Productive power and the 'practices of the self' in contraceptive counselling

Power and resistance within the hospital's hierarchical system: the experiences of chronically ill patients

AIMS AND OBJECTIVES

To explore experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings. Specifically, we explored how social and institutional discourses shape power relations during the negotiation process.

BACKGROUND

The hospital system is embedded in a hierarchical structure where the voice of the healthcare provider as expert is often given more importance than the patient. This system has been criticised as being oppressive to patients who are perceived to be lower in the hierarchy. In this study, we illustrate how the hospital's hierarchical system is not always oppressing but can also create moments of empowerment for patients.

DESIGN

A feminist poststructuralist approach informed by the teaching of Foucault was used to explore power relations between nurses and patients when negotiating patient care in hospital settings.

METHODS

Eight individuals who suffered from chronic illness shared their stories about how they negotiated their care with nurses in hospital settings. The interviews were tape-recorded. Discourse analysis was used to analyse the data.

RESULTS AND CONCLUSIONS

Patients recounted various experiences when their voices were not heard because the current hospital system privileged the healthcare provider experts' advice over the patients' voice. The hierarchical structure of hospital supported these dynamics by privileging nurses as gatekeepers of service, by excluding the patients' input in the nursing notes and through a process of self-regulation. However, patients in this study were not passive recipients of care and used their agency creatively to resist these discourses.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be mindful of how the hospital's hierarchical system tends to place nurses in a position of power, and how their authoritative position may positively or adversely affect the negotiation of patient care.

Care of the self and power relations: female nurses taking care of other women

OBJECTIVE:

to analyze the care of self of female nurses and the power relations established by them in the care of other women.

METHOD:

integrative review of literature published between 2005 and 2015. There were 25 publications in the sample.

RESULTS:

qualitative state of the art with reference domain of a liberating perspective, based on humanization, autonomy and empowerment as a risk reduction strategy in the practice of care to women. The findings suggest solidified power relations among female nurses and women, focused on professional domain concentrated on nurse education under the patriarchal and society's normalization discourse. Some studies consider the importance of understanding power in a capillary way, operating on the bodies of individuals.

CONCLUSION:

there is little discussion about the care of self of nurses and the effects on their professional practice, indicating gaps in knowledge in this field.

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective

AIMS AND OBJECTIVES

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement.

BACKGROUND

Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women.

DESIGN

Qualitative, in-depth interview

METHODS

A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data.

RESULTS

Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust.

CONCLUSIONS

The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions.

RELEVANCE TO CLINICAL PRACTICE

Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

Power in telephone-advice nursing

Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.