Benny Goodman | Independent Scholar (original) (raw)

Books by Benny Goodman

Nurse Education in Practice, 2011

&quot; An excellent text which highlights the key issues associated with care delivery in... more &quot; An excellent text which highlights the key issues associated with care delivery in today&#x27;s healthcare climate. A must for all students of nursing and other health related professionals.&quot; Thomas Beary, Senior Lecturer, University of Hertfordshire. This book is part of the Transforming Nursing Practice series, written specifically to support students on pre-registration nursing programmes. As modern healthcare rapidly changes, it is essential for nurses to work with a wide range of people to provide quality, holistic care to their patients. ...

Sustainability education: perspectives and practice across higher education, May 1, 2010

We accept that there is a potential crisis for the continued health of individuals and population... more We accept that there is a potential crisis for the continued health of individuals and populations, and that this crisis is linked to anthropogenic climate change (Hansen et al, 2007; World Health Organization [WHO], 2009; Costello et al, 2009) and to unsustainable patterns of living based on inappropriate economic models (Abdallah et al, 2009, Jackson 2009, Meadows et al, 2005). This crisis is deep-seated and has the potential to negatively affect the health and well-being of everyone on Earth (McMichael and Powles, 1999; UK ...

Communication and Interpersonal skills in Nursing, 2019

The new edition of this well regarded book introduces the underpinning theory and concepts requir... more The new edition of this well regarded book introduces the underpinning theory and concepts required for the development of first class communication and interpersonal skills in nursing.

By providing a simple to read overview of the central topics, students are able to quickly gain a solid, evidence-based grounding in the subject. Topics covered include: empathy; building therapeutic relationships; using a variety of communication methods; compassion and dignity; communicating in different environments; and culture and diversity issues.

Three new chapters have been added that point readers towards further ways of approaching their communication skills that are less model and technique driven and focusing more on therapeutic considerations, as well as looking at the politics of communication.

Critical Mental Nursing: Observations from the Inside. , 2018

An autoethnographic/sociological account of the vulnerabilities to mental health problems even i... more An autoethnographic/sociological account of the vulnerabilities to mental health problems even in those with a very positive suite of health assets.

The argument that propels this emphatic book is that mental health nursing cannot continue to pin the blame for its own actions and failings on the psychiatric hierarchy. As the editors point out, mental health nursing is a degree-level qualification; it has achieved its ambition to be ‘a profession in its own right’. But it has failed to find its own voice and identity or to challenge the coercive, invalidating and traumatising culture and practices within the mainstream mental health services.

It has failed above all to subject itself to its own critical scrutiny.

This is what these chapters set out to do, starting powerfully with an apology from the editors to all the many millions of users of mental health services who have been subjected to the profession’s failure to care: ‘We cannot think of a new knowledge, approach, skill or kind of empowerment that nurses have themselves forged as a “profession in our own right”, of which our service users are identifiably beneficiaries,’ they write.

The editors and several of the 13 contributors to this book are members of the Critical Mental Health Nurses Network, formally launched in 2015. The aim of the network is to provide an identity and forum for shared experience for mental health nurses who are able to admit that the world is far more complex than many would prefer to believe, that people’s messy lives cannot be tidied away into discrete diagnostic categories, and who are, above all, ‘critical’.

Chapters highlight the dilemmas and assumptions encountered daily in mental health nursing practice and ask readers to reflect and challenge them to take collective and individual action to bring about change. Topics include:

• recovery and recovery colleges, written from very different viewpoints
• rooting out the violence culturally embedded within mental health nursing
• nurse education and how to translate theory into ethical best practice
• negotiating the complex pressures of delivering frontline crisis care
• playing the power game within the mental health system
• how the Mental Health Act blocks creative nursing practice
• embedding critical thinking and reflective practice within the profession
• forming political alliances with social movement activists
• the role of social contexts and cultures in shaping mental health and relationships
• mental health nursing as a therapy.

A continuing theme is the ubiquity of coercion both embedded within and perpetrated by the mental health nursing profession. In the editors’ words, it is time for the profession to ‘open new forums... share our honest experiences and fears and, above all, look to all of the places in which imagination has been reignited... [to find] new possibilities that make coercive options fall away.

This book explores the sociology and psychology relevant to nursing and explains why it is so imp... more This book explores the sociology and psychology relevant to nursing and explains why it is so important to understand these subjects in order to be a good nurse. It has been written specifically for nursing students, and explains clearly the key concepts in both disciplines that they need to grasp. Chapters move from the individual to wider societal issues and look at the psychological and sociological basis of professional values, interpersonal relationships, nursing practice, decision making, leadership and management and teamworking. Each of the fields of nursing are explored to show the specific application of these disciplines to each.

Please see below a review of Nursing and Working with Other People, which was published in Nursin... more Please see below a review of Nursing and Working with Other People, which was published in Nursing Standard last month (vol 23, issue 19). It received the maximum 5 stars – an “excellent” rating!

"One of four books in the Transforming Nursing Practice series, this text helps nursing students achieve the proficiency standards set out by the Nursing and Midwifery Council.

The recurring theme is that there are many players in healthcare delivery, some working front of house and others behind the scenes. Together, their different backgrounds influence the quality of provision. However, while emphasising the importance of information sharing across professional boundaries, this book highlights the need to work with the service user.

