Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: Drawing on social representations theory and the concept of social identity, we explore how experts’ by experience and registered nurses’ understandings of OST contain discourses about the social representations, identity, and citizenship of the (...) participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. (shrink)

Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that (...) distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face‐to‐face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses’ orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses’ emotion work. (shrink)

This article brings together two concepts, ‘phantom fat’ and ‘liminal fat’, which both aim to grasp how fat in contemporary culture becomes a kind of material immateriality, corporeality in suspension. Comparing the spheres of representation and experience, we examine the challenges and usefulness of these concepts, and feminist fat studies perspectives more broadly, to feminist scholarship on the body. We ask what connects and disconnects fat corporeality and fat studies from ways of theorising other embodied differences, like gender, ‘race’, disability, (...) class and sexuality, especially when thinking through their perceived mutability or removability, and assumptions about their relevance for subjectivity. While it is important to consider corporeality and selfhood as malleable and open to change in order to mobilise oppressive normativities around gendered bodies and selves, we argue that more attention should also be paid to the persistence of corporeality and a feeling of a relatively stable self, and the potential for empowerment in not engaging with or idealising continuous transformation and becoming. Furthermore, we suggest that the concepts of phantom fat and liminal fat can help shed light on some problematic ways in which feminist studies have approached – or not approached – questions of fat corporeality in relation to the politics of health and bodily appearance. Questions of weight, when critically interrogated together with other axes of difference, highlight how experiential and subjugated knowledges, as well as critical inquiry of internal prejudices, must remain of continued key importance to feminist projects. (shrink)

This monograph reports on an empirical survey of 394 secondary school students investigating their desire to seek the meaning of their own lives. The theoretical framework upon which the study was based is that of Viktor E. Frankl's hypotheses that a human being wants to seek the meaning in his own life. The questionnaire consisted of tests measuring pupils' concepts of their own life's purposes, significance, and meaningfulness. Questions dealt with values and attitudes toward existential questions. Pupils could also evaluate (...) significance of school subjects in the the search for their own life's meaning. Initial results gave clear indication that students reflect quite a lot on the meaning of life, and most think that topics and questions dealing with existential questions should be addressed at school. Responses to open-ended questions on what they expected from school revealed that students asked for warmer and closer human relationships, more communication, more taking into account of individuality, more opportunity for choices, more support and encouragement, and more knowledge that has meaning for their personal life. The questionnaire is appended. (JD). (shrink)

Care for patients with multiple illnesses is often provided by several professionals from different parts of the health care system. In these cases, there seem to arise new demands for the communication and the cooperation between different professionals in the primary and the specialized care. In this paper, I shall describe how these challenges are met in an encounter which is a part of interventions called “Implementation Laboratories”. In these encounters, a new tool (care agreement) and a new practice (care (...) negotiation) are introduced and elaborated in internal-medicine patient care. I conceptualized the Implementation Laboratories as “border zones” where the learning processes between different communities are intensified. Learning in the Implementation Laboratories resembles learning at the Boundary Crossing Laboratory described by Engeström, Engeström &Vähäaho (1999a; 1999b). It is interwoven into the process of analyzing problems, planning and testing of solutions in order to improve the medical patient care. Learning appears as collisions between the different perspectives of the patient and professionals of different organizations, and may sometimes lead to reconstruction of boundaries. (shrink)

The care of patients with many illnesses often appears fragmented by many boundaries in the health care system when the care is provided in several locations of primary and secondary care. In the article, boundaries are examined in an interaction between patients and multiple providers in an effort to develop collaboration in inter-organizational provision in a Change Laboratory intervention. Firstly, it will be traced how the boundaries are expressed in the interaction. Secondly, it will be studied how the boundaries expressed (...) in the interaction relate to health care organizations and patient care practices. Thirdly, the practical activity that was embedded in the interaction between patients and providers will be focused on at the laboratory. The expression of boundaries was examined in activity theoretical terms as discursive actions. In discursive actions the ‘lived past’ becomes involved in the situational actions that orient towards future activity. The findings suggest that expressing boundaries uses various linguistic means and it seems relevant to propose that boundaries cannot be studied in a formal way; the analysis needs to be related to the organizational context of the specific study. However, the linguistic means may serve as useful “landmarks” or “pointers” of boundaries that are often expressed implicitly in the interaction. The laboratory session provides an opportunity to study boundaries “on the spot”, or “in their own right”. The realization of the emergent inter-organizational care at the session created challenges for the provision while contradicting some elements of the prevailing provision. During these kinds of interaction, the boundaries between providers became obvious. Furthermore, challenging the boundaries in the normal flow of interaction may be a potential for boundary crossing and even further, a re-constitution of boundaries. Consequently, a boundary crossing represents an interesting unit of analysis for future studies of boundaries and boundary crossing in interaction and discourse. At the laboratory setting was displayed the ability to control others through an indirect use of power that may reflect a simultaneous value system supported by the prevailing hierarchies. In the studies to come, it will be important to pay attention to these implicit power linkages when monitoring the boundaries in horizontal collaborations. (shrink)

