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Nostalgic and nostophobic referencing and the authentication of nurses' use of complementary therapies
Abstract
In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820-1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies.
... The vast majority of nursing literature to be found regarding CAM discusses the challenges posed by patients' increasing use of CAM, and nurses' potential responses and role-taking in relation to patients (Cattell, 1999;Damkier, Elverdam, Glasdam, Jensen, & Rose, 1998;DeKeyser, Cohen, & Wagner, 2001;Fitch, Gray, Greenberg, Labrecque, & Douglas, 1999;Montbriand, 2000;Muncer, Taylor, & Ling, 2001;King, Pettigrew, & Reed, 1999;Salmenpera, Suominen, & Lauri, 1998;Sohn & Loveland Cook, 2002;Trevelyan, 1996;Wilkinson & Simpson, 2002). These papers draw attention to the link between holistic nursing, patient-centred care models and CAM, many suggesting that nursing is well-situated to undertake a central role in patient education, and to a lesser extent, in CAM delivery (for example, Fitch et al., 1999;Frisch, 2001a, b;Glaus, 1988;Mayer, Orr, & Truman, 2001;Pfeil, 1994;Snyder & Lindquist, 2001;Taylor, 2002;Tovey & Adams, 2003;Wilkinson & Simpson, 2002), with particular attention given to therapeutic touch. Thus, the initial picture that emerges is that nurses seem to be much more open toward the practice of CAM, but admittedly there is very little empirical evidence to demonstrate this. ...
... Therefore, it is surprising that, despite the growing numbers of studies regarding CAM, very little theoretical development drawing upon sociology has taken place. Tovey and Adams (2003) have noted that: ''In recent years, what can loosely be described as a sociology of CAM has begun to emerge'' (p. 1469). ...
... Finally, we highlight the lack of theoretical development in this literature due perhaps to the paucity of in-depth, qualitative research from which theory could emanate. Tovey and Adams (2003) have argued that ''research in this area remains patchy and underdeveloped' ' (p. 1469). ...
There has been an explosion of literature on the attitudes of a variety of health care providers, particularly physicians, to the growing utilization of complementary and alternative medicines and modalities (CAM). What is most seriously lacking is a conceptual framework that helps to distill this mountain of literature into a manageable and more understandable amount. In this paper, we address these important issues by examining the literature that surveys the attitudes and behaviour of providers regarding CAM comparatively across the professions of medicine and nursing and across settings. We do so by drawing upon existing, more general theoretical contributions to the area of CAM in order to propose a comparative conceptual framework with which to interpret the diverse and at times discrepant results of this body of research.
... Questionnaires were handed out to 219 nursing students of Kyoto (61), Osaka (79), Okayama (59) and Nagoya (20) Universities, and 208 (95.0%) complete answers were analyzed (Shown in Supplementary Table 2). The age of the students was 21.0 ± 2.6 (mean ± SD) years old (range: 20-46), and 197 (94.7%) were female. ...
... Also, a study from UK reported the implementation of CAM education at 23% of departments of medicine and 73% of departments of nursing [19]. Tovey et al. [20] suggested that CAM, which emphasizes the recovery of the human balance and a cure, shared the same values and beliefs as a nursing goal. For example, a previous study showed that CAM relieved anxiety and agitation of patients using ventilators [21]. ...
Objective: Kampo education has been part of the curriculum in medical universities and colleges since 2001. However, it has not been the part of nursing university/college curriculum. The purpose of this study is to identify and follow the trend of Kampo education in Japanese nursing universities and colleges. We also gathered the opinion of beneficiaries of Kampo education, i.e. nursing students and teachers.Subjects and methods: The implementation status of Kampo education was investigated at departments of nursing in 90 schools of all Japanese public universities and colleges (n=90) in 2012 and 2016 using mail and web surveys. The recovery rate indicated 100%. In addition, questionnaire surveys concerning Kampo education were conducted among nursing students (n=208) and nursing teachers (n=365).Results: Although number of schools performing Kampo education increased from 27 in 2012 to 38 in 2016 significantly (p=0.04), it was smaller portion compared with medical courses (100%). In the consciousness survey on Kampo education, 75.5% of the nursing students and 88.8% of the nursing teachers responded that Kampo education was necessary.Conclusions: The present results indicated the necessity of Kampo education to nursing students. Because Kampo education was introduced into the nursing curriculum by the Japanese government recently, educational program should be arranged in the near future.
... CAM midwives regret the passing of a less sophisticated time, when life is thought to have been less complicated and when births took place in the home in a warmer, more supportive, and less threatening environment than the contemporary hospital. A similar trend has been noted by Tovey and Adams (2003) in their research among nurses using CAM in their practice. ...
... It is seen as superior to the present and imbued with greater depth and meaning. This stance parallels Tovey and Adams's (2003) view that the current interest of these professionals in CAM can be viewed as a continuation or revival of earlier patterns, which focused more on emotional needs and patient-centered practice. ...
This article focuses on midwives who practice complementary and alternative medicine (CAM) in Israel. After qualifying as nurses in mainstream biomedical institutions, these midwives have, at some point in their careers, opted to study a variety of CAM skills and practice them in hospital delivery rooms in Israel. The authors explore the relationship of selected elements of feminist ideology to the epistemology of CAM midwives. Seven context-specific themes are viewed as central to their epistemological stance: rejection of the medicalization of birth; a strong belief in the “naturalness” of childbirth; rejection of the overuse of technology; empowerment of women; nostalgia and reverence for the past; centrality of intuition, feeling, and emotion; and active advocacy. In-depth, semistructured interviews were carried out during 2004 to 2005 with 13 midwives. These narratives provided empirical material for a qualitative analysis. Evidence is shown to demonstrate the unique feminist quality of the core beliefs of the CAM midwives.
... (In Hyde et al (2005) we raised the question as to whether documenting complex psychosocial aspects is even feasible.) This heavily medicalised worldview of functional restoration is interesting, given the increasing attention to Complementary and Alternative Therapies (CAM) in nursing ( Tovey and Adams, 2003). Tovey's and Adams's (2003) analysis of texts on CAM within nursing noted that such texts draw attention to the preponderance of medicalised techniques in treatments to the detriment of human contact. ...
... This heavily medicalised worldview of functional restoration is interesting, given the increasing attention to Complementary and Alternative Therapies (CAM) in nursing ( Tovey and Adams, 2003). Tovey's and Adams's (2003) analysis of texts on CAM within nursing noted that such texts draw attention to the preponderance of medicalised techniques in treatments to the detriment of human contact. Yet our data suggest that in the busy atmosphere of the hospital ward, recourse to biomedical remedies to address functional problems in patients may be the quickest and easiest option for nurses in their efforts to rehabilitate patients and maintain social order. ...
Medicine is recognised as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse.
The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts.
45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis.
This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients' activities of daily living and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organising framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients' capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions become redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL.
We conclude by proposing that nurses' invigilation of patients' ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients' behalf in certain circumstances.
... Importantly, these types of CM engagement also link to specific, and in most cases different, considerations regarding education, professional registration, ethics and insurance. These types also appear to align in general terms with a range of integrative models as identified with reference to other health professionals and settings [125,126] and have wider implications for the politics of health professional identity and territory (especially with reference to conventional and CM providers) [126]. Differentiating these types of CM engagement within psychology also helps the discipline and profession of psychology to develop bespoke education and guideline material well suited to the particulars of CM integration occurring at the grassroots of psychology clinical practice. ...
Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists’ engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.
