Trudy Rudge

How to talk to doctors – a guide for effective communication

BACKGROUND Nurses and doctors undertake segregated and distinct preparation for clinical practice, yet are expected to communicate effectively with each other in the workplace. Most healthcare facilities have policies relating to written communication, but guidelines for verbal communication, which is used most in times of uncertainty and urgency, are generally less regulated. Poor communication and communication overload are shown to have a direct correlation with patient outcomes, adverse events and stressors among healthcare professionals. We suggest a guide for more effective verbal communication between nurses and doctors. METHODS We perform an integrated review of the extensive literature that identifies specific problems that contribute to ineffective communication between a doctor and nurse. We discuss these in five themes in the modern clinical context including intensification of workload, workforce mobility, differing perceptions, language use and heuristics. To combat these, we provide a four point practical guide to arm the nurse clinician with effective tools to ensure a satisfactory exchange of information in the context of patient advocacy. CONCLUSIONS The guide assists in overcoming the discussed barriers by creating a premise for fostering communication, understanding each clinicians information needs in a mutually respectful manner, especially in the context of uncertainty. We recommend that a shared mental model regarding communication in health be adopted at tertiary institutions offering pre-registration nursing and medical training and techniques and be woven into respective curriculum design.

Desiring productivity: nary a wasted moment, never a missed step!

The purpose of this paper is to explore how nurses are enrolled into and take part in programmes of efficiency and effectiveness. Using the philosophical theorizing about desire as a force or power, I focus specifically on what is understood as relations between desire and productivity in current Westernized health-care systems. Use is made of the idea from Spinoza that human emotions consist only of pleasure, pain, and desire as these act as a motive force. This is then linked with more contemporary work on the politics and discourses of desire. A report on the implementation of a productivity programme in the United Kingdom, The Productive Ward: Releasing time to care™, is explored for the ways its developers set about motivating nurses to endorse and enact the programme. In exploring the mechanics of desire in these processes, a view of desire as productive is promoted. Looking at desire as assembling actions, and an assemblage, moves the analysis to an interrogation of actions and practices used to enable and bring nurses to the process. Moreover, in working through the various modalities and operations of desire, the potential and limits of such projects are abstracted. Such potentials and limits are necessarily set by the intensification of power and desire in the capitalist economy, saturating areas of nursing, and health-care provision.

Producing children in the 21st century: A critical discourse analysis of the science and techniques of monitoring early child development

The purpose of this article is to identify the implications of commonly held ideologies within theories of child development. Despite critiques to doing so, developmental theory assumes that children’s bodies are unitary, natural and material. The recent explosion of neuroscience illustrates the significance of historical, social and cultural contexts to portrayals of brain development, offering the opportunity for a critical departure in thinking. Instead, this neuroscience research has been taken up in ways that align with biomedical traditions and neoliberal values. This article uses a critical discursive approach, supported by Haraway’s ideas of technoscience, to analyse a population-based early child development research initiative. This initiative organises a large-scale surveillance of children’s development, operating from the premise that risks to development are best captured early to optimise children’s potential. The analysis in this article shows an intermingling of health and economic discourses and clarifies how the child is a figure of significant contemporary social and political interests. In a poignant example of technobiopolitics, the collusion between health research, technologies and the state enrols health professionals to participate in the production of children as subjects of social value, figured as human capital, investments in the future, or alternatively, as waste. The analysis shows how practices that participate in what has become a developmental enterprise also participate in the marginalisation of the very children they intend to serve. Hence, there is the need to rethink practices critically and move towards innovative conceptualisations of child development that hold possibilities to resist these figurations.

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.

