Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea

Shih, Patti; Worth, Heather; Travaglia, Joanne; Kelly‐Hanku, Angela

doi:10.1016/j.socscimed.2017.09.049

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…As trained professionals with specialised medical knowledge and expertise in breast disease, clinicians according to many accounts occupy a socially privileged position of power in relation to their patients [ 7 , 25 ]. This power relationship was particularly evident at the start of the treatment, as patients were new to understanding their diagnosed disease and looked for expert direction and advice.…”

Section: Resultsmentioning

confidence: 99%

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Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Shih

Rapport

Hogden

et al. 2018

BMC Health Serv Res

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BackgroundA relational approach to autonomy refers to the way in which social conditions and relationships shape a person’s self-identity and capacity in decision-making. This article provides an empirical account of how treatment choices for women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, family members, and other aspects of their social environment.MethodsThis qualitative study recruited ten women undergoing treatment at a breast programme, and eight clinicians supporting their care, in a private teaching hospital in New South Wales, Australia. Fourteen patient-clinician consultation observations and 17 semi-structured interviews were conducted. Schema analysis of interview transcripts were undertaken by a team of researchers and corroborated by observational fieldnotes.ResultsRelational identities of patients influenced the rationale for treatment decision-making. Patients drew on supportive resources from family and medical advice from clinicians to progress with treatment goals. While clinicians held much social power over patients as the medical experts, patients highlighted the need for clinicians to earn their trust through demonstrated professionalism. Information exchange created a communicative space for clinicians and patients to negotiate shared values, promoting greater patient ownership of treatment decisions. As treatment progressed, patients’ personal experiences of illness and treatment became a source of self-reflection, with a transformative impact on self-confidence and assertiveness.ConclusionPatients’ confidence and self-trust can be fostered by opportunities for communicative engagement and self-reflection over the course of treatment in breast disease, and better integration of their self-identity and social values in treatment decisions.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3622-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Clinicians occupy a socially privileged position of power in relation to lay patients [ 7 , 25 ], to whom they look for medical expertise for guidance (Spectrums 2 and 4). However, patients demonstrated considerable discernment in response to the way which clinicians attempt to build trust and establish interpersonal rapport.…”

Section: Discussionmentioning

confidence: 99%

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Shih

Rapport

Hogden

et al. 2018

BMC Health Serv Res

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“…On the other hand, health workers in rural areas report hostility and harassment from the communities in which they work (Herbst 2017: 40;Razee et al 2012;Tynan et al 2013), increasing their sense of alienation from rural life. Shih et al (2017) note the national narratives, shared by many Papua New Guinean health workers, that "economic development and progress has been at the expense of traditional customary values and familial relationships, leading to the widespread decline in moral discipline and social order" (p. 51). At the same time, health workers have a deep ambivalence about traditional customary values and traditional relationships, as they can be incompatible with their own sense of themselves as Christian professionals.…”

Section: Discussionmentioning

confidence: 99%

Compassion or Corruption? Temporalities of Care and Nationhood in Papua New Guinean Nursing Education

Andersen

2022

Med Anthropol Q

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Nurse educators in Papua New Guinea (PNG) must prepare students for often demoralizing working conditions. This article analyzes classroom and practical lessons in a PNG Highlands nursing college. A variety of pedagogical practices, including role plays and other simulation technologies, were used to socialize students to imagine patients’ relatives while making clinical decisions, and to contemplate their own relatives and ancestors in reflecting on their moral commitments to health care. Such practices generate a mode of medical citizenship shaped by a regime of biocommunicability in which Christianity and education are thought to transform one's capacity to detach from the emotional appeals of kin. These pedagogies link the individual subjectivities of health workers to a persistent, though fragile, vision of the nation in which transgenerational, urban–rural kinship is a synecdoche for nationhood (and its deferral), despite professional counternarratives that cast these kinship ties as a slippery slope toward “corruption.” [medical citizenship, temporalities of care, nursing simulation, nationhood, Papua New Guinea]

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“…Le pouvoir pastoral étant déjà documenté au sein de la relation de supervision clinique, [41] il n'est pas étonnant si, par la suite, la pratique des infi rmières diplômées comprend des dimensions assujettissantes pour les patients et le recours au pouvoir pastoral dans différents contextes de soins. [42][43][44][45][46] La pratique réfl exive telle qu'utilisée actuellement, constitue un appel ferme à l'introspection, à l'auto-examen de ses conduites et de ses pensées pour permettre une transformation individuelle et d'apprendre à « réfl échir comme une infi rmière ». [13] Toutefois, il est diffi cile de circonscrire ce qu'est réfl échir comme une infi rmière, tandis que, comme nous l'avons vu, le concept même de pratique réfl exive est polysémique, mal circonscrit et fait appel au pouvoir pastoral.…”

Section: Critique De La Pratique Réfl Exive En Sciences Infi Rmièresunclassified

Analyse critique de la pratique réflexive en sciences infirmières

Bernard¹

2020

aporia

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La pratique réflexive est une phase non linéaire incontournable de la démarche de soin qui fait appel à différents savoirs. Les étudiantes en sciences infirmières sont encouragées à y recourir afin de dispenser de soins de qualité aux patients, à leur famille et à la population. Toutefois, cette pratique devrait être considérée dans son contexte sociopolitique afin de prendre en compte les mécanismes de pouvoir ainsi que son potentiel d’assujettissement des corps des infirmières. Une analyse critique foucaldienne du concept de pratique réflexive permet de rendre visible des théories et pratiques pédagogiques assujettissantes lorsque l’aveu est privilégié au détriment d’une réflexion critique essentielle à la pratique infirmière. Elle interroge l’assujettissement des femmes au travers de modèles théoriques valorisant le ressenti aux dépends de d’autres types de savoirs. Le concept de pratique réflexive comporte un paradoxe : il appelle à la critique et à la libération, mais contient également des potentiels assujettissants.

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Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea

Cited by 9 publications

References 39 publications

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Compassion or Corruption? Temporalities of Care and Nationhood in Papua New Guinean Nursing Education

Analyse critique de la pratique réflexive en sciences infirmières

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