Who needs evidence? Radical Feminism, the Christian Right and sex work research in Northern Ireland

This chapter describes my experiences of conducting research on commercial sex in Belfast, Northern Ireland which was conducted as part of a larger British Academy – Leverhulme Trust funded study that examined the policing and legal regulation of commercial sex in Belfast (Northern Ireland) along with three other cities: Manchester (England), Berlin (Germany) and Prague (Czech Republic). This study provided the first empirical analysis of commercial sex in the jurisdiction and was instrumental in shedding light on prevalence rates for those involved in the industry as well as providing demographic information on the age, nationality and sexual orientation of sex workers along with the sector worked in, whether on-street or off-street. In the chapter I consider my role as a researcher and highlight some of the difficulties that I experienced conducting what was seen as controversial research in the politically, socially and culturally conservative context of Northern Ireland.

Décentralisation et allocation des ressources : les détours de la municipalisation du système de santé brésilien.

Dans cette thèse, nous avons analysé le déroulement d’un processus de municipalisation du système de santé, effectué au Rio Grande do Norte (RN), un des états fédérés du nord-est du Brésil. En tenant compte des contextes historiques d’implantation, nous avons centré notre attention sur la contribution des acteurs impliqués dans ce processus, spécialement dans l’allocation des ressources financières du système. Les croyances, perceptions, attentes, représentations, connaissances, intérêts, l’ensemble des facteurs qui contribuent à la constitution des capacités cognitives de ces acteurs, favorise la réflexivité sur leurs actions et la définition de stratégies diverses de façon à poursuivre leurs objectifs dans le système de santé. Ils sont vus ainsi comme des agents compétents et réflexifs, capables de s’approprier des propriétés structurelles du système de santé (règles et ressources), de façon à prendre position dans l’espace social de ce système pour favoriser le changement ou la permanence du statu quo. Au cours du processus de structuration du Système unique de santé brésilien, le SUS, la municipalisation a été l’axe le plus développé d’un projet de réforme de la santé. Face aux contraintes contextuelles et de la dynamique complexe des espaces sociaux de la santé, les acteurs réformistes n’ont pas pu suivre le chemin de l’utopie idéalisée; quelques détours ont été parcourus. Au RN, la municipalisation de la santé a constitué un processus très complexe où la triade centralisation/décentralisation/recentralisation a suivi son cours au milieu de négociations, de conflits, d’alliances, de disputes, de coopérations, de compétitions. Malgré les contraintes des contextes successifs, des propriétés structurelles du système et des dynamiques sociales dans le système de santé, quelques changements sont intervenus : la construction de leaderships collectifs; l’émergence d’une culture de négociation; la création des structures et des espaces sociaux du système, favorisant les rencontres des acteurs dans chaque municipalité et au niveau de l’état fédéré; un apprentissage collectif sur le processus de structuration du SUS; une grande croissance des services de première ligne permettant d’envisager une inversion de tendance du modèle de prestation des services; les premiers pas vers la rupture avec la culture bureaucratique du système. Le SUS reste prisonnier de quelques enjeux institutionnalisés dans ce système de santé : la dépendance du secteur privé et de quelques groupes de professionnels; le financement insuffisant et instable; la situation des ressources humaines. Les changements arrivés sont convergents, incrémentiels, lents; ils résultent d’actions normatives, délibérées, formalisées. Elles aussi sont issues de l’inattendu, de l’informel, du paradoxe; quelques-unes plus localisées, d’autres plus généralisées, pour une courte ou une plus longue durée.

