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PubMed1992

The drama of nursing.

This exploratory paper considers a few possibilities for conceiving nursing as a form of aesthetic praxis. More specifically, drawing on the works of Erving Goffman on dramaturgy, and Elizabeth Burns on theatre, it makes some suggestions concerning nursing as a form of dramatic performance, and briefly attempts to relate this to concepts of praxis drawn from the writings of Hannah Arendt and critical social theorists. In contrast to Goffman's dramaturgy, which stresses the artifice of social relations and suggests a cynical view of human interactions, a critical theory of dramatic praxis introduces a normative dimension in which performance may become self-realizing and emancipatory as it aspires to the status of aesthetic praxis. Conceived in such terms, nursing practice becomes a powerful form of self-expression which has the potential to become liberating for the nurse and the patient.

Art↗

PubMed1995

Deputed power of medical control: the hidden message in the ritual of oral shift reports.

The exchange of oral shift reports between nurses is a prominent part of the everyday routine in a hospital ward. Increased awareness of the more or less explicit functions of such communication is likely to have a positive impact on the nursing profession. Oral shift reports in a nursing care system based on task allocation were therefore observed and analysed. Using an ethnographic approach, reports were tape-recorded, and nurses were interviewed regarding their experiences. During the shift report session, the nurses were found to receive ritually mediated deputed power of medical control from their colleague, but little attention was paid to nursing needs and measures. The nurses clearly demonstrated that they were caught in a system dominated by a medical paradigm that effectively obstructed the progress of nursing as a professional discipline in its own right.

Ceremonial Behavior↗

PubMed1996

Cultural perspectives of grief: an expanded concept analysis.

The concept of human grief has been of interest to scholars and practitioners for many years. However, there are many aspects of grief about which little is known. One of these is the role that cultural heritage plays in influencing the individual, intrapersonal experience of grief. Through the use of six focus groups, each consisting of persons from a specific cultural background, the investigator explored the concept of grief. The data were thematically analysed and the findings then compared to the findings from a previous concept analysis of grief drawn from professional literature. The findings indicated that individuals from a variety of cultural backgrounds whose knowledge of grief was derived primarily from their personal experiences defined grief in much the same way as had the authors of the professional literature. Most importantly, the findings also clearly indicated that although cultural differences are perceived to exist in mourning rituals, traditions and behavioural expressions of grief, there are no particular differences in the individual, intrapersonal experience of grief that can be attributed to cultural heritage or ethnicity alone. Implications for future research and considerations for practising nurses as they pertain to the highly individual and pervasive nature of grief are presented.

Adult↗

PubMed2005

'I'm just going to wash you down': sanitizing the vaginal examination.

AIM: This paper reports findings from an ongoing study exploring the qualitative experiences of midwives and women in relation to vaginal examination in labour, focusing on how vaginal examination is discussed and on the wash-down procedure used by some midwives. BACKGROUND: The body is a source of considerable ambivalence in sociological terms. Women's bodies, in particular, have been viewed as problematic and as a potential source of dirt and pollution. It has been suggested that vaginal examinations during labour are used, at least in part, as a ritual procedure by which healthcare professionals demonstrate that they are in control of both the labouring woman and the process of labour itself. Methods. In-depth interviews were undertaken during 2003 with six childbearing women and 10 midwives who had been involved in these women's care. Non-participant observation was also carried out of each woman's labour and birth. FINDINGS: During interviews, when discussing vaginal examination, midwives persistently used abbreviations or euphemisms as a means of distancing themselves from the realities of the procedure. Some midwives were observed washing women's genitals in a highly ritualized manner prior to vaginal examination, apparently as a strategy for establishing power differentials. CONCLUSION: Midwives commonly state that they are advocates for woman-centred care but their behaviour in relation to vaginal examination belies this and suggests that they regard women's bodies as contaminated and polluting. Healthcare students need to be taught specific communication skills to enable them to discuss vaginal examination more fully with women so that they feel less need to resort to euphemisms and abbreviations when discussing the procedure. It is also important to carry out vaginal examination in a way that is not demeaning and does not reinforce notions that women's bodies are dirty.

Attitude of Health Personnel↗

PubMed2006

Death the great leveller? Towards a transcultural spirituality of dying and bereavement.

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient.

Attitude to Death↗

PubMed2006

Repetitive and ritualistic behaviour in children with Prader-Willi syndrome and children with autism.

BACKGROUND: Recent research has shown that the range of repetitive behaviour seen in individuals with Prader-Willi syndrome (PWS) extends beyond food-related behaviour. METHODS: The presence and intensity of repetitive, rigid and routinized behaviour in children with PWS was compared with that seen in children with another neurodevelopmental condition in which repetitive behaviour is common: children with autism. Parents completed the Childhood Routines Inventory (CRI). RESULTS: Contrary to our predictions, controlling for developmental level, children with PWS and children with autism showed similar levels of repetitive and ritualistic behaviour overall and on the two CRI factors measuring 'just right' and 'repetitive' behaviour. Indeed, the majority of the sample of parents of children with PWS endorsed most items on the CRI. However there was some specificity at the level of individual items with parents of children with PWS more frequently endorsing an item on 'collecting and storing objects' and parents of children with autism more frequently endorsing 'lining up objects', 'has a strong preference for certain foods' and 'seems aware of detail at home'. CONCLUSIONS: These findings confirm the range of repetitive behaviours that form part of the behavioural phenotype of PWS, including insistence on sameness and 'just right' behaviours, and uncover a surprising overlap with those seen in children with autism. Clinical management for children with PWS should include advice and education regarding management of repetitive and rigid behaviour. Future research should investigate whether the repetitive behaviours that form part of the behavioural phenotype of both PWS and autism are associated with a common neuropsychological, neurotransmitter or genetic origin.

