bluuebunny/crossref_metadata_2025_split huggingface dataset:
Profession, market and class: nurse migration and the remaking of division and disadvantage
Authors: Smith Pam , Mackintosh Maureen 
Published: November 2007

Aims and objectives.  This article aims to analyse the part played by successive waves of nurse migration in changing patterns of division and disadvantage within nursing. We argue that migration has in part acted to reinforce disadvantage based on class and gender, race and ethnicity and identify the influence of changes in nursing structure and commercialization of care in these processes.Background, design and methods.  The historical analysis of division within nursing and the impact of migration are based on secondary sources (literature review) and primary research undertaken by ourselves and colleagues. The paper develops a concept of ‘remaking’ disadvantage drawing on analysis in social history of the interplay between agency and economic position in the ‘making’ of class. It uses the extended case method to focus on the residential care sector, showing how global and national influences operate at the frontline of service delivery.Results.  We show how social class and gender, race and ethnicity have interacted and are reflected in the division of labour within nursing. We demonstrate how the employment conditions of nurse migrants have reinforced patterns of disadvantage. The case study of the residential care home sector deepens our analysis of intersecting sources of professional disadvantage including aspects of commercialization, in a sector where they have severe effects for vulnerable staff and patients.Conclusions.  In the UK, migrant professional nurses have repeatedly acted both as a highly valued labour force on whom patients and clients rely and as involuntary contributors to remaking disadvantage. This situation is sustained by the current international labour market and rising commercialization which facilitate nurse migration and the segmentation of care work based on a ‘pecking order’ of specialties that reinforce existing divisions of social class, gender and race within nursing.Relevance to clinical practice.  Migrant nurses play a key role in the delivery of ‘frontline’ care to patients. The role many currently play reinforces disadvantage within nursing in ways that are problematic for the profession, patients and clients. The recognition and valuing of their skills is critical to the promotion of their own morale which in turn has an impact on their relationship with colleagues and the delivery of patient and client care.
Maternal experiences making a decision about heart surgery for their young children with congenital heart disease
Authors: Lan Shu‐Fan , Mu Pei‐Fan , Hsieh Kai‐Sheng 
Published: November 2007

Aim.  The aim of this study was to investigate the essence of the experience of mothers during the decision‐making process when facing their less than three‐year‐old child undergoing heart surgery due to congenital heart disease (CHD).Methods.  In this phenomenological study in Taiwan nine mothers were interviewed in their homes. They were invited to share their experience of family interactions and relationships while facing a decision about their child's heart surgery. The interviews were recorded and transcribed for further analysis according to Colaizzi's phenomenological methodology.Results.  The essence of the maternal experience themes during the decision‐making process included (i) understanding the surgery step by step, (ii) role pressure, (iii) constructing care‐taking ability, (iv) endeavouring to maintain family functioning while preparing for surgery and (v) deliberate consideration to make the correct decision.Conclusions.  When parents face their child having CHD and plan heart surgery, the whole family is living through a stressful decision‐making process. According to the results of this study, it is obvious that the caregivers and their whole families experience psychological distress, role reorganization and remodelling of family functioning.Relevance to clinical practice.  The results of this study provide evidence‐based essential knowledge that will assist the management of such decision‐making processes and help to prepare the child and the family to have confidence in the heart surgery.
The perceptions of Taiwanese families who have children with learning disability
Authors: Chang Mei‐Ying , Hsu Li‐Ling 
Published: November 2007

