"We are nurses - what can we say?": power asymmetries and Auxiliary Nurse Midwives in an Indian state.

In India, nurses and midwives are key to the provision of public sexual and reproductive health services. Research on impediments to their performance has primarily focused on their individual capability and systemic resource constraints. Despite emerging evidence on gender-based discrimination and low professional acceptance faced by these cadres, little has been done to link these constraints to power asymmetries within the health system. We analysed data from an ethnography conducted in two primary healthcare facilities in an eastern state in India, using Veneklasen and Miller's expressions of power framework, to explore how power and gender asymmetries constrain performance and quality of care provided by Auxiliary Nurse Midwives (ANMs). We find that ANMs' low position within the official hierarchy allows managers and doctors to exercise "power over" them, severely curtailing their expression of all other forms of power. Disempowerment of ANMs occurs at multiple levels in interlinked and interdependent ways. Our findings contribute to the empirical evidence, advancing the understanding of gender as a structurally embedded dimension of power. We illustrate how the weak positioning of ANMs reflects their lack of representation in policymaking positions, a virtual absence of gender-sensitive policies, and ultimately organisational power structures embedded in patriarchy. By deepening the understanding of empowerment, the paper suggests implementable pathways to empower ANMs for improved performance. This requires addressing entrenched gender inequities through structural and organisational changes that realign power relations, facilitate more collaborative ways of exercising power, and create the antecedents to individual empowerment.

Historical and social construction of the practices of auxiliary nurses and nurse technicians in Primary Care / Construcción histórica y social de las prácticas auxiliares y técnicas de enfermería en Atención Primaria / Construção histórica e social das práticas de auxiliares e técnicas de enfermagem na Atenção Primária

ABSTRACT Objectives: to analyze the practices of nursing auxiliaries and technicians in the context of Primary Health Care in a city in the interior of the state of São Paulo. Methods: transversal, quantitative study, realized with 104 nursing auxiliaries and 46 nursing technicians acting in the Primary Attention. The data, collected using structured questionnaires, are presented by descriptive statistics, and analyzed based on the essential elements of First Contact and Longitudinality. Results: the professionals were, majority, women, married, with children, low political and collective participation. We identified thirteen activities related to the First Contact: and ten on Longitudinality. Conclusions: the insertion and capillarization of auxiliary and nursing technicians' practices show these professionals as the main ones responsible for the first contact in this context, highlighting their relevance in the longitudinality of care and the work composition of health teams, contributing to the consolidation of the Unified Health System (SUS).

RESUMEN Objetivos: analizar las prácticas de las auxiliares y técnicas de enfermería en el contexto de Atención Primaria de Salud en un municipio de São Paulo. Métodos: estudio transversal, cuantitativo, realizado con 104 auxiliares de enfermería y 46 técnicas de enfermería actuantes en Atención Primaria. Los datos, recogidos por medio de encuestas estructuradas, presentados por estadística descriptiva y analizados basado en elementos esenciales de Primer contacto y Longitudinalidad. Resultados: las profesionales eran, mayoritariamente, mujeres, casadas, con hijos, baja participación política y colectiva. Identificadas 13 actividades relacionadas al Primer contacto; y 10, sobre la Longitudinalidad. Conclusiones: la inserción y la capilarización de las prácticas de las auxiliares y técnicas de enfermería evidencian esas profesionales como principales responsables por el primer contacto en ese contexto, destacando su relevancia en la longitudinalidad del cuidado y en la composición del trabajo de los equipos de salud, contribuyendo para la consolidación del Sistema Único de Salud.

