The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a (...) CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis‐oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western‐based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning. (shrink)

Our intention is to contribute to the development of Canadian Nursing and Medical Education (NursMed) and efforts to redress deepening, intersecting health and social inequities. This paper addresses the following two research questions: (1) What are the ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education with a focus on critically examining settler‐colonialism, health equity, and social justice? (2) What are the potential struggles and adaptations required to integrate Decolonial, Intersectional Pedagogies within Canadian NursMed Education in service of (...) redressing intersecting health and social inequities? Briefly, Decolonial, Intersectional Pedagogies are philosophies of learning that encourage teachers and students to reflect on health through the lenses of settler‐colonialism, health equity, and social justice. Drawing on critical ethnographic research methods, we conducted in‐depth interviews with 25 faculty members and engaged in participant observation of classrooms in university‐based Canadian NursMed Education. The research findings are organized into three major themes, beginning with common institutional features influencing pedagogical approaches. The next set of findings addresses the complex strategies participants apply to integrate Decolonial, Intersectional Pedagogies. Lastly, the findings illustrate the emotional and spiritual toll some faculty members face when attempting to deliver Decolonial, Intersectional Pedagogies. We conclude that through the application of Decolonial, Intersectional Pedagogies teachers and students can support movements towards health equity, social justice, and unlearning/undoing settler‐colonialism. This study contributes new knowledge to stimulate dialog and action regarding the role of health professions education, specifically Nursing and Medicine as an upstream determinant of health in settler‐colonial nations such as Canada, United States, Australia, and New Zealand. (shrink)

Neoliberal ideology and exclusionary policies based on racialized identities characterize the current contexts in North America and Western Europe. Nursing knowledge cannot be abstracted from social, political and historical contexts; the task of examining the influence of race and racial ideologies on disciplinary knowledge and inquiry therefore remains an important task. Contemporary analyses of the role and responsibility of the discipline in addressing race‐based health and social inequities as a focus of nursing inquiry remain underdeveloped. In this article, we examine (...) nursing's engagement with ideas about race and racism and explore the ways in which nursing knowledge and inquiry have been influenced by race‐based ideological discourses. Drawing on Henry and Tator's framework of democratic racism, we consider how strategic discursive responses—the discourses of individualism, multiculturalism, colour‐blindness, political correctness and denial—have been deployed within nursing knowledge and inquiry to reinforce the belief in an essentially fair and just society while avoiding the need to acknowledge the persistence of racist discourses and ideologies. Greater theoretical, conceptual and methodological clarity regarding race, racialization and related concepts in nursing inquiry is needed to address health and social inequities. (shrink)

SALMON A, BROWNE AJ, and PEDERSON A. Nursing Inquiry 2010; 17: 336–345 ‘Now we call it research’: participatory health research involving marginalized women who use drugsIn this paper, we discuss and analyse the strategies employed and challenges encountered when conducting a recent feminist participatory action research study with highly marginalized women who were illicit drug users in an inner city area of Vancouver, Canada. Through an analysis of the political economy of participatory praxis within current neoliberal contexts, we focus on (...) three main areas: (i) reconceptualizing the pragmatics of participation; (ii) the microeconomic implications of participatory research, including ethical issues in payment for research participation; and (iii) the value and limits of using research as a tool for activism and empowerment. We conclude with a brief discussion of what we see to be some of the most salient social justice implications arising from feminist and participatory approaches to health research within neoliberal political spaces. (shrink)

Nursing work centers around attending to a person's health during many of life's most vulnerable moments, from birth to death. Given the high‐stakes nature of this work, it is essential for nurses to critically reflect on their individual and collective impact, which can range from healing to harmful. The purpose of this paper is to use a philosophical inquiry approach and a critical lens to explore the potential influence of critical pedagogy (how we learn what we learn) on nursing praxis (...) (why we do what we do) with the aim of disrupting stigma and discrimination within the profession. This paper draws on the works of Paulo Freire, Henry Giroux, and bell hooks to alert readers to particular windows of opportunity where an intentional adoption of critical pedagogy in nursing praxis may help the profession think differently about two important and related topics: relational violence and peer‐led knowledge mobilization. As a practice‐based and theoretically grounded profession, nurses often strive to bridge the theoretical with the practical and the individual with the systemic. Thus, developing a robust and philosophically rooted disciplinary body of knowledge is particularly important to help us defensibly grapple with the notions of truth and ethics that shape our work's very essence and impact. (shrink)

