Ricardo A. Ayala

Exploring historical conflicts between midwives and nurses: a perspective from Chile

Abstract This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives’ nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.

Reconfiguring organisational patterns of power: An ethnography on the functioning of academic credentials in Chile

The evolution of academic credentials is not only a technical process, but also a social one. Whereas the technical process involves skill development for the increasing technologisation and sophistication of work, the social process comprises phenomena such as power struggles and status construction. Exploring the interplay between doctors and nurses, this article analyses what ideologies, institutions and devices lie beneath patterns of powers affecting healthcare organisations in Chile, examining the extent to which academic credentials are used, on the one hand, to question established patterns of power and, on the other hand, to wield power, reshaping in the process internal logics of stratification by class and ethnicity. Drawing upon ethnographic data, the authors argue that the transformation of the nursing curriculum coupled with ongoing state reform has led to a more open attitude towards power collectively, a process intertwined with the development of a series of alliances and the performance of negotiating abilities resulting in the gradual access to high-ranking positions. This may well reflect a move from a technical component of credentials to a more symbolic component, shaping cultural expectations of capabilities and a new code of power.

Twenty years of management of care in Chile: what we know, what we do not know, what is yet to come. An analysis of arguments

For over 20 years, the notion of ‘management of care’ has been foregrounded as key in the jurisdiction of the nursing profession, with the aim of detaching itself from the wider medical umbrella. A number of voices have advocated such centrality. These include juridical, academic and occupational perspectives. Critical stances, although peripheral, have also been voiced. These have been received, at best, with a ‘polite silence’ in mainstream circles. By looking at the arguments surrounding the ‘management of care’ circulated in these two decades, this article reports the various forms of discursive practice that participate in the political process of autonomy building. Particularly, we focus on the validity of the arguments as well as the cohesion across arguments within the knowledge system. In doing so, we evaluate its main premises and foundations, the reach of the conceptualisation and its disjointed, differing and incomplete bases. Similarly, we used an inferential technique for the reconstruction of omitted and unexpressed assertions. The article introduces an approach of the humanities that is seldom seen in healthcare. It also proposes a research agenda in regard to management of care for the upcoming decades.

Dusting off the looking-glass: A historical analysis of the development of a nursing identity in Chile

Histories of nursing that disregard their linkage to broader historical movements often lead to historically detached versions of nursing identity that omit the perspective of their sources and the ideas of their time. Drawing on materials retrieved through a multilayered research strategy comprising internal and external sources, this article examines the development of a nursing identity in Chile during the period starting in the 1950s through the early 2000s. We analysed the sociopolitical contexts in which the nursing profession grew, the changing direction of its role and how the nursing identity transformed itself. Through the use of historical sources and oral testimonies, we aim to give a nuanced account of how the history of public health and that of the country more broadly changed the object of identification of nurses, creating only relatively recently a sense of nursing community. Processes of identification, fragmentation and integration are highlighted, which challenge usual notions of history as a linear process.

CONGRUENCIA ENTRE EL DISEÑO CURRICULAR Y LA EVALUACION DE LOS APRENDIZAJES ESPERADOS EN CATEDRAS IMPARTIDAS EN UNA UNIVERSIDAD CHILENA

Resumen es: Estudio Cuantitativo que evalua la consistencia interna de asignaturas impartidas en una universidad privada, especificamente en cuanto a la evaluacion d...

Cold Interests, Hot Conflicts: How a Professional Association Responded to a Change in Political Regimes

In South America, the 1970s began with ardent sociopolitical crises leading to a wave of repressive military regimes. In Chile, most professional bodies suffered profound structural and functional modifications resulting from internal political polarization as well as state intervention. Nurses saw the same fate befall them, which created both a historical blackout and abrupt changes in power dynamics. Given the prominence of this process in the reconfiguration of modern nursing’s identity, this article traces the association’s political process during the short-lived 1970s Marxist-inspired government and the response of nurses collectively to the rapid shift into a repressive regime leading to a profound internal crisis and an identity break-up within nursing. By using archival sources and oral testimonies1 of 1970s and 1980s nurses, we reconstruct a historical account of a key period in the history of the country that for the nurses meant a progression of discord and division along with a self-imposed silence on the past. In so doing, the article adds to a growing literature on the participation of women in political life.