Retour post-isolement en milieu psychiatrique : développement, implantation et évaluation d’une intervention en soins aigus

L’isolement avec ou sans contention (IC) en milieu psychiatrique touche près d’un patient sur quatre au Québec (Dumais, Larue, Drapeau, Ménard, & Giguère-Allard, 2011). Il est pourtant largement documenté que cette pratique porte préjudice aux patients, aux infirmières et à l’organisation (Stewart, Van der Merwe, Bowers, Simpson, & Jones, 2010). Cette mesure posant un problème éthique fait l’objet de politiques visant à la restreindre, voire à l’éliminer. Les études sur l’expérience de l’isolement du patient de même que sur la perception des infirmières identifient le besoin d'un retour sur cet évènement. Plusieurs équipes de chercheurs proposent un retour post-isolement (REPI) intégrant à la fois l’équipe traitante, plus particulièrement les infirmières, et le patient comme intervention afin de diminuer l’incidence de l’IC. Le REPI vise l’échange émotionnel, l’analyse des étapes ayant mené à la prise de décision d’IC et la projection des interventions futures. Le but de cette étude était de développer, implanter et évaluer le REPI auprès des intervenants et des patients d’une unité de soins psychiatriques aigus afin d’améliorer leur expérience de soins. Les questions de recherche étaient : 1) Quel est le contexte d’implantation du REPI? 2) Quels sont les éléments facilitants et les obstacles à l’implantation du REPI selon les patients et les intervenants? 3) Quelle est la perception des patients et des intervenants des modalités et retombées du REPI?; et 4) L’implantation du REPI est-elle associée à une diminution de la prévalence et de la durée des épisodes d’IC? Cette étude de cas instrumentale (Stake, 1995, 2008) était ancrée dans une approche participative. Le cas était celui de l’unité de soins psychiatriques aigus pour premier épisode psychotique où a été implanté le REPI. En premier lieu, le développement du REPI a d’abord fait l’objet d’une documentation du contexte par une immersion dans le milieu (n=56 heures) et des entretiens individuels avec un échantillonnage de convenance (n=3 patients, n=14 intervenants). Un comité d’experts (l’étudiante-chercheuse, six infirmières du milieu et un patient partenaire) a par la suite développé le REPI qui comporte deux volets : avec le patient et en équipe. L’évaluation des retombées a été effectuée par des entretiens individuels (n= 3 patients, n= 12 intervenants) et l’examen de la prévalence et de la durée des IC six mois avant et après l’implantation du REPI. Les données qualitatives ont été examinées selon une analyse thématique (Miles, Huberman, & Saldana, 2014), tandis que les données quantitatives ont fait l’objet de tests descriptifs et non-paramétriques. Les résultats proposent que le contexte d’implantation est défini par des normes implicites et explicites où l’utilisation de l’IC peut générer un cercle vicieux de comportements agressifs nourris par un profond sentiment d’injustice de la part des patients. Ceux-ci ont l’impression qu’ils doivent se conformer aux attentes du personnel et aux règles de l’unité. Les participants ont exprimé le besoin de créer des opportunités pour une communication authentique qui pourrait avoir lieu lors du REPI, bien que sa pratique soit variable d’un intervenant à un autre. Les résultats suggèrent que le principal élément ayant facilité l’implantation du REPI est l’approche participative de l’étude, alors que les obstacles rencontrés relèvent surtout de la complexité de la mise en œuvre du REPI en équipe. Lors du REPI avec le patient, les infirmières ont pu explorer ses sentiments et son point de vue, ce qui a favorisé la reconstruction de la relation thérapeutique. Quant au REPI avec l’équipe de soins, il a été perçu comme une opportunité d’apprentissage, ce qui a permis d’ajuster le plan d’intervention des patients. Suite à l’implantation du REPI, les résultats ont d’ailleurs montré une réduction significative de l’utilisation de l’isolement et du temps passé en isolement. Les résultats de cette thèse soulignent la possibilité d’outrepasser le malaise initial perçu tant par le patient que par l’infirmière en systématisant le REPI. De plus, cette étude met l’accent sur le besoin d’une présence authentique pour atteindre un partage significatif dans la relation thérapeutique, ce qui est la pierre d’assise de la pratique infirmière en santé mentale. Cette étude contribue aux connaissances sur la prévention des comportements agressifs en milieu psychiatrique en documentant le contexte dans lequel se situe l’IC, en proposant un REPI comportant deux volets de REPI et en explorant ses retombées. Nos résultats soutiennent le potentiel du développement d’une prévention tertiaire qui intègre à la fois la perspective des patients et des intervenants.

