Helen Allan

Overseas nurses’ motivations for working in the UK globalization and life politics

This article addresses the theoretical integration of macro and micro dimensions of global workforce migration, detailing overseas nurses’motivations for working in the UK. The discussion is based on focus group interviews with overseas nurses in three areas in the UK. Their motivations for migrating are contrasted with their experiences of frequently being stereotyped as economic migrants who come from poor countries to gain financial benefits. These conflicting perspectives on overseas nurses’ motivations are explored through a discussion of Bauman’s notion of global and local values, which conceptually combines issues of globalization with the migrants’ perspectives. Giddens’ concept ‘life politics’ is introduced to take further account of individuals’experiences and perspectives. Our data suggest that overseas nurses take a global, transnational perspective on life. Likewise, the simplistic understanding of overseas nurses as economic migrants appears to reflect a local perspective where the lives of individuals are seen to be confined within the borders of nation states. The analysis suggests how perspectives on migration are shaped by individuals’ values and life orientations interfacing with conditions of globalization.

Overseas nurses’ experiences of discrimination: a case of racist bullying?

AIM We present three case studies of discrimination to illustrate how racist bullying as discriminatory practices operates in the workplace. BACKGROUND Workplace bullying in the British health care sector is reported along with evidence of discrimination towards overseas-trained nurses recruited to work in the United Kingdom (UK). METHODS The three interviews, which form the basis of the discussion in this paper, were selected purposively from a national study of overseas nurses because they present strong examples of the phenomenon of workplace bullying. The data on which this paper draws were collected through semi-structured, audio-recorded interviews and thematically re-analysed using nvivo V2. RESULTS The national study showed how racism is entrenched in health workplaces. Our findings in this paper suggest that racism can be understood by the concept of racist bullying. There are four key findings which illustrate racist bullying in the workplace: abusive power relationships, communication difficulties, emotional reactions to racist bullying and responses to bullying. CONCLUSIONS We argue that the literature on workplace bullying adds a layer of analysis of discrimination at the individual and organizational levels which enables us to further delineate racist bullying. We conclude that racist bullying can be specifically identified as a form of bullying. IMPLICATIONS FOR NURSING MANAGERS: Our data may assist managers to challenge current workplace working practices and support bullied employees. The three interviews show different responses to racist bullying which allow us to explore some implications for management practice.

Looking at infertility through the lens of religion and spirituality: a review of the literature

In spite of the growing body of literature that has focused on medical, psychological, social, and cultural consequences of infertility, issues such as religious and spiritual dimensions of infertility have received little attention. Considering that infertility is a multifaceted problem and results in multiple losses, we argue that health professionals need to consider all aspects of holistic care when caring for women with fertility problems. Holistic care considers not only the psychological, social and cultural needs of individuals, but also their religious and spiritual needs. Women may use their religious/spiritual beliefs to cope with crisis, and to find meaning and hope in their suffering. This article reviews the literature on religion/spirituality and infertility using Medline, CINAHL, PBSC, IBSS and ISI Web of Knowledge from 1985 to the present. It focuses on religious and spiritual care as one aspect of holistic care of women with fertility problems, and draws attention to the religious perspectives of infertility and reproductive technologies. It highlights the spiritual dimension of the infertility experience in previous research, and concludes with a discussion on the gaps in the literature and the implications of including religious and spiritual issues in infertile womens care.

Emotional Boundary Work in Advanced Fertility Nursing Roles

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or ‘bounded’ relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship.

Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?

Background:Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy.Methods:A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period.Results:Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations.Interpretation:Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.

