Nurses' ways of talking about their experiences of (in)justice in healthcare organizations: Locating the use of language as a means of analysis.

Nurses have their own ways of talking about their experiences of injustice in healthcare organizations. The aim of this article is to describe how nurses talk about their work-life experiences and discuss the discursive effects that arise from nurses' use of language regarding their political agency. To this end, we present the findings garnered from a study focused on exploring how nurses deploy their political agency to project their idea of social and political justice in public healthcare organizations and how they face the challenges and uncertainties of (re)thinking their institutional order when it does not resonate with their professional ethos. We then discuss the implications that nurses' use of language has in relation to their ability to deploy their political agency to oppose the forms of injustice they face in their daily practice. We conclude by stating that careful attention should be placed on understanding the discursive implications of nurses' use of language on their individual and collective emancipation in healthcare organizations.

Social acceleration, alienation, and resonance: Hartmut Rosa's writings applied to nursing.

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge.

An integrative literature review and critical reflection on nurses' agency.

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation.

The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study.

The large numbers of patients admitted to intensive care units due to COVID-19 has had a major impact on healthcare professionals. The incidence of mental health disorders among these professionals has increased considerably and their professional quality of life has suffered during the pandemic. This study aims to explore the impact of the provision of COVID-19 patient care on ICU healthcare professionals. A mixed methods study with an exploratory concurrent design was conducted between June and November 2020 in the Balearic Islands, Spain. Data were collected using a self-report online survey (n = 122) based on three validated questionnaires, and individual semi-structured in-depth online interviews (n = 11). Respondents scored 2.5 out of 5 on the moral distress scale, moderate/high on the compassion satisfaction scale, and moderate on the burnout and compassion fatigue subscales. Age was significantly and negatively related to professional quality of life but was positively related to workload and unavailability of protective equipment. Three main groups of themes relating to the impact of the pandemic emerged from the in-depth interviews: (a) clinical, (b) professional, and (c) personal and family impacts in the two waves. ICU healthcare professionals should be viewed as second victims of the COVID-19 pandemic as they have suffered significant psychological, professional, and moral harm.

Organisational Justice and Political Agency among Nurses in Public Healthcare Organisations: A Qualitative Study Protocol.

Nurses are rarely treated as equals in the social, professional, clinical, and administrative life of healthcare organisations. The primary objective of this study is to explore nurses' perceptions of organisational justice in public healthcare institutions in Majorca, Balearic Islands, Spain, and to analyse the ways in which they exercise their political agency to challenge the institutional order when it fails to reflect their professional ethos. An ethnomethodological approach using critical discourse analysis will be employed. The main participants will be nurses occupying different roles in healthcare organisations, who will be considered central respondents, and physicians and managers, who will be considered peripheral respondents. Data generation techniques include semi-structured interviews, a sociodemographic questionnaire, and the researcher's field diary. This is one of the first studies to address organisational justice in healthcare organisations from a macrostructural perspective and to explore nurses' political agency. The results of this study have the potential to advance knowledge and to ensure that healthcare organisations are fairer for nurses, and, by extension, for the patients in their care.

Práctica colaborativa interprofesional en salud: Conceptos clave, factores y percepciones de los profesionales / Interprofessional collaborative practice in healthcare: Key concepts, factors and professional's perceptions

En los últimos 20 años hay cada vez más evidencia de que la práctica colaborativa es un requisito para una atención de la salud de calidad y segura para la ciudadanía, los profesionales y el sistema de salud. A pesar de ello, los estudios señalan que sigue siendo un reto, a la espera de un mayor conocimiento sobre su complejidad para conseguir formas más óptimas y efectivas de trabajo colaborativo. Actualmente, la práctica colaborativa se encuentra lejos de lo que podría ser, enfrentándose a numerosos retos, entre los que se incluyen la socialización e identidad profesional, el liderazgo de los equipos, las jerarquías y la cultura organizacional. En este artículo se examina la evidencia sobre conceptos clave que establecen las bases para comprender la práctica interprofesional: su impacto en los indicadores de salud, los factores que condicionan el trabajo colaborativo y las percepciones de los profesionales de la salud sobre la práctica colaborativa. Finalmente, a modo de conclusiones, se apuntan algunos de los retos pendientes en relación con la práctica colaborativa en salud en nuestro país

Over the last 20 years there has been growing evidence that collaborative practice is a prerequisite for high quality, safe health care for the general population, professionals and the health system. Despite this evidence, research shows that implementing collaborative practice remains a challenge, awaiting better understanding of its complexity in order to achieve optimal and effective forms of collaborative practice. At present, collaborative practice is far from what it could be, facing numerous challenges including socialisation and professional identity, team leadership, hierarchies and organisational culture. This paper examines the evidence on key concepts which are the basis for understanding interprofessional practice, including its impact on health indicators - the factors that shape teamwork and health care professionals' perceptions of collaborative practice. Finally, by way of conclusion, some of the outstanding challenges in relation to collaborative practice in health care in Spain are pointed out

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.

