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Preface

Female caregivers¹, and with them their knowledge or their own discipline, are still epistemologically subject to a historical cultural domination imposed at the end of the 18th Century. Nurses have few historians. Others took it upon themselves to write their own history. As the narrator of the Howard Zinn film about American popular history would say, “Until the rabbits have a historian, the story will be told by the hunters”. Can we get rid of the cliché? Of course, it is up to the discipline and its members (the rabbits) to appropriate their history and define its object. However, as Gélis pointed out, “historians of health practices were for a long time doctors anxious to write the past of their profession; the helpers, the guards, the caretakers, were in their eyes only auxiliaries. The humble, everyday life; this was not… history!” [GÉL 88]. This may partly explain why nursing professors did not take ownership of the history of their knowledge from the very beginning. As a nurse, health executive or researcher, it is not common to study history. Who would fund such studies? Why not, however, try to expose the knowledge of the past, notably by publishing this book, in order to identify what our spaces of speech and language traditions are made of? “After all, why should we deny the right of the members of a profession to take up their past for themselves, as long as they meet the requirements of historical research?” [GÉL 88].

The role and conditions favoring the emergence of the history of knowledge within the nursing profession are not always well perceived and understood, as they are difficult to access. It did not all start with Florence Nightingale! Retrieving traces of daily care presents many difficulties for the nurse historian engaged in research. These traces, too ordinary to constitute scholarly heritage, have eluded health historians until recently. Before being able to describe and interpret the world that was theirs, women caregivers were linguistically colonized by dominant cultures. In order: church, medicine and the military (Red Cross). As Gérard Noiriel rightly points out, “one of the essential forms of domination in history was between those who had the power to describe and interpret the world through writing and those who had only oral language” [NOI 18].

Writing has status, and to write about nursing requires access to the legitimate places of knowledge production (e.g. university) and a cultural understanding of professional practices and the environment in which they are practiced. According to Marrou, “in order to know its purpose, the historian must have in his personal culture, in the very structure of his mind, the psychological affinities that will allow him to imagine, feel and understand the feelings of the past that he will find in the documents” [MAR 54].

Precisely in terms of personal culture, it may be relevant to describe the main stages, given the rather atypical profile of my educational and professional background. I was born under the bombing of the town of Montbéliard (France) in preparation for its liberation during the offensive of Marshal de Lattre de Tassigny between November 14 and 17, 1944. After technical training at the Peugeot Automobiles Apprenticeship School and several months of practice in this national company, I left my home region for a complete change of air and orientation. I couldn’t breathe! Being subservient to machines and workshop managers was not really meant to please.

It was then the restart of a training cycle. After training as a psychiatric nurse in French-speaking Switzerland and several years of care practice as a nurse in various hospital institutions, followed by two to three years of management practice as a nursing executive, followed by more than 30 years of teaching practice and 10 years of scientific research practice at the Haute école de santé de Fribourg (Freiburg’s Higher School of Health), my experience seems to be well diversified to be able to talk about it. After having climbed one by one up the ladder from primary school to post-doctorate, it is as a professor of nursing that my interest in studying the history and epistemology of this as yet little-known discipline developed.

