"Feeling Like an Island": Perceptions of Professional Isolation Among Emergency Nurses.

INTRODUCTION: Professional isolation, feelings of being isolated from one's professional peers and lacking mentoring and opportunities for professional interaction, collaboration, and development, is a challenge for workers across the labor market. The notion of professional isolation is particularly prevalent in low-resource health care settings and is common among emergency nurses. METHODS: This study explored the perceptions of professional isolation among emergency nurses working in a low-resource environment using individual interviews with 13 participants in 5 settings in Lesotho. RESULTS: The data were analyzed using qualitative content analysis and revealed an overarching theme of "feeling like an island" containing 3 categories, namely lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness. DISCUSSION: This study suggests that lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness have influenced feelings of professional isolation among emergency nurses working in low-resource environments. The findings of this research lend support to the idea that communities of practice may have a potential impact in addressing professional isolation.

Compulsory separation of women prisoners from their babies following childbirth: Uncertainty, loss and disenfranchised grief.

There is growing evidence to show increased mental ill health in women compulsorily separated from their babies at birth (Cantwell et al., MBRRACE-UK, 2018:56). For imprisoned women, the risk of self-harm and suicide may be exacerbated. This article draws on in-depth interviews with a sample of 28 imprisoned pregnant women/new mothers, 10 prison staff and observations to discuss the experience of separation from or anticipation of separation of women from their babies. Oakley (Signs, 4:607-631, 1980) reflected on the transition to motherhood with reference to the sociology of loss of identity. Women who have been compulsorily separated from their babies experience subjugated loss out of place with societal norms. The experiences of compulsory separation, in relation to concepts of disenfranchised grief, resonate with Lovell's (Social Science & Medicine, 17:755-761, 1983) research into the altered identities of mothers when loss occurs through late miscarriage or stillbirth. Additionally, this type of complex loss also denies a woman her identity as a 'mother'. This article offers a fresh sociological perspective on the ways loss and grief are experienced by women facing separation from their babies in prison, drawing on concepts of uncertainty, loss and disenfranchised grief.

Experiences of midwifery care in English prisons.

BACKGROUND: In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons. METHODS: A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method. RESULTS: Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery. DISCUSSION: Experiences of perinatal prisoners contrast starkly with best midwifery practice-women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon "good behavior" in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby. CONCLUSION: Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.

Interventions for managing professional isolation among health professionals in low resource environments: A scoping review.

BACKGROUND: Professional isolation is viewed as a sense of isolation from ones professional peers and this has contributed to compromised quality of health service delivery as well as quality of life for health professionals in low resource environments. Professional isolation is a multidimensional concept which may be either geographic, social, and/or ideological. However, professional isolation in low resource environments remains poorly defined with a limited body of research focusing on health professionals. AIM: To map and examine available literature on interventions for managing professional isolation among health professionals in low resource environments. METHODS: We conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research studies relevant to professional isolation in health professionals. RESULTS: Of the 10 articles retrieved, 70% were conducted in high income countries where the context may be different if applied to other low-income settings such as in Africa. Only 20% of the studies focused specifically on nurses or the nursing profession and only 10% were conducted on the African continent. CONCLUSION: There is insufficient research on the definition and origins of professional isolation among health professionals including the interventions that can be employed. Rural, remote and/or isolated settings significantly predispose health professionals to professional isolation but remain poorly defined. Additional research is recommended to explore and determine the interventions for managing professional isolation among health professionals in low resource environments.

Facilitating the development of emergency nursing in Africa: Operational challenges and successes.

The World Health Assembly declared 2020 as the 'Year of the Nurse and the Midwife' in recognition of the critical contribution of both professions to global health. Nurses globally are having to do more with less and in the already resource deficient African context, significant adaptation and leadership is required in the way emergency nurses work if they are to be effective in reducing mortality and morbidity within emergency populations. In 2011, an emergency nursing group, representing the largest group of nurses in Africa, swiftly engaged with this process by publishing the document 'Developing a framework for emergency nursing practice in Africa' (2012). From this document a strategic plan was devised within a tight timeframe, to operationalise the quest for enhanced emergency nursing in Africa. The purpose of this paper is to describe this development of emergency nursing in Africa and to explain the operational challenges and successes, as well as the lessons learnt in order to assist with future planning.

Pregnancy and childbirth in English prisons: institutional ignominy and the pains of imprisonment.

