Cultural adaptation and validation of the caring behaviors assessment tool into Spanish.

BACKGROUND: The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context. METHODS: Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses. RESULTS: The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions. CONCLUSIONS: The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

Agentes comunitarios de salud: ¿cómo articular esta estrategia en el contexto chileno? / Agentes comunitários de saúde: como articular essa estratégia no contexto chileno? / Community health agents: how to articulate this strategy in a Chilean setting?

Este artículo tuvo por objetivo situar la estrategia de Agentes Comunitarios de Salud adoptada recientemente en Chile como una intervención que podría contribuir a cerrar las brechas en salud. Para ello, empleamos como herramienta analítica la noción de participación de la sociedad civil, a menudo olvidada en los debates que contraponen los sistemas público y privado en el análisis de la salud. Al examinar esta iniciativa bajo el lente de la educación popular en Brasil, argüimos que esta forma de participación no puede plantearse como una intervención tecnocrática más, sino situarla en contexto, social e históricamente, donde la sensibilidad cultural es clave. En Chile, la participación ciudadana en salud tiene una larga tradición instalada y, en virtud de una reapropiación los discursos públicos en la última década, el aspecto agencial popular podría articularse e institucionalizarse.

O objetivo deste artigo foi situar a estratégia dos Agentes Comunitários de Saúde recentemente adotada no Chile como uma intervenção que poderia contribuir para fechar as lacunas na saúde. Para tanto, empregamos como ferramenta analítica a noção de participação da sociedade civil, frequentemente negligenciada nos debates que opõem os sistemas público e privado na análise da saúde. Ao examinar essa iniciativa por meio das lentes da educação popular no Brasil, argumentamos que essa forma de participação não pode ser vista como apenas mais uma intervenção tecnocrática, mas deve ser colocada em um contexto cultural e histórico, no qual a sensibilidade cultural é fundamental. No Chile, a participação cidadã na saúde tem uma longa tradição e, em virtude de uma reapropriação dos discursos públicos na última década, a agência popular pôde ser articulada e institucionalizada.

The purpose of this article is to situate the Community Health Agents strategy as a social intervention that may contribute to bridging the gap in health coverage. In doing this, we used the participation of nonprofit civil society as an analytical tool. Civil society is often neglected in debates about health, which tend to focus the analysis solely on the antagonism between public and private services. By examining this strategy through the lens of popular education in Brazil, we argue that this form of participation cannot be viewed as merely another technocratic solution, but should instead be understood within its cultural and historical context, emphasizing the importance of cultural sensitivity. Civil society's participation in health matters has a longstanding history in Chile. Considering the reappropriation of public debates over the past decade, the agential aspect of this intervention could be articulated and potentially institutionalized.

Nursing is not like organised crime: A theoretically informed commentary.

AIM: This article aims to contest misrepresentations and distortions of sociological writings on the nursing profession. BACKGROUND: During the latest ICN congress in Montreal, it has been suggested that professions, and the nursing profession for that matter, are thought of by sociologists in a similar way as organised crime, meaning that it is like a 'money sponge' sucking resources out of society, without however giving anything in return. Allegedly, there would be a distinct branch of sociology depicting the professions in this light. DISCUSSION: By sketching out relevant sociological ideas, including the sociology of nursing, I explain that there is no tradition portraying the professions as mafias. I demonstrate that while both the professions and organised crime are socially organised, they are radically different in legitimacy. The caring professions are themselves different in ethos from the classic professions, all the more so from criminal organisations. A distinct stream of research in sociology has been devoted to nursing, without however suggesting such an analogy. CONCLUSION: I lament that attendees to the ICN congress were indeed given an inaccurate representation of sociological thinking. Sociologists addressing nursing as a profession tend to highlight processes of emancipation, autonomy, vindication and social justice, as care work is essential to the broader socioeconomic order. IMPLICATIONS FOR NURSING POLICY: While nursing as a profession is socially organised, the power devices and tactics it deploys in the sociopolitical arena are characterised by their legitimacy. Unlike organised crime, nursing policymaking is situated within a framework of lawfulness, fairness and transparency.

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 paper's 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.

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.

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.

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 Cronbach's 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.

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.

Let's talk about society: A Critical Discourse Analysis of sociology courses in pre-registration nursing.