Surviving the adversity of childlessness: Fostering resilience in couples

Abstract In contemporary Western society, infertility has the capacity to impact greatly on couples, emotionally and socially. In the face of such infertility, couples are able to seek assisted reproductive technologies to assist in the pursuit of biological parenthood. These technologies are not infallible though, and the likelihood of success remains small. Therefore it is inevitable that some couples will remain childless, and this has been associated with grief and adversity. Findings present the narratives of participant couples’ through and beyond the many adversities encountered due to remaining childless despite infertility treatment. Regardless of theories that seek to pathologise couples experiencing this type of adversity, participant couples demonstrated resilience in redirecting their energies into areas of their lives where they could achieve positive outcomes. This research highlights the importance of caring for couples rather than individuals undergoing infertility treatment. It provides support for approaches that foster couples’ relationships with the aim of promoting individuals’ resilience.

Beyond caring? Discounting the differently known body

From this ethnographic study on a burns unit it was clear, when talking with the men and the nurses who care for them, that patients return to the outside world after treatment to a qualitatively different life. Very few of their family or friends can understand how the experience of trauma and subsequent treatment has altered them, and this lack of comprehension often extends to those who provide treatment. Such a lack of comprehension leads to feelings of uncertainty for everyone involved. The processes of care tend, due to the way that medical treatment objectifies patients, to focus more on surgical repair of the skin to the detriment of confounding effects on identity and embodiment. The focus on medical treatment is understandable, even taken for granted, as the highest priority. Moreover, to contain uncertainty, it becomes less threatening to disavow and contain emotions under the certainties of medical treatments and their seeming objectivity. Patients who are burnt and the nurses who care for them destabilize our sense of security as each reminds us we are vulnerable. Their embodiment is integrated in action and activities to accomplish what is needed to be done to re-cover skin and to recover from its subsequent trauma. Exploring mutual embodiments of nurses and patients brings into view another position on caring that does not discount the familiarity of ‘unknowingness’ of bodies. On one hand, I ponder how burnt bodies are thought about in health care, fuelled as this is by assumptions (what is known) from health care professionals as to the experience of burns. I trace how, in the bodily trauma of burns and the grafting of new skin, it is assumed that patients’ bodies become a ‘body unknown’. Particular bodily functions associated with skin are over-determined. On the other hand, I examine how the care of burnt people is a specialized form of care and is provided by nurses who have learnt to care for burnt people sometimes by working on units such as the one that is part of this study or sometimes by undertaking specialist education in intensive care or plastic surgery. To explore how this care

The work of nurses in private health: Accounting for the intangibles in care delivery

Abstract With the commodification of healthcare in general and of private health in particular, it is difficult not to acknowledge the growing influence of competition and ‘the market’ in shaping the way that nurses’ work is managed by private hospitals and by nurses themselves. This paper explores the discourses shaping nurses’ work in private healthcare, drawing upon data from an ethnographic study conducted in one Australian acute care private hospital. The framework for analysis relies on an exploration of the mentalities and governance of nurses’ work in such a setting. The study shows how marketing and performance measures are believed to ensure the viability of the enterprise while simultaneously commodifying nurses’ caring work. It is this work that remains invisible to the healthcare system and the hospitals where they work.