Adolescent↗

PubMed2004

Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders.

Excessive ingestion of salt is a well-recognized cause of hypernatraemia in children, is uncommonly recognized in debilitated elderly persons, but is rarely diagnosed in healthy, independent adults. We report a case of fatal salt poisoning in a 20-year-old lady who suffered of post-natal depression and ingested large quantities of salt as part of exorcism ritual. She presented with the highest ever documented serum sodium level of 255 mmol L(-1), associated with severe neurological impairment that was unresponsive to aggressive hypotonic fluid replacement. Post-mortem examination ruled out any other possible probable cause of death. The medical literature was reviewed, and 16 previous cases of severe hypernatraemia in adults secondary to excessive salt ingestion were retrieved. Common features of all reported cases included female gender (95% of cases) and evidence of underlying cognitive or psychiatric disorders (all reported cases). We conclude that women with documented cognitive or psychiatric disorders, in particular depression, are susceptible for psychogenic salt poisoning. Awareness should be raised to the potentially life-risking use of salty beverages as emetics or as part of 'exorcism' rituals.

Adult↗

PubMed2004

Conversation starters: re-examining and reconstructing first encounters within the therapeutic relationship.

This paper describes, analyses and reconstructs early encounters between nurse and client. Too often nurses take for granted ordinary encounters with clients and thus overlook opportunities to develop the nurse-client relationship. Common encounters, drawn from reflection on practice, are analysed using contemporary cultural theories. Creative alternatives are suggested and we argue that they represent opportunities to make meaningful connections with and for clients. As conversation starters, these ideas may be used by nurses to facilitate a more trusting therapeutic relationship. They may help to deepen understanding or insight into mental health problems and help to reveal hidden strengths and solutions. By noticing, valuing, discussing and developing this space, we as mental health nurses are extending our discipline base and articulating, with more precision and persuasion, exactly how we contribute to better health outcomes.

Ceremonial Behavior↗

PubMed2007

Traditional practices and exposure to bodily fluids in Lusaka, Zambia.

OBJECTIVES: To ascertain if there are specific sociocultural and behavioural practices associated with the exposure to saliva, semen and vaginal fluids, particularly through child-rearing practices and the use of traditional medicine in Lusaka, Zambia. METHODS: We conducted 11 focus group discussions with men and women from diverse ethnic and socioeconomic backgrounds (n = 105) in Lusaka, Zambia in March 2004. We also conducted a brief sociodemographic survey of all focus group participants. RESULTS: Discussions indicated that saliva was used while engaging in home health care practices associated with childcare and the use of traditional medicine. Additionally, semen and vaginal fluids may be used in rituals associated with childcare and health care for children. Our survey indicated that the use of traditional medicine is associated with lower socioeconomic status. CONCLUSIONS: Population-based studies are needed to evaluate the relationship between traditional behavioural and sociocultural practices, which involve exchange of saliva and other bodily fluids and risk of infectious disease.

Adult↗

PubMed2004

Dermatophytes in the rural area of Duzce, Turkey.

A total of 227 subjects (112 were male and 115 female), who were residents of the rural region of Duzce, were examined for dermatomycosis. A total of 120 samples (47 nail fragments, 73 skin scales) were collected from 81 patients for mycological analysis on the basis of the results of clinical evaluation. All specimens collected were analysed by direct microscopy and culture. Positive results were detected in the cultures of 53 (44.1%) of the 120 samples. About 46 (86.7%) samples also presented positive results in direct microscopy. In the cases of seven samples positive results were found in culture and negative results with direct microscopy. Both culture and direct microscopy presented negative results in 67 (55.8%) samples. The most frequently isolated aetiological agents were 33 Trichophyton rubrum (62.2%), and nine T. mentagrophytes (16.9%). In conclusion, traditional and religious habits such as cohabitation and performing ritual ablutions may affect the prevalence of dermatophyte infections. The performance of ritual ablutions is not in itself a risk factor for acquiring dermatophyte infection; rather it is not drying the extremities after ablutions, that is the main risk factor for this group. Tinea capitis was not found in any of the subjects in spite of the fact that it is one of the most common infectious conditions in children. This is the first paper to report the prevalence of fungal infections in Duzce, a western Black Sea region of Turkey.

Adolescent↗

PubMed1996

The discursive construction of the role of the nurse in medication administration: an exploration of the literature.

This paper draws on postmodern thought to interrogate the literature relating to nurses and medications. An examination of the representation of a specific nursing activity in the literature-the administration of medications-reveals much about the way in which the role of the nurse is discursively constructed. This is particularly evident from an analysis of the procedures shaping that role. These procedures, which nurses themselves develop and institute as rules to guide nursing practice, can have the effect of reducing nursing work to a series of rituals which contribute to the discursive construction of the nurse's role in medication administration.

Ceremonial Behavior↗

PubMed2006

. . . that the social order prevails: death, ritual and the 'Roman' nurse.

In this article, the importance of ritual as a collective response to death is discussed. A case example, taken from a larger ethnographic study, is used to explore the responses and reactions of a group of Italian nurses to death as it occurs within an intensive care unit in Rome, Italy. The material presented is used to analyse the significance that cultural, religious and social beliefs and quasi-beliefs can have in nursing practice. The issues highlighted in this examination of the place of ritual in death are located and discussed within their highly specific cultural context and suggest that, where emphasis remains on nurses as a collective rather than on the individual nurse, ritual acts to ensure that social and moral order prevails.

Adaptation, Psychological↗

PubMed1975