Читать книгу Discipline of Nursing - Michel Nadot - Страница 7

Introduction

At present, there are very few books on the foundations of the nursing discipline¹ and the progressive construction of its knowledge. Most of those that do exist start from the nursing reform carried out by Florence Nightingale, who, presented at the time as a pioneer (the English aristocratic heroine), found herself projected onto the nursing scene as the one who brought about the knowledge of care through spontaneous generation of knowledge. Yet care has been provided for a long time and long before Florence Nightingale’s entry into the hospital scene. Nursing practices and their knowledge did not wait until the middle of the 19th Century to exist. However, there is not much in common between Florence Nightingale’s social status and that of the hospital maids and governesses of the 19th Century. A good example of this is the prominent image of the English heroine Florence Nightingale or a confessional past of “nuns” among the caretakers. The emergence and foundations of the discipline of care are much more complex than this, and the role played by French-speaking Switzerland in the emergence of the first schools for care workers should not be overlooked. Florence Nightingale did indeed exist, but we cannot understand her involvement in care if we do not place her thinking in the context of the time, and this in relation to Valérie de Gasparin-Boissier, the Swiss woman who founded the first school for care workers in the world and who, in terms of values, was both her forerunner and her rival. Just as it is difficult to understand the role of nuns and the Church in hospitals if we do not know why at one time the Catholic Church began to send its nuns to civilian hospitals to replace the lay personnel already in place or, as in Quebec, to develop healthcare institutions that were to be established in the wake of French colonization, so too is it difficult to understand the role of the sisters and the Church in hospitals.

Contrary to existing beliefs, the nursing profession does not have good nuns as forebearers and has no medical paternity from the outset. With practices sometimes almost similar to those of today, but in different contexts, the knowledge at work in lay hospitals in secular times cannot be called “nursing”. The term nurse, moreover, is an exclusively religious term, as will be seen later, and belongs to the Catholic Church according to values proper to the ancient Scriptures. Why do the lay people still use it today?

NOTE.– The terms “infirmière” (i.e. “nurse” in French) and “garde-malade” (i.e. sick nurse in French) are neither synonymous, nor interchangeable and are rather historically in competition to qualify (the real!) professional care. Each term has its own history, and the latter does not tolerate mix-ups. It is not by chance, as Canadian nursing researchers point out, that the name to be given to future faculties of care poses a problem for rectors to gallicize the term nursing and illustrates “the difficulty of adequately translating the word nursing” [COH 02]. The difficulty is of the same order when it is necessary to explain the nature of the nursing discipline and to find a name for it.

Some nursing students, who are traditionally familiar with biomedical books or manuals and data sheets during their studies, are rarely required to obtain books that address the fundamentals of their discipline as is often the case in other academic disciplines. Moreover, there are very few critical works on the development of the discipline and its early theories. As Debout points out, “the English-language preponderance for scientific activities makes English the primary language of dissemination of the discipline’s work. Nursing research often does not take into consideration existing disciplinary knowledge and theories, but prefers to borrow those of related disciplines”. This, of course, has paradoxical consequences. “The professional group claims to be recognized in its singularity, but rejects a disciplinary content that seeks to establish this specific nursing perspective” [DEB 08].

Books on the history of nursing, women caregivers and the history of the profession are also available in bookstores. This history is sometimes local, with a short periodical time, rarely long term, as is the case with medicine, for example. Indeed, as Canadian historians note [BAT 05], “while medical historians trace the origin of their profession to Greek and Roman antiquity, nurses present a historical perspective with nursing dating back to Florence Nightingale” [BAT 05]. Before referring to Anglo-Protestant care models, we might wonder how care was provided in the ancient nations, for example, before the French colonists imposed a Franco-Catholic model on the Aboriginal or Métis populations, as well as on themselves. The Outaouais, Stadaconeans and other Hochelaguians were never asked about their pre-colonial conceptions of “caregiving”. The questioning of the status of the nursing discipline was not on the agenda. “Little is known about the nature or extent of healthcare practices in the Amerindian nations” [COH 02]. This shortcut around Florence Nightingale and the values of the English aristocracy does not really help in understanding the foundations of the discipline of care and the construction of its identity. Care practices and their knowledge existed long before Florence Nightingale. With contemporary North American researchers systematically referring to the English heroine Florence Nightingale to mark the beginnings of the discipline of nursing, and a discipline that bears the name nursing science, we are still far from identifying the real foundations of the knowledge that underlies the discipline in question.