The Glow of Unwork? Issues of Portrayal in Networked Learning Research

In this paper, we suggest that portrayal of research is often undervalued and seen as ‘unwork’ (Galloway, 2012). Portrayal is often seen as an issue that is relatively straight forward by qualitative researchers, and invariably refers to putting the findings of the study together with excerpts from participants and usually, but not always, some interpretation. It tends to be seen as the means by which the researcher has chosen to position people and their perspectives, and it is imbued with a sense of not only positioning but also a contextual painting of a person in a particular way. Yet there are an array of issues and challenges about what portrayal can or might mean in digital spaces. In this paper we argue that researching education in a digital age provides greater or different opportunities to represent and portray data differently and suggest that these ways are underutilised. For example, for many researchers legitimacy comes through the use of participants’ voices in the form of quotations. However, we argue that this stance towards plausibility and legitimacy is problematic and needs to be reconsidered in terms of understanding differences in types of portrayal, recognizing how researchers position themselves in relation to portrayal, and understanding decision-making in relation to portrayal. We suggest that there need to be new perspectives about portrayal and concept, and ideas are provided that offer a different view. Three key recommendations are made: Portrayal should be reconceptualised as four overlapping concepts: mustering, folding, cartography, and portrayal. Adopting such an approach will enable audiences, researchers and other stakeholders to critique the assumptions that researchers on tour bring to portrayal and encourage reflexivity. Researchers on tour should highlight the temporal, mutable and shifting nature of portrayed research findings, emphasising the need for continued and varied research to inform understanding. There is a significant need for greater insight into the influence of portrayal, as well as the difference between representation and portrayal. Future studies should prioritise this, and ensure that portrayal is considered and critiqued from the outset.

A guideline to improve qualitative social science publishing in ecology and conservation journals

A rise in qualitative social science manuscripts published in ecology and conservation journals speaks to the growing awareness of the importance of the human dimension in maintaining and improving Earth’s ecosystems. Given the rise in the quantity of qualitative social science research published in ecology and conservation journals, it is worthwhile quantifying the extent to which this research is meeting established criteria for research design, conduct, and interpretation. Through a comprehensive review of this literature, we aimed to gather and assess data on the nature and extent of information presented on research design published qualitative research articles, which could be used to judge research quality. Our review was based on 146 studies from across nine ecology and conservation journals. We reviewed and summarized elements of quality that could be used by reviewers and readers to evaluate qualitative research (dependability, credibility, confirmability, and transferability); assessed the prevalence of these elements in research published in ecology and conservation journals; and explored the implications of sound qualitative research reporting for applying research findings. We found that dependability and credibility were reasonably well reported, albeit poorly evolved in relation to critical aspects of qualitative social science such as methodology and triangulation, including reflexivity. Confirmability was, on average, inadequately accounted for, particularly with respect to researchers’ ontology, epistemology, or philosophical perspective and their choice of methodology. Transferability was often poorly developed in terms of triangulation methods and the suitability of the sample for answering the research question/s. Based on these findings, we provide a guideline that may be used to evaluate qualitative research presented in ecology and conservation journals to help secure the role of qualitative research and its application to decision making.

The Multi-Faceted Experience of Empathy in Intellectual Disability Settings: An IPA Study

