Running head NUTRITION1NUTRITION 8Nutriti.docx

Running head: NUTRITION 1
NUTRITION 8
Nutrition
Student’s Name
Institutional Affiliation
Date
Nutrition
Introduction/Key Points
Topic and Question
Topic five: Interventions to improve additional nutritional
status: What type of interventions improve adherence to
recommendations on nutritional intake?

Define the Topic and Question
This topic question is defined by interventions to enhance
adherence to dietary advice for preventing and managing
chronic diseases in adults. By introducing these interventions
earlier, it will be possible to prevent people from being affected
by chronic diseases.
Overview/Significance of the Problem
The acceptance and implementation of a healthy diet has been
recognized as the foundation for managing, preventing, and
fighting chronic diseases. However, the inability to be dynamic
and diversify one’s life diet can lead to significant problems. It
is also vital that people know that people acknowledge the
importance of obeying dietary counsel since one’s adherence
level can determine the efficiency of dietary treatment. The
ability of one to diversify his diet reduces the risk of
developing food allergy and intolerance (Ball et al., 2016).
Additionally, the lack of education has been mostly associated
with a poor quality and less diversified diet in people with
diabetes (Tiew, Chan, Lye & Loke, 2014). It is, therefore,
evident how the ability to diversify and be dynamic on one’s
diet improves the nutritional status.
Article Search
Current and Credible Sources
When searching for my article, I established the Chamberlain
Library as an essential tool to assist during the search. I started
with my electronic database known as CINHAL where I
successfully found the article.
Database search-terms and methods/ Number of articles located
While I was searching for the article, among the terms that I
used was; what type of interventions improve adherence to
recommendations on nutritional intake? The search provided me
with 1,123 articles to refer from. Other search terms that I used

were compliance, telemedicine, nutrition, dietary intervention,
chronic disease, and adults. The types of articles were limited to
be from the Chamberlain Library, written in English, academic
journals, descriptive statistics, and full-text peer-reviewed
articles. The publication year on the search filter was restricted
to 2015 to 2020 to provide the most recent data.
List additional sources outside of ATI module
Main article, “Understanding the nutrition care needs of patients
newly diagnosed with type 2 diabetes: a need for open
communication and patient-focused consultations,” written by
(Ball et al., 2016). Another article is “Factors Associated with
Dietary Diversity Score among Individuals with Type 2
Diabetes Mellitus,” published by (Tiew, Chan, Lye & Loke,
2014). Another article is “Prevent Type 2 Diabetes in Kids” by
(CDC, 2017).
Article Findings
Why this article?
I chose this article because it has been well written and has
incorporated all the necessary elements to be referred as a
scholarly article. Additionally, I was also interested in the way
open communication and patient-focused consultations could
help in understanding the needs of patients who have been
newly diagnosed with type 2 diabetes.
How it addresses the topic?
The main objective of using open communication and patient-
focused consultations is to build and maintain relationships with
patients who have T2DM (Ball et al., 2016). This article
effectively addresses the topic because it presents tow
interventions that can be used to help in improving one’s
dietary intake. This study specifically assessed the experience
of patients when changing their diets and their perceptions of
the way health professionals could effectively support the long-
term change in their diet (Ball et al., 2016, p. 2).
Types of Research Conducted
It is evident that this case was a qualitative study (Ball et al.,
2016). The article has incorporated the use of interviews and

tables for a better understanding and visualizing of the findings
in the article. The study had a sample population of 10
individuals who had been recently identified with T2DM. This
comprehensive review assessed the success of applying open
communication interventions when attaining dietary change in
adults who have a chronic disease (Ball et al., 2016). With the
help of these interventions, patients can access nutritional
programs and provide valuable feedback with regards to the
precise dietary requirements despite the latent barriers that may
arise. When barriers are removed, people can effectively adhere
to dietary recommendations. To effectively manage chronic
diseases in the long term, people must implement diverse
dietary changes, which can be sometimes overwhelming to
patients. Open communication can provide patients with regular
support and education that is easily accessible (Ball et al.,
2016). It is, therefore, evident that this article was selected
since it responds to the study question by offering an evidence-
based solution to implement open communication and patient-
focused interventions. These interventions were recognized to
adhere to the recommendations on nutritional intake.
Findings of Research
The findings in the study indicated that most of the study’s
participants experienced problems in blending to their recent
diagnosis of T2DM (Ball et al., 2016). This ultimately had a
direct negative effect on their perceptions concerning dietary
intake. The diagnosis also had a considerable negative impact
on the attitude of the participants towards food. More
specifically, it reduced their confidence about the types of food
to consume (Ball et al., 2016). The participants also did not
enjoy eating anymore and felt unease when eating with other
people. The study also indicated that the level of support
provided by health professionals needs to be improved (Ball et
al., 2016). Additionally, genuine support and open
communication was considered very important to build
relationships with patients who would in turn benefit from
trying to improve their diet.

Evidence for Practice
Summary of Evidence
Among the most important discoveries of this review was that
the dietary intermediations delivered by open communication
successfully promoted slights improvements in diet quality as
well as dietary recommendation compliance (Ball et al., 2016).
This review stresses the importance of open communication and
patient-focused interventions to be applied in practice to alter
dietary behavior while applying tools like videoconferencing,
the Internet and smartphones.
Improvement
This study enhances practices by providing clients with easy
ways to follow dietary changes that will improve their general
wellbeing and health, even though they have chronic diseases.
Open communication and patient-focused interventions use
practical means to help dietary changes and also provide
benefits like a higher degree of patient acceptability and
flexibility. Currently, more than 75% of the population in the
whole world is recognizing the importance of communication
when handling issues (Ball et al., 2016). This effectively
portrays the broad potential that the interventions can improve
the coverage, access, as well as implantation techniques, more
specifically in populations that have low socioeconomic status
(CDC, 2017). Evidence has also helped in ascertaining that by
using open communication and patient-focused interventions, it
is possible to improve one’s adherence to the intake of nutrients
(Ball et al., 2016). Fundamentally, this can help to influence
healthcare networks to incorporate this technique into their
practice.
Evidence decreasing a gap
With the help of findings from the study, it will be possible to
decrease the current gap in practice. As well indicated in the
article, patient-focused consultations and open communication
help people to develop a direct positive effect on their
perceptions concerning what they have been consuming or
eating (Ball et al., 2016).

Weaknesses/Concerns
When going through this article, the only concern that crossed
my mind was that the article provided recommendations to the
elderly populations who often face difficulties and
complications when trying to change their eating habits.
Additionally, as a result of the various barriers such as
depression, isolation, poor appetite, chewing difficulty, and
socio-economic challenges, the elderly population can be easily
influenced to alter their eating performances and diet plans
(Ball et al., 2016).
Sharing of Evidence
Who would you share the information with?
The information gathered in this comprehensive review must be
shared amongst health care networks, more specifically primary
healthcare providers. Primary healthcare facilities can also
derive immense benefits when using patient-focused
consultations and open communication because patients always
require a constant follow-up with their healthcare providers if
one has been diagnosed with a chronic disease. This will enable
providers to continually check their clients so that they
completely adhere to their dietary recommendations. If a client
lacks knowledge or is overwhelmed concerning the dietary
changes, patient-focused consultations and open communication
can play a significant role in enhancing a quick and convenient
involvement for healthcare providers. Additionally, these
interventions assist in saving office visit times during complex
circumstances.
How would you share this information?
The most efficient way of sharing this information precisely and
effectively would be using medical representatives. Medical
representatives help to introduce new products to healthcare
professionals, relay instant answers to questions, and raise
product awareness.
What resources would you need to accomplish this sharing of
evidence?

