Review: Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions

This is a review of paper published in the Journal of Research in Nursing about Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions by Louise P Hoyle, Richard G Kyle and Catherine Mahoney. Cite as: De Souza, R. (2017). Review: Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions . Journal of Research in Nursing, 0(0) 1–2. https://dx.doi.org/10.1177/1744987117736600

Mass media comprises the storytellers and portrayers of our social worlds (Nairn et al., 2014), and has a central role in reproducing the contradictory views held about nurses by the public. As the reviewed paper shows, media representations are far from harmless: they influence public understanding and confidence in the profession and impact on recruitment, policy and nurses’ self-image (Kalisch et al., 2007). Nurses are considered
highly trustworthy by the public due to their virtues of care and compassion. However, the dominant representations of nurses in the media are often inaccurate, erasing male nurses from the profession and downplaying the autonomous judgement of the nursing
professional. Nurses as feminised handmaidens play a subordinate support role to medical decision makers. The media nurse engages in bedside routines and repetitive tasks, and is sometimes a sex object, an angel of mercy or a battleaxe, sometimes all three. These stereotypical representations have changed over time, and sometimes nurses are depicted as strong and confident professionals (Kalisch et al., 1981; Stanley, 2008). Yet the significant professional, theoretical and scholarly innovations that have reshaped the role of nurses are largely invisible to the public (Ten Hoeve et al., 2014). In tandem with nursing’s processes of
professionalisation, austerity measures in the neoliberal health system have demanded efficiency and cost containment, while also reorienting services so they can be more clientcentred. This twin move to the proletarianisation of nursing care (through the growth of
various classes of healthcare assistants doing tasks previously performed by nurses) and democratisation of health within a technocratic, market-led and more participatory health system has profound implications for the future of nursing.

The reviewed paper is timely, given the growing focus on shared decision making and participation as an outcome of client-centredness in Western health systems. It raises questions about the customary role of nurses as gap fillers and problem solvers, who maintain the status quo on doctors’ orders. New media channels such as the Internet allow access to on-demand health information outside of authoritative channels, and new
technologies such as fitness trackers and wearables produce a wide range of personal health information. These technologies do some of the work of nursing in the sense that they put recipients at the centre of the health experience and allow health information to enhance the consumer’s knowledge of, control of and impact on their own healthcare. The role of the
nurse as a facilitator in these new flows of health information is yet to be effectively represented within the profession’s view of itself, let alone in the mass media, as this paper suggests.

The reviewed study’s findings on the aversion felt by nurse participants to informed consumers is an issue with significant ramifications. The question that remains is whether there is an opportunity for nurses to enter the public sphere in a meaningful alignment with consumer aspirations for healthcare? If healthcare is to become more participatory, equitable and consumer-driven, what transformative changes will we as nurses need to
make in our own self-identity and practice?

References
Kalisch BJ, Begeny S and Neumann S (2007) The image of the nurse on the internet. Nursing Outlook 55(4): 182–188.
Kalisch BJ, Kalisch PA and Scobey M (1981) Reflections on a television image: The nurses 1962–1965. Nursing & Health Care: Official Publication of the National League for Nursing 2(5): 248–255.
Nairn R, De Souza R, Barnes AM, et al. (2014) Nursing in media-saturated societies: Implications for cultural safety in nursing practice in Aotearoa New Zealand. Journal of Research in Nursing 19(6): 477–487.
Stanley DJ (2008) Celluloid angels: A research study of nurses in feature films 1900–2007. Journal of Advanced Nursing Available at: http://onlinelibrary.wiley.com/doi/10.1111/j. 1365-2648.2008.04793.x/full (accessed 30 September 2017).
Ten Hoeve Y, Jansen G and Roodbol P (2014) The nursing profession: Public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing 70(2): 295–309.

The Australian Women’s and Gender Studies Association (AWGSA) member profile

If you could have a superpower, what would it be?

