Emancipatory Practice Research Articles

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.

Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research

This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.

Arts-Based Critical Inquiry in Nursing and Interdisciplinary Professional Education

In this article, transformative educators are encouraged to use an arts-based critical inquiry approach within their diversity-sensitive teaching practice. Using a Socratic dialogue, the authors describe how guided imagery, images, narratives, and poetry have been useful in developing transformative insights in relation to spiritual/ecological values, sexual orientation, and culture in the context of nursing and interdisciplinary professional education. Arts-based approaches that incorporate constructivist dimensions can potentially stimulate critical inquiry in educational settings that can spark the thoughtful dialogue and passion needed for practitioners to engage in emancipatory practices for social change. The underlying adult learning theoretical frameworks for this teaching and learning dialogue are transformative learning and unlearning. Innovative arts-based and experiential approaches to diversity-sensitive teaching nurture the dynamic engagement and individual and collective reflection that fosters interpersonal understanding and hope for meaningful community connections and social change.

More Travels with Herodotus: Tripping over Borders Lightly or “Psychiatric Imperialism”1

The main argument of this book is that there is no global social justice without global cognitive justice. Probably more than ever, global capitalism appears as a civilizational paradigm encompassing all domains of social life. The exclusion, oppression, and discrimination it produces have not only economic, social, and political dimensions but also cultural and epistemological ones. Accordingly, to confront this paradigm in all its dimensions is the challenge facing a new critical theory and emancipatory practices. Contrary to their predecessors, this theory and these practices must start from the premise that the epistemological diversity of the world is immense, as immense as its cultural diversity and the recognition of such diversity must be at the core of the global resistance against capitalism and of the formulation of alternative forms of sociability (de Sousa Santos, 2007, p. xix).

Developing Person-Centred Care: Addressing Contextual Challenges Through Practice Development

Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of developments, a commitment both in clinical teams and across organizations. Contextual factors pose the greatest challenge to person-centredness and the development of cultures that can sustain person-centred care. We will begin with a general comment on 'context' and its meaning before exploring three particular factors that influence the practice context, namely, workplace culture, learning culture, and the physical environment. Next we explore a particular approach to developing person-centred care through emancipatory practice development. We highlight the importance of facilitation through emancipatory practice development programmes and describe how person-centred care can be developed through the presentation of a case study that illustrates the principles and processes of emancipatory practice development as well as the outcomes achieved. We conclude with an application to clinical practice. A key consideration for all organisations in the development of person-centred care is to move from what we suggest are 'person-centred moments' (individual, ad hoc experiences of person-centredness) to 'person-centred care' as an underpinning culture of teams and organisations.

Entre quatro paredes: a questão da liberdade em Sartre doi:10.5007/2177-7055.2010v31n61p147

The work aims to investigate the concept of human freedom and its relations based in the play ‘No Exit’ - Huis Clos – written by the french existentialist philosopher Jean-Paul Sartre (1905-1980). Sartre believed that human existence is inseparable of its own liberty – within the notion of the ontology of being. The concern with individual freedom, present in the early writings of Sartre, gradually gave way to an ethic of caring for collective liberty and its consequent responsibility. To understand the concept of Sartrean freedom in the social-political struggle for human implies a constant come-to-be. It means to seek the possibility of change through a liberating and emancipatory practice to build human dignity.

Social work as a practice of freedom

• Summary: In the second decade of the 21st century, the development of social work is of vital moment. For the past 30 years the social space within which social workers practise has been reduced via the managerial technologies of the neoliberal era. At a time when the parameters of practice are increasingly constrained it is incumbent upon us to critically reconsider the notion that social work is aligned with social justice and human emancipation. In order to champion the voice of social work it is first necessary to examine what it is that this voice has to say: to reflect upon the possibilities intrinsic to social work. • Findings: The following discussion examines the emergence of social work as a child of modernity and the heritage of the Enlightenment. It is contended that the development of social work has mirrored contradictions inherent to modernity. It is argued that social work is characterized by a particular interstitial positioning that offers a unique experience of these contradictions. The conflicted nature of practice can generate resilient action for both workers and clients, and potentially facilitates processes of resistance and change, individually and socio-politically. • Applications: An appreciation of the epistemic possibilities of social work may help inform a commitment to emancipatory practice. Recognition of the unique vision that social work has to offer represents the unrealized potential of the social work project. The development of effective organization and advocacy to this end remains the challenge for theory, practice, and education in the coming decade.

