Nurse Educ&m Today (1992) 12,274-278 @ Longman CroupUK Ltd 1992
An exploration of issues relating to feminism and nurse education Brian Millar and Francis C Biley
This paper explores the issue of feminism in relation to nursing and nurse education. As a result of this exploration, the authors suggest there is a need for a move away from traditional patriarchal approaches to nurse education, towards an educational programme based on empowerment principles that maximises the potential of feminine patterns of thinking.
consequence
INTRODUCTION There
engaged
is a continually
between
feminism
mutually
enhancing
for the advancement tice and significant
developing
and nursing.
This
and exciting of innovative nursing
and
relationship offers
a
opportunity nursing prac-
research.
is primarily
occupation, inspired
the
female
can be said to have
male-dominated
principles
upon
which it has been based, as well as the historical evolution
of the profession.
and nurturing identified the essence
Increasingly,
(which are concepts
with females) of nursing
opposite
attempts
may provide
have
caring
traditionally
are being identified (Leininger
become
views -
domesticity
Hughes (1990) reports that to merge these two ideologies
an explanation
that domesticity
for the constraints
has had on the lives of women in
1988).
as
As a
Despite
and rights, Florence
to align
herself
(Chinn
Brian Millar Lecturer in Nursing Studies, University of Wales College of Medicine, Francis C Biley Lecturer in Nursing Studies, University of Wales College of Medicine, School of Nursing Studies, Heath Park, Cardiff CF4 4XN, UK (Requests for offprints to BM) Manuscript accepted 22 January 1992
feminism
all of her work in support
suffrage
with the women’s
& Wheeler
1985).
of women’s
Nightingale
failed
movement
Until fairly recently,
the same could have been said of the majority
of
her successors, who have had no more than an ‘uneasy alliance’ (Vance 1985) with feminism. Yet there is increasing the
feminist
practice,
274
ideological
and professionalism. nursing’s
nurses
to blend two conflicting
The need to acknowledge in nursing
a male-dominated
a fact which
this,
our society.
DOMESTICITY AND PROFESSIONALISM Nursing
of
in attempting
evidence
movement
and in particular
of women both as patients researchers are becoming ested
in the health
has
of the influence had
on
nursing
on nurses perception and as carers. Nurse aware of and inter-
experiences
of women.
A
significant number of studies are being undertaken examining the experiences of women with, for example, alcoholism, or cardiac disease.
NURSE EDUCATION
Nurses are also bringing attention to the growing number of women’s health related conditions such as osteoporosis, depression, rape and agoraphobia (for example, Kervik & Martinson 1979; Evason 1982). Current changes in the education of nurses provide an opportunity for nurse educators to critically examine their educational philosophies and to address the crucial health care needs of society for the year 2000 and beyond. With the increasing questioning of the dominance of technological and scientific knowledge, the responsibility of nursing to assume its rightful role as a major force for change in the provision of health care is ours. Feminist ideology, which is one that ‘values women and confronts systematic injustices based upon gender’ (Chinn & Wheeler 1985) is now emerging from within the profession through the work of such nurses as Peggy Chinn and Jean Watson in North America and Christine Webb in the United Kingdom. The feminist movement is primarily concerned with fighting oppression, or more particularly the use of power by one group to dominate another. Such use of ‘power over’ forms of power are vigorously rejected. The (male) medical profession has been guilty of the use of such ‘power over’ forms of power, especially in relation to the passive, submissive role of (f-emale) nurses. Stein (1978) clearly illustrates the conflict and the oppressive features of the doctor-nurse relationship in his paper ‘The Doctor-Nurse Game’. For example, consider the current concerns about the use of eusol in wound care; despite numerous reports ofthe danger of such practices, doctors continue to ignore, and in some cases positively disregard, the views or knowledge of nurses. Such a repressive form of power is rejected by the feminist movement who instead favour personal empowerment and the application of personal power promoting growth, transformation, justice and peace. Smith (1988), in a study of how power operates in the USA, is convinced that ‘power depends heavily on the illusion of power’. Doctors and medicine, in the past, present and f’uture, really have far less power than either nurses or patients imagine; their success comes from the impression they have created of being
TODAY
275
powerful healers. This illusion of power is maintained through a lack of awareness and a passive silence within our society and sadly in the nursing profession.
