An Ethnographic Study of Nursing on a Surgery Ship Providing Humanitarian Care

Abstract

Less than half the world’s population has access to essential health services (United Nations, 2020), the majority of whom live in low to middle-income countries (LMICs; Meara et al., 2015). The inability to access health services denies people a life of dignity. To bridge this current gap in the provision of health care, nongovernmental organisations are responding by deploying specialist, short term healthcare teams (Ng-Kamstra et al., 2016). Nurses, as the largest group of health professionals, provide care within those teams. Substantial literature is linked to nurses deployed in a disaster response situation, However, there is limited research into nurses’ roles within teams meeting a humanitarian response outside that urgent disaster context, and what their contribution brings. The purpose of this ethnographic study was to explore nursing involvement within humanitarian healthcare provision to generate insight into the area of humanitarian nursing in an acute, short term, nondisaster context and to extend the research literature surrounding this topic. The study was framed within the context of a faith-based nongovernmental organisation delivering specialist surgery on a civilian hospital ship. The aim was to advance the mission and purpose of humanitarian (nondisaster) nursing, providing a detailed description of the culture of nursing care in that setting. An interpretivist standpoint, influenced by a social constructivist theoretical position, was taken. Data were collected over 6 months, using participant observation, a reflection of artefacts, and the collective voice of volunteer nurses. Thematic analysis was conducted considering Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Findings elucidated nursing within the context of a community of nursing practice (CoNP), revealing four major themes: (1) “What drew us here?” (expressions of motivation), (2) “Who we are and how we do what we do” (expressions of engagement), (3) challenges (embracing change), and (4) development (expressions of transformation). This study contributes new knowledge by describing the culture of nursing and how nurses enact their care in a previously undescribed humanitarian context. Based on the analysis of findings, a professional practice model (PPM) named HHEALED was proposed. An in-depth application of the model was made to the specific organisational context framing the study. Recommendations arising from this study address nurses’ social and professional roles within humanitarian care that could further validate and strengthen policies and programs for the delivery of humanitarian health care for a mobile platform providing specialist surgical care.