BACKGROUND: The discussion of teaching and learning in nursing has been prolific. Whereas most of the debate tends to focus on core contents of nursing programmes, little has been discussed about the teaching in 'supporting subjects' with relevance to both nursing education and nursing practice. This article offers a perspective on sociology scholarship for applied professions by using the case of nursing programmes. METHODOLOGY: Syllabus is a rich source of data, and in its representational capacity it becomes both a discursive construction and a vehicle of ideology. Accordingly, we present a Critical Discourse Analysis of syllabi of nursing schools in Chile as to identify core contents and ideologies, and implied challenges for nursing education. FINDINGS AND DISCUSSION: We argue that while the syllabus as a discourse discloses a significant cleavage, the biggest challenge is precisely to challenge the ideologies constructed by and embedded in the syllabi. Our reflection thus points to a better interdisciplinary dialogue as to enhance the actual contribution of sociology to nursing.

El concepto de situs ocupacional: por qué esta propuesta no es plausible: una explicación sociológica / The concept of occupational situs: why this notion is not plausible: a sociological explanation

Seis años atrás apareció en este mismo medio una propuesta desde el interior de la enfermería académica, que sugería el desarrollo -y aun la preexistencia- de un situs ocupacional de enfermería. Siguiendo este concepto, la enfermería podría tomar distancia de la dominación médica e instalar un situs propio de enfermería, con las enfermeras en la cúspide de la estructura y otras ocupaciones asociadas en posiciones subalternas. Esta proposición, aunque muy prometedora, no logró despertar mayor discusión en las revistas del rubro. En parte, esta omisión puede ser resultado de que al tratarse de un concepto de limitado interés empírico, aun para la sociología de las profesiones (desde donde proviene), el situs ocupacional se ha enmohecido en el olvido. En el presente artículo tendré como objetivo el argumentar por qué los conceptos de situs y situs ocupacional, además de tener poca utilidad hoy en día, no son aplicables en la conformación de un 'situs de enfermería' La estratificación de categorías ocupacionales es un fenómeno mucho más complejo que meramente disponer lo que un grupo de profesiones 'debería' incluir o dejar fuera, por lo que sugiero su inoperatividad en la recomposición de estructuras profesionales. Representaciones contemporáneas sobre la estratificación social en el trabajo son mejor descritas a través del análisis del funcionamiento de credenciales académicas y, sobre todo, de las relaciones sistémicas a través de las cuales las profesiones tienen influencias mutuas, tanto en sus campos de práctica como en la construcción de narrativas profesionales.

Six years ago, there appeared in this same journal a proposal from the field of academic nursing, suggesting the development or even the pre-existence of an occupational situs of nursing. By using this concept, nursing could take distance from medical dominance and establish its own occupational situs, meaning that nurses would be on top of the structure and subordinate occupations on lower levels. Although promising, this proposal did not persuade other researchers into developing a debate in related journals. This omission may be partly due to the fact that, given its empirical limitations even for the sociology of professions (where the concept originates), the concept of occupational situs has fallen into oblivion. In this article I discuss why concepts such as situs and occupational situs, besides their limited usefulness today, are no longer applicable to the conformation of a 'nursing situs.' The stratification of occupational categories is much more complex than merely deciding what a group of professions should include or not include; I thus suggest the ineffectiveness of the concept in setting up professional structures. Contemporary representations of social stratification in different occupations are best described by analysing the role of academic credentials and, especially, the systemic relations through which professions develop mutual influence both in their practical fields and in the construction of professional narratives.

How does stigma influence mental health nursing identities? An ethnographic study of the meaning of stigma for nursing role identities in two Belgian psychiatric hospitals.

BACKGROUND: Stigma constitutes a threat for professionals who work in mental health care, through their association with mental illness as a discrediting attribute. Together with nurses' unclear self-perception, recent insights suggest that stigma may inform the apparent identity crisis within the mental health nursing profession. OBJECTIVE: This article explores how stigma may give meaning to mental health nursing identities. The nursing role is built upon official labels, a prime trigger of stigma. Therefore, due to nurses' ambiguous relation with the psychiatric/medical care and their own stigma experiences due to their association with mental health problems, they can be considered as a stigmatizing, de-stigmatizing and stigmatized group. Dynamics which inform this intricate relation between stigma and mental health nursing identity are the focus of this article. Accordingly, this article points to the importance of including stigma in the overall study of mental health nursing identity. DESIGN, SETTINGS AND PARTICIPANTS: This research uses a qualitative case-study design. Ethnographic data were gathered from 33 nurses in 4 wards in two psychiatric hospitals in the region of Ghent (Belgium). METHODS: Participant observation and semi-structured interviews were combined to access the meaning of being a mental health nurse in these specific care contexts and its possible interference with mental health stigma. RESULTS: The findings suggest that tackling stigma is a particularly important personal motive for nurses to work in mental health care. The meaning of stigma is closely entangled with nurses' troublesome relationship with the medical model of care. Variations between hospitals regarding the extent to which stigma informs the professional role constructs and identity of nurses are found to be related to the degree of formalization of the nursing roles in these different hospitals. CONCLUSION: The present study points to the relevance of the integration of stigma in mental health nursing identity research. Furthermore, the focus on stigma may offer an opportunity to link contexts of illness and care, and nurses' identity constructs.