The study provides insights on why large Finnish municipalities are engaging in sustainability reporting. The dataset consists of the sustainability disclosures of five large Finnish cities and of a set of interviews conducted with the personnel responsible for composing the sustainability reports in these cities. Preliminary findings suggest that this rising practice is again an example of a fad, arising as the public sector organizations mimic the corporate sector without anyone really pondering whether the municipalities and the public sector as (...) a whole truly need a similar practice the corporations have. We maintain that there are better ways to use a municipality’s scarce resources than imitating the corporate sustainability reporting practices through producing a sustainability report, the main task of which seems to be to exist. (shrink)

This paper discusses and provides a tentative model of a firm for purposes of accounting. The paper first presents the neo-classical capital circulation model of the firm—a model that has been an integral part of Finnish business economics and accounting education for at least half a century. During the same period the stakeholder model has become an alternative model of the firm in Scandinavia. These models have represented two alternatives to define the firm in education. In this paper we try (...) to combine these two models to provide a more comprehensive picture of the firm, especially from the accounting education perspective. An earlier version of this model was presented in 1995 in a book edited by Juha Näsi. Stakeholders with business transactions were seen to be crucial to firms and were categorized as primary in the 1995 model. In addition to stakeholders, a number of stakeholder issues were illustrated in the stakeholder model serving accounting as an educational framework. In this paper the earlier model has been updated, taking into account the current globalization and other developments in the business world. (shrink)

Substance-abusing women are vulnerable to specific kinds of epistemic injustice, including stigmatization and discrimination. This article examines the development of the epistemic agency of female substance abusers by asking: How does the use of a formal discussion protocol in community rehabilitation interaction alleviate epistemic injustice and strengthen the epistemic agency of substance abusers? The data were collected in a Finnish rehabilitation center by videotaping six group discussions between social workers, peer support workers, and rehabilitation clients with substance abuse problems. Of (...) these data, one recorded group discussion between four female participants—two rehabilitation clients, a peer support worker, and a social adviser—was used in this paper. Using conversational analysis, the findings indicate that, through the collaborative activities of sharing experiential knowledge about substance abuse and discussing the experiences of abuse in the rehabilitation interaction, substance abusers can develop novel ways to strengthen their epistemic agency by enhanced self-awareness. The discussion protocol is an epistemic tool that professionals and clients can learn to use in ethically and epistemologically successful ways in interaction. The use of a discussion protocol is an example of social professionals’ clinical knowledge of intensifying collaboration and sharing experiential knowledge in community rehabilitation and other substance abuse services. (shrink)

As pressure to publish increases in the academic nursing world, journal submission numbers and rejection rates are soaring. The review process is crucial to journals in publishing high quality, cutting‐edge knowledge development, and to authors in preparing their papers to a high quality to enable the nursing world to benefit from developments in knowledge that affect nursing practice and patient outcomes and the development of the discipline. This paper does not intend to contribute to the debate regarding the ethics of (...) reviewing, but rather seeks to explore notions of how the quality of the reviewing process can be enhanced to benefit authors, the reviewers, and the state of nursing knowledge. Furthermore, a call is made to editors to devise strategies for aiding reviewers to attain higher validity and reliability within the reviewing process by establishing clear standards and expectations and to ensure published work is judged against industry norms for quality. (shrink)

Sexual and reproductive health is a challenge worldwide, and much progress is needed to reach the relevant UN Sustainable Development Goals. This paper presents cross-sectional data collected in Sierra Leone on sexual and gender-based violence, family planning, child, early and forced marriage, and female genital mutilation using an innovative method of measurement: situational judgment tests, as a subset of questions within a larger survey tool. For the SJTs, respondents saw hypothetical scenarios on these themes and had to indicate how they (...) would react. The objective is to give an impression of beliefs and norms on specific behaviors, which provide insights for social and behavior change interventions. Data was collected by enumerators traveling to villages randomly selected in six districts of the country. The sample is composed of 566 respondents. Results show that FGM in particular seem to be a priority topic, in comparison to the other topics for which the norms seem to be stronger against those practices. Age differences emerged and suggest priority groups to be targeted. In terms of validity of the measurement methods, situational judgment test answers correlated positively with other items in the survey, but the magnitude of the association is often small, and sometimes not significant. Thus, more studies are needed to further explore the validity of this measure by comparing against a reference value. Using SJTs could complement other data collection tools to perform community assessment, and orient the direction of the program in its planning phase. (shrink)

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in ‘the ethical imperative’ of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers’ decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management (...) practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected. (shrink)

This paper sheds further light on the role of quantification in corporate environmental disclosures. Quantification is an inherently social practice, which has attracted a fair amount of academic interest in recent years. At the same time, in the field of social and environmental accounting there is a paucity of research on quantification or the role it plays for organisations, for organisational communication and in societies more broadly. Accordingly, in this paper, we will draw on a qualitative case study to discuss (...) the potential implications that might arise from the use of quantified information in corporate environmental disclosures. Our case study illustrates the diverse effects of quantification suggested in the prior literature by placing them in the context of corporate environmental disclosures. We discuss how quantification implies fake precisionism and promotes commensuration of incomparables, thereby limiting the discussion to themes and questions preferred by company management. We maintain that quantification, while appearing to produce neutral and value-free information, has a substantive ethical dimension through how it implicates accountability relationships as well as the respective power relations between diverse stakeholders in societies. (shrink)