Space and place for health and care - Nationalist discourses in Swedish daily press during the first year of COVID-19.

Sweden's strategy during COVID-19 with restrictions but no firm closure of the society surprised the rest of the world and was questioned, not least by neighbouring countries. This article analyses public discourses on space and place for health and care in the Swedish daily press during the first year of the pandemic, 2020. Critical discourse analysis was conducted on daily press newspaper articles to approach issues of space, place, health and care during the COVID-10 pandemic. The findings suggest three main discourses. First, a powerful discourse on unity against the threat is articulated, urging citizens in Sweden to be loyal in the national space. Secondly, an affirming national reconstructing discourse is manifested, related to constructions of borders of national space but also in relation to places of family life and social contacts to 'flatten the curve' and stay healthy. Thirdly, later in the period the overarching discourse of the nation and its loyal citizens was torn apart and increasing tensions were articulated due to, as it appeared, the uncertain actions from the government. This study adds to the literature on a theoretical and practical level. Raising awareness on nationalist discourses in relation to place, space, health, and care could prove important in combating inequalities in the local society as well as when cooperating on an international level.

Building multiscalar sustainable ocean governance: How do global perspectives interact with the Portuguese national approach?

UNESCO's Intergovernmental Oceanographic Commission launched the United Nations Decade of Ocean Science for Sustainable Development in 2021 to boost global and sustainable Ocean governance. The initiative resulted from historical and political dynamics at the global and lower political scales, with maritime environmental and economic concerns becoming more prominent in 2010. The Ocean Decade's pillars include science and research, sustainability, conservation, and bridging gaps for a global Ocean-Climate-Biodiversity nexus. The Sustainable Development Goals recognized the importance of oceans and marine resources, and the Ocean was officially perceived as a determining factor of Climate Change at CoP 21 in 2015. Portugal has built integrated and far-reaching policies for ocean governance, including significant involvement with an international perspective since the Lisbon World Exhibition in 1998. In addition, the national government established a Ministry of the Sea in 2015 to re-develop relations with its maritime space. This article analyzes and compares the discourse of the United Nations' Sustainable Development Goals reports and the Portuguese government programs (2005-2022) to explore the prominent trends in Portuguese Ocean governance discourse and how global and national perspectives interact. Through this case study, the research aims to develop insights into the multiscalar impacts of promoting global and sustainable Ocean governance and its interaction with national perspectives.

What discourses shape and reshape men's experiences of accessing mental health support?

The research employs a single embodied case study design with the aim to examine the discourse of men accessing and receiving mental health support alongside those who are the providers of the support. Three groups of adults were interviewed: men who had experienced mental health problems and had attempted to access mental health support; lay people who supported them, such as partners and non-mental health professionals and professionals, such as mental health nurses, social workers, clinical psychologists and general practitioners. Critical discourse analysis (CDA) is used to identify discourses around three emergent themes: well-being, power and dominance and social capital. Participants seeking mental health support often referred to mental health services as not listening or that what was offered was not useful. A lack of belonging and community disconnectedness was apparent throughout all participant interviews. The study is reported according to the COREQ guidelines.

Environmentally driven migration in EU discourse: norms, policies and realities.

For decades, the European Union (EU) has been addressing issues related to climate change and ecological degradation as a self-proclaimed pro-environmental and human rights-oriented actor. Correspondingly, the topic of the so-called environmentally driven migration entered the EU discourse at the dawn of the new millennium. Considering the EU's interest in the human rights and environmental/climate issue areas, I argue it is important to ask what the Union's approach to this matter has been. Thus, this article assesses the European Union discourse related to the topic of environmental migration over the past 20-year period. Through the theoretical lens of the Copenhagen School of Security Studies and the normative power EU conception, this paper critically analyses the EU's securitisation of climate change in relation to persons referred to as environmental migrants. Based on a qualitative discourse analysis, the preliminary results imply that the topic has been receding into the background of the EU agenda. In line, environmental migrants have been pushed aside by a multiplicity of other subjects threatened by climate change, thus receiving lesser attention in the EU climate change and migration management policies. Overall, the findings show a shift from an alarmist discourse to more pragmatism on the EU's behalf and a larger focus on adaptation and resilience in most affected areas. With this in mind, this article questions the normative standard the EU sets for itself when it comes to the case of environmental migrant protection.