Prompting professional prerogatives: new insights to reopen an old debate about nursing.

A profession is defined by neither a set of structural qualities nor a description idiosyncratic to a single culture. Rather, a profession detects problems in an area of work, intellectualizes that work, and offers solutions, developing a logic of competition with coexisting occupations. The best that structural explanations can offer to nursing is rigid, unmovable definitions such as "a semi-profession," whereas the ecological theory of the professions regards the continuous interplay among occupations cohabiting in an interacting system as the fundamental process of gaining or losing professional status. In this theoretically driven article we draw upon the notion of "social ecology of nursing" as a vector of development, arguing that nursing's professional status lies in its ability to adapt to "landscape" transformations and to protect its jurisdiction from competitors, equating fully established professions. In discussing the application of this theory, we invite readers to reopen a debate about the professional nature of nursing, considering cross-national versions of nursing for more comprehensive definitions of the profession.

Blessed art thou among women: male nursing students and gender inequalities in Chile.

BACKGROUND: The evolution of nursing education into an academic curriculum and the growing interest of men in nursing have been significant landmarks in the development of a 'female' occupation. Chilean nursing is considered as the leading example of nursing education in Latin America, demanding a five-year training on a full-time university programme. The consequences of education, however, are assumed as more egalitarian opportunities, disregarding the latent replication of structures that perpetuate inequalities. OBJECTIVE: To comprehend the socialisation of male nursing students and its relation with their masculine identity and the construction of inequalities in nursing education. METHODS: We draw upon interviews undertaken with beginner and advanced nursing students from a Chilean university. Approval was obtained from the relevant Ethics Committee. The data were organised to allow the development of concepts by using the Grounded Theory approach. RESULTS: The analysis uncovers paradoxical results of nursing education and its ineffectiveness in preventing gender-based inequalities. The interest in empowering nursing politically may lead to favour an increasing number of men entering nursing in ways that facilitate male students' progress. Furthermore, there exist discourses of compassion that feed consideration for male students, engendering in the process the prospect of professional success and the gravitation into strategic positions in the employment market. These are mechanisms that reproduce earlier gender-based inequalities in nursing. CONCLUSIONS: In the light of the social reproduction theory, the academisation of Chilean nursing seems to be built upon historical gender asymmetries. Although the interest of men in embracing a career in nursing may have a meaningful resonance with the transformation of contemporary society, this process needs a judicious examination in order to protect academic integrity and, ultimately, prevent the reproduction of those inequalities in question. This analysis offers a perspective for understanding social patterns embedded in the practice of nursing education in Chile and elsewhere.

Academisation of nursing: An ethnography of social transformations in Chile.

BACKGROUND: Nursing in Chile is considered to be the leading example of professional development in Latin America - nurses must undertake five years of university education on a full-time programme. Academisation of nursing education is a key aspect in the evolution into professional status. The consequences of education, however, are commonly related to the replication of social institutions and structures that perpetuate social inequalities. OBJECTIVE: The study's aim was to comprehend the consequences of nursing academisation and its relationships with the social transformations which that country has witnessed. METHODS: We draw upon ethnographic data, gathered between 2010 and 2011 in a 500-bed, high-quality university hospital in Chile. Participants were nurses ranging from beginners to experienced professionals and recruited from wards representing technically expert nursing and caring-oriented nursing. The data were organised to allow the development of concepts and patterns, using the Grounded Theory approach. RESULTS: Despite the fact that Chilean nursing originated from the educated elite class, today's nurses share a middle-class consciousness, and a sense of class distinction is encouraged throughout academic training - the 'eliteness' of professional groups. This discourse antagonises middle-class people who 'should' adopt a professional-class identity. A tension among nurses surfaced, based on a competition for a scarce resource: social mobility. Furthermore, an antagonist stratification between university-trained nurses and auxiliary nurses has developed, and in the process the title 'nurse' and the practice of 'nursing' have been monopolised by university-trained nurses, resulting in a relationship of domination-subordination. CONCLUSIONS: The academisation process followed by Chilean nursing is rooted in the social-class transformations of that country. Such process has been ineffective in preventing social inequalities, resulting in the reproduction of earlier historical class differences in nursing, inhibiting nurses' individual development. Class differences are manifest in the socially constructed distinction between the nurse and the auxiliary nurse, resulting in a schism of the nursing family. By reconstituting a broken-up occupation, the political power of nursing could be strengthened.