Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.

Genealogy as a critical toolbox: deconstructing the professional identity of nurses.

AIM: To discuss the Foucauldian concept of genealogy as a framework for understanding and transforming nurses' professional identity. BACKGROUND: The professional identity of nurses has primarily been defined by personal and interpersonal attributes and by the intradisciplinary dimensions of nursing, leading to its conceptualization as a universal, monolithic phenomenon. The Foucauldian genealogical perspective offers a critical lens to examine what constitutes this professional identity; Spanish nursing offers a historical case study of an active effort to impose an identity that fits the monolithic ideal. DATA SOURCES: Five of the 33 professional conduct manuals for nurses' training published from 1956-1976 during the Franco dictatorship in Spain and six interviews with nursing instructors or students at the time were analysed using a theoretical framework drawn from Foucault's writing. DISCUSSION: Foucault's genealogical framework considers practices of normalization and resistance as a means of understanding knowledge continuities and discontinuities, clarifying practices that constitute nurses' professional identity in a particular way in specific contexts and analysing the implications of this theoretical frame. IMPLICATIONS FOR NURSING: The genealogy concept offers valuable tools to determine how professional identities are constituted, questions assumptions about the profession and its professionals and envisions alternative approaches. This theoretical approach helps both scholars and practitioners understand, question and transform their practices as needed. CONCLUSION: The genealogical approach prioritizes analysis of the phenomenon over its description and challenges many unknown, forgotten, excluded and/or unquestioned aspects of identity from a position of diversity and complexity.

The Health Consequences of Neocolonialism for Latin American Immigrant Women Working as Caregivers in Spain: A Multisite Qualitative Analysis.

In Spain, most jobs available for Latin American immigrant women are in intimate labour (caregiving and domestic work). This work is usually performed under informal employment conditions. The objective of this study was to explain how the colonial logic mediates the experiences of Latin American women working in intimate labour in Spain, and the effects of such occupation on their health and wellbeing, using a decolonial theoretical framework. A multi-site secondary data analysis of qualitative data from four previous studies was performed utilizing 101 interviews with Latin American immigrant women working as caregivers in Spain. Three interwoven categories show how the dominant colonial logic in Spain creates low social status and precarious jobs, and naturalizes intimate labour as their métier while producing detrimental physical and psychosocial health consequences for these immigrant caregivers. The caregivers displayed several strategies to resist and navigate intimate labour and manage its negative impact on health. Respect and integration into the family for whom they work had a buffering effect, mediating the effects of working conditions on health and wellbeing. Based on our analysis, we suggest that employment, social, and health protection laws and strategies are needed to promote a positive working environment, and to reduce the impact of caregiving work for Latin American caregivers.

[Informal caretakers in Spain, their profile and care provided]. / Los cuidadores informales en España. Perfil y cuidados prestados.

The authors carried out a systematic search in main data bases and a methodological content review by paired authors about selected publications. The authors reviewed and analyzed 332 articles about informal caretakers and they chose 182 which complied with their selection criteria. The profile for informal caretakers of persons aged over 65 in Spain is identified as well as the type of care he/she provides. It is worth highlighting the introduction of a new factor in caretaking for the elderly during recent years at a national Spanish level, and since the 1990s on an international level: paid non-professional immigrant caretakers. This phenomenon makes the different traits which ethnic minority caretakers have reflect on the dynamics and the results of this study.

Determinants of Subjective Social Status and Health Among Latin American Women Immigrants in Spain: A Qualitative Approach.

This qualitative study was carried out to better understand factors that determine the subjective social status of Latin Americans in Spain. The study was conducted following a theoretical framework and forms part of broader study on subjective social status and health. Ten immigrant participants engaged in semi-structured interviews, from which data were collected. The study results show that socioeconomic aspects of the crisis and of policies adopted have shaped immigrant living conditions in Spain. Four major themes that emerged from the analysis were related to non-recognition of educational credentials, precarious working conditions, unemployment and loneliness. These results illustrate the outcomes of current policies on health and suggest a need for health professionals to orient practices toward social determinants, thus utilizing evaluations of subjective social status to reduce inequalities in health.