I would also request assistance from the administrator or
manager of the facility, thereby facilitating the transfer of
critical information between healthcare staff and patients. The
information provided in the article is also critical for healthcare
practitioners like nurses. Nurses act as the ears and eyes of the
doctors; therefore, this article is beneficial because it creates
options and strategies from consistent medications.
Conclusion
Generally, this research has met its expectations because it
proves that patient-focused consultations and open
communication can help in improving the welfare of patients.
Effectively, it has helped to show the forms of interventions
that can be applied to make people adhere to their
commendations on nutritional intake. This comprehensive
review assessed the efficiency of patient-focused consultations
and open communication when performing dietary changes in
elders infected with chronic diseases.
References
Ball, L., Davmor, R., Leveritt, M., Desbrow, B., Ehrlich, C., &

Chaboyer, W. (2016). Understanding the nutrition care needs of
patients newly diagnosed with type 2 diabetes: a need for open
communication and patient-focused consultations. Australian
Journal of Primary Health, 22(5), 416. doi: 10.1071/py15063
CDC. (2017). Prevent Type 2 Diabetes in Kids | Diabetes | CDC.
Retrieved 27 November 2019, from
https://www.cdc.gov/diabetes/prevent-type-2/type-2-kids.html
Tiew, K., Chan, Y., Lye, M., & Loke, S. (2014). Factors
Associated with Dietary Diversity Score among Individuals with
Type 2 Diabetes Mellitus. Journal Health Population and
Nutrition, 32(4), 665–676. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438697/
Understanding the nutrition care needs of patients newly
diagnosed
with type 2 diabetes: a need for open communication
and patient-focussed consultations
Lauren BallA,C, Ruth DavmorA, Michael LeverittB, Ben
DesbrowA, Carolyn EhrlichA
and Wendy ChaboyerA
AMenzies Health Institute Queensland, Griffith University,
Gold Coast 4222, Qld, Australia.
BSchool of Human Movement and Nutrition Sciences, The
University of Queensland,
Brisbane 4072, Qld, Australia.
CCorresponding author. Email: [email protected]
Abstract. Patients who are newly diagnosed with type 2 diabetes

mellitus (T2DM) commonly attempt to modify their
dietary intake after receiving nutrition care from primary health
professionals. Yet, adherence to dietary recommendations
is rarely sustained and factors influencing adherence are poorly
understood. This study exploredT2DMpatients’ experiences
of dietary change and their views on how primary health
professionals can best support long-term maintenance of dietary
change.Apurposive sample of 10 individuals recently
diagnosedwithT2DMparticipated in three individual semi-
structured
qualitative telephone interviews: at baseline, then at 3 and 6
months after recruitment. Interview questions were modified
from the initial interview inorder to investigate
emergingfindings.A two-step data analysis process occurred
throughcontent
analysis of individual interviews andmeta-synthesis of findings
over time. Participants initiallymadewide-ranging attempts
to improve dietary behaviours, butmost experienced negative
emotions from the restraint required tomaintain a healthy diet.
Participants felt confused by the conflicting advice received
from health professionals and other sources such as friends,
family, internet and diabetes organisations. Participants
frequently reported feeling rushed and not heard in
consultations,
resulting in limited ongoing engagement with primary
healthcare services. These findings suggest that there is
opportunity
for primary health professionals to enhance the dietary support
provided to patients by: acknowledging the challenges of
sustained improvements in dietary intake; open communication;
and investing in patient relationships through more
patient-focussed consultations.
Additional keywords: chronic disease, general practice, primary
care, nutrition therapy, nutritional management.

Received 28 April 2015, accepted 18 August 2015, published
online 5 October 2015
Introduction
Type 2 diabetes mellitus (T2DM) is a lifestyle-related chronic
disease and leading cause of morbidity andmortality in
Australia
(Australian Institute of Health andWelfare 2007). Over 5%of
the
Australian population has been diagnosed with T2DM, and an
additional 0.9% is predicted to be diagnosed annually
(Australian
Bureau of Statistics (ABS) 2012). T2DM is typically diagnosed
and managed in the primary healthcare setting, and patients
with
T2DM receive health care from a variety of primary health
professionals (Diabetes Australia 2012). Importantly, the health
outcomes of patients with T2DM are influenced by their dietary
intake (Coppell et al. 2010). Therefore, facilitating patients
to have a healthy dietary intake is a key component of T2DM
management (Diabetes Australia, Royal Australian College of
General Practitioners (RACGP) 2008; National Health and
Hospitals Reform Commission 2009).
Patients who are newly diagnosed with T2DM commonly
attempt to modify their dietary intake after receiving nutrition
care from primary health professionals (Castro-Sánchez and
Avila-Ortiz 2013). In the first 6 months after diagnosis, patients
often experience changes to their enjoyment of food while
trying
to follow a recommended diet, and most report only temporarily
adherence to dietary recommendations (Castro-Sánchez and
Avila-Ortiz 2013). The United Kingdom Prospective Diabetes
Study was the largest clinical research study into diabetes

management (n = 3867 participants), and has shown that
establishing short-term optimal glycaemic control in the early
stages after diagnosis reduces the risk of macro- and micro-
vascular complications, as well as all-cause mortality 10 years
after diagnosis (Murray et al.2010).Given the influenceofdietary
intake on glycaemic control of patientswith T2DM,
investigating
ways to further support patients to maintain healthy dietary
behaviours in the early stages after diagnosis is important.
Exploring patients’ experiences and perceptions is crucial
to understanding how to provide patient-centred care. Patient-
centred care is an approach to health care that meets the specific
Journal compilation � La Trobe University 2016
www.publish.csiro.au/journals/py
CSIRO PUBLISHING
Australian Journal of Primary Health, 2016, 22, 416–422
Research
http://dx.doi.org/10.1071/PY15063
mailto:[email protected]
needs, values and beliefs of patients (McMillan et al. 2013) and
is
regarded as imperative to the optimal management of chronic
disease, including T2DM (Holman and Lorig 2000). Many
primary health professionals, such as GPs, practice nurses and
dietitians, report providing ‘nutrition care’ to patients, referring
to
anypractice conducted to support patients to improve their
dietary
intake (Ball et al. 2010; Ball et al. 2012). Recent investigations

into the nutrition care provided by primary health professionals
indicate that patient-centred care is not always achieved, and
this
may be hindering the efficacy of nutrition care for chronic
disease
management (Ball et al. 2012; Ball et al. 2013; Ball et al. 2014).
Given the importance of optimal dietary intake in T2DM self-
management, it is necessary for primary health professionals
to better understand the experiences, challenges and needs of
patients attempting to improve their dietary behaviours in order
to provide effective patient-centred nutrition care.
The aim of this study was to examine the perceptions of
patientswho have been recently diagnosedwith T2DMregarding
nutrition care provided by primary healthcare professionals.
Specifically, the study explored patients’ experience of dietary
change and their views on how primary health professionals
could best support long-termmaintenance of dietary change.
This
understanding can be used to facilitate health professionals to
provide nutrition care that addresses the needs and experiences
of patients.
Methods
This study utilised a longitudinal, qualitative design to describe
the perceptions and experiences of patients who have recently
been diagnosed with T2DM. The study was approved by
the Griffith University Human Research Ethics Committee
(reference number PBH/09/14/HREC).
Participant recruitment
A purposive sample of individuals with T2DM (<4 months since
diagnosis) was recruited via e-newsletters and social media
pages of Diabetes Australia, and state branches of Diabetes New

