Nurses' experiences of ethnographic fieldwork.

AIM: To reflect on the experiences of nurses performing ethnographic fieldwork in three studies. BACKGROUND: The application of ethnography to nursing research requires discussion about nurses' experiences of ethnographic fieldwork. This article examines some of the dilemmas that arise during the research process. DATA SOURCES: Three ethnographic studies conducted by the authors in the south and southeast of Brazil. Excerpts from field diaries created during each research are presented at the end of each topic discussed. REVIEW METHODS: This is a reflexive paper that explores the nurses' experience in ethnographic fieldwork. DISCUSSION: This article discusses the main tasks involved in ethnographic research, including defining the study aim, reading and understanding anthropological theoretical bases, and setting a timeframe for the study. The article also discusses the idiosyncrasies of the cultural contexts studied, the bureaucracy that may be confronted when gaining access to the field, the difficulty of transforming the familiar into the strange, why ethnocentric perspectives should be avoided, and the anthropological doubt that places the ethnographer in the position of apprentice. It also discusses the importance of listening to others, reflexivity and strategies to stay in the field. CONCLUSIONS: For researchers, ethnographic fieldwork can be a rite of passage, but one that provides invaluable experiences that emphasise the value of relationships based on dialogue, reflexivity and negotiation. IMPLICATIONS FOR PRACTICE/RESEARCH: The main tasks undertaken in ethnographic research discussed in this article could contribute to the nurse' experience of conducting ethnographic fieldwork.

Postpartum depression: the (in) experience of Brazilian primary healthcare professionals.

AIM: This article reports experiences of Brazilian physicians and nurses caring for women with postpartum depression in primary healthcare settings. BACKGROUND: Prevalence of postpartum depression in Brazil ranges from 12-37%, which fits with international claims about differences in the magnitude of the problem and consistency of screening. DESIGN: Qualitative descriptive. METHOD: This study was situated in health units of the Family Health Strategy in Campina Grande, Brazil. Data were collected from September 2010-January 2011 through open-ended interviews with ten nurses and seven physicians, observations, and field diary records. Inductive content analysis was used to develop categories. FINDINGS: Three categories: (1) Limited professional exposure to postpartum depression; (2) Postpartum depression as the domain of psychiatry; and (3) Challenges dealing with postpartum depression demonstrated that few professionals felt postpartum depression merited their attention. Women, with signs of postpartum depression, were usually identified by family members who noticed behaviours that seemed abnormal. Care providers indicated they had inadequate time and access to screening techniques to identify women with depression attending unit-based pregnancy and postpartum groups. When identified, women were referred directly to psychiatric care. CONCLUSION: Without consistent screening and diagnostic techniques, Brazilian health professionals are insecure about identifying and treating cases of postpartum depression. Referring women to psychiatric units entail more time for women to be diagnosed and treated and increased costs for health services. Primary healthcare professionals require training to screen, identify, and treat postpartum depression in primary healthcare settings.

Atmospheric conditions, lunar phases, and childbirth: a multivariate analysis.

Our objective was to assess extrinsic influences upon childbirth. In a cohort of 1,826 days containing 17,417 childbirths among them 13,252 spontaneous labor admissions, we studied the influence of environment upon the high incidence of labor (defined by 75th percentile or higher), analyzed by logistic regression. The predictors of high labor admission included increases in outdoor temperature (odds ratio: 1.742, P = 0.045, 95%CI: 1.011 to 3.001), and decreases in atmospheric pressure (odds ratio: 1.269, P = 0.029, 95%CI: 1.055 to 1.483). In contrast, increases in tidal range were associated with a lower probability of high admission (odds ratio: 0.762, P = 0.030, 95%CI: 0.515 to 0.999). Lunar phase was not a predictor of high labor admission (P = 0.339). Using multivariate analysis, increases in temperature and decreases in atmospheric pressure predicted high labor admission, and increases of tidal range, as a measurement of the lunar gravitational force, predicted a lower probability of high admission.

[Body and sexuality during pregnancy]. / Corpo e sexualidade na gravidez.

