Background:Maintaining patient’s dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.Objectives:The aim of this study was to uncover the cultural factors that impeded maintaining patients’ dignity in the cardiac surgery intensive care unit.Research Design:The study was conducted using a critical ethnographic method proposed by Carspecken.Participants and research context:Participants included all physicians, nurses and staffs working in the study setting. Data collection methods included participant observations, formal and informal interviews, and (...) documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.Ethical Consideration:Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.Findings:The findings of the study fell into the following main themes: “Presence: the guarantee for giving enough attention to patients’ self-esteem”, “Instrumental and objectified attitudes”, “Adherence to the human equality principle: value-action gap”, “Paternalistic conduct”, “Improper language”, and “Non-interactive communication”. The final assertion was “Reductionism as a major barrier to the maintaining of patient’s dignity”.Discussion:The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.Conclusion:Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships. (shrink)

The need for energy system change in order to address the energy 'trilemma' of security, affordability and sustainability is well documented and requires the active involvement of individuals, families and communities who currently engage with these systems and technologies. Alongside technical developments designed to address these challenges, alternative ways of living are increasingly being envisaged by those involved in low-impact development. This article draws on data from a qualitative longitudinal study involving residents of a low-impact ecovillage in West Wales, UK, (...) in order to consider how the successful meeting of their planning targets has not been without personal and social troubles, which are absent from official measures of the project's success. We argue that, in exploring issues pertaining to scaling up, policy timescales and the legacy of such projects (such as inspiring others), insights drawn from this study have a wider relevance beyond the specific case site. (shrink)

Understanding how and why practices may be transformed is vital for any transition towards socio-environmental sustainability. However, theorising and explaining the role of individual agency in practice change continues to present challenges. In this paper we propose that theories of practice can be usefully combined with a psychosocial framework to explain how agency is biographically patterned and how this patterning is a product of attachment relationships and emergent strategies for dealing with uncertainty. Biographical interview data from the project Energy Biographies (...) is used to illustrate the ways in which this theoretical approach can enhance understanding of how potential for practice change may be opened up or obstructed. (shrink)

The problem of how to make the transition to a more environmentally and socially sustainable society poses questions about how such far-reaching social change can be brought about. In recent years, lifecourse transitions have been identified by a range of researchers as opportunities for policy and other actors to intervene to change how individuals use energy, taking advantage of such disruptive transitions to encourage individuals to be reflexive toward their lifestyles and how they use the technological infrastructures on which they (...) rely. Such identifications, however, employ narratives of voluntary change that take an overly optimistic view of how individuals experience lifecourse transitions and ignore effects of experiences of unresolved or unsuccessful transitions. Drawing on interview data from the Energy Biographies project at Cardiff University, we explore three case studies where the effects of such unresolved transitions are significant. Using the concept of liminal transition as developed by Victor Turner, we examine instances where “progressive” narratives of energy use reduction clash with other “narrative genres” used to make sense of change. Such clashes show how narratives that view lifecourse transitions as opportunities ignore the challenges that such transitions may pose to efforts to construct or sustain identities. (shrink)