In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity (...) in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice. (shrink)

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased (...) continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or ‘bounded’ relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship. (shrink)

In this paper we comment on the changes in the provision of fertility care in Australia, New Zealand and the UK to illustrate how different funding arrangements of assisted reproductive technologies (ART) shape the delivery of patient care and the position of fertility nursing. We suggest that the routinisation of in vitro fertilisation technology has introduced a new way of managing the fertility patient at a distance, the distal fertility patient. This has resulted in new forms of organisational routines in (...) ART which challenge both traditional forms of nursing and advanced nursing roles. We discuss the consequences of this increasingly globalised approach to infertility through the lens of three national contexts, Australia, New Zealand and the UK to unpack the position of nursing within the new forms of organisational routines. (shrink)

How nursing as a profession is valued may be changing and needs to be explored and understood in a global context. We draw on data from two empirical studies to illustrate our argument. The first study explored the value of nursing globally, the second investigated the experiences of overseas trained nurses recruited to work in a migrant capacity in the UK health care workforce. The indications are that nurses perceive themselves as devalued socially, and that other health care professionals do (...) not give nursing the same status as other, socially more prestigious professions, such as medicine. Organizational and management structures within the NHS and the independent care home sector devalue overseas nurses and the contribution they make to health care. Our conclusions lead us to question the accepted sociocultural value of the global nursing workforce and its perceived contribution to global health care, and to consider two ethical frameworks from which these issues could be discussed further. (shrink)

We consider two issues relating to WH-questions:(i) when you ask aWH-question you already have a description of the entity you are interested in,namely the description embodied in the question itself. You may evenhave very direct access to the entity – see (1) below.In general, what you want is an alternative description of some item thatyou already know a certain amount about.

A ‘good enough’ nurse: supporting patients in a fertility unitIn this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as ‘emotional awareness’ and ‘non‐caring’ as ‘emotional distance’ may be forms of nursing akin to Fabricius’s (1991) arguments around the ‘good enough’ nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach (...) to caring and do not expect an emotionally intimate relationship from nurses. (shrink)

This paper explores the experiences of infertile women who occupy a liminal space in society, and argues that the fertility clinic served as a space to tolerate women's experiences of liminality. It provided not only rituals aimed at transition to pregnancy, but also a space where women's liminal experiences, which are caused by the existential chaos of infertility, could be tolerated. The British experience seemed to differ from the American one identified in the literature, where self‐management and peer group support (...) are described as strategies used by infertile women to manage infertility. The British women in this study did not appear to draw so much on self‐management or peer group support to deal with their experiences of infertility. They appeared to be isolated in their experience. The clinic thus provided a space in which recognition was given to their intensely private experiences of difference from those in the outside fertile world and allowed them to manage these socially unacceptable, culturally taboo and invisible experiences. However, because of its very limited success rate in enabling women to become pregnant, rather than facilitating the transition of status from infertile to fertile woman, the clinic also served to reinforce the liminal experiences of those women who remained infertile. Inadvertently, the clinic offered a way of being in limbo while at the same time reinforcing the liminal experiences of women. (shrink)

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to (...) attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and (...) National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on ‘new public management’, we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning. (shrink)

BackgroundFear of cancer recurrence is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research.MethodsMembers of the International Psycho-oncology Society Fear of Cancer Recurrence Special Interest Group were invited to participate in an online Delphi study. Research domains identified in Round (...) 1 were presented and discussed at a focus group to consolidate the domains and items prior to presentation in further survey rounds aimed at gaining consensus on research priorities of international significance.ResultsThirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified.ConclusionThe findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need. (shrink)

