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Becoming aware of blind spots — Norm-critical perspectives on healthcare education
Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).ORCID iD: 0000-0002-2358-5086
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

This dissertation takes a critical look at norms and normality in healthcare education, focusing on the specific case of a nursing education programme at a Swedish university college. The concepts of norms and normality have a long history in healthcare professions, and have become important for many aspects of social life. A norm-critical perspective is central to the studies, as it exposes constructions of power and privilege related to norms and normality. It may also be useful in revealing underlying assumptions and matters which healthcare professionals take for granted, and which may result in failure to provide equitable care for all.

Aim

The overall aim of the dissertation is to describe and scrutinise norms and normality in a healthcare education context from a norm-critical perspective. A further aim is to explore how a norm-critical perspective on nursing education can contribute knowledge to existing fields of critical inquiry.

Designs

The four studies were designed using qualitative approaches to written and spoken text, as well as a number of different approaches to an instrument development process.

Methods

In study I, document analysis was underpinned by thematic analysis, while critical discourse analysis was used to analyse focus group discussions in study II. Study III analysed written responses to open survey questions using a discursive approach. Instrument development and factor analytic techniques were used in study IV.

Findings

Study I revealed the occasional use of politically correct rhetoric in curricular documents and literature, in parallel with a number of outdated views in terms of identity and normality. In study II, three discourses were identified in nursing teachers’ talk, all with norm-critical potential, though criticism of norms was not strong enough to form a discourse of its own. Study III showed how nursing students used more or less politically correct or reflexive approaches to construct images of norms and normality. Study IV developed and validated the Norm-critical awareness scale.

Conclusions

This dissertation expands knowledge about norm-critical perspectives in healthcare contexts. It exposes constructions of normative, taken-for-granted aspects within healthcare education, and concludes that the apparently desirable concept of tolerance needs to be problematised more fully in relation to norms, privilege and power. Norm criticism as an educational and intellectual tool can increase awareness of the norm-related mechanisms underlying healthcare encounters, even if awareness is only a first and necessary phase of change, and is not in itself sufficient to bring about change.

Implications

In a practical sense, the findings can facilitate understanding, planning and implementation of further norm-critical initiatives in educational contexts. Where theory is concerned, the studies fill a knowledge gap by contributing to norm-critical approaches in settings where future healthcare professionals are being educated, which have barely been explored until now. The studies also add to existing research traditions involving critical, emancipatory and anti-oppressive perspectives in terms of healthcare professions.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2019. , p. 108
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 100
Keywords [en]
Discourse, Equality, Equity, Instrument development, Normality, Norm criticism, Norms, Nursing education
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-43653ISBN: 978-91-85835-99-7 (print)OAI: oai:DiVA.org:hj-43653DiVA, id: diva2:1315191
Public defence
2019-06-14, Albertsalen (F104), University West, Trollhättan, 13:00 (English)
Opponent
Supervisors
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-27Bibliographically approved
List of papers
1. Norm-critical potential in undergraduate nursing education curricula: A document analysis
Open this publication in new window or tab >>Norm-critical potential in undergraduate nursing education curricula: A document analysis
2019 (English)In: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 42, no 2, p. E24-E37Article in journal (Refereed) Published
Abstract [en]

The documents and literature that regulate nursing education are based on certain values and knowledge, and the underlying power in the curriculum raises the question of how health care professionals are molded during the course of their education. Norm criticism is a concept with its roots in critical pedagogy and gender and queer studies, emphasizing the origins as well as the consequences of marginalization, power, and knowledge of what is generally accepted as "normal" and "true." Norm criticism is used in this article to analyze the documents and literature underlying a nursing program in Sweden, which are shown to include a sometimes politically correct rhetoric, but one lacking a firm basis in social justice values.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
Keywords
antioppressive education, document analysis, norm criticism, nursing curriculum, nursing education, social justice, Sweden
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-41947 (URN)10.1097/ANS.0000000000000228 (DOI)30325741 (PubMedID)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2019-05-27Bibliographically approved
2. Discourses with potential to disrupt traditional nursing education: Nursing teachers’ talk about norm-critical competence
Open this publication in new window or tab >>Discourses with potential to disrupt traditional nursing education: Nursing teachers’ talk about norm-critical competence
2017 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 24, no 1, article id e12166Article in journal (Refereed) Published
Abstract [en]

