This chapter examines some of the more recent sociological writings on nursing and discusses them in relation to the practical insights they have to offer for nursing.
Recent nursing reforms in Australia and the united Kingdom are analyses to see how these might be interpreted through a sociological lens. Implicit in this analysis will be a focus on the tension between the structure of the health system (particularly the influence of medicine) and the agency of nurses in these different accounts of nurses and nursing work.
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Key terms agency biological determinism biomedical model class discourse doctor/nurse game empirical essentialist ethnography feminism/feminist 314 gender horizontal violence materialist analysis medical dominance meta-narratives nurse practitioner patriarchy phenomenology post-structuralism primary health care (c) Oxford University Press Second Opinion 3rd edition, 2005 For individual use only reflections project racism sexual division of labor (OSDL) social institutions social structure structure-??agency debate theory GERMEN-PAGES/RENAL 3:06 PM page 315 Nursing and Sociology: An Uneasy Relationship 315 Introduction In the period following World War II, nursing training in Australia was broadened to include both the technological and clinical advances that had occurred as a result of nursing experiences in war. Further expansion of nursing curricula occurred during the asses and asses to include input from the social sciences, namely psychology and sociology. This was based on a IEEE of nursing that held that nurses needed an understanding of the social context of health c a re deliver rye as well as the individual, psychological needs and perceptions of their patients.
The sociology introduced at that time, with few exceptions, revoke Veda around the concept of’ or I e s’ and role relationships, such as the role of the doctor and nurse in health care deliver rye and ‘the role of the patient in hospital care’. As such, it encouraged an acceptance of existing social relationships and their hierarchies of power and authority. It did, never ruthless, encourage nursing students to think about social relationships and the impact of these relationships on nursing work and on patient care. As the 1 sass pro g erased, the popularity of more radical approaches within sociology began to be taken up and applied to sociology courses within nursing education. New interpretations of nursing history and practice, based on feminist theory in part c u I a r, began to appear, especially in theory the new diploma and later degree courses within universities.
These A system of ideas that uses courses encouraged a more critical examination of nursing history and researched evidence to explain reactive, as well as a more critical interpretation of the relationship of certain events and to show nursing to other health occupations, especially medicine. Why certain facts are related. See chapter 2 for an overview of feminist theories At the same time as broadening the ways of understanding nursing, these more radical approaches had the unintended effect Of presenting nursing in a much more negative light; so much so that in recent years, sociological writings about nursing have presented an almost uniformly negative picture.
Repeatedly, nursing has been presented as a ‘subordinated’ occupation, and urges themselves as passive victims of medical power. While there have been differences in the way that various sociological perspectives view nursing, it is also possible to see a consistent theme running through all the interpretations, from social histories of nursing through to more radical feminist accounts. In the historical accounts, it is argued that many of the enduring characteristics of nursing have their roots in nineteenth-century gender re gender/sex actions and associated ideas re GA riding the appropriate behavior for This term refers to the women in Victorian society.
This argument has become the ‘holy grail’ of socially constructed structuring history and is trotted out whenever a potted history of nursing is gorier of feminine and masquerade as an introduction to current trends in nursing. For instance, it cline (the cultural values that has been argued that ‘Ct]hose [strategies] replicated within the hospital dictate how men and women the existing gender relationships of Victorian society, and did not shoulder behave), as opposed Lange pre availing male notions of womanly behavior. D f e Renee to docs to the categories of biological sex (female or male). Torso and acceptance of the “handmaiden role” was a cornerstone of this GERMEN-PAGES/ANAL 316 Page 316 The Social Organization of Health Care: Professions, Politics, and Policies strategy’ (Be a redraws & Robinson 1990).
And in an Australian version, it is explained that ‘[s]nice 1 868, when the first Nightingale graduate arrived in Australia, nursing as an occupation has tended to attract re I a it eve passive and subordinate women from middle and lower class lay backgrounds who have accepted that their occupation was inferior and subordinate to malcontented medicine’ (SSH o art & Sherman 1 995, p. 236). In all of these potted historical overviews, and in the analyses that follicles (or social class) low, there is a theoretical and logical flaw. It is assumed that the political A position in a system of strategy of those in charge and the real-life behavior of the nurses in structured inequality based on the unequal distribution of question we re one and the same. Victorian doctors and administrators power, wealth, income, and may well have desired the nurse to be ‘restrained, disciplined and beatitudes.