The precarious rights of senior citizens, especially those who are highly educated and who are expected to counsel and guide the younger generations, has stimulated the creation internationally of advocacy associations and opinion leader groups. The strength of these groups, however, varies from country to country. In some countries, they are supported and are the focus of intense interest; in others, they are practically ignored. For this is reason we believe that the creation of a network of all these associations (...) is essential. The proposed network would act as a support for the already-existing policies of the United Nations’ High Commission for Human Rights, of independent experts, and of the Global Alliance for the Rights of Older People. All three have long ago recommended the creation of a recognized instrument for uniting presently scattered efforts. The proposed network, therefore, will seek to promote the international exchange of relevant expertise, and it will reinforce the commitments and actions that single countries are currently taking to meet these objectives. For example, informative public events can be organised to promote particular support initiatives and to provide an opportunity for new members of the network to be presented. The network will promote health for senior citizens, disease prevention, senior mobility, safe free time for seniors, alimentary education, protection against new risks and dangers, as well as equity in the services necessary for seniors to adopt new information and communication technologies. In the case of retired academic members, the network will promote equality with respect to continuing use of digital technologies (particularly email), continuing access to research libraries, and the guaranteed ability for seniors to fund their own research programs and to deliver free seminars. (shrink)

Values‐based practice is deemed essential for healthcare provision worldwide. In England, values‐based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students’ personal values align with the values of the National Health Service (NHS), which focus on compassion and patient‐centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students’ perceptions of their values over the duration of their education programme as a (...) ‘values journey’. The aim of this hermeneutic longitudinal focus group study was to explore the ‘values journey’ of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this. (shrink)

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non‐European Union (EU) and non‐White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory (...) due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices. (shrink)

Helen Longino seeks to break the current deadlock in the ongoing wars between philosophers of science and sociologists of science--academic battles founded on disagreement about the role of social forces in constructing scientific knowledge. While many philosophers of science downplay social forces, claiming that scientific knowledge is best considered as a product of cognitive processes, sociologists tend to argue that numerous noncognitive factors influence what scientists learn, how they package it, and how readily it is accepted. Underlying this disagreement, (...) however, is a common assumption that social forces are a source of bias and irrationality. Longino challenges this assumption, arguing that social interaction actually assists us in securing firm, rationally based knowledge. This important insight allows her to develop a durable and novel account of scientific knowledge that integrates the social and cognitive. Longino begins with a detailed discussion of a wide range of contemporary thinkers who write on scientific knowledge, clarifying the philosophical points at issue. She then critically analyzes the dichotomous understanding of the rational and the social that characterizes both sides of the science studies stalemate and the social account that she sees as necessary for an epistemology of science that includes the full spectrum of cognitive processes. Throughout, her account is responsive both to the normative uses of the term knowledge and to the social conditions in which scientific knowledge is produced. Building on ideas first advanced in her influential book Science as Social Knowledge, Longino brings her account into dialogue with current work in social epistemology and science studies and shows how her critical social approach can help solve a variety of stubborn problems. While the book focuses on epistemological concerns related to the sociality of inquiry, Longino also takes up its implications for scientific pluralism. The social approach, she concludes, best allows us to retain a meaningful concept of knowledge in the face of theoretical plurality and uncertainty. (shrink)

Philosophers have long suspected that thought and discourse about what we ought to do differ in some fundamental way from statements about what is. But the difference has proved elusive, in part because the two kinds of statement look alike. Focusing on judgments that express decisions--judgments about what is to be done, all things considered--Allan Gibbard offers a compelling argument for reconsidering, and reconfiguring, the distinctions between normative and descriptive discourse--between questions of "ought" and "is." Gibbard considers how our (...) actions, and our realities, emerge from the thousands of questions and decisions we form for ourselves. The result is a book that investigates the very nature of the questions we ask ourselves when we ask how we should live, and that clarifies the concept of "ought" by understanding the patterns of normative concepts involved in beliefs and decisions. An original and elegant work of metaethics, this book brings a new clarity and rigor to the discussion of these tangled issues, and will significantly alter the long-standing debate over "objectivity" and "factuality" in ethics. Table of Contents: I. Preliminaries 1. Introduction: A Possibility Proof 2. Intuitionism as Template: Emending Moore II. The Thing to Do 3. Planning and Ruling Out: The "Frege-Geach" Problem 4. Judgment, Disagreement, Negation 5. Supervenience and Constitution 6. Character and Import III. Normative Concepts 7. Ordinary Oughts: Meaning and Motivation 8. Normative Kinds: Patterns of Engagement 9. What to Say about the Thing to Do: The Expressivistic Turn and What it Gains Us IV. Knowing What to Do 10. Explaining with Plans 11. Knowing What to Do 12. Ideal Response Concepts 13. Deep Vindication and Practical Confidence 14. Impasse and Dissent References Index This is a remarkable book. It takes up a central and much-discussed problem - the difference between normative thought and "descriptive" thought. It develops a compelling response to that problem with ramifications for much else in philosophy. But perhaps most importantly, it brings new clarity and rigor to the discussion of these tangled issues. It will take some time to come to terms with the details of Gibbard's discussion. It is absolutely clear, however, that the book will reconfigure the debate over objectivity and "factuality" in ethics. --Gideon Rosen, Professor of Philosophy, Princeton University Gibbard,/author> writes elegantly, and the theory he develops is innovative, philosophically sophisticated, and challenging. Gibbard defends his theory vigorously and with admirable intellectual honesty. --David Copp, Professor of Philosophy, Bowling Green State University. (shrink)