... En términos profesionales, los grupos más conservadores reclaman la producción de datos estandarizados que demuestren la eficacia y seguridad de dichas terapias, redundando en una incorporación subordinada de aquellas formas terapéuticas consideradas más asimilables a la epistemología biologicista/materialista de la medicina ortodoxa (y una exclusión de las más esotéricas) 7 . Al mismo tiempo, se registra la recuperación de estas disciplinas por parte de profesionales de la salud (sobre todo no-médicos) como una táctica para fortalecer su posición incorporando nuevas destrezas 8,9 . Lo que también puede ser leído bajo una lógica de expropiación que -según Conrad 10 -ya forma parte del normal accionar de la biomedicina. ...
Este artículo analiza problemas asociados a un estudio cualitativo de orientación etnográfica que explora el fenómeno de las medicinas no-convencionales en contextos hospitalarios en Ciudad de Buenos Aires (Argentina). En diálogo con la literatura académica que explora los desafíos metodológicos, éticos y políticos de hacer etnografía en el ámbito sanitario, el artículo se divide en dos apartados: (1) uno que explora las dificultades asociadas al acceso; y (2) otro que analiza las dificultades que se desprenden del carácter sensible y marginal del tema a investigar. Se constata que las características del proceso de construcción del conocimiento no son extrañas a las relaciones de poder que atraviesan el campo a ser abordadas, y que las dinámicas sociales generadas en hospitales exigen respuestas negociadas y flexibles por parte del investigador.
... In addition, most of the studies on alternative medicine in the international sociological literature (which are mainly Anglo-Saxon in origin) are theoretical. The few studies that have empirically investigated this issue have tended to be descriptive studies of the actions and profiles of users and are often limited to patients with a given disease (Broom and Tovey, 2007;Tovey and Adams, 2003). ...
... They argued that this outcome is influenced by the personal and professional characteristics of the provider, the personal characteristics and disease state of the patient, the physical and organizational structure in which they were working, and the epistemological and political status of the CAM modality under consideration. Other research has considered how professional identity is shifted and asserted in relation to the adoption of CAM practices, as a way to emphasize 'care', 'holism' or 'health' (Baer 2008;Dew 2000;Gilbert 2004;Tovey and Adams 2003;Winnick 2006), but it has been recognized that the impact of this on practice has been constrained by the continued authority of biomedicine and the medical profession (Cant et al. 2011). ...
Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. This article reviews the sociological literature on the topic. First, it addresses the question of terminology, arguing that the naming process is a glimpse into the complexities of power and history that characterize the field. Second, focusing on the last 15 years of scholarship, it considers how sociological research on users and practitioners of TM/CAM has developed in that time. Third, it addresses two newer strands of work termed here the ‘big picture’ and the ‘big question’. The big picture includes concepts that offer interpretation of what is happening at a societal level to constrain and enable observed patterns of social practice (pluralism, integration, hybridity and activism). The big question, ‘Does it work?’, is one of epistemology and focuses on two developing fields of critical enquiry – first, social critiques of medical science knowledge production and, second, attempts to explain the nature of interventions, i.e. how they work. Finally, the article examines the role of sociology moving forward.
... Pregnant and birthing women have been identified as substantial CAM users with prevalence rates of between 20% to 60% [5] a usage suggested to be in line with the search for a 'natural' pregnancy and birthing experience (free, where possible, from medical intervention) [10,11]. While a small but emerging body of literature highlights acupuncture/acupressure, aromatherapy, chiropractic, homoeopathy, massage and yoga as popular amongst pregnant women [5,12] opinions differ on the validity and safety of these CAM practices for pregnancy [10,13,14]. ...
Abstract Background There is little known about women’s concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners. Methods A sub-study of pregnant women (n=2445) was undertaken from the nationally-representative Australian Longitudinal Study on Women’s Health (ALSWH). Women’s consultations with conventional practitioners (obstetricians, GPs and midwives) and CAM practitioners for pregnancy-related health conditions were analysed. The analysis included Pearson chi-square tests to compare categorical variables. Results The survey was completed by 1835 women (response rate = 79.2%). A substantial number (49.4%) of respondents consulted with a CAM practitioner for pregnancy-related health conditions. Many participants consulted only with a CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Meanwhile, women consulted both CAM practitioners and conventional maternity health professionals (obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a general practitioner (GP) 3–4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often (p
... In what follows we illustrate how the nostalgia embedded in discourses of temporal commitment serves as a resource for maintaining power and status within the modernised and feminised NHS. We show how heavily emotional and material attachment to masculine discourses of temporal commitment offers a safe space for collective identification (Brown and Humpreys, 2002), authentication of professional identity (Tovey and Adams, 2003) and resistance to change, in particular a change in gender order at a time when high numbers of women are entering the profession (RCP, 2009). We present the discursive discourses senior hospital doctors draw on and discuss the identity work they engage in. ...
Purpose
Attempts to modernise the National Health Service (NHS) in the UK involve promoting flexible approaches to work and training, restructuring postgraduate training and increasing control and scrutiny of doctors' work. However, the medical community has responded with expressed anxiety about the implications of these changes for medical professionalism and the quality of patient care. This paper aims to address these issues.
Design/methodology/approach
Drawing on literature on nostalgia, gender, identity and organisations, the paper explores the narratives of 20 senior NHS hospital doctors to identify ways in which doctors use nostalgia to react to organisational and professional challenges and resist modernisation and feminisation of medicine.
Findings
This paper illustrates how senior hospital doctors' nostalgic discourses of temporal commitment may be used to constitute a highly esteemed professional identity, creating a sense of personal and occupational uniqueness for senior hospital doctors, intertwined with gendered forms of othering and exclusionary practices.
Practical implications
Nostalgia at first sight appears to be an innocuous social construct. However, this study illustrates the significance of nostalgia as a subversive practice of resistance with implications for women's career and identity experiences. Change initiatives that seek to tackle resistance need also to address discourses of nostalgia in the medical profession.
Originality/value
The main contribution of this study is that we illustrate how supposedly neutral discourses of nostalgia may sometimes be mobilised as devices of resistance. This study questions simplistic focus on numerical representation, such as feminisation, as indicative of modernisation and highlights the significance of exploring discourses and head counts for understanding resistance to modernisation.
... Many authors have identified a curiously nostalgic quality to nursing such that new activities are supported by reference to their apparent interconnectedness with its history (Tovey and Adams, 2003). Yet here the habitus of nursing appears also to be attuned to contemporary struggles for status and symbolic capital and debates about nurse education. ...
This paper reports upon a qualitative interview study of 22 matrons, infection control staff and operating theatre staff who were questioned about their working lives and the role they played in the control of healthcare acquired infections such as MRSA virus in the UK. A theoretical framework drawing upon the work of Bourdieu is deployed as his notion of habitus captures the combination of practical work, physical disposition and ways of looking at the world which are displayed in the interview accounts of labour in the healthcare field. Three themes emerged from the analysis: first, the 'securitization' of healthcare work, concerned with control, supervision, 'making sure' and the management of risk through inspection, audit and the exercise of responsibility; second, the sense of struggle against doctors who were seen to represent a threat to the carefully organized boundaries, through such alleged violations as not washing their hands, wandering between theatre and canteen areas in soiled clothing and thinking the rules did not apply to them; third, in a 'back to basics' theme participants emphasised the fundamentals of what they saw to be nursing work and were concerned with cleanliness and practically based training -- the habitus of hygiene itself. This was formulated in nostalgic terms with reminiscences about basic training earlier in the participants' careers. The preoccupation with hygiene and its 'basic' processes can be seen as a way of managing uncertainty, accumulating a certain kind of symbolic capital and constructing and maintaining boundaries in the healthcare field. It also makes for self-governing, self-exploiting individuals who accrue responsibility to themselves for implementing the 'habitus of hygiene'.