The re-construction of women's sexual lives after pelvic radiotherapy: A critique of social constructionist and biomedical perspectives on the study of female sexuality after cancer treatment

Pelvic radiotherapy creates physical effects and psychological responses that negatively affect the sexual health of women and couples, yet these sexual consequences are not frequently researched or clinically assessed. This focused ethnographic study explored factors that influence the clinical assessment of treatment-induced female sexual difficulties after pelvic radiotherapy within routine medical follow-up. Participant observation of follow-up clinics (n = 69) and in-depth interviews with 24 women, 5 partners and 20 health professionals were undertaken at two cancer centres in the South East of England from 2005 to 2006. Thematic analysis of interview transcripts resulted in five emergent themes, two of which are explored in detail within this paper. A social constructionist approach to human sexuality was used to explore representations of female sexuality in oncology follow-up constructed by clinicians, women and their partners. Yet neither social constructionist nor biomedical (the predominant model in medical follow-up) perspectives on human sexuality provided an adequate interpretation of these study findings. This paper argues that the comprehensive study and practice of sexual rehabilitation in oncology requires a synthesis of both biomedical and social constructionist perspectives in order to capture the complex, subjective and embodied nature of the female sexual response in both health and illness.

Mentoring overseas nurses: Barriers to effective and non-discriminatory mentoring practices

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice.

Are pedagogies used in nurse education research evident in practice

This paper considers two questions: what pedagogies for teaching nursing are used in nurse education research? Are these pedagogies transferred to learning in the workplace? We argue that there are underpinning pedagogies identified in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active, reflective and socially constructed. We consider possible answers to these questions through an exploration of empirical work by Evans et al. (2009) which has focused on knowledge transfer in the workplace. Their work offers insights into how pedagogies can be applied to nurse education research which in turn may be transferred into the workplace. In particular, they argue that the concept of knowledge transfer is outdated and we should focus instead on how knowledge learnt in one context (the academy) is re-contextualised in another (the workplace). We also draw on Aranda and Laws (2007) paper on the debates concerning the use of sociology in nurse education to explore competing narratives. We conclude that the pedagogies identified in educational research are not transferred to nurse education and practice yet offer an alternative view of knowledge transfer as illustrated by Evans et al.s work which explores how learning in the workplace may be facilitated more effectively. We conclude that the lack of transfer of nurse education research pedagogies to practice learning undermines the position of nurse teachers within the academy as nurse education becomes a practice or professional discipline without a discrete disciplinary base.

Nursing the clinic and managing emotions in a fertility unit: Findings from an ethnographic study

This paper presents the findings from an ethnographic study of a fertility unit. Data were collected using participant observation and semi-structured interviews over a period of 2 years. Fifteen patients and 23 members of staff were interviewed. Data analysis was completed using a modified thematic analysis. The findings indicated that the emotions evoked by infertility and medical treatments were powerful and frightening. Patients managed their emotions privately although they were conscious of an emotional awareness by nurses, which they described as ‘caring’. Nurses were associated strongly with caring and their role was primarily to manage emotions; however, to do this, nurses used noncaring (emotional distance) rather than caring. Nurses were responsible for managing emotions in the public spaces of the clinics and moved between emotional distance and awareness according to the needs of the clinic. In this article, it is argued that non-caring was a defence against anxiety about coping with painful feelings and that the nursing role was to ‘nurse the clinic and the doctor’ rather than the patient.

The introduction of modern matrons and the relevance of emotional labour to understanding their roles: developing personal authority in clinical leadership

This paper discusses the findings from case studies of six modern matrons and their emerging role in four local NHS Trusts in the South East of England. The studies develop previous work by the authors which explores the emotional component of leadership in nursing. In this study, we have focused on the role of modern matrons and leadership to re-examine the relevance of emotional labour in the context of the reform of the NHS. The data from the case studies involved focus groups and individual semi-structured interviews. These interviews were audiotaped and transcribed verbatim by the researchers and analysed using thematic and narrative analysis. We suggest that the themes arising from these interviews contribute to the development of working hypotheses to increase understanding of the modern matrons role and newly emerging positions of nursing authority. These hypotheses suggest that the modern matron may choose from a range of approaches to respond to demands made upon her. The approaches proposed in this paper include emotion management, patient liaison, clinical leadership and nursing management. We suggest that these approaches allow the modern matron to use personal authority to provide clinical leadership to manage relationships intra- and inter-professionally and provide the interface between the organisation, the professions and the patient.