People who share a .NET, [carrying] out the orders of doctors in a suitably humble and deferral’s position typically share entail way’ (Davies 1977). But this did not mean that matrons, nurses, similar life chances. ND sisters always cooperated in this way. T h e re is ample evidence to show that they frequently did not. For instance, in the earliest era of modern nursing in London, there was an important dispute at Guys Hospital A research method that is b e t when Mrs. Buy art (the matron) and the doctors (Able-Smith 1960), and based on direct observation of a particular social group’s the e re we re also the disputes at SST Thomas Hospital over the timing of social life and culture-??of medical rounds (the Doctors versus the Nurses’ 1 962, up. 783-??4). In what people actually do.
Australia, the disputes between Lucy Osborn, the doctors, and the lay administrators at the Sydney Infirmary we re so intractable that the governmental violence ornament of the day had to re s o art to a Royal Commission to settle (in the A concept derived from Paolo matron’s favor) the struggle for authority (Wicks 1 Bibb). In addition, Ferrier that describes a evaluators history has documented various forms of industrial action taken our common to all c o I e c t eve by nurses over the past century. Finally, ethnographic studies lay oppressed groups, whereby, h a eve revealed numerous examples of negotiation, disagreement, suave arbutuses of their powerlessness, the oppressed are signs, and open conflict s constant elements of nurse-doctor interactions unable to direct their anger within hospital settings (Game & Pricing 1 983; Hughes 1988; Porter towards their oppressor and 1995; Sevenths 1996; Wicks 1999).
Against this evidence, an orthodoxy so turn it towards each Other, has developed within both mainstream and more radical approaches that with various degrees fashion focused on the power of doctors, hospitals, and medicine more gentlemen and negativity. Really. Nurses we re thought to have inherited a tradition of passivity and powerlessness, and worse, a tendency to engage in horizontal violence social structure Or b e arts 1983). Indeed, given these characteristics and the twin edifices of The recurring patterns of social interaction through class and gender, the position of nurses was considered to be all but hopscotch people are related to less (SSH o art& Sherman 1995). The common thread running through each other, such as social these accounts has been an emphasis on the power of social structure to institutions and social groups. Shape and control nurses’ work, identity, and behavior.
More recently, theoretical developments in feminist theory, and within sociology more generally, have promoted a re-examination of the A eye debate in sociology debate concerning individual choice versus determination by outside over the extent to which forces (structure-agency debate), and of the need to understand an human behavior is determined by social structure. Issue that has such important implications for politics and social life. 306 PM page 317 Through the influence of post-structuralism, there has been a reemphasizes on individual choice and action in the making and re-making of social institutions. While some authors think that this trend has gone ‘too far’ (Wally 1992), others see it as liberating, challenging the ‘grand narratives’ that hairdresser groups such as women as being oppressed by strong and unchanging social structures (Barrett 1991). Shall begin With a brief review of some earlier feminist approaches to nursing, of what they had to offer, and of what they missed.
I will then examine nursing responses to these, discuss new sociological approaches to nursing, and look at recent developments and directions for nursing practice in Australia and Great Britain. Finally, I will address the question of how nursing and sociology might have a more mutually productive relationship in the future. 317 post-structure realism/ postmodernism Often used interchangeably, these terms refer to a broad perspective that is opposed to the view that social structure determines human action, and instead emphasizes a pluralistic worldview that explores the local, the specific, and the contingent in social life. Formal structures within society-??such as health care, gob- Earlier feminine sit approaches ornament, education, religion, and the media-??that are organized to address identity- fled social needs.
In the early asses, two writers from the USA-??Barbara Rehiring and Deirdre re English-??turned conventional theories on their head with their sexual vision of labor pamphlet Witches, Midwives and Nurses: A Hi SST o rye of Women Healers This refers to the nature of (1973). Their work, with its strong feminist perspective, was a breath of work performed as a result of fresh air in a field dominated by conventional histories of medicine. And gender roles. The stereotype is yet its widespread influence in the decades since its publication has also that of the male breadwinner had a detrimental effect on feminist sociological analyses of nursing. This and the female home-maker. Teems from the way that Rehiring and English view the struggle within lath care as something that took place in an earlier period between train unproven belief that nontraditional women healers and formal male practitioners. According to their Vidal and group behavior analysis, the defeat of the women healers ushered in an epoch of wideband social status is an spread subordination to organized, scientific male medicine. For instance, inevitable result of biology. They are critical of middle-class reformers, such as Florence Nightingale, and of nineteenth-century feminists who ‘did not challenge nursing as an oppressive female role’ (1973, p. 38). This analysis overlooks much that is An analysis that is embedded crucial to a dynamic analysis of the historical relationship between nursing the real, actual, material reality of everyday life. Ins and medicine.
