The Simulated Human: An Actor-Network exploration of the materialities of mobilising practice learning in uncanny spaces

The use of simulated human mannequins in nursing education is widely assumed to provide active learning of clinical skills in the safety of a realistic ward environment without causing harm to patients. While the uptake of this pedagogy increases, research into its efficacy has concentrated mostly on student perceptions and outcomes with little regard for the perceptions of the lecturers or in relation to the purpose of simulation in nursing education. The body of research has been criticised for being considered only from a positivist perspective that might not adequately fit with the complexities and particular subtleties of how practice learning is mobilised in this context. This study has been guided by Actor-Network Theory so as to trace the sociomaterial assemblages and identify the practices, patterns and connections that facilitate effective learning of immediate life support skills. Data were gathered by performing ethnographic observations of the delivery of the immediate life skills course at a nursing school in Scotland and by conducting in-depth interviews with the lecturers. These were analysed thematically and the datasets compared in an iterative way. The findings suggest that the lecturers employ elements of both the real and the imagined nursing practice by creating a hybridity between their own past clinical experiences and the past placement experiences of the students in the simulated scenarios and projecting them into future imaginings of practice. They draw greatly on the strength of this uncanny space to make the unreal real, using the hybridity to enact a form of créolité, which seems to facilitate this method of practice learning. This assemblage provides a bridge or scaffolding between the two spheres of practice placement and creates a hybrid space where opposing elements in nursing education are comingled effectively. This study is the first to consider this particular pedagogy in a sociomaterial way through a postcolonial lens. While this study is very small and cannot be generalised to the wider population of nursing schools, it has opened up new possibilities in understanding this dynamic and multifaceted pedagogy from a more critical perspective so that future research might follow

Simulated human patients and patient-centredness: The uncanny hybridity of nursing education, technology, and learning to care

Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation—what is real and what is simulated—is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, andcréolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman

Opening the 'black box': what does observational research reveal about processes and practices of governing?

Despite several decades of research on governance, very little is known about processes and practices of governing and, crucially, the links between governing and organisational performance. This has led to calls to penetrate the ‘black box’ of the boardroom by conducting research which draws on data gathered through direct observation. Such calls, however, have so far produced a rather sparse and inchoate literature which would benefit from review in order to give shape to the field and provide direction for future research. Here, we critically examine the findings of this research, in particular focusing on three emergent themes: (1) the extent to which empirical research supports the established theories in the field, particularly agency and stewardship theories; (2) what research says about ‘good’ and ‘effective’ governance and the relationship between them; and (3) the methodological and conceptual orientations which frame this research, in particular the claims made for ‘processual’ approaches. We conclude with an agenda for taking the field forward in order to extend knowledge and to contribute to theory around governing

Modes of knowing in simulated human pedagogies: The uncanny double of performance in nursing education

Computerised simulated human technologies are often considered to be the gold standard in clinical education, but calls to critically enhance the theoretical and philosophical foundation of this pedagogy have largely been left unanswered. The simulation learning literature is vast, but it is concerned mostly with measuring student outcomes and learning satisfaction, and little is known about how these technologies influence the practices of clinical educators or how professional practice learning is embodied in this complex, contentious, and uncanny space. This thesis explores the ways in which nurse educators enrol computerised simulated human patients into the assemblages within their pedagogical practices. Guided by the sensibilities of actor-network theory (ANT), and Mol’s (2002) notion of praxiography, ethnographic observations were undertaken with nurse educators at two nursing schools. The educators wore digital videoglasses to record their teaching practices from their own visual perspective during the observations. In-depth elicitation interviews were held to further explore these practices. The ANT sensibilities of allegory, translation, and multiple worlds guided a posthuman analysis of the assembled materials. The analysis revealed an understanding of the practices of simulation education as being doubly performative. The hybrid assemblages of simulation and educator tell stories that act on multiple levels; simultaneously specific and allegorical, theatrical and practice-focused. These multiple layers of the uncanny are integral to the allegorical practices that must contend with the tension of teaching students to pretend to be nurses while they are learning to become nurses. While professing to enact ‘scientific’ and evidence-based approaches to teaching, the nurse educators’ practices are inextricably bound with storytelling, indicating that the scientific and folkloric are not in binary opposition. Further, the thesis has refined the use of allegory in and beyond ANT-inspired approaches to conceptualise research in education and practice settings

Boards in action: processes and practices of 'strategising' in the Boardroom

Normative expectations are that Governing Boards will be involved in setting the strategic direction of the organisation. However, knowledge of the processes and practices by which Boards engage in strategy is limited. In particular, very few empirical studies have penetrated the ‘black box’ of the Boardroom and examined the complex Board/Management interactions that amount to Boards ‘doing’ strategy. Here we address this gap, presenting an in-depth analysis of an unfolding process in which the Board and Management of a single organisation engaged in setting strategic direction over an 18-month period. We observed planning events, video-recorded Board meetings, analysed texts pertaining to the initiative, and spoke to key personnel. We adopt a ‘strong’ process approach which brings together strategy as process and as practice (SAPP). Our analysis is multi-modal: we track the iterative development of the strategy through documents/texts produced for Board meetings; and we adopt a sociomaterial approach in illuminating the entanglements of the human and nonhuman which constitute strategising. By considering events over a series of episodes, we have built a picture showing how micro-level practices in the Boardroom are layered incrementally in the emergence of strategy at organisational level. Relatedly, we show how these practices enable the Board to negotiate the tensions between control and service/collaboration. Hence the paper contributes to theory and knowledge around Board engagement in strategic activities

