"He just teaches whatever he thinks is important": Analysis of comments in student evaluations of teaching.

Student evaluations of teaching are ubiquitous in higher education; however, most prior research has focused on the numeric ratings, with little systematic attention given to the qualitative comments. In this study, written comments were collected as part of the regular evaluation of a community health nursing course over four semesters. Taken as a whole, student comments were strikingly consistent and mostly negative. Students emphasized the authority of the textbook and framed the course as preparation for the National Council Licensure Examination (NCLEX). Instructor efforts to focus on critical analysis of social issues were met with confusion, suspicion, and resistance. Student comments were further analyzed in relation to 3 levels of discourse: the student/teacher level, the nursing-education level, and the social-historical level. For each level, the comments reveal problems, but not the ones suggested by a conventional reading of student evaluations. If students and teachers have conflicting expectations about goals and methods for learning, formal student evaluations may be less useful as a measure of teaching effectiveness. This study also raises troubling concerns about current practices in nursing pedagogy, particularly the emphasis on standardized testing and highly structured didactics, and the overlap between student evaluation systems and the technologies of neoliberalism.

Practical Discourse Revisited: Hermeneutics at the Intersection of Philosophy and Nursing.

Three early papers by Janice Thompson-Practical Discourse, Critical Scholarship, and Hermeneutic Inquiry-are examined in reference to the historical context of the time (1985-1990), and implications for current scholarship. Hermeneutic philosophy has been neglected in recent years, overshadowed by its weaker cousin phenomenology. I argue that renewed attention to hermeneutics would help us focus on the "situatedness" of nursing scholars, the class politics of academia, and a better balance in interpretative work between faith and suspicion. Critical hermeneutics also offers a more robust understanding of praxis and phronesis, and links to pragmatism and social studies of science.

'Looking like a bad person': vocabulary of motives and narrative analysis in a story of nursing collegiality.

Collegiality among nurses is necessary for the accomplishment of the tasks of care, for safety and quality improvement and for professional self-regulation. Nurses, especially in hospitals, are more likely to work in groups than other professionals, yet those relationships have not been well explored. Bullying, intimidation and fear are frequently identified, while respectful disagreements are rarely described. In this paper, a single story by a nurse about her conversational conflict with another nurse is given a close reading. I use the 'triadic line' of William Carlos Williams to format an extended excerpt of interview text, in order to make visible the rhythms and organization of spoken language. Mills' concept of a 'vocabulary of motives' is used to examine the rhetorical strategies deployed by each nurse. Finally, I analyze the narrative structure of the story, highlighting the ways that moral certainty and uncertainty function to involve the reader in the story, and the complex role of virtue in nursing discourse.

Professional collegiality and peer monitoring among nursing staff: an ethnographic study.

BACKGROUND: Patient safety and professional self-regulation systems both rely on professional colleagues to hold each other accountable for quality of care. OBJECTIVES: To understand how staff nurses manage variations in practices within the group, and negotiate the rules-in-use for quality of care, collegiality, and accountability. DESIGN/METHODS: Ethnographic case study; participant-observation, semi-structured interviews, policy analysis. SETTING: In-patient unit in an urban US teaching hospital. RESULTS: Explicit acknowledgment of conflicts and practice variations was perceived as risky to group cohesion. The dependence of staff on mutual assistance, and the absence of a system of group practice, led to the practice of "mutual deference", a strategy of reciprocal tolerance and non-interference that gave wide discretion to each nurse's decisions about care. CONCLUSIONS: Efforts to improve professional accountability will need to address material constraints and the organization of nursing work, as well as communication and leadership skills.

Making the case: leveraging resources toward public health system improvement in Turning Point states.

Leveraging funds to sustain the efforts of a grant-funded initiative is often an explicit, or implicit, expectation in philanthropy. However, the magnitude of funds leveraged and the factors that facilitate success in leveraging are rarely researched. An example of one of these grant-funded initiatives is the National Turning Point Initiative. Twenty-one states received funding from The Robert Wood Johnson Foundation as part of this initiative to establish and implement strategic goals for achieving significant statewide public health system improvement through diverse, cross-sector partnerships. Leaders from 17 of these 21 states participated in a two-phased study regarding the leveraging of additional funds for their public health infrastructure improvement activities. This article reports on the second phase of the study. In this phase, key informant interviews were conducted to examine how leveraging of resources occurred as part of this large national initiative. Findings indicate that the combination of a comprehensive planning process and a broad-based partnership was crucial in securing resources to expand their efforts. The ability to strategically respond to unexpected events and opportunities also helped states use their plans and partnerships to "make the case" for additional resources to improve their public health infrastructure.

Building sustainable public health systems change at the state level.

Reforming the public health infrastructure requires substantial system changes at the state level, including the reorganization of state agencies' plans, roles, and relationships with other sectors and communities. Beyond the limited time period of pilot programs and grants, how are these public health system changes to be sustained? Turning Point is an initiative of The Robert Wood Johnson Foundation to transform and strengthen the public health system. The 21 states participating in this initiative developed multisector partnerships to produce public health improvement plans and from these, chose one or more priorities for implementation. Reform efforts to strengthen the public health system occur within complex fiscal and political environments, however, and must cope with both uncertainty and turbulence in the process of implementing change. Turning Point state partners have developed a variety of approaches to the challenge of incorporating effective community collaborations as a permanent strategy for transforming public health systems. A qualitative, descriptive study design was used to analyze the strategies used by Turning Point state partnerships to meet the challenges of sustaining their system improvements. These strategies included: institutionalization within government, establishing "third sector" institutions, cultivating relationships with significant allies, and enhancing communication and visibility among multiple communities.

Turning point and public health institutes: vehicles for systems change.

Public Health Institutes are free-standing multisector entities able to function as conveners to improve health status and foster innovations in health systems. Turning Point is a program funded by The Robert Wood Johnson Foundation, involving 21 statewide initiatives and 2 "linked" states that formed multisector collaborative partnerships for public health systems change. In 18 of the Turning Point states, there are also Public Health Institutes, some formed by Turning Point partnerships and some established independently. Both Turning Point and Public Health Institutes represent efforts to reform and enhance public health systems. What has been the relationship between these two organizational forms? This descriptive, qualitative study examined the relationships between state-level Turning Point partnerships and Public Health Institutes in states that have both. Key participants in both institutions were interviewed, and models were developed to represent those relationships. Principal findings suggest that the relationships of Turning Point state partnerships with Public Health Institutes have taken many shapes. Factors that influence the choices and sequencing of these options are largely related to the political and economic resources of each state. Turning Point participants perceived Public Health Institutes to be a useful organizational form for sustaining public health systems change. Public Health Institutes have more administrative and fiscal flexibility than state government and greater opportunities for policy development and advocacy. However, free-standing institutes also have greater financial uncertainty.