Mid Sweden University

Aim: The aim of this article was to introduce Fairclough's critical discourse analysis (CDA) in caring and nursing science, to provide a guide on how to perform such an analysis, and to describe the wider context of discourse epistemology. Design: The article is designed as a methodological paper, including (a) epistemological roots of discourse analysis, (b) an overview of discourse analytical research within caring and nursing science which points out an increased trend, and (c) a guide to conducting a CDA. Analysis: It is important that discourse analysis is available and accessible to nursing and caring researchers. Through the process of encircling discourses, valuable insight is given into fields that otherwise would be lost or would not be available. Conclusion: Our summary stance is that discourse analysis as it is presented in this article is strongly advisable for use in nursing and caring sciences. 

Background: Campus-based clinical learning centres are used for practice and learning in nursing students' education and can be arenas in which to enhance students' awareness and competence in social justice issues. Norm-critical approaches can be used as pedagogical tools in these centres to prepare students for hands-on caring situations in which social norms can bias the outcome. Objectives: To describe nursing teachers' conceptions of learning norm-critical approaches and implementing them in a clinical training centre. Setting and participants: The study is based on interviews with 10 teachers at a Swedish university college. Methods: The data was analysed using a phenomenographic approach. Results: Five categories of description emerged in the analysis that described conceptions related to norm-critical approaches. These categories were: personally developing and meaningful; easily integrated with established nursing concepts; highlighting surrounding power; something to lean on when letting students take the first steps in norm-critical initiatives; and helping implementation in teaching and education. Conclusions: Teachers who are facing the task of providing norm-critical, practical education to nursing students in campus-based clinical learning environments are ambivalent towards the core principles of norm criticism, which they conceive as natural and provoking, at the same time. We therefore need to un-dramatise norm criticism and better prepare teachers in how to use it. Teachers would benefit from follow-up activities and formal collaborations regarding norm-critical teaching, so that they are given context to discuss, reflect, and learn from each other. 

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus-based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyond nursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre.” The case study indicates that the incorporation of norm criticism into a campus-based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus-based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics. 

In this article, we explore the core concepts of norm-critical pedagogy developed in Sweden and only recently applied to nursing education praxis. These concepts, norms, power, and othering, are defined and demonstrated with exemplars from recent nursing education research. The theoretical model illustrates the ways in which these elements articulate in relationship to each other in nursing education praxis in ways that are dynamic, interlocking—like the gears of a clock—and resistant to interruption. We discuss the potential of a structurally oriented critical reflexivity—an equal and opposite force to the motion of the gears—to interrupt their motion.

Studies have reported that men’s uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and “tailored for women”. They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men’s sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men’s sexual health in SHC. 

We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the “right” decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses

Health care professionals’ (HCPs) notions about gender may influence the provision and quality of care. If care-seeking men are met by HCPs holding idealized and stereotypical notions of masculinity, this could reinforce barriers to adequate care. This study explored notions about men and masculinities among HCPs working with men’s sexual health in Sweden. Focus group interviews with 35 HCPs from primary health and sexual health clinics were analyzed using qualitative content analysis. The analysis resulted in three descriptive themes: (a) Contradictory masculinity—elusive but clear. Notions of masculinity as a phenomenon or concept were elusive, but masculine and un-masculine traits, behaviors, and qualities were clear. (b) Sexual health care is a social place where men and masculinities can be challenging. Male patients were associated with unwanted sexual tensions. Masculinity could challenge professionality. Seeking sexual health care was perceived as doing un-masculinity. (c) Regarding masculinity as irrelevant—a difficult ambition to achieve. Participants strived for gender-neutrality by regarding patients as humans, individuals, or patients rather than as men and masculine. The analysis also identified a theme of meaning: Notions of masculinity are situated relationally. HCPs situate masculinity in real and hypothetical relationships. Romantic and sexual preferences were used to define preferred masculinity. This study identified themes that showed how HCPs balanced professional and private notions of men and masculinity in their patient encounters. Increased gender awareness and training are needed to professionalize the management of gendered notions in encounters with men who seek care for sexual health problems.

PURPOSE: Understanding of the capacity to work among employees with common mental disorders (CMDs) is important, but contemporary knowledge on this issue lacks the managers' perspective. The aim of this study was to explore and describe managers' experience-based understanding of capacity to work in employees with CMD.

METHODS: A qualitative focus group study was designed. Managers with experience in supporting employees with CMD were recruited via organizations and networks. Eight focus group interviews with 31 participants took place.

RESULTS: The analysis resulted in five categories. (1) Capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) Capacity to commit to continuous and coherent task changes, making tasks that span longer periods of time difficult. (3) Capacity to independently adapt to the needs of the situation decreases, and employees need more guidance and instructions than usual. (4) Capacity to keep up professional appearances is reduced, and the employees struggle with the professional role. (5) Ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace.

CONCLUSIONS: This study adds managers' perspective to the increasing knowledge on how capacity to work is influenced by CMDs. Managers understand CMDs in employees as changed, reducing the capacities needed for occupational functioning. A deeper understanding of reduced capacity to work is needed to adapt workplaces, and our findings can facilitate work accommodations for employees with CMDs.