Becoming aware of blind spots — Norm-critical perspectives on healthcare education

Sammanfattning: BackgroundThis 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.AimThe 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.DesignsThe 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.MethodsIn 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.FindingsStudy 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the occasional use of politically correct rhetoric in curricular documents and literature, in parallel with a number of outdated views in terms of identity and normality.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.ConclusionsThis 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.