section three

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Objectives

when you have completed your study of this section, you should be able to discuss:
the ways in which the definition of 'the problem' in ethnic relations has changed over the last four decades
the concepts of personal, cultural and institutional racism.

The oldest problem in the field of 'ethnic relations', as an issue in contemporary societies, is the definition of the problem itself. The identification of these problems - and the construction of the ethnic relations agenda - has been undertaken not by academics but by the dominant actors in the political arena in each society. Not surprisingly, the definition of the 'problem' sets the agenda for what should be done and different starting points for responding to ethnic diversity lead to very different views about how multicultural policies ought to look.

In this section, therefore, you'll be considering five key ways in which the ethnic relations problem has been defined - and redefined over the last four decades and these are:

The minority ethnic groups themselves are the problem: the majority ethnic communities see themselves threatened by the development of minority ethnic communities, and their claims for equitable participation in society
The minority ethnic groups experience problems due to 'cultural deficits': any difficulties or disadvantage experienced by minority ethnic communities are interpreted by the majority society as largely arising from the 'unfortunate' cultural practices of the minorities themselves.
The minority ethnic groups experience problems due to personal prejudice - a personal dislike of and hostility towards minority ethnic groups on the part of certain people in the majority culture
The minority ethnic groups experience problems due to cultural racism in the majority culture - a result of the socialisation process (already discussed under National identity and ethnicity) through which membership of one group provides strong negative images of other groups, based on cultural 'markers'
The minority ethnic groups experience problems due to institutional racism in the majority culture - which is tied up with the power relations in society. The cultural boundaries of people who hold the power in institutions can mean that - whether consciously or unconsciously - they build discrimination into the processes and procedures by which the institutions are run. (Since the majority of institutions in British society are managed and run by white men, for example, this puts black people and women at a disadvantage.)

Read the following text

1. 'Minority Ethnic Groups Are The Problem'

In the European experience, the arrival of migrant workers and their transition into settled minority ethnic communities has all too often been defined as an 'immigration problem'. New additions to the national labour market have been conceived of as a cultural and economic threat to the interests of the indigenous population. (This has happened even when these states had a policy of encouraging immigrant labour. It appears that their labour power was needed, but their social and cultural persons were not.)

As you learnt in Section 1, there was a very real demand for labour in post war Europe and the influx of immigrants was essential to the post-war productivity of the developed European states. By the early to mid-1970s, there was a downturn in the European economy and the structural changes in the manufacturing industries in these countries produced increasing unemployment. However, the migrants were still essential, to fill those jobs that the indigenous labour force now regarded as undesirable - tasks that were deemed too dirty or poorly paid or which required people to work hours that were deemed too anti-social. The immigrants could be exploited as cheap labour, in a way that other sectors of the labour market could not. This still happens - go through almost any international airport in Europe and note who sells you your ticket, who serves you your coffee, who clears the cups away and, if you can glance behind the swing-doors, who washes up the crockery in the kitchen. The segmentation of the labour market along ethnic lines has become part of the European experience.

Immigrant workers, then - who have become the settled minority ethnic groups - have been (and to some extent continue to be) an essential segment of the national labour force and generators of wealth. However, they are not recognised as such - in fact, these new minority ethnic groups have habitually been identified as 'a' problem, if not 'the' problem.

Whether we look at Britain in the 1960s-70s, Norway in the 1980s, or Austria in the 1990s, the creation of a moral panic over the 'Immigration Problem' has been a characteristic element of each state's response to the growth of minority populations.

The construction of events in terms of an Immigration Problem generates a powerful in-group / out-group dynamic in which:

the homogeneity of the in-group - the majority population - is exaggerated - a uniform 'Us/We'
the heterogeneity of the immigrant out-groups is denied - a uniform 'They/Them'.

It then becomes scandalously easy for claims of the kind, "WE are being economically and culturally threatened by THEM", to go unchallenged. In addition:

the denial of equitable economic, political, and social and cultural rights to these 'outsiders' can appear self-evidently legitimate
should minority ethnic individuals trapped within this paradigm attempt to pursue their human rights in relation to welfare provision, say, or employment, they are likely to be labelled as welfare-scroungers or ''political''.

