Drawing on Arthur Frank’s conceptualization of narrative repair, we consider how pediatric oncology nurses restore and re-story the narratives of patients and families whose biographies have been thrown off course by the diagnosis and death of a child from cancer, as well as their own narratives as caregivers. Frank argued that when one’s life story is shipwrecked by chronic or life-threatening illness, storytelling is way to reorient one’s biography to a new ending, repairing the narrative wreckage created by the illness experience. In this critical narrative study with nine pediatric oncology nurses in Ontario, Canada, we highlight how, through physical, narrative, and moral proximity, nurses become entwined in their patients’ and families’ illness narratives, and how developing this narrative knowledge provides nurses with opportunities to steer families onto new terrain. As well, we examine how nurses re-story and repair their own identities as “good” caregivers in situations when they are prevented from acting on behalf of their pediatric cancer patients. These findings contribute to literature on illness narratives by considering narrative repair as a relational process enacted as part of pediatric oncology caregiving.

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.

Background The purpose of this study was to explore the dimensional structure of the Environmental Health Officer (EHO) responses to the BARRIERS Scale from data collected in 2012 and 2020 to: (1) uncover new holistic ways of interpreting the factors influencing research utilization (RU); and (2) apply a theoretical lens to the data. Methods Principal Component Analysis was used to analyze the dimensional structure of the 2012 data and develop a structural equation model (SEM). The resultant factors were categorized using the Active Implementation Frameworks (AIFs). Confirmatory Factor Analysis was applied to the SEM using the 2020 data. Results A four factor solution was identified and the resultant SEM aligned with the following AIFs: Competency Drivers, Useful Innovations, Leadership Drivers, and Organization Drivers. The SEM was found to explain 52% of the loading variation, capturing a satisfactory amount of information from the dataset. The SEM was analyzed for goodness of fit using 2020 data and it showed a statistically sound but imperfect fit. Conclusions These four factors provide a useful way to understand and mitigate barriers to RU in EHO practice. Three of the factors align with the Implementation Drivers Framework (Competency Drivers, Leadership Drivers, and Organization Drivers) and the fourth factor was associated with the Useful Innovations Framework, representing only two of the six AIFs, thus demonstrating a theoretical gap. The imperfect goodness of fit test indicated a statistical gap. These results suggest that more research is needed to better understand the full set of barriers to RU experienced by EHOs.

Understanding the barriers to research utilization (RU) experienced by Environmental Health Officers (EHOs) facilitates evidence use and improved outcomes in both normal and emergency practice. The purposes of this study were to (i) understand the barriers to research use in the everyday work of EHOs and (ii) determine how these barriers change in the context of emergency practice. The Barriers to Research Utilization (BARRIERS) Scale was disseminated to a cross-sectional sample of Canadian EHOs. Responses were analyzed using measures of central tendency. Data were collected during a typical work period in 2012 (311 respondents) and during the COVID-19 pandemic in 2020 (82 respondents). The three greatest barriers to RU identified by EHOs at both points in time were (i) a lack of authority to implement changes in practice, (ii) a lack of time to review research, and (iii) a lack of time to implement research findings. Mean ratings were not statistically different in 2012 and 2020. The consistency of the top three barriers to RU suggests they are particularly embedded in EHO practice in Canada, indicating that they are useful intervention targets to increase RU. Further, it can be inferred that targeted interventions to support RU will benefit outcomes in both normal and emergency situations. More research is needed to understand the embedded structural and organizational issues influencing EHO practice behaviour.

