Response
Debate on articles in Contemporary Nurse
Susan Tregoning
School of Nursing and Midwifery, University of South Australia, SA
PP: 050 - 051
Article Text
Dear Editor,
I was very interested to read the article 'The power to be different: is professionalization the answer?' in Contemporary Nurse Volume 2(3). Stephen Kermode has raised many pertinent and complex issues which will need to be effectively dealt with if professional status is to become a reality.
The author's view of professional power as 'an energy which allows professions and professionals to make things happen' is interesting. The concept and use of power in nursing is poorly understood and the potential to abuse the exercise of power and control in the work setting, particularly at the nurse/ patient (client) interface, should not be underestimated. Any increase in autonomy and control achieved in the name of professionalization must be balanced with professional accountability. 'Making things happen' in the best interest of the consumers of our services should be the primary concern in these steps and should include an emphasis on the patient (client) advocacy role.
The key to successful moves toward professionalization will lie in the implementation of changes based on Australian nursing research. Furthermore, these should be achieved in such a way that they are well understood and accepted by all affected by such changes.
I recommend this article to nurses, as food for thought.
Vera lrurita RN PhD FRCNA
Associate Professor, School of Nursing, Curtin University of Technology, WA
Dear Editor,
There are few concepts in nursing that seem to cause more confusion than 'primary health care', and in her recent article in Contemporary Nurse Volume 2(2), Winsome St John has made a valuable contribution to clarifying this issue. Most importantly, she suggests how the nursing profession can incorporate this concept into its role and practice.
As she describes in her article, primary health care can simultaneously mean a level of care (first contact, on-going responsibility, accessible, affordable), an approach (prevention oriented, population focused), and a philosophy based on a social view of health (equity, social justice, community development, empowerment). Nursing, as is the case with other health professions, does seem to understand primary health care as a level of care quite well. This is illustrated by the development of the nurse practitioner role both overseas and more recently in Australia. It is a role that fits comfortably with the traditional focus of professional practice-the individual and the family-and is compatible with the approach of the health services.
Adoption of the concept of primary health care as an aggregate approach and a community development philosophy is, however, much more difficult. Not only do nurses usually lack the knowledge and skills for population-based practice, but this approach runs contrary to health service structures and practices. By suggesting an integrated model of practice that can view development as either individual/family development or community development, nursing can at least be philosophically more comfortable with the primary health care concept. I suspect, however, that until health services are reoriented, few nurses will actually be able to emphasize community development work in their role to the degree desired.
Kay Plyrnat, Senior Lecturer
Faculty of Health Sciences, The University of Sydney
Dear Editor,
It was with interest that I read the challenge 'Nurses need to debate the issue of deregulation' made by Kay Price and Merri Paech in Contemporary Nurse Volume 2(2). They argue that we need to be aware of the potential for nursing to be oppressed by the stakeholders of nursing through the use of regulation. They also suggest that such regulation perpetuates medical domination in health care.
While I believe that we should always question and debate the status quo and move forward where necessary, I suggest we think about why such legislation was made in the first place. Also, why is legislation seen to perpetuate medical domination? Isn't it more to the point that it is how nursing acts and how nurses do or do not own the decision making that will do this?
I have recently returned from working in an Asian country where there was no legislative regulation of nursing. How helpful it would have been to have had the power of legislation behind me when I was trying to reinforce the role of the nurse. In that country it was the 'manpower' authority of the country that determined who could work as nurses. There was no registering authority. All hospitals were run by doctors who determined working conditions, negotiated nurse salaries and wages, and staffing numbers. The Director of Nursing was responsible to the Medical Director.
If, as had been my professional experience in Australia, I had had the benefit of documentation from the professional body, industrial organization and/or registering authority, many of the difficulties I encountered over the two years of establishing a new hospital would have been more easily resolved.
I believe that the Acts, regulations, standards, guidelines and policies the nursing profession has been instrumental in designing in this country, have enabled us to have a voice, and consequently power, for nurses to speak and act for nurses.
What would supporters of deregulation offer as an alternative and how would this be operationalized to prevent a repeat of the problems they see in the current system?
Lesley Siegloff, District Director of Nursing
Far West Health Service, Broken Hill, NSW
Dear Editor,
'Cultural' research in nursing has been recently explored by Christine Duffield and her colleagues in Contemporary Nurse Volume 2(2) and (3). My concern is not so much with the 'what' of the research, but rather the 'how'. It seems to me that if we are to ask questions of the structures and relations which constitute our complex and unstable culture, then we must devise methods which attest to the richness and diversity of the practices nurses live and breathe on a daily basis. In a culture unabashedly oral and indelibly female, perhaps we might consider turning to methodologies which privilege the narrative structures central to the ways in which we impart a sense of order and coherence on the fragmented and volatile nature of our experiences.
Duffield et al address important concerns, but do so in a style bereft of passion and a sense of engagement with the very world they purport to study. The material they uncover is significant but suffers from a style that effaces the sophisticated processes with which nurses engage in making sense of their lives, by speaking for them through research techniques that render sterile the data and analysis. Ethnographic techniques which valorise the fluidity and diversity of cultural accounts might better inform the interpretive endeavour inherent in all such cultural research. These techniques recognize that cultures do not stand still for their portraits and must be represented through research conventions ever sensitive to the dynamic yet always partial, contingent, and utterly historical nature of cultural research.
In suggesting ways beyond the tyranny of positivistic techniques of analyzing and writing up our cultural data, I am drawn to the recent work of scholars such as Annette Street, Jocalyn Lawler and Judy Lumby. In their work can be heard a variety of textual strategies which privilege the voices of the nurses with whom they are studying and which acknowledge the density, the contradictions and the silences ever present in cultural research. As the second millennium draws to a close, perhaps some of the most urgent work before us is to think creatively and openly about how we do research with each other as nurses. This work will necessarily find us confronting long cherished values and beliefs about what constitutes 'good' research. But if we are to continue asking of ourselves ever more probing questions concerning the culture in which we are immersed, then we must also prepare to brave new territory in the methodologies we employ to do this pressing work.
Kim Walker RN PhD
Lecturer, Tasmanian School of Nursing, University of Tasmania
eContent Home
