The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more ‘women-centred and family-friendly’. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.

Exploring the possibilities of an expanded practice repertoire in child protection

Summary: This article discusses research that explored an alternative to proceduralized child protection practice informed by the risk paradigm, by expanding the repertoire available to practitioners through combining features of the risk paradigm with social constructionism. This approach incorporates three dimensions: theories of knowledge and power, related professional roles, and practice skills. In this article, we discuss and critically evaluate only the first dimension: theories of knowledge and power. Through dialogue facilitated by semi-structured questions, we explored practitioners' perspectives about the relevance and appropriateness of the alternative approach for practice.

Findings: The practitioners' participation and feedback offer insights into complex connections between `theory' and `practice' with the practitioner as a positioned subject and mediator of practical meanings of formal concepts.

Applications: 1) Recognition of each practitioner's interpretation of formal concepts and how they are applied in actual practice, even within shared organizational contexts. 2) The importance of dialogue to expand the range of possibilities that maintain openness to ongoing learning. 3) The value of theoretical pluralism that may offer greater opportunities for professional discretion, rather than single self-contained approaches that may constrain effective and ethical practice.

What can Arendt's theorising add to critical social workers empowerment practice?

Empowerment is one of the most frequently invoked concepts in critical social work theory and practice. Critical social work theory tends to privilege the concept of “power” as the central concept in em-power-ment. However over the last two decades postmodern and poststructural thought has discredited how power was understood in critical social work. Some leading critical social workers have re-thought the notion of “power” with Foucault’s early and middle work. One of the key problems raised by leading social workers is about how to re-think “allowance for difference” in empowerment practice (Fook 2002; Healy 2000). I argue that to re-think power in relation specifically to problems with “allowance for difference” using Foucault’s early and middle work is not possible because he is still conflating power with domination. Hence I turn to Hannah Arendt’s theorising on power. For Arendt power is understood as the capacity of people to “act in concert” and to create something new. Arendt’s concepts of “plurality”, “natality” and “publicness”, I argue can add a much to critical social work empowerment practice by re-thinking the notion of “allowance for difference” in critical empowerment social work.

Action research in cooperative education projects : developing lifelong capabilities for improving practice

There are natural synergies between action research as a method of inquiry and the practice of cooperative education. In the search to integrate theory and practice, action research is underpinned by a philosophy of experiential learning. Similarly, cooperative education is underpinned by the belief that in order to learn, there also needs to be action. The work of cooperative education students is also founded on data-based reflection is highly context based and usually collaborative; important characteristics of action research (Cardno, 2003). These similarities between action research and cooperative education provide a starting point in conceptualizing the adoption of action research for sport cooperative education projects. How can action research be integrated within cooperative education projects? This paper will discuss the theoretical basis of action research and illustrate through the use of case studies why and how action research has been utilized in cooperative education projects in sport and recreation. Sport students undertake a range of activities in the cooperative education setting. Some complete basic day to day tasks in recreation centers and with sports teams and others act as volunteers in major events. While these types of roles can fulfill desired outcomes for cooperative education program (for student, industry organization and institution), the adoption of action research can add a further dimension because it aims to create change within the setting under investigation. Through the use of cooperative education projects, students are in a unique position to frame a problem, integrate theory, determine action, and implement and evaluate that action. This paper explores how action research is used in cooperative education projects to help develop capabilities for improving practice.

Opting in and opting out: a grounded theory of nursings contribution to inpatient rehabilitation

Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.

Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable.

Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.

Concepts of temporality in the theory of transference

This paper examines the temporal concepts that underlie the theory of transference in psychoanalysis. The paper reviews Freud's rejection of linear temporality as characteristic of unconscious thought in favour of regression, repetition, and deferred action. It then develops concepts drawn from Jacques Lacan's theory of the formation of the ego. Here, the biologically determined helplessness derived from the human prematurity of birth becomes transformed into an ego that anticipates subjective unity. The paper then moves on to the more complex theory of the temporality implied in subject formation, offered in Lacan's later theory of separation. Implications are drawn for the use and understanding of transference in the practice of psychoanalysis via clinical examples. In addition, Lacan's ideas on subject formation are proposed as an extension and clarification of previous psychoanalytic theories of development.

Mental health triage : towards a model for nursing practice

Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.

Blended learning in entrepreneurship education in the Asia-Pacific : a grounded theory approach to entrepreneurship pedagogy

Using a grounded theory approach, this pedagogical study explores “What are the key content areas and pedagogical interventions around which to build a blended learning method for Generation Y (also known as the Net Generation) entrepreneurship students (as opposed to other business students)?” The study uses a variety of “information-rich cases” and presents the argument that entrepreneurs learn
differently from other students. The author develops the Etappe Method of Training Entrepreneurs, a blended learning approach for the technology-savvy generation under the motto “Teaching is best done online and learning is best done in the classroom”. Drawing upon the theory of experiential learning as concretised by learning styles inventories, this learning method provides entrepreneurs, in their unique teachable moments, with active and concrete pedagogical interventions that can be enhanced through a blended learning environment of online and face-to-face modalities leading them step-by-step through deepening learning in the theory, process and practice of entrepreneurship. In conclusion, the author presents suggestions for further research that can verify this emerging theory in an empirical fashion.

