Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.

Spanish nursing under Franco: reinvention, modernization and repression (1956-1976).

This article examines Spanish nursing during a critical 20-year period (1956-76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state-run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS-Ayudante Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women's Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid-twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first-year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender-related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women's branch of the ruling Falangist Party in mid-twentieth century Spain.