Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis, Edited by Kagan, Smith, Chinn, 09/2014: chapter Towards an “Ethics of Discomfort” in Nursing: Parrhesia as Fearless Speech; Routledge.
[Show abstract][Hide abstract] ABSTRACT: In this article, we examine the concept of HIV viral load and how it has evolved over time (1995–2013) in the field of HIV/AIDS. Although the term viral load is used extensively in this field, few efforts have been directed toward the conceptualization of HIV viral load, which is often left unquestioned, undertheorized, and portrayed as a neutral and objective laboratory value that has remained relatively stable over time—with the exception of progressive advancements in technology, techniques, and sensitivity. The purpose of this article is to apply the evolutionary concept analysis method developed by Rodgers (1989, 2000a) to the concept of HIV viral load. To set the stage, we establish the need for a concept analysis of HIV viral load and provide an overview of the evolutionary view. Then, drawing on the steps proposed by Rodgers (2000a), we outline the process of data collection, management, and analysis. We then offer an in-depth discussion of the findings (attributes, antecedents, and consequences) informed by Wuest's (2000) critical approach to concept analysis. We conclude by highlighting the implications of this analysis for clinical practice, research, and theory.
Research and Theory for Nursing Practice 01/2014; 28(3).
[Show abstract][Hide abstract] ABSTRACT: HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure 'community viral load'. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of 'community' through the re-configuration of space, the problematization of viral concentrations in specific microlocales, and the government (in the Foucauldian sense) of specific bodies which are seen as 'risky', dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition - forming the 'conditions of possibility' - for the recent shift to high impact prevention tactics that are being scaled up across North America.
Critical Public Health 12/2012; 22(4):471-483. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, the lipodystrophy syndrome has become one of the biggest challenges in the field of HIV/AIDS. Yet, few qualitative studies have examined how lipodystrophy affects the lives of people living with HIV/AIDS by reconfiguring their bodies in unexpected ways. The main objective of this qualitative study was to explore and describe the transformation process that women experience following the onset of lipodystrophy. The data were collected using semi-structured interviews and were then analysed following the principles of grounded theory. Overall, the research participants explained how lipodystrophy had transformed their bodies, disrupted their identities and confined them to a fragile social trajectory. In this sense, the experience of lipodystrophy was described as a profoundly disruptive transformation that includes three distinct stages: normalisation, problematisation and pathologisation. This process was characterised by the progression of lipodystrophy, as well as an intensification of the efforts to regain control over the body. At last, this study provides health care providers with a better understanding of the psychosocial impact of lipodystrophy and the needs of women who suffer from this condition.
Journal of Research in Nursing. 05/2012; 17(3):215-228.
[Show abstract][Hide abstract] ABSTRACT: As it currently stands, mandatory human immunodeficiency virus (HIV) testing of prisoners is performed by nurses in more than 24 states and throughout the federal correctional system. The aim of this article was to bring to the attention of the nursing community the inner workings of mandatory HIV testing and its implications for HIV-positive prisoners. Building on a recent report published by Human Rights Watch, we critically examine the deployment of mandatory HIV testing in state correctional facilities located in Alabama and South Carolina. We, therefore, intend to situate this practice within a bio-political logic and explore its human rights consequence.
ANS. Advances in nursing science 03/2012; 35(2):145-53. · 0.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: GAGNON M, JACOB JD and GUTA A. Nursing Inquiry 2012 [Epub ahead of print] Treatment adherence redefined: a critical analysis of technotherapeutics Treatment adherence issues in the context of chronic illnesses have become an important concern worldwide and a top priority in the field of health-care. The development of devices that will allow healthcare providers to track treatment adherence and monitor physiological parameters with exact precision raises important questions and concerns. The aim of this study is to interrogate the use of these new technological devices which allow for previously unavailable data to be recorded on an ongoing basis and transmitted via a tiny microchip inserted into the body. Drawing on the work of Michel Foucault, we analyze how this anatomo-political and bio-political instrument serves to discipline chronically ill individuals and govern the health of entire populations who suffer from chronic conditions. To support our analysis, this article comprises three sections. First, we provide an overview of treatment adherence and technotherapeutics. Then, we explain how technotherapeutics concern the government of bodies and conducts at the individual level and population level more generally. Lastly, we provide an example of how this analysis can be connected to routine nursing practice in the field of HIV.
