Reconnecting with policy: requirements for survival as a mental health nurse

This article discusses the disconnection between mental health nurses and policy, and the importance of reconnecting such relationships not only to benefit the consumers with whom we work but also to influence health care policies and, ultimately, contribute to strategies to improve the health of our nation. In this article, I draw on my own experiences and apply these to a discussion of how we, as mental health nurses, can influence and strengthen our relationships with nursing policy.     

Complaints,Sensitivities and Responsibility: An Ethnographic Investigation into the Debates Concerning the Care of Bangladeshi Mothers in the East End

The subject of this paper is a maternity services awareness day organised by a community centre in the East End of London. In what I interpret as the fractured political landscape of Tower Hamlets (in East London), this event formed a rare focus for the diverse groups of people I worked with in my fieldwork and provides a focal point through which to reflect upon issues of diaspora, culture and health care. This paper attempts to analyse the public voices of a diasporic community which were challenging mainstream health provision. In this paper, I suggest that the voicing of complaint both reified and contested the needs of Bangladeshi mothers specifically, yet did not alter the services provided. The ways in which “culture” is used or discarded as a critical platform on which to base claims about health care are discussed.     

Beyond Cans and Capacity

Many essential public services are provided through networks of community‐based nonprofit organizations. Previous research has demonstrated that simply providing additional resources to these organizations is insufficient to better address demands for public services. We also know little about how and why these organizations adopt network‐level objectives related to service provision. In this analysis, we expand the focus of service provision beyond capacity to incorporate the unique roles that define the very existence of nonprofit organizations, and how these roles affect organizational behavior with respect to service network objectives. We use focus group, survey, and administrative data from one hundred community‐based nonprofit organizations in an emergency food service network to explore the relationships among capacity, roles, and specific program objectives.     

Mental health promotion in forensic & correctional environments

I hope this brief glimpse into the concept of mental health promotion within forensic and correctional environments will challenge nurses to explore creative ways in which a mental health agenda can be formulated and actualized in practice.     

Standby Mothering: Temporalities,Affects, and the Politics of Mobile Intergenerational Care

ABSTRACT

In this paper, I showcase how left-behind mothers in the Philippines use digital communication technologies in delivering care to their overseas adult children in Melbourne, Australia. As part of a broader research project on transnational family life, the findings were drawn upon in-depth interviews, visual methods, a simple participant observation, and field notes taking and analysis. The study deployed a mediated mobilities lens, paying close attention to the different forces that shape the provision of intergenerational care through mobile device use. Building upon a critical analysis of the digitalization of intergenerational relationships in a transnational context, I coin the term ‘standby mothering.’ This conception encapsulates the femininized, ubiquitous, networked, and ambivalent intergenerational care practices that are experienced and negotiated by distant mothers. On the one hand, mobile device use enables left-behind mothers to deliver emotional and practical caregiving. On the other hand, everyday temporal conditions and technological barriers impede the provision of intergenerational care. Communicative constraints are constantly managed through various tactics, ensuring the sustenance of transnational relationships. By interrogating the contradictory outcomes of transnational caregiving, I underscore the politics of mediated mobilities in a digital society. Here, the mobilization of gendered, networked, and differential care practices is influenced by uneven structural and even socio-technological dimensions. Ultimately, this paper elucidates a critical stance on re-examining the provision of informal, gendered, and networked care practices.     

'Tinged with Bitterness': re-presenting stress in family care

The provision of care within families, and specifically the difficulties within such relationships, has become the focus of much research, legislation and debate in recent years. This paper explores carers' and carees'[1] talk about 'stress', home-based care, and comments on how such talk is reflected in UK social policy. Carers' and carees' accounts are presented to theorise the construction of difficulties in the present relationship--focusing in particular on the taking up of or resistance to roles and responsibilities within the family. The way in which competing discourses and discursive strategies are deployed to achieve certain effects within the family, social services and other support agencies is also explored. Family care is re-presented with a focus on language, and a reflection on how such relationships can become tinged with bitterness.     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

Towards a Sociology of Disclosure: The Case of Surgical Performance

Despite the increasingly widespread emphasis on the need for transparency in health‐care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of such data and then presents an analytical framework as a vehicle for conceptualising the nature of disclosure in surgery and health‐care more generally. The framework addresses key dimensions concerning one surgical specialty (cardiac surgery) and its relationship with a range of stakeholders in an English context. In particular, we examine the interaction between surgeons and between surgeons, patients, managers and policy‐makers. These relationships are framed in terms of choice and calculativeness, strategies and tactics, and trust, and need to be understood at micro, meso and macro levels. We conclude by considering how this framework provides a research agenda for a sociology of disclosure.     