In Europe, the press and the broadcast news media have played a crucial role in defining the 'Immigration Problem' and fuelling popular disquiet within the majority population about the emergence of minority ethnic communities within their society. The main factors here have been:

the media's inherent bias toward simplification, sensationalism and conflict (Bad news makes good stories)
the political interests represented in media ownership.

The news media have habitually responded reactively to the symptoms of intergroup tension, rather than providing a sustained proactive analysis of the material basis for conflict between the majority ethnic populations and immigrants or settled minority ethnic populations. This means that members of the majority population acquire a superficial and distorted picture of the political and economic realities of immigration, which has further facilitated the political exploitation of immigration as an issue.

Exercise 3.1 Reflective activity

Do you recognise this response to immigration and the presence of minority ethnic communities in Britain?
What are the sources of this view in Britain at present? Can you identify:
(a) specific political sources.
(b) specific media sources.
(c) specific individuals in your work place and neighbourhood.
What is your response to their argument?

Acknowledging diversity and recognising disadvantage

The reality of the settled minority ethnic communities within the states of Western Europe has, over time, resulted in the necessary recognition of a new reality - the difficulties and hardships experienced by minority ethnic individuals. Necessary, in the previous sentence, is used to demonstrate that this has not been a spontaneous response by national and local governments to the situation of minority ethnic groups. Many forces have been at work in generating this shift, including:

the routine experience of employees of the local state, in welfare and social service agencies, in health education and policing. Their responses to the demands made upon them by minority ethnic communities may often have been expressed in the language of professional threat, resentment and outrage, but it did constitute a very particular form of evidence of the unique needs and experience of minority ethnic communities.
the collection of comparative statistics by academics, non-governmental agencies and local authorities cumulatively depicted the problems encountered by minority ethnic persons
the increasing political power of the minority ethnic communities themselves made the recognition of their problems necessary
parliamentary social democracies operate within a consensual framework of values relating to a commitment to the rule of law, the virtue of tolerance and the equitable participation of citizens within the political process. The different treatment of ethnic or other minorities threatened to challenge and demystify these values which obscured, and contained, the class and gender inequalities in these societies.

Over time, empirical evidence has demonstrated that members of minority ethnic communities are disadvantaged, in comparison to members of the majority population, on a number of indices. You can find evidence of the nature of these disadvantages and of their implications for health care needs in:

Modood T et al (1997) Ethnic Minorities in Britain: Diversity and Disadvantage, London: Policy Studies Institute
Nazroo J Y (1997) The Health of Britain's Ethnic Minorities, London: Policy Studies Institute
The Runneymede Trust (2000)The Future of Multi-Ethnic Britain, London: Profile Books
Refer to the Module 'Towards an Epidemiology of Diversity, by Mark R D Johnson.

Recognising disadvantage is of course not the same as explaining their origins or planning the strategies for their removal. How disadvantage is explained has a powerful impact on how plans to remedy its consequences are developed. In Britain these disadvantages have been explained as being due to:

cultural 'deficits' in the minority ethnic group
discrimination against minority ethnic groups by the majority population, whether personal, cultural or institutional

2. 'Cultural 'Deficits' are the problem

For first-generation migrants, at least, deprivation could be related to their migrant experience. Initially, for example, they may:

lack the social network of family and friends that facilitates mutual aid in job- or house-hunting
suffer linguistic disadvantage or be unfamiliar with the institutions and norms of the society they have joined
inherit the class disadvantages which go with their (often lowly) position in the labour market.

All these things may be true, and yet they have not been sufficient to explain the extent of the disadvantage experienced by minority ethnic communities, or the continuation of this degree of disadvantage over time. In fact, as will be discussed in Section 4, the different histories and contemporary cultures of minority ethnic communities have been exploited to explain their failure to thrive in Britain.