[Show abstract][Hide abstract] ABSTRACT: Facial lipoatrophy has been described as the most distressing and stigmatizing expression of the lipodystrophy syndrome, a syndrome that is caused by antiretroviral combination therapy. In recent years, reconstructive treatments (such as poly-l-lactic acid and polyalkylimide) have been increasingly considered for this condition. These treatments allow for facial contours and facial fullness to be restored while being minimally invasive.
The main objective of this qualitative research was to explore and describe the experience of people who suffer from facial lipoatrophy, specifically in regard to reconstructive treatments.
A qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. The data was collected using semi-structured interviews and was then analyzed following the principles of thematic analysis.
Over a period of three months, 11 men and 1 woman enrolled in the study which was conducted in Montreal (Quebec), Canada.
Overall, participants explained that facial lipoatrophy had forced them into a situation of intense vulnerability by making them recognizable as persons living with HIV/AIDS and discreditable in the eyes of others. In this sense, they were willing to go to great lengths to restore their facial features and regain a sense of normalcy. Findings revealed that people who suffer from facial lipoatrophy engage in a process of reconstruction to reduce the visibility and disruptiveness of their condition but face many uncertainties along the way.
While the findings of this research corroborated what has been previously stated by other researchers about the impact of reconstructive treatments, they also shed light on the consequences of not making these treatments accessible as well as the undocumented realities of those who cannot afford the recommended course of dermal fillers.
International journal of nursing studies 11/2011; 49(5):539-48. · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, the lipodystrophy syndrome has become one of the biggest challenges in the field dof HIV/AIDS. However, few qualitative studies have examined how lipodystrophy affects the lives of people living with HIV/AIDS by reconfiguring their bodies in unexpected ways. The main objective of this qualitative study was to explore and describe the transformation process that women experience following the onset of lipodystrophy. The data was collected using semistructured interviews and was then analyzed following the principles of grounded theory. The purpose of this article is to synthesize our research findings with a particular emphasis on the basis social process (BSP) that emerged during the data analysis, namely, the bodily transformation process. Our objective is to highlight the experiences shared by women who go through this bodily transformation process and the challenges they face as they move progressively from one bodily state to another. Following the presentation of the bodily transformation process, we will discuss the implications of our findings for the advancement of nursing knowledge as well as the development of theories specific to the situations of people who suffer from chronic conditions and undergo a physical transformation as a result of medical treatment. Lastly, we will address the implications of our findings for nursing research and nursing practice.
Research and theory for nursing practice 02/2011; 25(1):23-38. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fear appeals are once again popular in public health campaigns aimed at preventing unhealthy behaviors and dangerous life practices such as smoking, unsafe sexual practices, drug use, alcohol abuse, impaired driving, etc. Every year in the province of Quebec (Canada), a new prevention campaign for sexually transmitted infections is launched by the SLITSS (Service de lutte contre les infections transmissibles sexuellement et par le sang). In 2006–2007, the SLITSS created a fear-based campaign entitled ‘Condoms: They aren’t a luxury’ for the prevention of sexually transmitted infections in young adults. The purpose of this paper is to share the results of a discursive analysis of the documents retrieved from this campaign, which was developed using commercial advertising and marketing strategies. Using situational analysis and the mapping process proposed by Clarke (2005), we critically examine the use of fear appeal in the campaign. Drawing on Michel Foucault's concepts of governmentality and bio-power, we assert that fear should be understood as a bio-political technology deployed to manage/govern young adults’ sexual practices. In doing so, we critique the use of fear as a strategy to create a state of permanent (in)security and challenge the adoption of commercial advertising and marketing strategies to develop public health campaigns.
