Extending the methodology of critical discourse analysis using Haraway's figurations: The example of The Monstrous Perpetrator within contemporary responses to child neglect and abuse.

Critical discursive analyses offer possibilities for equity-oriented research, and are a resource for addressing resistant social problems, such as child neglect and abuse (CN&A). A key challenge for discourse analysts in health disciplines is the tensions between materiality and social constructions, particularly at the site of the body. This paper describes how Donna Haraway's ideas of figuration and technobiopower can augment critical discourse analysis to address this tension. Technobiopower, an intensification of biopower in the context of technoscience, is seen as underpinning the melding of material and semiotic practices. The subject is no longer a material body, but a hybrid body that exists in tropic figuration between the real and unreal. This paper uses an analysis of the figuration of The Monstrous Perpetrator from a study of nursing responses to CN&A to illustrate how Haraway's figuration aligns with and provides an analytical tool to extend critical discursive analyses. Specifically, this methodology offers new ways to identify the discursive qualities of bodies, and how material aspects of bodies are exaggerated, concealing their hegemonic ideologies and discriminatory effects. By identifying discourses within or inscribed upon the body, they can be disrupted, opening new possibilities for social change.

Control of resources in the nursing workplace: Power and patronage relations.

Immigrant nurses make up a large percentage of the Australian nursing workforce. Since the support in the workplace is expected to be inclusive for all nurses, the aim of this article is to explore how support and opportunities for professional growth, learning and development are distributed across different categories of nurses working in a neonatal intensive care unit (NICU). An ethnographic approach has opened an examination of the everyday workplace practices in the NICU to gain insight into how nurses made sense of the social and power relations occurring between themselves and their senior colleagues and how they experienced the support and opportunities they received in their workplace. As today's workplaces such as the NICU are diverse in races, culture and experiences, the concepts of intersectionality and cultural safety assisted in identifying inequality and injustice related to such diversity. The results showed how patronage relations rendered nurses with immigrant status with major disadvantage and left them clinically and culturally vulnerable. Such inequity defeats the reasons for encouraging skilled migration of nurses and poses questions on the cultural competency of recruiting organisations. Considering how cultural safety might guide staff development offers opportunities for authentic support to culturally diverse nurses.

Making things work: Using Bourdieu's theory of practice to uncover an ontology of everyday nursing in practice.

Seeking to answer the question of what it is that nurses do, scholars researching nursing have worked with theoretical approaches ranging from the more abstract to the concrete: from philosophizing the nature of nursing to emphasizing the interpersonal nature of nursing practice to exploring processes of clinical decision-making. In this paper, we engage with Bourdieu's theory of practice as an alternative approach that helps to understand the finer points of nurses' everyday practices of nursing as being grounded in an ontology of practice. We first outline the foundations of Bourdieu's thinking as he established both a relational philosophy of science and an embodied philosophy of action to develop the theory of practice around notions of habitus, capital and field. Then, using the inter-relationships of these key elements of the theory of practice as a 'toolkit to think with', we explore an instance of nursing in practice in an acute care setting and show how, in taking account of social context, the dialectics between the elements reveal the social interactions that are accomplished in the doing. Moving to the relationships of these three elements with Bourdieu's further notions of illusio, symbolic power and symbolic violence, we uncover an ontology of nursing practices in the everyday. We conclude by summarising what this ontology of practice has to offer investigations into practices of nursing in any social context.

Beyond and around mandatory reporting in nursing practice: Interrupting a series of deferrals.

Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how nurses engage with and interrupt these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection.

Conceptualizing nurses' night work: an inductive content analysis.