It explores the history and context of healthcare policy and examines the relationship between doctors and nurses, with special emphasis on how this affects communication and decision-making. I was impressed with the research-based theories on which the discussions are based. Interprofessional learning is examined, as well as teamwork and multi-agency working. Readers can reflect on the social and emotional intelligence they bring to work.

Questions raised generate critical thought and personal reflection. Each chapter ends with a summary, outline answers and a knowledge review.

I recommend this book for assessing practice and team-building exercises."

Reviewed by Thelma George, enhanced modern matron for health visiting and school nursing, City and Hackney Primary Care Trust.

Chapter 6 Ethnomethodology. Discusses this sociological perspective as applied to understanding t... more Chapter 6 Ethnomethodology. Discusses this sociological perspective as applied to understanding the everyday world of nursing.

Co-authored with Frank Strange.

Papers by Benny Goodman

In July 2016 doctors and nurses protested against Candidate Trump in Cleveland, Ohio (Cleveland.c... more In July 2016 doctors and nurses protested against Candidate Trump in Cleveland, Ohio (Cleveland.com), and currently the US Facebook group ‘Nurses Resisting Trump’ is building up its members. Why should this trouble or be of interest to nurses and nurse academics in the rest of the world? If the answer is not immediately obvious, this signals a problem. The issue is not a conventional one of political differences between health care professionals based on old differences between republican and democrats, or conservatives versus progressives. The fact that nurses in the US protested against a candidate and now against the President, his Republican Administration and what this stands for internationally, is pivotal.

The inauguration of Donald Trump was greeted with mass citizen protest throughout the world. Yet, despite losing the popular vote, he gained office because enough American citizens believed the narrative he voiced. Clearly, those citizens are not all racists, homophobes, misogynists, or climate change deniers, and this has to be remembered when we critique and call for international resistance of nurse educators to the Trump regime.

Trump repeatedly stated very clearly what many politicians are conspicuously silent about: ‘wealth buys influence’ (Ornitz and Struyk, 2015). In this context, he asserted time and again that there are losers as well as winners in the globalisation game. This narrative resonates disturbingly with the many on the left, and should do so with all nurses and their educators internationally who subscribe to supporting and valuing cultural diversity and difference (Bach and Grant, 2015, Grant and Goodman, 2017).

It will of course be argued that there are of course always legitimate political differences and values in the world of international politics, and these do not ordinarily overspill into the lifeworlds of nurses and their educators. But the case of the current Republican Administration is crucially different. The magnitude of global issues, such as climate change and its implications for health, and continuing inequalities in health, require far more intelligent and human responses than those associated with Trump and other authoritarian populists internationally, such as Putin, Erdoğan, Modi and their associates (Garton Ash, 2017, Varoufakis, 2016).

Nurse Education Today

Higher Education institutions across the globe are changing and changing fast. Several writers ha... more Higher Education institutions across the globe are changing and changing fast. Several writers have expressed dismay, as well as seeing opportunities to move in different directions, in response to what has been called the ‘University in Ruins’ (Readings 1996). Gary Rolfe (2013), picking up on Reading’s work addressed ‘scholarship in the corporate university’ and suggested that academics must ‘dwell in the ruins’ in an authentic and productive way through the development of a community of philosophers who will dissent, subvert and challenge the ‘corporate university’ from within. Tools for subversion are at hand. Social media, and the development of new academic websites such as Researchgate and academia.edu, give academics new ways to reach students, and indeed anybody, way beyond the physical confines of their campus. Accepting that there are issues of peer review and hence quality, these tools allow open access and may facilitate dialogue in ways unheard of just few years ago. Th...

Nursing standard (Royal College of Nursing (Great Britain) : 1987)

Nursing, 2000

Measuring the impact of the whistleblowers' act is difficult and there is evidence nurses... more Measuring the impact of the whistleblowers' act is difficult and there is evidence nurses still fear reprisal. However, the campaign group that lobbied for the legislation says good employers and nurses are making it work, and it offers guidance to would-be whistleblowers.

Nurse Education in Practice, 2011

Sustainability education: perspectives and practice across higher education, May 1, 2010

Communication and Interpersonal skills in Nursing, 2019

Critical Mental Nursing: Observations from the Inside. , 2018

It has failed above all to subject itself to its own critical scrutiny.

"One of four books in the Transforming Nursing Practice series, this text helps nursing students achieve the proficiency standards set out by the Nursing and Midwifery Council.

Questions raised generate critical thought and personal reflection. Each chapter ends with a summary, outline answers and a knowledge review.

I recommend this book for assessing practice and team-building exercises."

Reviewed by Thelma George, enhanced modern matron for health visiting and school nursing, City and Hackney Primary Care Trust.

Co-authored with Frank Strange.

Nurse Education Today

Nursing standard (Royal College of Nursing (Great Britain) : 1987)

Nursing, 2000

Nursing standard (Royal College of Nursing (Great Britain) : 1987)

The case for organising care around the patient and integrating services is generally accepted, b... more The case for organising care around the patient and integrating services is generally accepted, but progress towards integration has been patchy. This article, the first of two on integrated care, looks at the different forms of integration. It reveals how health and social care were integrated in Torbay, a transition that has delivered benefits. The second article will be published in Nursing Standard on June 6.

