Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries
Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries
复制标题
DOI：
10.1016/j.ssmqr.2021.100024
复制
发表时间：
2021-12-01
期刊：
影响因子：
--
通讯作者：
Nzinga, Jacinta
中科院分区：
文献类型：
--
作者：
Mbuthia, Daniel Waweru;Mcgivern, Gerry;Nzinga, Jacinta
我们研究了中低收入国家（LMIC）的新护士在进入临床实践并遇到违反程序标准的实际规范时，如何构建其职业身份。我们对 47 名肯尼亚护士进行了访谈和焦点小组讨论。我们描述了新护士在进入护理实践时所经历的 "冲击"（独自工作和学习，同时负责许多病人并从事 "脏活累活"），这与她们理想化的护理形象和期望以及之前的培训形成了鲜明对比。我们利用有关身份和身份工作的理论来解释这种转变，我们认为这种理论能够阐明护士在低收入和中等收入国家的经历。我们认为，护士向临床实践的过渡违背了对其专业身份的原有期望，从而引发了 "磨砺"、"在经验中成熟 "和 "学习实践规范 "的身份工作。通过这种身份认同工作，并最终从照顾和护理病人恢复健康中获得满足感，一些护士得以恢复其有价值的专业身份。我们的研究结果突出表明，低收入和中等收入国家的专业教育者和医疗政策制定者需要重新考虑新的医疗工作者如何为专业实践做好准备并使其社会化，同时承认护理实践往往与培训大相径庭。我们认为，应为医护专业人员提供成长空间，让他们可以安全地讨论偏离程序标准的实践规范。在这种对话的基础上，在资源有限的情况下，有利于质量和安全的实用规范可能会被纳入护理标准，并找到解决损害患者护理的实用规范的方法。
We examine how new nurses construct their professional identity in Low- and Middle-Income Countries (LMICs) when they enter clinical practice and encounter practical norms violating procedural standards. We conducted interviews and focus group discussions with 47 Kenyan nurses. We describe new nurses experiencing 'shock' entering nursing practice (working and learning alone while responsible for many patients and doing 'dirty work'), which contrasted with their idealized image and expectations of nursing and prior training. We explain this transition using theory about identity and identity work, which we argue elucidates nurses' experiences in LMICs. We suggest that nurses' transition into clinical practice violated pre-existing expectations for their professional identities, which then triggered identity work of 'toughening up', 'maturing through experience', and 'learning practical norms'. Through this identity work, and finally experiencing satisfaction from caring for and nursing patients back to health, some nurses were able to restore their valued professional identity. Our findings highlight the need for professional educators and healthcare policymakers in LMICs to reconsider the way new healthcare workers are prepared for and socialized into professional practice, acknowledging that nursing practice is often very different to training. We argue for developing formative spaces in which health professionals can safely discuss practical norms deviating from procedural standards. Drawing on such conversations, practical norms benefitting the quality and safety in resource constrained contexts might then be incorporated into care standards and ways found to address practical norms harming of patient care.