... In what follows we illustrate how the nostalgia embedded in discourses of temporal commitment serves as a resource for maintaining power and status within the modernised and feminised NHS. We show how heavily emotional and material attachment to masculine discourses of temporal commitment offers a safe space for collective identification (Brown and Humpreys, 2002), authentication of professional identity (Tovey and Adams, 2003) and resistance to change, in particular a change in gender order at a time when high numbers of women are entering the profession (RCP, 2009). We present the discursive discourses senior hospital doctors draw on and discuss the identity work they engage in. ...
Regulation of time, management of gender equality and discourses of professionalism are often studied in isolation from one another in the context of hospital medicine. Drawing on qualitative analysis of 20 interviews with senior National Health Service (NHS) hospital doctors in Wales, UK, we demonstrate the complex interplay between professionalism and regulation of time and gender in hospital medicine. We examine the connectivity of gender and time in norms about professional behaviour in hospital medicine and demonstrate how a certain discourse of professionalism is used in turn to retain and reproduce a temporally regulated gender order at work. Based on our findings, and congruent with the spirit of modernisation of management of human resources in healthcare, we offer new directions for gender equality, regulation of time and development of professionalism in hospital medicine.
... As Derrida (Derrida, 2005) views this, power can never be exercised without its communication and reflects the complexity of power alongside the similar Foucaldian stance of power as mutually constitutive. Many nursing health-related agendas and practices have been determined by the far more powerful political lobby of the medical professions (Powers, 2002;Tovey and Adams, 2003;Hyde et al., 2005). For nurses to effectively engage in health promotion activities, they are required to know how they can contribute to the development of health policy and related socio-political strategy (McDonald, 1998;Hewison, 2007). ...
The objective of this study was to identify the current position of health promotion in nursing as it relates to its practice, theory and policy and, where possible as a secondary aim, compare and contrast this against the health promotion position of other health professional groups. This was achieved using the framework of a Derridean-derived discourse analysis of existing health promotion literature specific to nurses and nursing practice. The overall process examined a 'corpus' of the literature considered exemplary texts of that kind and classification. A number of binary oppositions and tensions, in the Derridean tradition, were uncovered. Strong themes to emerge were that nursing has yet to clearly contextualize and differentiate health promotion and health education and the specific role and function of nursing. Also evident was the view that nursing-related clinical practice is yet to universally reflect the theory and language of 'general' health promotion. Furthermore, nursing has not yet demonstrated a clear and notable wider health policy/political role in formulating and implementing health promotion agendas. Although this state of affairs has existed for some time now, there is evidence that nursing knowledge and practice is changing-even if this is not a universal phenomenon. Studies, like this one, are part of the step towards a more widespread reform for health promotion in nursing.
... There is a growing literature that assesses mainstream health providers' views and behaviour regarding CAM, particularly with regard to physicians, 2,4-6 albeit to a lesser degree with regard to nurses 5,8,[11][12][13][14][15][16][17][18][19][20][21] and midwives. 1,22,23 Among physicians there is a moderate level of interest in or incorporation of CAM. ...
The purpose of this paper is to explore how mainstream practitioners define and categorize complementary and alternative medicine (CAM) as one component of assessing their views. The following themes emerged from interviews with Canadian physicians, midwives and nurses: epistemological, evidence-based, medical domain, political-regulatory, funding-based, and role-based definitions of CAM. We also assess any possible links to their behaviour vis-à-vis CAM. We found that classifying something as CAM does not appear to inhibit most providers from recommending, referring for, or supporting their patients' use of these treatments. In conclusion, we highlight that despite their clear definitional boundaries around CAM, providers tend to evaluate each individual therapy on its own merits, taking other situational factors into consideration.
... Palliative specialists' enlistment of CAM, within their organisational context, may function as a means of intraprofessional distinction, contributing to the legitimacy of palliative care through constructing it as a more patient-centred, open-minded and holistic sub-specialty of medicine. This process mirrors that seen in the nursing profession, with particular elements separating themselves out and using CAM as a method of intraprofessional distinction and legitimation (Tovey and Adams 2003). ...
The integration of complementary and alternative medicine (CAM) into cancer services is increasingly discussed as a potential part of UK health policy but as yet there has been little sociological research examining this process. This paper examines the results of a study on the provision of CAM to cancer patients in two distinct organisational contexts: the hospice and the hospital. It is based on interviews with medical specialists, nursing staff and CAM therapists. This paper focuses on how integration is managed in each organisation, examining professional boundary disputes and inter-professional dynamics. Discussion focuses on the rhetorical and practical strategies that are employed by a variety of differently positioned interviewees to negotiate the complexities of the interface of CAM and biomedicine. The results show significant differentiation in how differently positioned cancer clinicians view and utilise the biomedical hierarchy of evidence. We argue that the integration of CAM should not be conceptualised as a mere challenge to biomedicine, or, as resulting in a linear process of de-professionalization. Rather, it should be seen as producing a complex array of processes, including strategic adaptation on the part of medical specialists and NHS organisations.
... A continuing lack of CAM-related research, of this type, is noted in the literature. 41 ...
To explore the factors which underpin the healthcare consumers' decision-making to use CAM in the primary setting.
An explorative, multiple case-study of seven convenience-sampled participants where in-depth, semi-structured interviews were employed.
The findings showed that participants would continue to utilise CAM, even where CAM had no scientific evidence. The participants believed that CAM should be integrated into mainstream healthcare service delivery.
There are few international studies that have reported on the utilisation and prevalence of CAM within the General Practice (GP) or clinic setting. The reasons why clients select specific CAM therapies, where they are offered in these settings, remain unclear. This study, however, casts further light on this matter.
The ever-increasing integration and expansion of CAM modalities within nursing (Tovey and Adams, 2003) has given rise to questions about the meanings of CAM for nurses. This chapter will examine the place of CAM within nursing and the notions of ‘care’ and ‘holism’ that its integration depends on. While meanings of care and holism vary within and across professions (Kaptchuk 1996; Cassidy 1998), these meanings are used to hold off and differentiate both individual identity, and professional boundaries (see also Shuval chapter). Simultaneously, the hinge of ‘care’ invoked by the participants in the samples drawn upon for this chapter serves to integrate the often intrinsically contradictory health belief models underpinning allopathic medicine and CAM. Through building on definitions of care, what it should be, what it should address, who provides the care, and how it should be provided (Wilson 2000), nurses erase potential disjunctions and opposition between the contradictory health belief models of allopathic medicine and CAM in the context of care provision. Debates about (CAM) nursing care speak closely to sociological debates about the ethics of care more generally, and this chapter will consider the opportunities for critical engagement these two growing literatures offer each other.
Evidence‐based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three‐article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings—all of which raises more questions regarding its application to provider‐patient decision making, pedagogy, and policy.
The profile of complementary and alternative medicine (CAM) has risen dramatically over the last decade and cancer patients represent its most prolific users. As a result, the NHS and UK cancer services are attempting to develop a wider range of therapeutic options for patients. Despite such developments, little is known about why cancer patients use CAM, its perceived benefits and the perspectives of the doctors and nurses involved. Drawing on extensive fieldwork in the UK, Therapeutic Pluralism includes over 120 interviews with cancer patients and professionals, plus innovative 'diary' data which, for the first time, detail the experiences of CAM users. It gives a systematic analysis of issues such as: The development of patient preferences and influences on decision making Expectations of CAM and interpretations of 'success' in cancer treatment The nature and importance of 'evidence' and 'effectiveness' for patients The organisational dynamics involved in integrating CAM into the NHS Pathways to CAM and the role of the Internet The role of oncology clinicians in patients' experiences of cancer and their use of CAMs Therapeutic Pluralism is essential reading for students and researchers of medical sociology, complementary and alternative medicine and cancer. It will also be useful to medical and health professionals, and policy-makers with an interest in complementary and alternative medicine.