The cultural deficit model has sought to argue that the disadvantaged status of minority ethnic communities is the result of the misfit between their culture and the demands of life in Britain. This model is convenient for the majority ethnic populations since it effectively blames the victims: they are responsible for their failures.

The processes of migration and the time taken to develop skills in operating within the formal and informal institutions of a new country may very well disadvantage migrants and their descendants. However, we can see from the experience of migrants to America and Australia that, over time, minority ethnic communities do penetrate - and are able to operate effectively within - the institutional structures of these societies. We must look to complementary or alternative forces, to explain the continuing disadvantage of minority ethnic communities.

Increasing documentary evidence has led to the recognition of the discrimination experienced by minority ethnic individuals. However, recognising the fact of discrimination is not the same as explaining the reasons for its existence. Once again, there are various reasons why discrimination might be thought to occur (and the definition of the problem provides the basis for the policies aimed at its eradication). The three main types of racism - personal, cultural and institutional - are the remaining topics for this section.

3. Personal prejudice is the problem

Prejudice might be seen as a common human failing with its roots in earlier psychological trauma or in faulty learning. Gordon Allport, in his major text The Nature of Prejudice, defined 'ethnic prejudice' as follows:

Ethnic prejudice is an antipathy based upon a faulty and inflexible generalisation. It may be felt or expressed. It may be directed toward a group as a whole, or toward an individual because he is a member of that group.

(Allport, 1954 : 10)

In essence, prejudice is an irrational hostility supported by strongly held stereotypes. It is a form of self-sustaining cognitive strategy:

Because we avoid those we dislike, we are unlikely to disprove our stereotypes
We think the worst of those we do encounter, because we employ selective perception
When we are forced to admit that someone does not fit the stereotype we do not correct the stereotype. Rather, in Allport's words, we 'fence them off' - they are the 'exceptions that prove the rule'.

When prejudices are widely shared, as part of a collective culture, they can be very resilient and difficult to eradicate. Such prejudice becomes racist when race thinking and racial ideologies are drawn upon to provide the content of the stereotype and to legitimate the reasonableness of the hostility.

Both in its origin in the social sciences and in the way it has been co-opted by policy-makers, prejudice has proved to be a very conservative conceptual tool. Essentially, prejudice is seen as being the property of an individual - and these individuals become the new definition of the problem and the basis for its solution. In this instance, discrimination is seen as a more-or-less-normal human foible - an individual pathology, which must be expected in some proportion of all societies. Such an account provides the apparently rational basis for the 'rotten apple theory' of discrimination. Wherever an instance of explicit discrimination against members of minority ethnic communities is publicly identified - whether in the action of employers, welfare-workers or the police - the instance can be isolated as the consequence of the behaviour of a prejudiced individual, rather than of the routine practices of a profession or institution. The argument runs, 'Since all institutions recruit from the general population they will have their inevitable share of rotten apples'.

This account of discrimination is highly consistent with the beliefs in the essential equity and openness of society, which characterises European social democracies. Since discrimination constitutes an unfair block to 'normal' rewards - which should in principle reflect individual talents and effort - then it cannot be condoned. It is politically comfortable, therefore, that accounting for discrimination in terms of individual prejudice leaves the essential integrity of the social order intact.

Personal prejudice in the workplace

There will be members of the health care profession, as in any walk of life, who are actively racist - explicitly believing in the reality of 'races' and emotionally committed to a belief in the inferiority of races other than their own. Such people discriminate against others deliberately and their verbal comments are intended to demean and hurt. Some are quite skilled at moderating the style of their assault to fit the circumstances and take advantage of the unwillingness of the majority of their colleagues to challenge their behaviour explicitly.

The need to be able 'to get along together' in a working environment can be a powerfully unspoken force in any workplace. Reports of student nurses on placement certainly provide distressing evidence of such pressures. (Gerrish et al 1996). Our language is full of euphemisms that allow for the negotiation of the extremist in our midst - 'They have a bee in their bonnet', 'They do have a thing about foreigners, but we don't take any notice'. However, the effect of 'not taking notice' is to collude with their racism. Such collusion can allow a single committed racist to effectively define the attitudinal environment of a workplace. Even worse, an extremist minority can convince the majority that they in comparison are moderate and tolerant, even though they are colluding with the racism.

