Navigating a maze: Midwives' identity response to the enactment of an abortion law in Chile.

BACKGROUND: Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. OBJECTIVE: To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. METHODS: This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. FINDINGS: Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements. CONCLUSION: Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.

Chilean midwives' experiences while providing induced abortion care after the enactment of a law decriminalising abortion.

INTRODUCTION: The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care. METHODS: A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study. RESULTS: This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'. CONCLUSION: Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives.

Experiences of postmenopausal osteoporosis: a narrative review.

PURPOSE: A narrative review was conducted to identify, critically appraise, and synthesise primary research on the lived experiences of postmenopausal women with osteoporosis. MATERIALS AND METHODS: A systematic search of qualitative studies published between January 1960 and August 2021 was conducted across seven databases. The selected qualitative studies reported the lived experiences of postmenopausal women with osteoporosis, both with and without a history of fragility fractures. RESULTS: A total of 17 publications (n = 334) were identified. These results suggest that osteoporosis and fragility fractures significantly affected postmenopausal women's lives. They reported difficulties in carrying out daily activities due to pain and change in their routines to cope with health problems. Some women were satisfied with the information provided by healthcare professionals. Their medicine adherence was also determined by their belief in the importance of their scheduled treatment for osteoporosis. CONCLUSION: Qualitative studies that explored the lived experiences of postmenopausal women with osteoporosis can provide important insights into the impact of the disease on women's lives and potential pathways for improving care and management.Implications for rehabilitationOsteoporosis and fragility fractures affect the quality of life of postmenopausal women worldwide.The provision of targeted and tailored health information for postmenopausal women with osteoporosis is paramount in improving their health literacy and aiding in the long-term management of their bone health.What is already knownOsteoporosis and related fragility fractures are common, affecting more than 200 million people worldwide, including three million people in the UK.Osteoporotic fractures have significant clinical and public health impacts.What this study addsOsteoporosis, particularly fragility fractures, has a significant impact on the lives of postmenopausal women, including pain and functional impairment.Women's belief in the importance of their scheduled treatment plays a significant role in their concordance with the prescribed medications for osteoporosis.Provision of targeted health information for postmenopausal women with osteoporosis is key to their involvement in decision-making and disease management.

Impact of postmenopausal osteoporosis on the lives of Omani women and the use of cultural and religious practises to relieve pain: A hermeneutic phenomenological study.

INTRODUCTION: Osteoporosis is a significant clinical and public health concern worldwide. Despite the impact of this condition on women's lives, most studies have focused on its clinical manifestations, drug efficacy, and medical treatment. Furthermore, most studies have been conducted in the West. This study aimed to uncover the personal experiences of postmenopausal Omani women living with osteoporosis. METHODS: In this interpretive phenomenological study, a purposive sample of 15 postmenopausal Omani women with osteoporosis was recruited from primary and secondary care facilities in Muscat, Oman. Semi-structured one-to-one interviews were conducted via Zoom and telephone because of coronavirus disease 2019 restrictions. The interviews were audio-recorded, and the Ajjawi and Higgs framework was used to analyse the data thematically. RESULTS: The following key themes were constructed from the interviews: the impact of osteoporosis on religious practices, cultural and social life, and financial status, and the benefits derived from religious and cultural practices and rituals, including Muslim prayer, recitation of Quranic verses, and herbal remedies to cope with osteoporosis-related pain and suffering. CONCLUSION: Osteoporosis and fragility fractures have a significant impact on the religious, cultural, and financial lives of postmenopausal Omani women with osteoporosis. Muslim prayers, recitation of Quranic verses, and herbal remedies are coping strategies for pain in this population. PATIENT OR PUBLIC CONTRIBUTION: Postmenopausal Omani women with osteoporosis participated in this study through interviews and contributed their lived experiences. Orthopaedic doctors helped recruit patients with postmenopausal osteoporosis.

Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals.

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.

Experiences of midwives and nurses when implementing abortion policies: A systematic integrative review.

