Re-inscribing Gender in New Modes of Medical Expertise: The Investigator-Coordinator Relationship in the Clinical Trials Industry

This article analyses the ways in which research coordinators forge professional identities in the highly gendered organizational context of the clinic. Drawing upon qualitative research on the organization of the clinical trials industry (that is, the private sector, for profit auxiliary companies that support pharmaceutical drug studies), this article explores the relationships between predominantly male physician-investigators and female research coordinators and the constitution of medical expertise in pharmaceutical drug development. One finding is that coordinators actively seek to establish relationships with investigators that mirror traditional doctor-nurse relationships, in which the feminized role is subordinated and devalued. Another finding is that the coordinators do, in fact, have profound research expertise that is frequently greater than that of the investigators. The coordinators develop expertise on pharmaceutical products and diseases through their observations of the patterns that occur in patient-participants' responses to investigational drugs. The article argues, however, that the nature of the relationships between coordinators and investigators renders invisible the coordinators' expertise. In this context, gender acts as a persistent social structure shaping both coordinators' and investigators' perceptions of who can be recognized as having authority and power in the workplace.     

The politics of midwifery education and training in New South Wales during the last decades of the 19th Century

This paper focuses on the introduction and development of midwifery education and training in Sydney during the last decades of the 19th century. The aim of the training, it is argued, was to displace the lay midwives by trained midwifery nurses who would work under medical control. The lay midwives were one of the largest occupational groups among women and two-thirds of births in NSW were being delivered by them in the late 19th century. It was a period of professionalisation of medicine and medical men laid claim to midwifery as a legitimate sphere of their practice and saw it as the gateway for establishing a family practice. The lay midwife stood in the way of their claim. The training programs were established purportedly to control maternal mortality. From the beginning in 1887 medical men were in control of midwifery nurse training. In addition to training at the Benevolent Society Asylum, three more women's hospitals were established in the 1890s in Sydney making it possible to train a stream of midwifery nurses. The midwifery nurses were charged exorbitant fees for their training; the fees contributed substantially towards running the new hospitals that delivered birth services to the poor and destitute women mostly in their homes. The midwifery nurses worked hard in miserable conditions under the guise of clinical experience required for training. When a critical mass of poorly trained midwifery nurses were in the offing, a Bill was introduced into the Parliament in 1895, restricting registration to midwifery nurses and this would have eliminated the lay midwife if passed. It took more than two decades to get a Registration Bill passed in the NSW Parliament.     

新型护患关系下优化护理实习的探讨

医学模式的转变,整体护理的推广,市场经济的运作,以及患者法律意识的增强,使护患关系呈现出新的特点。临床带教老师和护理实习生须充分认识和重视这一变化,并采取相应措施,强化角色意识,培养自控能力,提高综合素质,建立和谐的新型的护患关系,确保实习教学目标的实现,培养高质量、高素质的护理人才。     

浅析护士心理问题的表现形式、成因及对策

近年来护士心理问题已经受到越来越多的关注,阐述了护士容易出现心理问题的表现形式,分析了护士心理问题产生的原因,在此基础上提出了改善管理制度、创造沟通环境和支持系统、提高护士心理素质、提供心理咨询服务4个方面的对策。     

The Care–tech Link: An Examination of Gender,Care and Technical Work in Healthcare Labour

Despite the dramatic increase of technology in the healthcare field, little is known of how care work and technical work are related. Examining substitute healthcare providers offers a useful illustration of the care–tech link because nursing (care) and medical (technical) models often merge. Forty‐two interviews with men and women (nurse practitioners, nurse anaesthetists and physician assistants) were conducted in the USA. The results showed that the gendered nature of care–tech boundaries has shifted in small but important ways and that the gendering of work influenced the shape of these boundaries. Men often encountered barriers when moving too far into the care realm and attempted to overcome this by ‘caring cautiously’ and emphasizing problem‐solving care. Women faced similar barriers from the ‘old boys network’ when they entered highly technical areas. There is also evidence that men and women challenged existing care–tech boundaries and moved beyond their traditional roles.     

老年人烧伤的监护体会

目的鉴于老年烧伤患者病情的特殊性,探讨其监护特点。方法统计2001年～2002年我院不同程度烧伤老年患者25例,分析其监护特点及护理体会。结果 25例均得到较好的治愈。结论只有充分认识老年烧伤患者的特殊性,才能尽可能好的护理和治愈患者。     

患儿入院初期的心理反应与对策

分析了不同年龄阶段的患儿在入院初期对陌生的医院环境和医务人员所产生的各种不同的心理反应,针对这些反应,给出了各种不同的护理措施,在临床工作中运用这些措施,达到了较好的效果。     

More than ‘information provider’ and ‘counselor’: Constructing and negotiating roles and identities of nurses in genetic counseling sessions

This paper contributes to research on genetic counseling by exploring the complexity of this activity from the angle of identity construction. We argue that an analysis of the processes through which healthcare providers construct and negotiate their roles and identities in these encounters may contribute to a better understanding of the complexities of genetic counseling. Drawing on more than 150 video‐recorded genetic counseling encounters between nurses and clients in Hong Kong, we illustrate that the discursive processes involved in the construction of the nurses' identities are complex, overlapping and at times contradictory as the nurses respond to the (sometimes) competing norms and expectations of their institution, their clients and their own. They manage to solve these tensions by drawing on the roles traditionally assigned to nurses in these encounters such as information provider and counselor, as well as creating the new roles of co‐decision maker and cultural broker/mediator.     

新形势下专科护生临床实习存在的问题及对策

由于护理模式及市场环境的转变,护生实习期间存在管理制度不够健全、实践技能操作机会不多、沟通能力有待加强、生活保障不到位、对自己的个人发展设计欠缺等问题。为此,可以采取以下对策应对存在的问题：通过树立服务意识,强化沟通能力的培养;加强对临床带教的管理,共建实训基地;规划职业生涯,丰富择业途径等。     

Outcry Consistency and Prosecutorial Decisions in Child Sexual Abuse Cases

This study examines the correlation between the consistency in a child’s sexual abuse outcry and the prosecutorial decision to accept or reject cases of child sexual abuse. Case-specific information was obtained from one Texas Children’s Advocacy Center on all cases from 2010 to 2013. After the needed deletion, the total number of cases included in the analysis was 309. An outcry was defined as a sexual abuse disclosure. Consistency was measured at both the forensic interview and the sexual assault exam. Logistic regression was used to evaluate whether a correlation existed between disclosure and prosecutorial decisions. Disclosure was statistically significant. Partial disclosure (disclosure at one point in time and denial at another) versus full disclosure (disclosure at two points in time) had a statistically significant odds ratio of 4.801. Implications are discussed, specifically, how the different disciplines involved in child protection should take advantage of the expertise of both forensic interviewers and forensic nurses to inform their decisions.