Exercise 3.2 Reflective activity

Consider how in your world people use the notion of prejudice:
- Do they suggest everyone is a little prejudiced and hence racial prejudice is more or less inevitable?
- Do they regard racism as only the 'extreme prejudice' of a minority?
Consider how in your work place expressions of prejudice are challenged.

Exercise 3.3 Group activity
Discuss your shared understanding of "the nature of prejudice", and how acceptable you believe prejudice is as an explanation for minority ethnic disadvantage.

4. Cultural racism is the problem

Earlier generations used the Darwinian language of 'scientific racism' - to justify the 'inevitable' boundaries between people of different 'races' on the basis that some races were genetically inferior to others.

In the 'New Racism', culture, rather than biology, is used to justify such boundaries. Barker (1981) argues that within this new theorisation of 'race', the belief in the absolute inferiority of the out-group is not crucial to their exclusion. Rather, he argues, it is the non-negotiable nature of their cultural difference that sets them apart:

This, then, is the character of the new racism. It is a theory that I shall call biological, or better, pseudo-biological culturalism. Nations on this view are not built out of politics and economics, but out of human nature. It is in our biology, our instincts, to defend our way of life, traditions and customs against outsiders - not because they are inferior but because they are part of different cultures. This is a non-rational process; and none the worse for it. For we are soaked in, made up of, our traditions and our culture

(Barker, 1981:23)

The core of new racist theory, then, is the naturalness of in-group preference and out-group hostility - it is human nature to 'prefer your own'. This invocation of 'human nature' was given scientific legitimacy in the 1960s and 1970s by ethnologists such as Lorenz and Morris. More recently, it has been given further academic support in the theoretical developments of sociobiology, which have, for example, been applied directly to 'race relations' by Van den Berghe (1981, 1986).

The 'new racism' is not a coherent academic theory, which has been systematically developed and set down in a definitive text. However:

because it refers back to notions that already exist - in 'common-sense', 'taken-for-granted', popular belief - the various elements of the new racism appear to cohere in a seemingly rational and, more importantly, reasonable package

the assemblage of ideas has been generated by a loosely structured coterie of right-wing politicians, academics and journalists - a group that Hall et al. (1978) would term 'primary definers'. Their personal status ensures that the concepts and issues are taken up in wider circles - they have been very successful in gaining access to the national press and establishing a language which is echoed there by other journalists. For example, Gordon and Klug (1986: 14) give examples such as these:

a Daily Express editorial claimed that 'it is equally wrong not to recognise that racial selectivity - a natural human preference for one's own kind - is deeply ingrained in ALL peoples, whatever their colour or creed' (20.4.81)
a Daily Star's commentator Robert McNeill argues that: 'Any fool knows (though some fools would rather not know) that the process which Darwin called natural selection means that, on the whole, people prefer their "ain folk" - their own ethnic stock. It's in our genes. It is part of every person's nature, black or white' (18.4.84).

Barker (1981) identified the linkage between this pseudo-biological definition of 'race' and the definition of 'nation'. Both are made of 'one's own kind' - people who share a common culture, a way of life. The concept of 'nation' is crucial in providing a linkage between the political and economic concerns of the New Right, and the racist discourse of new racism. It is a 'natural' boundary for the organisation of cultural and economic life.

[ For an account of the development and content of the new racism, you could read Gordon and Klug, 1986 and/or Seidel, 1986 ]

Seidal (1986) suggests that the ideas of nation and nationality have provided a language that allows a coded vicarious discussion of 'race' - what Reeves (1983) has called 'discursive deracialisation'. By this, he means that

'persons speak purposely to their audiences about racial matters, while avoiding the overt deployment of racial descriptions, evaluations and prescriptions'

(Reeves, 1983: 4).

