (enabled and/or hindered) HCC. Particular attention was paid to barriers and enablers at three nested levels of context (policy, hospital and community) and, drawing primarily on the qualitative case studies, it is this aspect that is the focus of this paper. That such collaborations continue to be widespread despite a generally unfavourable policy environment and hospital institutional culture that poses significant barriers, suggests that the extent to which HCC flourishes (or exists at all) crucially depends on the presence and ongoing enthusiasm/commitment of one or more 'champions' within the hospital, and the commitment of both parties to overcome the marked cultural differences between hospital and community. We conclude with a discussion of implications for policy and practice.