Reviewing the strategic influence of governance professionals in UK colleges: Acting as the translator of the conduct of conduct

This article considers the contribution of the governance professional to the governing of further education colleges in the United Kingdom and arises from a wider study of the ways in which college boards develop and implement college strategy. This is the first observational study to focus on what the governance professional does within the college governance space. From observation and other forms of evidence, the governance professional performs a significant, challenging and expert role in the processes and practices of governing colleges. The governance professional is instrumental as a governance sense-maker and, at a higher level, as translator of governing deliberations and decision making. The governance professional role in practice can vary depending upon a range of personal, local institutional and national factors. However, in essence the governance professional exists to legitimise college governance through the structures, processes and reporting of governing interactions. The article considers the extent to which the governance professional is pivotal to the governing of colleges and analyses the implications for college governing. Our research identifies some barriers to gaining greater impact from the college governance professional.Output Status: Forthcoming/Available Onlin

Walking groups for women with breast cancer: mobilising therapeutic assemblages of walk, talk and place

Walking is widely accepted as a safe and effective method of promoting rehabilitation and a return to physical activity after a cancer diagnosis. Little research has considered the therapeutic qualities of landscape in relation to understanding women’s recovery from breast cancer, and no study has considered the supportive and therapeutic benefits that walking groups might contribute to their wellbeing. Through a study of a volunteer-led walking group intervention for women living with and beyond breast cancer (Best Foot Forward) we address this gap. A mixed-methods design was used including questionnaires with walkers (n=35) and walk leaders (n=13); telephone interviews with walkers (n=4) and walk leaders (n=13); and walking interviews conducted outdoors and on the move with walkers (n=15) and walk leaders (n=4). Questionnaires were analysed descriptively. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Our study found that the combination of walking and talking enabled conversations to roam freely between topics and individuals, encouraging everyday and cancer-related conversation that created a form of ‘shoulder-to-shoulder support’ that might not occur in sedentary supportive care settings. Walking interviews pointed to three facets of the outdoor landscape – as un/natural, dis/placed and im/mobile – that walkers felt imbued it with therapeutic qualities. ‘Shoulder-to-shoulder support’ was therefore found to be contingent on the therapeutic assemblage of place, walk and talk. Thus, beyond the physical benefits that walking brings, it is the complex assemblage of walking and talking in combination with the fluid navigation between multiple spaces that mobilises a therapeutic assemblage that promotes wellbeing in people living with and beyond breast cancer

Postpartum opportunistic advice in primary care for women who have had gestational diabetes: a qualitative study of health care professionals' views

Background Women who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk. Methods The study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with two health visitors, three practice nurses, two GPs, two diabetes consultants and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering brief opportunistic advice during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing of any such intervention. A thematic approach was used to analyse the qualitative data generated. Results The interviews/discussion lasted from 15 to 51 min. There was widespread support from all participants for offering opportunistic advice, and general consensus that health visitors would be best placed to do this as part of the Universal Health Visiting Pathway in Scotland. Thematic analysis generated three significant points of discussion: implications for training of health visitors, the need for a systematic approach to identifying women with gestational diabetes, and the optimal timing of delivery. Despite an already demanding schedule of providing advice and education to women, health visitors were confident that they could offer educational advice, provided that they received appropriate training to do so. However, there would need to be a watertight system for identifying women in their care who had had gestational diabetes. In terms of timing, later visits around 6–8 months after delivery were considered most suitable. Conclusions There is support from health care professionals, and most pertinently from health visitors, that the frequency of routine visits with women during the Universal Health Visiting Pathway programme in Scotland provides potential opportunities for education around future diabetes risk to women who have had gestational diabetes

Processes and practices of governing in colleges of further education in the UK: Uncovering the complexities of governing

This report sets out the findings from an investigation of the processes and practices of governing in colleges of further education in the UK. The aim of the study was to examine how governing boards contribute to achieving the strategic aims of colleges in meeting the needs of learners, employers and labour markets. The study involved observation of board meetings in eight colleges over the course of a year. Here we report our findings on key themes emerging. We have set these out in terms of the tasks undertaken by boards; and the roles of board members. The key tasks are: engagement in strategy; risk management; practices of accountability; and issues of diversity and equality. The key roles reported on here are: the Chair, the governance professional; and the student governor. We also report on findings from the observation of online board meetings as a result of the pandemic. We conclude with recommendations for boards

Processes and practices of governing in colleges of further education in the UK: Uncovering the complexities of governing

This report sets out the findings from an investigation of the processes and practices of governing in colleges of further education in the UK. The aim of the study was to examine how governing boards contribute to achieving the strategic aims of colleges in meeting the needs of learners, employers and labour markets. The study involved observation of board meetings in eight colleges over the course of a year. Here we report our findings on key themes emerging. We have set these out in terms of the tasks undertaken by boards; and the roles of board members. The key tasks are: engagement in strategy; risk management; practices of accountability; and issues of diversity and equality. The key roles reported on here are: the Chair, the governance professional; and the student governor. We also report on findings from the observation of online board meetings as a result of the pandemic. We conclude with recommendations for boards