Between nature and culture - Interpreting students' sexuality in physical education.

Introduction: As sexuality in physical education (PE) is often treated as a taboo subject, social media platforms, online chats, and internet forums are emerging as spaces where it is negotiated more openly and broadly by current and former actors of the field. This paper contributes to a better understanding of the discursive construction of sexuality in PE in such online communication. Methods: In line with The Sociology of Knowledge Approach to Discourse (SKAD) we investigate basic schemes of interpretation of sexuality with a heterogeneous sample of threads (17 threads from seven different online forums) on different PE situations in Germany. The threads are analyzed using grounded theory coding procedures. Results: Our discourse analysis reveals that the multifaceted and often controversial online discussions are structured by two dominant schemes of interpreting students' sexuality in PE, both of which are differentiated in complex ways: The online communication draws on - and by that reproduces - a nature and a culture perspective on constellations of body, sex, gender, and sexuality. We detail how from each perspective, different knowledge about these constellations, different everyday phenomena and problems in PE, and different norms for dealing with these phenomena and problems become important. Discussion: Discussing these results in the context of previous literature, we argue that it is important to address sexuality in a subject-specific approach and take the discursive knowledge and fundamental schemes of interpretation into account that shape the (im-)possibilities of addressing sexuality in PE.

Reliability of the picture description task of the Western Aphasia Battery - revised in Laurentian French persons without brain injury.

Objective: Limited normative data (including psychometric properties) are currently available on discourse tasks in non-dominant languages such as Laurentian (Quebec) French. The lack of linguistic and cultural adaptation has been identified as a barrier to discourse assessment. The main aim of this study is to document inter-rater and test-retest reliability properties of the picnic scene of the Western Aphasia Battery - Revised (WAB-R), including the cultural adaptation of an information content unit (ICU) list, and provide a normative reference for persons without brain injury (PWBI). Method: To do so, we also aimed to adapt an ICU checklist culturally and linguistically for Laurentian French speakers. Discourse samples were collected from 66 PWBI using the picture description task of the WAB-R. The ICU list was first adapted into Laurentian French. Then, ICUs and thematic units (TUs) were extracted manually, and microstructural variables were extracted using CLAN. Inter-rater reliability and test-retest reliability were determined. Results: Excellent inter-rater reliability was obtained for ICUs and TUs, as well as for all microstructural variables, except for mean length of utterance, which was found to be good. Conversely, test-retest reliability ranged from poor to moderate for all variables. Conclusion: The present study provides a validated ICU checklist for clinicians and researchers working with Laurentian French speakers when assessing discourse with the picnic scene of the WAB-R. It also addresses the gap in available psychometric data regarding inter-rater and test-retest reliability in PWBI.

"I Feel Like a Fraud Who Acts Like a Feminist": The Discussion Themes and Sexual Scripts in the Porn Free Women Online Forum.

Research on online pornography abstinence movements has predominantly focused on men's perspectives, often within the context of the broader manosphere. This focus has overshadowed the unique experiences and viewpoints of women in these movements. Our study aimed to fill this gap by exploring women-centric perspectives in pornography abstinence forums, particularly Porn Free Women (r/pornfreewomen). Using a mixed methods approach, this study examined the sexual scripts presented in women-dominated pornography abstinence communities. Our structural topic modeling analysis delineated the interplay of therapeutic, heteronormative, and empowerment themes that were evident in women's narratives and expressions. Further, our discourse analysis elucidated three specific scripts: the addiction script, the heterosexual script, and the liberation script. These interweaving narratives show that discussions of women's pornography abstinence are multifaceted and include a variety of perspectives to negotiate. These results contribute to a nuanced understanding of the values of health and well-being, sexual liberation, and feminism within women's pornography abstinence communities.

Managing the new wave of weight loss medication in general practice: A qualitative study.

In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study.

AIM: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS: We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS: Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION: Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE: Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD: We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: We interviewed patients on study wards pre and post intervention.

'You Are Not Alone, We've Got You': Power Plays, Devotion, and Punishment on Healthy Eating and Pro-Eating Disorder Websites.