[The centrality of the family as a resource for homecare: gender and generational perspectives]. / La centralidad de la familia como recurso en el cuidado domiciliario: perspectivas de género y generación.

Given the critical situation of informal caregiving in Spain, we explore how in the current socio-economic and political context main caregivers value and understand their family members as a resource to support caregiving. This qualitative study had a postfeminist orientation and was developed in Mallorca (Spain) through individual interviews and focus groups with men and women home caregivers from three generations. The participants identified their families, understood as women, as their main source of help due to the emotional quality of care they provide. However, internal conflicts and gender inequities, among others, made us question the dominant discourse of family's privileged position to take care of dependent people. The implications of these results to public policy are discussed.

[Quality of life in Latin American immigrant caregivers in Spain]. / Calidad de vida de trabajadoras inmigrantes latinoamericanas como cuidadoras en España.

OBJECTIVE: To describe perceived quality of life in Latin American caregivers working in Spain and how it varies in relation to certain variables shared by this group. METHODS: We used the SF-36 to measure perceived quality of life in 517 women residing in five Spanish regions: the Balearic Islands, Catalonia, the Basque Country, the Canary Islands, and Madrid. Several variables related to the socio-demographic profile and migration process were studied using Student's t test, ANOVA and linear regression models. RESULTS: The participants scored very low on the dimensions of physical and emotional roles. The factors associated with lower quality of life scores within the group were working as a live-in caregiver, lack of contract, multitasking, irregular status, and younger age. CONCLUSIONS: The vulnerability of these women can be explained by poor working conditions and other factors related to the migratory process.

[Reflexivity and positionality tools to promote theoretical-methodological congruency on commencing a qualitative study]. / Herramientas de reflexividad y posicionalidad para promover la coherencia teórico-metodológica al inicio de una investigación cualitativa.

The interest in responding to socially determined health needs has led to an increased use of qualitative methodology by researchers and health professionals. This situation has prompted a search for new tools that will facilitate implementation and promote the quality of their research. The researcher's reflexivity and positionality have been described as very useful rigour strategies to promote theoretical-methodological congruency in qualitative research, as well as in generating new knowledge with a greater impact on health. Two methodological tools are presented here in the form of self-reflective questions, with some examples from qualitative health studies conducted in Spain, which can help novice researchers to plan how to commence a qualitative project. Some implications for the health research, practice and policy are discussed.

Relationship between subjective social status and perceived health among Latin American immigrant women.

OBJECTIVE: to explore the relationship between socioeconomic status and subjective social status and explain how subjective social status predicts health in immigrant women. METHODS: cross-sectional study based on data from 371 Latin American women (16-65 years old) from a total of 7,056 registered immigrants accessed through community partners between 2009-2010. Socioeconomic status was measured through education, income and occupation; subjective social status was measured using the MacArthur Scale, and perceived health, using a Likert scale. RESULTS: a weak correlation between socioeconomic and subjective social status was found. In the bivariate analysis, a significantly higher prevalence of negative perceived health in women with no education, low income, undocumented employment was observed. In the multivariate analysis, higher odds of prevalence of negative perceptions of health in the lower levels of the MacArthur scale were observed. No significant differences with the rest of the variables were found. CONCLUSIONS: the study suggests that subjective social status was a better predictor of health status than the socioeconomic status measurements. Therefore, the use of this measurement may be relevant to the study of health inequalities, particularly in socially disadvantaged groups such as immigrants.

Relationship between subjective social status and perceived health among Latin American immigrant women / Relação entre status social subjetivo e saúde percebida entre mulheres imigrantes latino-americanas / Relacion entre el estatus social subjetivo y la salud percibida entre mujeres inmigrantes latinoamericanas

OBJECTIVE: to explore the relationship between socioeconomic status and subjective social status and explain how subjective social status predicts health in immigrant women. METHODS: cross-sectional study based on data from 371 Latin American women (16-65 years old) from a total of 7,056 registered immigrants accesse through community parthers between 2009-2010. Socioeconomic status was measured through education, income and occupation; subjective social status was measured using the MacArthur Scale, and perceived health, using a Likert scale. RESULTS: a weak correlation between socioeconomic and subjective social status was found. In the bivariate analysis, a significantly higher prevalence of negative perceived health in women with no education, low income, undocumented employment was observed. In the multivariate analysis, higher odds of prevalence of negative perceptions of health in the lower levels of the MacArthur scale were observed. No significant differences with the rest of the variables were found. CONCLUSIONS: the study suggests that subjective social status was a better predictor of health status than the socioeconomic status measurements. Therefore, the use of this measurement may be relevant to the study of health inequalities, particularly in socially disadvantaged groups such as immigrants. .