This research thesis explored the concept of empathy. The specific purpose was to further understand the idea of empathy in relation to the experience of male support workers who provide residential care to adults with intellectual disabilities (ID) and challenging behaviour. The thesis aimed to provide some insights into how support workers develop and extract meaning from their experiences of relationships with clients and the impact of this on their own self-care, namely, self-compassion. Since personal accounts of experience were required, a qualitative methodology was employed, Interpretative Phenomenological Analysis (IPA) (Smith, 2004). This methodology was selected as it allows for the exploration and interpretation of idiographic lived experience and meaning making. 8 experienced support workers were interviewed using a semi structured interview. Four superordinate themes emerged from the data. These included: 1. Making sense of the others inner world; 2. Processes that enhance empathic practice; 3. Tensions and conflicts, and 4. Management of distressing feelings. Differing accounts of interpreting the needs of clients were identified which helped participants understand, make sense of their interpersonal experience and participate in their role. These included utilising academic knowledge and senses, particularly sight and hearing, which were seemingly complemented by a level of reflective practice. Additionally, to make sense of the experience of a client, they appeared to put themselves in their position, suggesting a form of empathy. Participants appeared to engage in a process of reflection on their relationships with clients, which helped them think about what they had learned about the person’s needs, moreover, this process enabled them to identify some of their own responses and feelings. However, participants seemed to struggle to recognise the occurrence or impact of distressing emotional experience and to express their feelings, possibly in response to a deep sense of responsibility and fear of transferring emotional distress to others. This dilemma of holding two potentially conflicting views of experience seemed to inhibit self-compassion. Although not specifically testing theories of empathy, from the overall findings, it could be suggested that empathy may be a dynamic, transient process that is influenced by reflexivity, values and context. The context in which participants discussed their practice, and situated within their accounts, suggested a sense of confusion and uncertainty. Consequently, it is suggested this impacted on how participants understood and related to clients, and to themselves. There were some specific implications for Counselling Psychology practice, mostly concerning training and supervision. These included recommendations for staff training and supervision, systemic organisational intervention, policy development, recommendations for revisions to models of specialist care frameworks and clinical training.

Décentralisation et allocation des ressources : les détours de la municipalisation du système de santé brésilien

Dans cette thèse, nous avons analysé le déroulement d’un processus de municipalisation du système de santé, effectué au Rio Grande do Norte (RN), un des états fédérés du nord-est du Brésil. En tenant compte des contextes historiques d’implantation, nous avons centré notre attention sur la contribution des acteurs impliqués dans ce processus, spécialement dans l’allocation des ressources financières du système. Les croyances, perceptions, attentes, représentations, connaissances, intérêts, l’ensemble des facteurs qui contribuent à la constitution des capacités cognitives de ces acteurs, favorise la réflexivité sur leurs actions et la définition de stratégies diverses de façon à poursuivre leurs objectifs dans le système de santé. Ils sont vus ainsi comme des agents compétents et réflexifs, capables de s’approprier des propriétés structurelles du système de santé (règles et ressources), de façon à prendre position dans l’espace social de ce système pour favoriser le changement ou la permanence du statu quo. Au cours du processus de structuration du Système unique de santé brésilien, le SUS, la municipalisation a été l’axe le plus développé d’un projet de réforme de la santé. Face aux contraintes contextuelles et de la dynamique complexe des espaces sociaux de la santé, les acteurs réformistes n’ont pas pu suivre le chemin de l’utopie idéalisée; quelques détours ont été parcourus. Au RN, la municipalisation de la santé a constitué un processus très complexe où la triade centralisation/décentralisation/recentralisation a suivi son cours au milieu de négociations, de conflits, d’alliances, de disputes, de coopérations, de compétitions. Malgré les contraintes des contextes successifs, des propriétés structurelles du système et des dynamiques sociales dans le système de santé, quelques changements sont intervenus : la construction de leaderships collectifs; l’émergence d’une culture de négociation; la création des structures et des espaces sociaux du système, favorisant les rencontres des acteurs dans chaque municipalité et au niveau de l’état fédéré; un apprentissage collectif sur le processus de structuration du SUS; une grande croissance des services de première ligne permettant d’envisager une inversion de tendance du modèle de prestation des services; les premiers pas vers la rupture avec la culture bureaucratique du système. Le SUS reste prisonnier de quelques enjeux institutionnalisés dans ce système de santé : la dépendance du secteur privé et de quelques groupes de professionnels; le financement insuffisant et instable; la situation des ressources humaines. Les changements arrivés sont convergents, incrémentiels, lents; ils résultent d’actions normatives, délibérées, formalisées. Elles aussi sont issues de l’inattendu, de l’informel, du paradoxe; quelques-unes plus localisées, d’autres plus généralisées, pour une courte ou une plus longue durée.