The new racism, then, has acquired a theory and a range of styles of argumentation, which are enveloped in a self-evident reasonableness and this renders them superficially unobjectionable. At one level, 'race' and 'ethnic self-interest' may be talked of as a 'normal' expression of human nature. At another, when people speak of 'national' culture they may be understood in 'race' terms. The importance of this is that the new racism avoids the explicit superiority claims of earlier, social-Darwinist-informed racism and benefits from comparison with it.

The very familiarity of the language of the new racism makes it easy for people to employ its arguments without undue embarrassment. They don't have to adopt the explicit language of biological racism that is routinely associated with neo-fascists and extremists. It provides a 'common-sense, taken-for-granted' discourse, which easily facilitates its collusive acceptance.

Cultural racism in the workplace

Acts of consensual racism can start with the sharing of racist stereotypes. This might involve referring to patients or colleagues by demeaning names or mocking aspects of their culture - assuming that such opinions are shared in the work environment. As Beishon et al (1995) and Gerrish et al (1996) have demonstrated, such behaviour is far from being unknown in British nursing. This type of racism may often be employed without intentional malice - in fact, the perpetrators are often shocked when their behaviour is challenged. They may deny any intention to cause offence and, indeed, often accuse their questioner of being unduly sensitive, or not being able to take a joke. However, even though such behaviour doesn't require an active intention to cause offence - it is still offensive. And, if the utterance or behaviour is expressed through the discourse of race, or is legitimated by racist belief, then it is also racist.

One feature of this form of consensual racism is that it does not require the degree of personal antipathy that is typical of actively prejudiced individuals. There is no need for a visceral personal dislike, or even a wish to avoid people of other ethnic identities. Thus, nurses fully committed to practicing individualised holistic care may well express consensual culturally racist views. For it is the very perceived reasonableness of these views that make them viable. It is a perspective on the world that has an ethnocentric logic that is reinforced by nationalist and racist ideologies and that have achieved a taken-for-granted acceptability. Discursive deracialisation provides a linguistic code that further submerges the racist core of the beliefs and attitudes.

Exercise 3.4 Reflective activity
Consider situations in your working environment where negative beliefs and attitudes are expressed regarding minority ethnic colleagues or patients.

Try to clearly recall two such instances.
What was the content of the statements?
Do you think that 'discoursive deracialization' was being employed? - namely using an 'acceptable' language style to convey racist sentiments.

You may find it useful to think of how feminism produced an awareness of the gendered power relations in everyday speech - of how men felt threatened by this - of how this awareness became integrated into a change in many work place cultures. Sexist language was so 'normal', became challenged and is now subject to work place disciplinary codes of practice.

Exercise 3.5 Group activity
Discuss your experiences of cultural racism in the work place.
Try to identify why there is a difficulty in trying to challenge this type of behaviour.

5. Institutional racism is the problem

In examining the basis of racism in the health care system we cannot allow ourselves to become fixated on the actions and motivations of individuals. Our understanding of racism must also include an analysis of institutions as systems of management and practice.

The concept of institutional racism has been made highly visible through the political importance attached to the Lawrence Enquiry (Macpherson of Cluny, Sir William. The Stephen Lawrence inquiry - report. HMSO Cmnd 4262-1). It occurs wherever individuals in carrying out the routine practices of their employment produce outcomes that disadvantage members of minority ethnic communities - for example:

employers who use outmoded culturally biased entrance tests
hospitals that fail to provide the possibility of females being treated by female staff
universities and professions that fail to recognise overseas qualifications.

All these practices potentially discriminate against particular minority ethnic groups, regardless of the intentions of the personnel involved. This form of discrimination is much more insidious than that attributable to prejudice or to cultural racism and requires more extensive initiatives in monitoring and training if it is to be countered.

The core of the concept of institutional racism is the irrelevance of the intentions of the actors involved. Instead, it emphasises institutional power, practices and responsibilities - leading to a need to examine:

where the power lies in institutional structures
those points in the institution where people are able to exercise discretionary power: to make decisions, set rules and allocate resources
the ways in which these rules and norms are legitimated
the ways in which they produce discriminatory outcomes.