Aims and objectives.  To explore the perceptions of families in Taiwan of living with a child who have learning disability and the parents perspectives on the cultural influences on their spiritual experiences.Background.  Traditionally, the family is the most important unit of society, family functioning is a key field of interest among helping professionals who provide family interventions.Design.  This study adopted qualitative research with semi‐structured interviews. The study analysis used content analysis which was a process of identifying, coding and categorizing the themes in the data.Methods.  Semi‐structured interviews were conducted with 117 parents in their homes and were interpreted by using content analysis to extract key conceptual themes from the transcribed interview texts.Results.  The findings revealed that the perceptions of families with learning disability children were wide‐ranging. The stressors did not occur in a fixed order, they were different in degree and importance from one family to another.Conclusions.  The results showed that the experience of analysing qualitative data was extremely valuable for parents in that it aided their own understanding of the real‐life experiences of the parents and in coming to know the parents in a richer, more meaningful way. In doing so, nurses need to be aware of their own thoughts and environment without letting it influence others.Relevance to clinical practice.  The nurse should demonstrate knowledge and understanding of the family's culture and be able to show respect for cultural difference to assess and identify culturally acceptable health‐care interventions.
Embodiment of discrimination and overseas nurses’ career progression
Authors: Larsen John Aggergaard 
Published: November 2007

Aim and objectives.  To examine empirically and in‐depth how discriminatory attitudes and practices are experienced by overseas nurses and how the discrimination may affect their well‐being and career progression and, furthermore, to apply the theoretical perspective of embodiment in understanding these processes.Background.  The UK healthcare sector has, in recent years, relied on overseas‐trained professionals to fill up vacancies in nursing and other professions. Research shows that overseas nurses claim that their UK colleagues, managers and patients express discriminatory, racist and xenophobic attitudes.Design and method.  The paper provides an existential phenomenological analysis of in‐depth interviews with two overseas nurses. The data are drawn from a study of overseas‐trained healthcare workers’ experiences working and living in the UK. The two cases have been purposively selected to provide an illumination and discussion of personal experiences with discrimination, how individuals may respond to these and how their professional career is affected.Findings.  Discrimination towards migrant workers may, at times, be experienced as ‘blatant racism’ or, in more subtle forms, as ‘aversive racism’. It is demonstrated how such discrimination may impact on the afflicted person's sense of self, suggesting a theoretical model of the embodiment of discrimination. Discrimination not only works at an interpersonal and institutional level, but is a form of ‘symbolic violence’ that may be internalized to affect the person's ‘habitus’; it can be resisted through meaning‐making activity that explains and hence objectifies and embodies the experience in a way that allows individuals to positively influence their situation through agency.Conclusion.  This article details how social and institutionalized discrimination in the UK healthcare sector may be internalized by overseas workers and affects their professional careers.Relevance to clinical practice.  The study allows a theoretical reflection on the damage inflicted by discrimination, and it may contribute to the eradication of discriminatory practices and the development of necessary support and monitoring mechanisms.
The quality of written information for parents regarding the management of a febrile convulsion: a randomized controlled trial
Authors: Paul Fiona , Jones Martyn C , Hendry Charles , Adair Pauline M 
Published: November 2007

Aims and objectives.  To identify whether providing a new information leaflet for parents regarding the management of a febrile convulsion was more effective in comparison with standard leaflets.Background.  Although information leaflets are frequently recommended within healthcare, their quality is often poor. Furthermore, the evidence regarding the effectiveness of leaflets is inconsistent. Few studies have evaluated the effects of providing leaflets that have been developed to improve their quality. Within the specialty of paediatrics, parents are often unprepared regarding the management of febrile convulsion at home and the provision of supplementary leaflets is recommended, despite limited evidence regarding the effectiveness of this approach. There is also limited evidence regarding whether improving the quality of these leaflets leads to better outcomes, e.g. increasing parents’ behavioural knowledge.Design.  Double‐blind randomized controlled trial.Method.  One hundred and twenty‐six parents of children hospitalized due to benign febrile convulsion were recruited (May 2000–February 2002). Seventy‐one parents were randomized to receive the standard care (control leaflet) and 55 parents received the intervention (new leaflet). Data were collected from parents on discharge immediately prior to receiving the intervention and 7–14 days following the intervention via telephone interview.Results.  Parents who received the new leaflet found this to be more reassuring and easier to understand than parents who received the control leaflet. No differences between groups were identified regarding the primary outcome, i.e. behavioural knowledge and most of the secondary outcomes, e.g. perceived confidence, state anxiety and satisfaction with the leaflet.Conclusion.  Although this study provides modest support for the effectiveness of providing high‐quality leaflets, further research is required to determine the best methods for optimizing the effectiveness of leaflets provided at hospital discharge.Relevance to clinical practice.  The quality of leaflets may influence some outcomes, e.g. understanding and reassurance with the written information provided; however, additional strategies to inform parents may be necessary.
Engaging with a new reality: experiences of overseas minority ethnic nurses in the NHS
Authors: Alexis Obrey , Vydelingum Vasso , Robbins Ian 
Published: November 2007