Fearless speech or parrhesia.

Favourite food?

I have to say Goan food. It represents connection to my ancestral homeland, as well as to my family. It has sustained me through multiple migrations and immediately evokes comfort and nurturance.

What do you think is an important feminist issue in Australia at the moment?

The policies of detention and deterrence that are being invoked in the state management of asylum seekers

Why are you a member of AWGSA?

As a relative newcomer to Australia, I want to be involved in the inter-disciplinary conversations happening in feminist spaces. I attended the conference in Melbourne two years ago and made some great new friends. As a nurse socialised into a very gendered hierarchy, I have a unique contribution to makes as a feminist woman of colour, but I don’t want to be limited to conversations only within my discipline.

If you could have been at one historical event, which one would it have been?

Being a diasporic Goan I would have been interested in being at the liberation/Invasion of Goa by the Indian government.

Who are your academic/feminist heroes?

Octavia Butler (overcoming shyness, having self-belief and being committed to her writing), Audre Lorde (for living with illness, for her writing), Angela Davis (for her activism).

Where would you like to live?
Exactly where I live now, South Gippsland.

What do you appreciate most about your friends?

I’d have to say conversations that are energising, learning, rich and which mean that the friendship continues to deepen and has potential for depth and transformation.

Favourite book?

Too many to count but I’ve just been reading Jhumpa Lahiri’s short stories and am awed by her ability to draw you into her character’s worlds. Another favourite was Americanah by the Nigerian author Chimamanda Ngozi Adichie.

A goal?

To learn more about the Aboriginal history of Australia and Aboriginal feminists. Not in an appropriative way but to be a better ally.

Review: Australian mental health nurses and transgender clients: Attitudes and knowledge

This is a longer version of a review of Damien Riggs & Clare Bartholomaeus’ paper published in the Journal of Research in Nursing: Australian mental health nurses and transgender clients: Attitudes and knowledge. Cite as: De Souza, R. (2016). Review: Australian mental health nurses and transgender clients: Attitudes and knowledge. Journal of Research in Nursing, 0(0) 1–2. DOI: 10.1177/1744987115625008

I have never forgotten her face, her body, even though more than twenty years have passed. She was not much older than me and she desperately wanted to be a he. I had no idea how to respond to her depression and her recent self-harm attempt in the context of her desire to change gender. There was nothing in my nursing education that had prepared me for how I might be therapeutic and there was no one and nothing in the acute psychiatric inpatient unit that could resource me. I feel embarrassed now that I had no professional understanding and experience to guide me to help me provide effective mental health care to my client. I was an empathic kind listener, but I had been immersed in a biologically deterministic (one’s sex at birth determines ones’ gender) and binary view of gender despite my own diverse cultural background which I had been socialized to see as separate from my mainly white nursing education. I had not been educated to critically consider discourses of sex and gender, to provide competent safe care to someone who wanted to change her gender and express her gender differently from normative gender categories (Merryfeather & Bruce, 2014). My work has since led me to consider the ways in which “differences” are produced culturally, politically, and epistemologically specifically in terms of categories including “race”, ethnicity, nationality, class, and more recently sexuality and gender.

Four critiques of biomedicine as a dominant framework for understanding ‘problems with living’ have inspired transformation of the mental health system. Firstly, the emphasis on participation and inclusion through consumer-led and recovery-oriented practice has profoundly changed the role of consumers from passive recipients of care to being more informed and empowered decision-makers whose lay knowledge and personal experience of mental illness are a resource (McCann and Sharek, 2014). This reconceptualisation has been formalised in the ‘recovery’ model, which has critiqued the stigmatising judgements of medico-psychiatric discourse about deviance and their accompanying social exclusion and disadvantage (Masterson and Owen, 2006). The third has been the recognition of cultural diversity and a critique of the limits of universalism. Finally, gender activism has exposed fractures in the sex/gender system and has led to a greater awareness of diversity, with regard to gender and sexual orientation.

