Sioban Nelson

The lost path to emancipatory practice: towards a history of reflective practice in nursing

This paper historicizes the taken-for-granted acceptance of reflection as a fundamental professional practice in nursing. It draws attention to the broad application of reflective practice, from pedagogy to practice to regulation, and explores the epistemological basis upon which the authority of reflective discourse rests. Previous work has provided a series of critiques of the logic and suitability of reflective practice across all domains of nursing. The goal of this paper is to commence a history of nursings reflective identity. The paper begins with a discussion of Dewey and Schön then focuses on Habermass Theory of Communicative Action as the epistemological basis of reflective practices standing as a authoritative discourse in nursing.

Motivations of nurses who migrate to Canada as domestic workers

BACKGROUND While some trained nurses migrate to destination countries to work as domestic workers, little is known about their migration motivations. AIM This study explores the motivations of Philippine educated nurses who migrated to Canada through the Live-in Caregiver Program from 2001 to 2011 (a Canadian domestic worker programme). METHODS A single case study qualitative methodology and the transnational feminist concept of global care chains were utilized for this study. Interviews of 15 Philippine educated nurses who migrated to Canada as domestic workers were conducted in the province of Ontario, Canada, between February to October 2012. All participants had a baccalaureate degree from the Philippines. Interviews were tape recorded, transcribed verbatim and analysed using critical discourse analysis, aided by NVIVO 10 data analysis software. RESULTS Findings reveal a multi-step immigration process in which nurses migrate from the Philippines to the Middle East (especially Saudi Arabia) and finally to Canada. While emigration from the Philippines is mainly economically driven, migration from the Middle East to Canada is primarily motivated by the desire for Canadian citizenship for the family. Also, perceived social status and lifestyle in Canada as compared to the Middle East motivates this group of women to migrate to Canada. LIMITATION The major limitation of this study is the lack of input from nursing policy makers. CONCLUSION Gender-based familial ideologies and perspective on social status influence the migration decision of this group of nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY Implications for nursing and health policy makers include the provision of clear pre-migration information (including on the nursing registration process) to internationally educated nurses, advocacy for stronger immigration policies to ensure the integration of internationally educated nurses and a consideration of gender in all health human resource policies.

Networks of identity: the potential of biographical studies for teaching nursing identity.

This article reviews the historiographical elements of the professional identity of nursing, focusing on what historians have denoted as the “history of the present.” Professional identity interacts with elements of power, gender, politics, philosophy, and history, and its value is tied to the importance it assumes at any given time in any given society. The collective identity of the profession is elucidated by the construction of nursing history, linked to the history of women and gender relationships in professional care and educational, organizational, and class practice, and also by the biographies of individuals who have shaped this identity through their reputations and life stories. In this light, it is argued that biographies could help illuminate the elements of identity formation of interest to nursing scholars and further the development of the profession; they could also bring discussions of the past and present into the teaching – learning process for nursing students. The authority and significance of these identities will also be discussed.

Teaching nursing history: The Santa Catarina, Brazil, experience

Nursing history has been a much debated subject with a wide range of work from many countries discussing the professions identity and questioning the nature of nursing and professional practice. Building upon a review of the recent developments in nursing history worldwide and on primary research that examined the structure of mandated nursing history courses in 14 nursing schools in the state of Santa Catarina, Brazil, this paper analyzes both the content and the pedagogical style applied. We postulate that the study of history offers an important opportunity for the development of student learning, and propose that more creative and dynamic teaching strategies be applied. We argue the need for professors to be active historical researchers, so they may meaningfully contribute to the development of local histories and enrich the professional identities of both nursing students and the profession. We conclude that historical education in nursing is limited by a traditional and universalist approach to nursing history, by the lack of relevant local sources or examples, and by the failure of historical education to be used as a vehicle to provide students with the intellectual tools for the development of professional understanding and self-identity.

