Context and contingency in the history of post World War II nursing scholarship in the United States

PURPOSE: To examine the context for the development of nursing scholarship post World War II. METHODS: Historiographical analysis of the social, political, and cultural context of nursing scholarship in the postwar period, with an understanding of how this context shaped nursing scholarship. FINDINGS: The development of nursing scholarship was influenced by three contextual strands: Nurses' use of experiential clinical knowledge to situate practice questions in the changing clinical care milieu of the 1950s to the 1970s; The development of an intellectual genealogy through new educational opportunities at the baccalaureate and graduate level from the 1960s to the 1980s that provided the foundation for reintegrating practice and education; and the creation of a growing cadre of nurse scholars and their political influence on the relationship between power, knowledge, and clinical practice. These formulations are critical for understanding how scholarship changed over time and help us understand contemporary clinical practice, its authority structure, how it helps us define a body of knowledge from which practice proceeds, and then, how it responds to public demands. CONCLUSIONS: Nursing scholarship is nested in a particular social, political, economic, and cultural context. This context also determines how and why it is generated, debated, and used. Its production does not always follow a rational, logical pattern. Nursing knowledge development is influenced as much by the political underpinnings of health care as it is by social, economic, cultural, and scientific foundations.     

Foucault and nursing: a history of the present

While a commitment to the development of nursing theory has been a significant force in nursing scholarship, particularly in the US, the authors have noted a recent trend among nurses in different countries to develop Foucauldian interpretations of nursing. The objective of this paper is to identify those publications by nurses that employ a Foucauldian perspective and to provide a useful summative review of these works to date, which illustrate the potential contribution of a Foucauldian reading of nursing. The authors have reviewed 27 publications written by nurses which present a Foucauldian analysis. These publications were issued between 1987 and 1998 in English, Portuguese and German. The most frequent concepts treated in the literature reviewed are power/knowledge, surveillance, discourse, discipline, resistance, docile bodies, clinical gaze, and panopticon. The literature reviewed illustrates that Foucault's concepts can have a profound impact on the way we conceive of nursing as a discipline and as a profession. Nursing care becomes a political event, nursing knowledge contributes to the dissemination of regimes of truth, and nurses, rather than being powerless, are perceived as professionals who exercise power over life in society. A Foucauldian reading of nursing enables nurses to move into a broader interdisciplinary and critical scholarship.     

'Telling stories about ourselves': historical methodology and the creation of mental health nursing narratives

This paper considers the processes through which historical narratives are shaped. Interest in this area emerged from the author's struggle to understand contemporary mental health nursing in Ireland, and to situate this profession within its historical context and trajectory. It is argued that both the historical narrative and contemporary image of Irish mental health nursing are heavily influenced by the methodologies adopted by historians working in this area. The 'progressive historical approach', which remains the predominant methodological tradition adopted in nursing history, is firstly considered in this paper. The limitations of this approach are explored and an 'interpretive historical approach' is suggested as methodological counterpoint to the progressive tradition. 'Critical perspectives' are also considered and contextualized with reference to interpretive schools of thought. It is proposed that a fusion of the interpretive and critical approaches can offer a sound theoretical basis for the development of contemporary histories of nursing that transcends progressive narratives of altruistic caring interventions.     

Seeking the both/and of a nursing research proposal.

Much of contemporary nursing scholarship challenges us to critique the assumptions that underlie the processes of inquiry as well as the knowledge that we claim as our results. This article examines the layers of assumptions that circumscribe an ethnographic study of the relationships among health, environment, policy, and culture in one Hispanic community. The author seeks to analyze these assumptions as sources of meaning and interpretation by illuminating discourses contained within the text of the proposal. This discourse analysis provides perspectives from which to consider questions of knowledge, power, and relationships in nursing inquiry.     

Nursing scholarship in Japan: Development, facilitators, and barriers

This qualitative study sought a contemporary view of the development, facilitators of, and barriers to nursing scholarship in Japan from the perspectives of the scholars. In-depth interviews were conducted with 13 scholars across Japan, which were digitally recorded, and the data were subjected to content analysis. Five themes emerged: a spirit of collectivism; a lack of nursing control; a lack of English ability; a high workload; and collaboration. The participants considered that culturally based consensus and communication behaviors, as well as the control and dominance by the medical profession, were hampering nursing scholarship. Furthermore, Japanese nurses were not in control of the profession in a period of unprecedented growth in university nursing education and a growing nursing shortage. A lack of English-speaking and English-writing abilities hindered collaboration with scholars internationally and the writing of international publications. Most of the participants felt unable to compare the extent and nature of Japanese scholarship with that of their Asian neighbors. The Japanese scholars need to grasp opportunities to learn English, collaborate with other nurses nationally and internationally, learn assertion and political skills to give them the confidence to take control of nursing education, and be more involved in research collaboration and international publications.     