Los modelos conceptuales, una estrategia de poder con implicaciones profesionales / Conceptual models; a power strategy with professional implications

Los modelos conceptuales y las teorías de enfermería son considerados por algunos autores como patrones que guían el pensamiento sobre cómo ser enfermera y hacer enfermería. Algunos autores defienden que sin el uso de los modelos enfermeros, difícilmente se podrá perfeccionar la disciplina y la práctica enfermera, e incluso transformar la identidad profesional vinculada a la sumisión, obediencia y humildad. La finalidad de este artículo no es discutir sobre la verdad o falsedad, la utilidad o no de los modelos conceptuales enfermeros, sino analizar desde una perspectiva postestructuralista su uso como una estrategia de poder ejercido por las enfermeras fundamentalmente, a partir de los años setenta en España y las implicaciones profesionales, no intencionadas de su adopción para la profesión. La base de este análisis la constituyen parte de los resultados obtenidos en la tesis doctoral de la autora, en la que analizó los procesos de continuidad y transformación que han constituido la identidad profesional de las enfermeras en España entre 1956 y 1976. Se destacan algunas consecuencias políticas y sociales de articular la práctica de las enfermeras, alrededor de los discursos holísticos, humanistas, moralistas transmitidos por los modelos enfermeros, en ocasiones confrontados a los discursos biopatológicos, técnicos y clínicos (AU)

Conceptual models and nursing theories are considered by some authors as standards that guide the thinking on how to be a nurse and practice nursing. Some authors defend that without the use of nursing models it could be difficult to improve the discipline and nursing practice, and even to transform a professional identity linked to submission, obedience and humility. The purpose of this article is not to argue about the truth or falseness, the usefulness, or not, of conceptual nursing models, but to analyse, from a post-structuralist perspective, their use as a power strategy exercised mainly by nurses since the 1970's in Spain and the unintentional professional implications of their adoption by the nursing profession. The basis of this analysis is from the results obtained in the PhD thesis of the author, in which it analysed the processes of continuity and transformation which constituted the professional identity of nurses in Spain between 1956 and 1976. Some political and social consequences are highlighted on nursing practices, on the holistic, humanist and moralist discourses transmitted by nursing models, on occasions compared with bio-pathological, technical and clinical discourses (AU)

[Conceptual models; a power strategy with professional implications]. / Los modelos conceptuales, una estrategia de poder con implicaciones profesionales.

Conceptual models and nursing theories are considered by some authors as standards that guide the thinking on how to be a nurse and practice nursing. Some authors defend that without the use of nursing models it could be difficult to improve the discipline and nursing practice, and even to transform a professional identity linked to submission, obedience and humility. The purpose of this article is not to argue about the truth or falseness, the usefulness, or not, of conceptual nursing models, but to analyse, from a post-structuralist perspective, their use as a power strategy exercised mainly by nurses since the 1970's in Spain and the unintentional professional implications of their adoption by the nursing profession. The basis of this analysis is from the results obtained in the PhD thesis of the author, in which it analysed the processes of continuity and transformation which constituted the professional identity of nurses in Spain between 1956 and 1976. Some political and social consequences are highlighted on nursing practices, on the holistic, humanist and moralist discourses transmitted by nursing models, on occasions compared with bio-pathological, technical and clinical discourses.

Teoría fundamentada ¿es una traducción adecuada para grounded theory? / No disponible

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[Follow-up of a case by the hospital-at-home service: a new alternative]. / Seguimiento de un caso clínico en hospitalización a domicilio: una nueva alternativa.

The present article is a continuation of two previously published articles in Enfermería Clínica that describe the clinical course of María, a 26-year-old woman with Down syndrome. The first article described the patient's admission to the intensive care unit (ICU) with a diagnosis of atypical pneumonia. During admission, the patient was completely dependent. The second article described the weaning process when the patient showed anxiety, which was favorably resolved. Maria was discharged to a conventional ward with a nursing discharge report that contained the nursing care performed during her stay in the ICU. The present article describes the patient's follow-up by the hospital-at-home team. The specialized team suggested to María that she continue admission with the possibility of being at home until she could be discharged and followed-up by primary care. The evaluations were performed in 2 phases: a first evaluation before the patient's return to home, in which the suitability of domiciliary care was evaluated, and a second evaluation in which care was planned with María and her family. A hygiene deficit and ineffective management of the family therapeutic regimen were identified. Both problems were approached by the specialized healthcare team within the context of domiciliary care, in which work with the family is essential.

