Exploring nursing expertise: nurses talk nursingIt has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence‐based practice. The material presented within this article has been interpreted drawing from discourse analysis1to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (...) (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants’ clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse–patient relationship, ‘maverick’ nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a ‘catalyst’ that alters treatment pathways and maximizes patient‐centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non‐conventional practice that in itself can be isolating and challenging to the status quo of contemporary health‐care. (shrink)

This paper is a review of the experiences gained whilst working with the ‘expertise in practice project’. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice‐based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people (...) who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners’ concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient‐participants’ role as a sophisticated evaluator of health‐care. As a result, we present a case for transformational qualitative research. Such research is values‐driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its ‘ends’ (i.e. research products) but also, intentionally, through its ‘means’ (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self‐reflection) to examine and critique their personal values. (shrink)

Drawing on calls by researchers to examine corporate scandals involving potential conflicts of interest or compromise to professional independence involving the actuarial profession, this article outlines one such case. The consulting actuaries – to a large Australian listed company, James Hardie Industries Limited – found themselves advising two parties in a corporate restructuring where the interests of each were sometimes competing and the interests of the public appeared to be ignored. The James Hardie case is instructive in a number of (...) ways: first, it demonstrates the subtlety with which conflicts of interest or pressures on professional independence can arise; second, it demonstrates how important professional issues can be obfuscated by more obvious and pressing financial and strategic issues; and finally it demonstrates that adherence to professional codes of conduct and the ease with which professional ethics can be compromised when those codes are vague and transgressions are rarely actionable. The James Hardie case highlights structural issues in the employment of consulting actuaries which presents risks to the profession. It demonstrates that the combination of an aggressive corporate management with a strategic agenda reliant on consulting actuaries that have a vested interest in promoting and maintaining valuable relationships, both financially and professionally, results in ethical challenges. (shrink)

Drawing on calls by researchers to examine corporate scandals involving potential conflicts of interest or compromise to professional independence involving the actuarial profession, this article outlines one such case. The consulting actuaries – to a large Australian listed company, James Hardie Industries Limited – found themselves advising two parties in a corporate restructuring where the interests of each were sometimes competing and the interests of the public appeared to be ignored. The James Hardie case is instructive in a number of (...) ways: first, it demonstrates the subtlety with which conflicts of interest or pressures on professional independence can arise; second, it demonstrates how important professional issues can be obfuscated by more obvious and pressing financial and strategic issues; and finally it demonstrates that adherence to professional codes of conduct and the ease with which professional ethics can be compromised when those codes are vague and transgressions are rarely actionable. The James Hardie case highlights structural issues in the employment of consulting actuaries which presents risks to the profession. It demonstrates that the combination of an aggressive corporate management with a strategic agenda reliant on consulting actuaries that have a vested interest in promoting and maintaining valuable relationships, both financially and professionally, results in ethical challenges. (shrink)

A philosophically useful account of social structure must accommodate the fact that social structures play an important role in structural explanation. But what is a structural explanation? How do structural explanations function in the social sciences? This paper offers a way of thinking about structural explanation and sketches an account of social structure that connects social structures with structural explanation.

Recent work on social injustice has focused on implicit bias as an important factor in explaining persistent injustice in spite of achievements on civil rights. In this paper, I argue that because of its individualism, implicit bias explanation, taken alone, is inadequate to explain ongoing injustice; and, more importantly, it fails to call attention to what is morally at stake. An adequate account of how implicit bias functions must situate it within a broader theory of social structures and structural injustice; (...) changing structures is often a precondition for changing patterns of thought and action and is certainly required for durable change. (shrink)

The terms ‘structural injustice’ and ‘systemic injustice’ are commonly used, but their meanings are elusive. In this paper, I sketch an ontology of social systems that embeds accounts of social structures, relations, and practices. On this view, structures may be intrinsically problematic, or they may be problematic only insofar as they interact with other structures in the system to produce injustice. Because social practices that constitute structures set the backdrop for agency and identity, socially fluent agents reproduce the systems, often (...) unknowingly and unintentionally. The account aims to capture how agents both depend on and enact structures, and do so in ways that, as Ta-Nehisi Coates says, ‘land on the body’. (shrink)

Journal of Social Philosophy, EarlyView.