With a prison population of approximately 9000 women in England, it is estimated that approximately 600 pregnancies and 100 births occur annually. Despite an extensive literature on the sociology of reproduction, pregnancy and childbirth among women prisoners is under-researched. This article reports an ethnographic study in three English prisons undertaken in 2015-2016, including interviews with 22 prisoners, six women released from prison and 10 staff members. Pregnant prisoners experience numerous additional difficulties in prison including the ambiguous status of a pregnant prisoner, physical aspects of pregnancy and the degradation of the handcuffed or chained prisoner during visits to the more public setting of hospital. This article draws on Erving Goffman's concepts of closed institutions, dramaturgy and mortification of self, Crewe et al.'s work on the gendered pains of imprisonment and Crawley's notion of 'institutional thoughtlessness', and proposes a new concept of institutional ignominy to understand the embodied situation of the pregnant prisoner.

Reflections on researcher departure: Closure of prison relationships in ethnographic research.

BACKGROUND: The United Kingdom has the highest incarceration rate in Western Europe. It is known that women in prison are a vulnerable female population who are at risk of mental ill-health due to disadvantaged and chaotic life experiences. Accurate numbers of pregnant women held in UK prisons are not recorded, yet it is estimated that 6%-7% of the female prison population are at varying stages of pregnancy and around 100 babies are born to incarcerated women each year. There are limited published papers that document the departure of the researcher following closure of fieldwork with women in prison. This article identifies the dilemmas and challenges associated with the closure of prison fieldwork through the interwoven reflections of the researcher. Departure scenarios are presented which illuminate moments of closure talk with five women, supported by participant reflections regarding abandonment and loss, making pledges for the future, self-affirmation, incidental add-ons at the end of an interview and red flags, alerting the researcher to potential participant harm through ill health or self-injury. OBJECTIVES: The primary intention of the study was to observe the pregnant woman's experience with the English prison system through interviews with pregnant women and field observations of the environment. RESEARCH DESIGN: Ethnographic design enabled the researcher, a practising midwife, to engage with the prisoners' pregnancy experiences in three English prisons, which took place over 10 months during 2015-2016. Data collection involved semi-structured, audio-recorded interviews with 28 female prisoners in England who were pregnant or had recently given birth while imprisoned, 10 members of staff and a period of non-participant observation. Follow-up interviews with 5 women were undertaken as their pregnancies progressed. Computerised qualitative data analysis software was used to generate and analyse pregnancy-related themes. ETHICAL CONSIDERATIONS: Favourable ethical opinion was granted by National Offender Management Services through the Health Research Authority Integrated Research Application System and permission to proceed was granted by the University of Hertfordshire, UK. FINDINGS: Thematic analysis enabled the identification of themes associated with the experience of prison pregnancy illuminating how prison life continues with little consideration for their unique physical needs, coping tactics adopted and the way women negotiate entitlements. On researcher departure from the field, the complex feelings of loss and sadness were experienced by both participants and researcher. DISCUSSION: To leave the participant with a sense of abandonment following closure of fieldwork, due to the very nature of the closed environment, risks re-enactment of previous emotional pain of separation. Although not an ethical requirement, the researcher sought out psychotherapeutic supervision during the fieldwork phase with 'Janet', a forensic psychotherapist, which helped to highlight the need for careful closure of research/participant relationships with a vulnerable population. This article brings to the consciousness of prison researchers the need to minimise potential harm by carefully negotiating how to exit the field. Reflections of the researcher are interlinked with utterances from some participants to illustrate the types of departure behaviours. CONCLUSION: Closure of fieldwork and subsequent researcher departure involving pregnant women in prison requires careful handling to uphold the ethical research principle 'do no harm'.

How much training in ultrasound would emergency nurses need?

Ultrasound sonography, in which a high-pitched sound wave travels at different speeds through objects of variable density, offers effective clinical diagnostic applications to identify problems, such as free abdominal fluid following blunt trauma, cardiac effusion and long bone fractures.

Be alert and stay safe.

In this issue of Emergency Nurse, we report on the latest NHS Protect figures on health service staff who have been assaulted ( page 6 ).

Compassion is a constant.

Compassion is a powerful word that describes an intense feeling of commiseration and a desire to help those struck by misfortune. Most people know intuitively how and when to offer compassion to relieve another person's suffering. In health care, compassion is a constant; it cannot be rationed because emergency nurses have limited time or resources to manage increasing demands.

Nursing is a global concern.

I had the privilege last month of speaking at the International Council of Nurses (ICN) conference in Seoul, South Korea, where about 7,000 nurses from 119 different countries explored the importance of global co-operation in nursing.