Of these critiques, gender activism has received the least attention in mental health nursing; which is a concern, given the negative effects of heteronormativity and cisgenderism. Mental health nurses must continue to challenge or trouble the dominant binary views of gender and the discourse of biological determinism, the notion that the sex that one is assigned at birth determines ones’ gender (Merryfeather and Bruce, 2014). There is growing evidence of negative attitudes, a lack of knowledge, and a lack of sensitivity toward people whom are expressing diverse genders and sexualities. This discrimination creates barriers to the patients’ health gain and creates disparity (Chapman et al., 2012; McCann and Sharek, 2014).

The reviewed article on the attitudes of mental health nurses towards transgender people is therefore timely, given the relative invisibility of issues of gender identity within nursing theory, practice and research. As Fish (2010) wrote previously in this journal, the culture, norms and values of social institutions can inhibit access to healthcare and reinforce disparities in health outcomes. Cisgenderism (the alignment of one’s assigned sex at birth and one’s gender identity and gender expression with societal expectations) suffuses every aspect of clinical access to and through services, from written materials including mission statements, forms, posters and pamphlets; the built environment such as gender-specific washrooms; and interactions with both health professionals and allied staff, all of which reinforce a message of exclusion of transgender people (Baker and Beagan, 2014; Rager Zuzelo, 2014). In turn, these exclusionary practices are shaped through a dearth of policies and procedures, and scant educational preparation at the undergraduate and graduate levels (Eliason et al., 2010; Fish, 2010).

Nurses have a professional responsibility to challenge structural constraints and social policies, rather than passively accepting them. This paper provided compelling evidence for how nursing as a discipline and mental health nursing as a unique speciality can critically reflect on discourses regarding sex and gender; and on how these influence practice and consequently, can develop safer, ethical, effective and high-quality care for people whom either change their sex or express their gender differently from the standard culturally determined gender categories (Merryfeather and Bruce, 2014). Furthermore, this paper challenges mental health nurses to challenge heterosexism and cisgenderism; to speak out about social determinants of health that contribute to health inequities and health disparities, such as transphobia; and to address discrimination against transgender people. These challenges must be embedded into processes at the organizational, regulatory and political level (DeSouza, 2015).

References
Baker K and Beagan B (2014) Making assumptions, making space: An anthropological critique of cultural competency and its relevance to queer patients. Medical Anthropology Quarterly 28(4): 578–598. doi:10.1111/maq.1212.
Chapman R, Watkins R, Zappia T, et al. (2012) Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing 21(7,8): 938–945. doi:10.1111/j.1365-2702.2011.03892.
De Souza R (2015) Navigating the ethics in cultural safety. In: Wepa D (ed.) Cultural safety. Port Melbourne, Australia: Cambridge University Press, pp. 111–124.
Eliason MJ, Dibble S and Dejoseph J (2010) Nursing’s silence on lesbian, gay, bisexual and transgender issues: The need for emancipatory efforts. Advances in Nursing Science 33(3): 206–218. doi:10.1097/ANS.0b013e3181e63e4.
McCann E and Sharek D (2014) Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual and transgender people in Ireland: A narrative account. International Journal of Mental Health Nursing 23(6): 525–533. doi:10.1111/inm.12081.
Masterson S and Owen S (2006) Mental health service user’s social and individual empowerment: Using theories of power to elucidate far-reaching strategies. Journal of Mental Health 15(1): 19–34. doi:10.1080/0963823050051271.
Merryfeather L and Bruce A (2014) The invisibility of gender diversity: Understanding transgender and transsexuality in nursing literature. Nursing forum 49(2): 110–123.
Rager Zuzelo P (2014) Improving nursing care for lesbian, bisexual and transgender women. Journal of Obstetric, Gynecologic and Neonatal Nursing 43(4): 520–530. doi:10.1111/1552-6909.1247.