INTRODUCTION: Policy implementation can be affected by what individuals believe to be right and wrong. When implementing abortion policies, providers' moral beliefs can be relevant in the success of the implementation process. Considering that midwives and nurses are direct providers of abortion care, exploring their experiences related to abortion policy implementation could provide helpful information to prevent policy failure. METHODS: Systematic integrative review. The studies were identified through an electronic search strategy and the screening of the reference lists of all selected articles. Studies were retrieved from eight medical and social sciences databases. Thirty-one studies focused on midwives' and nurses' experiences of implementing abortion policies, irrespective of setting or age of study were included in this review. Studies included used qualitative, quantitative and mixed methods. Study quality was appraised using the Mixed Method Appraisal Tool version 2018. No study was excluded from this review based on its quality appraisal. RESULTS: In terms of their quality, most studies included in this review were conducted appropriately. Three superordinate themes represent the main elements that challenge midwives and nurses when providing abortion care. The first superordinate theme identified that many midwives and nurses believed fetuses are sentient beings, making them worthy of compassionate treatment. The next superordinate theme was focused on preferences and expectations about abortion care. Finally, the third superordinate theme illustrates midwives' and nurses' experiences with other team members, highlights their creativity when challenged with insufficient resources and provides a glimpse of the numerous techniques used for coping with work-related stress. CONCLUSION: Midwives and nurses worldwide face multiple challenges when providing abortion care. Guidelines aiming to support policy implementation should consider how abortion affects healthcare providers and suggest appropriate measures to reduce these and other barriers. Midwives and nurses technical and ethical competencies for abortion provision should be strengthened.

Corporatising compassion? A contemporary history study of English NHS Trusts' nursing strategy documents.

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009-2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents.

An exploration of stakeholders' perceptions of the extent to which the individual and collective views of patients with long-term conditions and their carers are heard and used to inform commissioning decisions within primary care.

BACKGROUND: Involving patients and carers in decisions that influence the delivery of health services is a statutory requirement across the NHS. However, current evidence suggests a gap exists between the theory, legislation and policy intentions and their practical implementation. AIM: This research aimed to identify the nature and extent of that perceived gap. METHOD: Adopting a mixed-methods approach using questionnaires and semi-structured interviews, stakeholders' perceptions were explored regarding the extent to which the views of patients with long-term conditions and their carers are heard and used within primary care, across four clinical commissioning groups. Descriptive statistics were used to analyse the quantitative data; thematic analysis was applied to explore the qualitative data. RESULTS: Data analysis demonstrated considerable difference between patients' and carers' perceptions and those of healthcare professionals regarding how well involvement is implemented. Three key themes emerged that were perceived to influence the effectiveness of involvement. These related to the need for effective communication of relevant, accessible information that meets people's requirements; the need to take account of individuals' expectations, ability, motivation, assumptions, and previous experience; and the need for organisations to provide effective systems and processes, including adequate time and focused training to support involvement, in addition to robust monitoring and evaluation of the extent to which outputs from involvement influence commissioning decisions. CONCLUSION: The literature suggests that no existing framework addresses all three key themes. Therefore, a revised framework for involvement was developed, informed by the three key themes, that can be tested across a larger sample and different healthcare settings.

"Not Only with Thy Hands, But Also with Thy Minds": Salvaging Psychologically Damaged Soldiers in the Second World War.

This essay breaks new ground in exploring the tensions in female nursing during the Second World War as the mental health needs of the injured were increasingly acknowledged. Advances in weaponry and transportation meant that the Second World War was a truly global war with mobile troops and enhanced capacity to maim and kill. A critical mass of female nursing sisters was posted to provide care for physical trauma, yet the nature of this uniquely modern war also required nurses to provide psychological support for troops readying for return to action. Most nursing sisters of the British Army had little or no mental health training, but there were trained male mental health nurses available. Publications of broadcasts by the Matron-in-Chief of the British Army Nursing Service detail the belief that the female nurse was the officer in charge of the ward when the patients had physical needs. However, that the nursing sister held this position when the patients' requirements were of a psychological nature was at times tested and contested. Through personal testimony and contemporary accounts in the nursing and medical press, this essay investigates how female nursing staff negotiated their position as the expert by the psychologically damaged combatants' bedside. The essay identifies the resourcefulness of nurses to ensure access to all patient groups and also their determination to move the boundaries of their professional work to support soldiers in need.

Crisis at Guy's Hospital (1880) and the nature of nursing work.

