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Reproduced with Permission of the Copyright Owner. Further Reproduction Prohibited Without Permission A b stra ct A Case Study of the Professionalization of Mexican Nursing: 1980 to 2005 Allison Patricia Squires 2007 The study of the evolution of a healthcare profession in a developing country context has many implications not only for healthcare human resources policy structuring, but also for health and development outcomes. With the global shortage of nursing personnel, understanding the country-specific factors involved in the recruitment and retention of nurses into the profession becomes critical for ensuring ongoing, quality health care services delivery. Using theories about professions, an examination of the process of the professionalization of nurses is one way to improve understanding about nursing human resources. Professionalization is a developmental process that structures how a group organizes to advance itself socially, politically, and economically in a country. Mexico is an economically high-middle income country with an established but underdeveloped nursing profession. This exploratory case study examined the professionalization of nursing in Mexico between 1980 and 2005 with the aim of improving understanding about Mexican nursing human resources. The twenty-five year period was selected because it represented a period of significant economic and political change in Mexico that would have impacted Mexican nurses both personally and professionally. Methods included semi-structured interviews with 32 Mexican nurses from both rural and urban healthcare settings, an extensive interdisciplinary literature review from the designated period, and a contextual analysis of Mexican federal government and Ministry of Health documents related to nursing human resources. Study findings indicate that eight variables strongly affect the development of the nursing profession: professionalization processes, the workplace, unions, history, economic, political, sociocultural factors, and international influences. The relationships among the variables suggest the presence of a country-level “nursing system” that produces nursing personnel and affects health-system outcomes. To illustrate the relationships and potential effects on these outcomes, a theoretical model was developed. The findings of this study have implications for the production, development, and management of nursing human resources in other developing countries and may also apply to nursing in developed countries. -i- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. A Case Study of the Professionalization of Mexican Nursing: 1980 to 2005 A Dissertation Presented to the Faculty of the Graduate School of Yale University in Candidacy for the Degree of Doctor of Philosophy by Allison Patricia Squires, MSN, RN Dissertation Director: Sally Solomon Cohen, PhD, RN, FAAN December 2007 -ii- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. © Copyright 2008 by Allison Patricia Squires. All rights reserved. -iii- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents Chapter 1: Introduction........................................................................................................................ 1 Why Mexico?..................................................................................................................................... 5 Chapter 2: Review of the Literature.................................................................................................11 The Importance of Professional Human Resources for Healthcare Services Delivery 11 Professions........................................................................................................................................14 Nursing and Professionalization.................................................................................................... 21 The Mexican Economy in the Late Twentieth Century.............................................................. 26 Historical and Political Aspects of the Mexican State in Relation to Nursing and Healthcare Services in Mexico........................................................................................ 35 Sociocultural and Gender-Based Variables and the Development of the Nursing Profession in Mexico.................................................................................................49 Chapter 3: M ethods............................................................................................................................. 56 Time, setting, and sample ............................................................................................................... 57 Data collection and management................................................................................................... 60 Data analysis.................................................................................................................................... 64 Chapter 4: Results, Part A - Descriptive Statistics and Document Analysis ............................67 Period I: 1980 to 1993 - Economic Collapse and Its Consequences..........................................72 Period II: 1994 to 2000 - NAFTA, The Peso Crisis, and Jump-starting Professionalization....................................................................................89 Period III: 2001 to 2005 - Political Exclusion to Inclusion, Corruption, and the Effects on Professionalization................................................................................. 102 Policy Legacies of the Mexican State..........................................................................................110 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 5: Results, Part B - Interview Analysis.......................................................................... 116 Interview Sample......................................................................................................................... 118 Present-day Legacies of Economic Instability............................................................................129 The Sociocultural Aspects of Gender and Their Effects on Mexican Nursing.......................134 Professionalization: The Influence of Internal Dynamics.......................................................145 The Workplace............................................................................................................................... 170 Unions............................................................................................................................................. 185 International Influences: Globalization and Mexican Nursing................................. 192 Future Visions: The Hopes and Dreams of Mexican Nurses for Their Profession................ 194 Chapter 6: Discussion ........................................................................................................................ 199 The Nursing System: A Conceptual Model and Significant Findings .....................................200 Professionalization: Pros and Cons............................................................................................. 220 Limitations......................................................................................................................................215 Potential Implications of the Study............................................................................................. 217 Suggestions for Future Research................................................................................................. 220 Conclusion............................................................................................................................................233 References............................................................................................................................................ 235 Appendix A: List of Abbreviations and Acronyms..................................................................... 290 Appendix B: Chronology of Healthcare and the Nursing Profession in Mexico...................293 Appendix C: Interview Guides in English and Spanish ............................................................. 298 Appendix D: Conceptual Definitions of the Major Themes Affecting Professionalization.....................................................................................300 Appendix E: A Theoretical Conceptual Model of the Nursing System...................................303 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. List of Tables and Figures Tables 1: Document origins and types.......................................................................................................... 68 2: Sample demographics................................................................................................................... 119 3: Salary data reported by nurses in the study ................................................................................120 4: Site data for Mexico City and Oaxaca........................................................................................ 121 5: 2005 Mexican Education System Enrollments with Gender Breakdown............................... 122 6: Physician and nursing human resources data for Mexico
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