‘That’s definite discrimination’: practice under the umbrella of inclusion

Inclusive practice is well embedded across society and has developed over time. However, although policy and public view have moved forward, the way organisations address the agenda for inclusion often represents a superficial interpretation of this concept. Qualitative data were gathered using new ethnography to explore the experiences of a library-based reading group for visually impaired readers. The voices of the individuals shed light on the individual and collective experience of reading. These insights challenge the traditional views of distinct provision that are designed to address targets for inclusion of individuals with disabilities. We argue for a clearer focus on the unintentional consequences of practice in the name of inclusion that leave individuals feeling marginalised. This paper suggests the alternative focus on social justice as offering a discourse that focuses on society and away from the individual.     

An Intersectional Analysis to Explaining a Lack of Physical Activity Among Middle Class Black Women

In this essay, I make the case that the intersectionality framework is useful to explain the high level of obesity among Black women. I describe how the intersectionality framework reformulates the examination of racial and gender disparities in health by deconstructing traditional frames of Whiteness and maleness. Next, I discuss key barriers that operate as mechanisms to reduce Black women's level of physical activity. Then, I provide ways to potentially combat these barriers. In doing so, I argue that being physically active is a privilege rooted in how race, place, gender, and body image converge differently on Black women's propensity to be physically active than other raced and gendered groups. Middle class Black women are excluded from class‐based privileges and experience a form of space invasion where their temporal space, geographic space, and bodily space are invaded. In this regard, this research agenda is not solely about physical activity but rather how the structural arrangements of communities contribute to healthy lifestyles.     

Ethical considerations when conducting ethnographic research in a nursing home setting

In this article I provide an overview of ethical concerns when conducting ethnographic research in nursing home settings where participants are vulnerable and submissive to authority, and I consider how particular research methodologies may benefit the participants. The focus of the article is primarily on the issues of privacy and autonomy and the relationship between the researcher and the participant. My own experiences of doing research in a nursing home will be woven throughout the article, as will the accounts of other researchers who have studied life in nursing homes. In reflecting on my work as a researcher I have come to a deeper understanding of the ethical issues involved in doing research in a nursing home and of the importance of ethically sound research.     

Sexual Pleasure and Wellbeing

ABSTRACT

Pleasure may be the key to the successful working of the reproductive systems of humans. However, for all the enjoyment sexual relationships can provide, there are countervailing forces of guilt and disappointment at work on the individual psyche. Religious and social norms enforce limits on sexual expressiveness. These controls are defended as means to protect individuals and their partners from unhappiness due to infidelity. The contrasting balance of potential pleasure on the one hand and deeply felt self-controls on the other gives rise to many problems of sexual health. Couples with discordant expectations about sexual pleasures can find their relationships crumbling. Deeply planted understandings about inappropriate behavior can cause individuals to feel shame or fear when faced with choices about their sexuality and particularly their desires. People unable to achieve desired pleasures due to physical handicaps experience a loss of wellbeing that can be extremely distressing. Simultaneously society struggles to control the individual expression of harmful sexual behavior such as child molestation while protecting the rights of individuals to enjoy personal satisfaction. The recognition and promotion of sexual pleasure as an integral part of wellbeing is one of the most challenging elements on the sexual health agenda. Progress in this area will require extraordinary efforts by professional groups and political leaders to forge a forthright understanding of the meaning of pleasure in people's lives, and the priority of promoting healthy sexuality as a part of a global health agenda.     

Toward a sociology of global comparative placemaking

I call for a globally informed sociology of comparative placemaking that integrates historical and contemporary processes and includes the ephemeral, institutional, and personal. By placemaking, I am referring to the explicit or tacit cooperation among people to create, maintain, and give meaning to places in space through bodily occupation given differential resources and constraints. I review select place, space, and community-based literature about urban, Black, migrant, LGBTQ, and international populations to think about how we can build upon and integrate multiple theoretical, methodological, and epistemological insights to form an explicit placemaking research agenda. A US focus on neighborhoods contrasts with a comparative examination of global urban networks, social polarization, and transformation of the built environment in the interdisciplinary field of global urban studies (Ren, 2018). I argue for a placemaking research agenda that bridges insight from US Urban Sociology with Global Urban Studies to consider how various structures and actors constrain and facilitate place projects. With a globally reaching and comparatively informed sociology of placemaking, we can illuminate our multi-structured story of place and agency in context. We can answer questions about how and why we co-create and are simultaneously disciplined by the process of creation.     

Mediators and moderators in the evaluation of programs for children. Current practice and agenda for improvement

The author examines the role of mediators and moderators in the evaluation of programs for children. The terms are defined and examples of each are presented. Using bibliometric analysis, the author examines how evaluators use mediators and moderators in treatment studies in education, juvenile justice, health care, child protection, and mental health. The use of mediators and moderators is sporadic and vague at best. An agenda for improvement is outlined that includes greater use of program theory and intensive case studies to find out why researchers in prevention and health promotion incorporate mediators and moderators more effectively in their evaluations.     