A construção do habitus musical dos músicos amadores

Com esta dissertação pretende-se estudar a construção dos habitatus musicais nos projetos musicais amadores, com base, sobretudo, na teoria da prática de Pierre Bourdieu, procurando-se igualmente compreender o papel da reflexividade e dos quadros de interação ao longo das trajetórias musicais. Entende-se que os músicos amadores assumem uma relação específica com a música, ainda que entre si seja heterogénea e, desta forma, tomou-se como objetivos centrais apreender as matrizes e os modos de socialização, analisar o papel da reflexividade na produção musical e também comparar os habitatus musicais dos músicos amadores. Para tal, utilizou-se uma metodologia qualitativa, dado o cariz analítico do estudo, através da aplicação de entrevistas semidiretivas e, complementarmente, de observação direta não participante; ABSTRACT: With this dissertation it is intended to study the construction of the musical habitatus in amateur musical projects, based, especially, in the Theory of Practice of Pierre Bourdieu, looking for to understand, as well, the role of reflexivity and the interaction settings along the musical trajectories. It is considered that the amateur musicians assume a specific relation with music, even if it’s heterogeneous between them and, therefore, it was taken as the main objectives to learn the pattern and methods of socializing, to analyze the role of reflexivity in the musical production and to compare the musical habitatus between amateur musicians. For such, was used a qualitative methodology, given the analytical nature of the study, through the application of semi directive interviews and, complementarily, of the nonparticipating direct observation.

Retour post-isolement en milieu psychiatrique : développement, implantation et évaluation d’une intervention en soins aigus

L’isolement avec ou sans contention (IC) en milieu psychiatrique touche près d’un patient sur quatre au Québec (Dumais, Larue, Drapeau, Ménard, & Giguère-Allard, 2011). Il est pourtant largement documenté que cette pratique porte préjudice aux patients, aux infirmières et à l’organisation (Stewart, Van der Merwe, Bowers, Simpson, & Jones, 2010). Cette mesure posant un problème éthique fait l’objet de politiques visant à la restreindre, voire à l’éliminer. Les études sur l’expérience de l’isolement du patient de même que sur la perception des infirmières identifient le besoin d'un retour sur cet évènement. Plusieurs équipes de chercheurs proposent un retour post-isolement (REPI) intégrant à la fois l’équipe traitante, plus particulièrement les infirmières, et le patient comme intervention afin de diminuer l’incidence de l’IC. Le REPI vise l’échange émotionnel, l’analyse des étapes ayant mené à la prise de décision d’IC et la projection des interventions futures. Le but de cette étude était de développer, implanter et évaluer le REPI auprès des intervenants et des patients d’une unité de soins psychiatriques aigus afin d’améliorer leur expérience de soins. Les questions de recherche étaient : 1) Quel est le contexte d’implantation du REPI? 2) Quels sont les éléments facilitants et les obstacles à l’implantation du REPI selon les patients et les intervenants? 3) Quelle est la perception des patients et des intervenants des modalités et retombées du REPI?; et 4) L’implantation du REPI est-elle associée à une diminution de la prévalence et de la durée des épisodes d’IC? Cette étude de cas instrumentale (Stake, 1995, 2008) était ancrée dans une approche participative. Le cas était celui de l’unité de soins psychiatriques aigus pour premier épisode psychotique où a été implanté le REPI. En premier lieu, le développement du REPI a d’abord fait l’objet d’une documentation du contexte par une immersion dans le milieu (n=56 heures) et des entretiens individuels avec un échantillonnage de convenance (n=3 patients, n=14 intervenants). Un comité d’experts (l’étudiante-chercheuse, six infirmières du milieu et un patient partenaire) a par la suite développé le REPI qui comporte deux volets : avec le patient et en équipe. L’évaluation des retombées a été effectuée par des entretiens individuels (n= 3 patients, n= 12 intervenants) et l’examen de la prévalence et de la durée des IC six mois avant et après l’implantation du REPI. Les données qualitatives ont été examinées selon une analyse thématique (Miles, Huberman, & Saldana, 2014), tandis que les données quantitatives ont fait l’objet de tests descriptifs et non-paramétriques. Les résultats proposent que le contexte d’implantation est défini par des normes implicites et explicites où l’utilisation de l’IC peut générer un cercle vicieux de comportements agressifs nourris par un profond sentiment d’injustice de la part des patients. Ceux-ci ont l’impression qu’ils doivent se conformer aux attentes du personnel et aux règles de l’unité. Les participants ont exprimé le besoin de créer des opportunités pour une communication authentique qui pourrait avoir lieu lors du REPI, bien que sa pratique soit variable d’un intervenant à un autre. Les résultats suggèrent que le principal élément ayant facilité l’implantation du REPI est l’approche participative de l’étude, alors que les obstacles rencontrés relèvent surtout de la complexité de la mise en œuvre du REPI en équipe. Lors du REPI avec le patient, les infirmières ont pu explorer ses sentiments et son point de vue, ce qui a favorisé la reconstruction de la relation thérapeutique. Quant au REPI avec l’équipe de soins, il a été perçu comme une opportunité d’apprentissage, ce qui a permis d’ajuster le plan d’intervention des patients. Suite à l’implantation du REPI, les résultats ont d’ailleurs montré une réduction significative de l’utilisation de l’isolement et du temps passé en isolement. Les résultats de cette thèse soulignent la possibilité d’outrepasser le malaise initial perçu tant par le patient que par l’infirmière en systématisant le REPI. De plus, cette étude met l’accent sur le besoin d’une présence authentique pour atteindre un partage significatif dans la relation thérapeutique, ce qui est la pierre d’assise de la pratique infirmière en santé mentale. Cette étude contribue aux connaissances sur la prévention des comportements agressifs en milieu psychiatrique en documentant le contexte dans lequel se situe l’IC, en proposant un REPI comportant deux volets de REPI et en explorant ses retombées. Nos résultats soutiennent le potentiel du développement d’une prévention tertiaire qui intègre à la fois la perspective des patients et des intervenants.