Ideological implications of paradigm discourse

Whilst the notions of paradigm and paradigm shift have become popularized in nursing's scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivation underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.     

Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development

BACKGROUND: Two dominant discourses in contemporary nursing theory and knowledge development have evolved over the past few decades, in part by unitary science views and caring theories. Rogers' science of unitary human beings (SUHB) represents the unitary directions in nursing. Caring theories and related caring science (CS) scholarship represent the other. These two contemporary initiatives have generated two parallel, often controversial, seemingly separate and unrelated, trees of knowledge for nursing science. AIM: This paper explores the evolution of CS and its intersection with SUHB that have emerged in contemporary nursing literature. We present a case for integration, convergence, and creative synthesis of CS with SUHB. A trans-theoretical, trans-disciplinary context emerges, allowing nursing to sustain its caring ethic and ontology, within a unitary science. METHODS: The authors critique and review the seminal, critical issues that have separated contemporary knowledge developments in CS and SUHB. Foundational issues of CS, and Watson's theory of transpersonal caring science (TCS), as a specific exemplar, are analysed, alongside parallel themes in SUHB. By examining hidden ethical-ontological and paradigmatic commonalities, trans-theoretical themes and connections are explored and revealed between TCS and SUHB. CONCLUSIONS: Through a creative synthesis of TCS and SUHB we explicate a distinct unitary view of human with a relational caring ontology and ethic that informs nursing as well as other sciences. The result: is a trans-theoretical, trans-disciplinary view for nursing knowledge development. Nursing's history has been to examine theoretical differences rather than commonalities. This trans-theoretical position moves nursing toward theoretical integration and creative synthesis, vs. separation, away from the 'Balkanization' of different theories. This initiative still maintains the integrity of different theories, while facilitating and inviting a new discourse for nursing science. The result: Unitary Caring Science that evokes both science and spirit.     

Natural science and nursing science: where do the horizons fuse?

The natural sciences have an influential effect on society, contemporary world-views, and other scientific disciplines. A brief history of the major advances in the natural sciences and the associated philosophies provides a platform for scholarly discourse regarding the subsequent influence on nursing epistemology. The concepts of knowledge and understanding are differentiated and a cautionary word is expressed not to cast aside the natural sciences and their corollary philosophies as nursing embarks upon its epistemological journey into the 21st century. Aesthetics is presented as a possible fusion of horizons of nursing and natural science.     

Talking the talk: a discourse analysis of mental health nurses talking about their practice

Mental Health nursing exists as a discipline in the UK within the wider contemporary health care establishment. Throughout its history it has attempted to define itself in ways that differentiate mental health nursing practice from other health care professions and fields of nursing. However, it is not surprising in this climate of contemporary healthcare for individual professional identities to become 'lost' in the melange of interdisciplinary practice. This research presents a discourse analysis of individual mental health nurses' rhetorical constructions of their professional role(s) as they emerge in their talk with each other in focus group discussions. In particular, the focus in this paper is their discursive repertoires related to the historical legacy of mental health nursing and how this sits with what they consider to be a 'custodial and controlling' element of their role. The particular discourse analytic approach adopted in this study illustrates how individuals use language in a particular way to make justifications and explanations of mental health nursing identities. This analytic approach is ensconced within the domain of social psychology and lies at the interface of ethno-methodology and conversation analysis. It is concerned with structural units of discourse, beyond the level of the sentence, that emerge as the nurse participants engage in talking about their practice (Potter and Wetherell, 1987 p.53).     