Objective: To explore primary care practitioners' personal and professional beliefs about traditional and complementary approaches (TCA) to health and the influence of professional socialization in the UK.
Methods: As part of a larger study on child TCA use in a multi ethnic community, semi-structured, one on one, face-to-face interviews with 30 primary care practitioners (GPs, nurses and health visitors) explored experience, knowledge and attitudes regarding TCA. Framework analysis was used. This paper explores the key emergent issues of personal and professional beliefs and professional socialization resulting from the qualitative data obtained during the interviews.
Results: Personal factors (ethnicity and personal use) influence attitudes, but professional factors appear to dominate, including biomedical theory, evidence based medicine, safety and treatment choice. Curbing of personal views and experience may be due to caution and conformity from increasing regulatory power. Inter- and intra-professional group differences also emerged, likely due to variation in training, status and professional role.
Conclusions: Practitioners need to understand patients' diverse health beliefs and practices and discuss TCA with families, despite regulatory and organizational constraints, to fulfil their professional duty to patients, particularly regarding safety. Further research is needed to verify the professional socialization process and the influence of specific regulation on training.
A emergência de sistemas de saúde alternativos dá lugar ao pluralismo de cuidados que corresponde a construções reflexivas de percursos que estão para lá da normatividade da medicina. Essas escolhas leigas correspondem a racionalidades distantes da razão da ciência ao constituírem-se como sistemas explicativos complexos que se referem à experiência subjetiva. Este artigo problematiza o fenômeno ‘protagonismos alternativos nas trajetórias de saúde’ entendido como as atitudes ativas de construir a própria saúde com recurso a abordagens que não se incluem na biomedicina. O que leva os indivíduos a procurar sistemas ‘alternativos’ para promover a saúde e lidar com a doença? Como integram esses sistemas no seu cotidiano e como os articulam com o sistema biomédico? Quais as racionalidades leigas que privilegiam na sua configuração explicativa e interventiva os sistemas alternativos? Sendo este fenômeno relativamente recente na sociedade portuguesa e praticamente não analisado sociologicamente, interessa-nos situar os pilares analíticos que baseiam a sua compreensão. Nesse sentido, retomamos as dicotomias clássicas que têm marcado o debate sobre a produção do conhecimento, nomeadamente sobre saúde/doença – diálogos entre ciência e senso comum; entre natureza e cultura; entre racionalidades médica e leigas.
IntroductionResearch indicates that many midwives support the use of complementary and alternative medicine to manage the normal challenges of pregnancy and birth. However, midwives’ responses involve highly complex processes and assuming that their positive views will translate into advocacy of the therapies in practice fails to appreciate the impact of contextual conditions.MethodologyGrounded theory was employed to explore the personal, social and structural factors that influence midwives’ behaviour and attitudes towards the use of complementary and alternative medicine. Twenty-five midwives who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semi structured interviews and non participant observation of a subgroup, over an 18-month period in 2010–2011.ResultsContextual conditions exert a powerful influence on midwives’ behaviour towards complementary and alternative medicine. The most significant factors identified in our study include the context of professional work, the midwife's beliefs and knowledge, and the woman's expectations and health.Conclusions
Midwives’ professional behaviour regarding complementary and alternative medicine is the result of the complex interface of opposing factors. While many assert that the use of complementary therapies is congruent with their professional philosophy and there is a strong demand from women, integration into clinical practice remains limited in the Australian maternity setting.
Drawing on in-depth interviews with cancer patients, this article examines patients' perspectives on the nature of evidence and the degree to which different understandings of evidence inform decision-making about complementary and alternative medicine (CAM) and biomedical cancer treatments. Results illustrate the ways in which many cancer patients critically engage with questions about the nature of knowledge and the potential pitfalls of science.Their accounts can largely be characterized by a dialectical tension between individuation (espoused by many CAM therapies) and depersonalization (implicit in biomedical care); a tension mediated by individual cancer patient's prognosis and age. On the basis of the results we argue for a re-focusing of social theory to embrace an understanding of grass-roots ontological tensions seen in the experiences of individual cancer patients.The problematic nature of maintaining a narrowly defined `evidence-base' policy on CAM and cancer is also discussed in light of the data.
Drawing on comparative fieldwork in the UK, Pakistan and Australia, this book provides the first systematic assessment of pathways and access to CAM and how it is used in health practice and by individuals with cancer. Giving fresh and invaluable insights into how differing health and societal structures influence the use complementary and alternative medicine, the book explores: the empirical, theoretical, and policy context for the study of CAM/TM and cancer. The history and character of the eight support groups in which fieldwork took place in the UK, Australia and Pakistan. The nature and structure of patient support groups' history, affiliation and evolution. How groups function on a day-to-day basis. The extent to which what is being offered in these CAM-oriented groups is in any way innovative and challenging to the therapeutic and organisational mainstream. The value of sociological work in the field which is not tied to immediate and narrow policy objectives. This is an essential resource for those studying complementary and alternative medicine sociologically, to those involved in the provision of cancer care on a day-to-day basis, and to those looking to establish a more informed (evidence-based) policy. © 2007 Philip Tovey, John Chatwin and Alex Broom. All rights reserved.
Despite recent developments in the sociology of complementary and alternative medicine (CAM), a critical analysis of the apparent affinity between CAM and nursing has, to date, remained essentially undeveloped. An empirical project is currently being conducted as an initial step to address the absence of such important critical research. A total of 30 written life history narratives were obtained from nurses working with and using CAM to explore such matters as professional boundaries and nurses' authentication strategies and conceptualisation and operationalisation of CAM. This paper addresses questions and conflicts that arose as the analytical tools were considered for these narrative accounts. Specifically, the paper explores whether the storied narrative sits easily with a critically oriented sociology of CAM; the differences between the role of "storyteller" or "story analyst"; and ask whether there is potential for developing a critical sociology of CAM nursing that retains the essence of personal stories.
Evidence-based medicine has enhanced the predictive capacity of biomedicine in population terms, but it has also introduced new challenges for patient care and biomedical expertise. In this article we examine the negotiation of prediction and indeterminacy by oncology clinicians, exploring the ways in which they report delivering prognosis and engaging with indeterminacy in conversation with their patients. We examine oncologists' strategies for delivering "news," the technological mediation of uncertainty, and reported conversational turns toward a focus on indeterminacy and individual response. Drawing from these accounts, we argue that, although predictive capacity remains central to oncological expertise, notions of individualism, subjectivity, and self-determination are being heavily drawn on by clinicians. Rather than presenting a challenge, such ideas might be becoming increasingly central to oncological expertise. Interviews with cancer nurses illustrate their precarious relationship with evidence, uncovering tensions in their approach to patients and in their attempts to traverse diverse paradigms of care. We argue for an understanding of oncological expertise as evolving within the context of potentially competing contemporary cultural shifts, and against a simplistic notion of indeterminacy as necessarily eroding expertise.