Capacity to monitor severe maternal morbidity in Australia

Maternal mortality has traditionally been the key element in the monitoring of maternal health and adequacy of obstetric services in Australia and around the world. In developed countries, the ability of maternal mortality to serve this purpose is reduced because of the rarity of maternal mortality, reflected in very low maternal mortality ratios. Internationally, there has been increasing interest in severe maternal morbidity as an indicator to monitor maternal health and maternity services. The aim of this paper is to critically examine the capacity to measure and monitor maternal morbidity in Australia. There is a paucity of reliable maternal morbidity data in Australia; Australia is lagging behind peer countries that are endeavouring to monitor severe maternal morbidity. Dedicated efforts and adequate resources are needed in order to monitor severe maternal morbidity in Australia.

Embodied knowing? The constitution of expertise as moral practice in nursing

Importantes autores del area de enfermeria, como lo es Patricia Benner, han influenciado la creciente tendencia de conceptuar la etica, como siendo una forma de conocimiento contextual incorporado en la expertise de la enfermeria. En el presente articulo se discute que la idea de la etica como expertise, mas que revelar un manifiesto de la verdad moral, constituye la practica de la enfermeria como un empeno moral, y, la enfermera como siendo una profesional que ha adquirido una conducta moral peculiar. De hecho, sucede que la enfermera expert, como categoria moral y etica, es resultado de la elaboracion de importantes discursos humanisticos en la formacion educacional y profesional de enfermeras. Esos discursos actuan en las enfermeras de forma individual y son desempenados a traves de su participacion en ejercicios eticos especificos, los cuales dan como resultado la constitucion de una subjetividad deseada. Es de suma importancia la adopcion de perspectivas fenomenologicas sobre el cuerpo de la enfermeria y su practica, las cuales se encuentran difundidas en la pedagogia de enfermeria y en la literatura profesional. Este articulo examina los origenes intelectuales asi como las implicaciones contemporaneas de esta tendencia para las enfermeras asistenciales.Autores proeminentes da enfermagem, como Patricia Benner, tem influenciado a crescente tendencia de conceituar etica como uma forma de conhecimento contextual embutido na expertise de enfermagem. Sera discutido aqui que mais do que revelar um manifesto da verdade moral, a ideia de etica como expertise constitui a pratica de enfermagem como um empenho moral e a enfermeira como uma profissional que tenha adquirido uma conduta moral peculiar. De fato, acontecera que a enfermeira expert como categoria moral e etica, e resultado da elaboracao de prestigiosos discursos humanisticos na formacao educacional e profissional de enfermeiras. Estes discursos agem sobre as enfermeiras de forma individual e sao desempenhados atraves da sua participacao em exercicios eticos especificos, que resultam na constituicao de uma subjetividade desejada. De suma importância aqui e a adocao difundida na pedagogia de enfermagem e na literatura profissional, de perspectivas fenomenologicas sobre o corpo da enfermagem e sua pratica. Este artigo explora tanto as origens intelectuais como as implicacoes contemporâneas desta tendencia para enfermeiras assistenciais.

Workforce Integration of Philippine-Educated Nurses who Migrate to Canada through the Live-in Caregiver Program

Nurses who migrate through the Canadian Live-in Caregiver Program face significant barriers to their subsequent workforce integration as registered nurses in Canada. This study applies the concept of global care chains and uses single case study methodology to explore the experiences of 15 Philippine-educated nurses who migrated to Ontario, Canada, through the Live-in Caregiver Program. The focus is the various challenges they encountered with nursing workforce integration and how they negotiated their contradictory class status. Due to their initial legal status in Canada and working conditions as migrant workers, they were challenged by credential assessment, the registration examination, access to bridging programs, high financial costs, and ambivalent employer support. The results of the study are pertinent for nursing policymakers and educators aiming to facilitate the integration of internationally educated nurses in Canada.

Maternal severity of illness across levels of care: a prospective, cross-sectional study.