SouthWales,DiabetesQueensland,Diabetes SouthAustralia and
Diabetes Tasmania. The sampling strategy aimed to recruit a
combination of male and female, young and old, employed and
unemployed/retired participants. Potential participants who
contacted the research team were provided with a plain
language
information sheet, before being asked to provide consent and
attend an initial interview.
Data collection
Each participant was involved in three individual semi-
structured
telephone interviews; at baseline, and then at 3 and 6months
after
recruitment into the study.A semi-structured interviewguidewas
developed for each round of interviews. Interviews included
questions such as: ‘How has your recent diagnosis influenced
your feelings about food?’; ‘Describe your interactions with
health professionals regarding food and healthy eating’; and ‘At
this moment, how could health professionals be most helpful
in supporting you in healthy eating?’ Elaboration probing,
clarification probing and attention probing were utilised to
gain a deeper understanding of the participants’ perceptions
(Liamputtong 2010). Interview questions were modified from
the initial interview in order to investigate emerging findings
(Thomson and Holland 2003).
All interviewswere conducted by one investigator (RD), were
30–60min in length and were digitally recorded and transcribed
verbatim. Immediately after each interview, an entrywasmade in
a reflective journal that outlined the impressions of the
interview.
Data collection and analysis were conducted concurrently;
recruitment and data collection continued until data saturation

was considered to have been achieved. In practical terms,
saturation was considered to have been reached when no new
responses and subsequent preliminary categoriesweredetectedas
interviews progressed (Strauss and Corbin 2007).
Data analysis
A two-step data analysis process was used for this study. First,
content analysis was used to analyse the verbatim transcripts
because it allows an in-depth understanding of the participants’
nutrition care needs (Graneheim and Lundman 2004; Hsieh and
Shannon 2005). Analysis of verbatim transcripts involved an
iterative process of reading the transcripts to become familiar
with the data, generating initial subcategories, searching for
categories, reviewing the categories and, finally, labelling the
categories (Graneheim and Lundman 2004; Hsieh and Shannon
2005). Triangular analysis was conducted by two investigators
(LB andRD), who independently generated initial subcategories,
and then compared and discussed to reach agreement. Second,
a meta-synthesis approach was undertaken to synthesise and
interpret the data across the three time points (Sandelowski and
Barroso 2007). The process involved extracting the
subcategories
and interpreting them in order to identify higher order
categories
that transcend findings from each period. Regular meetings
were
held with the whole research team in which emerging findings
were critically reviewed, ensuring that the identified and
defined
subcategories accurately reflected the data for transferability
and
credibility.
Results

Ten individuals participated in the study, each completing three
interviews. The participants consisted of three males and seven
females, and their ages ranged from 27 to 74 years. A summary
of
the three categories and subcategories that emerged from the
analysis are displayed in Table 1.
What is known about the topic?
* Patients newly diagnosed with type 2 diabetes
commonly attempt to modify their dietary intake after
receiving nutrition-related care. Adherence to dietary
recommendations is rarely sustained and factors
influencing adherence are poorly understood.
What does this paper add?
* The results suggest that there is opportunity to enhance
the dietary support provided to patients by investing
in patient relationships through more patient-focussed
consultations and open communication.
Nutrition care for type 2 diabetes mellitus Australian Journal of
Primary Health 417
Adjusting to diagnosis
The first category encompassed the impact of being diagnosed
with T2DM on participants’ perceptions about the food they eat
and their broader dietary intake. The adjustment process
involved
considerable emotional adaptation, which occurred at different
rates among participants. Initially, participants reported feeling
shocked and surprised at being diagnosed with T2DM. Most
considered their usual dietary intake to be healthy, and this
added

to the challengeof coming to termswith having a long-
termhealth
condition:
I’ve always considered [that] we ate healthy . . . It never
entered my mind that I would have sugar diabetes.
(Participant 7, Interview 1)
The diagnosis of T2DM appeared to have an immediate
negative impact on participants’ views about dietary intake in
general, particularly in social situations when others reacted to
the news:
All the sad faces, they say, ‘Oh, you’ve got diabetes.’
People are now scared to cook for me. It’s actually
intimidated them to think they can’t actually cook normal
food. (Participant 8, Interview 1)
Three and six months after the initial interview, participants
began to adapt to the diagnosis of T2DM, generally moving on
from the initial shock and feelingmore in control, as the
following
statements from the same participant in successive interviews
demonstrate:
I keep saying tomyself, ‘I’mnot depressed, I’mnot allowed
to be depressed.’ I got so depressedwhen I was diagnosed,
of course, and I don’t feel quite as black as that, but I don’t
feel that I’m in control of myself at the moment, either.
I’ve accepted it now, and just have a little swear and curse
every now and then. It’s been a little bit easier lately, I’m
handling it better. (Participant 7, Interview 3)
After adjusting to thediagnosis, participantswantedcontinued

improvement in their management of T2DM, even beyond the
goals suggested by their supporting health professionals:
The doctor said she was really happy with my BGL [blood
glucose level] at 6.5, but I think maybe below 6 is better.
I know it’s quite difficult, but I want to try anyway.
Modifying dietary behaviours
The second category related to participants’ experiences of
modifying their dietary behaviours in order to improve their
blood glucose management and other health outcomes. These
experiences ranged from logistical considerations of food
preparation to broad emotional adaptation to having different
dietary behaviours compared with before diagnosis.
Initially,wide-ranging attempts to improvedietary behaviours
were undertaken by participants. Participants experienced an
emotional impact of restricting their diet, as well as managing
ongoing changes:
I’vemade somewholesale changes to theway I vieweating,
what I eat and [now I pay] particular attention, like stuff
like food labels . . .making sure I eat three meals a day and
don’t skip meals. (Participant 2, Interview 1)
As time progressed, participants had differing experiences
of sustaining dietary changes, with some finding that
monitoring
blood sugar levels provided useful feedback on food choices:
I’ve got to the stage now where I don’t think too much
about the diet because . . . you’re just in the habit of
eating healthy meals. I know now what I should be
eating, and what are ‘sometimes’ foods. (Participant 2,

Interview 2)
You know you’ve eaten the right thing because the [blood
sugar] reading is lower. (Participant 6, Interview 2)
Table 1. Categories and subcategories emerging from the
interviews
Category Definition Subcategories
Adjusting to diagnosis Impact of being diagnosed with T2DM
on perceptions
about food and dietary intake
*Shocked and surprised at being diagnosed with T2DM
*Immediate negative views about dietary intake
*Beginning to move on from the initial shock of diagnosis
*Wanting continued improvement beyond suggested goals
Modifying dietary
behaviours
Patient experiences of modifying their dietary behaviours
in an attempt to improve management of blood glucose
levels and other health outcomes, ranging from
logistical considerations of food preparation to broad
emotional adaptation to eating differently to before
diagnosis
*Wide-ranging attempts to improve dietary behaviours
*Emotional impact of restricting diet and managing ongoing
changes
*Differing experiences of sustaining dietary changes
*Maintaining a healthy dietary intake continues to be a
challenge