Bell inequalities play a central role in the study of quantum nonlocality and entanglement, with many applications in quantum information. Despite the huge literature on Bell inequalities, it is not easy to find a clear conceptual answer to what a Bell inequality is, or a clear guiding principle as to how they may be derived. In this paper, we introduce a notion of logical Bell inequality which can be used to systematically derive testable inequalities for a very wide variety of (...) situations. There is a single clear conceptual principle, based on purely logical consistency conditions, which underlies our notion of logical Bell inequalities. We show that in a precise sense, all Bell inequalities can be taken to be of this form. Our approach is very general. It applies directly to any family of sets of commuting observables. Thus it covers not only the n-partite scenarios to which Bell inequalities are standardly applied, but also Kochen-Specker configurations, and many other examples. There is much current work on experimental tests for contextuality. Our approach directly yields, in a systematic fashion, testable inequalities for a very general notion of contextuality. There has been much work on obtaining proofs of Bell's theorem “without inequalities” or “without probabilities.” These proofs are seen as being in a sense more definitive and logically robust than the inequality-based proofs. On the hand, they lack the fault-tolerant aspect of inequalities. Our approach reconciles these aspects, and in fact shows how the logical robustness can be converted into systematic, general derivations of inequalities with provable violations. Moreover, the kind of strong non-locality or contextuality exhibited by the GHZ argument or by Kochen-Specker configurations can be shown to lead to maximal violations of the corresponding logical Bell inequalities. Thus the qualitative and the quantitative aspects are combined harmoniously. (shrink)

This paper offers an account of ideology in terms of social meanings. Such meanings - constituting a cultural technē - are public, conflicting, and fragmented; yet because they guide our practices, they frame our agency and identities. A cultural technē is ideological when it perpetuates unjust subordination; ideology critique offers liberating alternatives.

Hegels Enzyklopadie der philosophischen Wissenschaften, deren erste Version im Jahre 1817 erschien, hat noch immer mit Vorurteilen gegen den sich in ihr bekundenden Wissens- und Erkenntnisanspruch zu kampfen. Der Frage freilich nach den systematischen Grunden, aus denen Hegel dem Enzyklopadie- wie auch dem Systemgedanken von Beginn seiner philosophischen Laufbahn eine zentrale Bedeutung beigemessen hat, ja fur ihn Philosophie wesentlich Enzyklopadie sein musste, wird eher selten nachgegangen. Die Beitrage des vorliegenden Bandes wollen im Ausgang primar von der Enzyklopadie von 1817 zunachst (...) Anspruch und Sinn des Hegelschen Enzyklopadiegedankens klaren. Dem folgen Einzeluntersuchungen zu logischen, natur- und geistphilosophischen Themen, wie sie von Hegel enzyklopadisch aufbereitet worden sind; ein gewisser Schwerpunkt liegt hierbei auf Hegels Praktischer Philosophie. Den Abschluss bildet ein Beitrag aus erster Hand zur Entstehung der kritischen Ausgabe von Hegels Werken. (shrink)

“Female sexual dysfunction” is the type of contested disease that has sparked concern about the role of the pharmaceutical industry in medical science. Many policies have been proposed to manage industry influence without carefully evaluating whether the proposed policies would be successful. We consider a proposal for incorporating citizen stakeholders into scientific research and show, via a detailed case study of the pharmaceutical regulation of flibanserin, that such programs can be co-opted. In closing, we use Holman’s asymmetric arms race framework (...) as a tool for evaluating policies in industry-funded science. (shrink)

Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant (...) within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate. (shrink)

ABSTRACTThis paper compares Margaret Archer’s morphogenetic critical realism and Michel Foucault’s implicit discursive realism. It argues that there is a surprisingly high degree of correspondence between the two social ontologies. Specifically, both ontologies suggest that there are three largely autonomous domains in operation: cultural, structural, and agentive. Yet, while each of these domains have a level of independence, yet they are also partially constituted by the content and form of the others. This paper discusses the potential to integrate the two (...) approaches in such a way as to overcome their respective short-comings, namely the underdevelopment of culture in Archer’s ontology, and the underdevelopment of social agency in Foucault’s ontology. (shrink)

It is a great honor to have such excellent commentary on my book, and I am happy to have the opportunity to discuss these issues with others who have done such important work on the topics. I will reply to the commentaries separately, beginning with the critique by Charles Mills (2013) and moving on to Karen Jones’s (2013). Reply to MillsRevisiting my projectMills considers four views that pose challenges to my account of race as a hierarchical social category.(1) Kitcher (2007) (...) and Andreasen (1998) (and others) argue that there is a biological reality to race. If, as I argue, it is not helpful to draw a sharp boundary between the social and the natural, should we embrace their framework and allow that race is both social and biological? Or is biologism’s history too troublesome for that? Am I implicitly committed to a problematic naturalism about race myself, given that I embrace a broad naturalism?So a remapping of this contrast would be something like the “natural” unmediated by hum .. (shrink)