[Why are we the way we are? Discourses and power relations in nurses' professional identity in Spain (1956-1976)]. / Por qué somos como somos? Discursos y relaciones de poder en la constitución de la identidad profesional de las enfermeras en España (1956-1976).

OBJECTIVE: To explore the continuities, transformations and ruptures in the discourses building the social identity of nurses in Spain between 1956 and 1976. METHOD: From a poststructuralist and postfeminist perspective, we carried out a genealogical discourse analysis of the manuals of professional morals used during the training of nurses. RESULTS AND DISCUSSION: Analysis of the manuals revealed that the professional identity of nurses was constituted by a discoursive matrix and power relations, in which a residual Christian moral discourse and other dominant gender, technical and biomedical discourses can be identified. CONCLUSIONS: These discourses fundamentally highlight power relations of a disciplinary and pastoral nature. Some of these discourses have brought about a symbolic matrix which remains in the foundations of professional practice, health policies, social image, etc. The hegemony of these discourses for 20 years and the observation of current reality allow us to infer that nurses in Spain have managed to transform and break many of these elements and to propose other ways of viewing the profession.

¿Por qué somos como somos? Discursos y relaciones de poder en la constitución de la identidad profesional de las enfermeras en España (1956-1976) / Why are we the way we are? Discourses and power relations in nurses' professional identity in Spain (1956-1976)

Objetivo: Analizar las continuidades, transformaciones y rupturas de los discursos que han constituido la identidad social de las enfermeras en España entre 1956 y 1976. Método: Partiendo de los referenciales postestructuralista y posfeminista, se planteó un estudio de análisis de discurso de carácter genealógico de los manuales de moral profesional usados durante la formación de las ayudantes técnicos sanitarios (ATS). Resultados y discusión: El análisis de los textos revela que la identidad profesional de las enfermeras --en este estudio para referirnos a ATS o enfermera/o se ha optado por mantener como género neutro el femenino-- ha estado constituida por un entramado discursivo y de relaciones de poder, en el que se puede identificar un discurso residual moralista cristiano y otros dominantes de género, técnicos y biomédicos. Conclusiones: Estos discursos vislumbran fundamentalmente ejercicios de poder de carácter disciplinario y pastoral. Algunos de ellos han engendrado un entramado simbólico que permanece en la base de prácticas profesionales, políticas sanitarias, imágenes sociales, etc. La dominancia de estos discursos durante 20 años y la observación de la realidad actual, nos permite inferir que las enfermeras en España han conseguido transformar y romper muchos de estos elementos y proponer otras miradas acerca de quiénes son (AU)

Objective: To explore the continuities, transformations and ruptures in the discourses building the social identity of nurses in Spain between 1956 and 1976. Method: From a poststructuralist and postfeminist perspective, we carried out a genealogical discourse analysis of the manuals of professional morals used during the training of nurses. Results and discussion: Analysis of the manuals revealed that the professional identity of nurses was constituted by a discoursive matrix and power relations, in which a residual Christian moral discourse and other dominant gender, technical and biomedical discourses can be identified. Conclusions: These discourses fundamentally highlight power relations of a disciplinary and pastoral nature. Some of these discourses have brought about a symbolic matrix which remains in the foundations of professional practice, health policies, social image, etc. The hegemony of these discourses for 20 years and the observation of current reality allow us to infer that nurses in Spain have managed to transform and break many of these elements and to propose other ways of viewing the profession (AU)

[Nursing treatments in Majorca]. / Los cuidados enfermeros en Mallorca.

In this article, the authors analyze the role the "Sant Vicente de Paül" Sisters of Charity had in treating the ill in Majorca during the 19th Century. The authors carried out their research on two primary resources: The Rules of Life and a record of members of the order called the Book of the Curia. The authors tried to identify the methods the sisters followed in their work inside the Rules, searching for those aspects indicating their possible influence on the health of the population to whom they served as well as searching for references to their dedication as teachers, nurses and/or managers. In the Book of the Curia, the authors analyze the social data registered for the first 320 members of the order; evaluating their age upon entrance, their length of stay in the order, their job, and the cause of their death in order to compare these according to whether a sister was a teacher or a nurse.