AIM: To develop a conceptual model of nurse-identified effects of night work. BACKGROUND: Studies designed to predict shift work tolerance are frequently unsuccessful in incorporating the intersections between physiological, psychological and social issues involved in such work. Where nurses have been the participants of such studies they have rarely been involved in ways that would allow their points of view to be heard directly. Consequently, the issues of personal importance to nurses as shift and night workers in 24/7 organizations are rarely identified in discussions about that work. DESIGN: Inductive qualitative content analysis. METHODS: Survey responses were provided by 1355 night working RNs employed in a state/public health system in 2012. Data derived from open-ended questions about nurses' own perceptions of the advantages and disadvantages of night work are analysed here. RESULTS: Four main categories providing a descriptive summary of the major elements of nurses' night work were identified: 'Lives' and 'Bodies' of night working nurses, the 'Work' of nurses at night and the nurses' 'Workplace' at night. CONCLUSION: The work nurses undertake at night, and the demanding organizational and clinical environments where they do this are uniquely related to the time of day that this work occurs. The Nurses' Night Work model deconstructs the established binary considerations of the lives and bodies of workers to permit a 24/7-based consideration of nurses' night work and its frequently unacknowledged relationship with the day work required of the same nurses when working a rapidly but randomly rotating shift work schedule.

Desiring productivity: nary a wasted moment, never a missed step!

The purpose of this paper is to explore how nurses are enrolled into and take part in programmes of efficiency and effectiveness. Using the philosophical theorizing about desire as a force or power, I focus specifically on what is understood as relations between desire and productivity in current Westernized health-care systems. Use is made of the idea from Spinoza that human emotions consist only of pleasure, pain, and desire as these act as a motive force. This is then linked with more contemporary work on the politics and discourses of desire. A report on the implementation of a productivity programme in the United Kingdom, The Productive Ward: Releasing time to care™, is explored for the ways its developers set about motivating nurses to endorse and enact the programme. In exploring the mechanics of desire in these processes, a view of desire as productive is promoted. Looking at desire as assembling actions, and an assemblage, moves the analysis to an interrogation of actions and practices used to enable and bring nurses to the process. Moreover, in working through the various modalities and operations of desire, the potential and limits of such projects are abstracted. Such potentials and limits are necessarily set by the intensification of power and desire in the capitalist economy, saturating areas of nursing, and health-care provision.

Image, measure, figure: a critical discourse analysis of nursing practices that develop children.

Motivated by discourses that link early child development and health, nurses engage in seemingly benign surveillance of children. These practices are based on knowledge claims and technologies of developmental science, which remain anchored in assumptions of the child body as an incomplete form with a universal developmental trajectory and inherent potentiality. This paper engages in a critical discursive analysis, drawing on Donna Haraway's conceptualizations of technoscience and figuration. Using a contemporary developmental screening tool from nursing practice, this analysis traces the effects of this tool through production, transformation, distribution, and consumption. It reveals how the techniques of imaging, abstraction, and measurement collide to fix the open, transformative child body in a figuration of the developing child. This analysis also demonstrates how technobiopower infuses nurses' understandings of children and structures developmentally appropriate expectations for children, parents, and nurses. Furthermore, it describes how practices that claim to facilitate healthy child development may inversely deprive children of agency and foster the production of normal or ideal children. An alternative ontological perspective is offered as a challenge to the individualism of developmental models and other dominant ideologies of development, as well as practices associated with these ideologies. In summary, this analysis argues that nurses must pay closer attention to how technobiopower infuses practices that monitor and promote child development. Fostering a critical understanding of the harmful implications of these practices is warranted and offers the space to conceive of human development in alternate and exciting ways.

The Social Relations of Ethnographic Fieldwork: Access, Ethics and Research Governance.

The focus of this methodological paper is to discuss the challenges of conducting fieldwork, using reflections from our experiences of accessing a research site for ethnographic data collection. The research project aimed to explore nurses' social relations in their workplace and the inequities between and within these relations among nurses of diverse social positions. Due to the sensitive nature of this topic, access to the research site posed several challenges and was further complicated by the bureaucratic ethics process that governs clinical sites in Australia. Although this study was considered a low and negligible risk research, negotiating the ethics process was full of hitches and hindrances resulting in the refusal of access. This paper offers ethnographers a reflection on challenges in accessing clinical sites to conduct research and a discussion of strategies that may be useful to navigate and counter these challenges by managing social relations in the field.

Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplace.