Scaffolding students' learning in EME150 introduction to learners and learning theory : on looking back

This is a reflective article on the importance scaffolding in the EME 150 unit taught in collaboration with Deakin University Australia. Being the first unit introduced in the second semester of the first academic year, students were given a lot of support to enhance their understanding and learning since this curriculum was solely developed by Deakin University and introduced for the first time in teachers education curriculum. The scaffolding tools discussed in this article enabled students to a) establish deep learning of the theory. b) engage in collaborative and engaged learning which established good ethical relations between students c) transfer learning by applying theory into practice.

Clinical supervision and symmetrical communication : towards a critical practice of supervision

The central argument of the thesis is that the dominant modes of the supervision of teaching are in need of critique and reconstruction. From a critical perspective, supervision is viewed as a political and ideological process enacted through asymmetrical relations and structures of communication. It is underpinned by a discourse of technocratic rationality and control Clinical supervision, a currently popular model of teacher supervision, has (despite its emancipatory origins) been accommodated by the dominant ideology and is employed as a hegemonic mechanism of evaluation, control and even dismissal of teachers. However, historical analysis reveals that teachers have contested and resisted authoritarianism and centralized control in favour of developing more democratic and participatory forms of professional development. In these moves can be found a rationale for a reconstruction of the theory and practice of clinical supervision around the concepts of symmetrical communication and critical pedagogy. The researcher engaged in a self-reflective study with a group of supervisors and teachers in N.S.W. schools to explore the possibilities and limitations of a critical and counter-hegemonic practice of supervision. The outcomes, in the form of three case studies, are analysed in terms of a dialectic of reconstruction and maintenance of the status quo. The evidence reveals that some of the research participants sought to reconstruct their supervisory relationships in ways which challenged the bureaucratic structures of their workplace. Others, however, rejected the emancipatory possibilities and resolved to maintain their traditional hierarchical relationship.

Grounded theory of nursing's contribution to inpatient rehabilitation

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

Teacher education and critical inquiry : the use of activity theory in exploring alternative understandings of language and literacy

This paper explores the challenges of espousing a critical pedagogy within the managerial climate that presently shapes teacher education. It argues that current discourses of professionalism are incommensurate with a view of literacy as social practice and that they disregard complex semiotic ecologies in which both school and university students operate. Graduate teachers are constructed as the ‘providers’ of decontextualised literacy skills to school students whose existing communication networks are ignored. Rejecting this narrow view of professional practice, we draw on activity theory to analyse the social configuration of tertiary students’ identities and the textual resources that mediate their professional learning. This kind of research is needed to reveal the contradictions within and between activity systems in which tertiary students participate as well as to construct possible solutions to the contradictions identified.

Teacher education and critical inquiry : the use of activity theory in exploring alternative understandings of language and literacy

This article explores the challenges of espousing a critical pedagogy within the managerial climate that presently shapes teacher education. Current discourses of professionalism are incommensurate with an understanding of the way that literacy practices are grounded in the social worlds in which both school and university students operate. Such discourses construct graduate teachers as the providers of decontextualised literacy skills to school students whose existing communication networks are ignored. We argue that an alternative understanding of professional practice can be developed by focusing on the textual resources university students use to mediate their learning, and by locating their emerging professional identities within the activity systems and meaning-making practices in which they participate.

Reinventing liberatory practice : how do we work with groups of which we are not a part?

The research that informed this paper asked: how can we work as allies of groups of which we are not a part? This question is particularly focused on work with people who have experienced colonisation by those who are aligned (by race, class, gender, culture or position) with the colonisers or oppressors. The research brings together literature in the fields of community work, adult education, and feminist and postcolonial theory, with Indigenous viewpoints and experience. An analysis of Indigenous viewpoints identified a range of key ideas about achieving social change.

These ideas are developed into several frameworks, two of which will be discussed here. The first framework offers a way of conceptualising work against oppression and proposes that it must involve a focus on fostering emancipatory agency. Emancipatory agency involves the capacity to know and to act towards social justice ends via meaning making which follows ethical criteria. An ethics of meaning making is proposed which includes a focus on: multiplicity and difference; the partial nature of all knowings; the context / situatedness of meaning; and the critical / reflective attitude in meaning making. This type of agency is dependent on the process of transformative dialogue which is inherently communal and is based on four micro processes: affirming the O/other; encountering, exploring and experiencing of multiple and partial views; moving between positions of self and others; and enacting meaning into the world. A second framework operationalises these ideas in the field of community development, and offers a method of practice.

Environmental education : from policy to practice

The field of environmental education faces a process of continuous conceptual reconstruction that is underpinned by the complexity of the social and political changes occurring throughout the world as consequences of environmental crises and the different perspectives through which they are understood in different contexts. Thus there is a need to review and reflect on the meanings of environmental education, its theory and its practice. To address such issues the seminar, 'Environmental Education: from policy to practice', was held at King's College London in March 2001, under the sponsorship of the British Council and directed by Justin Dillon. The seminar brought together environmental educators from a broad spectrum--policy developers, researchers and practitioners--from Belize, Botswana, Brazil, Canada, Colombia, Cyprus, the Czech Republic, India, Mexico, the Russian Federation, Singapore, Swaziland, Sweden, the United Kingdom, the United States of America, Venezuela and Zimbabwe. During a thought-provoking six days the seminar discussed a diverse range of ideas about the current trends and future practices in environmental education. In this report we present our 'reading' and reflection on two major aspects of the discussion: the meanings of environmental education and education for sustainable development in different cultures and contexts. This we do from our own positions as academics working on environmental education in Latin American contexts.