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Thinking Nurse

This blog will reflect my interests in learning disabilities, nursing, nursing theory, philosophy and politics and my general interests in the arts and literature. (Nursing is an art as well as a science!) Philosophy and nursing have been intrinsically linked since the days of Socrates, his mother was a midwife, and taught him everything he knew!

Thursday, December 09, 2004

The Need For Social Consciousness In Nursing Theory

Here is a piece I wrote, originally as a post to the student nurses' discussion board on the International Council of Nurses website: it received no replies!

"I have been studying some nursing theories, and feel that many, if not all, lack awareness of social and political issues.
I do not disagree with studying closely the relationship between nurse and patient, but I feel that many such approaches rip the patient out of the social and political world and view him instead as an isolated individual.

Many major health factors facing people today are social and political - the domination of the globe by huge multinationals, which are affecting the way we spend our time, what we eat, how we interact with each other. The results are overwork, stress, obesity, violence etc etc, all the 'ills' of modern society.

The effects on the ex-colonial countries of exploitation by the multinationals is more devastating still, with a third of the world's population living on less than a dollar a day.

We cannot ignore the major deleterious effect that war has on the physical and mental health of all those it affects, or that behind every war there are economic motives.

Nurses need to look at society itself, and the way it discriminates against those who are different. People with physical disabilities, mental illness, with learning disabilities, or who are simply 'neurodiverse' find themselves excluded and discriminated against.

The position of nurses themselves in society also needs to be considered. All too often nurses are low paid and overworked, in a society that values stockbrokers and arms manufacturers above healthcare workers.

Perhaps because nursing theories have trapped themselves inside the hospital, nurses have seemed nervous about commenting on these major political issues (with several important exceptions!).

I am searching for a 'theory of nursing as human solidarity', which treats human beings as social and political, as well as personal, enabling nurses to look at approaching the social and political causes of much ill health, rather than always struggling to cope 'firefighting' the symptoms. Such a theory could be informed by the social model of disability - but reflect more specifically the potential of nurses to intervene as socially conscious health activists."


At 3:16 PM, Anonymous RNegade said...

The problem I see with a Theory of Nursing as Human Solidarity is that unless it is grounded in concrete nursing situations, activism becomes something nurses do outside their work. Assuming this would be on the level of the "grand theories," the same sort of inapplicability that kept practicing nurses from using these theories would likely occur.

For many of us, activism is part of our identity as nurses, but in the US it amounts to lobbying efforts and political work outside our roles as nurses. Perhaps it is different in the UK.

The need for social consciouness in nursing has never been greater. For example, who were the nurses at Abu Ghraib and Guantanmo Bay that allowed alterations of records, use of mental health histires as means of determining vulnerabilities to be exploited in interrogation, and concealment of torture injuries, and concealment of homicide through insertion of tubes post-mortem to mimic patient care that was never given? We ought to rein in our own unethical colleagues, and publically repudiate their actions. At the same time, we must closely examine how structural and discursive elements constrain nurses from preserving human rights.

The social consciousness question hinges on autonomy with accountability in the direct care sphere. To the extent that nurses cannot or will not protect patients from human rights abuses, the door is open for neglect, maltreatment, inadequate treatment, and selective access to services.

Nursing education, at least in the US, is geared toward conformity. Collectively organizing or individually acting in response to a poor care situation is not considered an essential "skill," or a great deal more time would be devoted to it.

Social consciousness is needed on the global level as well as in the microcosms of a society that are replicated in the care situation. These include gender, racial, religious, class, and sexual orientation biases. Analysis of cases needs to include the effects of these biases on the health of the patient, and the degree to which the care situation is potentially a context for reinforcement of repression.

Foucault describes "discipline" in part as a function of the roles played by police, teachers, nurses, physicians, etc. who create expectations for correct behavior. There is no argument when a nurse tells someone to remove their clothing and put on a patient gown. It is an expectation that does not require a reason, because patients already "know the drill." Recognition of the subtle, and direct ways that nurses already function to reinforce the powerlessness of patients' predicament in the care situation should come first.

We cannot rest on the consensus that the core of nursing is care, and thus we are opposed philosophically to oppressive and dehumanizing conditions. Nurses perpetuate discourses that conceal abuses, disparities in care, and deferral to profit motives. For too long we have been preoccupied with our constraints as an "oppressed group." We are highly educated, and indispensible to the functioning of any health care system. We are not powerless.

The frame for opposition to dehumanization is the hands-on daily work of nursing. It is there that critical examination and exposure of nursing complicity in oppressive practices is most needed, and admittedly, most difficult.

I am making the case for social consciousness in nursing practice. Thus far, in the US, theory has not guided practice, except to some degree at the middle range and situation-specific levels. We have an ethical standpoint in many international nursing documents about human rights, and our support of the right to health and health care. Theory would seem to be a potential bridge to the application of stated values. Practices, however, are the substance of care. To accomplish structural change is more a matter of organizing than theorizing.

At 12:25 PM, Blogger Thinking Nurse said...

Thanks for your excellent and considered comment RNegade.

I have posted my reply to your comment here:

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