Institutional racism in the workplace

One of the disturbing implications of institutional racism is that 'nice people' may be implicated in racist practices. Thus, for nurses and midwives we must begin any inquiry into challenging racism - and guaranteeing culturally safe practice - by understanding the contexts in which they practice.

The literature on nurse socialisation shows how strongly nurses come to identify with their professional identities. Anyone who has naively called a midwife a nurse knows immediately the power and importance of professional identities in health care delivery. Indeed, whilst nurses may have a common identity in their commitment to delivering holistic individualised care, the transition from CFP to branch marks a distinct shift in professional identity.

Nurses work in conjunction with other professions, doctors, physiotherapists and radiographers for example, and professional boundaries are negotiated with all the care and concern that we have observed in relation to ethnicity. These boundaries are sustained by powerful ideals about who we are and by the practical routines of what we do. Again, there is a consciousness of kind and a distinct institutional infrastructure, which shapes the construction and defence of these professional identities.

Institutional racism begins to enter into practice when institutional routines reflect the interests of only one group, usually the majority. And, when the discriminatory consequences of these routines remain undetected and unchallenged - because of consensual cultural racism - we have the elements of institutional racism in operation:

Diagram I below outlines a 'formula' of institutional racism

Diagram I: Formula of Institutional Racism
Institutional Racism =	routine institutional practices that are discriminatory in their effect
	+
	structures and power relations made unproblematic by routine race thinking

However, it is important to recognise that it is not racial ideologies alone that normalise these practices. Professional identities and practices also normalise the way things are. Career structures make all staff familiar with hierarchies of power:

there are people with authority
there are proper procedures for getting things done
there are shared ways of making grievances bearable, in a way that does not confront these power structures.

Socialisation into a profession is intended to ensure that those inhabiting it will accept the existing values and structures as normal. In the Health Service, this entails accepting certain models of health (with different health care professions sustaining their own preferred variant) and certain philosophies of care. Being 'a good professional' is no guarantee of our ability to step outside of the routines of our practice in order to imagine alternative modes of practice.

Nurses operate with specific professional identities and they deliver care in quite specific health care situations. Communities of practice (Lave and Wenger, 1991), formed by groups of colleagues working in particular settings - develop their own norms for routine practice and for coping with the pressures generated in that work site. Whether it is A & E, a secure ward in a mental health setting, a hospice or community nursing, there are distinct institutional pressures and shared strategies for operating within them.

An understanding of these communities of practice within nursing and midwifery is essential to developing effective multi-cultural health care. At the heart of this understanding must be a recognition of the independent, but interacting, forces that have either an institutional or personal-subjective basis. In essence, it requires us to distinguish between personal professional capacities and responsibilities and the power and modes of influence of institutional systems. Both factors need to be recognized and employed in developing strategies to meet the health care needs of Britain's multi-ethnic population.

The significance of communities of practice was revealed in the recent ENB research Nurse Education and Communities of Practice carried out by Ian Burkitt, Charles Husband, Jennifer Mackenzie and Alison Torn, with Rosemary Crow. (Research Reports Series No 18, May 2001.) Through participant observation and critical incident interviews in a variety of clinical settings, and through focussed group and individual interviews in an academic setting (a School of Nursing), detailed insight was gained into the construction of nursing identities and the collective acquisition and delivery of nurse care skills.

The concept of "communities of practice" was found to be a most meaningful tool in providing a coherent understanding of nurses learning to practice.

'A community of practice refers to any group involved in joint activities, who also reproduce the community over time by the gradual induction of new participants or learners.'

Lave, J. & Wenger, E. (1991)

The concept of a community of practice requires us to understand the ways whereby individuals, in interaction in a specific context, construct shared meanings and ways of acting that enable them to achieve their collective goals. In both the clinical and academic contexts two defining dimensions of a community of practice were found.

