Amélie Perron

The use of postcolonialism in the nursing domain: colonial patronage, conversion, and resistance.

The current context in nursing requires radical political analyses to deconstruct the dominant discourses that map both the discipline and the profession. In response to the strong reaction to articles, which critically examined the evidence-based movement in health sciences, we believe that it is essential to offer a perspective that is capable of resisting the progress of such discourses, which currently prevail in nursing and thus shape our profession. We believe that the biomedical model/ideology is a form of colonial patronage that is becoming more and more influential in nursing. Such colonization takes the forms of powerful discourses (eg, evidence-based medicine) and institutional practices that pervade all spheres of nursing: practice, research, education, and administration. In previous articles, we have criticized this trend; consequently, the objective of this article is not to replicate our previous arguments but rather to demonstrate that to what extent a postcolonial approach to nursing constitutes an efficient tool for disrupting the colonizing effects of the biomedical discourse.

Understanding Disgust in Nursing: Abjection, Self, and the Other

From the seeming chaos of war zones and emergency rooms to the ritualized order of forensic psychiatric settings and sexual health clinics, nurses often experience feelings of disgust and repulsion in their practice. For these intense feelings to occur, an abject object must exist. Cadaverous, sick, disabled bodies, troubled minds, wounds, vomit, feces, and so forth are all part of nursing work and threaten the clean and proper bodies of nurses. The unclean side of nursing is rarely accounted for in academic literature: it is silenced. Using a theoretical approach, the objective of this paper is to demonstrate how fruitful the concept of abjection is in understanding nurses’ reactions of disgust and repulsion regarding particular patients or clinical situations.

Nurses Amidst Change: The Concept of Change Fatigue Offers an Alternative Perspective on Organizational Change

This article aims to clarify the concept of change fatigue and deems further exploration of the concept within the discipline of nursing is relevant and necessary. The concept of change fatigue has evolved from the discipline of management as a means to explore organization change and its associated triumphs and failures. Change fatigue has typically been described as one and the same as change resistance, with very little literature acknowledging that they are in fact distinct concepts. Concept clarification has highlighted the striking differences and few similarities that exist between the concepts of change fatigue and change resistance. Further exploration and subsequent research on the concept of change fatigue is needed within the discipline of nursing. The concept not only presents new and alternative perspectives on the processes of organization change, but provides opportunity for theory development that recognizes the impact organizational change has on nurses’ work lives.

Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placements.

The growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty-first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as a means to fulfil nursings social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtins notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels.

The Politics of Nursing Knowledge and Education Critical Pedagogy in the Face of the Militarization of Nursing in the War on Terror

This article critically examines the incursion of the military in nursing education, practice, and knowledge production. New funding programs, journals, and degrees in (bio)terrorism, emergency preparedness, and disaster management create a context of uncertainty, fear, and crisis, and nursing is portrayed as ideally positioned to protect the wider public from adverse (health-related) events, despite important ontological, epistemological, and ethical considerations. In this article, we discuss implications for nursing education and knowledge production. We posit that a critical pedagogy framework promotes critical reflection, resistance, and a renewed sense of agency not dependent upon external organizations such as the military, intelligence agencies and public health surveillance organizations.

Reformulating Lead-Based Paint as a Problem in Canada

Leaded gasoline was officially removed from the Canadian market in December 1990. The removal of a major lead source and the subsequent decline in childrens blood lead levels marked an important transition point and sparked the emergence of new discourse on lead in Canada. Today, childhood lead poisoning is viewed as a problem of the past or a problem of the United States. Sparse Canadian surveillance data supported this view. Moreover, tensions among federal agencies evolved into a power struggle, with Health Canada ultimately becoming the dominant authority, thereby relegating important research initiatives to obscurity and also shaping a vastly weaker regulatory response to lead than occurred in the United States.

“Insufficient” but still “necessary”? EBPM's dangerous leap of faith: Commentary on Porter and O’Halloran (2009)

In the opening lines of ‘The postmodernist war on evidence-based practice’ (Porter andO’Halloran, 2009), the authors erect a false binary between health care practice ‘informed by research’ and ‘those who argue that there should be no restrictions on the sources of knowledge used by practitioners’. This, the authors submit, is the distinction between the evidence-based approach and the postmodern approach. But nothing could be further from the truth. First, according to this characterisation, the relatively narrow understanding of ‘‘research’’ promulgated by the evidence-based practice movement is set up as the only type of research that can count as research. This is empirically false and dangerously misguided. Second, the authors understand postmodern approaches as epistemologically vacuous and as ‘‘anything-goes’’. This view is also wrong. It is unsurprising, then, that the paper’s summary of our critical work on evidence-based practice movement (EBPM) is at times misguided, decontextualised. Fine; but let us focus instead on the epistemic stakes, the claims of the paper itself. The paper fails to provide a substantive reflection regarding the limits of EBPM in clinical practice. These limits are acknowledged by the authors, but are not met with solutions or alternatives that would address them. While what the authors contend is not incorrect, it does not contribute anything new to the ongoing debate about the hegemony of EBPM in clinical and research settings. For instance, it is not enough to claim that EBPM is

The forensic patient's moral career as a measure of institutional disciplinary processes

This paper reports the findings of a qualitative research conducted in a Canadian medium-security forensic psychiatric institution. The purpose of the study was to explore the way patient subjectivities are shaped in the admissions unit of the selected facility, using nursing progress notes as a primary source of data. More detailed findings from this study were published elsewhere. In this paper, I wish to focus specifically on the way a patients course through the admissions unit begins a particular subjectivity-forming process described by Goffman as moral career. This paper discusses evidence, in nursing progress notes, of the onset of the patients moral career. It also explores the way disciplinary power, devised by Foucault, is useful in understanding the establishment and the unfolding of the forensic subjects moral career.

Sovereign power, spectacle and punishment: a critical analysis of the use of the seclusion room

The purpose of this paper is to engage with the reader in a theoretical reflection regarding the use of the seclusion room as a punitive nursing intervention (behaviour modification technique for instance). To set the stage, we explore the internal structure and functioning (culture) of the psychiatric institution – as total institution – from a Goffmanian perspective. Then, drawing on the work of the late French philosopher Michel Foucault, we introduce the concept of sovereign power and explore how various forms of punishment (as manifestations of power) came into play at different moments in history. Through an exploration of seclusion and its use in the psychiatric domain, we critically examine this practice when used as a behaviour modification technique. Finally, the use of seclusion is discussed in terms of the concept of sovereign power with the purpose of highlighting the political forces surrounding such a coercive practice in psychiatric nursing.

Capture, mortification et dépersonnalisation : la pratique infirmière en milieu correctionnel

Resume Les ecrits de Goffman en regard des institutions totales evoquent les effets de celles-ci sur les personnes qui y sont internees. En utilisant des donnees recueillies en milieux correctionnels francais et canadien, nous demontrons dans quelle mesure les effets de mortification et de depersonnalisation affectent egalement ceux qui y travaillent, notamment le personnel infirmier. Les ecrits de Goffman sont utiles dans la comprehension des effets alienants des institutions totales, et mettent en evidence leur ampleur en regard de professionnels dont le mandat initial est de soigner des populations captives.