Healthy eating (HE) and pro-eating disorder (pro-ED) websites are popular sources of dietary and weight loss information, social support, and lifestyle inspiration. However, the discursive styles and language used by authors/moderators and users of these two site genres have not been widely studied or compared. Forty-three HE websites and twenty-four pro-ED websites were analysed using Fairclough's model of critical discourse analysis. Findings indicate that sites share common characteristics in terms of power relations played out by authors, 'successful' dieters, and those attending these sites. These power plays encourage moral and spiritual commitment to the care of one's body, with authoritative language used to support readers' loyalty and adherence to dietary plans. On HE sites, medicinal properties were attributed to 'clean' or 'pure' foods, whereas pro-ED sites conveyed their importance for weight reduction. Healthy eating sites were largely entrepreneurial, promoting products or themselves. Pro-eating disorder sites typically featured discussions of bodily disgust, the chastisement of others, and self-discipline in the name of 'Ana', such that dieting came to be framed as part of a devotional, often punitive, body project. On both sites, morality discourses were gendered around the thin female body and the 'ideal mother', with occasional praise for muscular male bodies. Our findings indicate how transitioning from healthy eating preoccupations to eating disorders may be facilitated by normalising discussions about restrictive dieting and the shaming of bodies, overseen by self-appointed diet 'experts' and 'buddies' online.

Proposing a new history of grief's medicalisation: A critical discourse analysis.

Conceptualisations of grief have transformed significantly in recent decades, from an experience accepted and expressed in community spaces to a diagnosable clinical phenomenon. Narratives of this transformation tend to focus on grief's relationship to major depression, or on recent nosological changes. This paper examines the possibility of a new narrative for medicalisation by grounding in the networks of language and power created around 'grief' through a critical discourse analysis of psy-discipline articles (n = 70) published between 1975 and 1995. Focusing on shifts in definitions of, methods used to approach, and rationales motivating study of the experience, it posits that the psy-disciplines exerted exclusive expertise over grief decades before its creation as a diagnosis. By reconceptualising grief in the terms of psy-specific symptoms and functional performance and by approaching it with the decontextualising and interventionist methods of an increasingly scientific psy-discipline, the psy-community medicalised grief between 1975 and 1995. Identifying neoliberal and other cultural influences shaping this process of medical construction and reconsidering narratives of grief's history mindful of the powers exerted in medicalisation, this paper establishes that these moments played a critical role in the development of the present's grief.

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective.

BACKGROUND: Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms. METHODS: This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee's Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea. RESULTS: We identified four categories of discourses: (1) both "left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses' beliefs in their nursing values. CONCLUSION: ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses' discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses' understanding of their professional roles and identities as caretakers for dying patients.

Exploring the Meaning of Sexuality, the Body, and Identity After Birth Using Feminist Poststructuralism.

OBJECTIVE: To explore how sexual health in the postpartum period is influenced by and negotiated through relations of power. DESIGN: Discourse analysis informed by feminist poststructuralism. SETTING: Telephone interviews conducted in Nova Scotia, Canada. PARTICIPANTS: Eleven women who gave birth in the last 1 to 6 months and lived in Nova Scotia. METHODS: We recruited participants through social media and invited them to share their experiences after birth through individual interviews. Using Baxter's approach to discourse analysis, we focused on identifying how participants created meaning within their experiences. RESULTS: We identified two main themes: Negotiating Change and Renegotiating Identity. Participants defined their bodies in new ways that could be sexual and/or nonsexual and created new meaning(s) of their identities as mothers and as sexual beings after birth. CONCLUSION: The meaning of the body and identity are intricately connected and significantly affect how sexual health is experienced by women during the first 6 months after birth. As such, it is critical that care providers prioritize, acknowledge, and validate how women in the postpartum period choose to define their sexuality, identity, and bodies to ensure the provision of person-centered care.

Evaluating the use of casuistry during moral case deliberation in the ICU: A multiple qualitative case study.