By viewing the nineteenth-century formation of modern nursing only in terms of capitulation and defeat, the work has had the unintended effect of devaluing contemporary nurses and nursing work. The most influential piece of writing on nursing and its relationship to medicine is Eve Gawkiness’s ‘Sexual Division of Labor: The Case of Nursing (1978). In this important paper, Kangarooing challenges accounts of the sexual division f labor (OSDL) that are based on ‘naturalism’ or biological determinism-??that is, the idea that it is ‘natural’ for women to be nurses in the same way that women are ‘naturally’ maternal. She argues, rather, for a materialist analysis, which locates the OSDL as a social relationship that is not inevitable or natural 318 Page 318 but that has been socially constructed.
This was such a significant breakthrough, in an area typified by naturalist explanations, that sociological analysis to this day continues to refer to it to establish a position that runs counter to biological or naturalist accounts of the nurse-??doctor relationship see, for example, Game & Pricing 1983; Hazelnut 1 990; Russell & Sheffield 1986; Short & Sherman 1995; Willis 1983). It is still widely regarded as the necessary foundation on which any critical sociological account of nurse-doctor relations must be built. Howe eve r, upon closer examination, it is evident that G m a r n I k account is located a s q u a rely within a ‘modernist’ feminist theoretical model, with its attendant problems of overstraining and universalistic. In this case, Ga m a r n k owe generalizes the structural o p p erosion of all nurses by all doctors through patriarchal ideological strut CT u re.
While G m a r in k sows approach provides a crucial sense Of the strength and pervade s I venues Of social a s t our c TU re in explanations of the OSDL, it does so at a price. Both Or b e art. Connell (1987) and, more recently, Anne Witt (1992) make the point that this approach ignores or at least minimizes the importance of patriarchal practices within the labor market and the workplace itself. What is the point of resistance in the workplace if gender (and/or class) relations are determined elsewhere? The effect of this emphasis on patriarchal ideology ND strut CT u re in Ga m a r n I k sows account, and other accounts derived from this analysis, has been the re presentation of nurses as an undifferentiated bloc of subordinated women.
Individual or cool e c t I eve acts of resistance have either been ignored or minimizes, being characterized as insignificant or as yet another variant of ‘complaint’ among nurses (see Turner Bibb). The emphasis on an all-pervade s eve ideological strut c TU re has also had the effect of denying nurses subjectivity (their own identity), for in accounts based on the power and pervade s I venues of strut c t u re, the voices f nurses we re rarely heard. (There are some e exceptions, Howe veer: notably the work of Game & Pricing 1983. ) patriarchy A system of power through Comparisons contribution was pivotal for a critical reassessment of which males dominate the conventional literature on nurse-doctor relations.
Indeed, the households. It is used more emphasis on power relationships in general, and patriarchy in particularly by feminists to refer lard, opened up the traditional nurse-doctor relationship to a sophistic society domination by acted and long overdue sociological critique. Nevertheless, an emphasis patriarchal power, which n structural oppression, and on an inferred passivity on the part of functions to subordinate nurses, also runs the danger of indirectly contributing to the status quo women and children. By emphasizing the inevitability and hopelessness Of the situation. Medical dominance A general term used to describe the power of the Nursing backlash? Deiced profession in terms of its control over its own work, over the work of other health workers, and over health resource allocation, health policy, and the way that hospitals are run. Given these theoretical directions and assumptions, there was certainly attention for academics, students, and intellectual leaders in nursing to develop an ambivalent attitude towards sociology and towards feminist sociology in particular. Why are sociology lecturers so surprised when student nurses appear hostile to their lectures on medical dominance 1/12/08 Page 31 9 319 and begin, in their postgraduate work, a mass exodus towards phenomena main aim is the analysis oenology? Why, indeed, are academics surprised that students do not and description of everyday enthusiastically embrace the notion that, on graduation, they are to be life.
It is the study of the ways nominated and oppressed as both women and nurses? Is it any wonder in which individuals construct that they prefer to believe their nursing mentors, who make use of the the daily realities of their more comforting language of professionalism, with its associated charcoals world through intercontinental of nurses as authoritative, autonomous practitioners? Zion with others. Interestingly, this is not the case with those working, clinical nurses who professionalisms/ enter universities on a part-time basis as mature-age students.