Starting a care improvement journey: focusing on the essentials of bedside nursing care in an Australian teaching hospital

To evaluate and improve patient assessment practices, care practices, recognition of patient deterioration and communication in the acute ward environment. A growing recognition of patient safety-related concerns in acute hospitals, a nursing shortage and a reduction in availability of skill and experience levels at the bedside led a group of clinicians to explore the issues that impacted on patient care at a ward level within their organisation. Multimethod practice development study. This paper reports phase one of concept development. A practice review was conducted using clinical audit processes that examined practice and documentation in relation to patient assessment parameters and care planning, specifically identifying whether changes in clinical parameters were identified and acted on. Results highlighted a clear discrepancy between the care that was identified on the nursing care plan and the care the patient was receiving. Actions as a result of the disappointing audit results included changes to education programmes, strategies to improve critical discussion regarding clinical practices and the development of assessable domains of nursing care that were relevant and realistic to ward-based nurses. The results enabled the identification of eight domains of care and associated care outcomes that target strategies for care improvement. Emancipatory practice development methodology will be used to further progress this work and ensure successful implementation into clinical units. This paper examines the critical discussions, audit processes and actions that took place, leading to the development of care outcomes for nurses.

Valuing equality in Irish social care

In this article the author critiques Irish social care by presenting an equality perspective on practice. An equality perspective involves developing emancipatory practices, that is, ways of helping that provide egalitarian solutions and outcomes. Although emancipatory values are often contrasted with traditional social care values, the author seeks a pragmatic and integrated approach to emancipatory practices rather than a restatement of traditional dichotomies. Emancipatory practice begins with an appreciation of the nature and relevance of inequalities on the lives of diverse social care users. Building a commitment to equality within social care education and practice is an important step in altering many individual and institutional social care practices by focussing on equality processes and outcomes as central social care objectives. Using a well credited framework that outlines five dimensions of inequality (Baker, Lynch, Cantillon and Walsh, 2004), the author argues that social care educators and practitioners need to debate the issues raised and develop emancipatory practices.

Developing person‐centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people

To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the 'Person-Centred Nursing Index'. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on 'technical' aspects of care, to one where 'intimate' aspects of care were more highly valued. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships.

Constructions of dignity: a pre‐requisite for flourishing in the workplace?

To explore the relationship between nurses' understanding of dignity and how it is enhanced and developed in their practice environment. Dignity is a ubiquitous concept in an era of healthcare reform yet is referred to almost exclusively in terms of the quality of care delivered to support the experience of the patient rather than the caregivers engaged in the relationships of care. This article focuses on dignity in the professional life of nurses in aged care. This is part of a doctoral study of the implementation of a palliative approach in residential aged care using emancipatory practice development methodology. Constructions of dignity were co-created with participants through creative reflective activities and subsequently analysed using reflexive methods and data from other sources within the study. Constructions of dignity and subsequent actions taken by nurses on their own behalf to articulate their experiences of transforming practice are interconnected with dignity enhancing relationships and emancipatory ways of working in practice development. Dignity enhancing ways of working in an active learning group and workplace have been interlinked with actions that promote person-centredness in developing a palliative approach to care.

