Читать книгу Discipline of Nursing - Michel Nadot - Страница 11

The daily care routine can be both a lure and a necessary detour. You have to learn to navigate between the two. The lure lies in the fact that the perceptions, sensations and emotions of caregivers cannot be reached by today’s historian. Servants who were both wives and servants did not write! Therefore, any projection into the past is to be forgotten. However, it is still interesting by this necessary detour to try to reconstruct their working world from the traces of their activity in the daily life of hospital care. The geographical space, the job descriptions and rules, the relationship with the powers in place, their living conditions, the capacities demanded in the use of care equipment, the relationship with things and people and the use of their work spaces at least allow us to question their living conditions, the knowledge required for their occupations and the reality of their careers.

During 1970–1980 or so, work on the history of the nursing profession gained momentum within the French-speaking community with the work of historians and/or anthropologists intrigued by traditions relating to the body, health, the dimensions of care and the practical and identity-related conditions of those who provided it. Marie-Françoise Collière, then professor at the École internationale d’enseignement infirmier supérieur de Lyon¹ (EIEIS), paved the way for reflection in 1982 by publishing a historical–anthropological work on care, a work that was noticed by the profession at the international level [COL 82]. Ten years later, she identified with great foresight the difficulties encountered by researchers in nursing sciences when they were interested in the history of their profession.

Restoring the professional group’s memory is not a matter of course. The writings of women caregivers are indeed quite rare. They have an oral tradition and have not left many traces of their activity. “Either they are not introduced to writing or they are denied access to it so as not to write their own writings” [COL 92]. Not very initiated to writing, this is the case of those who were presented as governesses, servants, hospital maids under the Ancien Régime2 and graduate nurses until the end of the 20th Century. We also know that historical sources relevant to the nursing profession and the history of women are not always kept in an official archive department. The public archives “were constituted by men on the actions of men; women only appear in the background, when they appear” [DIÉ 88]. Some hospital archives are rather difficult to access due to the lack of awareness of places of memory.

After the difficulties related to the sources of care practice, Collière also mentions the difficulties related to the subject itself. “Care belongs first and foremost to the history of daily life, of which it is one of the major components. Now, this daily experience is not spectacular; it is part of the mundane, the obvious, what is repeated, but which we cannot do without” [COL 92]. Any elucidation of the history of care practices risks threatening the status quo established within the discipline, because it is representative of the place and role assigned to women caregivers by institutional authorities. If the nurse thinks that she is working in the natural sciences (medicine), discovering that this is not the case and that her discipline is more in the humanities can destabilize the constructed identity. Moreover, for Collière, historical works do not reach “the deculturated mass of midwives, nurses who − with a few exceptions − are unaware of their publication, do not see the interest, do not feel concerned³. Moreover, this is not the concern of professional leaders who, for the most part, are unaware of history or fear its questions” [COL 92]. Nearly 30 years later, we can generally see that this statement still applies!

We can agree with some of the students’ concerns. History does not really help to heal. But it has never displayed that purpose! Nor does it help to apply an ordinary healing technique. It does not help to master the knowledge and daily gestures necessary to take care of people who expect service from nurses. This disillusionment among some students taking a history course when they are impatient to discover their future place of work so that they can finally “be able to give injections or treatments”, to use a cliché, means that the history resulting from fundamental research on the discipline does not provide them with any means of establishing their know-how. This is a fact. The impact of history has no relevance if the motivation to know the traditions of language and where one comes from is met with indifference or incomprehension.

On the contrary, history helps students to build an identity in order to position themselves among the many health professions. It allows them to emancipate themselves from the role attributed to them in the 18th Century by medicine and the ruling classes. “From the nurse’s aide, whose subordinate tasks are defined with industrial precision, to the ‘professional’ nurse, who translates the doctor’s prescriptions into tasks for nurses’ aides, the status of nurses is that of uniformed servants in the service of dominant male professionals” [EHR 15]. We may agree with this view, but the word “domestic” perhaps deserves some attention. It had some value at the time it was introduced. It is then beneficial if the so-called domestic activity is seen as one that makes it possible, in the noble sense of the term, to take care of the life of the estate, the Domus, the house, the hospital, that is, of the living environment of care, of the languages required and of the first spaces of speech. Apart from this kind of representative alienation of women from domestic and free work, which is very present at the beginning of institutional care, it already requires some spatio-temporal skills to understand the organization required for a collective household to function.