BACKGROUND The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs. AIM To examine severity of illness in women with severe maternal morbidity. METHODS A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002-2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28). RESULTS 137 women participated in the study: ICU (n=33), HDU (n=46) and DS (n=58). The mean APACHE II score was 8.6 (95% CI 7.7-9.5) and mean TISS 28 score was 22.5 (95% CI 21.2-23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3-16.9) and TISS 28 (mean 31.5, 95% CI 28.2-35.5) compared to women not admitted to ICU (p<.005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5-9.9) and DS (7.0, 95% CI 5.2-8.8; p=.20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19-8.97). Known risk factors like multiple pregnancy, age≥35 years and nulliparity were not associated with ICU admission. CONCLUSIONS There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.

Spanish nursing under Franco: reinvention, modernization and repression (1956–1976)

This article examines Spanish nursing during a critical 20-year period (1956-76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state-run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS-Ayudante Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Womens Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid-twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first-year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender-related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful womens branch of the ruling Falangist Party in mid-twentieth century Spain.

A imagem da enfermeira - as origens históricas da invisibilidade na enfermagem

In the nineteenth century thousands of European women felt called by God to care for the sick. In the nursing orders of sisterhoods that proliferated at this time women accomplished remarkable things in the name of God: they travelled the world establishing communities of immigrant and local women, they built and ran large hospitals, and even networks of hospitals, and they built schools, orphanages and other important social institutions for the poor. At times these women functioned with a great deal of autonomy, far away from bishops or other authority figures in the Church. At other times they were in direct conflict with the men of the Church as the sisters attempted to follow what they believed to be their mission on earth. These women were not just meek and humble nurses devoted to God, but dynamic builders, creating social institutions and health care in alliances with municipal, state or federal governments. Often they made partnerships that the Catholic Church was not happy about, allying with Jewish or Protestant community leaders to get hospitals built and to provide care for the poor. At the same time they typically ran very good private hospitals in order to make money to support their work among the poor. In other words they were formidable capable women who transformed their communities – yet despite their accomplishments they remained invisible to everyone around them and their achievements are little appreciated today. One of the central themes of my book, ‘Say Little Do Much’: Nurses, nuns and hospitals in the nineteenth century (University of Pennsylvania Press, 2001), was that because they were women, and because the Church was concerned to contain their independence and autonomy, it was critical to their survival that the sisterhoods downplayed their accomplishments and successes (the title ‘say little do much’ comes from St Vincent De Paul). In the first place, these were religious women and modesty was the fundamental virtue they all needed to acquire. Furthermore, all they did was for God and nothing else was important. Second, if they were too visible the Church would get worried about women having too much independence and their freedom would be cut short and they would be placed under the close supervision and direction of men (which indeed happened to many communities of women). In my book I described this phenomenon as building nursing and health care institutions ‘under the radar’ (or beneath the notice) of the church and the men who ran the Church. Over the late nineteenth and early twentieth centuries, as non religious women moved into nursing, and the profession began its secular professional evolution, nursing still constituted itself as a feminine domain of moral authority and womanly skill. To create nursing into a profession that would be respectable enough to attract middle class women, who would not be a threat to medical authority, what took place was the continued downplaying of nursing knowledge and skill and an emphasis on virtue and ethics. This meant that the very success of nurse reformers in creating the first mass profession for women, put nurses in the paradoxical position of playing an important role in health care while sentimentalizing and trivializing the very critical role they played. The only legitimacy nurses could claim was to couch their description of their work in charitable, devotional or altruistic terms. In our edited book Complexities of Care: Nursing reconsidered (Cornell University Press, 2006), Suzanne Gordon and I pulled together a series of essays that looked at the challenges facing nursing and the problem we as a profession have created for ourselves by talking only of caring and emotional and relational work and never about the technical and scientific basis of nursing expertise. We argued that even where the primary intervention is emotional support – this is not because the nurse is a good person, or a natural carer due to her femininity or religious vocation, but because she or he has understood that this is the intervention that the patient requires at this time, and because the nurse has the expertise and education to effectively provide support to the patient. This is not holding someone’s hand – this is a psychosocial intervention and takes education and training.