Reflexivity as a Ground-Clearing Activity Within the Context of Early Years’ Pedagogy

The article concerns itself with the struggles that are prompted by the question, “What is my position as a teacher who whilst wanting to pursue emancipatory practices nevertheless is fearful of finding herself supporting and perpetuating normalizing structures?” An extract drawn from a journal entry serves as a base on which a series of reflexive readings are rehearsed. These have spanned over a period of time (2000-2009) and, as a consequence, convey the theoretical vantage points that have been used to create conceptual openings where there are possibilities for thinking “differently.” Both practices of deconstruction (Derrida) and anthropological work on purification rites (Douglas and Kristeva) are used to shift the means with which the author makes sense. Overall, the article depicts an individual’s attempts at creating a becoming space, where thinking and doing may be a little less bounded.

Grassy Narrows Blockade: Reworking Relationships between Anishnabe and Non-Indigenous Activists at the Grassroots

The case example of Grassy Narrows argues that the localized experiences and discourses between Grassy Narrows First Nation ‘blockaders’ and non-Indigenous ‘activists’ reflected constrained and emancipatory practices of transforming various forms of asymmetrical power between them. Both a process and an outcome of negotiated understandings, collaboration and trust delineated by solidarity, the case of the Grassy Narrows First Nation (GNFN) blockade offered examples of grassroots practices for wider social change. In this case study, it was the negotiation from a marginalized position too often accorded the ontologies and epistemologies of one group—in this case, GNFN (Anishnabe peoples)—, and repositioning (privileging) it as the centre point of practice and leadership vis-a-vis another group (non-Indigenous activists). The case example asked what could be learned from a grassroots situation where differently situated parties have different privileges/status at the structural (macro) level but choose to attempt to renegotiate these at the local level. It suggested that transforming of larger social relations of power began at the local level through inverting/disabling unequal past practices and that in doing so, offered a counter point to established relations of power.

Power relations in IT education and work: the intersectionality of gender, race, and class

PurposeSocial exclusion as a result of gender, race, and class inequality is perhaps one of the most pressing challenges associated with the development of a diverse information technology (IT) workforce. Women remain under represented in the IT workforce and college majors that prepare students for IT careers. Research on the under representation of women in IT typically assumes women to be homogeneous in nature, something that blinds the research to variation that exists among women. This paper aims to address these issues.Design/methodology/approachThe paper challenges the assumption of heterogeneity by investigating how the intersection of gender, race, and class identities shape the experiences of Black female IT workers and learners in the USA.FindingsThe results of this meta‐analysis offer new ways of theorizing that provide nuanced understanding of social exclusion and varied emancipatory practices in reaction to shared group exposure to oppression.Originality/valueThis study on the under‐representation of women as IT workers and learners in the USA considers race and class as equally important factors for understanding variation among women. In addition, this paper provides rich insights into the experiences of Black women, a group that is largely absent from the research on gender and IT.

An evaluation of nurse engagement in emancipatory practice development: The diary of a critical companion

AbstractThere is a paucity of research in the area of nurse engagement in the process of practice development. Little is published about the sequencing of engagement with consent and pre‐measures in a research project. It has, however, been recognized that without engagement, development of one's practice, and subsequently health service change, would be minimal. This article reports on nurse engagement in the first six weeks of the implementation of a new model of care in two correctional service health care settings. Copyright © 2009 John Wiley & Sons, Ltd.

Professing nursing as an emancipatory practice: A response to Betts, C.E., The critical practice of professing nursing: A contribution to the professors of nursing debate, Nurse Education in Practice (2008), doi:10.1016/j.nepr.2008.08.001

I read with interest the latest instalment in the ongoing debate that followed from Thompson and Watson’s editorial on the role of the professor of nursing (Thompson and Watson, 2006). Betts, who originally penned an editorial in response to theirs, takes issue in his latest paper (Betts, 2008) both with Thompson and Watson and also with my reply to them (Rolfe, 2007). Unsurprisingly, I find myself in broad agreement with Betts; indeed, my only real cause for disagreement is with his assertion that we disagree. I should perhaps add as a caveat that it depends on which Betts I am referring to, since his original editorial (Betts, 2006) and his later paper (Betts, 2008) are so widely divergent, and even contradictory, that I am beginning to suspect that there might be two Clinton Betts at McMasters University.