POWER AND EMPOWERMENT The concepts of power and empowerment are further key issues in feminist thinking. These feminist ideals are expressed in the premise that ‘the personal is political’. Such a statement offers an insight into the world we live in and more importantly into the identification of those problems considered to be significant and how they might be solved in the world today. Being confronted by such powerful insights brings nurses into direct contact with the critical issues of power and freedom. The statement that ‘the personal is political’ can help nurses to see that every aspect of our personal circumstances evolves from, and contributes to, much larger political realities within our worlds. From this insight it is possible to realise that if we change the political reality then personal reality will also begin to change and vice versa. In any critique of domination, or the reflective criticism of forms of socially unnecessary constraint upon human freedom, an association with radical or extreme political views may perhaps be a reason why nurses and nursing have remained aloof from mains1 ream feminist thinkers and activists for so long. Indeed the perceived association of feminism with radical or extreme political views has influenced the potential contribution of a feminist critique, which following its reconceptualisation (along with a number of other oppressed groups) in critical philosophy, could be more properly termed ‘critical theory’ (for example, Thompson 1987). Our present health care system operates within a structure which has to be openly acknowledged as patriarchal (Watson 1990). This has created oppression in nursing which is manifest in the relative absence of feminist thinking in nursing literature and theory (Chinn
276 &
NURSE EDUCATION
Wheeler
patriarchal
TODAY
1985) and in the dependence
upon
forms of education.
thought
and contribute
which is central (1988),
to a devaluation
to nursing
Pontin
in a small study of the sex role characteri-
zation of a group
of male and female
found
nurses
that female
that is, had both masculine
MEDICINE AND NURSING
of that
. . . caring.
nurses,
were ‘androgenous’, and feminine
psycho-
logical traits. Could this be an indication In both the past and present it has been believed
effects of a male-dominated
that ‘womens caring work is invisible, and some-
the female
how subsumed
under
men (medicine)
in the patriarchal
health
system’ (Watson
1990).
such as this
have been literature
identified commonly
nurse/dominant tionship
the important Inequalities
of
care
Never
mind? before
of knowledge.
on the
patriarchal
passive
style rela-
1983). In this relationship,
of nursing
and
the
the
being seen as women’s
concept
that of the curing
of
work, and there-
fore of little value when compared
to the ‘hard’
work of men. Medi-
cine has dominated nursing. Within, or perhaps because relationship
radical
shift in our conception
include the work of researchers
has received
little attention.
How do nurses treat each other, and is it possible of the patriarchal
that
between
has existed The
was an alarming female ment
nurses
student nurses.
imbalance in both
Whilst
to every
registered
in England
nurse
However,
doctors
one nurse
in 1980, there
in the ratio of male to
who had reached
positions
education.
and
between
answer must, unfortunately,
be yes. For example,
there
10 females, to every
top manage-
nursing was
service
1 male there
and
nursing
was 1 male
5 female
registered
there is a reversal of this ratio
when one examines the senior management in nursing, with nearly 60% of the posts being occupied by men (Salvage 1985). Why should this be so? One reason
may be the dichotomy
as a result of the style of education
that arises
or training
of
those entering the profession. This style, which is predominantly based on the patriarchal model of education, is being used to educate a female occupation. Such an educational style may be guilty of inculcating preferences, which
of education
to
such as Belenky
who, in a study of females, five patterns
have
of feminine
thinking. ideology
in nursing
the prevailing
has regarded
knowledge
as a distinct product
be acquired
by the student.
a framework
fascinating
Belenky
developed
to
et al (1986)
by Perry
in a
develop
self,
study of how women
voice and mind. The results identified sternologic
a
is a
five epi-
positions:-
relationship
nurses
in the relationship
and another?
health
Traditionally
utilised of, this the nurse/
to see a reflection present
in our advanced
dwelling
identified
nurse
so much
new and more critical role. What is needed
et al (1986)
science,
Today,
invested
into the production
care systems, the social sciences have acquired
‘soft’ caring
has society
time and so many resources
nurse and nursing is held in low esteem, with the science
of the style on
for a long time with the
physician,
(Roberts
work
educational
male values and learning could stultify original
1. Silence:
In this position,
ence themselves
females
as mindless,
subject to the whims of external 2. Received
knowledge:
ceive of themselves
Where
external
able of creating 3. Subjective
females
knowledge authorities,
knowledge
knowledge:
truth and knowledge and subjectively
authority. con-
as capable of receiving
or even reproducing knowing
experi-
voiceless and
of the all but incap-
themselves.
Where females view as personal,
or intuitively
private,
known.
4. Procedural knowledge: Where females are invested in learning and applying objective procedures
for obtaining
and communi-
cating knowledge. 5. Constructed knowledge: Where all knowledge is viewed as contextual and women experience themselves as creators of knowledge. They value both subjective and objective strategies for knowing.
h’;URSE EI)U(:A~I‘IOS
Knowledge Implicit
Critical to the future must be the development
building
in these five epistemologic
positions
is
the message that we need to be working towards rhe stage of constructed and our students builders,
not
multiple
wherein
we
permitting
but
being
raising
the
findings
of Belenky of critical
4 Are we preparing
by
themselves
as knowledge silence
and
to think of
builders or do we
and the acceptance
of
knowledge?