The profile of complementary and alternative medicine (CAM) has risen dramatically over recent years, with cancer patients representing some of the highest users of any patient group. This article reports the results from a series of in-depth interviews with oncology consultants and oncology nurses in two hospitals in Australia. Analysis identifies a range of self-reported approaches with which oncology clinicians discuss CAM, highlighting the potential implications for patient care and inter-professional dynamics. The interview data suggest that, whilst there are a range of consultant approaches to CAM, ;risk' is consistently deployed rhetorically as a key regulatory strategy to frame CAM issues and potentially direct patient behaviour. Moreover, ;irrationality', ;seeking control', and ;desperation' were viewed by consultants as the main drivers of CAM use, presenting potential difficulties for effective doctor-patient dialogue about CAM. In contrast, oncology nurses appear to perceive their role as that of CAM and patient advocate - an approach disapproved of by the consultants on their respective teams, presenting implications for oncology teamwork. CAM education emerged as a contentious and crucial issue for oncology clinicians. Yet, while viewed as a key barrier to clinician-patient communication about CAM, various forms of individual and organizational resistance to CAM education were evident. A number of core issues for clinical practice and broader work in the sociology of CAM are discussed in light of these findings.
Evidence-based medicine (EBM) is strongly shaping the nature and direction of biomedical practice and organisational culture. Clinicians are now expected to adopt the principles of EBM and evidence-based practice (EBP) whilst also maintaining such things as professional autonomy, clinical judgement and therapeutic integrity. Little sociological work has been done on the implications of EBM in oncology contexts. Drawing on in-depth interviews with 13 oncology consultants and 12 oncology nurses in Australia, in this paper we explore how oncology clinicians utilise and/or critique types of evidence and statistical probabilities; the organisational systematisation of care; and, wider policies of EBM. The results illustrate significant variation in perception of EBM between the oncology sub-specialties examined, and the central role of organisational structures and intra-professional hierarchies in how evidence is viewed and utilised in practice. The interviews also capture the ways in which oncology specialists are negotiating the systematisation of care under the rubric of EBM, and the contradictory effects of professional de-skilling vis-à-vis the reinforcement of biomedical objectivity/power. Finally, we examine the experiences and perceptions of oncology nurses in relation to evidence and EBM, exploring the interplay of processes of professionalisation and distinction in shaping the evidence-based trajectories of nursing. We contrast these results with previous sociological writings on EBM, reflecting on the applicability and limitations of these theoretical positions when applied to the experiences of oncology clinicians.
Interest in complementary and alternative medicine (CAM) continues to grow at an exponential rate despite the advances made by conventional medicine. Complementary and alternative medicine use is increasingly manifest across a wide range of health care settings, and is particularly prevalent in cancer and palliative care. In these arenas, patient groups and self-help organizations play a significant supportive role. There is evidence that they are a key informative and pragmatic resource in the provision of CAM services to patients. However, there is a significant paucity of research dealing with the functional aspects of these groups and the way in which they advocate, promote and supply CAM. In this paper we provide a critical review of the literature pertaining to themes around CAM provision and cancer care, and suggest that for a more complete picture of the field, the impact of group mediation of CAM needs to be addressed, and attention focused on the social and interactional dynamics that underpin these groups and organizations.
The article is concerned with nurses in Israel who incorporate alternative health care practices into their work, and considers strategies used by them to reconcile a variety of theoretical and practice traditions. The analysis utilizes boundary theory and focuses on the following boundaries: territorial, epistemological, authority, and social. In-depth narrative interviews were carried out in 2004 with 15 nurses who were working or recently worked in both biomedical and complementary and alternative medicine (CAM) settings. The findings show that nurses using CAM practices do not seek to change the epistemological and authority boundaries of biomedicine. Even so many believe that CAM methods should be included within the cognitive boundaries of biomedicine. They are not disturbed that most of these techniques have not passed the test of biomedical research criteria, though they feel blocked by physicians who keep the cognitive boundaries of biomedicine closed.
In this paper I present a model of professional knowledge forms that accounts for the different, and sometimes contradictory, ways in which medical doctors (MDs) and various complementary and alternative medicine (CAM) practitioners define their competencies and make legitimacy claims. The first section provides a schema for problematising knowledge and its relationship to legitimacy by distinguishing between the context, form and content of professional knowledge. I draw particularly upon Jamous and Peloille's (1970) distinction between the technical or indeterminate forms of professional knowledge. I argue that their characterisation might be enriched by attending to dimensions of 'exclusive' versus 'everyday' knowledge forms. In particular, I point out that both technical and indeterminate forms are amenable to exclusion, or conversely can be made accessible as everyday knowledge. Both forms can thus be employed in attempts to legitimate professional practice. In the final section, I map the current context of CAM and biomedicine onto this expanded professional knowledge map.
High levels of use of complementary and alternative medicine (CAM) have been consistently reported amongst cancer patients over recent years. This is occurring in the context of an apparent increase in sources of information on therapeutic alternatives and a growth in the range of those claiming professional expertise in the field. To date there has been little research on patient experience of discussions about CAM with biomedical cancer specialists in this increasingly complex social environment. This paper addresses three issues: patient experience with cancer specialists; the significance of that experience for patient engagement with CAM; and the nature and significance of inter-professional dynamics. It draws on the results of a qualitative study with cancer patients in the UK. In-depth interviews with 80 purposively sampled patients, incorporating a range of disease types and stages, were conducted. Patients reported three main types of approach by oncologists: explicit or implicit negativity; supportive ambivalence; and, pragmatic acceptance. Crucially, patients' accounts suggest that the type of approach adopted influences (though does not determine) patient action. Specialist cancer nurses emerged as potentially powerful mediators between oncologists and patients. Despite the apparent potential for influence from multiple information sources and 'experts', on the basis of this study we would argue that oncologists remain crucial to patient engagement with CAM. However, this is not to argue that the influence is a simplistic one. Where patient and medical perspectives diverge, strategic alignment with specialist nurses may help patients make choices which conflict with perceived advice.
Cancer is the second leading cause of death in Pakistan. There is increasing evidence that patients are using a range of (biomedical and nonbiomedical) therapeutic options for cancer treatment. To date there has been no sociologically informed research into the engagement of cancer patients in Pakistan with available modalities. In this article, the authors present findings from the first such study. They purposively sampled 46 cancer patients from four hospitals in Lahore and conducted semistructured interviews with them. They argue that individuals are actively mediating therapeutic possibilities by drawing on, and at times being constrained by, personal, social, and cultural resources. It is the authors' contention that this can be conceptualized by an appreciation of individuals' active engagement with three temporally and spatially specific dimensions: structural and practical constraint; pragmatic experimentation; and cultural and religious affiliation. The negotiation (and varying power) of these dimensions is crucial to the process.
To provide an understanding of Hong Kong registered nurses' personal and professional use of complementary and alternative medicine.
Cross-sectional questionnaire study.
Registered nurses who were members of the Hong Kong College of Nursing were invited to participate.
Demographic data of the respondents, prevalence of personal and professional use of complementary and alternative medicines, including their use for detailed clinical conditions.
A total of 187 nurses participated in this study. Nearly four fifths (80%; 95% confidence interval, 74-86%) of the participants had used at least one form of complementary/alternative medicine. In addition to the personal use of such treatment, over two fifths (41%; 95% confidence interval, 34-48%) had recommended at least one form of complementary/alternative medicine to their patients. These included bone-setting (20%), Chinese remedial massage (tuina, 19%), and meditation (19%). Specifically, registered nurses recommended acupuncture or acupressure to patients with musculoskeletal disorders, chronic pain, or headaches/migraines.
Personal use and professional recommendations for complementary and alternative medicine by registered nurses in Hong Kong is substantial. Registered nurses played an active role in advising such treatment for their patients based on their personal knowledge of perceived benefit in specific conditions. Further investigations with a larger sample size should focus on registered nurses' educational needs in respect of complementary and alternative medicine and the advice they recommended.