Introduction No consent for health and medical research is appropriate when the criteria for a waiver of consent are met, yet some ethics committees and data custodians still require informed consent. Methods A single-blind parallel-group randomised controlled trial: 1129 families of children born at a South Australian hospital were sent information explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance with 4 weeks to opt in or opt out by reply form, telephone or email. A subsequent (...) telephone interview gauged the intent of 1026 parents (91%) in relation to their actions and the sociodemographic differences between participants and non-participants in each arm. Results The participation rate was 21% (n=120/564) in the opt-in arm and 96% (n=540/565) in the opt-out arm (χ2 (1 df) = 567.7, p<0.001). Participants in the opt-in arm were more likely than non-participants to be older, married/de facto, university educated and of higher socioeconomic status. Participants in the opt-out arm were similar to non-participants, except men were more likely to opt out. Substantial proportions did not receive, understand or properly consider study invitations, and opting in or opting out behaviour was often at odds with parents' stated underlying intentions. Conclusions The opt-in approach resulted in low participation and a biased sample that would render any subsequent data linkage unfeasible, while the opt-out approach achieved high participation and a representative sample. The waiver of consent afforded under current privacy regulations for data linkage studies meeting all appropriate criteria should be granted by ethics committees, and supported by data custodians. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12610000332022. (shrink)

Researchers studying depression often encounter research participants in serious preexisting distress. Examining investigators' ethical responsibilities to these subjects, Stanton and New found that depression researchers reported actions that ranged from doing nothing to contacting both the distressed subject and a significant other. By experimentally manipulating consent form information regarding potential treatment referral, we examined whether subjects adjusted their responses on depression measures as a function of the level of follow-up they expected to receive. Results reveal that subjects who potentially could (...) receive the most intrusive intervention were less likely to report depressive symptoms than were subjects who anticipated less intrusive follow-up. Willingness to report depressive symptoms in particular conditions varied in part as a function of subject sex. Thus, ethical safeguards used in studies with subjects in preexisting distress may have consequences for the validity of self-report depression measures. (shrink)

Depression might be associated with accelerated cellular aging. However, does this result in an irreversible state or is the body able to slow down or recover from such a process? Telomeres are DNA‐protein complexes that protect the ends of chromosomes and generally shorten with age; and therefore index cellular aging. The majority of studies indicate that persons with depression have shorter leukocyte telomeres than similarly aged non‐depressed persons, which may contribute to the observed unfavorable somatic health outcomes in the depressed (...) population. Some small‐scale preliminary studies raise the possibility that behavioral or pharmacological interventions may either slow down or else reverse this accelerated telomere shortening, possibly through increasing the activity of the telomere‐lengthening enzyme telomerase. This paper covers the current state of evidence in the relationship between depression and the telomere‐telomerase system and debates whether depression‐related cellular aging should be considered a reversible process or permanent damage. (shrink)

Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine initiatives, it is (...) important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

Background:Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.Research hypothesis:We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a (...) person or an action that overcomes fears or other challenges to achieve something of great moral worth.Research design:The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.Participants and research context:A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.Ethical considerations:The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.Findings:Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.Discussion:Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.Conclusion:Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes. (shrink)

This book investigates humanities, social sciences and politics from the perspective of the concept of creation order. It is the second volume in a series that provides a unique and topical overview of attempts to assess the current health of the concept of creation order within Reformational philosophy when it is compared with other perspectives. Divided into a section on fundamental reflections and a section on normative practices, it discusses issues such as redemption, beauty, nature, love, justice, morality, and ethics. (...) It concludes with discussions on a practice-based theory to explain religion in international relations and a normative model for the practice of cooperation in development. This series reflects the role that the branch of Christian philosophy called ‘Reformational’ philosophy plays in the discussion on the status of laws of nature. Ever since its inception, almost a century ago, the concepts of order and law have been at the heart of this philosophy. One way to characterise this tradition is as a philosophy of creation order. Firmly rejecting both scholastic metaphysics and Deism, Reformational philosophers have maintained the notion of law as ‘holding’ for reality. Questions have arisen about the nature of such law: is it a religious or philosophical concept; does law just mean ‘orderliness’? How does it relate to laws of nature? Have they always existed or do they ‘emerge’ during the process of evolution? (shrink)

In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)

"The main spine of this book stems from a comprehensive series of interviews with subjects recalling their experiences of 1930s cinemagoing. Your feel the breath of life in these spectators, a rarity in film studies, thanks to the painstaking work contracting the interview subjects and recording and tabulating their testimony."- JUMPCUT In the 1930s, Britain had the highest annual per capita cinema attendance in the world, far surpassing ballroom dancing as the nation's favorite pastime. It was, as historian A.J.P. Taylor (...) said, the "essential social habit of the age." And yet, although we know something about the demographics of British cinemagoers, we know almost nothing of their experience of film, how film affected them, how it fit into their daily lives, what role cinema played in the larger culture of the time, and in what ways cinemagoing shaped the generation that came of age in the 1930s. In Dreaming of Fred and Ginger , Annette Kuhn draws upon contemporary publications, extensive interviews with cinemagoers themselves, and readings of selected film, to produce a provocative and perspective-altering ethno-historical study. Taking cinemagoers' accounts of their own experiences as both "the engine and product of investigation," Kuhn enters imaginatively into the world of 1930s cinema culture and analyzes its place in popular memory. Among the topics she examines are the physical space of the cinemas; the role film played in growing up; the experience of being a member of a cinema audience; film-inspired fantasies of American life; the importance of cinema to adolescence in offering role models, ideals of romance, as well as practical opportunities for courtship; and the sheer pleasure of watching such film stars as Fred Astaire, Ginger Rogers, Nelson Eddy, Ronald Colman, and many others. Engagingly written and painstakingly researched, with contributions to film history, cultural studies, and social history, Dreaming of Fred and Ginger offers an illuminating account of a key moment in British cultural memory. (shrink)

