An institutional ethnography of substance-use practices among nurses and related management intervention practices in a province in Western Canada
Notice bibliographique
Résumé
When nurses have problems with substance use and are reluctant to seek treatment, their health and wellness are put at risk and their care provision to the public is potentially compromised. Nurses’ substance-use problems and their management through professional organizations’ treatment programs are under-researched and poorly understood overall, and particularly from a Canadian perspective. The disjuncture I experienced between my own embodied experiential knowledge as a nurse and the conceptually based, decontextualized, individuated “official accounts” of the issue I found in the professional and scholarly literature became the problematic that I explored in a multi-phase, manuscript-based doctoral study. I carried out a critical integrative review of the literature on nurses’ substance-use problems, followed by an institutional ethnographic inquiry, in which I aimed to discover (a) how dominant discourses in nurses’ talk about their everyday worlds organized their substance-use practices and (b) how nurses’ experiences were managed in a regulatory treatment program. I utilized data from interviews with 12 standpoint informants (nurses in a regulatory program for substance-use problems) and six secondary informants from different standpoints in the institution, as well as analyses of relevant institutional texts.\n\nThis work yielded significant original findings. Dominant individuated, moralistic, decontextualized discourses in nurses’ talk about their everyday worlds and in professional and scholarly texts silenced nurses’ experiences of work stress. Employers’ roles in nurses’ working conditions were obscured. Nurses’ substance-use practices, particularly alcohol, were organized in ways that enabled them to silently manage their distress and keep working. Nurses gaining capacities to self-advocate for improved working conditions was linked to their recovery from substance-use problems. The standardized regulatory treatment program studied was not based on current norms of practice; did not afford nurses the right to choose treatments; privileged physicians while silencing and subordinating nurses; and was rife with conflicts of interest, power imbalances, and private corporate benefits—all acritically accepted by the regulatory body.\n\nThe important new nursing knowledge gained informs prevention, treatment, regulatory, and education processes aimed to address nurses’ substance-use problems. It does so from nurses’ everyday knowledge and standpoint, furthering their interests and those of other disciplines concerned with professional power and domination.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,018 | 0,009 |
| Communication savante | 0,004 | 0,001 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».