In Studying Human Behavior, Helen E. Longino enters into the complexities of human behavioral research, a domain still dominated by the age-old debate of “nature versus nurture.” Rather than supporting one side or another or attempting..

Alain Ehrenberg’s essay, “The American Self versus the French Institution,” describes the emergence in France of what Ehrenberg calls a new discourse on psychological suffering. The kind of ‘suffering’ is not examined in detail, other than suggesting that it is experienced as social and moral misfortune, and represented in psychiatric diagnoses and interventions. If I understand Ehrenberg correctly, these misfortunes are products of a changing social reality: the progressive weakening of social ties, a diminishing sense of community and shared obligation, (...) and the valorization of personal autonomy and separateness. Ehrenberg is describing a historical pathway that would seem.. (shrink)

This paper considers Davidson's critique, in his paper 'Causal Relations' of the Millian notion of the 'whole cause' of an event. The paper attempts to show why Davidson's criticisms of Mill, taken to its logical conclusion, entails that we must give up 'the network model of causation', a model which dominates contemporary philosophy of mind (as well as many accounts of the nature of causation in general) and shapes prevailing ideas about the form of some of its most important questions.

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This essay warns of eroding accountability in computerized societies. It argues that assumptions about computing and features of situations in which computers are produced create barriers to accountability. Drawing on philosophical analyses of moral blame and responsibility, four barriers are identified: 1) the problem of many hands, 2) the problem of bugs, 3) blaming the computer, and 4) software ownership without liability. The paper concludes with ideas on how to reverse this trend.

This article presents the findings of a study about the history of aversion therapy as a treatment technique in the English mental health system to convert lesbians and bisexual women into heterosexual women. We explored published psychiatric and psychological literature, as well as lesbian, gay, and bisexual archives and anthologies. We identified 10 examples of young women receiving aversion therapy in England in the 1960s and 1970s. We situate our discussion within the context of post-war British and transnational medical history. (...) As a contribution to a significantly under-researched area, this article adds to a broader transnational history of the psychological treatment of marginalised sexualities and genders. As a consequence, it also contributes to LGBTQIA+ history, the history of medicine, and psychiatric survivor history. We also reflect on the ethical implications of the research for current mental health practice. (shrink)

Van Dijk argues that it is from news that the majority of people obtain most of their social and political knowledge. Therefore, it should concern us that current research evidence suggests that the discourse of public relations is growing in influence over the discourse of journalism to an extent that journalists are relinquishing their agenda-setting function. Using the concepts of intertextuality and genre, the form and content of examples of public relations material and the news stories which resulted from them (...) are discussed. Erjavec’s method of comparative analysis is employed to examine the texts as well as discuss the discourse processes. Fairclough’s argument that texts are a set of options is used to show that the options journalists are choosing are not necessarily based on the accepted rules of news values. (shrink)