Accounting for the unaccountable: theorising the unthinkable

During a graduate seminar, students of nursing were able to talk freely about what could or would disgust them in the care they would give to bodies in the line of providing nursing care. In answering questions about what caused them to have averse feelings, they learned what might disturb, then where such feelings might come from and not that they were inappropriate or to be silenced. Such a process is a rare occurrence in a nursing course. Yet from the seeming chaos of war zones and emergency rooms to the ritualised order of forensic psychiatric settings and many other practice environments, 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, weeping wounds; products of bodies, such as vomit and faeces, are all part of nursing work and threaten the clean and proper bodies of nurses. One of the mechanisms to disavow what we term the unclean side of nursing is silence: nursing’s academic literature rarely confronts this material. The objective of this editorial is to open up a discussion that theorises the unaccountable and dark side of nursing care and to suggest that the concept of abjection, as developed by Julia Kristeva (1982), can be used in nursing, health and social sciences to look at bodily boundary work. We do this because we have noted a continuing return to Kristeva’s work with its particular salience to all that disgusts, horrifies and renders the certain, uncertain. This use of Kristeva’s work arises out of the relevance of the emotional defence of the abject to explanations about lack of boundaries, sullying of subjectivities and when various attempts to regain certainty are mobilised. It is challenging enough to describe what occurs in these situations; to truly represent the range and extent of human reactions is virtually impossible. Kristeva’s theorisation of the psychical defence of abjection affords the possibility of voicing the incomprehensible in bodies that leak, in the chaos of illness and disease and in the monstrosity of illnesses such as cancer, as well as in much that is deemed ‘out of place’ in nursing and health care. For example, nurses are exposed to and confronted by many forms of disruptive health issues and practices that challenge the order of the clean and proper and affect them at a personal level of anxiety and perhaps even fear. At the core of the process of abjection is a shrinking from the abject even in the face of extensive professional socialisation to do otherwise. To continue to work in the face of the abject, nurses must appear to systematically reject their own sensibilities to maintain professionalism. Kristeva’s original example of the corpse that so clearly evokes our own mortality is something that every nurse can relate to (witnessing our first death, our first preparation of a dead body for its social rituals are rites of passage for many nurses). But there are many more situations, such as nursing the homeless person, the rape or incest victim, the person with leprosy, the burn victim, the cancer victim, the rapist, the serial killer, the paedophile or the IV drug user. Our challenge is to bring into the open the important concept of abjection, which historically has been silenced in theorising nursing. The mapping of what counts as proper and improper, clean and unclean, possible and impossible is accomplished through the work and authority of the nurturing, maternal function (Kristeva 1982). The maternal function is associated forever with civilising the infant body, even as abjection places this function outside the control of the symbolic order and signifies the maternal function as ‘lack’. Paradoxically, such exclusion constitutes the basis of the maternal power – a power that both repels and pleasures. It is this duality of the abject that signifies why nurses and their work are a challenge to present in the symbolic order of language. Kristeva’s psychoanalytic concept offers nurses and other health researchers a way to bring this incomprehensibility to our understanding. She makes apparent why nurses run to religious symbolism such as ‘vocation’ to understand their work and their pleasure in it or, on the other hand, to science and evidence, to contain and disavow the horror of the work they do.

Men’s Perceptions and Attitudes Toward the Partner With Premenstrual Syndrome

This study focused on the young adult men’s perceptions and behavior toward their women partners who they acknowledged as experiencing the effects of premenstrual syndrome (PMS). A qualitative study was conducted, framed by social constructivism, where individual interviews with 20 young Brazilian men aged 21 to 29 years were analyzed thematically. Four descriptive categories to express the men’s experiences: (a) men’s observations on partner’s behavior changes, (b) early in the relationship: apprehension and confusion, (c) knowledge about PMS led men to better understanding about changes, and (d) need for support from a health care provider and medication. The men’s perceptions and behavior toward their partners were strongly influenced by biomedical conceptions of PMS. Participants believed that their partners’ emotions and behaviors were determined by PMS during some days of the month, consequently PMS had affected the couple’s relationship. Another consequence of such medicalization was that women’s complaints about PMS were rendered invisible except when viewed as a serious medical problem requiring cure, rather than a part of women’s cyclical patterns. It is the case that the systematic description of men’s perceptions about their partner’s PMS provides an approach to this topic in educational and health care activities, with the potential to improve gender relations.

It just alienated us: a case study to explore the impact of assisted reproductive technology on family relationships.

New reproductive technologies have the capacity to impact on both personal and healthcare relationships. This article utilizes a case study approach to unpack experiences of one couple who encountered immense and unforeseen difficulties as a result of treatment with assisted reproductive technology. Findings of this case reveal both difficulties and breaches in obtaining informed consent and the consequences these breaches have on relationships. Comprehensive information contributes to positive relationships between patients and healthcare providers. Maintaining supportive relationships between all parties concerned with assisted reproductive technology services is essential, as rifts in these relationships can be devastating and long-lasting.