*Monitoring blood sugar levels provides useful feedback on
food choices
*Feeling aware of the consequences of not eating healthy foods
Receiving support from
health professionals
Experiences of interacting with health professionals and
discussing food and dietary intake
*Receiving overwhelming, conflicting nutrition information
*Receiving initial directives from dietitians is challenging
*Ongoing engagement with primary care services is limited
and not highly valued
*Feeling rushed and not heard in consultations
418 Australian Journal of Primary Health L. Ball et al.
However, formany participants,maintaining a healthy dietary
intake continued to be a challenge as time progressed, mostly
because it felt restrictive:
It’s a challenge . . . I’ve beenputting abitmore onmyplate,
having a second serve of something . . . It’s the old habits
. . . It’s not something I could maintain. (Participant 3,
Interview 2)
I’m getting to the point where I’m cheesed off with always
having to have diabetic biscuits and other things. You get
bored with them. I’m feeling I’mhaving tomake a sacrifice
that other people don’t have to. (Participant 9, Interview 3)

Despite the challenge of maintaining a healthy dietary intake,
some participants reported feeling aware of the consequences of
not eating healthy foods:
I can’t see myself drifting back to eating the same way as
I was, because I know what the consequences are.
Receiving support from health professionals
The third category related to participants’ experiences of
receiving nutrition care from health professionals. Participants’
perceptions extended beyond the content of advice provided by
health professionals to broader experiences of support and
communication in healthcare consultations.
When participants were initially diagnosed with T2DM, they
received an overwhelming amount of conflicting nutrition
information. The information came from health professionals as
well as dietary advice from friends, family, online sources and
T2DM organisations:
I kept finding somuch controversy it mademyhead spin . . .
They say you have protein, you have carbs, and you have
your veggies and stuff. Well, then you read no meat, no
animal protein, none of this . . . Who is right and who is
wrong? I found it confusing. (Participant 2, Interview 1)
Participants found their initial interactions with dietitians to
be challenging because of the direct, instructional nature of
the nutrition care provided:
A few days after I was diagnosed, I went to a dietitian and
she laid it all out . . . I wasn’t impressed. This woman was
just there to purposefully lay down a diet . . . to put me in
line and show me this, that and that. (Participant 1,

Interview 1)
I’d had a nice lead-in with the educator and then, all of a
sudden, I saw the dietitian and shewas laying down the law
and I was thinking, ‘This is a bit of a turnaround!’
Participants found that aside from the support provided by
dietitians, other health professionals, aswell as family and
friends
and online support, were helpful on occasions:
The diabetes educator . . . she handled me very well and I
felt different when I came out of there . . . They put it in
perspective, which is sort of what I needed. (Participant 2,
Interview 1)
There’s one lady at work, her husband has type 2 diabetes
and she tells me what she does with him, so yeah, that is
really good. (Participant 3, Interview 2)
Overall, participants had limited ongoing engagement with
primary healthcare services. This appeared to be a result of
limited
understanding about how the primary care system operated, and
the role of different health professionals, as well as the limited
value patients placed on the services provided in this setting:
TheGPgavemeoneof those ‘goand seefive people a year’
diabetes plans but I haven’t organised any of it . . . It’s not
a big deal, it’s just something I probably need to tick off
to keep everybody happy and then I can relax again for
another year. (Participant 8, Interview 2)
I didn’t quite understand what diabetes educators did or
the dietitians. (Participant 2, Interview 2)

Most participants thought that the support provided by primary
health professionals had considerable room for improvement
because they felt rushedandnotheard inconsultations,
andbecause
open communication was not always achieved:
They get you in there, they tell you you’ve got type 2 and
you’ve got to make these changes, and it always feels like
[they’re in] a rush to finish with you and get you out the
back door and start with a new case. (Participant 2,
Interview 3)
You’re talking to someone and they go, ‘Your half hour’s
up, I’ve got another patient waiting’. Nobody has got the
time to sit and take the time to talk. I find that very
frustrating and annoying. You just start to say something
and then you’ve got to leave.’ (Participant 1, Interview 3)
Differences in accommodating new dietary behaviours
The collective experiences of participants over time suggest that
individuals have different experiences in accommodating new
dietary behaviours after being diagnosed with T2DM. The
experiences of participants in this study appeared to be
influenced
by contextual conditions such as immediate family support and
responsibilities, confidence in existing food knowledge, and
familiarity with health professionals and the healthcare system.
Three archetypical experiences were apparent in this study.
First, some individuals appeared to take a factual and directive
approach to adjusting to their diagnosis and modifying their
dietary behaviours. In order to achieve this, they preferred clear
instructions from health professionals and felt most comfortable
eating in accordance with a predetermined plan. Positive

feedback from continued healthy eating (such as improved
blood
glucose management and weight loss) outweighed the negative
emotions felt from being restricted in their food choices, and
this
motivated continued adherence to the point of sustained
improvement in dietary behaviours.
Second, some individuals appeared to take an adaptive
approach to adjusting to their diagnosis, modifying their dietary
behaviours and seeking support from health professionals. The
initial shock of diagnosis reduced their confidence in making
dietary choices, and they placed considerable importance on
Nutrition care for type 2 diabetes mellitus Australian Journal of
Primary Health 419
guidance from health professionals and other sources of dietary
information (such as family, friends, internet and diabetes
organisations). Early improvements in dietary intake were not
considered sustainable because of the negative emotional
impact dietary restrictions had on their quality of life. However,
over time, adjustments to dietary intake that were considered
reasonable and achievable were made. These individuals
perceived themselves as having made general improvements in
their dietary behaviours that had positive impacts on blood
glucose management and other health outcomes. However, these
individuals also experienced regular occasions of making food
choices that were not viewed as ideal, and risked having a poor
dietary intake over time.
Third, some individuals experienced persistent negative
emotions after diagnosis and did not makemeaningful
adaptations

to their dietary behaviours over time. These individuals felt
overwhelmed by the conflicting information received from
health
professionals and other sources of dietary information, which
caused them to withdraw from the experience of making dietary
choices and receiving support. Improvements in blood glucose
management and other health outcomes appeared to be a result
of
undereating and avoiding social eating situations, which was not
identified in consultations with health professionals. These
individuals perceived themselves as requiring considerably
more
support thanwhat they feltwas available, andwere frustratedby
the
lack of immediate success when following guidelines provided
by
primary health professionals.
Discussion
This study contributes new information on patients’ experiences
of dietary change after being diagnosed with T2DM and their
views on howprimary health professionals can best support
long-
term maintenance of dietary change. Participants’ insights
resulted in the generation of three categories: adjusting to
diagnosis, modifying dietary behaviours and receiving support
from health professionals. This information is important
because
of the relationship that exists between healthcare experiences,
chronic disease self-management practices (including dietary
behaviours) and healthcare outcomes (Sequist et al. 2012).
Participants in this study experienced challenges in adjusting
to their recent diagnosis of T2DM; this had a direct negative
impact on their views about their dietary intake. Being
diagnosed

