Slavery and jouissance: analysing complaints of suffering in UK and Australian nurses’ talk about their work

Nursing has a gendered and religious history, where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealised notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing’s professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis we focus on the nurses’ apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as ‘slaves’ or ‘martyrs’ in the healthcare system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse’s role. We argue that a remnant of a quasi-religious ethic within the profession makes it acceptable for nurses to talk about self-sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions

An evaluation of the Islington community education provider network super hub.

‘Super Hubs’ are novel initiatives which have arisen in order to aid various workforce developments and service improvements for promoting creative thinking and practice. The Islington Super Hub is a workstream of the Islington Community Education Provider Network (CEPN) which aids the learning and development of community nursing and new apprenticeships (Health Education North Central and East London 2015). In this paper we report on the findings from a realist evaluation of the Islington Super Hub (Pawson and Tilley 1997) using data from a range of provider organisations. The following areas of direct relevance to the Super Hub’s activity will be analysed: i) the factors enabling nursing staff to transfer between sectors; ii) the variety of current preceptorship and induction programmes supporting newly registered nurses moving into community roles; iii) the current links between primary/secondary care for strengthening inter-sectoral working and the core training needed for hospital-based nurses to support patient journeys; iv) the practice learning experiences of specialist practice community nurses, such as General Practice Nurses, District Nurses and Health Visitors as well as non-specialist practitioners and health care assistants; v) the current approaches for sustaining practice-based learning for enhanced learning/development; vi) the current approaches to multi-professional education across localities which contribute to establishing robust community focussed multi-professional collaborative educational approaches; vii) the availability of student nurse placements in community settings and the associated mentorship capacity. Our analysis concludes with critical reflection on the relative merits of the Super Hub’s programme of learning and development which aims to promote creative thought/practice and the contextual factors surrounding the newly emerging apprenticeship roles. References Health Education North Central and East London (2015) Nursing and Midwifery Education Strategy. London: Health Education North Central and East London. Pawson R, Tilley N (1997) Realistic Evaluation. London: Sag

Engaging perioperative students in online learning: human factors

The aim of this article is to reflect on how a specific approach to teaching and learning – role-play and in particular the ‘radio play’ format – can overcome some of the alienation and barriers to student engagement that the necessity for online teaching can engender. The example used is a post-registration module in perioperative nursing delivered in a London University. Authors reflect on experiences of developing and implementing an activity designed to increase student engagement in an online session focussing on Human Factors in the perioperative setting. The aim of the session was to highlight the factors that potentially lead to clinical error in a way that engaged students and enabled them to relate learning to their own experiences. The challenge was how best to do this in an online setting. This article describes the use of an approach devised by AdvanceHE. Two student participants contribute their reflections to this article and focus on the extent to which the session facilitated a new understanding of the impact of human factors in a perioperative setting. These reflections suggest that the approach to the teaching employed was useful to participants and that it has promise as an online approach. The authors recommend evaluation of this approach

Impact case studies submitted to REF2014: the hidden impact of nursing research

The UK’s Research Excellence Framework (REF) 2014 rated the research from 154 universities and the impact of research was evaluated in 6975 impact case studies. Nursing was returned within unit of Assessment (UoA) 3 which also included Dentistry, Pharmacy, Allied Health Professions, although nursing research was also submitted within other UoAs. The study aim was to collate and categorise available REF impact case studies involving nursing researchers or on topics of relevance to nursing. Using nurs* as a search term 469 case study entries were retrieved from the REF database and placed into three categories determined by the level of involvement of nurses. Some 80 impact case studies were submitted by nurses across 11 UoAs: the majority being in UoA3 (n=55). A further 50 revealed some relevant impact, though nurses did not have an obvious research role. A total of 248 case studies described actual or potential impact on health or social care but were not associated specifically with nursing. Nursing research has demonstrable impact, however there is a significant body of research with relevance for nursing that has not been associated with the profession in the REF. More attention should be paid to the ‘hidden impact’ of nursing research to ensure the full impact of nursing is recognised