This paper describes the discourses underlying nursing teachers’ talk about their own norm-critical competence. Norm criticism is an approach that promotes awareness and criticism of the norms and power structures that exert an excluding effect in society in general and in the healthcare encounter in particular. Given the unequal relationships that can exist in healthcare, for example relationships shaped by racism, sexism and classism, a norm-critical approach to nursing education would help illuminate these matters. The studied empirical material consisted of focus group interviews. Nursing teachers discussed their norm-critical competence based on the university course “Norm-Aware Caring” in which they had recently participated. Through a critical discourse analysis, three discourses were identified in their talk, all of which had the potential to disrupt traditional, normative nursing education. However, in all three discourses there was an underlying discourse of normality, clearly positioning the teachers as exemplifying the “normal.” The binary constructed between normality and otherness contradicts a basic tenet of the norm-critical approach and may hamper the development of genuine norm-critical competence in nursing education.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
competence; critical discourse analysis; focus groups; healthcare disparities; norm criticism; nursing education; social norms
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-32261 (URN)10.1111/nin.12166 (DOI)000393814300006 ()28124809 (PubMedID)2-s2.0-84997456771 (Scopus ID)
Note

Special Issue: Beyond the Gender Binary

Available from: 2016-11-10 Created: 2016-11-10 Last updated: 2019-05-27Bibliographically approved
3. From political correctness to reflexivity: A norm-critical perspective on nursing education
Open this publication in new window or tab >>From political correctness to reflexivity: A norm-critical perspective on nursing education
2019 (English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-43651 (URN)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-27
4. Constructing the Norm-critical awareness scale: A scale for use in educational contexts promoting awareness of prejudice, discrimination, and marginalisation
Open this publication in new window or tab >>Constructing the Norm-critical awareness scale: A scale for use in educational contexts promoting awareness of prejudice, discrimination, and marginalisation
2019 (English)In: Equality, Diversity and Inclusion, ISSN 2040-7149, E-ISSN 2040-7157, Vol. 38, no 6, p. 652-667Article in journal (Refereed) Published
Abstract [en]

Purpose

Healthcare professionals' conscious or unconscious norms, values and attitudes have been identified as partial explanations of healthcare inequity. Norm criticism is an approach that questions what is generally accepted as "normal" in society, and it enables professionals to identify norms that might cause prejudice, discrimination and marginalisation. In order to assess norm-critical awareness, a measurement scale is needed. The purpose of this paper is to develop a scale for measuring norm-critical awareness.

Design/methodology/approach

The scale-development process comprised a qualitative item-generating phase and a statistical reduction phase. The item pool was generated from key literature on norm criticism and was revised according to an expert panel, pilot studies and one "think aloud" session. To investigate the dimensionality and to reduce the number of items of the scale, confirmatory factor analysis was performed.

Findings

The item-generation phase resulted in a 46-item scale comprising five theoretically derived dimensions revolving around function, consequences, identity, resistance and learning related to norms. The item-reduction phase resulted in an instrument consisting of five dimensions and 20 items. The analyses indicated that a summary score on the scale could be used to reflect the broad dimension of norm-critical awareness.

Originality/value

The Norm-critical awareness scale comprises five theoretically derived dimensions and can be used as a summary score to indicate the level of norm-critical awareness in educational contexts. This knowledge is valuable for identifying areas in greater need of attention.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019
Keywords
Equal opportunities, Health services, Higher education, Instrument development, Norm criticism, Social norms
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-43649 (URN)10.1108/EDI-10-2017-0222 (DOI)2-s2.0-85065662520 (Scopus ID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-08-09Bibliographically approved

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