Nursing standard (Royal College of Nursing (Great Britain) : 1987)

Leadership and Management are emphasized within health care as important aspects of the health ca... more Leadership and Management are emphasized within health care as important aspects of the health care professionals’ role. This document aims to address some of the issues they face but cannot cover all relevant material. The focus here is on understanding what we may mean by these two words within a critical, and criticised, context.

It is my contention that health care delivery operates in a highly political context and clinical leadership requires political and policy awareness. The critique draws from a critical realist perspective and from the sociological and philosophical work of Marx and from feminist theory. There will not be an exposition of this theory to avoid confusion, but the reader is pointed to Graham Scambler’s (2018) work ‘Sociology, Health and the Fractured Society’ for a fuller discussion.

This is also not a technical training manual. It does not provide a ‘how to guide’ to use in everyday clinical practice. There are technical managerial tasks that are required to be used and applied – budgeting, staff allocation, auditing, running meetings, staff appraisals, evaluating new IT and technology for use in practice – but many of these come with an organisation’s ‘training manual’, or a procedure book or a set of ‘how to’ policies. These reduce management to a set of pre-determined technical tasks which although very necessary can easily be learned via a set of behavioural techniques and training sessions.

What follows is an attempt at some critical analysis of the exercise of leadership and the application of managerial techniques in an attempt to encourage critical reflexivity and critical analysis. The hope is that this leads to the offering of solutions (by you) to the problem of delivering high quality services in settings that sometimes makes this a challenge.

Leadership in nursing has become almost a panacea to address issues of quality in health care. Ho... more Leadership in nursing has become almost a panacea to address issues of quality in health care. However, without putting it into its context, there is a danger of seeing it as such while missing issues of power. This document supports a module in leadership and management in critical care for Spanish nurses. It takes a critical approach while at the same time introducing the general reader to some core ideas. Anyone interested in understanding leadership may find these ideas and concepts useful for a wide variety of settings.

Leadership and Management are currently emphasized within health care as important aspects of the... more Leadership and Management are currently emphasized within health care as important aspects of the nurse’s role. This short document aims to address some of the issues but cannot cover all relevant material. The focus here is on understanding what we may mean by these two words. This is also an attempt at investigating the context in which nurse work. If the context is not understood then some of the tools used by nurse leaders (e.g. the PDSA model of quality improvement) may be harder to use. If one understands the problems one faces then there is a chance that the right answers may be offered.

This document cannot offer answers because each clinical setting will have its own issues.

We cannot begin to talk about learning for sustainability in the health care professions without ... more We cannot begin to talk about learning for sustainability in the health care professions without considering the role of the professional, statutory and regulatory bodies – PSRBs – which govern health care education. A recent study at the University of Dundee found that few PSRBs make explicit reference to sustainability issues, with the exception of disciplines such as engineering, planning and architecture.

Nursing’s PSRB, the Nursing and Midwifery Council, does not have anything to say about sustainability. However, you can see that the four domains of competency do offer some potential to integrate ESD principles into nursing curricula. It is up to curriculum developers such as ourselves to interpret the standards to address sustainability. This assumes of course you know what sustainability means. My view is that sustainability is about health and illness having implications for public health and the acute sector. This is based on dare I say it a ‘holistic’ understanding of nursing practice in theory. In practice, clinical nurses may well be constrained by clinical setting and the type of patient they see. Your views on sustainability may also therefore rest on how you consider what the main focus of nursing practice may be, again starting with illness/disease and/or health.

We argue there is a sustainability-climate change-health triad which needs to be addressed more e... more We argue there is a sustainability-climate change-health triad which needs to be addressed more explicitly by nursing education.

Health (at both individual and population levels) is based upon both sustainable living, by building resilience, mitigating and adapting to climate change.

In addition to ‘healthy genes’, human health is based on the fundamentals of physical environment (clean air, clean water, sufficient food and safe waste disposal) and also upon good psycho- social-political environments (e.g. low unemployment and absence of military conflict). A sense of aesthetics and the need ask what constitutes the ‘good life’ for human happiness cannot be ignored when assessing human health and well-being.

Health is also founded upon on social and environmental factors that transcend national boundaries. Therefore, as the determinants for health are social and often global, one way of addressing the issue is through developing a sense of global citizenship. In addition, because sustainability, climate change and global health are inextricably linked, health has to have sustainability at its core

Climate change is largely resulting from increasing carbon dioxide (and CO2 equivalent) emissions as a result of fossil fuel energy consumption. Unsustainable economics (and lifestyles based on current economic structures) also contribute to this process and to ecological degradation). Thus addressing carbon emissions and climate change cannot be achieved without addressing sustainable living.

Sustainable living entails ensuring that current patterns of consumption and lifestyles do not endanger the physical and non physical resource base for coming generations. Climate change threatens health as it threatens both the physical environment and the psycho-social-political environment, the latter, for example, as water becomes a scarce commodity and replaces oil as a source for conflict. Environmental pollutants, radioactivity and toxins also affect the health of current generations and future generations by increasing the likelihood of passing on genetic defects.

We cannot begin to talk about learning for sustainability in the health care professions without considering the role of the professional, statutory and regulatory bodies – PSRBs – which govern health care education. A recent study at the University of Dundee found that few PSRBs make explicit reference to sustainability issues, with the exception of disciplines such as engineering, planning and architecture.

