Subversive mythical figures and feminist resistance: On the rise of posthuman 'professionals'

Within the context of neoliberal healthcare, nurses and other health professionals face working conditions that leave them perpetually feeling inadequate, as though they are not enough. They are consistently expected to achieve more with less resources. In such an environment, mere professionalism proves wholly insufficient, enforcing norms of altruism and kindness. Professionals must transcend this disciplinary tool and embody a 'more-than-professional' approach. This study, informed by critical posthumanism, employs three mythical archetypes-the Medusa, the Witch and the Siren-to illuminate potential avenues for resistance against prevailing trends in healthcare. Drawing on the perspectives of Hélène Cixous, Silvia Federici and Jacques Rancière, we introduce a process of resistance for healthcare professionals pushing back against the challenges of crumbling healthcare systems. Cixous' feminist reimagining of Medusa symbolizes intensified embodied sensory experiences, emphasizing the power of irony, laughter and writing in highlighting the daily struggles faced by healthcare workers. Federici's depiction of the Witch exposes clandestine alliances among healthcare workers and patients, akin to a pact with the devil, countering the individualistic, alienating approach to care provision and resisting neoliberal pressures. The Witch archetype embodies resistance grounded in creativity against the commodification of public healthcare. Finally, Rancière's 'politics of the Siren' offers a strategy for disrupting entrenched hierarchies from the underworld. Like Sirens, healthcare workers and patients can subversively transform their silence into songs of resistance, simultaneously operating from beneath the surface of accountability measures. Our intention is to showcase the emergence of posthuman 'professionals' who adapt by forging new modes of social relations in response to neoliberal constraints, straying from conventional, apolitical notions of 'professionalism'. Drawing lessons from mythical figures of resistance offers a fresh understanding of subversion as a catalyst for social and political transformation within the healthcare sector.

The evolution of advanced nursing practice: Gender, identity, power and patriarchy

To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health-care provision, there has been a worldwide policy to promote increased flexibility within the health-care workforce. This is being done primarily by extending the 'scope of practice' of existing occupational roles into what is referred to as 'advanced' practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel.

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post-training? A narrative review

AIM AND OBJECTIVE

To identify training strategies and determine how registered health and social care practitioners change their practice after Mental Capacity Act training.

DESIGN

Narrative literature review.

DATA SOURCES

Seventeen databases were searched up to December 2019: CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, MEDLINE, Science Direct, Ovid, 0of Science, British Nursing Index, DH-Data and King's Fund Library Catalogue.

REVIEW METHODS

Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed-methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified.

CONCLUSION

To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario-based and relevant to trainees' practice.

RELEVANCE TO CLINICAL PRACTICE

The Mental Capacity Act is widely misunderstood and implemented poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation. The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.

Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015

BACKGROUND

Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources.

OBJECTIVES

Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios.

DESIGN

This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden.

METHODS

We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources.

RESULTS

Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios.

CONCLUSION

This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.