The objective of this ethnographic study was to understand how women experience their body's physiological processes during pregnancy and their effects on sexuality. The study involved seven women living in a poor neighborhood in São Paulo. Data collection was performed through participant observation and interviews using guiding questions. The data were presented in the narrative form and then organized into the following categories: realizing the changes in the body; living with the changes in the body; and feelings and sensations experienced in sexual life during pregnancy and imagining the body after pregnancy. The women referred to the changes in their bodies as discomforts, and expressed their concern that these changes would be permanent. They expressed they hoped that, after childbirth, their body would go back to what it was like before pregnancy and that they would recover their sexual desire. Recognition of these concerns is an essential tool to guarantee appropriate professional practices.

Body and sexuality: puerperas' experiences.

The aim of this study was to determine how women deal with sexuality and bodily changes during the puerperium. A qualitative methodology was used and a semi-structured interview with a leading question script was chosen as the research tool. Six puerperas from the west area of São Paulo (Brazil) took part in this study. The interviews were accomplished at their homes. In analysis, the responses were grouped into three main categories: "Changes", Sexuality" and "Social Support". The study results revealed that during this period there are important changes. Sexuality has been shown to evolve many difficulties, fears and worries. The relationships with the person's partner and support network have revealed themselves as being of great importance. It can be concluded that the puerperal period evolves in terms of many transformations in the emotional and psychosocial areas. Thus it is necessary for health professionals who deal with women's care to value this period.

Inter-unit Doctoral Program in Nursing of the University of São Paulo: characterization of graduates and theses defended in a decade.

This descriptive study aimed to characterize the graduates of the Inter-unit Doctoral Program in Nursing of the School of Nursing of the University of São Paulo, who defended their theses in the period 1998-2008, in relation to the location they developed their Masters and their pre and post-doctoral employment, also to investigate the theses defended in relation to the thematic areas and methodological approaches used. Data were collected from the Fenix-USP System and the Lattes Curriculum System. Of the 190 graduates, 178 had curricula available online. Of those, 58.4% performed teaching and research activities when they entered the doctoral program, which were activities mainly developed at Federal Universities (34.8%). This predominance was maintained after the conclusion of the doctoral studies. The thematic areas most studied were Women's Health (20.5%) and Adults/Elderly Health (13.2%). Regarding the methodological approach, 68.4% used qualitative methods. The data evidenced the contributions of this Program to research.

Sexuality in the puerperium: the experience of a group of women.

Puerperium is a period of great changes in women's lives, in physiological, psychological and socio-cultural terms. Female sexuality is a broad topic that should be explored vis-à-vis the singularity of woman's experiences which themselves vary at different moments in time. This article is part of the project: Sexuality in the Puerperium, the objective of which was to understand what women's experience of their sexuality is in the postpartum period. Observation and semi-structured interview were used. The research approach was qualitative and narrative was used as the conceptual and methodological method. Six primiparas who gave birth in a public hospital in São Paulo took part in the study. Observation took place in the in-patients unit in the immediate post-partum period. The interviews were conducted in the women's homes. The results of the study have enabled an understanding to be formed of the meanings and changes in sexuality during the postpartum period as well as of the experiences every woman faces in her new roles, relationships and difficulties.

Mothers' health in Brazil and recovering the training of midwives for care in the birth process.

The authors briefly analyze the situation of maternal health care in Brazil and, based on their findings, they comment that there have been transformations in the health care model for women and families and propose some measures, including recovery of the work of the obstetric nurse or midwife (obstetriz, in Portuguese). They comment that women care tendencies in the delivery process presuppose incorporation of the paradigm of improving the physiology of valuing women's experience, the approach to the family, health advice that prioritizes prevention, education and relationships, without ignoring safety. They appoint that building this health care model, which includes the work of the midwife, may improve maternal health indicators.

[Post-partum depression: a latent problem]. / Depressão pós-parto: um problema latente.

A systematic review of post-partum depression (PPD) was undertaken to check how the issue is being addressed and the presence of nurses involved in such studies. The search for articles was conducted in the Virtual Health Library 106 articles were found 60, in MEDLINE, 28 in LILACS, and 18 in SciELO. It was limited to samples only the articles which the complete texts can be found in SciELO. Of the articles found, two are written by nurses. There was evidence that scientific production is present on the five continents of the world, a quantitative approach being the predominant one, and focusing on the incidence and prevalence, associated factors and treatment of PPD. It was observed that PPD is a problem that affects an increasing number of women during the post-partum period, and requires research that might inform diagnosis, therapy and nursing care for this syndrome.