Nursing’s PSRB, the Nursing and Midwifery Council, does not have anything to say about sustainability. However, you can see that the four domains of competency listed here do offer some potential to integrate ESD principles into nursing curricula. It is up to curriculum developers such as ourselves to interpret the standards to address sustainability. This assumes of course you know what sustainability means. My view is that sustainability is about health and illness having implications for public health and the acute sector. This is based on dare I say it a ‘holistic’ understanding of nursing practice in theory. In practice, clinical nurses may well be constrained by clinical setting and the type of patient they see. Your views on sustainability may also therefore rest on how you consider what the main focus of nursing practice may be, again starting with illness/disease and/or health.

We believe the grid can help us to explore where sustainability sits in relationship to both how we conceptualise health and illness and thus where we see nursing practice focusing its activities. What frame of reference do we inhabit and what solutions and activities do we then proffer to address health/illness?

The EU supports HE students to experience study in EU countries other than their base. This surve... more The EU supports HE students to experience study in EU countries other than their base. This survey explored UK and spanish student nurses views on studying and working abroad.

In advance of a Care Quality Commission (CQC) inspection of NHS trusts, GP premises and care home... more In advance of a Care Quality Commission (CQC) inspection of NHS trusts, GP premises and care homes, information is collected on the opinions of patients, carers and staff. Staff preparations in making sure that CQC standards are adhered to need to start well in advance.

The Sociological Imagination is a key work in the sociological literature and provides a way of ... more The Sociological Imagination is a key work in the sociological literature and provides a way of thinking about our experiences as individuals in society at any given point in time. The argument is that to fully understand ourselves we have to apply the ‘sociological imagination’ to our ‘personal troubles’. The relevance for nursing is that this takes us beyond making overly simplistic analysis of the health behaviours, experiences and decisions of patients, clients and of course ourselves. If our analysis is too simplistic then we come up partial answers to health care issues at best and irrelevant, judgemental or dangerous answers at worst.

In 1978 Barbara Carper published ‘Fundamental patterns of Knowing in Nursing’, a paper much cited... more In 1978 Barbara Carper published ‘Fundamental patterns of Knowing in Nursing’, a paper much cited in the nursing literature. Jacobs-Kramer and Chinn (1988) modified the patterns to produce a model for further clarification.

However, the framework for understanding the work of nurses with their patients was not complete. Jill White (1995) added a fifth: Socio-Political. White argued the other four provided answers to the ‘who, how and the what' of nursing practice but not the ‘wherein’, the context.

One of the explanatory frameworks, or 'discourses', for ill health and health inequalities around... more One of the explanatory frameworks, or 'discourses', for ill health and health inequalities around access to health services and health outcomes, is that of the ‘material deprivation’ thesis, which underpins much of the Marmot Review ‘Fair Society Healthy Lives’. It sits within a ‘Redistribution discourse’, which suggests the answer is redistribution of material resources. Alongside this is the ‘Psychosocial Comparison Thesis’, which underpins such work as Wilkinson and Pickett’s ‘The Spirit Level’. This forms part of the ‘Social Integrationist discourse’ in which reduction of social inequalities and better integration of marginalised groups is important. This also addresses measuring poverty.

A brief introduction to the idea of masculinities and how the subjective experience of, for examp... more A brief introduction to the idea of masculinities and how the subjective experience of, for example, cancer impacts on men

At first blush the work of Marcuse is irrelevant to nurses. He does not discuss healthcare at all... more At first blush the work of Marcuse is irrelevant to nurses. He does not discuss healthcare at all, at least not explicitly. It is only when we understand his critique of society that we begin to reveal the links between well being and society to grasp wider social determinants of health. This is a fundamental challenge to taken for granted modes of thought.

Decision making operates in an organisational and social context and can be very difficult to ide... more Decision making operates in an organisational and social context and can be very difficult to identify. Thus, clinical decisions may be buried within many factors that impinge more onto the patient’s experience than an individual decision to choose between two courses of action.

The EBP model is linear and idealistic – it is a sharp description of how decisions should be made not how they are actually made. The proponents of EBP acknowledge this practice-theory gap as a driver for a more considered application of EBP.

Decision making in a social context: What drives our behaviour? To what degree are we rational ac... more Decision making in a social context: What drives our behaviour? To what degree are we rational actors?

In this short paper the question regarding nurses’ freedom to choose to act is addressed by trying to understand three concepts: ‘habitus’, ‘lifeworld’ and ‘mode of reflexivity’. The point is to move beyond simple explanations of human action, which on the one hand relies on explanations of social structures that in some way may ‘determine’ action, and on the other hand explanations that prioritise free rational will, often underpinning ‘individual responsibility’ arguments. First however there is a need to ensure we understand two key words – structure and agency. If you want to explain what underpins your decisions then this framework provides another way of doing so beyond appeals to rational action decision making based on acquired knowledge/evidence as a simple ‘cause –effect’ human action.

This paper examines the components of decision making and the process of making clinical decision... more This paper examines the components of decision making and the process of making clinical decisions. An issue to consider is to what degree do we make decisions based on systematic reasoning, rational enquiry, and the best available evidence? What are the thinking processes, i.e. cognition, that we use when making accountable decisions, bearing mind a key part of accountability is our ability to articulate and justify the decisions we make. This also leads us to consider errors in decision making and thus ways to reduce them.
What follows is by no means exhaustive, it is an introduction to the large study of decision making, reasoning and exercising clinical judgment. After a short exercise to define nursing clinical decision making, there are three sections:
1. Clinical Decision Making: Normative Theory, how it should be done.
2. Clinical Decision Making: Descriptive Theory, how it is done.
3. Clinical Decision Making: Prescriptive Theory, how it might be done better.

