Praxis methodology: action research without a group

Reflections on the practice of facilitating group-based antenatal education: should a midwife wear a uniform in the hospital setting?

The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the 'expert'. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.

Transformation for health: A framework for health disparities research

The task of generating knowledge addressing disparities in health among vulnerable populations in American society is explored. The community-based participatory approach as an alternate paradigm to traditional research is mentioned as a process for understanding the realities of the populations of interest. Identification and testing of mediating and moderating variables is suggested to guide the process of increasing knowledge regarding health disparities. Transformation for Health is proposed as a conceptual framework to study how these third variables influence the relationship between the primary variables of interest. A theoretical example is offered describing the application of the framework to study the mediators and moderators in an investigation of childhood obesity. Analytical challenges in the exploration of "third variables" are described, and the authors recommend that salient methodological issues should be addressed when conducting these types of investigations.

Reflecting on practice to theorise empowerment for women: using Foucault's concepts

The aim of this research is to understand how power operates in the medical encounter with the childbearing woman and to theorize ways in which midwives can empower women to experience control over what happens to them. Thirty-three Australian pregnant young women and the researcher participated in this study. A post-modern, feminist praxis approach was the research method used. Data was collected using participant observation, in-depth interviewing and reflective journaling. Data was analysed using Michel Foucault's theoretical concepts concerning disciplinary power/knowledge. Key theoretical findings are: knowing how power operates allows midwives to predict what will happen if the woman is intending to resist standardised medical birthing practices. When disciplinary medical power is used the purpose is to coerce patients to do what the doctor wants. Power and knowledge are inseparable, as each strengthens the other, thus Foucault writes of a single concept--Power/Knowledge. Medical power operates most effectively with the co-operation of the midwife and the submission of the childbearing woman. Medical power is normally invisible; it only becomes visible when resistance is encountered, whereupon rewards, threats and punishments are used in an attempt to gain submission. Women can be more empowered if the midwife shares knowledge, not just about pregnancy, labour and birth, but also about the woman's legal rights and what might happen if she decides to refuse standardised medical care. In this way women's empowerment can be facilitated so that they are more likely to experience the type of childbirth they desire.

Academics and practitioners: nurses as intellectuals

Academics and practitioners: nurses as intellectuals In the author's experience, nurse educators working in universities generally accept that they are 'academics', but dismiss suggestions that they are 'intellectuals' because they see it as a pretentious description referring to a small number of academics and aesthetes who inhabit a conceptual world beyond the imaginative capacity of most other people. This paper suggests that the concept of the 'intellectual', if not the word itself, be admitted into nursing discourse through the adoption of a non-élitist Gramscian understanding, similar to the more recently formulated conception of the reflective practitioner. According to the Italian Marxist scholar Antonio Gramsci, intellectuals are those people who develop ways in which to construct the conditions of their own existence, a possibility he believed was open to all. It is suggested that, from a Gramscian perspective, all nurses are intellectuals to varying degrees, and nurse educators should not only be nurturing their own intellectualism but also the potential for intellectualism as it exists within each individual. The ways in which this project are related to Habermasian critical theory are also briefly outlined.

Being a midwife or doing midwifery?

As a profession, we need to be more conscious of the way in which our discipline has been subsumed into techno-rational science and away from our 'with women' focus. The ACMI Philosophy says that we value 'being with' women as the foundation for midwifery practice, therefore the concept 'being with' should be a competency which is reflected in the ACMI Professional Standards and Competencies. Currently, there is no Professional Standard for "Being With Women": all midwifery care has been subsumed under the rubric of problem-solving. The problem-solving approach is part of the modernist, techno-rational approach to human life experiences. Problem-solving, I am claiming, has been over-generalised and imposed upon human experiences where it is not appropriate. This paper argues against adopting problem-solving as the framework for practice because this means that every aspect of midwifery care has to be problematised. This paper concludes by suggesting one way in which our philosophy could be honoured in our professional standards and competencies.

Postmodern feminist emancipatory research: is it an oxymoron?

Many nurse-researchers who use feminist methods believe that postmodernism undermines the scientific and emancipatory aspirations of our discipline and they are therefore wary of postmodern theories. One of the main threats of postmodernism is the critique of humanism because humanism forms the ethical foundation for both nursing and feminism. These critiques expose the dark underside of humanistic ideals and show how, paradoxically, humanism has functioned to oppress people. The arguments presented here help emancipatory researchers to defend their practices, both in relation to research participants and in the ways in which the subjects is theorized. The conclusion is that postmodernism can be compatible with politically motivated, humanistically-based inquiry.