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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