Using a critical reflexive process ( An Invitation to Reflexive Sociology , 1992; Theory, Culture & Society , 13, 1996, 17), this article identifies and examines issues of power, complicity and knowledge production as they emerged in the first author's master's research on migrant women farmers' economic and reproductive health experiences in the middle belt of Ghana. We examine the ambivalent positionality of the international graduate student researcher as “other of the other” ( Signs: Journal of Women in Culture and Society , 30, 2005, 2017, p. 2025), and how diverse fields of power, including the researcher's educational institution and cultural norms regarding gender relations, mediated interactions among various actors in the research process. Specifically, we examine how the student researcher was complicit in reinforcing patriarchal standards, perpetuating western saviourism and committing symbolic violence. Situating these reflexive findings in relation to insights from feminist postcolonial theories, we highlight how power relations, gender and social class informed these ambivalent complicities. Rather than erase/silence these tensions in the research process, we argue that such ambivalences may be an inevitable dimension of transnational knowledge creation, and thus, it is imperative that researchers consider how their ambivalent positionalities and complicities may be navigated and leveraged most productively and with the least harm to research participants.

Despite their low and inconsistent rates of success, assisted reproductive technologies (ARTs) are presented by fertility clinics and constructed in media and popular culture as an effective treatment for infertility. The ways in which such technologies medicalize women's health and bodies have been well documented by social scientists and feminist health researchers. However, little is known about the struggles women face in cases of "failure"; that is, when ART does not achieve its purported potential to assist women in their attempts to conceive and have the desired outcomes of conception and birth. Using a post-structural feminist interpretive framework combined with a narrative methodology, this paper critically examines the ways in which social and cultural narratives about gender and biotechnology shape women's accounts of discontinuing ART. Thirty-six interviews were conducted with twenty-two women across Canada who were at various stages of discontinuation and who utilized a variety of treatment types. Three inter-related narrative themes were developed to categorize the stories of struggle: (i) a growing desperation to be pregnant; (ii) confronting paternalistic medical expectations; and (iii) internalizing and resisting blame for treatment failures. These themes highlight both the explicit and subtle ways in which restrictive social and cultural narratives about womanhood and motherhood were perpetuated in clinical interactions, which ultimately made ending treatment more difficult. Our analysis illustrates how women navigated and resisted such narratives, through pausing or ending treatment despite provider recommendations and clinical messages. We suggest that fertility providers critically reflect on the potentially harmful language used during interactions with patients and recommend that discontinuation discussions become a recurring, normalized component of treatment protocols and patient-provider conversations so that women feel better supported to end treatment when they believe it is financially, emotionally, and physically beneficial for them to do so.

PURPOSE:This paper aims to examine emotional labour in the work of frontline staff (FLS) of the Canadian Blood Services' Cord Blood Bank (CBB), contributes to understandings of emotional labour by allied healthcare workers and suggests implications for healthcare managers.DESIGN/METHODOLOGY/APPROACH:Qualitative interviews with 15 FLS were conducted and analyzed as part of a process evaluation of donor recruitment and cord blood collection in Canada.FINDINGS:Emotional labour with donors and hospital staff emerged as a vital component of FLS' donor recruitment and cord blood collection work. Emotional labour was performed with donors to contribute to a positive birthing experience, facilitate communication and provide support. Emotional labour was performed with hospital staff to gain acceptance and build relationships, enlist support and navigate hierarchies of authority.RESEARCH LIMITATIONS/IMPLICATIONS:The results indicate that FLS perform emotional labour with women to provide donor care and with hospital staff to facilitate organizational conditions. The findings are based on FLS' accounts of their work and would be enhanced by research that examines the perspectives of donors and hospital staff.PRACTICAL IMPLICATIONS:Attention should be paid to organizational conditions that induce the performance of emotional labour and may add to FLS workload. Formal reciprocal arrangements between FLS and hospital staff may reduce the responsibility on FLS and enable them to focus on recruitment and collections.ORIGINALITY/VALUE:This paper addresses a gap in the healthcare management literature by identifying the emotional labour of allied healthcare workers. It also contributes to the cord blood banking literature by providing empirically grounded analysis of frontline collection staff.

This article presents a key finding from a reflexive ethnographic study of the work disabled people and their support networks do to organize self-managed attendant services: that disabled 'self-managers' and their 'attendant' employees perform relational work to increase autonomy in the context of austerity-driven systemic constraints. Through a temporal lens informed by feminist and disability studies perspectives, 'clock time' was seen to obscure personal resources of energy, time and skill that self-managers and attendants contribute to the performance of relational work. 'Crip time' is explored as an alternative temporal orientation that might meaningfully inform future policy and programme development.