Aim and objective.  The purpose of this study was to explore, describe and develop a greater understanding of the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England.Background.  For the past five decades, the NHS has been recruiting overseas black and minority ethnic nurses from several former British colonies to alleviate the manpower shortages. More recently there has been a shortage of nurses in the labour force and as a result the NHS has once again recruited overseas nurses. Despite this recruitment drive there are limited studies outlining how overseas black and minority nurses have fared in the NHS.Methods.  This qualitative phenomenological study used four purposeful focus groups and all participants involved were interviewed at a place convenient for them. These all non‐white participants originated from Asia, Africa and the Caribbean. Each focus group contained six participants with an overall total of 24 participants involved in the study.Results.  Following thematic analysis, the findings revealed six themes such as, the devaluation process, concept of self‐blame, discrimination/lack of equal opportunity, concept of invisibility, experiencing fear and benefits of being here. Several overseas nurses felt devalued and indicated that white UK nurses appeared to have placed little trust in them. They stated that both discrimination and lack of equal opportunity were present in the workplace and they also revealed that some white UK nurses were sometimes abusive. As a result they tolerated such behaviour for fear of being thrown out with their families. Despite such negative experiences participants indicated that the experiences gained whilst working in the NHS were useful.Conclusions.  There is a need for overseas nurses to be treated fairly and with respect particularly in the light of an acute labour shortage of nurses in the NHS. The findings suggest that overseas minority ethnic nurses’ experiences have been mixed, with some positive as well as negative experiences, within a process that devalues them as workers.Relevance to clinical practice.  This paper highlights a need for a re‐evaluation of equal opportunity policies and proposes more diversity training so as to prepare nurses to cope with an increasingly complex and diverse workforce.
Institutionalized disadvantage: older Ghanaian nurses’ and midwives’ reflections on career progression and stagnation in the NHS
Authors: Henry Leroi 
Published: November 2007

Aims and objectives.  This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi‐structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH).Background.  Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK‐trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades.Conclusions.  This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate.Relevance to clinical practice.  These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention.
Overseas nurses in the National Health Service: a process of deskilling
Authors: O'Brien Terri 
Published: November 2007

Aims and objectives.  This paper shows that overseas nurses (OSN) recruited to UK hospital trusts become deskilled in technical aspects of clinical practice.Background.  Existing research reports that many newly recruited OSN are prevented from using technical skills acquired in training abroad, to the detriment of the National Health Service (NHS) and the concern of the nurses themselves.Design.  The author conducted case study work in three NHS hospital trusts in the northwest of England. The findings reported are part of a wider investigation into the assimilation1 of OSN from the Philippines, India and Spain into NHS hospitals. Semi‐structured interviews were undertaken with members of four groups of actors: managers, OSN, home nurses (HN) and mentors, which were analysed thematically.Results.  The research confirms the finding that many OSN are prevented from using technical skills in the UK, but also suggests reasons why this is so. The finding of deskilling emerged strongly in all three cases and is singled out for discussion in this paper.Conclusions.  The experience of OSN highlights ambiguity surrounding the role of the nurse in British hospitals. This arises partly because OSN tend to be recruited to the bottom grades of nursing in the NHS, where their technical skills are underused.Relevance to clinical practice.  Segmentation within the nursing hierarchy contributes to the conflicting messages and mismatch of expectations experienced by nurses at the ward level, regarding the role of the nurse.
Interrogating the language of integration: the case of internationally recruited nurses
Authors: Raghuram Parvati 
Published: November 2007