Figure(s) de sang : amours secrètes, troubles fratries et « miscégénation » dans The Searchers, The Unforgiven et The Missing

International audience

Building, shaping, forming, researching with metaphor

Ben Whitburn and Lucinda McKnight are two recent Deakin PhD graduates who thought with metaphor in their doctoral research projects, and found this process both exhilarating and frustrating. Ben teaches in inclusive education, and Lucinda is a professional writer who teaches in education; they bring to this workshop their different perspectives on how metaphor can be useful for consciously initiating creative and cohesive research strategies, and also how it can be insidious in restricting our worldviews.They will introduce participants to theory underpinning metaphor and provide opportunities to explore this theory in the context of HDR students' own projects, whether in Humanities, Communication, Creative Arts or Education.• How might metaphor assist with inspiring a research design?• How might metaphor invite researcher reflexivity?• What kinds of metaphors have other researchers employed?• What can we learn from the ways in which metaphor inevitably fails?These questions and others will be considered; participants should come prepared to write, talk, draw and think!

An analysis of the use of autobiographical narrative for teachers’ intercultural learning

The currency of intercultural education has risen worldwide in response to increased diversity within societies resulting from migration and global lows of populations. As intercultural education becomes a core responsibility of schooling, critical, detailed analysis of pedagogies for teachers’ own intercultural learning is largely absent in education research, in contrast to attention to developing students’ intercultural capabilities and theoretical and policy analyses. In beginning to address this limitation, this article offers a critical, reflexive analysis of our use and the efficacy of using autobiographical narrative for teachers’ intercultural learning. Framing theories include interculturality, autobiographical narratives for teachers’ professional learning, reflexivity, and the effects of silence and silencing in relation to diversity and intercultural relations in schools. Three instances of teacher autobiographical narrative elicited as part of a large-scale, longitudinal study of intercultural education in Australian schools are deconstructed to elucidate their explicit and hidden meanings and effects. The analysis reveals that while autobiographical narrative has productive potential as a strategy for stimulating teacher reflexivity about cultural identities and intercultural relations, it also contains hidden dangers and traps that caution against viewing it as a pedagogical cure-all in the development of teachers’ intercultural knowledge and skills.

Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

AIMS AND OBJECTIVES: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. BACKGROUND: Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. DESIGN: A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. METHODS: A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. FINDINGS: Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. CONCLUSIONS: The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. RELEVANCE TO CLINICAL PRACTICE: Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.

BUILDING A DISCOURSE: BRIDGING THE GAP BETWEEN NEW MEDIA'S CONVERGENCE AND RHETORIC AND COMPOSITION'S MULTIMODALITY

My dissertation emphasizes the use of narrative structuralism and narrative theories about storytelling in order to build a discourse between the fields of New Media and Rhetoric and Composition. Propp's morphological analysis and the breaking down of stories into component pieces aides in the discussion of storytelling as it appears in and is mediated by digital and computer technologies. New Media and Rhetoric and Composition are aided by shared concerns for textual production and consumption. In using the notion of "kairotic reading" (KR), I show the interconnectedness and interdisciplinarity required in the development of pedagogy utilized to teach students to develop into reflective practitioners that are aware of their rhetorical surroundings and can made sound judgments concerning their own message generation and consumption in the workplace. KR is a transferable skill that is beneficial to students and teachers alike. The dissertation research utilizes theories of New Media and New Media-influenced practitioners, including Jenkins' theory of convergence, Bourdieu's notion of taste, Gee's term "semiotic domains," and Manovich's "modification." These theoretical pieces are combined in order to show how KR can be extended by convergent narrative practices. In order to build connections with New Media, the consideration and inclusion of Kress and van Leeuwen's multimodality, Selber's "reflective practitioners," and Selfe's definition of multimodal composing allow for a greater establishment of conversation order to create a richer conversation around the implications of metacognitive development and practitioner reflexivity with scholars in New Media. My research also includes analysis of two popular media franchises Deborah Harkness' A Discovery of Witches and Fox's Bones television series to show similarities and differences among convergence-linked and multimodal narratives. Lastly, I also provide example assignments that can be taken, further developed, and utilized in classrooms engaging in multimodal composing practices. This dissertation pushes consideration of New Media into the work already being performed by those in Rhetoric and Composition.

Book review: Laurel Kamada, Hybrid Identities and Adolescent Girls: Being Half in Japan. Bristol: Multilingual Matters, 2010