Las enfermeras de las unidades de cuidados intensivos asumen un rol fundamental en la humanización de los procesos de toma de decisiones al final de la vida / Intensive care nurses play a major role in humanizing the end-of-life decisionmaking

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Ansiedad durante el proceso de destete. Estudio de un caso / Anxiety during the weaning process. Study of a case

María es una mujer de 26 años, con síndrome de Down, obesidad mórbida y antecedentes de problemas cardíacos, ingresada en una unidad de cuidados intensivos (UCI) a causa de una neumonía atípica, y en el momento de la valoración estaba sedada y conectada a un ventilador. Este artículo presenta la continuación de un caso clínico publicado con anterioridad en Enfermería Clínica, en el que se describe la evolución clínica y la planificación de los cuidados enfermeros de los nuevos problemas que presentó María durante el proceso de destete del ventilador hasta que fue dada de alta de la UCI. Los diagnósticos enfermeros presentados durante este proceso fueron: ansiedad, que se solucionó a los 3 días de la implementación del plan de cuidados, y suplencia parcial en la necesidad de evitar peligros, causada por la agitación al disminuir la sedación farmacológica. Después de afrontar el proceso de destete satisfactoriamente, se planificaron los cuidados recomendados al alta en la UCI incluidos en el informe de continuidad de cuidados

María is a 26-year-old woman with Down syndrome, morbid obesity and a history of heart abnormalities, was admitted to an intensive care unit due to atypical pneumonia. At evaluation, she was sedated and connected to a ventilator. We present the continuation of a case previously reported in Enfermería Clínica. The clinical course and nursing care planning of new problems presented by María during the process of ventilator weaning until discharge from the intensive care unit (ICU) are described. The nursing diagnoses formulated during this process were: anxiety which was resolved 3 days after implementing a nursing care plan and providing assistance in the need to avoid danger, caused by agitation on reducing sedation. After the patient was satisfactorily weaned from the ventilator, the care recommended on discharge from the ICU included in the continuity of care report was planned

Las parteras y/o comadronas del siglo XVI: el manual de damiá Carbó / Midwives in the 16th century: damiá carbó's manual

El propósito de este artículo es reflexionar sobre la manera cómo pensaba las cuestiones , de la salud reproductiva de las mujeres y de los ninas, un médico de Mallorca, quien en el afio de 1541 redactó un pequeno manual sobre obstetrícia, ginecología y pediatría. Partiéndose de la situación actual de los estudios de la obstetricia y de su evolución histórica, se realiza una revisión de la literatura sobre el manual de Carbó y un análisis critico dei documento en donde se contextualizan y examinan Ias propuestas dei autor, con respecto a las actitudes que debería reunir la matrona y / o partera, sus competencias y destrezas. La enfermera/ obstetra de la época gozaba de prestigío social, los médicos aprovechando su experiencia se constituyen en actores de los cuidados obstétricos y utilizan la formación de la partera como un vehículo de autopromoción. Carbó concibió a las parteras como Ias expertas en su arte, con buena disposición física, ingeniosas, discretas, honradas y buenas cristianas...

Planificación enfermera ante una persona con falta de autonomía. Estudio de un caso / Nursing care planning in a patient lacking autonomy. A case study

Este trabajo muestra, a través de un caso clínico con datos reales, la integración del modelo de Virginia Henderson en la práctica asistencial. Se expone la valoración de una mujer de 26 años ingresada en una unidad de cuidados intensivos, así como la situación de su familia. Se formulan los problemas detectados y se realiza la planificación de los cuidados de enfermería. En el momento de la valoración, al día siguiente del ingreso, María Climent está sedada y de momento no puede modificar conducta alguna, por lo que no se plantean problemas para la independencia. Tiene una falta total de capacidad física y psíquica para hacer por sí misma las acciones apropiadas para satisfacer las necesidades básicas, por lo que se identifican 4 problemas de autonomía relacionados con la higiene y la protección de la piel: la eliminación, moverse y mantener la postura adecuada, así como el mantenimiento de la temperatura corporal

Through a case study with real data, this study shows the integration of Virginia Henderson's model in nursing practice. The evaluation of a 26-year-old woman admitted to the intensive care unit and the family situation are described. The problems detected were formulated and the nursing care plan was drawn up. At evaluation, the day after admission, María Climent was sedated and was unable to modify any form of behavior. Therefore programs of independence were not considered. The patient presented a complete lack of physical and mental capacity to satisfy her basic needs and consequently four problems of autonomy related to hygiene and skin protection, excretion, movement and maintenance of appropriate posture, and body temperature were identified