Alexandra Gibson

‘Take ownership of your condition’: Australian women’s health and risk talk in relation to their experiences of breast cancer

Western understandings of breast cancer are primarily shaped both by neo-liberal, individual-oriented approaches to health and illness and by ‘consumer-led’ health movements. In this ‘healthist’ context, diagnosis of breast cancer typically marks a crisis in women’s lives, which may prompt them to account for the development of the illness and reposition themselves as self-governing individuals who have control over their health and who can manage future ‘risks’. We present a thematic discourse analysis of interviews conducted in 2012 with 27 women across Australia who have had breast cancer. Using the lenses of ‘healthism’ and ‘risk management’ in this analysis, we identified a cultural discourse of ‘individual responsibility and empowerment’. Women utilised this discourse while ‘accounting’ for their illness by engaging in ‘health talk’ and ‘risk talk’. While many women emphasised the shock of the diagnosis in light of having been ‘always healthy’, others expressed the inevitability of ‘risk’ on the basis of individual behaviours or genetic history. This discourse provided women one way to explain and make sense of their illness, potentially enabling them to cope with the fear and uncertainty of breast cancer. Drawing on this discourse, women could also position themselves in socially desirable and empowered ways as responsible health consumers, as self-governing and as taking responsibility in dealing with the illness and remaining vigilant for recurrence. We discuss how this neo-liberal approach can be empowering, but also has the effect of positioning women as primarily responsible for managing their health and their illness.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care

Aim:Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. Methods:The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. Results:The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. Conclusion:Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

‘If you grow them, know them’: Discursive constructions of the pink ribbon culture of breast cancer in the Australian context

The ‘pink ribbon culture’ dominates understandings of breast cancer in Western societies. We describe this as an ‘illness culture’, consisting of neoliberal discourses and practices, which construct the breast cancer experience. We take a feminist post-structuralist approach to review current breast cancer lay materials available to women in Australia, to examine how breast cancer is discursively constructed within this context. Further, we consider how women with breast cancer are positioned and what the implications are for women’s lives. We discuss neoliberal discourses of ‘individual responsibility and empowerment’ and ‘optimism’, and the central practices that focus on individual health behaviours and survivorship. This illness culture has productive and restrictive effects for women’s subjectivity. Whilst women are positioned as ‘empowered’ regarding their health, this comes at the price of self-regulation and responsibility. Support and information additionally reposition women in feminine, heteronormative ways, whilst excluding women who do not fit narrow cultural stereotypes.

Online Research Methods in Psychology: Methodological Opportunities for Critical Qualitative Research

This special issue showcases the contributions of mostly early career researchers to illustrate the methodological opportunities and challenges that arise in doing critical qualitative research on the Internet. As we discuss, the articles included in this special issue demonstrate innovative qualitative methods that can be applied to Internet research and the steps that need to be taken to conduct rigorous and ethical qualitative research, from a critical psychological perspective. This special issue focuses on a range of methodological issues that can arise while conducting qualitative research online. The authors are seen to acknowledge the power relations that shape online spaces and relationships, and to reflexively and continually consider their roles in data collection or generation. The articles presented in this special issue also highlight ways in which critical qualitative researchers can innovatively negotiate the ethical issues that can occur within a dynamic context, and challenge the status quo through conducting this type of research. Online spaces continually change and present ongoing opportunities and challenges for researchers, yet, this special issue illustrates how critical qualitative researchers are well equipped to continue developing this line of research.

Representations of women on Australian breast cancer websites: Cultural ‘inclusivity’ and marginalisation

Despite ‘cultural competence’ rhetoric within health care, women’s varied breast cancer experiences are often overlooked within the ‘pink ribbon culture’ of breast cancer, which focuses on white, heterosexual, middle-class women’s accounts. We present a multimodal critical discourse analysis of four Australian breast cancer organisations’ websites, which provide information and support to women. We examine how they represent the needs and experiences of women from minority groups, specifically lesbians, women from ‘culturally and linguistically diverse’ backgrounds, and women from Indigenous backgrounds. Through the two discursive themes: ‘boys do cry’ and ‘being breast aware’, we illustrate how women from these groups are sometimes included and at times marginalised on websites. We also identify a discourse of ‘diversity’, which seemingly supports ‘cultural competence’ but actually obscures the assumptions that underpin cancer care. We suggest that women who are not white, heterosexual or middle class could find available resources inappropriate, or experience barriers to access.

Staff members' negotiation of power in client engagement: analysis of practice within an Australian aged care service.

