This article investigates discursive practices associated with the co-management of patients between healthcare providers. Specifically, we focus on two genres written by optometrists and ophthalmologists — two groups who are experiencing interprofessional tension over their scopes of practice. In our analysis we foreground four kinds of modality associated with verbs — epistemic, deontic, phatic and subjective. We found that these healthcare providers shared in the epistemic resources used to hedge their sense of clinical certainty, and that ophthalmologists used deontic resources (...) to control future action. However, we also noted that both professions used deontic, phatic and subjective resources to create dialogical space for each other to participate in some future relationship. In fact, one of the main points of this correspondence might be to establish personal relationships between practitioners. Unfortunately, however, this subtle use of modality to negotiate professional boundaries is fading as many ophthalmologists, due to workload issues, are not responding to referral letters or are converting their correspondence to form letters. (shrink)

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals between January 2015 and December 2017. By consensus, we identified those that addressed (...) system flaws. Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity. (shrink)

The mature cerebral cortex contains a staggering variety of projection neuron subtypes, and a number of complementary studies have recently begun to define their identity and embryonic origin. Among the different types of cortical projection neurons, subcerebral projection neurons, including corticospinal motor neurons (CSMN), have been extensively studied and some of the molecular controls over their differentiation have been elucidated. Here, we first provide an overview of the approaches used to purify and molecularly profile neuronal populations of the neocortex and, (...) more broadly, of the central nervous system (CNS). Next, we specifically review recent progress in understanding the genes that define and control development of the CSMN population. Finally, we briefly discuss the relevance of this work to current questions regarding the mechanisms of the establishment of projection neuron subtype identity in the neocortex and its implications to direct the differentiation of CSMN for therapeutic benefit. (shrink)

This article responds to and reflects upon the articles in this special issue. Specifically, it deals with the usage of theory in each of the articles, what we might see, as examples of re-descriptive usage in autonomous theorizing. The articles utilize different theories and varying intellectual resources—Foucault and Deleuze, Bourdieu, Levinas and Butler —to analyse the topic of the My School website and associated new accountabilities in Australia schooling. This article argues that their usage of the My School website must (...) be seen as a condensation symbol to signify a broader neo-liberal agenda in Australian schooling that has global as well as national elements to it. The fact that the social today is no longer straightforwardly homologous with the nation also challenges ‘methodological nationalism’ and suggests the pressing need to ‘deparochialize’ theory in research and reject a reading of Northern theory as universal. The article uses the provocations of these articles to reflect upon the necessity of theory in educational research more generally, and to consider its usage in research with different purposes, while accepting that theory should be endemic in all stages of research. Theory serves a different purpose in research with different goals; quantitative correlational research demands theory to move to explanation, interpretive research requires theory to strengthen interpretation and plausibility, while critical research utilizes theory to uncover the hidden as a step towards emancipation. These articles implicitly suggest alternative forms of accountability and politics, but I argue in conclusion that, additionally, we need a broader politics that will move us towards a non-utopian post neo-liberal social imaginary. (shrink)

Transnational articulation programmes are one way China is attempting to advance its higher education system. We report a study of twelve Chinese students’ experiences in two China-Australia 2...

This article responds to and reflects upon the articles in this special issue. Specifically, it deals with the usage of theory in each of the articles, what we might see, as examples of re-descriptive usage in autonomous theorizing. The articles utilize different theories and varying intellectual resources—Foucault and Deleuze (Richard Niesche), Bourdieu (Carmen Mills), Levinas (Sam Sellar) and Butler (Christina Gowlett)—to analyse the topic of the My School website and associated new accountabilities in Australia schooling. This article argues that their (...) usage of the My School website must be seen as a condensation symbol to signify a broader neo-liberal agenda in Australian schooling that has global as well as national elements to it. The fact that the social today is no longer straightforwardly homologous with the nation also challenges ‘methodological nationalism’ and suggests the pressing need to ‘deparochialize’ theory in research and reject a reading of Northern theory as universal. The article uses the provocations of these articles to reflect upon the necessity of theory in educational research more generally, and to consider its usage in research with different purposes, while accepting that theory should be endemic in all stages of research. Theory serves a different purpose in research with different goals; quantitative correlational research demands theory to move to explanation, interpretive research requires theory to strengthen interpretation and plausibility, while critical research utilizes theory to uncover the hidden as a step towards emancipation. These articles implicitly suggest alternative forms of accountability and politics, but I argue in conclusion that, additionally, we need a broader politics that will move us towards a non-utopian post neo-liberal social imaginary. (shrink)

This paper presents an empirical account of mediatization from a Bourdieuian perspective, based on the development of a number of new concepts, such as cross-field effects and the rescaling of such effects as linked to processes of globalization. Built on an Australian empirical case relating to educational policy and the knowledge based economy, this paper argues that mediatization can be understood in relation to the cross-field effects of different fields of journalism on subsequent fields, which have their genesis in forms (...) of practice that cross different social fields. Specifically, the case analysis details interactions between the field of print journalism and the field of policy over the course of an Australian science capability review, chaired by the then chief scientist, Dr Robin Batterham, which led to Australia adopting a national version of the knowledge economy. The empirical case also leads us to consider the impact of both global and national fields of journalism on fields of educational policy in relation to mediatization. (shrink)