The system of nursing in Chile: Insights from a systems theory perspective

Nursing is possible owing to a series of intricate systemic relations. Building on an established tradition of sociological research, we critically analysed the nursing profession in Chile, with an emphasis on its education system, in the light of social systems theory. The papers aim was to explore basic characteristics of nursing education as a system, so as to outline its current evolution. Drawing on recent developments in nursing, we applied an empirical framework to identify and discuss functionally differentiated systems that are relevant to nursing and observe communications between them. We found that the dynamics of nursing as a whole develop from communications with closely related systems, including the nursing profession and the education system more broadly. While the discipline (as a system of representations) strives to control the profession (as an applied occupational field), the necessities of practicing nurses imply other forces mediating the making of the profession, a process framed by market dynamics in education and health.

Examining “Elite” Power Dynamics in Informant–Research Relations and Its Impact on Ethnographic Data Construction

This article explores how power dynamics between informants and field researchers shape ethnographic data construction, drawing on fieldwork at a pharmaceutical company. Pharmaceutical companies are considered elite settings, and often assumed to be powerful in relation to the researcher and dominating the data construction. However, such a view conceptualizes power in terms of fixed categories, in which there is a superior and subordinate position. We reconsider the impact of elite informants in the light of a constructivist, interactionist view on power, in which power is dynamic and not necessarily entailing domination. We answer the following research questions: (1) How can we observe power dynamics, as conceptualized in a constructionist and interaction orientation, in ethnographic research? and (2) How can we reflect on what these power dynamics mean for data construction, based on our experiences in elite settings? To do so, we make use of discursive and interactional analytic methods and propose three levels of analysis: (1) the level of conversation, (2) the level of ethnography, and (3) the level of the organization in society. They respectively shed light on power in relation to (1) what is said and how, (2) the meanings attached to the ethnographic events, and (3) the meaning of the ethnography in relation to the discourses on the organization in society. With this article, we aim to provide researchers with a methodological tool to approach and to reflect on the significance of power relations in the context of ethnography and interviewing and its impact on data construction.

Cultural adaptation and validation of the Caring Behaviors Assessment tool in Chile

This study reports the process of cultural adaptation of the Caring Behaviors Assessment tool for the Spanish language, and determine its validity and reliability. We used a mixed-methods approach with a sample of adult participants after translation and adjustment, correlations and multiple regressions were used to explain differences in perception. Internal consistency and reliability were determined by using Cronbachs alpha. While slight modifications to syntax, language, and the interval scale were necessary to enable better comprehension, all items had high average scores as did the seven subscales. Additionally, similarities with previous literature suggest cultural suitability of the instrument across countries. This version of the tool was judged to be valid and reliable, and will facilitate care measurability and theoretical sensitivity in Spanish-speaking countries.

Book Review: Robert Brym (with Bonnie Fox), From Culture to Power: The Sociology of English CanadaBrymRobert (with FoxBonnie), From Culture to Power: The Sociology of English Canada (25th anniversary edn), Rock’s Mills Press: Oakville, Canada, 2015; 224 pp.: ISBN 9781772440027, CDN

Robert Bryn could not tell the story of English Canada in the way he does unless he had mastered its levels of intricacy, contradiction, and nuance. Not for nothing is he an award-winning author, and the present book is a 25th anniversary edition. Despite its modest appearance, and though short it may seem, what this book brings in about 200 pages, made up of just five chapters and a brief conclusion, seems to imply with great acuity that which may have been left out. This is not an impressionistic type of a book reflecting on broad, groundless ideas about what the country is. Quite the contrary – the axis of this work is a fine-toothed-comb treatment given of the main arguments that attempt to explain Canada’s social nature: its values, growth, stratification, and development. And the author does so with authoritative knowledge – and a steady voice – drawing on an incredibly comprehensive empirical base. In sum, everything one would expect when opening a book of this kind. Bryn thinks, and so claims the title, this is a book on sociology. But I think this is a book on sociology and history and political science. For it inevitably takes us to important historical national movements and how they have altered the way Canadians live and face power relations at a macro-social level. The book starts off with what I believe was an attempt to exorcise the remains of the 1960s well-respected culturalism out of the social thinking of the 1980s, an allencompassing take that drew generalizations on ‘all things Canadian’ by (speculative) value differences with, archetypically, the US-American culture: 18th-century Canadians were believed to feel more loyalty to the British monarchy and would be more inclined to adhere to Catholic ethics, which, along with the centralization of the state, would have led to the immobility of their society and generally more conservative thought all along. Such interpretation became increasingly implausible as 725268 ISS0010.1177/0268580917725268International Sociology ReviewsReviews: National knowledge traditions research-article2017