Structural impact on gendered expectations and exemptions for family caregivers in hospice palliative home care

Exploring feminist political economy and feminist critical discourse analysis as methodologies in critical nursing research

AIMS

This paper explores two critical feminist methodologies for nursing research: feminist political economy and feminist critical discourse analysis. The aim was to appreciate varied methodological approaches available for nurses to understand complexities in healthcare environments, above and beyond socially normative ways of knowing.

DESIGN

Discursive paper.

DATA SOURCES

Published articles from nursing databases (CINAHL and ProQuest; no date restrictions) and interdisciplinary databases (Women's Studies International, Sociological Abstracts and Ovid MEDLINE; publication dates between 2017 and 2022).

METHODS

A discursive paper exploring and critically synthesizing the literature on feminist political economy and feminist critical discourse analysis to demonstrate how each methodological approach can be used in nursing.

RESULTS

The findings of this discursive paper suggest there is an opportunity to draw on interdisciplinary studies for creative insights into how these methodologies may be helpful for nurses' scholarship and programmes of research. Although few nursing studies explicitly name a feminist political economy or feminist critical discourse analysis approach, several studies apply principles of these methodological approaches.

CONCLUSION

There is an opportunity for these methodologies to be applied within the same project when there is a fit between the research questions and aims of both methodologies (studies where notions of gender and power are considered central and there are potential insights from exploring social progress, structures and the material, along with the social relations of discourses).

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Feminist political economy and feminist critical discourse analysis offer novel options for methodological analyses.

IMPACT

Application of these methodologies may benefit critical nursing scholars looking for diverse critical methodological avenues to explore and to broaden nursing's methodological toolbox towards meeting social justice aims.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Everyday sexism in nursing degrees: A cross-sectional, multicenter study

BACKGROUND

Gender stereotypes are reproduced in healthcare settings, leading to unequal relationships, discrimination, and sexism. University students express insecurity about their ability to identify and handle these situations. There are gaps in our knowledge about everyday sexism in academic and clinical nursing settings.

AIM

To describe how nursing students perceive sexist behavior in their daily life at university and during university teaching.

DESIGN

Cross-sectional, multicenter study using an online questionnaire.

SETTING

Eight universities that offer nursing degrees in Catalonia.

PARTICIPANTS

In total, 317 valid responses were collected. The inclusion criteria were to be a third- or fourth-year undergraduate or a first- or second-year postgraduate nursing student in Catalonia. There were no exclusion criteria. Snowball sampling.

METHOD

Online questionnaire designed ad hoc with sociodemographic variables, academic characteristics, and perception of sexism and discrimination in students' daily life collected between November 2020 and March 2021. The Microsexism Against Women Scale was used as a frame of reference to formulate questions on sexism and discrimination at the nursing school and during practicums. A descriptive, bivariate analysis of the data was performed.

RESULTS

Students do not place importance on differences between genders in involvement, task distribution, and oral presentation of group work. In this setting, there seems to be no perception of situations of power or inequality. Female students reported a higher frequency of unwanted physical contact than male students; however, the percentage was similar for both in practicums. Everyday sexism and discrimination were perceived at the nursing school but not in practicums.

CONCLUSIONS

Everyday sexism is perceived in nursing degrees in the context of relationships within the school but not during classroom teaching or in care settings. Various mechanisms make it difficult for students to consciously detect such behaviors. Addressing sexism in nursing training is necessary to ensure a safe learning environment.

Analysis of gender perspective in the use of NANDA-I nursing diagnoses: A systematic review

AIM

To identify, describe and analyse the gender perspective in the use of the diagnoses contained in the NANDA-I taxonomy in observational studies published in the scientific literature.

DESIGN AND METHODS

A systematic review has been conducted spanning from 2002 to 2020. The most frequent NANDA-I nursing diagnoses in care plans reported in observational studies, and the defining characteristics and related factors identified for men and women have been described. The Preferred Reporting Items for Systematic Reviews (PRISMA-P) have guided our research. The main findings have been summarized using a descriptive narrative synthesis approach.

RESULTS

Forty-one articles were included in our study. With regard to gender analysis, the percentage of men and women that make up the sample were not specified in all articles, and half of the studies did not identify gender either in the diagnosis label or in their defining characteristics or related factors. Based on the reviewed articles, gender perspectives are not systematically incorporated in the use of the NANDA-I diagnosis. Therefore, gender biases in its use in the scientific literature may exist. This situation poses barriers to determine the health responses that are different and unequal between women and men.

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz's theory. The sample consisted of 21 participants. Three inter-related data categories emerged: "Floating between acceptance and resistance: Perceiving the proximity of death", "Analysing the end from other perspectives: it is in the encounter with death that life is understood" and "Accepting the path: between the love of letting go and the love of wanting to stay". The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.

Empowerment of Women to Provide Home-based Supportive and Palliative Care for Patients with Cancer: Participatory Action Research Protocol

Background: Determining the needs and challenges of women, who care for patients with cancer and providing appropriate strategies to empower them in the design and implementation of appropriate change programs pave the way for the promotion of these women's health and empowerment. Objectives: This study aims at identifying the needs and challenges of women and developing a program to empower women, who care for patients with cancer. Methods: The present study is based on a participatory action research approach and uses the Kemmis and McTaggart model. The participatory action research of this study will be in 4 phases of planning, action, observation, and reflection. In the planning phase, the needs and challenges of female caregivers are examined from the perspective of women and the health team and, then, women's empowerment strategies in providing home-based supportive and palliative care for patients with cancer are determined, using the results of the qualitative phase and review of the literature by using the decision matrix. In the action phase, the selected strategies are implemented with the help of process owners. In the observation phase, combining different methods, data will be collected to measure the results of change. Finally, in the reflection phase, the results of the implementation of the strategies are evaluated and this cycle continues until the intended results are achieved. Discussion: Empowerment of the women, who care for patients with cancer requires awareness, motivation, and active participation of women and the health team. As many cultural and social factors affect the health and participation of these women, participatory research can involve them in promoting their health.

Disrupting gender norms in health systems: making the case for change

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems reinforce patients' traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women's empowerment collectives can increase health-care access and provider responsiveness. We see promise from social movements in supporting women's reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.