Powerful Concepts in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

In this paper we emphasize the importance of questioning the global validity of significant concepts underpinning global health policy. This implies questioning the concept of global health as such and accepting that there is no global definition of the global. Further, we draw attention to ‘quality’ and ‘empowerment’ as examples of world-forming concepts. These concepts are exemplary for the gentle and quiet forms of power that underpin our reasoning within global health

Accreditation and Power - A discourse analysis of a new regime of governance in higher education

This article studies discourses within the accreditation of Norwegian higher education conducted by the Norwegian Agency for Quality Assurance in Education (NOKUT), using one concrete case (the accreditation of bachelor programs in nursing). Analysis of policy documents and accreditation reports are influenced by two of Foucault’s concepts of power; governmentality and panopticon. The analysis provides insights into firstly, how the two forms of power are woven into the schemes used for quality control by redefining quality to be a quantifiable concept; secondly, how the supervision of quality gives privilege to specific types of knowledge; thirdly, how supervisory power is reformulated to require self-control mechanisms within higher education in terms of constant quality development and realization of unexploited potentials; and fourthly, how this power legitimates itself by making all parties guardians of quality control, deconstructing the difference between evaluator and evaluated

Increased unintended patient harm in nursing practise as a consequence of the dominance of economic discourses

Caring is characterized by close and fragile relations between nurses and patients. At times, even with good intentions, nurses cause unintended harm of patients. We argue that the dominance of economic discourses in health care and their subsequent influence on service delivery and health care practices has the potential to increase unintended patient harm. Similar techniques and practices can result in either desired outcomes or harmful outcomes. We explore the notion of unintended harm and some of the ways it arises in nursing practice. We argue there is a clear link between the dominance of economic discourses and an increased risk of unintended harm. As a consequence of the dominance of economic rationalist discourses and the subsequent systems of control introduced, the practice of nursing has been significantly influenced. The challenge for nurses and the nursing profession is to develop strategies to refuse to give in to the dominance of economic interests over the need to prevent harm.C

Omsorgsmakt. Relasjonsnære sonderinger mellom makt og avmakt

Utgangspunktet for artikkelen er en mangelfull artikulering av makt i omsorgsutøvelse og forskning om omsorg. Det presenteres utvalgte bidrag fra den norske Makt- og demokratiutredningen som gir innsikter i hvordan makt utøves, endres og erfares i konkret omsorgsarbeid. Maktforskernes analyser viser interessante og ulike forståelser av dynamikken mellom omsorgsutøvelse og velferdsstatens hierarkiske nivåer, politikk og forvaltning. Omsorgsarbeid utøves primært av kvinner, og forskerne peker på avmakt som et gjennomgående trekk i dette kvinnedominerte arbeidet. Forfatterne stiller spørsmål om fokus på avmakt kan stå i veien for synliggjøring av makt. Gjennom presentasjonen av et case, hentet fra eldreomsorgen, gis det et utfyllende og delvis korrigerende bilde av makt. Caset beskrives og analyseres ved hjelp av maktperspektiver hentet fra Michel Foucaults arbeider. Forfatterne viser hvordan omsorgsmakt kommer til syne i relasjonen mellom den som yter og mottar omsorg og brukes på måter som både svekker og styrker pasienters verdighet

Assessment of learning in contemporary nurse education : Do we need standardised examination for nurse registration?

In Australia and Norway final examinations to determine eligibility for registration as a nurse were discontinued during the period when nurse education moved into the higher education sector. In response to recent calls for the reintroduction of final examinations we explore the range of knowledge needs for the practice of nursing. These various forms of knowledge demand different forms of mediation and acquisition as well as assessment. There are numerous problems identified in the literature about the shortcomings of examinations as the foundation of assessing clinically based professions. There is a need to develop systems of appropriate assessment to ensure that graduates of nursing demonstrate adequate knowledge and competence to enter their profession. © 2006 Elsevier Ltd. All rights reserved.C

From evidence-based to sustainable healthcare: Cochrane revisited

Evidence-based healthcare is the prevailing model for healthcare services. In Cochrane's seminal thinking, political context was included with the purpose of promoting healthcare equity. However, the subsequent evidence-based healthcare models marginalized political context. In this paper, we argue that current models of evidence-based healthcare fail to respond to emerging healthcare challenges. We claim that reintegration of political context is crucial to make healthcare sustainable. Global communities are anticipating ecological crises with immense repercussions for healthcare. This prospect illustrates that healthcare models failing to integrate political context also risk neglecting some of the most relevant healthcare issues of our time.publishedVersio

Politics and Power in Global Health: The Constituting Role of Conflicts Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health”

In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms’ conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation

Picture of Norwegian clinical learning laboratories for undergraduate nursing students

Clinical preparation for practice is a vital part of undergraduate education in nursing. This study explored contemporary constructions of clinical skills laboratories in two nursing undergraduate programs in Norway using qualitative collective case study methods. Data were gathered using individual and group interviews and observation during site visits. The data revealed slightly different ways of organizing teaching and experimenting with use of pedagogical methods to facilitate learning of technical skills as well as encouraging students to activate relevant theoretical knowledge. While there was a lively and striking enthusiasm among staff about the way learning was managed within the laboratories, the pedagogical underpinnings for their particular approaches were less certain amongst participants. The paper concludes with the necessity to provide evidence for the outcome of laboratories learning and investigate suitable pedagogical methods for effective teaching and learning of practice skills. Hence, a need for research on transfer of knowledge and skills between the different sites (academy, clinical settings, and laboratories) is identified. © 2008 Elsevier Ltd. All rights reserved

Multiple psychological senses of community and community influences on personal recovery processes from substance use problems in later life: a collaborative and deductive reflexive thematic analysis

Purpose: There is a pressing need for substance use services to know more about how to promote recovery from substance use problems, particularly in later life. Psychological sense of community (PSOC) is an important recovery dimension. This study aims to clarify in what ways PSOC and communities influence later life recovery processes. Method: A collaborative and deductive reflexive thematic approach was used to analyse 23 interviews with older adults in recovery from different substance use problems. Results: The findings suggest that PSOC and recovery in later life include multiple commu nities (relational, geographical, substance use-related, ideal and service-related) and affective states (PSOC and NPSOC). Older adults’ recovery, moreover, can be described as personal and heterogenic (with respect to community relationships, individual needs, type of substance use problem, age of onset and meaningful activities). Conclusions: The findings confirm age of onset, type of substance use problem and com munity memberships as essential to later life recovery. They also supplement prior evidence on community resources and challenges to later life recovery. Importantly, the new findings extend and nuance current understandings of later life recovery. Taken together, the article illustrates MPSOC as a useful concept, with central practical and theoretical implications for later life recovery.publishedVersio

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.publishedVersio