You will be presented with:
• An opportunity to review the concept of ‘decision making’.
• An introduction to the components of clinical decision making.
• A discussion on our abilities to use our ‘cognitive’ abilities and errors that may result from normal thinking.
• An introduction to ideas of ‘human factors’ and ‘error wisdom’.
• A brief consideration of the future for decision making based on information technologies.

In this brief paper, I discuss the importance of the patient's story and having the space to list... more In this brief paper, I discuss the importance of the patient's story and having the space to listen to it.
The way doctors come to their diagnoses, how they listen to patient’s stories, how they decide what to treat, is not a straight forward process though it might seem so. Take a history-perform a physical examination-order tests-analyse results-diagnose-treat-evaluate treatment. It looks linear. It is supposed that the hypothetico-deductive method accurately describes this thinking. However, the objective gathering of data, the analysis of that data to produce a hypothesis, the testing and revision of that hypothesis and subsequent diagnosis could be more an objective academic description of a process rather than an accurate description of what happens in actuality.

In the many contributions to the debate about poor quality care, there is often a distinct lack o... more In the many contributions to the debate about poor quality care, there is often a distinct lack of a sociological imagination. While individuals can be rightly criticised for giving poor care, the antecedents are to be found beyond the personal trouble of individual nurses and their patients, and can be classed as a public issue: that of the political, social and economic failures of the governing, managerial and administering classes over the past few decades.

An outline of Graham Scambler's GBH for student nurses. “Considerable evidence suggests that neoc... more An outline of Graham Scambler's GBH for student nurses. “Considerable evidence suggests that neocolonialism, in the form of economic globalization as it has evolved since the 1980s, contributes significantly to the poverty and immense global burden of disease experienced by peoples of the developing world, as well as to escalating environmental degradation of alarming proportions. Nursing’s fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment through political activism at local, national, and international levels to bring about reforms of the current global economic order”. (Falk-Rafael 2006)

During a leadership and management module in a pre registration nursing course, a student asked “... more During a leadership and management module in a pre registration nursing course, a student asked “Can the NHS go bankrupt?”. In trying to answer this question it soon became clear that their background knowledge regarding the UK’s fiscal policy and even what that means is less than clear. This is not a surprise. They are after all studying health and nursing and not economics. We then got into some basic background work on where the money comes from and why we are facing public sector cuts. The Royal College of Nursing is currently expressing a great deal of concern over those cuts to front line services so a good grasp of the figures is essential. If nurses are to really contribute to the debate on health sector finances which affects them and their patients then having some grasp of the basics of the national budget, the national debt and the health service budget, is necessary. In addition students need to understand that it is ideology and deliberate policy not a debt crisis that is driving changes to the NHS structure and funding.

Evidence based practice has been the mantra for several years and may be held up as the gold stan... more Evidence based practice has been the mantra for several years and may be held up as the gold standard for professional practice, as the method for driving policy: ‘Evidence based policy’. However, much of the focus in the topic has been on the methodologies, and discussions, around the various merits or otherwise of methodological approaches, say between quantitative and qualitative research, or the strengths and weaknesses of RCTs. There is also a need to take a wider perspective on evidence and understand that the use of evidence, no matter what research method underpins it, has a social and often political dimension to it. Evidence based policy is ‘socially constructed’. Social and political issues also affect what gets researched, how it gets published and perhaps what topics are off limits. To illustrate this process, an examination of the laws around the use of substances, be they caffeine, alcohol or ecstasy, indicates that public policy often has a tangential relationship to evidence. An argument is that the evidence should drive our policies; however it may well be the case that the policy comes first (drug prohibition) and then there is a search for the evidence to back that policy – ‘policy based evidence’. Other issues that may well fall into this category: climate change, fracking, economic austerity or even nursing staffing levels. The argument presented here is that ‘evidence based’ policy is socially constructed and may actually have little to do with evidence! Drugs policy will be used to illustrate the dynamic and oft contested nature of evidence and its use.

"Decision making operates in an organisational and social context and can be very difficult to id... more "Decision making operates in an organisational and social context and can be very difficult to identify. Thus, clinical decisions may be buried within many factors that impinge more onto the patient’s experience than an individual decision to choose between two courses of action.

The EBP model is linear and idealistic – it is a sharp description of how decisions should be made not how they are actually made.
"

An overview of leadership theory and the issues relating to it: gender, teamworking, interpersona... more An overview of leadership theory and the issues relating to it: gender, teamworking, interpersonal relationships, quality.

What follows is an attempt at some critical analysis of the exercise of leadership and the application of managerial techniques in an attempt to encourage critical reflexivity and critical analysis. The hope is that this leads to the offering of solutions (by you) to the problem of delivering high-quality services in settings that sometimes makes this a challenge.