[Menopause knowledge and experience for a group of women]. / Conhecimento e significado cultural da menopausa para um grupo de mulheres.

This ethnographic study is aimed at understanding a group of women's knowledge about menopause and how they experience it. The methods used for data collection were participant observation, recorded interviews and previously produced drawings. Data were analyzed based on a theoretical framework using both the ethnographic method and biographic interpretativism. From the narratives the authors obtained the cultural categories and themes. Thus it was possible to conclude that menopause is understood as a result of a unique construction integrated to a network of meanings built by the group that condition knowledge and experience within certain cultural patterns, among them the fact that menopause means leaving womanhood behind.

Historical and cultural aspects of the provision of care at an indigenous healthcare service facility. / Aspectos culturais e históricos na produção do cuidado em um serviço de atenção à saúde indígena.

This case study aimed to interpret the underlying historical and cultural aspects of the provision of care at an indigenous healthcare service facility. This is an interpretive, case study-type research with qualitative approach, which was conducted in 2012 at the Indigenous Health Support Center (CASAI) of the State of Mato Grosso do Sul, Brazil. Data were collected by means systematic observation, documentary analyses and semi-structured interviews with ten health professionals. Data review was performed according to an approach based on social anthropology and health anthropology. The anthropological concepts of social code and ethnocentrism underpinned the interpretation of outcomes. Two categories were identified: CASAI, a space between streets and village; Ethnocentrism and indigenous health care. Healthcare practice and current social code are influenced by each other. The street social code prevails in the social environment under study. The institutional organization and professionals' appreciation of the indigenous biological body are decisive to provision of care under the streets social code perspective. Professionals' concepts evidence ethnocentrism in healthcare. Workers, however, try to adopt a relativized view vis-à-vis indigenous people at CASAI.

[Breast cancer's causality analyzed through the Health Belief Model]. / A causalidade do câncer de mama à luz do Modelo de Crenças em Saúde.

The objective of this study was to explore the beliefs of a group of women regarding the causality of their breast cancer. Cultural Anthropology was the theoretical framework and Oral History the methodological choice. Interviews were performed with nine women who had been submitted to a mastectomy. The Health Beliefs Model was used as conceptual reference for a better understanding and explanation of these women's health behavior. The results highlighted certain aspects that need to be worked on in the educational process of women, in a more significant cultural context, with a higher chance of adherence to early diagnosis programs of breast cancer.

[Reflections about the vealed sexuality in the nurse image]. / Reflexoes sobre a sexualidade velada na imagem da enfermeira.

This article presents a reflection about the image that the female nurse makes of herself and the lack of sexuality in this image. The cultural interpretation of the theme has been carried out by means of the qualitative methodology. Data have been collected through the technique of the focal group, in eight sessions with fourteen nurses of a public university. The question: how do I see the nurse image? Led to the construction of these data. It has been revealed almost total lack of sexuality in the image nurses have of themselves. A conclusion has been drawn that, in Nursing, the existing cultural rules are veiled. They control and discipline individual attitudes, limit differences and level up the group.

[Exploring the photovoice in an ethnographic research: a strategy for data collection]. / Explorando a "fotovoz" em um estudo etnográfico: uma estratégia de coleta de dados.

This article describes the use of the photography for data collection in an ethnographic research. This study aims to understand the women's perception related to the hospital where they were supposed to give birth. These women were invited to take pictures of the hospital. After developing the pictures, the researcher appointed interviews and the pictures gave voice to them. The women pointed out positive and negative aspects related to the hospital, that were the reasons for their anxiety and stress. The use of photography allowed to dispel the myth of the factors that influence on the birth process.

[Risk of HIV infection: how women living in a slum perceive themselves in the chain of the virus transmission]. / Risco de infecção pelo HIV: como mulheres moradoras em uma favela se percebem na cadeia de transmissão do vírus.

The number of notified cases of women with AIDS is increasing in Brazil. Based on this, the authors developed this qualitative study theoretically based on Cultural Anthropology. The ethnographic methodology was used to collect and to analyze data. The investigation had the purpose to identify the perception about the risk for HIV infection of the women living in a slum located in the city of São Paulo, Brazil, through interviews and participant observation of the context. Results showed that the women have some knowledge about AIDS, about the transmission of HIV and its preventive measures through sexual intercourse. The cultural data also showed that the women do not feel susceptible to the disease, although most of them are dependent on their partners' income to maintain themselves healthy as well as their families. This way of thinking and acting may be contributing to increase the cases of women with AIDS in Brazil.

