Discourses of anxiety in nursing practice : a psychoanalytic case study of the change-of-shift handover ritual

This paper reports on the findings of a study that considered how anxiety might function to organise nurses' practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change-of-shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety.

Occupational distress in nursing : a psychoanalytic reading of the literature

Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or 'stressors', have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of 'stress'. It is argued that the notion of 'stress' and the domination of the questionnaire have produced a narrow reading of the topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of 'anxiety' and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of 'anxiety' is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety.

Teaching philosophy : moving from face-to-face to online classrooms

This article explores the similarities and differences between Canadian and Australian university teachers’ face-to-face and online teaching approaches and philosophies. It presents perspectives on teaching face-to-face and online in two comparable Canadian and Australian universities, both of which offer instruction in these two modes. The key research question was to determine if moving from face-to-face instruction to on-line teaching results in new teaching approaches or in a creative blend of those developed within each teaching modality. Qualitative data were collected using an open-ended survey, which asked participants for their thoughts on their face-to-face (f2f) and online teaching experiences. Quantitative data were collected using the “Teaching Perspectives Inventory,” which assessed participants’ teaching approaches and philosophies in terms of their beliefs, intentions, and actions. The authors’ conclusions address the issue of assisting teachers to successfully make the transition from traditional teacher-centred to newly emerging learner-centred teaching approaches in distributed classrooms.