This historical study aims to refine understanding of the nature of nursing work. The study focuses on the 1880 crisis at Guy's Hospital in London to examine the nature and meaning of nursing work, particularly the concept of nursing work as many 'little things.' In this paper, an examination of Margaret Lonsdale's writing offers an original contribution to our understanding of the ways in which nursing work differs from medical practice. In this way, we use the late-nineteenth-century controversy at Guy's Hospital as a prism through which to examine the contested nature of nursing work. Lonsdale's ideas are corroborated by examination of writings by nurse leaders Florence Nightingale and Eva Luckes. Luckes, in particular, elaborated what was meant by nursing as the performance of a thousand little things, which are specific to nursing work. While physicians had been performing much of what was considered to be nursing work, nurses developed some of these and other interventions into a unique body of work characterized by meticulous attention to significant details. Some implications regarding current nursing practice are discussed.

Nurses as therapeutic agents in the extreme environment of the desert war, 1940-44.

AIMS: The purpose of this article is to explore therapeutic nursing with combatants in the extreme environment of the desert in World War II. BACKGROUND: The notion of nursing as therapy gained credence in the 1990s and is currently experiencing resurgence, as nurses seek to find meaning in their work and improve patient care in the post-Francis environment. DESIGN: This discussion paper will use the hostile space of the desert war zone in World War II to explore nurses' therapeutic engagement with their combatant patients. It will examine how nurses provided care and comfort through the use of self, fundamental nursing skills, improvisation and innovation and the manipulation of the environment. DATA SOURCES: The data used are a combination of letters, diaries, memoirs and published archival material. Much of the personal testimony is part of an uncatalogued archive of correspondence between nurses and the Matron-in-Chief of the Queen Alexandra's Imperial Military Nursing Service. IMPLICATIONS FOR NURSING: Nurses sometimes struggle to identify the importance of their work, compared with other members of the multidisciplinary team. By understanding nursing as therapy, the profession can articulate how their work is fundamental to the healing, or support to a dignified death of their patients. This article illustrates how the therapeutic engagement with patients, even in the most difficult of environments, is possible and brings comfort. CONCLUSION: Deserts are among the most hostile of any space inhabited by people. Yet, even in a place where survival is difficult, therapeutic nursing can support healing and recovery.

Nursing typhus victims in the Second World War, 1942-1944: a discussion paper.

AIMS: This article explores the care British nurses provided to victims of typhus during the Second World War. BACKGROUND: Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops. DESIGN: This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters. DATA SOURCES: The published sources for the paper include material from nursing and medical journals published between 1940-1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943-1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas. IMPLICATIONS FOR NURSING: Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable. CONCLUSION: Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts.

'Uninterested in anything except food': the work of nurses feeding the liberated inmates of Bergen-Belsen.

AIMS AND OBJECTIVES: The aim of this article is to explore the work of nurses feeding and helping liberate the inmates of Bergen-Belsen concentration camp in the spring of 1945. BACKGROUND: A considerable amount has been published on the relief of Belsen, but the majority of the research has focused on the medical staff and the army in general. The exception to this is an article published by Ellen Ben-Sefer, but its analysis of the actual work of the nurses is limited. DESIGN: The data are explored through the medium of nurses' work, especially feeding work and its place in the historiography. METHODS: This article will offer an analysis of archival material, including official reports and personal testimony and published primary sources. RESULTS: Nurses were very much hidden from the liberation picture, partly through government policy, partly because of gendered ideologies and partly because of the desire of many to hide their memories. However, the data identify the pivotal role of nurses in the saving of lives and rehabilitation of inmates. This article demonstrates this role through the work of feeding. CONCLUSION: The nurses had to continually negotiate and renegotiate their place in the liberation. As women, their place at Belsen was problematic and often thwarted by the ideologies of the day. Nevertheless, the services of registered nurses during the war had proved indispensible. The Allied governments and Royal Army Medical Corps were ultimately to rely on their professional expertise. The nurses' work in the feeding of starving inmates demonstrates their value. RELEVANCE TO CLINICAL PRACTICE: This article demonstrates the importance of nurses' feeding work and their role in the caring of people's humanity.

Managing the burden: nursing older people in England, 1955-1980.

This article is a historical exploration of the work undertaken, by both nurses in training and qualified ward level nurses, on older adult wards of the National Health Service hospitals in England between 1955 and 1980. It focuses particularly on the personal care given to older patients, including pressure area care, the importance of meal times for the patients and the central role of the ward sister in the administration of food, and the training of the student nurses. These key practice themes will be examined in turn and related to the realities that the nurses faced in terms of the shortages of equipment, expertise, training, and also the low status accorded to the care of older people. It will be demonstrated that the care received by the elderly patients was often uncaring, routine and regimented. However, the blame for this treatment cannot be laid solely at the feet of the nurses themselves, but the system which conspired against them and their patients - a system, based on a prevailing attitude in which the older adult population was considered to be a 'burden', or the 'cuckoos in the nest of the acute general hospital' (Grimley Evans 1997, 1076). It is hoped that this article will contribute to the emerging and important area of the history of nursing work.