Intensive care unit (ICU) professionals engage in ethical decision making under conditions of high stakes, great uncertainty, time-sensitivity and frequent irreversibility of action. Casuistry is a way by which actionable knowledge is obtained through comparing a patient case to previous cases from experience in clinical practice. However, within the field of study as well as in practice, evidence-based medicine is the dominant epistemic framework. This multiple case study evaluated the use of casuistic reasoning by intensive care unit (ICU) professionals during moral case deliberation. It took place in two Dutch hospitals between June 2020 and June 2022. Twentyfive moral case deliberations from ICU practice were recorded and analyzed using discourse analysis. Additionally, 47 interviews were held with ICU professionals who participated in these deliberations, analyzed using thematic analysis. We found that ICU professionals made considerable use of case comparisons when discussing continuation, withdrawal or limitation. Analogies played a role in justifying or complicating moral judgements, and also played a role in addressing moral distress. The language of case-based arguments is most often not overtly normative. Rather, the data shows that casuistic reasoning deals with the medical, ethical and contextual elements of decisions in an integrated manner. Facilitators of MCD have an essential role in (supporting ICU professionals in) scrutinizing casuistic arguments. The data shows that during MCD, actual reasoning often deviated from principle- and rule-based reasoning which ICU professionals preferred themselves. Evidence-based arguments often gained the character of analogical arguments, especially when a patient-at-hand was seen as highly unique from the average patients in the literature. Casuistic arguments disguised as evidence-based arguments may therefore provide ICU professionals with a false sense of certainty. Within education, we should strive to train clinicians and ethics facilitators so that they can recognize and evaluate casuistic arguments.

"It's beautiful and it's messy and it's tragic": exploring the role of compassion in the eating disorder recovery processes of 2S/LGBTQ + Canadians.

This research explores experiences of compassion among 2S/LGBTQ + Canadians living with eating disorders in the context of eating disorder treatment and community support. There is a growing body of scholarship showing disparities in eating disorder care for those within 2S/LGBTQ + communities. Among the reported concerns is a potential lack of compassion in eating disorder treatment and recovery settings, something which may serve to exacerbate feelings of isolation and perpetuate misunderstandings of 2S/LGBTQ + people's experiences. In an effort to understand these dynamics more deeply, we conducted semi-structured interviews with 2S/LGBTQ + Canadians who have experienced eating disorder care. The data collected were then subjected to Foucauldian discourse analysis, which produced three interconnected discursive considerations: feeling lack of structural compassion, 2S/LGBTQ + communities as places of respite, and 2S/LGBTQ + caregiving. One of the common threads among these discursive considerations was cis-heteronormativity ingrained in eating disorder treatment settings and health care systems more broadly. Our findings underscore the critical need for more enhanced compassion for 2S/LGBTQ + patients in eating disorder care settings. We conclude that compassion, when implemented on the levels of individual clinicians, policy and procedure, and institutions, may represent an avenue toward disrupting ingrained cis-heteronormativity and the associated discursive power structures contained in health care systems.

Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexually or gender diverse (2S/LGBTQ+) are at increased risk for eating disorders often related to minority stress, discrimination, and heteronormative gender expectations. Compassion is believed to be a fundamental aspect of healthcare that builds human connections and enhances positive outcomes. Healthcare, however, is steeped in heteronormative assumptions that may further isolate many 2S/LGBTQ+ patients. This study explored how 2S/LGBTQ+ Canadians living with eating disorders felt about their care and the role of compassion in their recovery journeys. We found that these individuals often felt misunderstood and isolated during treatment. However, they often experienced understanding by connecting with other 2S/LGBTQ+ people both in care and in the community, which provided the compassionate spaces lacking in their healthcare experiences. These findings highlight a need for making healthcare more compassionate for 2S/LGBTQ+ people. This can be done by changing policies, mandatory training for healthcare professionals, and treatment that recognizes and discusses minority stresses, uses trauma-informed practices, and gender-affirming approaches. By doing such items, standard norms can be challenged and the care for 2S/LGBTQ+ people living with eating disorders can be improved.

Who Is Centered in the Humanitarian Response to Gender-Based Violence? A Critical Discourse Analysis of the Survivor-Centered Approach.