with T2DM is recognised as a particularly alarming and
emotional time for patients because it is viewed as a
transformation point from a healthy person to one who is aware,
frightened and sometimes embarrassed by having a long-term
health condition (Histock et al. 2001; Hillson 2014). The impact
of thediagnosis onparticipants’ attitude to foodwas
considerable,
including reduced confidence in what to eat, reduced enjoyment
of eating, and feeling uncomfortable eatingwith others,
including
family, peers and friends. These factors have the potential to
influence the effectiveness of nutrition care provided by
primary
health professionals, and health professionals should be aware
of
this when providing nutrition care to patients.
Previous studies investigating dietary changes after diagnosis
with T2DM report that following initial dietary changes,
patients
often move into an accommodation-adaptation phase regarding
their dietary intake (Castro-Sánchez and Avila-Ortiz 2013).
However, this finding was not apparent in all participants in the
current study, even6months after recruitment into the study (up
to
10 months after diagnosis). While some participants did report
positive perceptions about their dietary intake as time
progressed,
many participants continued to experience negative emotions
as a result of the restraint required to maintain a healthy diet,
and
the conflict between diet-related social activities and necessary
self-management behaviours. The three archetypical experiences
apparent in this study and the individual timelines in which
participants adjusted to changes in dietary intake highlight the

importance of flexible and tailored support for patients in
the months after diagnosis.
Participants in this study reported that they have received an
overwhelming amount of contradictory nutrition information
from health professionals and other sources. A recent survey of
Australian adults who self-identified as needing to improve
their
dietary behaviours suggested that nutrition information sources
perceived as most trustworthy, credible and effective included
dietitians, nutritionists and GPs, but the most frequently utilised
sources were the internet, friends, family and magazines (Cash
et al. 2014). The use of family as a source of information aligns
with family systems theory, which conceptualises families as a
system of interrelated parts that influence each other and
contribute to the growth or detriment of others (Bowen 1966).
Further, the participants in the current study reported limited
ongoing engagement with health professionals such as dietitians
and GPs, despite these sources being described in the recent
survey as the most trusted, credible and effective (Cash et al.
2014). Further understanding about how patients decide which
nutrition information sources to use is clearly required.
The support provided by primary health professionals to the
participants in this study was generally reported as requiring
significant improvement. Interestingly, the factors that
weremost
influential in patients’ experiences of receiving nutrition care
appeared to be open communication, not feeling rushed
andbeing
genuinely supported, rather than any specific nutrition advice or
approach. This appeared to be important for all participants but
particularly those who experienced persistent negative emotions
after diagnosis. Open communication and genuine support are
considered critical for building relationships with patients with
T2DM, and the way this is displayed is influenced by a health

professional’s own personality and the emotions they are
experiencing (Kowitt et al. 2015). Similar factors that influence
patients’ experiences of health care have been identified in
other
Australian population groups, such as new mothers, whose
perceptions of their healthcare quality were reduced when they
felt unsupported and hurried in consultations (Corr et al. 2015).
Collectively, this suggests that primary health professionals
could enhance the delivery of their care by investing in patient
relationships through longer, more patient-focussed
consultations
and open communication.
Study participants described situations in which health
professionals provided nutrition care that did not meet their
needs. FacilitatingAustralian primary healthcare professionals
to
provide nutrition care in a patient-centred manner is important
to optimise self-management of T2DM and reduce the risk of
complications. It has been suggested that compassion fatigue –
a
gradual lessening of compassion over time as a result of being
regularly exposed to patients’problems– is occurring amongGPs
420 Australian Journal of Primary Health L. Ball et al.
and other primary health professionals in Australia (Shrestha
and Joyce 2011). This lack of empathy from health
professionals
has been associated with significantly increased metabolic
complications in patients with T2DM (Canale et al. 2012).
Given
this association, strategies to reduce compassion fatigue and
subsequently enhance patient-centred care appear to …

© 2015 Ohio Valley Philosophy of Education Society
DRESSING DIVERSITY:
POLITICS OF DIFFERENCE AND THE CASE OF SCHOOL
UNIFORMS
Samantha Deane
Loyola University Chicago
In The New York Times parenting blog, Motherlode, Debra
Monroe
writes about “the dynamic that makes public school
democratic—a place to
confront the humanity of others,” because she is concerned with
what
schooling teaches children about diversity and difference.1 This
paper begins
with a similar assumption and concern; I too think schools
ought to be places
where children learn to confront the humanity and difference of
others, and I
am concerned with how children are taught to do so. Through an
analysis of
school uniform policies and theories of social justice, I argue
not that children
consciously experience school uniforms as uniforming, but that
school
uniforms and their foregoing policies assume that confronting
strangers—an
imperative of living in a democratic polity—is something that

requires seeing
sameness instead of recognizing difference. Imbuing schooling
with a directive
that says schools ought to be places where children learn to
confront the
humanity of others requires that we ask questions about how
educational
policies teach children to deal with human difference. Broadly
speaking,
uniform policies undergird the assumption that a child’s
capacity to confront
difference is unimportant.2
To consider the ways in which school uniform policies unjustly
teach
children to disregard difference so that they can reasonably
participate in public
and school life, this paper engages in a rich conversation about
social justice.
Fundamentally, social justice is about recognizing grave
injustices between
individual persons and groups of people living in, or being
prevented from
living in, the world. The works of John Rawls, Iris Marion
Young, and Nancy
Fraser represent three common theoretical constructs for dealing
with social
justice. Rawls comes from a social contract position and
constructs a floating
theory of justice based on a Kantian self that ultimately
addresses injustices by
way of redistribution.3 Young aligns herself with critical
theory, founds her
critique in the messiness of the “real world,” and tackles
injustice by

1 Debra Monroe, “When Elite Parents Dominate Volunteers,
Children Lose.”
Motherlode (blog), New York Times (January 19, 2014),
http://nyti.ms/19EIwRF.
2 I am purposefully not differentiating between public and
private schooling, because all
schooling situated in a democratic context ought to teach
children to confront the
humanity of others. Moreover, children are a part of the larger
“public” in a Deweyan
sense.
3 John Rawls, Justice as Fairness: A Restatement, ed. Erin
Kelly (Cambridge, MA:
Harvard University Press, 2001).
Deane – Dressing Diversity
112
advocating for a politics of difference.4 All the while, Fraser
works out a
bivalent conception of social justice that bridges the divide
between the spheres
of distribution and recognition.5 Rawls’s Justice as Fairness: A
Restatement is
the theoretical backdrop against which this paper employs
Young’s Justice and
the Politics of Difference and Fraser’s “Social Justice in the
Age of Identity
Politics: Redistribution, Recognition, and Participation” to
speak to the ways in
which diversity can and should be “undressed,” and therefore,