Aims.  This paper suggested the need to interrogate the notion of ‘integration’ to facilitate the retention of migrant nurses.Background.  The growth in internationally recruited nurses in the UK's health system has led to a raft of policies that aim to ensure that such nurses are well ‘integrated’ into their ‘new environment’. It is assumed that integration will improve the quality of internationally recruited nurses’ experience in the UK, improve their retention rates and thus improve the quality of health delivery within the UK. However, most of the steps through which integration is sought tend to move between some version of assimilation and ‘respect for difference’.Contributions.  This paper aimed to add to existing literature on the integration of internationally recruited nurses in the UK by suggesting three steps towards rethinking ‘integration policies’. It suggests the need to recognize migration as only one of the differentiating factors within the nursing sector, to ensure that integration does actually become a two‐way process and to be cognizant of the multiple shapes that racism can take. The first two steps will prevent a slip between integration and assimilation while the last will help rethink any anti‐racist training that may form part of integration policies.Conclusions.  There are many factors influencing the experiences of internationally recruited nurses and not all of them can be addressed within current integration policies.Relevance to clinical practice.  Rethinking integration can help improve the experience of internationally recruited nurses.
Managing equality and cultural diversity in the health workforce
Authors: Hunt Beverley 
Published: November 2007

Aims.  This article offers practical strategies to managers and others for supporting overseas trained nurses and managing cultural diversity in the health workforce.Background.  Widespread nursing shortages have led managers to recruit nurses from overseas, mainly from developing countries. This paper draws on evidence from the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study reported elsewhere in this issue, which indicates that overseas trained nurses encountered widespread discriminatory practices including an overuse of complaints and grievances against them. The researchers also found that the overseas trained nurses responded to their experiences by using various personal strategies to resist or re‐negotiate and overcome such discriminatory practices.Methods.  A research workshop was held in June 2005 at the midpoint of the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study. Twenty‐five participants attended the workshop. They were the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study researchers, advisory group members, including the author of this paper and other researchers in the field of migration. The overall aim of the workshop was to share emerging research data from the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals and related studies. The final session of the workshop on which this paper is based, was facilitated by the author, with the specific aim of asking the participants to discuss and determine the challenges to managers when managing a culturally diverse workforce. The discussion yielded four main themes collated by the author from which a framework of strategies to facilitate equality and cultural diversity management of the healthcare workers may be developed. The four themes are: assumptions and expectations; education and training to include cultural sensitivity, equality and human rights; performance management; and transparent human resource management processes.Conclusion.  Managing a racially and culturally diverse workforce is complex and challenging for managers. There are no ready‐made tools to show them how to do so. Achieving effective management of a culturally diverse workforce comes from an intrinsic motivation to develop the cultural competence to engage with them.Implications for practice.  This article, together with others in this special issue, provides a springboard for moving this agenda on. It offers managers a framework of themes, which they can draw on to develop their own best practice for managing racial equality and cultural diversity in the health workforce.
Morphogenesis of koi herpesvirus observed by electron microscopy
Authors: Miwa S , Ito T , Sano M 
Published: November 2007

AbstractKoi herpesvirus (KHV or cyprinid herpesvirus 3) was inoculated onto three fish cell lines derived from carp, Cyprinus carpio L., and the process of virion formation observed with electron microscopy. Essentially, similar features of virus particles were observed in all three cell lines. The nucleus of infected cells was characterized by margination of chromatin and often contained many capsids of about 110 nm in diameter with varying morphology. The morphological variation of the capsids was very similar to that of mammalian herpesviruses. Some capsids protruded from the inner nuclear membrane, and others, with envelopes, were located in the perinuclear space between the inner and outer nuclear membrane, suggesting budding of capsids at the inner nuclear membrane. Naked capsids and envelopment of capsids by budding into vesicles were also observed in the cytoplasm. Mature, enveloped virions 170–200 nm in diameter were seen in cytoplasmic vesicles or outside the cell. These observations suggest KHV virions mature through a complex morphological pathway including two distinct envelopments, which have been found only in herpesviruses. These observations support the inclusion of KHV in the family Herpesviridae.