This article examines the attitudes and reported behaviors of physicians, nurses, and midwives regarding complementary and alternative medicine (CAM), with respect to one key theme that emerged from a broader qualitative study. Of central interest are the structural influences identified by study participants that either act as constraints or opportunities for their professional use of or referral for CAM. In an effort to interpret these results, the analysis is situated within the sociology literature that documents the influences of professional socialization, practice philosophy, regulation, and organizations on professional behavior. These influences are classified as either professional-level structures or work/organizational structures. The main conclusion is that future research should pay more attention to such structural dimensions that may be exerting influence on the decisions of providers about whether or not to professionally use or refer for CAM. This article is offered as a conceptual starting point for doing so.
The chapter explores the medical response to acupuncture in Britain.
Complementary or unconventional treatments are used by many doctors and other therapists throughout Europe. The major forms are acupuncture, homoeopathy, manual therapy or manipulation, and phytotherapy or herbal medicine. The relative popularity of therapies differs between countries, but public demand is strong and growing. Regulation of practitioners varies widely: in most countries only registered health professionals may practice, but in the United Kingdom practice is virtually unregulated. Germany and some Scandinavian countries have intermediate systems. Legal reforms are in progress in the Netherlands and the United Kingdom. European institutions are starting to influence the development of complementary medicine. Harmonisation of training and regulation of practitioners is the challenge for the future.
Ideas of 'nursing' and 'nurses' carry a powerful social charge. The image of the nurse continues to be a symbol of caring and of duty at the same time as it projects a view of femininity, 'stereotypical' in its gender relations.
How has this image come to be constructed?
An empirical investigation of representations of nursing practices in Britain focusing on publicity and promotional materials and their relationship to popular fictional narratives reveals a strong correlation between what are usually described as discrete forms of signification. Recruitment images, provide an important source of information and inspiration for those considering nurse training. Julia Hallam, draws from a wide range of sources including biographies, marketing and recruitment literature, popular fiction and film to explore this question. In doing so she makes an original contribution to the debates surrounding gender and occupational identity.
The book will provide a valuable resource for undergraduate and postgraduate students on courses such as the social history of nursing, the understanding of health and illness, women's studies, gender studies and sociology courses.
Scientists give conflicting interpretations about scientific work - drawing alternatively from the contingent repertoire and the empiricist repertoire (both discourses). Contingent, which is more common in interviews and informal talk, calls attention to the personal battles, mistakes, disagreements of scientific work and is very flexible, vague, and imprecise. Empiricist, which is more common in articles and publications, emphasizes the impersonality of scientific work. Discourse is context-dependant.
This paper examines the role and meaning of nostalgia, and its opposite nostophobia, in the contemporary railway industry. It charts the way the past is passively and actively used by organisational actors, management as well as at the political level. It is argued that in the contemporary railway industry history and heritage are selectively annexed, negatively in order to win consent for change, and positively in an attempt to recapture the `golden age of railways' for marketing purposes. The paper makes sense of these processes by deploying a framework derived from various writers on issues connected with nostalgia and the emotional attachment to work.
This article examines how nurse managers attempted to accomplish the formal boundaries of clinical nursing in a large UK district general hospital. The study was undertaken in the context of wider national policy developments which had provided the impetus for role realignment. The practices and rhetorical devices nurse managers employed in doing demarcation are treated herein as examples of “boundary-work.” The management context is an arena which has hitherto been neglected in symbolic interactionist studies of the hospital division of labor and, as a consequence, the understanding of the processes through which occupational jurisdictions are constituted remains partial. This article aims to begin to address this gap in the literature by considering the contribution of these microsociological processes to the practical accomplishment of the hospital division of labor.
The article theorizes the disruptive nature of immigrants' visit to the native home in terms of temporality and space. Such a disruption demands that immigrants reevaluate their relationships to the old home. Probing visiting tales elicited from immigration stories, the authors discuss how separation from the old home is effectuated during visits to the native home through the simultaneous and contrary processes of (1) linking up with the familiar, (2) distancing from the old home, and (3) appraising personal change in the new home. The authors conclude that these processes deconstruct the personal and cultural sources that cultivate a sense of nostalgia. This article argues that such diffusion or conversely the nurturing of nostalgia is context bound. The immigration stories were gathered by in-depth interviews conducted with forty-three university students who immigrated to Israel from the former USSR in the “big wave” in the 1990s.
Alternative medicine consumption is examined as a paradigm case of postmodern consumption. Content analysis of advertisements and analysis of a survey of purchasers of such medicines demonstrate niche markets delineated by life style, an emphasis on symbolic value rather than use value and the use of such medicines as a means of self-assembly – all features predicted by theorists of postmodern society. However, purchasers are predominantly female, and age and gender distinguish different types of products purchased, purchase is not entirely symbolic and many purchases are made to be consumed by others, making it uncertain whether they are used for self-assembly. These results suggest modifications to theories of postmodern consumption are necessary.
The notion of "social worlds" is used here to refer to a form of social organization which cannot be accurately delineated by spatial, territorial, formal, or membership boundaries. Rather, boundaries of social worlds must be determined by interaction and communication which transcend and cross over the more formal and traditional delineators of organization. The term "social world" is used here to develop a common referent for a number of related concepts which refer to similar phenomena. Thus, social world phenomena encompass that which other sociologists have referred to as: occupational contact networks, invisible colleges, behavior systems, activity systems, and subcultures. After tracing some of the sociological history of social world analysis, a series of concepts are developed which bring together and bind all of the previously mentioned concepts into a systematic whole. Major aspects of individual involvement, structural features of social worlds, levels of social world analysis, and some implications of a social world perspective are presented. In this way, a program for study and unification of related concepts is presented in preliminary form.
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The popularity of alternative therapies in the past two decades has been accompanied by a proliferation of sociological works investigating different aspects of this phenomenon.1,2 A major strand of the literature in ‘the sociology of alternative medicine’, which concerns three social actors: users of alternative therapies; practitioners of alternative therapies; and physicians (the orthodoxy). Research on users of alternative medicine has mainly investigated the causes of people’s use of these modalities and has focused on three questions: Why do people use alternative medicine? Why has alternative medicine become popular in recent times? and, What is the sequence of events that leads to alternative medicine use? Research on alternative practitioners has mainly investigated the issue of professionalization of these practitioners. Research on physicians has mainly investigated: physicians’ views on and professional relationships with alternative therapists; physicians’ views on the efficacy of alternative therapies; the orthodoxy’s views on the knowledge base of these therapeutic systems; and physicians who use alternative techniques. The article argues that a paucity of empirical research is a major weakness of the present state of the sociology of alternative medicine and thus several research possibilities are delineated. Its aim is to provide a critical review of the literature on each of the above topics and suggest future research possibilities.
In seeking to counter the grand narrative of capitalist "progress" with an alternative narrative of its own, ecological theory resounds with the clash of disputed histories. Visions of a better, more sustainable ecological future are tied to a variety of interpretations of the past.
History is deployed to establish what is possible for humanity, or appealed to as a proof that a way of life which once existed before can — if we so will it — be realized again
Discusses legitimation processes characteristic of social worlds: sets of common or joint activities bound together by a network of communication. The activities include discovering and claiming worth; distancing an emergent "social sub-world" from earlier, establishing social worlds; developing theory; establishing standards and modes of judgment; and setting and challenging boundaries. The intersection and segmentation of social worlds are seen as important general conditions for contemporary legitimation problems, and a potentially useful approach to the study of these issues is proposed. (36 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Technology and managed care may have destroyed her spirit.