“addressed” by
children in school.
To “address” diversity, the first section of this paper will focus
on the
language of school uniform policies. Policy makers tell us that
school uniform
policies are meant to: minimize disruptive behavior, remove
socioeconomic
tension, and maintain high academic standards.6 There is
nothing unjust about
wanting to reduce socioeconomic difference, nor valuing high
academic
standards. What is unjust is that these policies do not remove
socioeconomic
difference, nor cure disruptive behavior. School uniform
policies dress
difference; they do not address it. Accordingly, in an attempt to
“undress”
difference, and, perhaps, “redress” the injustice of school
uniform policies, the
second section of this paper argues that schools ought to be
places where
children are confronted with the humanity of others. The
argument is that
removing uniforms should not be a mere undressing that leaves
children to deal
with difference and humiliation on their own, but that we must
redress the
injustice by philosophically resituating schooling. Finally, the
concluding
section will sketch out what it might mean to philosophically
resituate schools
and to think of school life as a reflection of city life where, “the
public is
heterogeneous, plural, and playful, a place where people witness

and appreciate
the diverse cultural expressions that they do not share and do
not fully
understand.”7 Schools in this vision are not apolitical
sanctuaries where
children develop into perfect rational subjects; rather, schools
are messy,
vibrant, lively, worlds where children both constitute and come
to know the
diverse world and public(s) that surround them.
Dressing Diversity: The School Uniform Policy
A policy bulletin from Los Angeles states: “The Los Angeles
Unified
School District believes that appropriate student dress
contributes to a
4 Iris Marion Young, Justice and the Politics of Difference
(Princeton, NJ: Princeton
University Press, 1990).
5 Nancy Fraser, “Social Justice in the Age of Identity Politics:
Redistribution,
Recognition, and Participation.” Tanner Lecture Series,
Stanford University (April 30–
May 2, 1996), http://tannerlectures.utah.edu/_documents/a-to-
z/f/Fraser98.pdf.
6 David L. Brunsma, “School Uniforms in Public Schools,”
National Association of
Elementary School Principals (January/February 2006), 50.
7 Young, Politics of Difference, 241.
PHILOSOPHICAL STUDIES IN EDUCATION – 2015/Volume

46
113
productive learning environment.”8 While a policy from Pitt
County states:
“The implementation of school uniforms will help minimize
disruptive
behavior, promote respect for oneself and others, build
school/community
spirit, and, more significantly, help to maintain high academic
standards.”9
Most school uniform policies echo these sentiments. They
appear to originate
from a genuine desire for students to succeed academically,
and/or a need to
improve behavior and safety. Yet, the history of asking students
to appear one
way or another is a story of mingled concerns about academic
achievement,
juvenile delinquency, gender appropriateness, race relations,
and gang
affiliation.10 Ines Dussel historically situates these concerns
within a broad
trend toward institutional organization and control of people
who pivot around
the “axis of difference.”11 According to Dussel, “such policies
were tied to the
disciplining of ‘unruly’, ‘savage’, ‘untamed’ bodies, that is, the
bodies of those
who were not able to perform self‐regulation or
self‐government: women,
Black, Indian, poor classes, immigrants, toddlers or infants.”12
In Young’s
language, the victims of cultural imperialism are frozen “into a

being marked as
other,” while the dominant group occupies a universal
“unmarked” position.13
The impetus to uniform is at once entangled in a project to mark
or dress
difference and to extend the “universalized” position to the
“other.”14 The
policy trend toward institutional control vis-à-vis school
uniform policies is
enmeshed in the desire for definition and regulation of student’s
personal
bodies and is a means to regulate and define children’s
relationships with one
another.
School uniform policies are not merely concerned with what one
wears, but are a part of how we organize schools and the
students therein.
These policies are an attempt to make schools safer and better,
to regulate what
happens, and who affiliates with whom. A District of Columbia
uniform policy
hints at these underlying tensions by taking measures to define
what “uniform”
means within the policy: “The term ‘uniform,’ for the purposes
of a mandatory
uniform policy, is defined as clothing of the same style and/or
color and
8 Jim Morris, “Student Dress Codes/Uniforms,” Los Angeles
Unified School District
Policy Bulletin, BUL-2549.1 (December 2009), 1.
9 Ibid.
10 Wendell Anderson, “School Dress Codes and Uniform
Policies,” Policy Report

(ERIC Clearinghouse on Education Management), no. 4 (2002),
4. Anderson briefly
captures this history in the synopsis of his policy report.
11 Ines Dussel, “When Appearances Are Not Deceptive: A
Comparative History of
School Uniforms in Argentina and the United States
(Nineteenth–Twentieth
Centuries),” Paedagogica Historica 41, no. 1–2 (2005): 191.
12 Ibid.
14 To this point, Dussel, notes that elite, private, “preppy”
school dress was extended
down, as it were, to public mass schooling and has become the
school uniform we are
familiar with today, e.g. khaki pants and Oxford shirts.
114
standard look, as agreed upon by the school community.”15
Nonetheless, a
definition of “uniform” does little to draw attention away from
the fact that the
policy is asking all children to appear the same. The concluding
advice from a
US Department of Education policy report for drafting a
uniform policy reads:
“when they are justified by a school’s circumstances, wisely
conceived in
collaboration with the community, and coupled with appropriate
interventions,
dress codes and school uniforms may positively influence

school climate,
student behavior, and academic success. However, it is critical
to keep such
polices in proper perspective and avoid overestimating or
exaggerating their
potential benefits.”16 This hesitant endorsement of school
uniform policies
manages to advise caution about drawing specific cause-and-
effect
relationships between school uniforms and academic gains, and
in the same
instance, it glosses over the historical and philosophical
significance of asking
students to uniformly dress their difference. Standardizing how
students appear
may give the school an air of control over the schooling
environment, but in
doing so, these policies tell students that when and where
appearances differ,
danger lurks.
Addressing Diversity: Social Justice
and the School Uniform Policy
Claims for social justice, more often than not, stem from one of
two
directions; summed up by references to distribution or
recognition, social
injustices are either rectified by redistributing wealth/social
goods, or by
recognizing and valuing difference. Redistributive claims
generally follow the
logic of John Rawls’ theory of justice and utilize some version
of an “original
position.” The policy logic, or reasoning behind, school uniform
policies

broadly appeals to logic derived from a distributional ethic,
which finds its
ideal articulation of the student in the rational, reasoning, and
regulated self.
The problem with this ideal articulation and the distributional
ethic is best
illustrated by evaluating the ways in which Rawls’ theory of
social justice
informs the rationale of school uniform policies.
Rawls’s theory of justice and the school uniform policy share a
similar
objective: thinly constructed reasoning parties. In Justice as
Fairness Rawls
develops the “original position” whereby parties can agree to
the terms of
society and justice without conceding “differences in life
prospects.”17 That is
to say, difference or diversity is an essential consideration in
Rawls’ project. In
an effort to deal with the mandates of diversity, the fact of
pluralism, Rawls
adopts and builds upon the Kantian deontological self to
describe the sort of
people contracting in the original position. Accordingly, the
original position
15 “District of Columbia Public Schools: Notice of Final Rule
Making,” (District of
Columbia Register, vol. 56, no. 33, Chapter B24, Section
B2408, August 2009), 3.
16 Anderson, “School Dress Codes,” 4, my emphasis.
17 Rawls, Justice as Fairness, 6.3–6.4, 12.2.