The role of life experience in long-term care insurance decisions

This study uses data from a unique survey of the retirement planning behaviors of late middle-aged individuals living in New York State, to test hypotheses regarding the role of earlier life experiences on the demand for long-term care insurance. Our primary focus is on previous provision of informal long-term care, which some studies have found to be correlated with demand for long-term care insurance. We add to the literature by providing a test for causal relationships between previous care-giving and insurance demand, and by exploring the more generally the mechanisms through which previous life experiences are linked to insurance demand. Results are robust to a variety of empirical specifications and estimation methods, including consideration of current care-giving roles and endogenous selection into previous care-giving, and strongly support a causal relationship between previous long-term care-giving and demand for insurance. Our estimates also provide evidence that lifetime health trajectories and family relationships are associated with long-term care insurance demand, and suggest that both emotional and informational forces influence demand.     

Troubled hearts,care pathways and hospital restructuring: Exploring health services research as active knowledge

This paper explores the socially active character of contemporary forms of expertise through an institutional ethnographic analysis of health services research. The paper draws primarily on interview research to investigate how health services research helps shape text-mediated relations linking government health-care policy with local reform initiatives. In the paper, I focus on the use of a particular research report by managers, physicians, and others at a community hospital in Toronto, Canada as part of their efforts to standardize and reduce the duration of care provided to heart attack patients. I discuss how, through its intertextual presence, health services research helps to co-ordinate medical and managerial practices and rationalities into medico-administrative relations. I offer two examples of this process. The first focuses on the relations co-ordinated through the textual observance of inefficiency. The second addresses how the report helped resolve the problem of physicians’ resistance to reforming cardiac care. My analysis contributes to current perspectives on the relationship between discourse and action.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Globalizing ‘Girl Power’: Corporate Social Responsibility and Transnational Business Initiatives for Gender Equality

The recent emergence of ‘transnational business feminism’ [Roberts, A. (2014). The political economy of ‘transnational business feminism’. International Feminist Journal of Politics, 17(2), 209–231] accompanied by numerous ‘transnational business initiatives for the governance of gender’ [Prügl, E., &; True, J. (2014). Equality means business? Governing gender through transnational public–private partnerships. Review of International Political Economy, 21(6), 1137–1169] constitutes a significant area of debate in the feminist political economy literature. In this paper I focus on the confluence of the corporate social responsibility (CSR) agenda with the visibility of gender issues in development and the resultant corporate agenda for the promotion of women and girls’ empowerment. The paper draws on two gender-focused World Bank collaborations with private sector actors: the Global Private Sector Leaders Forum and the Girl Effect campaign. The paper argues that the dominant model of corporate citizenship inscribed within the discourse of transnational business initiatives is framed in terms of capitalizing on the potential power of girls and women, achieving an easy convergence between gender equality and corporate profit. I suggest that the construction of an unproblematic synergy between these goals serves to moralize corporate-led development interventions and therefore does not challenge corporate power in the development process, but instead allows corporations to subscribe to voluntary, non-binding codes and cultivate a socially conscious brand image.     

From ‘public health’ to ‘safeguarding children’: British health visiting in policy,practice and research

This study examines the location of British health visiting in contemporary policy discourses concerned with public health and safeguarding children. It argues that professional identity and orientation can be understood through health visiting’s long history of public health work with children and families, which has included an engagement with protecting children. The expansive safeguarding children agenda, which includes the requirement to undertake a progressive universal approach to service provision and which incorporates a broad concept of risk and requires early intervention, has created tensions, particularly given current workforce constraints. The location and visibility of British health visiting in the academic and practice worlds also shape how the profession is understood.     

Not <Emphasis Type="Italic">Merely</Emphasis> TLC: Nurses’ Caring Revisited

The profession and practice of nursing has been studied from quite diverse scholarly perspectives in the United States and abroad. Feminist critiques focus on the gendering of caring and its knowledge/skill features, while professionalization advocates view emotive caring as secondary to other critical activities necessary for the occupational advancement of nursing. Based on ethnographic observations 30 in-depth, semi-structured interviews with nurses across different units working at a large urban hospital, this paper examines how nurses define caring as knowledge-based, skilled work. Specifically, nurses described four types of skills—observational, analytical, interactional, and comforting—that they deploy in the accomplishment of caring work at the bedside. My findings go beyond previous literature in this area by showing how nurses think of caring work in line with occupational strategies that emphasize their biomedical knowledge and diagnostic skills and uphold an advocacy or intermediary role in health care. I argue that while this ideological work may reassure nurses of their professional identity and critical role in health care, it may also reinforce the dilemma of nurse professionalization by obscuring the organizational nature of caring, as it remains an unsupported dimension of their work.