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7 - ‘We are here for you’: the care crisis and the (un)learning of good nursing
- Edited by Lise Lotte Hansen, Roskilde Universitet, Denmark, Hanne Marlene Dahl, The University of Chicago, Laura Horn, Roskilde Universitet, Denmark
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- Book:
- A Care Crisis in the Nordic Welfare States?
- Published by:
- Bristol University Press
- Published online:
- 13 May 2022
- Print publication:
- 29 November 2021, pp 120-138
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Summary
Introduction
Over the last few decades, nurses have had to do the necessary, and sometimes life-saving, care work at hospitals under genuinely changing political and organisational conditions. Following the regimes of New Public Management (NPM), new managerial discourses have been set up in Scandinavia, as well as in many other OECD countries, which have placed ever-increasing pressure on health-care workers (Malmmose, 2009; Centeno and Cohen, 2012). Managerial regimes have been implemented, partly to encourage efficiency through standardisation of care, but also to ensure commitment to the marketisation discourse and make ‘health care services’ more consumer-oriented and open, to meet the consumer's ‘right to choose’ between different service providers. The arrival of these new regimes and discourses have been followed by policy instructions to take up a more service-minded approach, displayed through the slogan, ‘We are here for you’, advertising the Regional Health Service on the website (Region Sjælland, 2016). This is part of a policy regime, aiming to address the needs of patients-as-customers and announcing the political and organisational concern, not only for consumer choices, but also for their safety – as a first priority. While it could in fact be seen as a commitment to address citizens’ and patients’ needs, we will discuss a different and more complex reality. The focus of this chapter is on the consequences of the current transformations of these governing regimes – here based on the recorded experiences of newly educated nurses from different medical wards in Region Zealand, Denmark.
The work of nurses has, since the beginning of the 21st century, been deeply influenced by international discourses of safety programmes; especially as outlined in the World Health Organisation's (WHO) conceptualisation of ‘patient safety friendly hospitals’ (WHO, 2016). These safety programmes are clearly linked to the discursive visions of NPM to improve health care services to secure consumer satisfaction, directly targeteding the issue of reliability of services. The organisational commitments have led to intensified monitoring of care practices, shifting the implied responsibilities towards the professionals rather than the patients (Mitchel, 2008), which has imposed further demands on health professionals to safeguard patients from the risk of malpractice in the name of patient-centredness.
8 - Professionalisation of social pedagogues under managerial control: caring for children in a time of care crisis
- Edited by Lise Lotte Hansen, Roskilde Universitet, Denmark, Hanne Marlene Dahl, The University of Chicago, Laura Horn, Roskilde Universitet, Denmark
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- Book:
- A Care Crisis in the Nordic Welfare States?
- Published by:
- Bristol University Press
- Published online:
- 13 May 2022
- Print publication:
- 29 November 2021, pp 139-157
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Summary
Introduction
The field of early childhood education and care (ECEC) is characterised by great diversity in status and organisation in different countries. Care for children is commonly heavily dependent on unpaid and non-formal care work by mothers and relatives, or poorly paid nursing and childminding, for instance by migrant workers (Acker, 1990; Bäck-Wiklund, 2004). Consequently, a common strategy for the valorisation of care work pursued by feminist policy-makers and researchers, in the Nordic countries in particular, is that of professionalisation or ‘professional projects’ (Witz, 1990; Williams, 1996; Dahl, 2010). In Denmark, this political strategy has been advocated not only by the labour unions of the (social, educational and health) care workers and by their educational institutions. The possibilities and advantages of professionalisation have also been taken up and promoted as part of policy discourses and regulatory reforms around the ‘modernisation’ of public services as a means to enhance the quality of care, and the legitimacy of public service and reproduction on a broader scale (Wrede et al, 2008; Dahl, 2010). Seen from this point of view, professionalisation is not a controversial strategy.
Taking a closer look at the underlying interests and explicit reasons for professionalisation, there is however less consensus among the advocating agents. In fact, discussions of professionalisation expose controversies not only about the aims, but also the means of professionalisation. Following Witz (1990), this chapter argues that the potential of professionalisation as a strategy rests on the validation of the substance of the professional practice at its core: on the one side, the basic understandings and recognition of the services rendered; on the other side, the status of professional knowledge, qualifications and necessary judgements, values and ethics needed to act with professionalism to secure the quality of the tasks and services provided. This chapter explores the potentials of professionalisation strategies, motivated by the central question of whether professionalisation will actually help in providing recognition for essential ECEC care work – and whether this can counteract a ‘crisis of care’, as discussed in the contributions to this book.
The following discussion will raise concerns about the status of care work and the potential of professionalisation based on empirical research in the context of care work in Danish ECECs. The term ECECs is used to denote the common public institutions in the field of ECEC.
nine - Fathering as a learning process: breaking new ground in familiar territory
- Edited by Guðný Björk Eydal, Tine Rostgaard, Stockholms universitet Institutionen för socialt arbete
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- Book:
- Fatherhood in the Nordic Welfare States
- Published by:
- Bristol University Press
- Published online:
- 04 March 2022
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- 26 November 2014, pp 187-208
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Summary
Introduction
This chapter explores the learning processes of fathers engaging in everyday caregiving practices in family life based on a cross-Nordic qualitative study. The fathers were selected because they were seen as ‘pioneers’ in having made unconventional commitments regarding childcare. They had chosen to take longer paternity leave than normal, reduced their working hours or altered their career path so as to be actively involved in the everyday caring for their children. From a historical perspective, their commitments could be seen as avant-garde, and they are possibly the frontrunners of a broad social development.
The notion of ‘modern’ family life is itself an ambiguous term. This chapter departs from an understanding of Western societies as marked by ongoing modernisation and individualisation processes, meaning that contemporary family life unfolds in a context of continual social change (Beck and Beck-Gernsheim, 1995; Dencik et al, 2008; Westerling, 2008). Gillis’ renowned distinction between ‘families we live by’ and ‘families we live with’ (Gillis, 1997, p xv) is also central to the understanding of family and family life that informs the analysis in this chapter. Ideologies and practices are seen as related and connected but cannot be reduced to one or the other; both must be considered, and their relationship cannot be understood in simple or linear terms.
Informed by understandings of social learning and the modernity of critical theory, Olesen (2003) argues that a common disintegration of ‘the normal biography’ is occurring in modernity, requiring new types of social participation and practices – and possibilities for learning. Accordingly, it is possible to understand the involvement of fathers in childcare not merely as ‘chosen’, but also as ‘necessary’, that is, related to the unavoidable, practical arrangements and demands of everyday life.
In this sense, we see these fathers as ‘pioneers’ at the cutting edge of the social change in family life (Roseneil and Budgeon, 2004), challenging traditional, general and conventional forms of fatherhood and constructions of masculinity. In the analytical perspective adopted in this chapter, the fathers emerge as particular men with specific stories about practices and modes of orientation towards care and intimacy in everyday family life.