46
115
imbues these intrinsically worthy subjects with neutrality and
structural
impartiality, both of which ensure that they are representative
of any person
from society. Placed behind the “veil of ignorance,” the parties
are situated
symmetrically and on this undifferentiated plane they do not
claim a social
class, racial or sexual orientation, a comprehensive conception
of the good, or
any other distinguishing factor.18 Rawls states, “the parties are
artificial
persons, merely inhabitants of our device of representation: they
are characters
who have a part in the play of our thought experiment.” 19 In
consequence the
representatives in the original position are, admittedly, non-real
characters with
limited knowledge, or “complicated amnesia.”20 Moreover, it is
the
“complicated amnesia,” or the “veil of ignorance” that gives the
parties the
ability to be impartial and, more importantly, rational.
It is true that Rawls works to construct a thin consensus in the
public
about society’s basic structures because he wants to leave open
the ability to
construct individually defined thick lives; however, the parties

of the original
position are abstracted to such an extent that a monological
position ensues.
Michael Sandel summarizes the problem aptly: “The notion that
not persons
but only a single subject is to be found behind the veil of
ignorance would
explain why no bargaining or discussion can take place
there.”21 The “veil of
ignorance” removes the parties’ “thickness” so that they can
reason together.
The problem is that a truly pluralistic or diverse society will not
be the product
when a single subject conceives the definitions of justice.
What’s more, the
agreement of like-minded parties does not necessitate actual
participation—it
merely requires appearance. Uniform policies are theoretically
similar. They
function as a “veil of ignorance” for children who are too poor,
too brown, or
too different from one another to be members of the same
school. Uniform
policies imply that children in uniform are freed from any
context that might
impose a restraint on reason. Under a “veil of ignorance”
children are not asked
to think about why their classmate is poor, or brown; they are
required to show
up. Rawls’ theory of justice constructs thin, uniform, rational
people (students)
who can operate in the political sphere (school) as a way to
achieve some kind
of overlapping consensus (standard academic achievement). I
believe it is clear
that these thinly constituted people are both objectionable and

impractical;
nonetheless, Young helps draw out the unwelcome side affects
of favoring the
impartial subject and proposes an alternative solution.
Young approaches justice from within the messy, situated
context of
the world. Her argument for a politics of difference highlights
the fact that
theories of distributive justice have monopolized the
conversation about what
justice entails in the era of modern political philosophy, such
that “displacing
18 Ibid., 23.3, 25.3.
19 Ibid., 23.4.
20 Michael J. Sandel, Liberalism and the Limits of Justice
(Cambridge, UK: Cambridge
University Press, 1982), 105.
21 Ibid., 132.
116
the distributive paradigm” is part of accepting her theory of
justice as
recognition of difference.22 For Young the distributive
paradigms pose a large-
scale problem in the sense that the “ideal of impartiality or
logic of identity”
infiltrates every aspect of civic life. The logic of identity is
problematic because

of the intrinsic desire for unity. As such, “The logic of identity
seeks to reduce
the plurality of particular subjects, their bodily, perspectival
experience, to a
unity, by measuring them against the unvarying standard of
universal reason.”23
The reverence deferred to universal reason is part of the project
of moral ethics,
which defines impartiality as necessary for the capacity to
reason. The Kantian
deontological ideal is to find a point of view that everyone can
agree to, or see
from, irrespective of their particular difference. School uniform
polices strive
for the same ideal. The hope is that if kids are all wearing the
same clothing, no
one will notice another’s socioeconomic status, or speak from
their particular
position. The ideal of impartiality creates a dichotomy between
the “universal
and the particular, public and private, and reason and passion”
to the extent that
the civic public, the terrain of schooling, becomes the place of
universal
reason.24 Much like the problem identified by Sandel’s reading
of Rawls’
original position, universal reason requires agreement of
abstracted parties, not
dialogue with those who are differently situated. Furthermore, if
the terrain of
schooling is a place of universal reason it is no wonder that the
“either-or
thinking” of dichotomies reigns. Children are either uniformed
or partial,
uniformed or needy, uniformed or irrational.

Young pointedly explains that the “ideal of impartiality” is flat
out
impossible, because it requires expelling the aspects of
difference that do not
fit. In fact, “no one can adopt a view that is completely
impersonal and
dispassionate.”25 Additionally, my sense of imbeddedness
defines my “social
location” to the degree that I cannot enter someone else’s
location.
Nevertheless, if it is possible to strip myself of my location,
what then is the
purpose of having a location?26 Requiring the removal of
particularity for
uniformity, whether for moral cohesion or universal reason, is
an affected wish.
People do not have to be the same to get along; rather, it is
possible for people
to be both partial and have reasonable associations with each
other. Young
argues, “If one assumes instead that moral reason is dialogic,
the product of
discussion among differently situated subjects all of whom
desire recognition
and acknowledgement from the others, then there is no need for
a universal
point of view to pull people out of egoism.”27 Thus, the ideal
of impartiality is
not a necessity, and should not be a desire since it is a fanciful
fiction. Instead,
23 Ibid., 99.
24 Ibid., 97.
25 Ibid., 103.

26 Ibid., 105.
27 Ibid.,106.
46
117
if we grant that differently situated people can and should have
a voice to
discuss what matters to them, we will see their differences shed
new light on
relevant issues and aspects of justice.
School uniform policies, like the “ideal of impartiality,” create
unjust
expectations of neutrality on behalf of students, and in
removing the space for
actual conversation, depoliticize difference. In contrast, the
recognition of
difference presumes that “blindness to difference disadvantages
groups whose
experience, culture, and socialized capacities differ from those
of privileged
groups”28 and that “assimilation always implies coming to the
game late.”29 As
reflected in school uniform policies, the ideal of impartiality, in
its blindness to
difference, disadvantages students who are asked to assimilate
by removing the
space for conversation about difference. Moreover, no child
should feel like
they are coming to the game late, especially in a learning

environment.
Recognition of difference should be an essential function of
schooling to the
extent that any language of assimilation finds no purchase. Writ
large, Young’s
solution may appear obvious at this point, but it is worth stating
explicitly: “A
democratic public should provide mechanisms for the effective
recognition and
representation of the distinct voices and perspectives of those of
its constituent
groups that are oppressed or disadvantaged.”30 The solution
writ small in, say, a
school system, should mimic the same sentiments. Requiring
student to wear
uniforms is not the problem: the problem is the reason for
requiring uniforms.
A unique answer to Young’s demand to displace the distributive
is
Nancy Fraser’s mixing of the distributive paradigm with
recognition. Fraser
starts by noting that the distributive paradigm has a certain
theoretical heft—at
some point various groups or individuals have appealed to their
common
humanity, the original position, or impartial reason out of
necessity, perceived
or actual. With the weightiness of the distributive paradigm in
mind, Fraser
erects a “bivalent axis” of social justice she calls a “two
pronged” approach.
The bivalent axis of social justice is best thought of as a
spectrum within which
a pendulum can swing from distinctly distributional problems to
those

characterized as distinctly recognition-based, but where neither
is ever the
singular answer.31 The pendulum is always in motion.
According to Fraser, “A
bivalent conception treats distribution and recognition as
distinct perspectives
on, and dimensions of, justice, while at the same time
encompassing both of
them within a broader overarching framework.” This does not
mean that either
claim, distribution or recognition, is subsumed into the other.32
Instead, Fraser
locates their shared normative core as a “parity of
participation.”33 As she
explains, “According to this norm, justice requires social
arrangements that
28 Ibid., 164.
29 Ibid.
30 Ibid., 184.
31 Fraser, “Age of Identity Politics,” 22.
32 Ibid., 24.
33 Ibid., 30.
118
permit all (adult) members of society to interact with one
another as peers.”34
In other words, justice both of the distributional and recognition
varieties,
stems from the supposition that each member of society has

