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PubMed2002

Networks of nomads: negotiating access to health resources among pastoralist women in Chad.

Health resources among pastoralist groups are strongly gendered. While certain types of health resources fall within the female domain (home-based treatment, caring and supportive roles, and knowledge surrounding particular reproductive conditions) access to most outside health practitioners, treatments and knowledge is controlled largely by men. For pastoralist women, this means that actions taken during illness episodes depend largely on the nature and quality of social support systems available, and on their ability to mobilise them effectively. These support systems include husband and other affines, male kin, and networks of female kin and friends. Factors such as position within domestic and wider social units, as well as life cycle, affect women's ability to access and mobilise these different support systems for their health needs. However, seasonal mobility interacts with gender and social support systems in complex ways that profoundly influence women's access to health resources. Most literature on nomadic peoples and health focuses on the physical barriers posed by spatial mobility to accessing health resources. However, it is suggested here that, for pastoralist women in Chad, the spatial fluidity of social networks might be a more important consideration. At certain times of the year women enjoy relatively easy access to a large range of extended kin and other social contacts, while at other times, when people are very dispersed, options become much more limited, often resulting in illness treatment being delayed. Mobility should not, though, be seen purely as a constraint. It can also be an opportunity, increasing the potential geographical and social resource base with regard to health for women.

Agriculture↗
PubMed2004

Lay voices on allergic conditions in children: parents' narratives and the negotiation of a diagnosis.

Allergic conditions can be seen as an increasing as well as debated health problem in Western societies, but lay notions and experiences of these conditions are still not fully understood. As much attention is given to prevention of allergic conditions in early childhood, for example as medical advice to parents of young children, it is of particular interest to look at lay understandings of allergic conditions in childhood. This study, carried out in Sweden, explores understandings of child allergy, drawing on interviews with parents of children under 6 years, in a period when the children are medically assessed. The interviews are analysed as illness narratives, with a focus on how the parents explain the child's illness. The analysis reveals a complex pattern. The parents on the one hand refer to a shared knowledge about causes to allergic conditions, such as factors in the physical environment, family life-style and genetic causes. On the other hand, this knowledge is re-appropriated and intertwined with the parents' own experiences of allergic conditions in the process of making sense of the illness in their own child. In their stories, the parents link a potential allergic condition in the child to their own identities as allergic or non-allergic persons and to their family illness history. Child allergy is in this sense constructed as a "family condition".

Child↗
PubMed2002

Liminality and breastfeeding: women negotiating space and two bodies.

It is almost universally accepted that breastfeeding infants is nutritionally superior to bottle-feeding. However, despite this medical advice, in many countries breastfeeding rates remain low and in the UK, rates are relatively static. The literature on breastfeeding has discussed international rates and the broad socio-economic factors influencing these rates. Through an observational study of a group of breastfeeding and non-breastfeeding women in the United Kingdom, this research utilises contemporary theoretical perspectives on the body, space and rites of passage, and investigates the reasons why some breastfeeding mothers may be in a liminal period, and the breastfeeding event itself, at times, a liminal and marginalised act. The paper argues that, for the group studied, breastfeeding is sometimes discouraged by its medicalisation, and that breastmilk and breastfeeding are often considered by mothers to be embarrassing. Many of the women studied regarded certain public and private places to be unacceptable places to breastfeed and claimed to modify their behaviour accordingly. The paper demonstrates the value of conducting locally based qualitative research into breastfeeding experiences, and of using theoretical perspectives from post-medical geography to interpret women's experiences.

Attitude to Health↗
PubMed1994

Identity negotiation in roommate relationships: the self as architect and consequence of social reality.

The authors report two longitudinal studies of new college roommates (Ns = 69 and 95 pairs). In both studies, targets' initial self-views predicted changes in perceivers' appraisals of them, and perceivers' initial appraisals predicted changes in targets' self-views, although few dyads displayed both effects. The perceiver-driven and target-driven effects occurred when appraisals and self-views were negative as well as positive. Implications for self-verification theory and symbolic interactionism are discussed, and a less restrictive model of how appraisals influence self-views is proposed.

Ego↗
PubMed2001

Negotiating and managing partnership in primary care.

In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

England↗
PubMed2003

Nurses and 'difficult' patients: negotiating non-compliance.

BACKGROUND: There is a large body of nursing literature on patient non-compliance. While some articles address non-compliance as a patient problem to be resolved by nursing interventions, there is also a growing number that critique this approach. This reflects the discomfort many nurses feel about the practice of labelling patients as non-compliant. AIM: The aim of this discussion paper is to build on the critical nursing literature to offer an alternative to the interventions commonly directed at patients who do not follow health care advice. This alternative approach locates patients within their social context and focuses on those who adapt health care advice to fit with their beliefs, life situation and circumstances. The aim is to encourage nurses to learn about how health care treatments affect patients'lives, and not merely their health. METHOD: Specific nursing articles were reviewed to demonstrate the ways in which the concept of compliance is used within the nursing literature. These articles were then used to support an argument that promotes a patient-centred approach to health care. CONCLUSION: A patient-centred approach involves transferring power and authority away from health care professionals and towards patients. We encourage nurses to take a leadership role by changing the way in which health care is delivered towards a focus on patients'lives. Learning about patients' lives may assist nurses to offer health information to patients that is more relevant and, therefore, useful.

Delivery of Health Care↗
PubMed2002

Adaptation and negotiation as an approach to care in paediatric diabetes specialist nursing practice: a critical review.

Considerable attention has been given to diabetes care in children. However, nursing practice may be guided by biomedical models. Diabetes care in children should focus on family-centred approaches arguably based in the community. Psychosocial constructs have an important role in the development of self-management of chronic illness in children. Paediatric diabetes nurse specialists are pivotal in facilitating family-centred care based on personal models of child and family interventions.

Adaptation, Psychological↗
PubMed2000

Negotiating the boundaries: the experience of the mental health nurse at the interface with the criminal justice system.

Community mental health nurses working within the criminal justice system undertake an important function with regard to the strategic intent that wherever possible, mentally disordered persons should receive care and treatment from health and social services. Their precise role, and the particular function of court diversion/assessment schemes, is still being defined. This takes place within a broader context of reorientation of mental health nursing within the move to community care and exposure to the complexity of multidisciplinary working. Examining the experience of mental health nurses in court diversion schemes reveals the intensity of the experience of working in an inter-professional setting without the benefit of preparation or training, and without the frame of reference of a structured health environment. Adaptation of the language of mental health nursing was necessary to effect mutual understanding with other professional groups, and there was a recognition that the competences needed to operate in this environment had not previously been identified as part of their skills base. The result was to bring into question their professional practice and identity as mental health nurses. The handling of patient information in the context of an inter-professional setting remains an issue requiring clarification.

Community Mental Health Services↗