History is the mother of all human sciences, Michel Foucault told us [FOU 66]. This is an important statement for the nursing discipline. Nursing is concerned with the human being, and therefore belongs to the human sciences. Are today’s doctors of the nursing sciences aware of this? Now, the history of our language traditions is part of the first research to be carried out in order to imagine an identity for our discipline. “It is indeed more important for a discipline to determine the identity of its knowledge than to question the identity of the people who refer to it” [NAD 12a]. One does not become a nurse before using knowledge of the same nature as the proclaimed identity. History clearly shows that the title “nurse” is a myth for lay people [NAD 12b]. It came into being before the conceptualization of knowledge took shape or before the “nursing metaparadigm” and its theories became known. At a time when charitable and welfare institutions are growing and common sense is mixing their values or ideologies at the end of the 18th Century, it is important to rediscover according to which values and in which space of origin the activity of those who today are seeking a scientific identity to give to their own discipline began. In the French-speaking tradition, in the first half of the 20th Century, people began to call themselves “nurses” after having been given an identity imposed by doctors. This was in reference to a Franco-Catholic model of care (nuns), but before having been able to give a name to the discipline and conceptualize theoretical conceptual models in nursing or care theories.

It is the weight of the past that makes the invention of the future possible, it is said. This statement by the French historian Fernand Braudel highlights the fact that history brings to individuals the substance of their consciousness. Without history, individuals are condemned to follow the system of the moment. Not always giving the right place to historical knowledge in a training program, especially for nurses, or not evaluating the knowledge acquired in the field, also allows leaders (in our case, in the health field) or other disciplines to better instrument the values and ideologies of a field. When nurses seen as cheaply trained labor are sometimes manipulated, for example solely on the basis of health costs or socio-economic needs, they cannot fail to assert themselves in the name of their language traditions, convince politicians of their actions, form a scientific identity or participate in the critique of reason. If we are not careful, one day, for economic reasons, we will end up replacing nurses with their assistants. “The concept of identity thus refers both to the permanence of the social means of recognition and to the capacity of the subject to give lasting meaning to his or her experience” [SAI 85].

History also avoids the alienation of future generations and avoids the production of “efficient consumer workers and beings without memory, without identity, without roots” [BUG 04]. History participates in the construction of professional identity. But since we have been talking about it, what can it be used for? As Rocher points out, “professional identity is this essential condition for the maturity of the personality, it allows the harmonious social functioning of a person in his environment, as well as the cohesion of groups” [ROC 68]. It is nevertheless preferable for the harmonious social functioning of interdisciplinary work⁴, for example, to know the origins, contents and logic of action of the discipline we represent!

“The teaching of history also gives, whether premeditated or not, nourishment to what is and will be the work of the memory of those who follow us” [MON 93]. The function of memory represented by the saying to know where we are going, is to know (and accept) where we come from “is not to celebrate the office of the past, but to help us imagine the future” [MON 93]. It is therefore incumbent on nursing educators to update the collective memory of their own discipline. It is also the role of universities, particularly nursing faculties, to promote basic nursing research. While it is interesting to discover what the language traditions of caring are made of ethnographically, we must also accept a past that was not necessarily glorious or spectacular in the secular era or in the Ancien Régime according to the representations in use.

Initial nursing training today is increasingly being given in academic settings, particularly in English-speaking countries. This is why the term “discipline” appears. In the French-speaking community, there are also nursing faculties (Canada, Lebanon) and high schools (Switzerland, Belgium). As SIDIIEF (Secrétariat international des infirmières et infirmiers de l’espace francophone) stated in 2011: “The pursuit of graduate studies in nursing is fundamental to ensure the training of competent teachers capable of guaranteeing quality initial training as well as the training of clinical nurse specialists and the training of researchers. The development of nursing research remains an essential condition for the renewal of care practices and the evolution of knowledge” [SID 11]. But how can nursing faculty researchers produce new knowledge to develop their discipline if they ignore the language traditions inherited from the past and the ancient knowledge on which it is based?

NOTE.– Nursing researchers rarely refer to their language traditions, which, according to the philosophy, “represent the most important source of knowledge, both qualitative and quantitative” [POP 85]. New knowledge is often knowledge that modifies or enriches previous knowledge.

