Communication and the casualisation of nursing : a critical ethnography

The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce. Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention. Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes. Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research. This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care. The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.

Nursing casualisation and communication : a critical ethnography

Aim The aim was to explore the relationship between nursing casualization and the culture of communication for nurses in a healthcare facility. Background Casualization, or non-standard work, is the use of temporary, contract, part-time and casual labour. An increase in casual labour has been part of a global shift in work organization aimed at creating a more flexible and cheaper workforce. It has been argued that flexibility of labour has enabled nurses to manage both non-work related needs and an increasingly complex work environment. Yet no research has explored casualization and how it impacts on the communication culture for nurses in a healthcare facility. Design Critical ethnography. Methods Methods included observation, field notes, formal interviews and focus groups. Data collection was undertaken over the 2 years 2008–2009. Results The concepts of knowing and belonging were perceived as important to nursing teamwork and yet the traditional time/task work model, designed for a full-time workforce, marginalized non-standard workers. The combination of medical dominance and traditional stereotyping of the nurse and work as full-time shaped the behaviours of nurses and situated casual workers on the periphery. The overall finding was that entrenched systemic structures and processes shaped the physical and cultural dimensions of a contemporary work environment and contributed to an ineffective communication culture. Conclusion Flexible work is an important feature of contemporary nursing. Traditional work models and nurse attitudes and practices have not progressed and are discordant with a contemporary approach to nursing labour management.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol

Aim
To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance.

Background
Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy.

Design
A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods.

Methods
Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012).

Discussion
Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Analysing organisational culture : a critical ethnography of public relations and personnel specialists in a state bureaucracy

Following an introductory chapter, I examine (i) typologies which have differentiated the literature on organisational culture and symbolism (Chapter 2), (ii) the contribution of organisation theory to organisation culture (Chapter 3), and (iii) recent literature on organisational culture and symbolism (Chapter 4). Within these chapters, I adopt Habermas' (1972) notion of knowledge-constitutive interests, assessing the contrubutions to understanding organisational culture made by literature guided by technical, practical and emancipatory cognitive interests. In doing so, I suggest that more critical studies on organisational culture and symbolism have been comparatively neglected. Lamenting this neglect, I suggest that Giddens' theory of structuration can be employed to advance the development of a critical, emancipatory conceptualisation of organisational culture. In particular, I argue that this Giddensian analysis, by penetrating the existential, poltical and material processes of cultural reproduction (Chapter 5), is able to disclose some of the more contradictory features of organisation culture. The remainder of the thesis comprises of a critical ethnography of the work cultures of public relations and personnel specialists located in a state bureaucracy. I begin the ethnography with a dicussion of my research methods (Chapter 6) and an overview of the departments studied (Chapter 7): I then examine (i) the work cultures of the specialists (Chapter 8), (ii) the specialists' management of the relationships with the hosts bureaucracy (Chapter 9); and, (iii) opportunities the specialists had for developing an emancipatory praxis (Chapter 10). Finally, in a concluding section, I offer some critical reflections on the contributions of the thesis and suggest areas for future research.