OBJETIVO: explorar a relação entre nível socieconômico e status social subjetivo e explicar como o status social subjetivo prediz a saúde em mulheres imigrantes. MÉTODOS: estudo transversal com observações baseadas em 371 mulheres latino-americanas (16-65 anos) de um total de 7.056 registradas, recrutadas por meio de parcerias entre os anos 2009 e 2010. O nível socioeconômico foi mensurado por meio de escolaridade, renda e profissão; o status social subjetivo foi mensurado utilizando-se a Escala MacArthur, e a saúde percebida, usando-se uma escala tipo Likert. RESULTADOS: encontrou-se fraca correlação entre o nível socioeconômico e o status social subjetivo. Na análise bivariada, observou-se prevalência significativamente mais alta de saúde percebida negativamente em mulheres sem escolaridade, baixa renda, desempregadas e com emprego informal. Na análise multivariada, observaram-se maiores chances de prevalência de saúde percebida negativamente, nos níveis mais baixos da escala MacArthur. Não foram encontradas diferenças significativas nas demais variáveis. CONCLUSÕES: o estudo sugere que o status social subjetivo foi um melhor preditor de status de saúde do que as mensurações de status econômico. Portanto, o uso dessa medida pode ser relevante para o estudo das desigualdades em saúde, particularmente nos grupos em desvantagem social, como os imigrantes. .

OBJETIVO: explorar la relación entre el estatus socioeconómico y el estatus social subjetivo y explicar en qué medida el estatus social subjetivo predice la salud en mujeres inmigrantes. MÉTODOS: estudio transversal. Observaciones basadas en 371 latinoamericanas (16-65 años) de un total de 7.056 empadronadas, captadas a través de asociaciones entre 2009-2010. El estatus socioeconómico se midió a través de educación, ingresos y ocupación; el estatus social subjetivo usando la Escala MacArthur; y la salud percibida mediante una escala de likert. RESULTADOS: se encontró una correlación débil entre el estatus socioeconómico y el social subjetivo. En el análisis bivariante se observó significativamente una prevalencia mayor de salud percibida negativa en las mujeres sin estudios, con ingresos bajos, desempleadas e indocumentadas. En el análisis multivariante, se observaron Odds de prevalencia de salud percibida negativa más elevadas en los niveles de la escala MacArthur más bajos. No se observaron diferencias significativas con el resto de las variables. CONCLUSIONES: el estudio sugiere que el estatus social subjetivo es un predictor mejor del estado de salud que las medidas del estatus socioeconómico. Por tanto, el uso de esta medida puede ser relevante para el estudio de las desigualdades en salud, particularmente en los grupos en desventaja social como los inmigrantes. .

La centralidad de la familia como recurso en el cuidado domiciliario: perspectivas de género y generación / The centrality of the family as a resource for homecare: gender and generational perspectives

Frente a la situación crítica del cuidado informal en España, exploramos como en el actual contexto socio-económico y político las personas cuidadoras principales valoran y entienden a sus familiares como un recurso de apoyo al cuidado. Este estudio cualitativo tuvo una orientación postfeminista y fue desarrollado en Mallorca (España) a través de entrevistas individuales y grupos focales con hombre y mujeres cuidadores en domicilio de tres generaciones. Los y las participantes señalaron a la familia, entendida como mujeres, como su principal recurso de ayuda por su calidad emocional. No obstante, conflictos internos e inequidad de género, entre otros, hacen cuestionar el discurso dominante de la idoneidad de la familia para cuidar de personas dependientes. Las implicaciones de estos hallazgos para políticas públicas son discutidas.