Discourse analysis: towards an understanding of its place in nursing

AIM: This paper describes how discourse analysis, and in particular critical discourse analysis, can be used in nursing research, and provides an example to illustrate the techniques involved. BACKGROUND: Discourse analysis has risen to prominence in the 1980s and 1990s in disciplines such as the social sciences, literary theory and cultural studies and is increasingly used in nursing. This paper investigates discourse analysis as a useful methodology for conducting nursing research. Effective clinical reasoning relies on employing several different kinds of knowledge and research that draw on different perspectives, methodologies and techniques to generate breadth of knowledge and depth of understanding of clinical practices and patients' experiences of those practices. DISCUSSION: The steps in a discourse analysis include: choosing the text, and identifying the explicit purpose of the text, the processes used for claiming authority connections to other discourses, construction of major concepts, processes of naming and categorizing, construction of subject positions, construction of reality and social relations and implications for the practice of nursing. The limitations of discourse analysis, its relationship to other qualitative approaches and questions for evaluating the rigour of research using discourse analysis are also explored. The example of discourse analysis shows how a text influences the practice of nursing by shaping knowledge, values and beliefs. CONCLUSION: Discourse analysis can make a contribution to the development of nursing knowledge by providing a research strategy to examine dominant discourses that influence nursing practice.     

Teaching nursing history: The Santa Catarina, Brazil, experience

Nursing history has been a much debated subject with a wide range of work from many countries discussing the profession's identity and questioning the nature of nursing and professional practice. Building upon a review of the recent developments in nursing history worldwide and on primary research that examined the structure of mandated nursing history courses in 14 nursing schools in the state of Santa Catarina, Brazil, this paper analyzes both the content and the pedagogical style applied. We postulate that the study of history offers an important opportunity for the development of student learning, and propose that more creative and dynamic teaching strategies be applied. We argue the need for professors to be active historical researchers, so they may meaningfully contribute to the development of local histories and enrich the professional identities of both nursing students and the profession. We conclude that historical education in nursing is limited by a traditional and universalist approach to nursing history, by the lack of relevant local sources or examples, and by the failure of historical education to be used as a vehicle to provide students with the intellectual tools for the development of professional understanding and self-identity.     

Critical scholarship: the critique of domination in nursing

This article explores the development of critical scholarship in nursing. Recent examples of critical analysis in nursing literature suggest an emerging pattern of scholarship that focuses on the critique of domination in nursing. This is a pattern of scholarship that has emerged from contemporary social and historical contexts and one that reflects the experiences of working nurses exposed to contemporary schools of thought. The dynamics of critical scholarship, its origin, its progression, and some contemporary models that describe its outcomes are discussed.     

'Wanted: 16 nurses of the better educated type': provision of nurses to South Africa in the late nineteenth and early twentieth centuries

This paper is based on research in progress focusing on the histories of mission hospitals in the rural communities of KwaZulu Natal, while also building on earlier research into the pluralism of medical systems within the South African Cape. Sources have been drawn from a range of historical documents, including medical and nursing journals, the archives of a number of medical missionary societies and of the Overseas Nursing Association, but the research has also been informed by oral histories of a broad cross-section of health professionals who practised in South Africa. A large literature search included a number of biographies and institutional histories. The paper will be divided into three parts--the first provides a brief background to colonialism and the early nursing history of South Africa; the second looks in more detail at the role played by missionary nurses in establishing nursing as a profession and providing training opportunities for African nurses. The final part contrasts missionary nursing with the supply of, and work done by nurses from the Overseas Nursing Association operating within their quite specific, colonial remit. This will show how the two contrasting professional spheres--one reflecting a fairly short-term commitment, the other, a much broader, 'vocational' involvement--may be seen to represent quite different colonial attitudes, and ultimately quite diverse outcomes.     

Creating a space for recovery-focused psychiatric nursing care

Creating a space for recovery-focused psychiatric nursing care
Within contemporary mental health-care, power relationships are regularly played out between psychiatric nurses and service users. These power relationships are often imperceptible to the practicing nurse. For instance, in times of distress, service users often turn to or/and 'construct' discourses, beliefs and knowledge that are at odds with those which psychiatric nurses rely on to inform them of the mental status of the service user. The psychiatric nurse is in the position to impose knowledge onto service users, usually in concurrence with 'traditional or bio-psychiatry', without realizing or failing to acknowledge that the service user may have an alternative explanation of his/her mental health problems/experiences. In this paper, practice examples, based on the experiences of the four authors (from within and outside of services), are used to illustrate this 'hidden' power relationship. The authors use Foucault's ideas about: (i) government; (ii) the knowledge/power nexus and resistance; (iii) and his analytic tool of genealogy to help unravel this paradox within psychiatric nursing practice. The authors also use the emerging discourse of recovery as an alternative (and challenge) to 'traditional bio-psychiatry' and consider the implications for psychiatric nursing practice.     