Critical Public Health 01/2010; 20(2):245-256. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
International Journal of Culture and Mental Health 12/2009; 2(2):75-85.
[Show abstract][Hide abstract] ABSTRACT: Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear. The main objective of this theoretical paper is to engage the readers in a theoretical reflection regarding the concepts of abjection and fear since they both apply to the experiences of caring for mentally ill individuals in forensic psychiatric settings. Our contention is with the potential impact of feelings such as disgust, repulsion, and fear on the therapeutic relationship and, more particularly, with the boundaries imposed on this relationship when these feelings are unrecognized by nurses. Acknowledging that patients may evoke feelings of disgust, repulsion, and fear is essential if nurses wish to understand the implications of these emotions in the therapeutic process. In forensic psychiatric settings, caring for so-called "monsters" in the face of abjection and fear is not an easy task to achieve given the lack of theoretical understanding regarding both concepts. Given the actual state of knowledge in forensic nursing, we argue that theoretical (conceptual) analyses, as well as ethical and political discussions, are paramount if we wish to understand the specificities of this complex field of nursing practice.
[Show abstract][Hide abstract] ABSTRACT: In 1998, the US Supreme Court first held that asymptomatic HIV infection constituted a disability when it ruled on the case of Bragdon v. Abbott. The use of yet another label (disabled) to identify women living with HIV has been rarely (if ever) questioned. While we do value the use of this label as an anti-discriminatory strategy, we believe that there is a need to examine how language and more specifically, the use of words such as disability, limitation, and impairment may create new forms of identities for women living with HIV. Using this legal case as a starting point, the goal of this paper is to critically examine the 'fabrication' of asymptomatic HIV infection as a disability. Grounded in a feminist poststructuralist perspective, this paper exposes the relationship between language, social institutions, subjectivity, and power in the construction of difference. By doing so, it addresses the identification of women living with HIV/AIDS as disabled and the self-differentiation process that they must go through in order to live as normally as possible.
[Show abstract][Hide abstract] ABSTRACT: The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created.
Policy Politics & Nursing Practice 12/2008; 9(4):264-73.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to move beyond the biomedical standpoint in the field of HIV/AIDS in order to contribute to the recognition oflipodystrophy as a phenomenon that reaches far beyond its current definition as an unfortunate side effect of highly active antiretroviral therapy (HAART). This article hopes to demonstrate how theory, while remote to the clinical setting, can allow nurses to understand the experience of lipodystrophy as a social phenomenon and address it likewise in their practice. The specific aim of this article is to apply the concept of stigma to the experience of lipodystrophy in people living with HIV/AIDS. The objective of this theoretical piece is to fill the gaps in the way nurses address lipodystrophy in the clinical setting and to demonstrate the richness of Goffman's concept of stigma (1963) in understanding the experience of lipodystrophy.
Research and theory for nursing practice 02/2008; 22(4):228-40. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this paper is to explore the relationship between mandatory HIV testing and the institutional management of inmates in U.S. prisons. Mandatory HIV testing has been largely overlooked by the nursing community even though it has important human rights and ethical implications. Drawing on the work of Goffman (1990) on the inner workings of total institutions, the present article critically examines the deployment of mandatory HIV testing in U.S. prisons. To set the stage, we define mandatory HIV testing and describe the methods of HIV testing currently used in U.S. prison settings. Then, we provide a brief overview of the concept of total institution and the mortification process. Finally, we expand on the relationship between mandatory HIV testing and much larger institutional objectives of total control, total structuring, total isolation, and separation of inmates from society (as summarized by Farrington, 1992). And lastly, we provide a brief discussion on the implications of mandatory HIV testing (as a method of HIV testing) from a nursing perspective.