How do nurse-educational pressed
into
the
teams who are
dominant
educational
resolve the potential
cal conflict
that arises.
such conflict
affect
philosophi-
Indeed,
how does
the educational
environment,
and
prac-
processes
for
learning?
there are changes
way nurses
are socialised
adoption
of the Project
moves
towards
More
particularly,
and
links
with
and
for teaching.
continuous
and at present changes
thinking
EQUALITY
(traditional
A move towards
student-teacher
as someone
who has greater
techniques
with both accepting
the respect
knowing
and
innovative
cally decided
Democratiand assof more
and exciting
self-awareness
and
of examination
creative
of
of ways of creative
to the development
contribute
Examples
as
can help to
experience.
methods
essment lum.
a more
educational
experi-
themselves
situation,
for a diversity
stimulate
with
rather than as some
being in a mutual learning develop
equality,
nurse this
education
include
and assessment,
peer mutally
curricureview, agreed
examination topics and seen papers, rather than autocratically or paternalistically imposed examinations.
Should this occur then it is possible that,
with more attractive
methods
of education
that
are more in line with respecting and valuing women and how women think, will come the empowerment
and a greater
ability to use skills.
1he
nurse
that promotes knowledge cation).
assessment
male
a move
ryatterns
of
01’ knowledge towards
egalitarian
acquisition
pro-
to re-examine
This requires
education)
Especially
framework
do, however,
acquisition
a more
the devol-
is still f’undamen-
for nursing
predominantly
and
training
This move is far
upon a paternalistic These
from
education.
towards
with the emphasis on education. from complete
the and
requiring
of’ the knowledge
tally dependent
include
higher
examinations
ved examinations
care
curriculum
a move away from
centralised
regurgitation
These
2000
the process of education.
kind of expert,
of’
taking place in the into the health
system and the profession.
away
the teacher
at
concept
ASSESSMENT
vide an opportunity
ence of learning
hidden
require
in our under-
programmes
encourage
ideology,
of the
of
aimed
the
et al (1986) questions
students
nursing
received
profile
strategies
caring.
Currently
graduate
educational
educators
challenged
a number
tices,
and
promoting
As nurse
tuture debate:-
b)
research
view each other as knowledge
only
ourselves
research indeed
knowledge,
ways of knowing.
we find
277
TODAY
a system
approach
(innovative
nurse
since at the moment
to
edu-
‘no mat-
ter how brilliant or creative a woman’s work is. it can only be assessed in relation (Watson
1990).
ledge feminist approaches context
of the current
such approaches Hedin strated cation
and
to learning
Donovan
( 1989)
have
the previously
system they have employed
*Increased
dialogue
male
1970). Within their edu-
feminist
an education
demon-
predominant
cational created
how
that can free nurse edu-
system (Friere from
within the
can be utilised.
banking
istics drawn
men’
system and highlight
to learning
one approach from
to brilliant
What we need to do is acknow-
writing
characterand
have
system that cmphasises: - which is icss hierarchi-
cal, more egalitarian and promotes shared power. *The promotion of’ empowerment which in
278
NURSE EDUCATION
turn leads action. *Concern contextual *Admitting proporting *Attention
to
TODAY
emancipatory
thought
and
with relatedness, connectedness, truth. conscious partiality rather than to be value free to process and not just product.
By writing this paper, paternalism and its influence on nurse education and the development of knowledge, is, in a sense, perpetuated. This is not the intention. Readers are free to accept, reject or more realistically simply reflect upon them for themselves. By considering how feminist thinking can help us move beyond accepting the traditional subservient role in health care, nurse educators can focus upon the development of strategies aimed at the empowerment of professional nurses and to the re-emergence of caring as an equal within a world where science and technology are seen to dominate. As we approached the discussion and feminism and nursing, we have both felt tension. Trained as nurses and nurse educators mainly in the tradition of the paternalistic educational system, we have found the world of feminism somewhat foreign, even though it has been recognised that there are some men who have feminist qualities (Eisler 1988, cited in Bunting and Campbell 1990). Throughout our discussions both prior to and during the development of this paper, we became increasingly aware of our spent
male
socialisation.
most
somewhat
of our distanced
feminist theory.
We confess
lives dwelling
Hence,
haps even frequently,
from
the
to having in a world domain
on occasions,
of
and per-
we have a tendency
to
reduce what to us is new by interpreting it within a framework of that which is familiar to us. Knowing
this, we hope you will appreciate
uneasiness and naivety.
our
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