The other side of caring: abuse in a South African maternity ward

Abstract

The abuse of women by nurses in maternity units of hospitals world‐wide has been documented in research conducted by universities, non‐governmental organisations and government agencies. In the current paper, patients and nurses of a maternity unit of one particular South African hospital are interviewed about their experiences of childbirth and their experiences of being nurses in a maternity unit. Interviews were analysed using social constructionist grounded theory and Foucauldian discourse analysis. It was found that in both sets of interviews, patient abuse (as experienced or witnessed) was a prominent theme. Accounts of satisfactory nursing were rare. Previous findings about abuse and ritualised abuse of patients by nurses were thus corroborated. In analysing how such problematic interactions constitute an integral part of medical care in a particular maternity ward, and, as such have become ritualised, sanctioned, normalised and ultimately institutionalised, it was found that nurses (who are typically disempowered in the hierarchy of the medical system) and patients (often considered to be docile passive bodies in the context of a medical ward) oscillate between being passive and active, powerless and powerful in the construction of the nurse–patient relationship. It is suggested that both nurses and patients feel frustrated, disappointed, resentful and even enraged in a context where they cannot be in control and cannot care or be cared for. The study seems to suggest that the empowerment of nurses and patients is necessary in order for the abuse to stop. It is further recommended that future research explore cases where nurses and patients are satisfied with the caring that they have given or received; such studies will illuminate the conditions which make good nursing possible in a different way.

Keywords:

• childbirth
• qualitative methods
• abuse
• nurses

Notes

1. The authors are mindful of the fact that the use of racial categories in South African scholarship is controversial. However, such categories are socially constructed and carry important social meanings As such, the authors believe that, following the argument presented by Jewkes et al. (1998), it is impossible to conduct a meaningful analysis of our findings within the context of Post‐Apartheid without making reference to previous racial classifications, since these still inform existing power relations. In this paper then the category of ‘black’ will be used to refer to those designated as African under Apartheid racial classification. The category ‘Coloured’ is used to refer to South Africans said to be of diverse and mixed racial origins.

2. All relevant quotes were translated into English during the writing of this paper. First translations were done by the first author of this paper, but two experts in translation were consulted about translation and also checked the final translations. It seemed very clear that translation constitutes an important part of the interpretation process. Certain difficult translation decisions are indicated in footnotes.