Moral imagination is a central component of moral agency and person‐centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task‐driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also (...) be obscured by the task‐driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation ‘on both sides’ prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de‐escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person‐centred care. (shrink)

This essay reviews two recently published American books about masculinity politics - Michael Kimmel's pro-feminist Manhood in America and his edited collection The Politics of Manhood - in order to comment critically on the current debate underway in various parts of the world on 'boys' and their schooling which sees them as the 'new victims' of the educational process.

In this paper, the objects of philosophical reflection are the important lessons learned from a participatory action research program conducted by the Cordillera Studies Center of UP Baguio in Sagada, Mountain Province, in Northern Luzon, Philippines, which ran from March 1997 to February 2001. This research program used the Community Based Natural Resource Management (CBNRM) approach. Concepts of philosophy are made to re-describe “second order” concepts of theory, as well as “first order” concepts of community-based natural resource management research, planning, (...) testing, implementation, and monitoring. Concepts used in the context of field work are given philosophical re-descriptions in the form of the ontology of societal totality and nature, ethical thinking applied to land rights and to collective action of marginalized groups, and in the form of epistemological assertions concerning the interaction of indigenous knowledge and the conduct of scientific research itself on community-based natural resource management. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

Background:Attention to ethical leadership in nursing has diminished over the past several decades.Objectives:The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership.Research design:Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership.Participants and research context:These four original studies were conducted from 1999-2008 in Canada with 601 participants.Ethical considerations:Ethical approval from the original studies covered future analysis.Findings:Using the analytic strategy of lines-of-argument, we (...) found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day.Discussion and conclusion:Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care. (shrink)

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Although ethical leadership by formal nurse leaders is critical to enhancing ethical health-care practice, research has shown that many nurses feel unsupported by their leaders. In this article, we consider the limited attention directed toward ethical leadership of formal nurse leaders and how our own research on ethical nurse leadership compares to other research in this field. In searching Nursing Ethics since its inception 20 years ago, we found only a dozen articles that directly addressed this topic. We then reviewed (...) nurses’ professional codes of ethics in Canada and found significant retractions of ethical guidelines for formal nurse leaders’ ethical responsibilities over the past decade. We began to seek explanations of why this is so and offer some recommendations for the study and enhancement of ethics for formal nurse leadership. (shrink)

At almost every election, Americans are inclined to say that this is the most consequential election in American history. 2020 is no exception. However, what is particularly remarkable about the No...

There is increasing emphasis on the need for collaboration between practice and academic leaders in health care research. However, many problems can arise owing to differences between academic and clinical goals and timelines. In order for research to move forward it is important to name and address these issues early in a project. In this article we use an example of a participatory action research study of ethical practice in nursing to highlight some of the issues that are not frequently (...) discussed and we identify the impact of things not-named. Further, we offer our insights to others who wish to be partners in research between academic and practice settings. These findings have wide implications for ameliorating misunderstandings that may develop between nurse leaders in light of collaborative research, as well as for participatory action research. (shrink)

The profession of nursing has recognized the need for contextual and relational frameworks to inform knowledge development. Two‐Eyed Seeing is a framework developed by Mi'kmaw Elders to respectfully engage with Indigenous and non‐Indigenous knowledges. Some scholars and practitioners, however, are concerned that Two‐Eyed Seeing re‐instantiates dichotomized notions regarding Western and Indigenous knowledges. As dichotomies and binaries are often viewed as polarizing devices for nursing knowledge development, this paper explores the local worldviews in which Two‐Eyed Seeing emerged, proposing that the onto‐epistemological (...) and axiological ‘roots’ of the framework are antithetical to divisiveness, paradoxically asserting space for the dichotomy to stand. Two‐Eyed Seeing, if understood as a relational, decolonial praxis, could fundamentally change the way nursing scholarship and practice operate by facilitating space for diverse knowledges, ways of being, doing and relating. In this paper, considerations for nursing scholarship and practice, as well as recommendations to support the uptake of Two‐Eyed Seeing are explored. The authors assert that conceptual divisiveness, dichotomization and exclusion can be mitigated if nursing is informed by contextual knowledge, seeks to enact accountable partnerships with Indigenous knowledge holders, and holds the Mi'kmaq worldview upon which the concept developed in positive regard. (shrink)

At almost every election, Americans are inclined to say that this is the most consequential election in American history. 2020 is no exception. However, what is particularly remarkable about the No...