While language traditions thus play a primordial role in the constitution of knowledge, it is normal that this tradition be rediscovered (history of knowledge), maintained and updated to serve as a basis for subsequent knowledge produced by scientific research. These language traditions, whose importance Popper emphasized, are precisely those statements and those units of discourse that allow specific phenomena related to the action of caregiving in the field of discourse to emerge in the long term. These traditions, which, as we have seen [NAD 12a], are passed on by caregivers from generation to generation, are also mainly units that should be considered:

By what right they can claim a domain that specifies them in space and a continuity that individualizes them in time; according to what laws they are formed; on the basis of what discursive events they are divided; and if finally they are not, in their accepted and quasi-institutional indivisibility of duality, the surface effect of more consistent units. [FOU 69]

It is from this questioning that the history of the discipline known as “nursing” can access its statements. It is in fact a matter of finding the original statements:

How far and how often they are repeated, through what channels they are disseminated, in what groups they circulate; what general horizon they draw for men’s thinking, what limits they impose on it; and how, in characterizing an epoch, they make it possible to distinguish it from others. [FOU 69]

Certainly, historical research for the nursing discipline has little influence on day-to-day nursing practice, as noted above. However, it remains a necessity if only to teach students about the history of their own discipline. This has long been a seemingly normal procedure at university where, depending on the discipline taught, we can find the history of psychology, the history of medicine, the history of sociology or the history of education sciences, to name but a few. This logic is much less obvious within the nursing discipline where history when taught (!) often takes on hybrid, redundant, stereotyped, laudatory and even hagiographic aspects. But why should we be surprised? Moreover, what place do history courses have in the training programs? On a purely informative basis and without claiming to draw any comparison whatsoever, we find that between 1980 and 2009, for example, “the history of nursing” represented between 6 and 16 hours of teaching in the nursing course at the Fribourg University of Health (Switzerland). It also represented about 24 hours of teaching (foundations of the nursing discipline) and 4 credits in the master’s degree program in nursing research in 2016 at the Faculty of Nursing of the Saint-Joseph University in Beirut (Lebanon). It is also 15 hours of “history of the profession” courses that were registered in the curriculum of the schools of nursing run by Quebec hospitals in 1960 [COH 00] and between 2 hours (!) and 8 hours of “history courses” for five French nursing institutes (IFSI) in 2009 [HOM 12]. In contrast, we do not find the word “history” in the 1996 Bachelor of Science in Nursing program of the Faculty of Nursing at the Université de Montréal. It is assumed here that the course title “Introduction to the Discipline of Nursing” plays this role [COH 02].

In the history of the nursing profession, we know Florence Nightingale, but we often ignore the name of the woman who inspired Florence Nightingale to found a nursing school in Great Britain. It is around a religious problem resulting from a conflict of values between Valérie de Gasparin-Boissier and Florence Nightingale that training began in Europe. Why does one of these women take center stage and not the other? And of course, the history of the nursing discipline has nothing to do with the history of medicine or religion. There is often a tendency, not only in the media, for example, but also within the profession, to confuse disciplines and the places where knowledge is produced.

Why always position oneself as an “auxiliary profession” or present oneself as “para something”? Legislation on the profession does not explain everything. Just because women care workers from the servant and working classes were unable to access education in the 18th Century does not mean that the specificity and complexity of their task should be ignored today, especially if we interpret it from a biomedical paradigm that only very partially reflects actual practice.

Caring in ancient societies and in popular circles also means taking into account the environmental conditions and those of the habitat or domestic uses of the time. But, as Ehrenreich and English point out in connection with the witch hunt (empirical healers at the service of the peasant population), “domestic work is much more than cleaning the house. It is about physically, emotionally, sexually serving those who bring in the wages, keeping them ready for work day in and day out”. In the devaluation of women’s social role, “witch hunts have served the sexual division of labor and the control of men over women, their bodies and their labor” [EHR 15]. To understand also how care was instituted in pre-industrial society, it must be kept in mind that most secular healthcare professionals in institutional settings at the end of the 18th Century came from rural or domestic settings and school was not yet compulsory. There has to be a start to everything!

The history of nursing knowledge has little to do with the history of religion or the history of medicine. Rather, it would be the history of the organization of collective households, of the way they are run and how they function that is at issue. This history is simply concomitant with the history of hospitals (that of the house, the household, the Domus, the hospital). These hospital establishments are then the first spaces of speech devoted to hospitality. They are the first spaces for “discursive events” [FOU 69] to take institutional care of it or for the specialization of hospital domestic work.

1 1 The school was closed in 1995.

2 2 The Ancien Régime in France was its political and social system from the Late Middle Ages until the French Revolution of 1789, which led to the abolition of hereditary monarchy and the feudal system of nobility.

3 3 Collière seems to be speaking here more to history teachers in nursing schools than to the nurses themselves. In fact, most of the instructors of yesteryear (now educators) who taught the history of the profession in nursing schools and institutes in France, for example, were not, in general, researchers in history.

4 4 We sometimes speak of inter-trade or inter-professionality.