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The "as-if" world of nursing is a well-constructed, institutionally preserved and defended myth that asserts clinicians who are "just nurses" do not make decisions in the absence of "doctor's orders." Drawing on data from an ethnography exploring the interactions between nurses and industry, we explore the finding that many nurses did not identify as "decision makers" and were mystified by the attention of sales representatives. Many nurses experienced marketing as benign as there was no "decision" to sway. Nursing must deconstruct the "as-if" nondecisional myth by confronting conflicts of interest and owning fully its rightful clinical and advocacy roles. www.advancesinnursingscience.com.

The "as-if" world of nursing is a well-constructed, institutionally preserved and defended myth that asserts clinicians who are "just nurses" do not make decisions in the absence of "doctor's orders." Drawing on data from an ethnography exploring the interactions between nurses and industry, we explore the finding that many nurses did not identify as "decision makers" and were mystified by the attention of sales representatives. Many nurses experienced marketing as benign as there was no "decision" to sway. Nursing must deconstruct the "as-if" nondecisional myth by confronting conflicts of interest and owning fully its rightful clinical and advocacy roles. www.advancesinnursingscience.com.

BackgroundThe mainstay for addressing conflicts of interest in health care is disclosure of personal financial ties to industry. However, this approach fails to capture the complexity of industry interactions that are built into clinical practice. Further, the policy climate focuses on physicians and traditional pharmaceutical marketing.ObjectiveTo describe industry activities targeted at registered nurses.DesignQualitative, ethnographic study conducted from January 2012 to October 2014.SettingFour acute care hospitals in a western U.S. city.ParticipantsA purposive sample of 72 participants with direct experience with industry, including staff nurses, administrators, and industry and supply chain professionals.MeasurementsFieldwork, including observations (102 hours), semistructured in-depth interviews (n = 51), focus groups (n = 4), and documents analysis.ResultsNurses' reported financial relationships with industry were similar to those reported by prescribers. However, nurses reported that their most significant interactions with industry occurred in daily practice. The current policy environment rendered these interactions invisible, leaving nurses with little guidance to ensure that the boundary between service and sales remained intact.LimitationsThis study could not determine the frequency or prevalence of nurse-industry interactions. The sample is not representative.ConclusionNurse-industry interactions may be common and influential, but they remain invisible in the current policy climate. Although some aspects of these interactions may be beneficial, others may pose financial risks to hospitals or safety risks to patients. Disclosure strategies alone do not provide health professionals with adequate support to manage day-to-day interactions. Management of industry interactions must include guidance for nurses.Primary funding sourceAgency for Healthcare Research and Quality; Canadian Institutes of Health Research; and University of California, San Francisco.

Tobacco use is prevalent among service members, but civilian public health groups have not effectively addressed military tobacco control policy issues. We conducted focus groups in 2010 and 2012 with participants from public health and tobacco control organizations regarding their understanding of the military and of tobacco use in that context. Misperceptions were common. Military personnel were believed to be young, from marginalized populations, and motivated to join by lack of other options. Tobacco use was considered integral to military life; participants were sometimes reluctant to endorse stronger tobacco control policies than those applied to civilians, although some believed the military could be a social policy leader. Engaging public health professionals as effective partners in tobacco-free military efforts may require education about and reframing of military service and tobacco control policy.

BackgroundTobacco use is a major cause of chronic disease, disability and death among military personnel and veterans. However, civilian public health and tobacco control advocates have been relatively silent on the issue. Research on the tobacco industry shows a long history of interference in military tobacco policy through relationships with the United States (US) Congress. The military cannot autonomously implement tobacco control, but is subject to Congressional oversight. Thus, the primary obstacles to effective tobacco control in the military are Congressional political opposition and tobacco industry influence, and by extension, a lack of civilian awareness and support in the policy arena.MethodsAs part of a larger project to explore the topic of civilian support for military tobacco control, we analyzed data from focus groups with public health professionals to better understand their sense of agency and authority in regards to military tobacco control. Researchers conducted 4 focus groups with a total of 36 public health professionals at key conferences for those working in public health and tobacco control. Data were coded and the research team developed an interpretive account that captured patterns and variations in the data.ResultsPublic health and tobacco control participants shared a sense of futility regarding civilian efforts to engage in military tobacco control. This stemmed from feeling ignorant of military culture and structure, identifying powerful discourses that opposed tobacco control, particularly in a military context, and the very-real presence of the tobacco industry lobby throughout the policy process.ConclusionsA strong public health voice on military tobacco control might serve to begin problematizing the tobacco industry's influence in the military policy arena. As the military moves to institute stronger tobacco control policy, public health and tobacco control professionals should work to engage with and aid its efforts from the outside. Only with such civilian side support can the goal of a tobacco free military be realized.

BackgroundWith increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice.Methods and findingsWe searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis of this literature.ConclusionsNon-physician clinicians' generally positive attitudes toward industry interactions, despite their recognition of issues related to bias, suggest that industry interactions are normalized in clinical practice across non-physician disciplines. Industry relations policy should address all disciplines and be implemented consistently in order to mitigate conflicts of interest and address such interactions' potential to affect patient care. Please see later in the article for the Editors' Summary.

Post-truth strategies are characterized by the manipulation of facts and personal assertions of the truth for political gain. By seeding polarization, skepticism, and mistrust, post-truth presents challenges to teaching and learning within academic settings. In this paper, we explore how post-truth is articulated in higher education literature using a critical pedagogical lens. We suggest that pedagogical scholarship needs to expand its scope beyond a focus on the media antics of individual politicians in order to interrogate the reliance on dominant framings that simply define “post-truth” as circumstances where personal beliefs take precedence over established facts. We argue that the current framing of post-truth shapes the educational response to this issue, which focuses on helping students discern correct from incorrect information, as opposed to teaching students how power and knowledge are intertwined in post-truth and ways to understand and address the subsequent and potentially harmful power relations. Since post-truth strategies are enacted to restrict thoughtful reflection on dominant relations of power, we propose a critical pedagogical framework to problematize the notion of objective truth, account for the politics of exclusion, examine power relations, and contest post-truth strategies. [ABSTRACT FROM AUTHOR]

Aims: One tool for protecting quality use of medicines in hospitals is a drug and therapeutics committee (DTC) that oversees medicines availability. Pharmaceutical industry marketing to prescribers is associated with less appropriate prescribing and increased costs. There is little data on decision‐making practices of DTCs so it is unknown whether or how they might be vulnerable to pharmaceutical industry influence. This project explores DTC decision‐making with a focus on how pharmaceutical industry influence on access and use of medicines is identified and managed. Methods: We used a qualitative methodology with individual interviews of 29 participants who were current or recent members of public hospital DTCs across New South Wales, Australia. Participants included medical, pharmacy and nursing staff and 1 citizen. Committees were linked to specific hospitals or regions, and some were affiliated with paediatric, neonatal, rural or mental health services. Results: Drug committee processes for oversight of medicines in public hospitals are vulnerable to pharmaceutical industry influence at several points. Applications for formulary additions are sometimes initiated and completed by company representatives. Conflict of interest disclosures among applicants and committee members may be incomplete. In some institutions, medicines are available from pharmaceutical companies without committee review, including through free samples and industry‐supported medicines access programmes. Participants noticed the presence and impact of pharmaceutical company marketing activities to local clinicians, resulting in increased prescriber demand for products. Conclusion: Improved DTC practices and review of hospital policies concerning pharmaceutical marketing activities might preserve the independence of evidence‐based decision‐making for safe, cost‐effective prescribing. [ABSTRACT FROM AUTHOR]