With increasing focus on client control and active client roles in aged care service provision, client engagement is highlighted as fundamental to contemporary care practice. Client engagement itself, however, is complex and is impacted by a range of issues including the relationships and power dynamics inherent in the care context. These dynamics do not simply reflect the roles that are available to or taken up by clients; just as important are the roles and positions that staff of aged care services are offered, and take up, in client engagement. This paper presents the findings of a study that explored client engagement practice within a large Australian service provider. Analysis of interview and focus group discussions addressed the ways in which staff were positioned - by both themselves and by clients - in terms of the roles that they hold within engagement practice and the power relations inherent within these. Analysis of power from the dominant policy perspective of choice and control, and the alternative perspective of an ethic of care suggests that power relations within the care context are dynamic, complex and involve on-going negotiation and regulation by clients and staff members in aged care. The use of these two contrasting perspectives reveals a more dynamic and complex understanding of power in care practice than dominant uni-dimensional approaches to critique suggest.

Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature

Aim:Ensuring older adults’ involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on peoples behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care. Methods:The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form. Results:The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates’ perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families. Conclusions:The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.

(Dis)allowances of lesbians’ sexual identities: Lesbian identity construction in racialised, classed, familial, and institutional spaces

This article explores how lesbian identity construction is facilitated and constrained by the raced, classed, gendered, familial, and geographical spaces that women occupy. We present a narrative-discursive analysis of eight lesbians’ stories of sexuality, told within a historically white university in South Africa. Three interpretative repertoires that emerged in the narratives are discussed. The ‘disallowance of lesbian identity in particular racialised and class-based spaces’ repertoire, deployed by black lesbians only, was used to account for their de-emphasis of a lesbian identity through the invocation of a threat of danger and stereotyping. The ‘disjuncture of the (heterosexual) family and lesbian identity’ repertoire emphasised how the expectation of support and care within a family does not necessarily extend to acceptance of a lesbian identity. This repertoire was used to justify emphasis on familial rather than lesbian identity and how participants managed their emotions in relation to the family and timing their disclosure to relatives. The ‘expectation of routinisation of homosexuality within a liberal university’ repertoire emphasised the support and acceptance of lesbian identity within the university in which the study was conducted, while simultaneously rendering heteronormative policies and heterosexism visible.

Myth, manners, and medical ritual: defensive medicine and the fetish of antibiotics

Given the global crisis of antimicrobial resistance, the continued misuse of antibiotics is perplexing, particularly despite persistent attempts to curb usage. This issue extends beyond traditional “wastage” areas, of livestock and community medicine, to hospitals, raising questions regarding the current principles of hospital practice. Drawing on five focus group discussions, we explore why doctors act in the ways they do regarding antibiotics, revealing how practices are done, justified, and perpetuated. We posit that antibiotic misuse is better understood in terms of social relations of fear, survival and a desire for autonomy; everyday rituals, performances, and forms of professional etiquette; and the mixed obligations evident in the health sector. Moreover, that antibiotic misuse presents as a case study of the broader problematic of defensive medicine. We argue that the impending global antibiotic crisis will involve understanding how medicine is built around certain logics of practice, many that are highly resistant to change.

Clinical and social barriers to antimicrobial stewardship in pulmonary medicine: A qualitative study

HighlightsBarriers to antibiotic optimization in pulmonary medicine include clinical and social barriers.Pulmonary physicians describe mistrust in clinical guidelines for pulmonary infections.Diagnostic gray areas limit antibiotic optimization in pulmonary medicine.Immediate patient care is described as prioritized over long‐term resistance risks. Background The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections. Methods Twenty‐eight pulmonary doctors and nurses from 2 hospitals participated in semi‐structured interviews focusing on their experiences of antibiotic use. Results Barriers to antibiotic optimization in pulmonary infections were identified. Clinical barriers are as follows. The first is differentiating pneumonia vs chronic obstructive pulmonary disease: differentiating pulmonary diagnoses was reported as challenging, leading to overtreatment. The second is differentiating viral vs bacterial: diagnostic differentiation was perceived to contribute to excess antibiotic use. The third is differentiating colonization vs pathogen: the interpretation of ambiguous results was reported to lead to under‐ or overprescribing depending on the perspective of the treating team. Social barriers are as follows. The first is the perception of resistance: antibiotic resistance was not perceived as an immediate threat. The second is the perceived value of antibiotic clinical guidelines: there was mistrust in antibiotic guidelines. The third is hospital hierarchies: hierarchical structures had a significant influence on prescribing. Conclusions Substantial barriers to antibiotic optimization in pulmonary infections were identified. To facilitate change in antibiotic use there must be a systematic understanding and interventions to address specific clinical issues. In the case of pulmonary medicine, significant identified issues, such as mistrust in clinical guidelines and diagnostic challenges, need to be addressed.