Making practice visible: The Workplace Culture Critical Analysis Tool (WCCAT)

AbstractEmancipatory practice development has a key focus on changing the culture of practice to enable more person‐centredness to be developed in the care unit (ward, department or clinic). However, getting ‘inside’ the prevailing practice culture can be challenging and complex and it can be difficult to determine the specific aspects of culture that need to be addressed in a development programme. One way of doing this, and a key process of practice development, is observation of practice. However, many of the tools available for the observation of practice are inconsistent with the philosophy and values underpinning emancipatory practice development, i.e. they tend towards ‘judgement’ of quality rather than the facilitation of engagement. The WCCAT has been developed as an observation tool consistent with the philosophy and values of emancipatory practice development and is a facilitative process. In this paper we set out the framework underpinning the WCCAT, the phases involved in undertaking an observation and examples of how to use the tool in practice. An initial evaluation of the use of the tool by practice development facilitators is also provided. Copyright © 2009 John Wiley & Sons, Ltd.

Post Abortion Syndrome is a Clinical Reality: A Critical and Methodological Reflection on the Politics, Biology and Phenomenology of Unwanted Pregnancy and Abortion

Macleod (2009) criticizes Boulind and Edwards (2008) for using the concept of post-abortion syndrome (PAS) in their conceptualization of the case of Grace. This article responds to this by arguing the following points: 1) the appropriation of PAS into anti-abortion rhetoric is not sufficient reason to abandon it since this rhetoric distorts the facts, 2) methodological difficulties cited by Macleod in identifying the nature of the distress experienced by some women post-abortion are an artifact of the use of multivariate statistical methods which are not appropriate for answering these questions; 3) the well documented process of maternal foetal attachment, which has a neurobiological basis, shapes a pregnant women's experience of the foetus in the direction of experiencing it in personal terms; 4) the incorporation of this into the clinical concept of PAS carries no implications about foetal personhood; 5) there is considerable documentation of the loss of a foetus being experienced as a bereavement by some women and giving rise to a traumatic grief response; 6) there is a difference between a formal diagnosis in a diagnostic manual and a clinical syndrome which can guide case formulation. It is concluded that the presentation of the case of Grace, rather than offering evidence that supports a pro-life stance on abortion, is an example of the kind of emancipatory theory and practice that is advocated by Macleod.

Using focus groups to give voice to school underachievers

This paper analyses discourses on school failure of gymnasium students. Research strategy for establishment of dialogue with students is focus group. The method of analysis of the material obtained in the conversations with students is discourse analysis. First, two dominant strategies of focus group usage are discussed: as means for collecting data from subjects and as a social emancipatory practice. The prevailing discourses about school failure of students are mapped: the discourse of school as an insecure investment, the discourse of school marginalisation, the discourse of disinterest of students, the discourse of disinterest of teachers and the discourse 'school success does not have an alternative'. The concluding part discusses research implications on social position of students in power relations in education.

Human Rights Practice: Possibilities and Pitfalls for Developing Emancipatory Social Work

This paper seeks to analyse the contribution of a human rights perspective to emancipatory social work. Human rights practice builds on long-standing values and theoretical frameworks related to emancipatory, radical and structural social work and anti-oppressive practice. However, historical tensions within social work, notably in the United Kingdom, continue in contemporary forms, magnified by the global impact of neo-liberalism. The paper considers connections between human rights and other frameworks, including professional codes; ethical critiques drawing on feminist and indigenous perspectives; the articulation of human rights with social justice; and the strength of a rights-based approach demonstrated by community campaigns and service-user movements. It also addresses discontinuities between human rights and trends in social work and the wider context, including managerialism, privatization, and the consumerization of rights; unexamined rhetoric and limited regulatory interpretations; the dangers of rights being interpreted and imposed from dominant and/or Western perspectives; and the complexities of universal versus culturally specific rights claims. Drawing on the struggles of oppressed groups, the paper argues that a more critical and informed focus on human rights can be a further potentially powerful tool contributing to resistance to oppression, collective solidarity and the promotion of emancipatory change.