These lived experiences allow this somewhat naive explorer to open paths. Without having really programmed it, I find myself in new avenues with the feeling of being the “first” under different horizons. Being the “first” male nurse, a lay graduate in a Catholic hospital in the Swiss Jura region run by the Sisters of Saint Martha of Beaune, the “first” lay director of care in a small hospital on the Neuchâtel coast run by Protestant deaconess sisters, the “first” professor of history² and epistemology in nursing sciences in French-speaking Switzerland, the “first” teacher with a doctorate in a nursing school that was not yet a university level school at the time, the “first” professor at the Haute école de santé de Fribourg to have the status of associate professor in foreign nursing faculties (Canada, Lebanon), the “first” historian to bring the founder of the world’s first school of nursing out of the shadows (Valérie de Gasparin) and, finally, the “first” man to appear alongside major theorists of the nursing discipline on the websites of some North American nursing faculties, it is easy to understand why I keep traces in my memory that will help me grasp history. Without forgetting the fact that I am the first author of a conceptual model in nursing that is the “first” in French-speaking Europe. This model identified by researchers in the discipline in North America aroused a few curiosities. Since 2005, I have also been in charge of a network of researchers in the field of health and social work at the regional level, and with a post-doctorate in “Higher education and research policies” (Ecole polytechnique fédérale de Lausanne – EPFL), I can now take on the challenges of scientific research. Add, on a more personal level, two marriages, four children and twenty-six moves, and you can understand why I sometimes feel dizzy on this atypical, completely unexpected and yet well-filled career path. This “first” part, which goes off the beaten track and which seeks not only to escape from its main starting determinisms, but, above all, to understand where this incessant desire to know comes from, is really not to displease in the end.

I also discovered that it is not through the history of language traditions that nursing research began. Aside from a few cleverly maintained myths, the results of research say little about the historical foundations of the knowledge that constitutes the discipline today. The nursing discipline, situated in the human order in terms of science, is struggling to go beyond its ordinary social representations and its own myths to construct its specific knowledge and give it a name.

Focusing on what is now known as “nursing knowledge”, “nursing discipline” or “nursing sciences”, this book deals with a subject little discussed in the literature, particularly in Europe. Each of the three parts ends with a short critical analysis of the knowledge presented (image feedback). This image feedback is a kind of selfreflexivity on the content and context of knowledge emergence.

Several excerpts from this book are based on the author’s doctoral thesis [NAD 93], especially the unpublished passages. Also included are the results and reports of scientific research financed by the Swiss National Science Foundation (SNF) and developed since 1999 by the Health Mediology Laboratory of the Fribourg University of Applied Sciences (HES-SO)³. First-hand documents from partially published empirical research [NAD 12b, NAD 13] are also used, supplemented by a series of reflections published since 1982 and numerous scientific conferences held on several continents between 2000 and 2016.

Drawing inspiration from a diagram of the development of fundamental knowledge with reference to the philosophy of science (Figures 11.2 and 11.7), I believe that I can verify, through a succession of questions, whether the increase in knowledge reveals a thought process that has “as a starting point and as a term, the formulation of problems that are ever more fundamental and whose fruitfulness continues to increase, giving rise to other problems that are as yet unpublished” [POP 85]. Not only is an understanding of the language tradition a necessary condition for innovation, but also the knowledge carried by several concepts worked on as needs and questions arise makes it possible to envisage a reality that goes from the macroscopic to the microscopic. These concepts serve to delimit the object of the study carried out within the researcher’s specific discipline and practice, and drive the dynamics of the research. They have analytical value while delimiting both the object of the research and the disciplinary field concerned. They allow the object of the study to be treated from authoritative sources of knowledge found in what Popper calls the “third world” or what he calls “objective knowledge” [POP 91].

This book is primarily intended for nursing students, their professors and researchers involved in the development of the discipline. Although indirectly concerned, nurses in healthcare settings are also likely to be interested in this book, if only out of curiosity. It is also intended to contribute to the nascent academic debate on nursing knowledge, its origins, the discipline, nursing science, its existence, its orientations, its identity or the reasons for the indifference it arouses. How is the term “discipline” represented in the healthcare environment and why do the advancement of nursing science and its theories remain inaudible in the scientific community, the media, politics and the economy despite the efforts invested in this endeavor?

Michel NADOT

August 2020

1 1 Women have always been predominantly represented in the care world. Today, they still represent the majority of professionals in practice. On average, between 7% and 11% of the profession’s members are men, depending on the source or country.

2 2 At a time when the first word-processing typewriters heralded the arrival of the first computers.

3 3 This will exist for about 10 years (1999–2009), directed by the author.