BACKGROUND Umbilical cord blood (CB) is an important source of hematopoietic stem cells that are used to treat blood- and immune-system disorders. Public CB banks aim to build inventories with high-quality CB units to meet healthcare needs. While research has noted the influence of broader contextual factors on donor recruitment and CB collection processes, to date, no published study has identified the specific contextual factors and challenges to donor recruitment and CB collection. This paper addresses this gap in the literature. STUDY DESIGN AND METHODS A qualitative case study focusing on donor recruitment and CB collection processes was conducted to identify the contextual factors influencing these processes. This paper reports the findings from in-depth, semi-structured interviews conducted with 15 frontline staff of the Canadian Blood Services' Cord Blood Bank. Interview data were analyzed using inductive interpretive methods to identify the contextual conditions and factors that influence recruitment and collection. RESULTS Frontline staff described various social factors that influenced and challenged the processes of donor recruitment and CB collection. These were categorized into four overlapping contexts: birthing context, hospital context, CB bank organizational context, and sociocultural context. CONCLUSION Consideration of social context is necessary in order to effectively address the factors and challenges that influence the successful development of high-quality CB inventories, and to guide resource allocation. Further examination of contextually-rooted factors and their interactions is necessary to optimize donor recruitment and CB collection processes.

L’objectif était d’étudier le déploiement des discours sur la vaccination contre les VPH (VVPH) et leur impact sur les filles, les parents, les infirmiers/infirmières et les médecins canadiens.

This article takes as its starting point the idea that re-emerging infectious disease has become a paradigmatic way of thinking about disease. The framing of infectious disease as a threat to global public health and economic security coincides with preemptive forms of control. A particular type of preemptive regulation is global pandemic influenza planning that entails the governing of an imminent, albeit uncertain, global health event. We examine the discourse of ‘preparedness’ within pandemic planning documents produced by the World Health Organization from 1999 to 2009. We present key findings on: the construction of the influenza virus in terms of its potential to transform and expand across corporeal and territorial boundaries; and the integration of pandemic preparedness into everyday practices. Our analysis illustrates how the discourse of preparedness links the justification for population-level preemptive approaches to discursive constructions of the virus. By articulating this relationship, this article contributes to understandings of the implications of ‘molecular’ constructions for the biopolitical regulation of the global population.

The introduction of human papillomavirus (HPV) vaccination has resulted in a proliferation of discourse about HPV-related health risks, with a particular emphasis on the link between HPV and cervical cancer. Using a discursive narrative approach, we critically examine how young women navigate and construct their identities in relation to discourses on HPV vaccination, and the master narratives of risk, medicalization and individual responsibility for health that inform these discourses. Drawing on positioning theory, the narratives of three women who accepted, declined and were undecided about vaccination are presented to illustrate how they actively and uniquely negotiate their identities in relation to the positions idealized by HPV vaccination discourse, and in the context of their intimate relations and everyday lives. These findings fundamentally challenge dominant techno-scientific perspectives on health risk that underpin the majority of research on HPV vaccine decision-making, and health promotion research more generally. We suggest that discursive narrative approaches can advance critical understanding of how health risk discourse, and emerging technologies aimed at reducing health risks, are implicated in promoting neoliberal constructions of healthy citizenship that frame health risk management as an individual responsibility and moral obligation.

This paper examines the daily struggles of unionized employees whose municipal workplace was undergoing major change influenced by New Public Management. In-depth interviews with 45 front-line service providers revealed widespread frustration with working conditions and relationships with management. We interpret this response as an embodied expression of hysteresis, a term that Bourdieu used to describe the gap between changing field conditions and habitus. We argue that organizational change posed challenges for these workers because it produced a rupture between their taken-for-granted ways of being a “good” public servant (i.e., public service habitus) and what was expected of them after restructuring. Moreover, on the basis of gendered occupational class differences in employees’ practices, we suggest that hysteresis is itself a socially-structured phenomenon that reflects the tacit calculation of what was possible (or not) for workers occupying specific positions within the stratified order of the organization.