This paper was prepared as background to the 4 th edition of 'Communication and Interpersonal ski... more This paper was prepared as background to the 4 th edition of 'Communication and Interpersonal skills in nursing (Grant, A. and Goodman, B. forthcoming). In that book discourses of neoliberalism and their effects on health and health service delivery as well as the interpersonal communications nurses have with people will be explored and critiqued. An example is the discourse on 'individual responsibility for health' and 'lifestyle drift' responses to public health which draw upon the concept of 'sovereign individual' of neoliberal philosophy. This paper explores what neoliberalism might be to argue that it is more a discursive practice than a political action. 2

The following outline of climate change as a wicked problem (Rittel and Weber 1973) is based on a... more The following outline of climate change as a wicked problem (Rittel and Weber 1973) is based on a reading of Reinar Grundmann’s (2016) ‘Focus on Climate change and the social sciences’. The work of Jurgen Habermas (1984, 1987) and Wolfgang Streeck (2016) contextualises the exposition of climate change as a wicked social problem and this paper agrees with Grundmann’s analysis that there are no easy answers for the short or medium term, here defined as within 50 years, and adds that perhaps there might not ever be. Thus we are adopting Gramscian ‘pessimism of the intellect’ which requires urgent work on adaptation for a very different and perhaps dystopian world by the end of the century.

There is a continuing need to address current health threats, health care systems and nurses' rol... more There is a continuing need to address current health threats, health care systems and nurses' roles, understandings and action towards improving public health. The scale of the issues are outlined by such as the World Health Organisation (2007, 2015), the World Watch Institute (2015) and the United Nations Sustainable Development Goals (Global Goals 2015). There is an urgency that is probably measured in a couple of decades rather than by 2100 as such issues as global temperature rises continue. The context is set by the ecological, political and social determinants of health and inequalities in health (Ottersen et al, Barton and Grant 2006, Horton et al , marmot 2015, Dorling 2015). The context also includes Environment and Sustainability Education (ESE) and its attempt to address the problems of the world in which there is a mismatch between the fragmentary way we think about problems and the systemic, highly connected nature of the world. Health issues, for rich countries, include the neoliberal epidemics of obesity and type 2 diabetes, while for many others the issues are still around infections, poor life expectancy and far too high infant mortality rates. These health issues have to be addressed and understood as arising within interconnected systems. Our inability, or lack of input to do anything other than engage in downstream activities when harm has already occurred, is partly due to a deeply ingrained mode of thinking. This paper argues for systems thinking, and then practice, to be more fully integrated, understood and acted upon in Nurse Education. Not to do so places nurses on the wrong side of history, reacting to events instead of acting to prevent, mitigate and adapt. First, what is meant by systems thinking will be outlined and then a brief outline of obesity as a key issue to justify and illustrate this approach, a discussion about how this might be applied into nursing education.

This discussion paper outlines the concept of ‘Action Nursing’ (AN), acknowledging its relation t... more This discussion paper outlines the concept of ‘Action Nursing’ (AN), acknowledging its relation to ‘Action Sociology’ (Scambler, 2012a), basing its justification on social and health inequalities. A few challenges will be acknowledged in putting forward this view, but done so in recognition that AN might be part of wider ‘social movements from below’ (Cox & Nilsen, 2014). It also briefly provides a view of what the role of nurse academics might be in Higher Education vis a vis activism. This discussion is rooted firmly in the acknowledgement of the ‘politics of nursing’ and that some nurses may be feeling despair following reports into poor quality patient experiences (e.g. Francis 2010, 2013, RCP 2016). Various pressures can lead to disenchantment, disengagement and disillusionment with both politics and health care delivery systems in the UK and Internationally (Bickhoff, 2014; Maben, Latter & MacLeod Clark, 2007; Twibell et al., 2012). Jane Salvage suggested that nurses ‘wake up and get out from under’ (Salvage, 1985) and while recognising that for some this past entreaty to engage politically may further entrench those feelings, the need for nurses and nursing to do so has not diminished. As Stuckler and Basu argue, government policy becomes a matter of life and death as ‘Austerity is Killing people’ (Stuckler & Basu, 2013) and is seriously damaging their mental health (PAA 2015). Nurses are part of the front line in promoting health and working for those who are ill, dying or living with long term conditions and extremes of human misery (Grant 2015, Smith and Grant 2016). Their work is therefore framed by politics and political decisions. The bottom line is that there is a ‘bottom line’ to nurses’ work. Governments prioritise resources depending on their values, ideologies, lobbying and political expediency. As millions of people in the UK, and billions across the globe, experience a daily struggle to both give and receive social and health support as outlined in the United Nations’ sustainable development goals (Global Goals 2015), nurses should consider allying themselves with progressive forces which seek to redress the balance of power which currently results in inequalities in health (Dorling, 2013; Dorling, 2014; Dorling & Thomas, 2016; Marmot, 2015; Scambler, 2012b) and financial pressures in health (Appleby et al 2015) and social support (Collingwood 2015). ‘Progressive forces’ in this paper has a wide meaning and does not name political parties or philosophies. However, Action Nursing wishes to remove the ‘flowers from the chains’ so that we more clearly see what holds us back in providing more equitable health and social support for people

This manifesto calls for a social movement for political activism by nurses and other health prof... more This manifesto calls for a social movement for political activism by nurses and other health professionals, to address inequalities in health and the social inequalities that highly structure, but do not determine, health outcomes. This action can operate at individual, clinical, organisational, national and international level. Our aim is to respond to threats to health and socialised health service delivery from corporate, financial and political interests. Our vision is for decreasing social and health inequalities in which the social gradient is greatly diminished. Our goal is to create a networked social movement involving political and civic activism to bring critical understanding and action into the public sphere.