A visual critical ethnography of youth develoment in a Rio de Janeiro favela

Favelas are Brazilian informal housing settlements that are areas of concentrated poverty. In Rio de Janeiro, favelas are perceived as areas of heightened criminal activity and violence, and residents experience discrimination, and little access to quality education and employment opportunities. In this context, hundreds of non-formal educational arts and leisure programs work to build the self-esteem and identity of youth in Rio's favelas as a way of preventing the youth from negative local influences. The Morrinho organization, located in the Pereira da Silva favela in Rio, uses art as a way for the local male youth to communicate their lived reality. This study used a visual critical ethnographic methodology to describe the way in which the Morrinho participants interpret living in a favela. Seventeen semi-structured interviews with young men aged 15 to 29, the feature-length documentary film on the organization, 206 researcher produced documentary style photographs of the Morrinho artwork, and the researcher's field notes were analyzed. Truth claims, ways of seeing as communicated through words and actions, were induced through a cyclical process of reconstructive horizon analysis that incorporated the societal context and critical theory. The participants communicated their concerns about life in a favela; however, they did not describe their societal positions in terms of complete marginalization. They named multiple benefits of living in Pereira da Silva, discussed positive and negative experiences in school, and described ways they circumvented discrimination. Morrinho as an organization was described as an enthralling game and a social project that benefited dozens of local youth. Character development was a valuable result of participation at Morrinho. The Morrinho artwork communicates a nuanced vision of both benevolent and violent social actors, and counters the overwhelmingly negative dominant characterization of Rio de Janeiro's favelas. This study has implications for an inclusive critical pedagogy and the use of art as a means to facilitate a transformative education. Further research is recommended to explore terminology used to refer to favelas, and perceptions that favela residents have of their experiences in public education.

Postpositivist research in education : theorising social structure in critical and institutional ethnography

This chapter charts the theories and methods being adopted in an investigation of the 'micro-politics' of teacher education policy reception at a site of higher education in Queensland from 1980 to 1990. The paper combines insights and methods from critical ethnography with those from the institutional ethnography of feminist sociologist Dorothy Smith to link local policy activity at the institutional site to broader social structures and processes. In this way, enquiry begins with--and takes into account--the experiences of those groups normally excluded from mainstream and even critical policy analysis.

Powering a curriculum for all : a critical ethnographic study of inclusive education

This project makes a contribution to knowledge about the successful leadership practices that enhance education for young people with a disability in a Queensland Secondary School. The project used a critical ethnographic approach with a variety of data collection methods and analysis. For example, the use of work diaries, semi-structured interviews, document analysis and observation. These leadership practices were found to be relevant to the development of inclusive schools for all learners.The most powerful leadership practices found were those used by the leader to challenge, interupt and replace exsisting discourse and processes that led to exclusion of students with a disability.

"We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland

This thesis contributes to the decolonisation of health promotion by examining Indigenous-led health promotion practice in an urban setting. Using critical ethnography, the study revealed dialogical, identity-based approaches that centred relationship, community control and choice. Based on the findings, the thesis proposes four interrelated principles for decolonising health promotion and argues that Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian mainstream health promotion practice.

A critical search for the ‘self’ in adult education: Bourdieuian insights into transformative possibilities

This study investigates the ‘self’ of six Irish working-class women, all parenting alone and all returned to the field of adult education. Bourdieu’s concepts of habitus, field and capital are the backdrop for the study of the ‘self’, which is viewed through his lens. This study commenced in September 2012 and concluded in August 2014, in a small urban educational setting in an Irish city. All of the women in the study are single parents, most of them did not complete second level education, and none of them had experienced adult or third level education. Their ages vary from 30 to 55 years. The study pursues the women’s motivations for returning to education, the challenges they faced throughout the journey, and their experiences, views and perspectives of Adult Education. The methodology chosen for this research is critical eethnography, and as an emerging ethnographer, I was able to view the phenomena from both an emic (inside) and an etic (outside) perspective. The critically oriented approach is a branch of qualitative research. It is a holistic and humanistic approach that is cyclical and reflective. The critical ethnographic case studies that developed are theoretically framed in critical theory and critical pedagogy. The data is collected from classroom observations (recorded in a journal) and interviews (both individual and group). The women's life experiences inform their sense of self and their capital reserves derive from their experience of habitus. It also attempts to understand the delivery of the programmes and how it can impact the journey of the adult learners. The analysis of the interviews, observations, field notes and reflective journals demonstrate what the women have to say about their new journey in adult education. This crucial information informs best practice for adult education programmes. This study also considers the complexity of habitus and the many forms of capital. The theme of adults returning to education and their disposition to this is one of the major themes of this study. Findings reflect this uncertainty but also underline how the women unshackled themselves of some of the constraints of a restricted view of self. Witnessing this new habitus forming was the core of their transformational possibility becoming real. The study provides a unique contribution to knowledge as it utilises Bourdieuian concepts and theories, not only as theoretical tools but as conceptual tools for analysis. The study examined transformative pedagogy in the field of adult education and it offers important recommendations for future policy and practice.