Nursing expertise: a course of ambiguity and evolution in a concept

In this article, we clarify and describe the nature of nursing expertise and provide a framework to guide its identification and further development. To have utility and rigour, concept‐driven research and theories of practice require underlying concepts that are robust, valid and reliable. Advancing understanding of a concept requires careful attention to explicating its knowledge, metaphors and conceptual meaning. Examining the concepts and metaphors of nursing expertise, and how they have been interpreted into the nursing discourse, we aimed to synthesise definitions and similarities between concepts and elicit the defining characteristics and properties of nursing expertise. In clarifying the concept, we sought to move beyond the ambiguity that currently surrounds expertise in nursing and unravel it to make explicit the characteristics of nursing expertise from published peer‐reviewed studies and structured literature synthesis. Findings indicate a lack of clarity surrounding the use of the term expertise. Traditional reliance upon intuition as a way of explaining expert performance is slowly evolving. Emerging from the analysis is a picture of expertise as the relationship between networks of contextual reasoning, understanding and practice. Striking absences in the discourse include limited explication of ethical reasoning and theorising a broader interpretation of expertise reflective of contemporary forms of nursing.     

Nursing leadership: influencing and shaping health policy and nursing practice

The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio-political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi-structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined.     

From the Grey Nuns to the streets: a critical history of outreach nursing in Canada

This article traces the historic antecedents of outreach nursing in Canada, going as far back as the Grey Nuns in what is now Quebec. It attempts to place modern-day street nursing in a historical context, which includes Nightingale, Wald, the early Victorian Order of Nurses, and the social reform movements of the early 20th century. The article critiques the involvement of nursing in less than virtuous aspects of social control with respect to impoverished and otherwise marginalized groups. The article goes on to trace the origins of modern Canadian street nursing in three cities: Vancouver, Toronto, and Montreal. It uses both a search of the nursing literature and, because much of this history is undocumented, oral history and anecdotal information as well. It critiques nursing's traditional avoidance of political action and calls upon modern-day nurses to support and educate one another to engage in this work.     

Negotiated care: a model for nursing work in the renal setting

AIM: This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. METHODS: Materials from several streams of literature are used to conceptualize the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualized by viewing the renal setting as a specialized social context constituted by a dominant professional discourse and a contrasting client discourse. DISCUSSION: While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. CONCLUSION: Within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanize contemporary medical technologies by responding to clients' experiences of illness and therapy.     

The unbearable whiteness of being (in nursing)

My purpose in writing this paper is to uncover some of the ways in which nursing participates in, reproduces, and resists the detrimental practices associated with white cultural privilege and to share some instances of its personal and social costs. It draws upon the body of scholarship which interrogates racism as it is enacted through whiteness in North America. Whiteness is depicted not as a preordained biological property, but as a socially constructed category of race, wherein non-white people are racially designated, while whites escape such designation and occupy positions which allow them to carry on as if what they say is neutral, rather than historically and ideologically situated. While the concept of whiteness may not have much resonance in nursing, it offers another way to talk about racism, one that does not stop with the scrutiny of the racialized Other. The presumed neutrality of whiteness has been institutionalized so that its authority to define knowledge, membership, and language, as well as its ability to stipulate and enforce the rules and regulations of everyday concourse and discourse within nursing is concealed.     

The rise of practice development with/in reformed bureaucracy: discourse, power and the government of nursing

rudge t., holmes d. & perron a. (2011) Journal of Nursing Management 19, 837–844 The rise of practice development with/in reformed bureaucracy: discourse, power and the government of nursing Aim Using a neo-Foucauldian approach, a critique of texts explicitly dealing with the definitional work for practice development (PD) was undertaken. Background PD has been taken up by many organizations as a way of focusing on nurses’ practices to benefit patients and the organization. Evaluation Literature pertaining to the PD phenomenon was examined and the present study explores those texts accomplishing definitional work. The discourse corpus collected together articles in nursing journals, book chapters and textbooks. The corpus was analysed using the discourse analysis method. Key issues PD uses and manipulates its location in a network of managerialism, evidence-based nursing, safety and quality discourses in healthcare to verify (and confirm) its definition and its position as central to progress in nursing practice. Conclusion We argue that while PD is portrayed as ‘emancipatory’ and transforming, nurses bear the responsibility for the system and its failures in a web of intricate power relations. Implications for Nursing Management The present study offers a review of the PD ideology in nursing where a critical perspective has yet to be found. Nursing managers should understand that PD is not a panacea for improving patient care.