Health Care Quality – commissioning some basics. The CQC and organisational cultures. In this sho... more Health Care Quality – commissioning some basics. The CQC and organisational cultures. In this short piece, I argue that the CQC is about quality assurance rather than improving quality, that external inspections as QA might have unintended negative consequences, and outline an alternative perspective based on the long held recognition that front line staff are the key people who are able to drive quality forward.

A report suggests that United States’ Army officers may engage in dishonest reporting regarding t... more A report suggests that United States’ Army officers may engage in dishonest reporting regarding their compliance procedures. Similarly, nurses with espoused high ethical standards sometimes fail to live up to them, and may do so while deceiving themselves about such practices. Reasons for lapses are complex. However, multitudinous managerial demands arising within ‘technical and instrumental rationality’ may impact on honest decision making. This paper suggests that compliance processes, which operates within the social structural context of the technical and instrumental rationality manifest as ‘managerialism’, contributes to professional ‘dishonesty’ about lapses in care, sometimes through ‘thoughtlessness’. The need to manage risk, measure, account and control in order to deliver efficiency, effectiveness and economy (technical rationality), thus has both unintended and dysfunctional consequences. Meeting compliance requirements may be mediated by factors such as the ‘affect heuristic’ and ‘reflexive deliberations’ as part of the ‘structured agency’ of nurses. It is the complexity of ‘structured agency’ which may explain why some nurses fail to respond to such things as sentinel events, a failure to recognise ‘personal troubles’ as ‘public issues’, a failure which to outsiders who expect rational and professional responses may seem inconceivable. There is a need to understand these processes so that nurses can critique the context in which they work and to move beyond either/or explanations of structure or agency for care failures, and professional dishonesty.

Anaker and Elf (2014) undertook a concept analysis of sustainability in nursing. They argue that ... more Anaker and Elf (2014) undertook a concept analysis of sustainability in nursing. They argue that the “term is not clearly defined and is poorly researched in nursing.” (p382). This does not only apply in nursing, it has diverse and contested meanings in many disciplines (Williams and Millington 2004, Thompson 2011). The quest to tie down the concept is probably futile, as Anaker and Elf themselves suggest that

“a concept analysis is never a finished product” (p388).

Nonetheless, they provide a definition which is a helpful contribution to the discussion, while their model and contrary case illustrate for clinical nurses the value of trying to understand sustainability in practice. Throughout the paper they provide attributes and definitions from various sources and refer at times to sociocultural factors and political commitment. The defining attributes were ecology, environment, the future, globalism, holism and maintenance. However, while getting tantalisingly close to discussing the political economy underpinning such issues as climate change, ocean acidification and soil erosion and the social (WHO 2008) political (Ottersen et al) and environmental (Barton and Grant 2006) determinants of health rooted in the emerging concept of ecological public health (Lang and Rayner 2012) analysis misses something important, the link between Late (or Finance) capitalism, climate change and sustainability.

May 2015

I have recently come across the work of Rebecca Martusewicz (from her bio): “I work to engage st... more I have recently come across the work of Rebecca Martusewicz (from her bio): “I work to engage students in critical cultural-ecological analyses of the roots of current social and ecological crises. I have been actively engaged in learning with Detroit and other grassroots activists for over ten years in projects to revitalize the Detroit commons. I developed and direct a concentration in EcoJustice Education for the Masters Degree program in Social Foundations of Education, and I have been the editor in chief of Educational Studies: The Journal of The American Educational Studies Association for 15 years. I also helped to found and directed the Southeast Michigan Stewardship (SEMIS) Coalition, a group of teachers, community activists, and teacher educators dedicated to developing citizen stewards of the Great Lakes”.

Rebecca’s work has resonance for teachers and nurses alike if we take the time to explore this perspective. Our concern with climate change is not only to deal with the technical challenges of adapting to a warmer world but should also be focused on ideology, philosophy, epistemology and ontology. That is nurses need to confront entrenched and vested interests who sell their ideas as the only ideas worth having; nurses could explore how dualist and non dualist philosophy impacts on humanity and nature; nurses understand what counts as knowledge and how we come to that knowledge and nurses need to explore our ‘being in the world’.

"For the remainder of this century, the most worthy goal that nurses can select is that of arousi... more "For the remainder of this century, the most worthy goal that nurses can select is that of arousing their passion for a kind of political activism that will make a difference in their own lives and in the life of our society." (Peggy Chinn, 1984, quoted by Beall 2010).

Various nursing theorists have suggested or implied that politics and political awareness and knowledge is, or ought to be, a component of nursing knowledge (Chopooperian 1986, Stevens 1989, Albarran 1995, Cameron et al 1995, Chinn 2000), advocacy (Philips 2012) and leadership (Antrobus 1998, Cunningham and Kitson 2000). Nancy Roper referred to the sociocultural, envi-ronmental and politico-economic factors influencing the Activities of Living, while also lamenting a lack of their application (Siviter 2002). Jill White (1995) developed Carper's patterns of knowing to include it, Jane Salvage (1985) argued that it needs to be understood and acted upon and that nurses should ‘wake up and get out from under’.

