Neoliberalism and the government of nursing through competency‐based education

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally.     

Governmentality, student autonomy and nurse education

Title. Governmentality, student autonomy and nurse education. Aim. This paper is a report of a study to explore how governmental practices operated in nurse education. Background. Since the 1980s nurse education internationally has been strongly influenced by educational theories that aim to promote student autonomy by encouraging self‐direction and critical thinking. Newer curriculum models advocate transformative approaches leading to greater emancipation, social equity and inclusion. Although these changes have been positively evaluated there had been limited critical research on how student behaviour is governed. Method. A discourse analytic study was conducted from 2000 to 2004 using interviews (n = 30) with a purposive sample students and teachers in one United Kingdom university. Data were also collated from the course curriculum and student handbook for the students’ programme. Data were analysed to identify how student behaviour is governed. Findings. Two governing practices are described: control and technologies of the self. These practices contribute to an overall system of governing student behaviour that creates tension between the avowed progressive empowerment discourse and taken for granted everyday educational practices. Students are subjected to a range of governmental and disciplinary strategies and, through a process of normalization, ultimately become their own supervisors within the system. Conclusion. The tensions between the demands of a professional outcome‐based nursing programme and notions of empowerment and student autonomy have not been resolved. Instead, present educational practice is characterized by normalizing discursive practices that aim to produce a specific version of a student subject as autonomous learner. Thus, discourses of both empowerment and professional behaviour govern students.     

Pet bylaws and posthumanist health promotion: a case study of urban policy

Dog walking enables physical activity and positive social interactions, but uncontrolled dogs as well as dog feces can foster conflict and deter physical activity, for both dog owners and nonowners. This case study shows that previously reported associations with dogs (both positive and negative) can be linked to the wording and the day-to-day implementation of, or incompliance with, local governments’ bylaws on pets. In this example of posthumanist health promotion, the policy goal is to optimize the overall impact on well-being of pet animals. Analytically, the case study draws together insights from actor–network theory, Foucault’s theory of governmentality, Bourdieu’s theory of habitus, and anthrozoology (i.e. the study of human–animal interactions as well as related ideas and norms). Posthumanist health promotion is a theoretically informed approach that can assist in developing policy and implementation strategies, not only on pets but on a range of topics.     

Our bodies are our own: resistance to ABC-based HIV-prevention programmes in northern Tanzanian conservation organisations

ABC-based HIV-prevention programmes have been widely employed in northern Tanzanian wildlife conservation settings in an attempt to (re)shape the sexual behaviours of conservation actors. Utilising findings from 66 semi-structured interviews conducted in 2009–2010, this paper examines ABC prevention as a form of Foucauldian governmentality – circulating technologies of power that mobilise disciplinary technologies and attempt to transform such efforts into technologies of the self – and explores how individuals understand and respond to attempts to govern their behaviour. ABC regimes attempt to rework subjectivity, positioning HIV-related behaviours within a risk-based neoliberal rationality. However, efforts to use ABC as a technology to govern populations and individual bodies are largely incommensurate with existing Tanzanian sociocultural formations, including economic and gendered inequalities, and local understandings of sexuality. The language research participants used to talk about ABC and the justifications they offered for non-compliance illuminate this discrepancy. Data reveal that the recipients of ABC campaigns are active producers of understandings that work for them in their lives, but may not produce the behavioural shifts envisioned by programme goals. These findings corroborate previous research, which questions the continued plausibility of ABC as a stand-alone HIV- prevention framework.     

An analysis of the development of adolescent and young adult cancer care in the United Kingdom: A Foucauldian perspective

This paper analyses the development of the specialism of adolescent and young adult (AYA) cancer care via a Foucauldian lens to consider how knowledge and awareness have grown since questions were first raised about unmet needs of AYAs with cancer. The AYA specialism has gathered momentum over the last 30 years in the United Kingdom (UK) and is fast gathering pace internationally. Fundamental to this process has been the combined contribution from nursing and other health professionals, researchers, policy‐makers and philanthropists. From an initial process of problematisation, through a gradual growth in empirical knowledge and resultant shifts in health policy, a new nexus of expertise has emerged that enabled AYA cancer care to become recognised as distinct from either child or adult oncology. Different stakeholders contributed to the discourses that have underpinned this development—a process likely to continue as it expands further. This paper draws on examples from the growth of the AYA specialism, the emergence of new professional roles and a growth in research. It illustrates how the coalescing of multiple perspectives allowed new discourses and, ultimately, new practices to be established that now have global impact.     

Moral Adherence: HIV Treatment,Undetectability, and Stigmatized Viral Loads among Haitians in South Florida

In the United States, HIV is rendered a chronic condition, and viral transmission is minimized through strict adherence to pharmaceutical treatment. Treatment reduces viral loads to untraceable levels in the blood, a status known as “undetectable,” as determined by laboratory testing. For Haitians living with HIV in South Florida, “undetectable” has become more than a viral status; it is a means to know and govern themselves as moral actors and to survey and stigmatize others who remain “detectable.” The ethnographic evidence I present here suggests that Haitians adopt novel forms of subjectivity based on undetectability, producing identities entangled in biotechnical categorizations and dominant narratives of responsibility, morality, and health. Haitians’ experiences with these processes reveal the persistence of HIV stigmatization and the centrality of biomedical morality in mediating perceptions of inclusion, value, and worth of people living with HIV.     

Resistance through risk: Women and cervical cancer screening

This paper explores how individual women deal with, and react to, the very general information on cervical cancer risks they receive when invited to attend for cervical screening, and the general ‘at risk’ position that is suggested to them through the official discourse on screening and re-enforced by the uniform approach taken by the UK programme. By presenting data from a qualitative interview study it demonstrates how women respond to the presentation of risk in diverse and dynamic ways, and engage in a process of ‘self-positioning’ that individualises cervical cancer risk and makes it relevant to them as individuals. Within this process women draw on a range of risk themes that they regard as relevant to cervical cancer and implicated in its development. These are discussed in a range of ways, indicating that such risk themes do not exist in a vacuum but are situated within particular social and cultural contexts. I argue that, while the conceptualisation of risk as one of the strategies employed within neo-liberal forms of government to create particular kinds of individuals is useful, it is in danger of focusing too much attention on how individuals are controlled instead of how they respond to such attempts.     

Documentation,assessment and social control: ASI and the shaping of the discourse on addiction

This article comments upon the Addiction Severity Index (ASI) instrument as a system of notation and documentation, a governmental practice, which conditions communication about addiction and dependency and thereby influences the behaviours and conduct of those involved. The discourse of ASI is viewed as a language game. The ASI as a technology for reforming individuals aims at helping individuals to help themselves. To compel addicted persons to help themselves, they have to be transformed into calculable, accountable subjects. The ASI is described as a map, with certain characteristics that guide the players in the game. Among these are gaze, number, presentism and nominalization. The application of ASI varies within different contexts, and can lead to more or less obliging and universalizing interpretations and practices and more or less involvement of clients. The author suggests, however, that one ontological foundation of the ASI discourse is an understanding of addiction as otherness in terms of lack of freedom.