Simone de Beauvoir offers one of the most interesting philosophical accounts of childhood, and, as numerous scholars have argued, it is one of the most important contributions that she made to existentialism. Beauvoir stressed the importance of childhood on one's ability to assume one's freedom. This radically changed how freedom was construed for existentialism. Rather than positing an adult subjectivity that tries to flee freedom through bad faith, Beauvoir's account forces a recognition of a situated freedom that itself is also (...) developmentally achieved. In this article, I explore the influence of Jean-Jacques Rousseau on Beauvoir's discussion of childhood. By reading Beauvoir through Rousseau — who was one of her favorite authors — we see not just one but two accounts of childhood in Beauvoir's philosophical work. On the one hand is the idealistic childhood wherein the child is an apprentice to freedom. On the other is the constrained childhood whose product is apprenticed to the serious. I begin with a brief summary of Rousseau's Emile. Next, I offer some justification for reading Beauvoir alongside Rousseau before offering an account of Beauvoir's discussion of childhood. I end by exploring some of the implications of my reading for freedom. (shrink)

The paper indicates how social kinds may be internally and objectively unified in a way continuous with physical kinds. It argues that the practice of theorizing is continuous with other practices to the extent that theorists, like anyone engaged in a practice, needs to make choices that are responsive to purposes (and corresponding values) guiding the practice. The paper discusses Epstein's theory of anchoring, and argues for a theory of scaffolding social kinds.

Causal modelling provides a powerful set of tools for identifying causal structure from observed correlations. It is well known that such techniques fail for quantum systems, unless one introduces 'spooky' hidden mechanisms. Whether one can produce a genuinely quantum framework in order to discover causal structure remains an open question. Here we introduce a new framework for quantum causal modelling that allows for the discovery of causal structure. We define quantum analogues for core features of classical causal modelling techniques, including (...) the causal Markov condition and faithfulness. Based on the process matrix formalism, this framework naturally extends to generalised structures with indefinite causal order. (shrink)

Using relations of solidarity in global contexts, this article explores some of the debates about what constitutes solidarity. Three primary forms of solidarity are discussed, with particular attention to the different nature of the solidaristic relations and their moral obligations.

In Re D is the most recent in a line of cases to raise problems with the determination of legal fatherhood under s.28(3) of the Human Fertilisation and Embryology Act 1990. The judgments in In Re D are interesting in particular because they demonstrate the growing currency of the idea that a child has a right to ‘genetic truth’. They also further evidence the ‘fragmentation of fatherhood’. This case is best understood as part of a complex and ongoing negotiation of (...) men’s role in the family in the light of shifting family forms. (shrink)

How should we explore the relationship between race and educational opportunity? One approach to the Black-White achievement gap explores how race and class cause disparities in access and opportunity. In this paper, I consider how education contributes to the creation of race. Considering examples of classroom micropolitics, I argue that breakdowns of trust and trustworthiness between teachers and students can cause substantial disadvantages and, in the contemporary United States, this happens along racial lines. Some of the disadvantages are academic: high (...) achievement is more difficult when one faces mistrust, ego depletion, effort pessimism, and insult. And within a knowledge economy, exclusion from knowledge work makes one vulnerable to injustice. But the problem goes deeper than achievement, for schools are contexts in which we develop self-understandings and identities that situate us as members of society. If students of color are systematically denied full participation in trusting conversations that create shared knowledge—especially, knowledge that holds power within the dominant culture—they are unjustly deprived resources to form flourishing selves that are suited to the positions of power and authority. The argument suggests that knowledge is not best understood simply as a commodity to be distributed, and opportunity is not just a matter of access. Moreover, even if access is granted, those who are motivated and talented can fail: they drain their willpower by coping with insults, or reasonably lose optimism about their efficacy. Over time, motivation may shift away from achievement, and under the circumstances this can be a rational response. The barriers to achievement are many, but true opportunity is impossible without trust and trustworthiness. (shrink)

Effective interprofessional collaboration depends upon establishing understanding that respects differences in values and beliefs, and thus differences in response to the multiplicity of patient/client/user needs. To facilitate the latter, this article suggests that health and social care students need a formal knowledge of the meaning of values and the varieties of systems within which values are expressed. Students need especially to understand the genesis of their own professional value system and to recognize the gap that inevitably develops between the values (...) of the professional and those of the society within which a professional may function. The conceptual framework that underpins the approach to teaching values to health and social care professionals advocated here is derived from key concepts identified from the literature relating to education for, and participation in, a democratic, multicultural, multifaith society. These are: tolerance, compromise and education for dialogue. Finally, it is suggested that professional educators must take seriously the tasks of educating for professional pluralism. (shrink)

English summary: This book is both a study about the Socratic-Platonic conception of a good life, and an analytical study on self-knowledge, self-determination, and moral motivation.

Costa and Shrapnel have recently proposed an interventionist theory of quantum causation. The formalism generalizes the classical methods of Pearl and allows for the discovery of quantum causal structure via localized interventions. Classical causal structure is presented as a special case of this more general framework. I introduce the account and consider whether this formalism provides a causal explanation for the Bell correlations.

