Technorati href="http://www.technorProfile Thinking Nurse: Human Solidarity In Nursing - Theory and Practice

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!

Tuesday, May 17, 2005

Human Solidarity In Nursing - Theory and Practice

To what extent should social consciousness be a part of nursing theory, and of nursing practice?

I have just received an excellent and aposite reply from 'RNegade' to my post on the need for social consciousness in nursing theory. The reply is so relevant to the serious social questions facing Nurses today that I am reposting it here in full, followed by my reply:

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.

Thankyou for your comment RNegade, this is precisely the kind of debate and discussion I hoped to provoke when I started this blog. The questions you raise go directly to the heart of the crucial questions facing Nursing as a Profession in the context of a world society with such a breathtakingly steep gradient of wealth and power between a small elite and the rest of society.

I appreciate the thought you have put in to your comment, and will attempt to reply to your points paragraph by paragraph.

You suggest that a theory of Nursing as Human Solidarity should be grounded in concrete care situations, it is something that should apply to nurses in their work, as well as what they do outside work. I agree. 'Activism' as you term it, can take many different forms, and the form it takes within the workplace would neccessarily be different from that in the nurses 'own' time.

I would argue that simply being in possession of social consciousness would change the practice of many nurses in a way that makes their response to patients, different and more appropriate, their care responding to the person's social situation, rather than to a textbook version of an idealised patient.

People whose health is challenged tend to be disempowered by this very fact - you illustrate yourself the question of the powerlessness of patients when they are expected to wear gowns etc. Ill health and disability are shunned and feared in our society which focuses as you say on productivity and profit.

The question of health itself is inextricably linked to social and economic factors, with people from the most oppressed sections of society experiencing the worst health outcomes. In my own area of nursing, for example, people with learning disabilities are 58 times more likely to die before the age of 50 than the rest of society.

You suggest that a theory of Nursing As Human Solidarity could be as sterile as other 'Grand Theories' of nursing. It couls be that these 'Grand Theories' were so sterile because they confined themselves within the walls of the hospital, excluding the social realities outside,

These social realities disrupted these theories because they exist in the hierarchies of healthcare organisations, in legislation affecting healthcare, in the economics of healthcare and in the life experience of patients and nurses themselves.

Your points about Abu Ghraib and Guantanamo are well made. I have made similar points about the role of nurses and other health staff in the 'euthanasia' by the Nazis of thousands of people with Mental Health problems and Learning Disabilities in 1930s Germany.

These are the dire potential consequences of a lack of social consciousness within the Nursing Profession: By not having an explicitly stated 'Theory of Nursing as Human Solidarity', these nurses at Abu Ghraib and Guantanmo have instead adopted the implicit 'me first' values of western capitalist society, and accepted unquestioningly the existing power structures and the unethical actions that flow from these values and structures.

There is a need for theory here, unless we have an alternative to offer, all that remains are the hegemonic values of the powerful corporate elite.

A theory of Nursing as Human Solidarity would put human rights at the centre of Nursing Practice, making the preservation of human rights a key ethical responsibility of the Nurse. As you state so well "The frame for opposition to dehumanization is the hands-on daily work of nursing." This does require leadership, the willingness to speak out and preparedness to swim against the stream. This can be in big and small ways.

In the UK Nurses have an ethical obligation to challenge poor care practices and inadequate care situations. Legal protections for 'whistleblowers' are in place. Individually nurses still feel very exposed when they do challenge existing practices in this way, and there is a clear need for collective organisation that will back up those who stand up in this way.

You argue that "Practices, however, are the substance of care. To accomplish structural change is more a matter of organizing than theorizing." Theory without practice is indeed sterile, but practice without theory is blind.
There is indeed a 'theory - practice gap' in nursing, but this does not mean we should throw theory out of the window, instead we should be looking at ways to make our theories better and more directly relevant to the situations facing nurses.

The existence of the gap could be because existing theories have neglected to take into account the realities of how the social, economic and power structures of society affect the care situation and care practices.

A theory that directly and accurately addressed some of the unpalatable truths about our society might be more relevant and applicable to the day to day work of Nursing


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