The multiliteracies classroom

Mary Kalantzis and Bill Cope write in the foreword: “The Multiliteracies Classroom demonstrates in convincing detail how powerful learning can be achieved. Along the way, the book seamlessly weaves cutting-edge theoretical ideas into the fabric of its narrative. In one moment, we hear the lilt of the accents of the children’s discussions. In another, this is connected to the theoretical intricacies of ‘discourse’, ‘heteroglossia’, ‘multimodality’, or ‘dialogic spaces’. We witness the triumphs of a teacher who, in Mills’ words, ‘did not regard literacy as an independent variable. Rather, she regarded it as inseparable from social practices, contextualized in certain political, economic, historic and ecological contexts. Kathy Mills has produced a masterpiece of qualitative research.”

Can they go it alone? Addressing criticisms of coteaching.

This paper responds to Wassell and LaVan’s paper on the transition from a preservice coteaching experience to independent teaching as a beginning inservice teacher. Wassell and LaVan describe coteaching as an alternative to traditional teaching. In our response, we argue that coteaching can also be applied alongside independent teaching in preservice courses, as opposed to an alternative to independent teaching, which has been shown to alleviate some of the transition issues described by Wassell and LaVan. We then present a critical discussion of different models and vocabularies of coteaching which apply in different sociocultural settings to expand the concept of coteaching. We attempt to extend Wassell and LaVan’s use of Guba and Lincoln’s (Fourth generation evaluation, 1989) authenticity criteria from the research methodology towards considering the criteria also as a framework for coteaching as practice for preservice and cooperating teachers. Finally, we reflect on the role of critical ethnography in Wassell and LaVan’s study in terms of the researchers’ intervention and whether improvements in the transition can be effectively introduced which do not require such intervention. We conclude our discussion with some suggestions to take forward this important work.

Resistir na escola... desafios à transformação

Dissertação de mestrado, Ciências da Educação (Especialização em Educação Intercultural), Universidade de Lisboa, Instituto de Educação, 2014

Les sens des cris de personnes âgées vivant avec une démence en centre d’hébergement et de soins de longue durée

Dans les centres d’hébergement et de soins de longue durée (CHSLD), jusqu’à 80 % des personnes admises vivent avec une démence (Conseil des aînés, 2007). Parmi ces personnes âgées, plusieurs crient. Ce comportement a fait l’objet de quelques études, mais ces études ne fournissent pas une compréhension des sens de ces cris qui pourrait orienter le choix d’interventions face à ces personnes et leur entourage. À l’aide de la perspective infirmière de Leininger (2001) et de la théorie de la communication et des interactions à l’intérieur de triades d’Adams et Gardiner (2005), le but de cette étude était de décrire les sens des cris de personnes âgées vivant avec une démence et les facteurs les influençant en tenant compte de la perspective des personnes âgées, de leurs aidants familiaux et de leurs soignants. Pour atteindre ce but, l’ethnographie critique a été choisie comme méthode. L’étude s’est découlée dans un CHSLD au sein duquel sept triades, composées de personnes âgées vivant avec une démence qui crient, d’aidants familiaux principaux et de soignants, ont été recrutées selon un échantillonnage théorique. Diverses méthodes de collecte des données ont été utilisées dont l’observation des personnes âgées et du milieu et des entrevues semi-dirigées auprès des aidants et soignants. L’analyse des données a été effectuée à l’aide des quatre approches proposées par Spradley (1979) soit l’analyse : des domaines, taxonomique, componentielle et thématique. Les résultats ont permis d’identifier des thèmes sur les sens des cris et sur les facteurs influençant ceux-ci. Les cris peuvent avoir pour sens la vulnérabilité, la souffrance et la perte de sens vécues par la personne âgée. Ce comportement peut aussi indiquer diverses finalités, par exemple l’expression d’insatisfactions ou d’émotions. Ces finalités peuvent être distinguées à partir de critères de modulation tels que la prévisibilité des cris ou un faciès émotif. Par ailleurs, divers aspects rendent les sens des cris singuliers. La stabilité et la flexibilité dans la façon d’organiser les soins ainsi que l’effet réciproque entre les personnes âgées qui crient et les autres personnes dans le CHSLD se sont dégagées comme étant des facteurs qui influencent les sens des cris. Il s’est aussi révélé que les cris de chaque personne âgée peuvent être considérés comme un langage unique que les aidants et les soignants sont en mesure d’apprendre et qui influence l’interprétation des sens des cris. L’accompagnement de la personne âgée, en tenant compte de ses volontés, ses besoins et de sa personnalité, les fluctuations dans les relations de pouvoir au sein des triades personnes âgées-aidants-soignants et les sentiments d’impuissance et de culpabilité des aidants et des soignants sont d’autres facteurs qui influencent les cris. Les connaissances découlant de cette étude augmentent la compréhension sur les sens des cris des personnes âgées vivant avec une démence. Elles ont des implications pour les divers champs d’activités des infirmières et qui pourront contribuer à offrir des soins culturellement cohérents et caring pour les personnes âgées vivant avec une démence et leur entourage.