Bioethics has begun to see the revaluation of affects in medical practice, but not all of them, and not necessarily in the sense of affects as we know them. Empathy has been accepted as important for good medical practice, but only in a way that strips it of its affectivity and thus prevents other affects, like sympathy, from being accepted. As part of a larger project that aims at revaluing the importance of affectivity in medical practice, the purpose of this (...) paper is to develop a clinical sympathy that can serve as a trainable skill for medical professionals. While everyday sympathy may be problematic as a professional skill for physicians, this does not imply that sympathy should be entirely rejected. As a natural part of our moral psychology, sympathy is an intersubjective affect that aids in our interactions with others and our decision-making abilities. I present here a theory of clinical sympathy as an affective response to patients, in which physicians are both attuned to their affective response and understand how their affects are influencing their beliefs and judgments. In this way, clinical sympathy serves as a trainable skill that can aid physicians in their interactions with their patients. (shrink)

In response to commentaries by Esa Díaz León, Jennifer Saul, and Ra- chel Sterken, I develop more fully my views on the role of structure in social and metaphysical explanation. Although I believe that social agency, quite generally, occurs within practices and structures, the relevance of structure depends on the sort of questions we are asking and what interventions we are considering. The emphasis on questions is also relevant in considering metaphysical and meta-metaphysical is- sues about realism with respect to (...) gender and race. I aim to demon- strate that tools we develop in the context of critical social theory can change the questions we ask, what forms of explanation are called for, and how we do philosophy. (shrink)

It is somewhat of a mystery why one of Foucault's most important concepts—that of ‘dispositif’—is still quite vague in social and political theory; and while a small number of analyses have moved understanding forward, it remains stubbornly opaque. This paper argues that a strengthening of Foucault's concept can be achieved by (i) integrating elements of Althusser’s formulation of a dispositif (with its links to aleatory (‘chance’) events), and (ii) a detailed examination of the shared conceptual history between dispositifs and discursive (...) formations. Regarding (i), the paper contends that dispositifs restrict three types of aleatory event: first, a ‘continuous present’ exerted upon objects and subjects; second, overdetermining repetitious occurrences; and third, negating the effects of unexpected aleatory events. The paper also argues that dispositifs are capable of producing certain forms of aleatory change. Regarding (ii), four developmental thresholds of dispositifs are identified: strategic emergence, political elaboration, overdetermined a priori, and aleatory dominance. These two developments are argued to move Foucault's concept from being descriptive and largely passive to becoming a more theoretically active resource—what Deleuze terms changing the analytical (i.e. analysis of the past) to the diagnostic (i.e. interrogation of the present). (shrink)

A modest opposition to the brain disease concept of addiction has been mounting for at least the last decade. Despite the good intentions behind the brain disease rhetoric – to secure more biomedical funding for addiction, to combat “stigma,” and to soften criminal approaches – the very concept of addiction as a brain disease is deeply conceptually confused. We question whether Lewis goes far enough in his challenge, robust as it is, of the brain disease concept. For one thing, the (...) notion that addiction is a disease is challenging to refute or confirm because the disease concept itself is poorly defined in medical and psychological nosology. More important, quibbling over what kind of disease addiction is unlikely to be productive. The rational response to adjudicating whether addiction is a brain disease is not to engage in potentially fruitless debates over the question of disease classification but rather to view addiction as an enormously complex set of behaviors that operate on several dimensions, ranging from molecular function and structure and brain physiology to psychology, the psychosocial environment, and social and cultural relations. (shrink)

The purpose of this qualitative case study is to understand and critique the gendered political processes in the search for an athletic director following a merger between men’s and women’s intercollegiate athletic departments in a U.S. university. Semi-structured interviews were used to ask 55 athletic department stakeholders their perceptions of the search process and associated politics. Findings indicated gendered political activities occurred along gender-affiliated departmental lines. Political strategies contributed to gendered processes favoring certain masculinities and male candidates in the search (...) for an athletic director. While gender equity was an important consideration in the search process, because of the controversial nature of the merger and the politics expressed, the belief that hiring a man was essential to the merger’s success was widely accepted by many stakeholder groups. The findings are positioned in the critical management and sport literature. This research contributes to our understanding of the complexity of gender relations and provides insight into the gendered political processes that inform leadership searches. (shrink)

Nursing practice in correctional settings is ethically unique. Its premise is the contradiction between causing harm (the purpose of imprisonment) and acting for patients’ good (the purpose of health care). I describe three ethical regions in which correctional nurses can practise, based on different philosophies: punishment as retribution, as rationality, and as paradox. Retribution and rationality resolve the ethical contradiction by relegating offenders to intractable otherness. Restorative nursing based on paradox is an oppositional practice that preserves the contradiction, making engagement (...) possible between prisoner and nurse. Endorsement by nursing of one of the three philosophies of punishment could redefine care for the entire profession. (shrink)