This article critically examines the proliferation of information on the human papillomavirus (HPV) vaccination as integral to contemporary processes of medicalization that take the young female body and her nascent sexuality as its primary object and target. We suggest that the recent introduction of voluntary HPV vaccination for girls, in North America and elsewhere, constitutes a form of neomedicalization (Batt & Lippman, 2010 ) that links risks for future disease (cervical cancer) with the transmission of a common, sexually transmitted infection (HPV). Informed by findings from a critical discourse analysis of Canadian English newspapers, magazines, and public information about HPV vaccination, our interest is on how the emergence of sexual relationships becomes constructed as a time fraught with risks to future health, and that must be managed through biotechnological intervention (vaccination). We suggest that this configuration of medicalization, rather than demarcate a new category of abnormality that can be treated with pharmaceutical or medical intervention, positions the emergence of sexuality itself as the basis of risk and pathologization. The article concludes by considering the implications of this form of medicalization for constructions of female sexuality and sexual health education.

This paper explores the clinical pedigree as a risk technique within the context of the predictive genetic testing (PGT) clinic. We situate the PGT clinic as a site of genetic governance in that it is a site both for the production of knowledge about genetic risk and for intervening in the everyday lives of individuals and their families who learn to cultivate their relations with themselves and their biological relatives in relation to genetic risk knowledge. Drawing on literature of the pedigree as socially constructed and on notions of risk governance, we suggest that the pedigree operates as an epistemological tool and risk technique - that is, as a visual device that assists in organizing the social relations of knowledge production and aids in effecting shifts in patient subjectivity in ways that are consistent with neoliberal notions of active citizenship.

Current media representations of human papillomavirus (HPV) vaccination communicate a potent message that concerns about sexually transmitted infection (STI) are no longer restricted to sexually active “bad girls”. The mass marketing of vaccines against HPV – whether to serve industry efforts to establish markets for products or public health efforts to minimise STIs and cancer morbidity and mortality – firmly yet carefully inscribes the not-yet-sexually-active “good girl” as the primary target in the control of sexually transmitted disease. The rationale for HPV vaccination of girls prior to sexual contact in Canada and elsewhere derives from the high prevalence of the virus (which is typically described as the most common STI worldwide), its ease of transmission through non-penetrative, skin-to-skin contact and the relatively high incidence of HPV infection after onset of sexual relations.1 Because all forms of sexual contact are considered likely to expose girls/teens to HPV, the delivery and mass marketing of HPV vaccination prior to sexual activity frame parental decisions to vaccinate as the right, reasonable and responsible choice to “protect” their daughters and arm them “for life” in the ongoing war against cancer.2 3Unlike the girls targeted by the school-based vaccination programmes, young women who fall outside the recommended age range for vaccination, and those who are already sexually active, are left in a kind of limbo that stems from the disconnect between mass marketing messages and clinical evidence. On the one hand, the …

Flexible work is now endemic in modern economies. A growing literature both praises work flexibility for accommodating employees' needs and criticizes it for fueling contingency and job insecurity. Although studies have identified varied effects of flexible work, questions remain about the workplace dimensions of flexibility and how occupational workplace health is managed in these workplaces. This paper presents findings from a qualitative study of how managers in the computer software industry situate workplace flexibility and approach worker health. In-depth interviews were conducted with managers (and some workers) at 30 firms in Ontario, Canada. Using a critical discourse analysis approach, we examine managers' optimistic descriptions of flexibility which emphasize how flexible work contributes to workers' life balance. We then contrast this with managers' depictions of flexibility work practices as intense and inescapable. We suggest that the discourse of flexibility, and the work practices they foster, make possible and reinforce an increased intensity of work that is driven by the demands of technological pace and change that characterize the global information technology and computer software industries. Finally, we propose that flexible knowledge work has led to a re-framing of occupational health management involving a focus on what we call “strategies of resilience” that aim to buttress workers' capacities to withstand intensive and uncertain working conditions.