An evaluation of the Islington community education provider network super hub

‘Super Hubs’ are novel initiatives which have arisen in order to aid various workforce developments and service improvements for promoting creative thinking and practice. The Islington Super Hub is a workstream of the Islington Community Education Provider Network (CEPN) which aids the learning and development of community nursing and new apprenticeships (Health Education North Central and East London 2015). In this paper we report on the findings from a realist evaluation of the Islington Super Hub (Pawson and Tilley 1997) using data from a range of provider organisations. The following areas of direct relevance to the Super Hub’s activity will be analysed: i) the factors enabling nursing staff to transfer between sectors; ii) the variety of current preceptorship and induction programmes supporting newly registered nurses moving into community roles; iii) the current links between primary/secondary care for strengthening inter-sectoral working and the core training needed for hospital-based nurses to support patient journeys; iv) the practice learning experiences of specialist practice community nurses, such as General Practice Nurses, District Nurses and Health Visitors as well as non-specialist practitioners and health care assistants; v) the current approaches for sustaining practice-based learning for enhanced learning/development; vi) the current approaches to multi-professional education across localities which contribute to establishing robust community focussed multi-professional collaborative educational approaches; vii) the availability of student nurse placements in community settings and the associated mentorship capacity. Our analysis concludes with critical reflection on the relative merits of the Super Hub’s programme of learning and development which aims to promote creative thought/practice and the contextual factors surrounding the newly emerging apprenticeship roles

Development and preliminary validation of a tool measuring concordance and belief about performing pressure-relieving activities for pressure ulcer prevention in spinal cord injury

Objective: To develop and examine the reliability, and validity of a questionnaire measuring concordance for performing pressure-relief for pressure ulcer (PrU) prevention in people with Spinal Cord Injury (SCI). Methods: Phase I included item development, content and face validity testing. In phase II, the questionnaire was evaluated for preliminary acceptability, reliability and validity among 48 wheelchair users with SCI. Results: Thirty-seven items were initially explored. Item and factor analysis resulted in a final 26-item questionnaire with four factors reflecting concordance, perceived benefits, perceived negative consequences, and personal practical barriers to performing pressure-relief activities. The internal consistency reliability for four domains were very good (Cronbach's α = .75-.89). Pearson correlation coefficient on a test-retest of the same subjects yielded significant correlations in concordance (r = .91, p = .005), perceived benefit (r = .71, p < .04), perceived negative consequences (r = .98, p < .0001), personal barriers (r = .93, p= .002). Participants with higher levels of concordance reported a greater amount of pressure-relieving performed. Individuals viewing PrU as a threatening illness were associated with higher scores of concordance and tended to report a greater amount of pressure-relieving performance which provides evidence of criterion related validity. Conclusion: The new questionnaire demonstrated good preliminary reliability and validity in people with SCI. Further evaluation is necessary to confirm these findings using larger samples with follow-up data for predictive validity. Such a questionnaire could be used by clinicians to identify high risk of patients and to design individualised education programme for PrU prevention

Resonant Raman scattering off neutral quantum dots

Resonant inelastic (Raman) light scattering off neutral GaAs quantum dots which contain a mean number, N=42, of electron-hole pairs is computed. We find Raman amplitudes corresponding to strongly collective final states (charge-density excitations) of similar magnitude as the amplitudes related to weakly collective or single-particle excitations. As a function of the incident laser frequency or the magnetic field, they are rapidly varying amplitudes. It is argued that strong Raman peaks should come out in the spin-density channels, not related to valence-band mixing effects in the intermediate states.Comment: Accepted in Physical Review

Neurofibromin controls macropinocytosis and phagocytosis in Dictyostelium

Cells use phagocytosis and macropinocytosis to internalise bulk material, which in phagotrophic organisms supplies the nutrients necessary for growth. Wildtype Dictyostelium amoebae feed on bacteria, but for decades laboratory work has relied on axenic mutants that can also grow on liquid media. We used forward genetics to identify the causative gene underlying this phenotype. This gene encodes the RasGAP Neurofibromin (NF1). Loss of NF1 enables axenic growth by increasing fluid uptake. Mutants form outsized macropinosomes which are promoted by greater Ras and PI3K activity at sites of endocytosis. Relatedly, NF1 mutants can ingest larger-than-normal particles using phagocytosis. An NF1 reporter is recruited to nascent macropinosomes, suggesting that NF1 limits their size by locally inhibiting Ras signalling. Our results link NF1 with macropinocytosis and phagocytosis for the first time, and we propose that NF1 evolved in early phagotrophs to spatially modulate Ras activity, thereby constraining and shaping their feeding structures. DOI: http://dx.doi.org/10.7554/eLife.04940.00