This article draws upon empirical data from a qualitative study investigating issues around the food choices and preferences of a group of 34 heterosexual cohabiting couples, with and without children living at home, in a rural region of Australia. It explores their everyday food habits and preferences, their notions of a healthy diet and their use of and attitudes towards takeaway food and dining out. The study found that the participants, for the most part, demonstrated a conservatism in their food preferences, lacking the desire for exotica and the gourmand sensibility that characterises members of the metropolitan middle class. The aspects of food they found most pleasurable and valuable were nostalgia, tradition, balance, health, family togetherness and sociality.
In this paper we examine new genetics professionals’ accounts of the social context of their work. We analyse accounts given in interview by an ‘elite’ group of scientists and clinicians. Drawing on the work of Gilbert and Mulkay (1984), we consider interviewees’ discourse about knowledge, exploring the way in which they separate science from society through the use of what we have called the ‘micro/macro split’. We then go on to consider the reasons for such a discursive boundary, exploring the interviewees’ wider discourse about expertise and responsibility for the social implications of the new genetics. We argue that interviewees’ discursive boundaries allow them to appeal variously to their objectivity, to dismiss bad science and to characterize the public as ignorant. However, these discursive boundaries are permeable and flexible, and are employed to support the new genetics professionals’ role in guiding education and government policy, whilst at the same time deflecting ultimate responsibility for the use of knowledge on to an abstract and amorphous society. Responsibility is flexibly embraced and abrogated. These flexible discursive boundaries thus promote rather than challenge the cognitive authority of new genetics professionals as they engage in debates about the social implications of their work. We end by challenging the replication of these discursive boundaries, noting some of the implications of such a critique for evaluation of the new genetics.
Abstract The use of multi-disciplinary health care teams is an increasingly common aspect of service delivery in health care in Western countries. While the literature rehearses the putative benefits to practitioners and clients of such teams, there appears to be an absence of extensive evidence-based research on team practices to substantiate such claims. What evidence there is suggests that team work is in different ways problematic. This article is a progress report on a qualitative research project into the operation of health teams with responsibility for clients in hospitals and the community in New Zealand. The first part of the article presents some of the main themes in current research on health care teams. The second part argues that effective teamwork requires giving attention to a hitherto marginalised dimension of teamwork - the team's reflexive and representational practices. Attention to these practices appears to be particularly important in complex cases or when the team believes that its work with the client is not progressing as well as it might. The article concludes by highlighting the sociological significance of representational issues in team work and by drawing some inferences about factors affecting effective teamwork.
The early leaders of the hospice movement shared a number of attitudes with the founders of the alternative institutions of the 1960s and early 1970s: nostalgia for simple, old fashioned ways, dissatisfaction with bureaucratic and authoritarian institutions, faith in the power of nature, a determination to avoid domination by experts, and a desire to improve the quality of personal relationships. However, as hospices have become better established, they gradually have been incorporated into the dominant health care system and have lost their uniqueness. Some have affiliated with hospitals or home health agencies. Even autonomous organizations are subject to pressures for accommodation because they rely on the established order for resources, personnel, and political acceptance. Organizations receiving payment under the new Medicare benefit must adhere to a set of regulations that may distort the movement. Though creation of this benefit may have been facilitated by increased support for hospice ideals, the government views hospices primarily as a way to save money. Paradoxically, as hospices have grown in popularity, the critical force of the movement has been blunted.
We have outlined some of the characteristics of holistic nursing and have named and explored the concepts that we believe are important to holistic practice. We have outlined assumptions that offer to nursing a more caring and connected way of interacting with clients than currently exists in nursing practice. We do not have answers to the questions of how to implement this practice within the structure of current nursing practice. Occasionally when we discuss these ideas with other nurses, they tell us that nursing as currently practiced in hospitals and community agencies is just the "real world," as though we had better get used to it. Maybe the world that we have presented is the "unreal world," for the moment at least. We are proud to live and learn in this unreal world and in a community of folks who make their living in holistic practice. If we had to make our living working in the "real world" of health care, could we do something to change it before the conflicts drove us away? The concluding question is, "Will nurses use their joint power to build therapeutic environments within nursing, or must they defect from nursing to practice holistic care?"
This article has summarized the overwhelming sociocultural and geopolitical forces that influenced the development of modern nursing in Japan. The irony of Japanese nursing is that modern nursing, first introduced by navy physicians, served the needs of Japanese military efforts and those of physicians who required others to perform menial hospital chores. Because of the harsh realities of nursing in the battlefields or in hospitals, working as a Kangofu was, and is, not compatible with a traditional family life. Like Nightingale, the majority of active Kangofus, especially the leaders in the profession, are unmarried. The major impact of Nightingale on Japanese nurses has been in her role as a spiritual icon, giving nurses the strength to survive in the face of enormous hardship. The true professionalization of nursing in Japan lies on the horizon, 110 years after Nightingale's work was introduced in Japan and 50 years after Japan became a democratic country. Toward this new vision for nursing, I offer the Hokenfu model rather than the traditional Kangofu model, under which Japanese nurses have suffered oppression and discrimination for a century. In conclusion, Japanese nurses should expand their perspective on their profession and seize the opportunity for reform that now tantalizingly presents itself, not only to best serve their patients but also to fulfill their own potential as respected health professionals-potential that is, as of now, unrealized.
Although alternative medicine has achieved an increasingly high profile in recent years, surprisingly little social research has been conducted in the area. This is noticeably the case when considering inter-sectoral contact and collaboration. This paper fills that gap by drawing on evidence from a large-scale study of non-orthodox practitioners in the U.K. By examining the lived experience of interaction the study aimed to discover the level of professional legitimacy which alternative practitioners routinely enjoy or are denied by mainstream practitioners. Results show that the last decade has been characterised by an increasing liberalisation of attitude toward inter-sectoral collaboration throughout the mainstream. However, the evidence also shows that this cannot be equated with the existence of a generalised acceptance of alternative practitioners, professional legitimacy. There is a schism within orthodoxy on this issue and that schism is occupationally based: at the extremes, consultants remain characteristically dismissive of alternative practitioners, nurses overwhelmingly enthusiastic. The nature of the non-orthodox practice being considered was of little significance. It is argued that the identification of differentiation within orthodoxy on this issue marks a significant point in developing an understanding of relations between the "sectors" and its component parts. There is a clear potential for conflicting developmental paths of action between orthodox groups, and for differing conceptions of who and what constitute a legitimate part of the medical totality. Cross-sectoral alignments, which challenge the state sanctioned dichotomy of mainstream/alternative, are viewed in quite different ways throughout orthodoxy. Knowledge of this intra-sectoral differentiation is essential to an understanding of emerging patterns of inter-sectoral relations.
The American public is being overwhelmed with scientific sounding claims for products to be ingested and/or applied to the body that have no research support. To protect ourselves and our patients from potential harm or unnecessarily wasting their resources, we need to be aware of the problem. In addition we need to apply the standards we have learned for critiquing research to the claims made by the purveyors of these products.
Gastroenterology is a relatively new specialty but has roots dating back to 1868. Gabriella and Rudolph Schindler pioneered humane methods of performing gastroscopies with a semiflexible gastroscope that are still used today, including numbing of the throat, instruction about the examination to encourage cooperation, and spoken guidance and encouragement during the procedure. This history is presented to demonstrate the creativity and dedication of the founders of gastroenterology.