Arguably, the catalyst for the best research studies using social analysis of discourse is personal ‘lived’ experience. This is certainly the case for Kamada, who, as a white American woman with a Japanese spouse, had to deal first hand with the racialization of her son. Like many other mixed-ethnic parents, she experienced the shock and disap-pointment of finding her child being racialized as ‘Chinese’ in America through peer group taunts, and constituted as gaijin (a foreigner) in his own homeland of Japan. As a member of an e-list of the (Japan) Bilingualism Special Interest Group (BSIG), Kamada learnt that other parents from the English-speaking foreign community in Japan had similar disturbing stories to tell of their mixed-ethnic children who, upon entering the Japanese school system, were mocked, bullied and marginalized by their peers. She men-tions a pervasive Japanese proverb which warns of diversity or difference getting squashed: ‘The nail that sticks up gets hammered down’. This imperative to conform to Japanese behavioural and discursive norms prompted Kamada’s quest to investigate the impact of ‘otherization’ on the identities of children of mixed parentage. In this fascinat-ing book, she shows that this pressure to conform is balanced by a corresponding cele-bration of ‘hybrid’ or mixed identities. The children in her study are also able to negotiate their identities positively as they come to terms with contradictory discursive notions of ‘Japaneseness’, ‘whiteness’ and ‘halfness/doubleness’.The discursive construction of identity has become a central concern amongst researchers across a wide range of academic disciplines within the humanities and the social sciences, and most existing work either concentrates on a specific identity cate-gory, such as gender, sexuality or national identity, or else offers a broader discussion of how identity is theorized. Kamada’s book is refreshing because it crosses the usual boundaries and offers divergent insights on identity in a number of ways. First, using the term ‘ethno-gendering’, she examines the ways in which six mixed-ethnic girls living in Japan accomplish and manage the relationship between their gender and ethnic ‘differ-ences’ from age 12 to 15. She analyses in close detail how their actions or displays within certain situated interactions might come into conflict with how they are seen or constituted by others. Second, Kamada’s study builds on contemporary writing on the benefits of hybridity where identities are fluid, flexible and indeterminate, and which contest the usual monolithic distinctions of gender, ethnicity, class, etc. Here, Kamada carves out an original space for her findings. While scholars have often investigated changing identities and language practices of young people who have been geographi-cally displaced and are newcomers to the local language, Kamada’s participants were all born and brought up in Japan, were fluent in Japanese and were relatively proficient in English. Third, the author refuses to conceptualize or theorize identity from a single given viewpoint in preference to others, but in postmodernist spirit draws upon multiple perspectives and frameworks of discourse analysis in order to create different forms of knowledge and understandings of her subject. Drawing on this ‘multi-perspectival’ approach, Kamada examines grammatical, lexical, rhetorical and interactional features from six extensive conversations, to show how her participants position their diverse identities in relation to their friends, to the researcher and to the outside world. Kamada’s study is driven by three clear aims. The first is to find out ‘whether there are any tensions and dilemmas in the ways adolescent girls of Japanese and “white” mixed parentage in Japan identify themselves in terms of ethnicity’. In Chapter 4, she shows how the girls indeed felt that they stood out as different and consequently experienced isolation, marginalization and bullying at school – although they were able to make better sense of this as they grew older, repositioning the bullies as pitiable. The second aim is to ask how, if at all, her participants celebrate their ethnicity, and furthermore, what kind of symbolic, linguistic and social capital they were able to claim for themselves on the basis of their hybrid identities. In Chapter 5, Kamada shows how the girls over time were able to constitute themselves as insiders while constituting ‘the Japanese’ as outsiders, and their network of mixed-ethnic friends was a key means to achieve this. In Chapter 6, the author develops this potential celebration of the girls’ mixed ethnicity by investigating the privileges they perceived it afforded them – for example, having the advantage of pos-sessing English proficiency and intercultural ‘savvy’ in a globalized world. Kamada’s third aim is to ask how her participants positioned themselves and performed their hybrid identities on the basis of their constituted appearance: that is, how the girls saw them-selves based on how they looked to others. In Chapter 7, the author shows that, while there are competing discourses at work, the girls are able to take up empowering positions within a discourse of ‘foreigner attractiveness’ or ‘a white-Western female beauty’ discourse, which provides them with a certain cachet among their Japanese peers. Throughout the book, Kamada adopts a highly self-reflexive perspective of her own position as author. For example, she interrogates the fact that she may have changed the lived reality of her six participants during the course of her research study. As the six girls, who were ‘best friends’, lived in different parts of the Morita region of Japan, she had to be proactive in organizing six separate ‘get-togethers’ through the course of her three-year study. She acknowledges that she did not collect ‘naturally occurring data’ but rather co-constructed opportunities for the girls to meet and talk on a regular basis. At these meetings, she encouraged the girls to discuss matters of identity, prompted by open-ended interview questions, by stimulus materials such as photos, articles and pic-tures, and by individual tasks such as drawing self-portraits. By giving her participants a platform in this way, Kamada not only elicited some very rich spoken data but also ‘helped in some way to shape the attitudes and self-images of the girls positively, in ways that might not have developed had these get-togethers not occurred’ (p. 221). While the data she gathers are indeed rich, it may well be asked whether there is a mismatch between the girls’ frank and engaging accounts of personal experience, and the social constructionist academic register in which these are later re-articulated. When Kamada writes, ‘Rina related how within the more narrow range of discourses that she had to draw on in her past, she was disempowered and marginalized’ (p. 118), we know that Rina’s actual words were very different. Would she really recognize, understand and agree with the reported speech of the researcher? This small omission of self-reflexivity apart – an omission which is true of most lin-guistic ethnography conducted today – Kamada has written a unique, engaging and thought-provoking book which offers a model to future discourse analysts investigating hybrid identities. The idea that speakers can draw upon competing discourses or reper-toires to constitute their identities in contrasting, creative and positive ways provides linguistic researchers with a clear orientation by which to analyse the contradictions of identity construction as they occur across time in different discursive contexts