Volume 19 of _The Annual of Psychoanalysis_ turns to the ever-intriguing relationship between "Psychoanalysis and Art." This introductory section begins with Donald Kuspit's scholarly reflections on the role of analysis in visual art and art criticism, and then proceeds to a series of topical studies on Freud and art introduced by Harry Trosman. Egyptologist Lorelei Corcoran explores the Egypt of Freud's imagination, thereby illuminating our understanding of the archaeological metaphor. Marion Tolpin offers new insights into Freud's analysis of the (...) American writer Hilda Doolittle by focusing on the meaning of the Goddess Athene - whose statue rested on Freud's desk - to both analyst and analysand. Stephen Toulmin examines Freud's artistic sensibility - and places the historical significance of Freud's art collection in bold relief - by looking at the many contemporary art objects Freud chose _not_ to collect. Danielle Knafo identifies key events in the early life of Austrian Expressionist Egon Schiele that were "primary determinants" of the content and form of his self-portraits. And Barbara Almond examines the spontaneous healing process depicted in Margaret Drabble's novel _The Needle's Eye _as an analogue to the kind of growth and development mobilized by the psychoanalytic process. Section II, "Psychoanalysis and Development," begins with Barbara Fajardo's appreciation of the contribution of biology to analyzability; she reviews findings from both infant research and biogenetic research that tend toward an understanding of "constitution" as resilience in development and, subsequently, in treatment. Benjamin Garber adds to the psychoanalytic understanding of childhood learning disabilities by presenting the three-and-a-half-year analysis of a learning-disabled child. In a fascinating two-part contribution, "Bridging the Chasm Between Developmental Theory and Clinical Theory," Joseph Palombo sheds light on some of the knottiest problems in contemporary analysis, including the relationship between childhood events and the reconstruction of those events in treatment. In Section III, "Psychoanalysis and Empathy," Mary Newsome presents case material in support of her claim that the analyst's empathic understanding catalyzes the coalescence of the patient's affect and aim, that is, the patient's capacity to believe in and then realize his ambitions. The acquisition of the capacity, she contends, not only betokens a specific kind of structure formation, but is the bedrock of emerging self-cohesion. Her challenging paper is thoughtfully discussed by David Terman and Jerome Winer. Section IV of _The Annual_ offers Jerome Kavka's appreciation of the work of N. Lionel Blitzsten. Blitzsten, the first Chicago psychoanalyst and one of America's most gifted clinicians and teachers, anticipated modern concepts of narcissism in identifying "narcissistic neuroses" with special treatment requirements. Morris Sklansky furthers our understanding of Blitzsten in his discussion of Kavka's essay. Ranging across the analytic canvas with presentations as edifying as they are provocative, volume 19 of _The Annual of Psychoanalysis_ challenges readers to wrestle with issues at the cutting edge of the discipline. It takes a well-deserved place in the preeminent continuing series in the field. (shrink)

Douglas and Ellis suggest that institutionally universities and schools are required to work with different conceptual tool-kits. Seeking to minimise the potential standoff between academic and practitioner knowledge, and, therefore, to enhance the learning of student teachers, means, they suggest, rethinking both the social relationships and the processes of abstracting knowledge from experience. Lingard and Renshaw advocate that all education practitioners, policy makers and teachers, should have a researcherly disposition, be interested in research and knowledge production and see themselves (...) as participants in the field of educational research broadly defined. (shrink)

In our paper we aim at reflecting upon the extent to which educational theory may be used as a framework in the analysis of policy documents. As policy texts are ‘heteroglossic in character’ (Lingard and Ozga, in The Routledge Falmer reader in education policy and politics, Routledge, London and New York, 2007 , p. 2) and create “circumstances in which the range of options available in deciding what to do are narrowed or changed” (Ball in, Education policy and social (...) class: The selected works of Stephen J Ball, Routledge, London and New York, 2006 , p. 46), they need to be theoretically tackled in their underlying assumptions and implications. This proposal draws on an analysis of two sets of documents of the European Union: texts produced between 2000 and 2006, underlying the European Union programmes; and texts produced by a working group focusing on the key competences of Lifelong Learning (2003–2006). Initially, the framework for the analysis of different documents was grounded on the existing research in the field of educational policy. Now we attempt a secondary analysis of the collected data by transposing the borders of this particular and highly prolific field. We argue that what is outside the texts may reshape what is inside the texts. Educational theory allows us to define some conceptual tools in order to question the documents as political apparatus which open and constrain possibilities. Therefore, we will use educational theory as an arena where different matters, perspectives and possibilities may be explored and assembled. We have engaged in a conversation with both the data and some theoretical approaches. Central to this conversation are the concepts of “ignorant schoolmaster” (Rancière, in The ignorant schoolmaster five lessons in intellectual emancipation, Stanford University Press, Stanford, 1991 ), “learning contexts” (Edwards, in Rethinking contexts for learning and teaching, Routledge, Oxon and New York, 2009a , b ), and “experience” (Larrosa, in Revista Brasileira de Educação, 19:20–28, 2002 ). (shrink)