Why present a book that focuses on the history of knowledge within the nursing discipline rather than on its actors? Because this knowledge, like the discipline itself for that matter, continues to be inaudible. The actors are known, symbolically at least. What they know or what they experience is still sometimes a form of angelism. We certainly talk about nurses, but little about their discipline. Even in the era of nursing faculties, universities and doctorates in nursing, the discipline is still seen as something that allows nurses to do, in a general way, “a little bit of everything, anything and nothing special”, as one Canadian nursing professor famously put it [ADA 79]. Admittedly, this formula does not really help the professional or scientist to build a unique identity through successive socializations, and does not really tell society what nurses bring to it in terms of skills and costs. The nurse is not an interchangeable pawn on the health chessboard. What is her own discipline made up of, what is the locus of discourse, what are its foundations, what is its purpose, what is its scientific identity and what is it used for?

The different types of knowledge produced within the discipline are fragmented knowledge, just like the places where knowledge is produced, without links between them, without an epistemological foundation that would be in continuity with the traditions of language. Without links between them, knowledge struggles to ensure its visibility. However, these fragmented parts of knowledge can still be linked to each other in a fragile way over the long term. The knowledge that guides practices is arranged in different layers of sedimentation. The separation between the layers is blurred and varies in time and space depending on the region of the globe. It should also be noted that the discipline is still orphaned in terms of identity. The research methodologies are multiple and the scientific frames of reference are also used. Knowledge is scattered and volatile, applied research, sometimes called “clinical” research, proliferates and basic research is at a standstill.

Should nursing research be exclusively at the service of the profession’s four fields²³ of practice, or is it possible to envisage, for example, basic or free research for the nursing discipline? In the absence of basic research, we often have a partial picture of the nursing discipline. An overview and a homogeneous synthesis of knowledge built up over the long term is sorely lacking. Moreover, the vocabulary used has often been so mixed up in meaning that the origin, values and profile of the care professional (nurse) are not recognized today. This knowledge, produced and instrumented over the long term by groups with different value systems, as can be seen in Figure 13.1, does not always reveal its origins. A distinction must be made in terms of values between religious knowledge (French-Catholic or Anglo-Protestant) and lay knowledge. The activity at the Hôtel-Dieu differs from that of the civil hospital. The foundations of the discipline lie not in the natural sciences such as medicine, but within the human and social sciences. In the long term, the medical profession, since it has been authorized for practice in the hospital, often delegates new knowledge to nurses in order for them to develop advanced practices. However, each time advancement presupposes a higher requirement in terms of knowledge and not specialized knowledge specific to the discipline in order to clarify ordinary practice.

1 1 There are a multitude of ways to approach the notion of discipline. The place of language traditions in the constitution of a discipline must be taken into account and allows us to see the discipline as “a historically rooted articulation of composite elements that can make sense in a sustainable way and constitute a rational instance of knowledge” [BER 04]. However, the notion of discipline “is irremediably associated with the development of the university, of which it is an organizing principle” [FAB 13]. Today, it is known that the “epistemological analysis of the theoretical bases of nursing science shows the anchoring points around which the body of scientific knowledge belonging to the discipline is organized and defines its object according to four concepts: environment, person, care and health” [DAL 08a]. For Pépin et al., a discipline is also “a field of investigation and practice with a unique perspective or a distinct way of examining phenomena” [PÉP 10]. But we also know “that it is impossible to deal with the disciplinary question today without associating it with the political dimension of scientific activity. Discipline is an operation of domination before being a structure of knowledge production” [FAB 13].

2 2 In order of appearance: 1) care practice, 2) teaching practice, 3) management practice, 4) research practice.

3 3 Practice is a human action that is controlled and guided by symbolic elements included in a cultural system (knowledge, values, ideologies). Practice, even if it is only healthcare practice, “is then a consequence of the translation and understanding of values into norms of action” [NAD 93].