Since the 1990s, the international humanitarian system has developed approaches, tools, and standards for addressing gender-based violence (GBV) in emergencies premised on the survivor-centered approach (SCA). Utilizing critical discourse analysis, we explore how articulation of SCA within humanitarian discourse aligns with its stated intent to return control to survivors. The analysis reveals that humanitarian system power dynamics distort the application of SCA, leaving humanitarian service providers in charge of assessing the best course of action or severely limiting survivors' choices. We propose a survivor led approach as more aligned with the feminist and transformative goals of humanitarian action against GBV.

Common Language Development in Multilingual Contexts: A Study of Russian Language Policy in the Early Years of the Soviet Union.

In the field of Russian linguistics, history, and jurisprudence, the Russian language is widely regarded as a political instrument and, to some extent, reflects the development and influence of contemporary language policy of the Russian language in the Soviet Union. This study aims to examine the process, characteristics, influencing psychological and sociological factors, and consequences of Russian language policy in the early Soviet Union (1917-1930s). Thematic analysis and discourse strategy analysis methods were employed to achieve this goal. The results indicate that a well-thought-out language policy necessitates the establishment of language legislation and a precise legal definition of the status and use of different languages. The absence of language legislation can be a major drawback of language policy. While the Soviet Constitution and other relevant political documents broadly define the status and use of Russian and other languages, there is no specific language legislation regulating the use of each language. Analysis of word frequency statistics demonstrates that the key concepts of Stalinist policy differed compared to the time of Lenin's rule, resulting in a lack of effective legal force and strong mechanisms for controlling language policy practices. As the functional advantages of the Russian language become increasingly evident, some ethnic minorities tend to lean towards studying and using it, leading to the emergence of many bilingual and even trilingual individuals. Other minorities with small or underdeveloped populations turn to the Russian language, which is the most widely spoken language. These findings contribute to the theoretical and practical knowledge base for research in the fields of linguistics, linguistic culturology, history, psycholinguistics, and political science. Subsequent research can focus on current aspects of the country's language policy.

Composing adult lives with a ventilator at the intersection of developmental and neoliberal discourses of time.

This paper explores temporalities and experiences of time drawn from an analysis of interview data from a critical narrative inquiry of the experiences of young adults living with home mechanical ventilation (HMV). The analysis centers the ideological effects of dominant discourses that shape understandings of time in the Euro-Western world and the ways in which young adults' stories prompt a rethinking of time in health research and praxis. Data generation involved interviews and photo-elicitation with five young adults (ages 18-40). A critical narrative analysis of participants' stories surfaced the influence of ableist, developmentalist, and neoliberal discourses of time and the creative resistance that points to the potential of crip orientations to time in opening up possibilities for living. Implications for practice and research are offered.

Health professionals' perceptions of user involvement in a mental health centre: A critical discourse analysis.

The objective of this study was to investigate the engagement between healthcare professionals and users of mental healthcare at the individual level in a mental health hospital. A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews were conducted with nurses and other health professionals at a mental health hospital in Copenhagen and were explored using Fairclough's discourse analysis framework. This study shows how users can be subject to paternalistic control despite the official aim that user involvement be an integral part of the care and treatment offered. As evidenced in discussions by health professionals, the users were involved in plans based on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in mental health hospitals.

Deconstructing spiritual care: Discursive underpinnings within palliative care research.

Religion and spirituality are integral to the philosophy of palliative care, shaping its approach to spiritual care. This article aims to examine the discourses within palliative care research to illuminate prevailing assumptions regarding spiritual care. Eighteen original articles were analyzed to examine how spiritual care is understood within palliative care. The analysis, informed by Foucault, aimed to identify recurring discourses. The finding reveals that, in palliative care research, spirituality is viewed as enigmatic yet inherently human and natural, assuming that every individual has a spiritual dimension. The analysis points to healthcare professionals being expected to hold certain qualities to put spiritual care into practice. The analysis also reveals that in the analyzed articles, the concept of spiritual care is rooted in a Christian context, with the belief that all individuals possess inherent spirituality or religiosity, a concept often associated with Christian theology. The included articles often utilize theological terms and emphasize a monotheistic viewpoint. Spirituality is articulated as a complex, distinct concept, challenging clear definitions and professional responsibilities. Further, a moral formation of healthcare professionals is described, interpelling and ascribing qualities that healthcare professionals need to provide spiritual care.