This article presents an analysis of data from a critical qualitative study with 14 skilled black African migrant nurses, which document their experiences of nurse-to-nurse racism and racial prejudice in Australian nursing workplaces. Racism generally and nurse-to-nurse racism specifically, continues to be under-researched in explorations of these workplaces; when racism is researched, the focus is nurse-to-patient racism and racial prejudice. Similarly, research on the experiences of migrant nurses from a variety of ethnicities in Australia has tended to neglect their experiences of the social dynamics of the workplace, thus reinforcing their racialisation. When racialised, the migrant nurse becomes 'the problem' through a focus on English language competency and ensuing communication barriers. This paper applies Essed's framework of 'everyday racism' to theorise narratives of racism by black African migrant nurses in Australia. In so doing, it not only brings to the fore silenced discussions of nurse-to-nurse racism in Australia, but also exposes the subtle, mundane nature of contemporary racism. For this reason, while the data we present must be read within their context, that is, the Australian nursing workplace, it has significance for advancing a critical analysis of racialised minority groups' experiences of racism within seemingly 'race-less' nursing workplaces internationally.

Rethinking shiftwork: mid-life nurses making it work!

Many current analyses of shiftwork neglect nurses' own voices when describing the dis/advantages of a shiftworking lifestyle. This paper reports the findings of a critical re-analysis of two studies conducted with female mid-life Australian nurses to explore the contention that the 'problem-centred' focus of current shiftwork research does not effectively address the 'real' issue for mid-life nurses, that is, how to develop and maintain shiftwork tolerance. Participants used shiftwork to: (i) manage, navigate and negotiate various aspects of their nursing work and the workplace itself; (ii) facilitate more manageable work/life negotiations; and (iii) self-identify opportunities to engage in their own self-care (body work and mind work). The findings thus went beyond simply exposing what nursing bodies do in time and space by bringing to the fore discussions of 'time-body' relationships, the embodiment of time and nurses re/configuration of that time demonstrating that the frequently unacknowledged positive aspects of shiftwork, when centred in discussions, give voice to other ways to think about shiftwork and a shiftworking lifestyle. Thus, our contention is that the 'problem-centred' focus of current shiftwork debates does little to address the 'real' issue for shiftworking mid-life female nurses - the development and maintenance of shiftwork tolerance.

The rise of practice development with/in reformed bureaucracy: discourse, power and the government of nursing.

AIM: Using a neo-Foucauldian approach, a critique of texts explicitly dealing with the definitional work for practice development (PD) was undertaken. BACKGROUND: PD has been taken up by many organizations as a way of focusing on nurses' practices to benefit patients and the organization. EVALUATION: Literature pertaining to the PD phenomenon was examined and the present study explores those texts accomplishing definitional work. The discourse corpus collected together articles in nursing journals, book chapters and textbooks. The corpus was analysed using the discourse analysis method. KEY ISSUES: PD uses and manipulates its location in a network of managerialism, evidence-based nursing, safety and quality discourses in healthcare to verify (and confirm) its definition and its position as central to progress in nursing practice. CONCLUSION: We argue that while PD is portrayed as 'emancipatory' and transforming, nurses bear the responsibility for the system and its failures in a web of intricate power relations. IMPLICATIONS FOR NURSING MANAGEMENT: The present study offers a review of the PD ideology in nursing where a critical perspective has yet to be found. Nursing managers should understand that PD is not a panacea for improving patient care.

The 'well-run' system and its antimonies.

An aim of all of the management of healthcare systems is the smooth provision of services. A great deal of effort is put into ensuring processes will obtain this ideal--the well-run system. The central argument in this paper is that these processes result in a system that perpetrates violence and coercion on its clients and workers. This violence is structural and personalizing in its effects. Moreover, time and effort is taken away from the actual work of the system for its management. Under such managerialist control, the idea of chaos and the need to ensure order are used to fuel an apparatus that takes the focus from other aspects of the system such as the power relations that keep the system as it is. In such an ordering, the clinical audit is promoted as a method to ensure order by keeping ahead of, or removing the potential for chaos. In using Zizek's ideas about violence it is possible to identify how efforts and attempts to correct the system are doomed to fail just as they hide how nurses' enrolment in the service of the system leads to alienation and subjectification. A central aim of this paper is to rethink how power and implicit violence are practised in such processes. To overcome the inherent violence of the audit culture, this paper suggests an interruption of audit cultures with a promotion of more radical positions for nursing practice and clinically based research. The hope is to recalculate and interrupt how nurses are to operate in the management structures that organize healthcare.

Surviving the adversity of childlessness: fostering resilience in couples.

