A critical narrative analysis of shared decision-making in acute, inpatient mental health care

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients? care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Preparing for disaster: a comparative analysis of education for critical infrastructure collapse

This article explores policy approaches to educating populations for potential critical infrastructure collapse in five different countries: the UK, the US, Germany, Japan and New Zealand. ‘Critical infrastructure’ is not always easy to define, and indeed is defined slightly differently across countries – it includes entities vital to life, such as utilities (water, energy), transportation systems and communications, and may also include social and cultural infrastructure. The article is a mapping exercise of different approaches to critical infrastructure protection and preparedness education by the five countries. The exercise facilitates a comparison of the countries and enables us to identify distinctive characteristics of each country’s approach. We argue that contrary to what most scholars of security have argued, these national approaches diverge greatly, suggesting that they are shaped more by internal politics and culture than by global approaches.

Critical incident analysis: reflections of a teacher educator

As a teacher educator I consider myself an advocate for research-informed education, and strongly believe that it starts with one’s own critical self-reflection and analysis of one’s own teaching practice. Critical incident analysis is a pedagogical theory developed by Tripp (1993), whose analytical approaches allow reflection on teaching situations – ‘the critical incident’ – so that teachers can develop their professional judgments and practices. This article examines the concept of critical incident analysis through a teaching situation, with the aim of improving the teaching practice of students on teacher education programmes. I conclude that although critical incident analysis is a useful tool in navigating teaching practices, often challenges need to be addressed at much broader levels than the teaching context itself.