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Constructing the Norm-critical awareness scale: A scale for use in educational contexts promoting awareness of prejudice, discrimination, and marginalisation
Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Department of Health Science, Högskolan Väst, Trollhättan, Sweden.ORCID iD: 0000-0002-2358-5086
Department of Health Science, Högskolan Väst, Trollhättan, Sweden.
Department of Health Science, Högskolan Väst, Trollhättan, Sweden.
Department of Health Science, Högskolan Väst, Trollhättan, Sweden.
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. Vol. 38, no 6, p. 652-667
Keywords [en]
Equal opportunities, Health services, Higher education, Instrument development, Norm criticism, Social norms
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-43649DOI: 10.1108/EDI-10-2017-0222Scopus ID: 2-s2.0-85065662520OAI: oai:DiVA.org:hj-43649DiVA, id: diva2:1315180
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-08-09Bibliographically approved
In thesis
1. Becoming aware of blind spots — Norm-critical perspectives on healthcare education
Open this publication in new window or tab >>Becoming aware of blind spots — Norm-critical perspectives on healthcare education
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
Discourse, Equality, Equity, Instrument development, Normality, Norm criticism, Norms, Nursing education
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-43653 (URN)978-91-85835-99-7 (ISBN)
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

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