Care, Autonomy, and Gender in Nursing Practice: A Historical Study of Nurses' Experiences.

BACKGROUND: Care is the essence of the nursing role and is closely related to the concept of professional autonomy. Autonomy is implicated in power relations between doctors and nurses and between men and women. These relationships are closely linked to care practices and the inequality of nursing and medicine. PURPOSE: The aim of this study was to analyze nursing discourse regarding the concept of care and its relationship to the concept of autonomy and gender. METHODS: This is a historical study based on oral interviews that took place between November 2008 and February 2011. We interviewed 19 nursing professionals who currently worked at the Hospital of the Holy Spirit (near Barcelona) or had worked there between 1961 and 2010. Semistructured interviews were recorded, transcribed, and analyzed. RESULTS: We highlight four main themes: "a real nurse"; "more technology, less care"; "the fragility of autonomy"; and "the invisibility of nursing work." These themes show the contradictions in the nursing profession that are based on the concept of care. However, in daily practice, the concept of care varies. Time pressure distances the nursing practice from its theoretical context. Changes in the concept of care are related to transformations in the health system and nursing work. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Changes related to the autonomy of nursing are related to changes in the concept of care. In practice, care has a biomedical orientation. Care has become technologized and bureaucratized, which reduces the time that is spent with the patient. In a context in which medical authority predominates, nursing's struggle for autonomy is based on the recognition of the value of care. When care becomes invisible, the autonomy of nursing as a profession is threatened. This conclusion allows reflections about shifts in the concept of care and how they affect clinical practice and the autonomy of the nursing profession.

Discursos de profesionales de la salud y de mujeres sobre el aborto voluntario / Discourses of health professionals and voluntary women about abortion

El presente artículo indaga los significados del aborto voluntario desde el discurso de los profesionales sanitarios involucrados en ello y de mujeres que han experimentado una interrupción voluntaria del embarazo. Se toma como referencia la ley aprobada en España en el año 2010 y el objetivo es conocer como los sujetos implicados en este proceso social y de salud resignifican la ley con sus propios discursos en función de sus parámetros culturales y su rol en dicho proceso. Surgen así nomenclaturas, adjetivos y condicionantes sociales variados a pesar de encontrarnos ante un proceso que parece estar unificado, consensuado y aceptado ante la legislación, la sociedad y el modelo médico hegemónico (AU)

This article examines the different meanings of voluntary abortion which are given not only by the health professionals but also by women who have been involved in this situation. In this way, the last law approved in Spain in 2010 is taken as a reference. The aim is to know how the subjects involved in this social and health process resignify the law via their own point of view related to their cultural parameters and their role in the abortion process. For instance, it seems to be unified and approved by consensus with the legislation, society and the hegemonic medical model. However, although this matter is involved in a standard process, this issue arises many nomenclatures, adjectives and varied social conditions (AU)