RESUMO Objetivos: analisar as práticas das auxiliares e técnicas de enfermagem no contexto da Atenção Primária em Saúde em município do interior do estado de São Paulo. Métodos: estudo transversal, quantitativo, realizado com 104 auxiliares de enfermagem e 46 técnicas de enfermagem atuantes na Atenção Primária. Os dados, coletados por meio de questionários estruturados, são apresentados por estatística descritiva e analisados com base nos elementos essenciais de Primeiro contato e Longitudinalidade. Resultados: as profissionais eram, majoritariamente, mulheres, casadas, com filhos, baixa participação política e coletiva. Foram identificadas 13 atividades relacionadas ao Primeiro contato; e 10, sobre a Longitudinalidade. Conclusões: a inserção e a capilarização das práticas das auxiliares e técnicas de enfermagem evidenciam essas profissionais como principais responsáveis pelo primeiro contato nesse contexto, destacando sua relevância na longitudinalidade do cuidado e na composição do trabalho das equipes de saúde, contribuindo para a consolidação do Sistema Único de Saúde.

Experiences of auxiliary nursing trainees of poverty alleviation programme regarding nursing and nursing profession in Vhembe District, Limpopo Province.

BACKGROUND:  The Limpopo Department of Health and Social Development introduced a system to train children from poor families as auxiliary nurses as a poverty alleviation strategy in 2003. The programme targeted the needy families, those who depended on social grants, orphaned or child-headed families. The programme has been implemented for more than 10 years and the experiences of trainees were never explored. OBJECTIVES:  The purpose of this study was to explore the experiences of auxiliary nurse trainees of the poverty alleviation programme regarding nursing and the nursing profession. METHODS:  A qualitative approach was used. Purposive sampling was used to sample 15 auxiliary nurses who were trained under poverty alleviation programme in four of the seven hospitals of Vhembe District. Data were collected through in-depth individual interviews. One central question 'As a beneficiary of poverty alleviation programme, could you describe your experiences of training as a nurse and of the nursing profession in this hospital'. Data were collected until no new information emerged. Note taking and a voice recording was performed to capture all the information reported by the participants. Open coding method was used to analyse data. RESULTS:  Two themes emerged, namely experiences of being a nurse and about nursing as a profession, and interpersonal relationships between auxiliary nurses and the ward staff. CONCLUSIONS:  The Department of Health in Limpopo Province was commended and to be encouraged to develop other programmes as poverty alleviation strategy for other government departments, so that the affected children can have a wider career choice. The managers and supervisors in the wards to have moral and legal obligations to support initiatives that foster effective mentoring of neophyte nurses in the nursing profession.

Resilience of auxiliary nurses providing nursing care to patients with intellectual disabilities at a public mental healthcare institution.

BACKGROUND: Although mental health is regarded by the International Council of Nurses as a very important element of wellness, healthcare to patients with intellectual disabilities still remains neglected and under-resourced in most societies. Auxiliary nurses are crucial in providing nursing care to patients with intellectual disabilities. These nurses may not be prepared to handle challenges in providing nursing care to these patients, but their resilience can help them to manage these challenges. Limited research is available with regard to the resilience of auxiliary nurses providing nursing care to patients with intellectual disabilities. OBJECTIVES: To explore and describe the perceptions of auxiliary nurses providing nursing care to patients with intellectual disabilities on their resilience and protective mechanisms and vulnerability factors that influence their resilience when providing nursing care to these patients. METHOD: A qualitative, descriptive inquiry approach was used. The population comprised approximately 220 auxiliary nurses providing nursing care to patients with intellectual disabilities at a mental healthcare institution. Auxiliary nurses were selected through purposive sampling with the assistance of a mediator. The sample size was determined by data saturation. The data were collected through four focus group interviews with altogether 32 participants. RESULTS: Five main themes emerged from the data. Practical wisdom was applied by the participants. They also made use of different forms of interactions, including the application of strategies such as utilising induction programmes and being willing to learn, in order to remain resilient. Protective mechanisms and vulnerability factors influence their resilience. CONCLUSIONS: Recommendations to strengthen the resilience of auxiliary nurses caring for patients with intellectual disabilities were formulated from the research findings, including recommendations for nursing practice, education and nursing research. Informal peer support, as well as addressing ethical issues, improving nurse-patient communication, training to handle adverse working conditions, and continuing education and further research on the practical wisdom of auxiliary nurses, is recommended.

