What is nursing? What exactly does it mean to nurse a patient, and how has this definition changed over the past centuries? What does the discipline of nursing consist of? In this essay, I aim to attempt to answer these questions, along with the help of a myriad of nursing researchers whose studies have helped to broaden my perspective on what exactly it is that I now do for a living. I will be discussing the different types of nursing knowledge that assists us as nurses to care for patients and why it is that our discipline has, almost since it started, been seen as second to medicine.
I will also be comparing the public’s views of nurses and nursing and our status in society from the early 1980s to now, with help from some of my own personal experiences. Ever since Nightingale’s statement, “I will endeavour to assist the physician in his work,” (cited in Hilton, P. A. , 1997) it seems that the discipline of nursing has followed as such, simply existing as a profession to aid doctors in their work. Indeed, I myself sense the dominance of the bio-medical field in my practice, sometimes believing that nurses would be redundant if doctors were to cease to exist in the hospital.
Attempting to distinguish nursing as a line of work separate from medicine has been a tough task for many owing to Nightingale’s comment, labelling nurses as the ‘doctor’s handmaiden’ (Hilton, P. A. , 1997). What I have observed in healthcare organisations in the past few years is exactly that, majority of the tasks nurses are assigned to have been set by doctors, which reduces the time we have to actually nurse the patient. In that sense, we are not only viewed as serving patients, but serving other healthcare professionals as well. Tayray, J.
(2009) explained that in the early years of nursing, nurses blindly did as they were told by doctors. She says that nursing was “primarily a profession of giving”, and nurses did not make use of any particular scientific approach in practice. As ‘giving’ without expecting anything in return is generally seen as being satisfying for the giver, during Nightingale’s time “there was no imperative to pay nurses a fair and just salary” as simply caring for someone “was seen as the reward in and of itself” (Cutcliffe, 2008). However, as nursing is now deemed a profession, there is the separate reward of income.
Currently, however, we have enhanced our status by broadening our knowledge and including not just objective and methodological knowledge preferred by medical professionals but also relying on subjective and practical knowledge of our own in day to day work. Be that as it may, one researcher has commented that as the “dominance of physicians in healthcare” still exists, objective knowledge is still privileged over subjective knowledge. Objective knowledge refers to that which is concrete evidence, tangible, definite, e. g. you can see the patient sweating.
Whereas subjective refers to knowledge that exists in the mind, that is different in every individual e. g. the severity of pain a patient is feeling. As such, this makes it hard on nurses to boost our current rank as we feel our knowledge is invalid when it is not accepted by physicians (Canam, C. J. , 2008). The key here would be to have confidence and belief that our knowledge is important in its own way to our practice. In this way, as Rafferty (1996), Maslin-Prothero & Masterson (2002) phrased it, we can be “freed from historical oppression of the male-dominated medical profession” (Cutcliffe, 2008).
However, we still have a long way to go, as not only do we need healthcare professionals to approve of and acknowledge our opinions, we also need our patients to have confidence in our decisions. Nightingale has somehow actualised an arrangement where our nursing process “is directed by doctors, who predominantly operated from an emerging scientific medical paradigm” (Brennan, D. , 2005). Litchfield (2008) sets forth the view that nursing is still seen as a disunited discipline that is inferior to “the coherence of medicine to influence health sector change.
” As I have seen in my very own workplace, changes put forth by nurses only get recognised because of the sheer difference in population of nurses and doctors (more nurses compared to doctors). However, if it is just a few doctors starting something new, it is immediately accepted because they are seen as being more educated, more powerful. The “medicalization of health has led to the medical profession developing a legal monopoly over control of caring interventions” (Foucault, 1973, Illich, 1976, Loe, 1978, cited in Brennan, D. , 2005).
This male dominance is largely seen even in contemporary healthcare settings. ‘Curing’ is connected to medicine (dominated by males) while ‘caring’ has been entrusted to females, mainly seen in nursing (Dunlop, M. , 1986). This is mostly because women have always been perceived to be the more caring sex, that it is innate, because the female has always been expected to care for her family, her children, and even society. As Hughes (1990) shared, in the 19th century, having jobs with steady salaries to maintain the economy came to be ‘man’s’ work “while unpaid domestic labour at home became ‘woman’s’ work.
” This is where the ‘service’ orientation of nursing comes in, by caring for someone, we are identified as doing them a service. Nursing was seen as being a female’s “duty and vocation” (Brennan, D. , 2005). The Nursing Minor (1954) claims that majority of women do a certain amount of caring at different points of their lives, “adding some credence to Nightingale’s proposition that most women undertake nursing” (Hilton, P. A. , 1997). Hence, no argument is expected when someone claims that women are merely doing their ‘job’ when nursing a person. That being said, what exactly does nursing entail?
Is it a science, art or both? This has been debated at length by many researchers and theorists. Levine (1967), Roy (1976) and Parse (1981) argue that a marked amount of scientific/technical knowledge is required if nursing is to move forward (Hilton, P. A. , 1997). This is true, but nursing should not only be task-oriented. According to Tayray, J. (2009), “caring is the art, essence, tradition and process of interaction in nursing”. What differentiates us from the so-called scientific medical profession is our care, our human touch, our empathy and quality time spent on patients, this is the art of nursing.
The nurse, unlike the doctor, sees the patient not as an illness or disease, but as a whole person, and “strives instead to actualise an authentic relationship between two people” (Carper, B. , 1978). Henderson felt that nursing was nonaligned with medicine, though Nightingale saw nursing as “nothing more than an addendum to medicine” (Nightingale, 1969, cited in Hilton, P. A. , 1997). As Nightingale was one of the first people to ‘define’ nursing, this is what we have been coerced into viewing our profession as, and how society beholds us.
Considering nursing as an adjunct to medicine only helps to relate it to being a science, similar to medicine. Rogers (1970) conveyed that depicting nursing as a science “negates its humanistic aspects” which are regarded as the principal aspects of nursing. Non-medical ideas of caring/curing e. g. nursing have always been linked with medicine, making it appear as “a form of deviation from the accepted singular biomedical scientific ideal” (Brennan, D. , 2005). Medical approaches are still considered the more valued concepts compared to nursing.
Knowledge of physicians has now become considered as common knowledge, exercised by doctors and “selectively applied in the work of nurses” (Litchfield, 2008). This shows that nurses do in fact need a separate kind of knowledge in practice, knowledge that assists us to provide for our clients’ health and benefit. It is not possible for all patients to recover fully, back to their original state, and this is where a nurse comes in, aiding patients and their families “to cope with and understand their illness” (Travelbee, 1971, cited in Hilton, P. A. , 1997).
For this to occur, nurses need to have a certain amount of rapport with their patients, one that effectively allows them to communicate essential information in such a way that it is understood. In conclusion, it is important for us, as nurses, to understand the part we play when it comes to looking after patients, and not to be swayed by the impressions doctors, the public, or other healthcare professionals have of us. I believe each and every one of us has our own personal definition of nursing, and our own idea of how we plan to make a difference in a client’s life, and it is essential for us to stay true to that.
After all if we don’t stand up for ourselves, who will? Granted, collaboration with other healthcare workers and assisting doctors is part of our job scope, but we must learn to hold our own while doing so, and not be only seen as a supporting factor. As Falk-Rafael rightly shared, “nurses’ contributions to healthcare must first be made visible by nurses acknowledging their own expertise before expecting others to recognise it” (Canam, C. , J. , 2008). References Brennan, D. (2005). Commentary. The social construction of ‘woman’s work’: Nursing labour and status.
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