[Pregnant women's experiences and expressions related to the interaction with the health system: a photoethnographic approach]. / Experiências e expressões de gestantes na interação com o sistema de saúde: um enfoque fotoetnográfico.

This ethnographic study aimed to understand women's experiences related to their contact with the health system due to pregnancy. Cultural Anthropology and Ethnography were used as a theoretical-methodological reference framework. Data were collected through participant observation, photographical resources and interviews. The pictures were taken by pregnant women, who received prenatal care at the Basic Health Units in the area covered by the school hospital, which was considered the cultural scenario for this study. The data were presented as a narrative and were analyzed through the Interpretative and Biographical Method. Data resulted in eight categories, which gave rise to three cultural themes, by means of which the collaborators recover and classify their experiences, in order to ratify the results of important events considered positive or to reconsider the negative events. Next, they glimpse at the birth process in all of its dimensions. The eye of the camera sometimes allowed them to register and absorb facts, and sometimes avoided the capturing of things that would be difficult for them to elaborate at that moment. The findings of this study allowed for a comprehensive view on the collaborators' cultural knowledge, in relation to their interaction with the health system, as well as their expectations in the pregnancy-puerperal cycle.

[Sexuality as cultural construction: reflections on inherent prejudice and myths in a group of rural women]. / A sexualidade como uma construção cultural: reflexões sobre preconceitos e mitos inerentes a um grupo de mulheres rurais.

The present work focuses on sexuality as a cultural construct. To support this idea, a study was carried out with a group of eleven women from a rural community, in the countryside of Rio Grande do Sul, Brazil. The data was collected through semi-structured interviews and the narratives were analyzed qualitatively, seeking to extract meaning from the inquiries by viewing them through a cultural lens. Sexuality is viewed as a personal experience, composed of values, beliefs, myths and prejudice assimilated during the socialization of each respondent. Reflections highlighting the importance of cultural interpretation of the events for nurses, especially those referring to sexuality to the nurses, were included.

[The interpretative and biographical method for understanding experiences and expressions of pregnant women attending a health service]. / O método biográfico interpretativo na compreensão de experiências e expressões de gestantes usuárias de um serviço de saúde.

This objective of this study based on pictorial ethnography is to understand the experience of women in their contact with the health system during pregnancy. The data were presented by narrative and their analysis was done based on the Interpretative and Biographical Method. From the interviews eight cultural categories were taken, from which emerged three cultural themes: "Classification of life experiences," "Advancement of the birth process" and "Taking pictures of significant events." The findings allowed for a comprehensive vision of the participants' cultural knowledge related to their interaction with the health system, as well as their expectations of the puerperal gravid cycle.

[Invisible or hidden sexuality in nursing?]. / A sexualidade invisível ou oculta na enfermagem?

This article is a reflection which pervades the theme about invisibility or hiding of sexuality in the nursing care practice, or besides, of the nurses themselves, leading to questions which hold this bearing, how it was created and what maintains it. The approach presented here permits to assure that this theme goes beyond technical informative itself and, at the same time, is revealed in the nurses's cultural diverseness, giving the opportunity to instrument people for the being and the doing in nurging which provides an experience of life much more qualitatively meaningful.

[Sexuality on nursing assistance: reflections on a cultural perspective]. / A sexualidade na assistência de enfermagem: reflexões numa perspectiva cultural.

This study aimed to understand sexuality and how the construction of its meanings, symbols, feelings, and values is developed. The data were collected through focal group techniques and individual interviews with nurses. The emerging feelings were: embarrassment; fear; surprise; challenge; sorrow; worry, and personal satisfaction. The experience with the sexuality on nursing assistance revealed: the presence of a pathological and biological perspective in the action of nursing, showing this dimension as something that needs to be medically treated; on the other hand, it showed that this theme can be a way to self-knowledge, rethinking concepts, values and conflicts, as well as producing nursing care in a more ethical, committed and empathetic way, thus valuing the dignity of the ones cared for and the ones who take care.