Analyse critique de la culture de sécurité face aux risques biologiques et pandémiques pour les infirmières

Une préoccupation grandissante face aux risques biologiques reliés aux maladies infectieuses est palpable tant au niveau international que national ou provincial. Des maladies émergentes telles que le SRAS ou la grippe A/H1N1 ont amené une prise en charge des risques pandémiques et à l’élaboration de mesures d’urgence pour maîtriser ces risques : développer une culture de sécurité est devenu une priorité de recherche de l’OMS. Malgré tout, peu d’écrits existent face à cette volonté de sécuriser la santé et le bien-être par toute une série de dispositifs au sein desquels les discours occupent une place importante en matière de culture de sécurité face aux risques biologiques. Une réflexion sociopolitique était nécessaire pour les infirmières qui sont aux premières loges en dispensant des soins à la population dans une perspective de prévention et de contrôle des infections (PCI) dans laquelle elles se spécialisent. Dès lors, ce projet avait pour buts d’explorer la perception du risque et de la sécurité face aux maladies infectieuses auprès des infirmières cliniciennes et gestionnaires québécoises; d’explorer plus spécifiquement l'existence ou l'absence de culture de sécurité dans un centre de santé et de services sociaux québécois (CSSS); et d’explorer les discours en présence dans le CSSS en matière de sécurité et de risques biologiques face aux maladies infectieuses et comment ces discours de sécurité face aux risques biologiques se traduisent dans le quotidien des infirmières. Les risques biologiques sont perçus comme identifiables, mesurables et évitables dans la mesure où les infirmières appliquent les mesures de préventions et contrôle des infections, ce qui s’inscrit dans une perspective positiviste du risque (Lupton, 1999). La gestion de ces risques se décline au travers de rituels de purification et de protection afin de se protéger de toute maladie infectieuse. Face à ces risques, une culture de sécurité unique est en émergence dans le CSSS dans une perspective de prévention de la maladie. Toutefois, cette culture de sécurité désirée est confrontée à une mosaïque de cultures qui couvrent différentes façons d’appliquer ou non les mesures de PCI selon les participants. La contribution de cette recherche est pertinente dans ce nouveau domaine de spécialité que constituent la prévention et le contrôle des infections pour les infirmières québécoises. Une analyse critique des relations de pouvoir tel qu’entendu par Foucault a permis de soulever les questions de surveillance infirmière, de politique de l’aveu valorisée, de punition de tout écart à l’application rigoureuse des normes de PCI, de contrôle de la part des cadres infirmiers et d’assujettissement des corps relevant des mécanismes disciplinaires. Elle a permis également de documenter la présence de dispositifs de sécurité en lien avec la tenue de statistiques sur les patients qui sont répertoriés en tant que cas infectieux, mais également en termes de circulation des personnes au sein de l’établissement. La présence d’un pouvoir pastoral est perceptible dans la traduction du rôle d’infirmière gestionnaire qui doit s’assurer que ses équipes agissent de la bonne façon et appliquent les normes de PCI privilégiées au sein du CSSS afin de réguler les taux d’infections nosocomiales présents dans l’établissement. En cas de non-respect des mesures de PCI touchant à l’hygiène des mains ou à la vaccination, l’infirmière s’expose à des mesures disciplinaires passant de l’avertissement, la relocalisation, l’exclusion ou la suspension de l’emploi. Une culture du blâme a été décrite par la recherche d’un coupable au sein de l’institution, particulièrement en temps de pandémie. Au CSSS, l’Autre est perçu comme étant à l’origine de la contamination, tandis que le Soi est perçu comme à l’abri de tout risque à partir du moment où l’infirmière respecte les normes d’hygiène de vie en termes de saines habitudes alimentaires et d’activité physique. Par ailleurs, les infirmières se doivent de respecter des normes de PCI qu’elles connaissent peu, puisque les participantes à la recherche ont souligné le manque de formation académique et continue quant aux maladies infectieuses, aux risques biologiques et à la culture de sécurité qu’elles considèrent pourtant comme des sujets priorisés par leur établissement de santé. Le pouvoir produit des effets sur les corps en les modifiant. Cette étude ethnographique critique a permis de soulever les enjeux sociopolitiques reliés aux discours en présence et de mettre en lumière ce que Foucault a appelé le gouvernement des corps et ses effets qui se capillarisent dans le quotidien des infirmières. Des recherches ultérieures sont nécessaires afin d’approfondir ce champ de spécialité de notre discipline infirmière et de mieux arrimer la formation académique et continue aux réalités infectieuses cliniques.