The first was a subjective dimension which reflected the identities the participants sustained in their working environment. One identity was a generic core identity of being 'a nurse'. This inclusive identity of 'nurse' was common to practitioners, educators and students. It was what bound them together in delivering individualised holistic care. But, within this inclusive identity there was embedded specialist nursing identities: of being a burns nurse, an A& E nurse or a palliative care nurse. These specialist identities were themselves given meaning through the way they enabled the individual practitioner to be 'a good nurse'. In other words, there was a continuing interplay between the inclusive 'core' identity and the specialist identity.

A second defining dimension of each community of practice was found to be an 'Institutional Dimension'. This dimension was, at one level, defined by institutional routines and resources: the space, time available, the level of staffing and the power relations between professionals which gave each site its unique characteristics. The other defining feature of this institutional dimension was the managerial ideologies which shaped the activity in each site: a world defined by efficiency savings, cost-effectiveness, audit, competencies and now clinical governance.

Thus, e ach community of practice can be understood through sketching its particular unique features onto a common model of all communities of practice.

Community of Practice: the institutional and subjective axes

All nursing can be seen as a collective attempt to negotiate the strains between the constraints of the institutional dimension and the values and hopes of the subjective dimension.

We may ask - what is it like to provide nursing care in these circumstances? The multiple roles and multiple demands experienced by nurses in clinical settings was aptly described as making nursing "a process of successive interruptions". Each task that is started is interrupted by a demand for the nurse to fulfill another function. Fragmentation of purpose and practice was also amply evident in the educational setting: where amongst other things modularisation had fragmented ownership of the whole curriculum and severed a sustained link with individual tutees. Fragmentation is a characteristic feature of nursing practice and education.

We may ask what is the nature of the style of learning and the basis of practice that takes place within nursing communities of practice? We can distinguish between:

practical consciousness - a routinised, embodied capacity to do - and:
discursive consciousness - a rational, cognitive capacity to reflect upon what we know and what we do.

"Practical consciousness is the knowledge we have about the world that we cannot properly explain to ourselves and to others: we can tell someone what we know but not how or why we know it ... On the other hand, discursive consciousness relates to the knowledge and ability to practice that we can describe in detail to others, not just in terms of what we know but also of how and why we know it."

(Burkitt et al, 2001 :34)

In communities of practice the taken-for-granted knowledge that is practical consciousness is acquired and reinforced through the distinctive routine example and social discipline of the working group. Nursing skills are acquired and delivered in context.

This research strongly supports the view that the management of emotional labour, the shared skills in developing strategies to negotiate the stresses of delivering care and the acquisition and use of intuition in clinical practice are all permeated by the particular culture of specific communities of practice. Thus, we can see that the concept of communities of practice opens up our understanding of how the intersection of institutional constraints and individual subjective identities shape the routine practices of a work place. In all situations where health and social care is delivered it is important to identify the elements that define the subjective and institutional axes of that work place. The collective survival strategies and the pragmatic routines that have been developed in order to sustain professional self-respect within the limited resources of each working environment are the bed rock of practice that shapes the pattern of care delivery, in every instance.

Exercise 3.6 Reflective activity

Consider the description of communities of practice provided above - can you make it relevant to your place of work?
(a) what are the particular restraints of time and resources?
(b) what are the power relations between different colleagues?
(c) what is the professional identity that gives meaning to your work?
Can you identify the ways in which within your community of practice strategies have been developed to manage the contradictions within your working environment?

Exercise 3.7 Group activity

Share your understanding of how the concept of community of practice gives you insight into your work environment.
Discuss how the routine practices of your community of practice may unthinkingly contribute to institutional discrimination against minority ethnic colleagues or clients.

What have you learned so far?

If you are to understand the nature and operation of institutional racism it is important that you understand how institutions, and their organizational cultures, work. The concept of communities of practice is particularly helpful in helping us to see how individuals try to give meaning to their work. This makes them actively engage in the routines and beliefs that make their every day practice tolerable and worthwhile. It is this process that makes us all vulnerable to unthinkingly participating in processes of institutional discrimination.