The first undergraduate nursing students: a quantitative historical study of the Edinburgh degrees, 1960-1985.

AIMS: The aim of this article is to examine the experiences of the first 25 years of undergraduate nurses at the University of Edinburgh using a quantitative historical methodology. BACKGROUND: In 1960, the University of Edinburgh, Nursing Studies Unit commenced the first undergraduate degree with nursing in the United Kingdom. By 1967, nursing was a component of the academic award itself. METHODS: A questionnaire was sent to 225 graduates of nursing at the University of Edinburgh through the alumni office. The questionnaire combined biographical data and a Likert scale. DATA/RESULTS: Quantitative data can provide the historian with wide-ranging information about large groups of people, in this case undergraduate nurses. Although some of the responses may be more positive than what the participants felt at the time, the material provides useful information as to the experiences of early undergraduate nurses. CONCLUSION: This article has generated a previously unknown material related to the experiences of the early undergraduate nurses at Edinburgh. For example, the respondents did not feel that the course was too difficult and it appears that the University was accepting nursing as an academic subject. The additional qualitative data provided by the respondents has offered potential for further study.

Education and role conflict in the health visitor profession, 1918-39.

Health visiting was the public health profession in the UK, which arose during the Victorian period to support and supervise the mothers of the nation. The health visitor was expected to teach the new mothers hygiene, infant feeding and diet, help them in the home when necessary and then report back to the Medical Officer for Health. Her role therefore was multifaceted and required education and training from a number of differing bodies. She needed nursing skills to help with the practicalities of observation and home care, sanitary knowledge to ensure that the buildings were safe and training in law and epidemiology. In order to fulfil these professional requirements, by the middle of the twentieth century the health visitor was expected to be a nurse by background, be educated for health visiting in a university and understand community medicine. These differing and sometimes opposing requirements meant that the health visitor was often caught in-between conflicting ideologies. It is this idea of 'in-betweenness' from the work of the anthropologist Marilyn Strathern and its relation to the work and education of the health visitor that this article will focus.

Degrees of ambivalence: Attitudes towards pre-registration university education for nurses in Britain, 1930-1960.

The recent decision from the Nursing and Midwifery Council to make nursing a graduate profession has for some been the culmination of over a century of expectation. From the 1890s there were voices within the nursing and medical professions that nursing should be taught in universities. The purpose of this article is to explore two attempts in the mid-20th century to establish a degree in nursing at an English University; neither of which was successful. It will be demonstrated that there were too many conflicting ideas and personalities for these to have been achieved. The doctors wanted skilled assistants, many in the nursing profession considered that nurses should have 'common-sense, courtesy and kindness', in that order, the universities considered nursing to be a practical vocation, and the governments did not want the increased spending that such a move would necessitate.

'The geriatric hospital felt like a backwater': aspects of older people's nursing in Britain, 1955-1980.

AIMS AND OBJECTIVES: The aim of this article is to examine the experiences of ward-level nurses who cared for older people in general hospitals between 1955-1980. BACKGROUND: There is very little published on the history of older adult nursing and no recent material from the United Kingdom. There are, however, the works of Cecily Hunter in Australia and Erica Roberts in Canada. It is the intention of this study to contribute to this important area of research. DESIGN: This is an oral history project in which 20 nurses who had worked on older adults ward between 1955-1980 were interviewed. METHODS: All the interviews were taped, transcribed and data-themed. Ethical clearance for the project was obtained from the University Ethics Committee and all participants were anonymised. RESULTS: Many of the nurses found the experience very difficult, though there were exceptions. Several participants had worked on older adults ward during their training and then had never wanted to return. Most described a paucity of resources and longevity of staff on the wards. CONCLUSIONS: Using the sociological theory of Erving Goffman, this article introduces a novel method of understanding nursing history, although his ideas have been used in medical history. The value of his theories for this study is in the identification of nurses as being part of the same system as the patients themselves. IMPLICATIONS FOR CONTEMPORARY POLICY, RESEARCH AND/OR PRACTICE: For nurses to care effectively for their patients, nurses themselves must be valued. Subordination and regimentation tend to dehumanise the carers which, in turn, dehumanises the cared for.