In contemporary Western society, infertility has the capacity to impact greatly on couples, emotionally and socially. In the face of such infertility, couples are able to seek assisted reproductive technologies to assist in the pursuit of biological parenthood. These technologies are not infallible though, and the likelihood of success remains small. Therefore it is inevitable that some couples will remain childless, and this has been associated with grief and adversity. Findings present the narratives of participant couples' through and beyond the many adversities encountered due to remaining childless despite infertility treatment. Regardless of theories that seek to pathologise couples experiencing this type of adversity, participant couples demonstrated resilience in redirecting their energies into areas of their lives where they could achieve positive outcomes. This research highlights the importance of caring for couples rather than individuals undergoing infertility treatment. It provides support for approaches that foster couples' relationships with the aim of promoting individuals' resilience.

Citizen minds, citizen bodies: the citizenship experience and the government of mentally ill persons.

The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's concept of governmentality is helpful in understanding the production of the citizen subject, its location within the 'art of government', as well as the ethical and political implications of citizenship in the context of mental health.

Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health.

Whistleblowing has been examined from various angles over the past 40 years, but not yet as a matter of epistemology. Whistleblowing can be understood as resulting from the improper transmission of critical knowledge in an organization (eg, knowledge about poor care or wrongdoing). Using the sociology of ignorance, we wish to rethink whistleblowing and the failures it brings to light. This article examines how nurses get caught in the strategic circulation of knowledge and ignorance, which can culminate in acts of whistleblowing. The sociology of ignorance helps understand how whistleblowing is borne out of the complex and strategic circulation of knowledge and ignorance that spells multiple and intersecting epistemic positions for nurses. In particular, various organizational blind spots position nurses as untrustworthy and illegitimate speakers in the "business" of the organization. Organizational failings therefore remain concealed while nurses become hypervisible, both as faulty care providers and as problematic information brokers.

Research on couples: are feminist approaches useful?

AIM: This paper is an exploration of the utility and value of feminist approaches when undertaking narrative-based research with partner dyads (within both heterosexual and same sex partnerships) and when researching sensitive issues. BACKGROUND: Adverse life events or conditions experienced by individuals have been found also to have a negative impact on their partners. Most literature addressing partner issues uses quantitative methods, and existing qualitative research on couples has traditionally interviewed only one person in the partnership or coupled partners together. There is little discussion in the literature about the use of feminist research when researching male perspectives and experiences, and even less discussion of the possibilities that feminist research methods bring to the study of couple dyads. DISCUSSION: Qualitative methodologies informed by feminist perspectives, including issues of reciprocity and self disclosure, can be used to unpack structural, personal and political issues related to couples' experiences. A feminist approach allows us to show that the origin of oppression is not personal but very much about power and that men as well as women, regardless of their sexuality, may experience the effects of oppression. Narrative and story-telling complements feminist research because of the value it assigns to the storytellers. CONCLUSION: To care for women effectively, we must also consider the experiences of their partners as the health of one partner has the potential to impact on the other. The concept of oppression is not absent, but indeed is illuminated, in the lives of some men. Gathering stories using feminist perspectives enhances respect and mutuality in the research process.

Governing nursing: curriculum as a rhetorical vehicle using South Australian nursing schools from the 1950s onwards as an illustrative case.

This paper explores how governance processes for nursing curriculum in South Australia changed since the 1950s. The strategy used to undertake this analysis is through discourse analysis of nursing curriculum from the 1950s to recent times. An archive of curriculum data were collected from educational curriculum documents, historical records and government reports. Analysis of this textual data found changes in how curriculum governance occurred as this was increasingly transferred to the discipline of nursing throughout the period explored in this research. Curricula were found to be a rhetorical vehicle, carrying the beliefs and hopes of the nurse educators in their contents. Changes in the focus of the curricula also replicated changes in the locations and maturing of nursing in the higher education sector. Schools of nursing in universities in responding to both internal and external forces were made increasingly responsible as to curriculum content and structures. Historical analysis of South Australian nursing curricula shows changes common in Australia as it moved nurse education from hospital to the tertiary sector in the latter part of the twentieth century, to its contemporary shape as collaboration between profession, industry and discipline to produce nurses for the Australian workforce.