Healthcare providers and patients are becoming increasingly aware of the options available with alternative medicine or unconventional therapies. This article analyzes alternative medicine, examines rationale for its existence, and outlines some concerns. The author concludes that nurses must take the lead and become educated about this option in healthcare treatments in order to help patients make informed decisions.
Nightingale's passionate commitment to statistics was based on her faith in a god of order, who created a world that ran by law. God's laws could be known through research, as a result of which suitable interventions to better the world could be applied. Statistics were a vital component in her holistic approach to health care as a system. They served both to indicate serious problems and to assist in policy making, and then again to monitor the effects of the new policies. She pioneered the use of evaluative statistics and saw reforms achieved as a result of her advocacy. This article explores three key aspects selected from Nightingale's more than 40 years of applied statistical work: her adaptation of Quetelet's methodological foundations, the use of statistics in monitoring public health care systems, and her pioneering study of maternal mortality in childbirth.
This paper explores aspects of the controversy and conflict that has arisen within the nursing and medical professions regarding the emergence of nurse practitioners in the United Kingdom (U.K.). Difficulties in establishing satisfactory definitions of nurse practitioners, that allow them to be viewed decisively either within nursing or medical occupational roles, are discussed. The paper argues that the key to the debate may hinge on professional and occupational boundary redefinition which is currently resisted by some members of both the nursing and medical professions. The idea that nurse practitioners may be an evolving and discrete professional group, outside the currently accepted professional and occupational definitions of nursing and medicine, is explored. It is argued that both nursing and medicine are faced with a particular challenge in the nurse practitioner movement that is resulting in conflict as new boundaries are established.
The successes, failures, and ongoing dilemmas within nursing derive directly from the earliest nursing practices. The conflicting requirements between strictly prescribed scientific medical treatment and the nurturing care needed by mothers and infants have shaped the practice of obstetric nursing throughout the past century. The historical challenge, relevant to current practice, is that nurses not become so focused on techniques and routines that they forget the patients' needs for comfort and support.
Acupuncture gained considerable attention in anglophone countries in the 1970s. As part of that popularity many medical practitioners became interested in the therapy and learned acupuncture techniques. A number of studies have indicated that medical practitioners were able to take up the practice of acupuncture without threatening the cultural authority of medicine so long as they limited the scope of its practice and redefined acupuncture concepts in Western biomedical terms. These analyses tend to present the medical profession as monolithic and emphasize a dichotomous relationship between biomedicine and alternative therapies such as acupuncture. This study examines the ways in which acupuncture has been represented in different medical forums, suggesting that in order to understand the relationships between biomedicine and alternative medicine we need to be more aware of the changing nature of these representations and their dependency upon the context of the representation. Rather than emphasizing a duality between orthodox medicine and alternative medicine, it is argued here that there are pluralities of medical and healing worldviews.
The authors examine the problem of defining alternative medicine, and after a brief analysis conclude that a satisfactory unifying definition of the different practices is not possible. Scientific knowledge is a function of scientific method. In turn the principle of falsifiability proposed by Karl Popper is used as a demarcation line between science and pseudoscience. They assert that the various alternative modalities do not represent authentic scientific disciplines, as they lack many of the minimum requirements of scientific discourse and, above all, because they violate the principle of falsifiability. Until they overcome these methodological shortcomings, alternative medical practices cannot become authentic scientific disciplines.
An enhanced role for primary health care (PHC) is currently a matter of political priority in the UK. This higher profile is drawing attention to a range of unresolved challenges and issues, relating to both the structure and content of provision, which currently permeate the system. Running in parallel with this is a recognition that: to date, PHC has been under-researched; that, as a result, our understanding of it is frequently poor; and that, as a consequence, fresh perspectives are needed in order to effectively research this uncertain, evolving and increasingly important healthcare sector. In this paper we argue that social worlds theory (SWT) provides, albeit in a suitably modified form, an ideal conceptual framework for the analysis of contemporary primary care. SWT is an approach which assumes complexity and constant evolution, and its core concepts are directed towards unravelling the consequences of encounters between different interest groups--something which is of particular utility at this time given the increasing attention to user participation, and an ongoing questioning of established patterns of professional authority. It is an approach which has rarely been employed empirically, even beyond medicine. In order to illustrate the wide relevance of the approach, we discuss how it can facilitate research at all levels of PHC: i.e., in relation to aspects of medical practice (the case of medically unexplained symptoms); shifts in service organisation (changing professional roles and the introduction of policy reforms); and issues which straddle both organisation and content (the increasing use of complementary medicine in primary care). In each case the approach is able to embrace the complexity of situations characterised by the intersection of professional and lay social worlds and is able to provide the conceptual tools through which resultant processes can be tracked and investigated.
Consumer interest in and use of complementary/alternative therapies has increased exponentially in the past decades. Although many of the over 1800 therapies have not been used in the delivery of nursing care, a number of these therapies have a long tradition of use in nursing. Additionally, nurses have conducted research on selected complementary therapies. Nursing is in an excellent position to be a leader in integrating these therapies into the Western biomedical health model and in continuing the research that will provide a better scientific base for the use of complementary therapies.
There has been a movement towards integrating complementary and alternative medicine (CAM) into the NHS and a growing number of general practitioners (GPs) are personally practising CAM to treat their NHS patients (direct integrative practice). While research has begun to examine DIP, time constraints and related issues--of importance not only to practitioners but also to those purchasing and planning health care--have not yet received in depth attention. In response this paper examines GP therapists' experiences of the clinical reality of their DIP. The analysis reveals how a lack of time is perceived by GP therapists as a serious constraint upon their CAM practice and also how they employ a number of strategies in an attempt to overcome such difficulties.
Over recent years a sporadic, but not insignificant, sociology of complementary and alternative medicine (CAM) has begun to emerge. However, to date, the systematic sociological study of the apparent affinity between CAM, nursing as a profession and its practitioners has been absent from it. In this paper we argue for the need for a rigorous sociology of nursing and CAM and set out a provisional framework through which this might be operationalized. Three broad themes, as well as cross-cutting issues, are outlined. The way in which the challenges of CAM are mediated at the level of the individual and the profession are pivotal to analysis. An understanding of this mediation is crucial both as a means of extending knowledge, and as a means of engaging with complex issues such as the role of evidence, and the equity of provision, that are likely to accompany any extension of CAM mainstreaming.
Despite the depth of interest in complementary and alternative medicines (CAM) within the nursing community, the intersection between nurses, nursing and CAM has largely avoided sociological analysis. This paper presents findings from one part of an ongoing exploratory study of how nurses present and interpret the apparent affinity of their profession with CAM. A text analysis of papers published from within the nursing community on CAM was conducted. Within the broad area of professional identity, differentiation and development, two dominant themes emerged from the analysis. Firstly, the use of professional distancing to underpin the legitimacy of the nursing/CAM axis; and second, the potential offered by the relationship for a reconstruction of lines of professional authority. As one dimension of the way in which nursing's intersection with CAM is being constructed and perpetuated, the relationship with medicine appears to be of significance and requires further attention.
Beyond simulation: Production and the nostalgia industry
- M Woolley
Woolley, M. (1999). Beyond simulation: Production and the nostalgia industry. SSSP.Net 2, (1), September.
Complementary and alternative medi-cine
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Integrating complementary therapies in mainstream care Complementary medicine: New approaches to good practice
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Integration and paradigm clash: The practical difficulties of integrating two contradictory paradigms
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Coulter, I. (forthcoming). Integration and paradigm clash: The practical difficulties of integrating two contradictory paradigms. In: Tovey, P., Easthope, G., Adams, J. (Eds.), The mainstreaming of complementary and alternative medicine: Studies in social context. London, New York: Routledge.