This discussion paper argues for understanding care as a commodity, ultimately as a product of la... more This discussion paper argues for understanding care as a commodity, ultimately as a product of labour, whose use value far exceeds its exchange value and price, due to patriarchal and capitalist definitions of what can be valued in society. This under recognised commodification of care work obscures the real social and exploitative relationships involved. This matters because many care workers give of themselves to provide patient and resident care, but in doing so find themselves in subordinate subject positions. The 6Cs, while a worthy statement, may be nothing more than a screen deflecting understanding of the reality of the lived experiences of thousands of care workers and adds to the discourse of ‘care as a gift’ which can be given by the ‘naturally gifted’, usually female, care worker. Nurses may not have tools of analysis to critique their subject positioning by power elites and have thus been largely ineffectual in creating change to the context and conditions in which they work.

Compliance: Rules, regulations, inspections, monitoring, audits and reporting. In short, bureaucr... more Compliance: Rules, regulations, inspections, monitoring, audits and reporting. In short, bureaucracy which operates within the context of managerialism fuelled by poor risk assessment, suspicion of both clinical leadership and professional judgment, and the felt need to measure, account and control in order to deliver the holy trinity of efficiency, effectiveness and economy: otherwise known as profitability in the private sector or cost containment in the public sector.

This paper seeks to understand this response as constructing a moral panic which identifies gradu... more This paper seeks to understand this response as constructing a moral panic which identifies graduate nurses (and nurse education) as “folk devils”, and which panders to simplistic and misguided answers (i.e. return ‘training’ to hospitals while the wider social and contextual and personal factors are missed. Baumann’s (2000) idea of liquid modernity is an aspect of that social context and forms backdrop to connect the personal troubles of patients with the public issues of care in an uncaring society. We argue that there may be just cause for public concern but that laying the blame only on nurses without examining the hidden and other reasons for poor care is misplaced. The concern over poor quality care is not misguided, the analysis of why it happens often is. First we will address the idea of Moral Panic, then of liquid modernity before turning to a discussion of some of those other causes for lapses in care. This analysis exemplifies the need for critical scholarly enquiry into every day nursing practice.

Many people accept that ‘we live in interesting times’, and for example that liberal democracy in... more Many people accept that ‘we live in interesting times’, and for example that liberal democracy in the west is facing both internal and external threats. An internal threat is the democratic deficit in which people are beginning to feel the pointlessness of voting in the face of growing disparities of income and wealth. China’s economic success challenges notions of free market, politically liberal capitalism while at the same time the so called Arab Spring shows signs of disintegration. The IPCC’s 2013 fifth report on ‘climate change, the physical science basis’ has not yet radically altered our dependence on fossil fuels. In contrast, investment in fracking and tar sands continue unabated while carbon reaches towards 400 parts per million, a figure last noted over 415,000 years ago according to planet for life. In the UK the debate over energy is characterised by its cost and fuel poverty rather than production, efficiency or reduction in use. Sustainability solutions are being developed, but social change lags behind the unceasing rise in carbon emissions, ocean acidification and deforestation. This paper addresses the questions about our social responses and suggests that our lock in to high carbon economies are related to unreformed, and possibly unreformable, consumer capitalism.

Climate change is a grave threat to human health this century and has been recognized as such by ... more Climate change is a grave threat to human health this century and has been recognized as such by healthcare organisations. Sustainability is now a public policy directive and is supported by national legislation in the UK. However, modern consumer capitalism encourages high carbon and unsustainable lifestyles and has negative health impacts. A barrier to changing behaviour and adopting low carbon lifestyles is a dominant philosophical understanding (dualism and anthropocentrism) of our relationship to the planet and to nature. A good deal of Nursing theory implicitly assumes an uncritical stance towards these ideas and to consumer capitalism and needs to address this explicitly if nurses are to join in more force to address the grave threats to human health.

Despite the scientific consensus (IPCC 2007, Hulme 2009) around climate change and the growing co... more Despite the scientific consensus (IPCC 2007, Hulme 2009) around climate change and the growing consensus (Goodman 2011), in business, higher education, international and national government, public health (Griffiths et al 2009, Costello et al 2009, DH 2008, WHO 2009), and medicine (BMA 2011) there appears to be, in the UK at least, a relatively weak response from nurses and nursing (Goodman and Richardson 2010) in terms of leadership and curriculum application. Carbon reduction strategies are increasingly commonplace in NHS organisations. They are an express aim of the National Health Service Sustainable Development Unit in response to national legislation (NHSSDU 2008, DEFRA2008). Therefore the context in which nurses work also expressly accepts the need for carbon reduction. I wish to argue that the climate science is ‘settled’ enough on the question of anthropogenic global warming (AGW) leading to climate change, and that the issue is now one of politics, culture and social change, with divergence partly based on the conditional and epistemic character of scientific knowledge and partly based on vested interest. Given this wider context and despite evidence that there is some awareness within nursing (RCN 2007, RCN 2008 and RCN 2011), I will suggest reasons for why nursing and nurse education within HEI’s has not more fully prioritised this issue. I have already argued that nurse education must explicitly address this issue in curricula at both preregistration and professional development levels (Goodman 2011) and suggested rationales and principles for doing so. The wider context is that higher education itself faces challenges to its historic role of developing critical thinking and nursing academics in particular may be lost in delivering competency based vocational education to meet the workforce demands of the NHS. A result may be that nursing scholarship may suffer rendering it even less able to address the values based, philosophical issues and science of climate change.