Following the lead of Annette Baier, this essay argues that trust relations provide the ethical substance of everyday living. When A trusts B, A unreflectively allows B to approach sufficiently close so as to be able to harm A. In order for this to be possible, A practically presupposes that B perceives A as a person and will hence act accordingly. Trust relations are relations of mutual recognition in which we acknowledge our mutual standing and vulnerability with respect to (...) one another. A robust account of trust assumes: first, trust relations are primary and practical, and while monitored by reason, they are not rationally constituted; second, trust can sustain its practical primacy over moral reason because it is developmentally prior to reason; and third, trust relations can be the bearers of our worth and vulnerability because they are the developmental products of first love. (shrink)

Under patriarchy, the rationally autonomous agent engages in contractual relations in a marketplace society. The contractual model reinforces a negative conception of the vulnerable as weak and as susceptible to injury and exploitation. Recent feminist writing has a positive notion of vulnerability that is in conflict with contractualism. Positive notions of vulnerability, the paper argues, are found in Virginia Held’s conception of mothering, Nel Noddings’ analysis of teaching, and Annette Baier’s development of trust as essential for social relationships.

In lieu of an abstract, here is a brief excerpt of the content:The Philosopher’s Seduction: Hume and the Fair SexVicki J. SappFollowing the failed reception of his Treatise David Hume turned to writing essays and published these in various editions throughout his career. Among the first offerings were essays addressing “the female reader,” “the ladies,” or “the fair sex” in that current habit which Jonathan Swift labelled “fair-sexing it.” Hume’s Victorian editors T. H. Green and T. H. Grose classified and (...) commented upon these woman-appeal essays “apparently designed to attract the attention of ladies, and marked by the mannerisms of what was then a fashionable literature,” concluding that these “can hardly have been much to their writer’s taste, and... mingle strangely with a series of discussions on the British Constitution.” 1 Green and Grose refer to the fact that Hume gradually eliminated his woman-appeal essays from the editions; today, we find these “literary” texts safely removed from the “moral and political” frame and anthologized as “Essays Withdrawn and Unpublished” in the two modern editions of Hume’s essays. 2Following Hume’s apparent cue, the critical tradition has paid little heed to the woman-appeal essays except in those cases where kind neglect has given over to insult or factionalism. From the former category we find contemporary readers such as M. A. Box who in his rhetorical analysis of Hume’s opus echoes earlier judgments of these essays as frivolous, mercenary, essentially devoid of substantive or stylistic worth—and most certainly unphilosophical. In the latter case, scattered commentators from the 1970s and 1980s reflecting those decades’ gynocritical trend built cases for Hume’s “sexism” (primarily) or “feminism” (most notably the philosopher Annette Baier). And Jerome Christensen has attended to Hume’s female reader in his [End Page 1] elaborate theoretical play with Hume’s gender as a metaphor for his literary ambitions. 3What is curious is that each of the above readers has passed over the woman-appeal essays in favor of Hume’s “serious” writing (for example, Treatise, Book III, Part II, sect. xii, “Of Chastity and Modesty”) or his letters, even though the rejected woman-appeal essays are obviously rich sources for a study of Hume’s gender perspectives. It is true that in “Of Chastity and Modesty” Hume offers what is perhaps his best evidence of society’s conventional as opposed to metaphysical foundations, in his argument that the laws of chastity governing female education and behavior are certainly “notions... founded on the public interest,” that is, patriarchal property interest. In the woman-appeal essays Hume actually works out, by illustration, the gender-biased foundational intricacies of his social contract philosophy, especially the importance of education to the regulation of society: “As publick praise and blame encrease our esteem for justice; so private education and instruction contribute to the same effect.... For these reasons [parents] are induc’d to inculcate on their children, from the earliest infancy, the principles of probity, and teach them to regard the observance of these rules, by which society is maintain’d, as worthy and honourable, and their violation as base and infamous.” 4The rejected woman-appeal essays include titles that bespeak a focus on gender, education, and social formation (“Of Love and Marriage,” “Of Moral Prejudice”), as well as titles that appear more public or scholarly: “Of Essay Writing,” “Of the Study of History.” In spite of their topical neutrality or marginally “political” tone, these latter two I identify as Hume’s core woman-appeal essays. In them Hume brings the female reader into the spotlight, inviting her into a dialogue with the male philosopher-essayist; she is to share in a sort of Humean Utopia of gender-mixed educated, genteel company servicing the ends of true philosophy in the marriage of intellection and experience. As overt appeals to “women of Sense and Education” featuring some gestures towards gender equality, these essays, one suspects, were doomed to eventual rejection by both Hume and a subsequent critical tradition prone to the kneejerk devaluation of woman-appeal.I offer here evidence that the rejected essays do have “philosophical” merit as they take up or dramatize core ideas of Treatise philosophy. These essays also feature some... (shrink)