Les significations du processus transitionnel de personnes âgées hospitalisées nécessitant un hébergement permanent et vivant de multiples relocalisations

Au Québec, les personnes âgées hospitalisées nécessitant un hébergement dans le secteur public peuvent être déplacées plusieurs fois au sein d’un hôpital et de différents établissements jusqu’à ce qu’une place permanente soit disponible. Cette pratique peut avoir des conséquences sur leur santé. Les significations qu’accordent les personnes âgées à cette expérience sont peu connues alors qu’elles peuvent influencer leur processus transitionnel et les conséquences sur leur santé et leur bien-être. Basée sur la théorie de transitions de Meleis (2010), une micro ethnographie critique ayant pour but de comprendre les significations du processus transitionnel de personnes âgées hospitalisées nécessitant un hébergement et vivant de multiples relocalisations a été conçue. L’échantillon était composé de huit personnes âgées ayant vécu au moins deux relocalisations durant leur attente d’hébergement. Des entrevues semi-dirigées et des conversations informelles ont été utilisées. L’analyse des données a respecté la méthode décrite par Braun et Clarke (2006). Les résultats de cette analyse thématique ont démontré que les personnes âgées vivent, durant leur expérience transitionnelle, des discontinuités spatio-temporelles auxquelles elles attribuent différentes significations. Ces significations correspondent à la perception de vivre de longues périodes d’attente dans des milieux temporaires, des déménagements rapides et impromptus et des coupures affectives. L’incertitude et l’impuissance ressenties à divers degrés d’intensité par les personnes âgées sont également des significations qui ressortent du processus transitionnel. Une autre signification accordée par les personnes âgées à leur expérience de transitions est l’importance des « petites choses » de la vie quotidienne. Les connaissances issues de cette étude ont des implications pour les différents champs d’activités des infirmières. Notamment, elles offrent des pistes pour favoriser la santé et le bien-être des personnes âgées vivant un processus transitionnel.