equal dignity and
ought to have the means to interact with one another in the
public sphere.
Fraser’s “parity of participation,” relies on an understanding of
the
imbricated nature of culture and the economy. To say that
justice spans a
continuum from distribution to recognition is also to say that
the economy and
culture are institutions that make up our shared social world.35
The conditions
for this parity of participation require a form of legal equality,
and preclude
“forms and levels of material inequality, [and] cultural patterns
that
systematically depreciate some categories of people.”36 People
within this
framework are thickly defined and contextually situated. They
have both
objective being that requires some kind of material position,
and an
intersubjective status that mandates recognition. The objective
condition is,
thus, most often rectified by redistribution, whereas the
intersubjective
condition is nullified by recognition. Fraser takes a decidedly
rooted stance in a
turn toward the pragmatic and recommends that answers to the
injustice fit the
practical situation. The pragmatic approach is the tool by which
we ought to
deploy the bivalent pendulum, which is always seeking the
normative ideal,
parity of participation. In every case the remedy of an injustice
should be

tailored to the harm, and in all cases the goal is to create,
maintain, and
reimagine a space for equal participation of each person or
group of people.
Fraser’s pragmatic answer, and its normative assumption, is not
radically divergent from Young’s grounding in critical social
theory whereby
she defines a “politics of difference.” Young’s politics of
difference, after all,
takes that differently situated people can have a discussion that
leads to moral
reason and just social structures.37 The distinction between
Fraser’s parity of
participation and Young’s politics of difference rests on how
equality is
imagined to function. For Fraser the norm “parity of
participation” holds that
each person’s voice has equal weight or worth within political
discourse.
Conversely, Young notes that the groups who are “oppressed
and
disadvantaged” are those for whom mechanisms of recognition
must be
appropriated.38 The distinction lies in the fact that Fraser’s
“parity of
participation” necessarily strives toward structural equality, as
opposed to
merely “mitigating the influence of current biases,” as Young
puts it.39 Thus,
Fraser’s bivalent conception is an excellent tool to help us think
about the
34 Ibid.
35 As Fraser aptly characterizes the argument, the answer does

not lie in statements like:
“it’s the culture stupid,” nor its counterpart “it’s the economy
stupid,” 39–41.
36 Ibid., 31.
38 Ibid., 192–225.
39 Ibid., 198.
46
119
pointed experience of injustice, but Young’s normative politics
of difference is
a fuller norm to reach toward.
Conclusion: Redressing Diversity,
City Life as School Life
Employing Fraser’s bivalent continuum, we can say that school
uniform policies are attempts to organize children who may be
experiencing
both distributional and recognition related injustices, but
because the policies
appeal to a logic of identity and distributional ethic, school
uniform policies
operate at the expense of a politics of difference. Following
Fraser, a pragmatic
remedy for the injustice of uniforming children in school
requires that we
rearticulate the value of “bringing children together in a
common space.”40 An

assumption of this paper is that the value of schooling is
manifest in more than
narrowly defined achievement or the acceptance of socialized
roles. Rather,
because education is always answering a question about what it
means to be
human,41 the value of bringing children together in a common
space is
evidenced when they learn how to recognize and speak from
places of personal
difference. The “dynamic that makes public schools democratic”
is the activity
of engaging children and their humanity. Higgins and Knight
Abowitz ask,
“What might it mean to think of the classroom not as a room
within an
institution that is already public, but as a space in which
teachers and learners
make public?”42 It means that we must see children and their
teachers, and the
school at large, as a public making project. Democratic
schooling demands that
we see children as full of vigorous and playful humanity. It
requires that we
engage with children as partial, situated members of the public.
Young imagines an alternative form of social relations—
public—
where a politics of difference prevails as analogous to city
life.43 Young’s
imaginative view of city life highlights democratic modes of
being and is one
way to think about what it might mean to envision the school as
forever
“becoming” public. In Young’s parlance, “By ‘city life’ I mean
a form of social

relations which I define as the being together of strangers. In
the city persons
and groups interact with spaces and institutions they all
experience themselves
as belonging to, but without those interactions dissolving into
unity or
commonness.”44 Each day an encounter with the city on the
train, in the park, at
a restaurant, or in a building requires that we find ways to live
together. The
persistent encounter with difference forces city dwellers to
recognize that
40 Chris Higgins and Kathleen Knight Abowitz, “What Makes a
Public School Public?
A Framework for Evaluating the Civic Substance of Schooling,”
Educational Theory
61, no. 4 (2011), 369.
41 Gert J. J. Biesta, Beyond Learning: Democratic Education
for a Human Future
(Boulder: Paradigm, 2006), 2.
42 Higgins and Knight Abowitz, “Public School,” 379.
43 Young, Politics of Difference, 226–27.
44 Ibid., 237.
120
people are just differently situated, or socially located beings,
with whom they
can have a partial dialogue. Recognition of …

TOPIC : Interventions to improve nutritional status: What type
of interventions improve adherence to recommendations on
nutritional intake?
Example Study:
· Interventions to enhance adherence to dietary advice for
preventing and managing chronic diseases in adults.
WRITTEN ASSIGNMENT:
· Read the study and answer the required questions for each
category
· Must write the paper using provided Summary Paper Format
on page #3.
· Grading Rubric/Description on page 4-5
ATI #3: Skills Module Contents: Summary Paper Format
· Bold for each Heading and Subheading
· Include in-text citations for all information/contents as needed
· Summary paper MUST be written in this format
Introduction and Key Points
Define the Topic and Question
· How do you interpret and/or understand the topic and question
you selected?
Overview/Significance of Problem
· Describe Overview and Significance of Problem of the topic
and question you selected
· Include in-text citations
Article Search
Current and credible resources: List Chamberlain library
Database(s) used
Database search-terms and methods

Number of articles located
List additional sources outside of ATI module: List all sources
you used for article search outside of ATI (CDC, American
Diabetic Association, etc.)
Article Findings
Why this article chosen?
How it addresses the topic? State the “Purpose/Aim of Study”
as the author stated in article
Type of Research conducted:
· Quantitative, Qualitative, Descriptive, or Mixed-Method
study?
· Briefly describe what was done (sample, methods,
measurement tools used)
Findings of Research: Comprehensively describe ALL Findings
in the article.
Evidence for Practice
Summary of Evidence
· Briefly summarize the overall purpose and findings.
How will this evidence improve current practice?
· Briefly describe what the current practice is.
· Describe how this evidence improve current practice?
How will this evidence decrease a gap in current practice?
· Briefly describe difference between the current knowledge,
skills, competence, practice, performance or patient outcomes
and the ideal or desirable state
· Describe how this evidence decrease a gap in the practice?

Any concerns or weaknesses in the evidence/finding? (Found in
Discussion)
Sharing of Evidence
Who would you share the information with? (colleagues, other
disciplines, patients, families)
How would you share this information? (in-services, health fair
for patients, educate healthcare professionals)
What resources would you need to accomplish this sharing of
evidence?
· List resources you may need for sharing the evidence as you
stated in above 2 questions (who and how) (i.e. administrator,
manager, support for materials….etc.)
Why would it be important to share this evidence with the
nursing profession?
Conclusion
· Summarizes the Theme of Paper, Findings, and Key points.
· Do NOT include Conclusion/Implication on the article

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