The paper argues that it is possible for an incompatibilist to accept John Martin Fischer's plausible insistence that the question whether we are morally responsible agents ought not to depend on whether the laws of physics turn out to be deterministic or merely probabilistic. The incompatibilist should do so by rejecting the fundamentalism which entails that the question whether determinism is true is a question merely about the nature of the basic physical laws. It is argued that this is a (...) better option for ensuring the irrelevance of physics than the embrace of semi-compatibilism, since there are reasons for supposing that alternate possibilities are necessary for moral responsibility, despite Fischer's claims to the contrary. There are two distinct reasons for supposing that alternate possibilities might be necessary for moral responsibility—one of which is to do with fairness, the other to do with agency itself. It is suggested that if one focuses on the second of these reasons, Fischer's arguments for supposing that alternate possibilities are unnecessary for moral responsibility can be met by the incompatibilist. Some possible reasons for denying that alternate possibilities are necessary for the existence of agency are then raised and rejected. (shrink)

This paper explores the relationship between a person's claim right not to be harmed and the duties this claim confers on others. I argue that we should reject Jonathan Quong's evidence-based account of this relationship, which holds that an agent A's possession of a claim against B is partly determined by whether it would be reasonable for A to demand B's compliance with a correlative duty. When B's evidence is that demanding compliance would not be reasonable, A cannot have a (...) claim against B. I suggest that some of the putatively problematic cases that Quong identifies can be resolved by plausibly narrowing the scope of the right not to be harmed. I also argue that Quong's view leads to implausible conclusions, and that his account of what happens to A's claim in the face of lesser-evil justifications is inconsistent with his broader view. I then defend the view that agents are required, and not merely permitted, to act on lesser-evil justifications. I further argue that A may not defend herself against the infliction of harms that are justified on lesser-evil grounds. However, she may defend herself in cases where B is only evidentially, and not objectively, justified in harming her. (shrink)

Adam Hosein has recently proposed that a sufficient degree of intervening agency between a person’s contribution to an unjust lethal threat and the posing of that threat can exempt the contributor from liability to defensive killing. Hosein suggests that this will exempt most civilians from liability to lethal defence even if they contribute to unjust killings. I argue that intervening agency does not bear on a person’s responsibility for a threat, and does not exempt her from liability to defensive killing.

There is a form of argument for a certain kind of essentialist conclusion which appears not to depend upon any appeal to intuition. Identity statements involving natural kind terms are often adverted to in the literature as examples of the necessary a posteriori, and it can appear as though the essentialist is on very strong ground with respect to these claims. It is not merely that they are apt to strike one as plausible in the light of philosophical arguments or (...) modal intuitions; rather, they appear to be provable, given only fairly trivial logical principles and uncontroversial scientific truths. This paper attempts to counter the claim, made particularly convincing by the work of Saul Kripke, that this indeed the case. (shrink)

The philosopher and novelist Ayn Rand is a cultural phenomenon. Her books have sold more than twenty-eight million copies, and countless individuals speak of her writings as having significantly influenced their lives. Despite her popularity, Rand’s philosophy of Objectivism has received little serious attention from academic philosophers. _Concepts and Their Role in Knowledge_ offers scholarly analysis of key elements of Ayn Rand’s radically new approach to epistemology. The four essays, by contributors intimately familiar with this area of her work, discuss (...) Rand’s theory of concepts—including its new account of abstraction and essence—and its central role in her epistemology; how that view leads to a distinctive conception of the justification of knowledge; her realist account of perceptual awareness and its role in the acquisition of knowledge; and finally, the implications of that theory for understanding the growth of scientific knowledge. The volume concludes with critical commentary on the essays by distinguished philosophers with differing philosophical viewpoints and the author’s responses to those commentaries. This is the second book published in Ayn Rand Society Philosophical Studies, which was developed in conjunction with the Ayn Rand Society to offer a fuller scholarly understanding of this highly original and influential thinker. The Ayn Rand Society, an affiliated group of the American Philosophical Association, Eastern Division, seeks to foster scholarly study by philosophers of the philosophical thought and writings of Ayn Rand. (shrink)