Experiences of frontline nurses with adverse medical events in a regional referral hospital in northern Ghana: a cross-sectional study.

BACKGROUND: Adverse medical events (AMEs) are threats to delivery of quality healthcare services, particularly in resource-poor settings such as Ghana. In sub-Saharan Africa, 30% of deaths are attributed to AMEs and a significant proportion of these events are not reported. This study explored personal experiences of nurses with AMEs and the constraints to reporting them. METHODS: This is a descriptive cross-sectional study among professional (n = 133) and auxiliary (n = 88) nurses in a regional referral hospital in northern Ghana. A test for differences in experiences of professional and auxiliary nurses was done using Wilcoxon Mann-Whitney test. Ordered logistic regression analysis (proportional odds ratio models) and probit regression were used to ascertain the determinants of staff's knowledge on AMEs and the odds of exposure, respectively. RESULTS: Overall, knowledge and awareness level on AMEs was average (mean = 3.1 out of the five-point Likert scale of 1 = "Very poor" to 5 = "Excellent"). Knowledge levels among professional nurses (mean = 3.2) were relatively higher than those among auxiliary nurses (mean = 3.0), (p = 0.006). The predominant type of AME experienced was wrongful documentation (n = 144), and the least experienced type was wrong transfusion of blood and/or intravenous fluids (IVF) (n = 40). Male staff had higher odds of experiencing medical errors relative to female staff, OR = 2.39 (95% confidence interval (CI), 1.34-4.26). Inadequate logistics was the most perceived cause of AMEs. Knowledge on types of AMEs was significantly associated with gender of the respondents, OR = 1.76 (95% CI, 1.05-2.94); moreover, male staff had higher odds of knowing AME post-exposure action than female staff, OR = 1.75 (95% CI, 1.04-2.93). CONCLUSION: Knowledge levels of nursing staff on AMEs were generally low, and even though exposures were high they were not reported. There is the need to integrate AME modules into the pre-service and in-service training curricula for nurses to enhance their knowledge on AMEs; reporting registers for AMEs should be made available in clinical sites and staff incentives given to those who report AMEs. Lastly, protocols on AMEs should form part of the quality assurance value chain for health facilities to promote compliance.

Adherence to standard nursing protocols on nasogastric tube feeding in a secondary referral hospital in Ghana: comparing self-ratings by professional and auxiliary nurses.

BACKGROUND: Data on nurses' adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study explored self-rated adherence to standard protocols on NG tube feeding among professional and auxiliary nurses and the perceived barriers impeding compliance to these standard protocols. METHODS: This is a descriptive analytical cross-sectional study among professional (n = 89) and auxiliary (n = 24) nurses in a major referral hospital in one of the ten administrative regions in Ghana. Four-point Likert scale was used to ascertain the level of adherence to standard guidelines on nasogastric tube, ranging from 4 "Very large extent" to 1 "Very little extent". Wilcoxon Mann-Whitney test and univariate ordered logistic regression tests (proportional odds models) were performed to determine the odds of higher self-ratings among professional and auxiliary nurses. RESULTS: Overall, the odds of higher self-ratings on adherence to standard nursing protocols on NG tube feeding was higher among auxiliary nurses than professional nurses (OR = 2.76, p = 0.031) after adjusting for age, gender, education and years of work experience. Key barriers to adherence to standard protocols on NG tube feeding were: limited opportunities for in-service trainings and insufficiency of NG tube feeding protocols on the wards. CONCLUSION: There is the need for more routine in-service trainings for nursing staff to update their knowledge on NG tube feeding. Hospital management should also make current nursing protocols available to nurses to guide their practice alongside routine onsite supervision of nurses.