Soapbox
Women's health challenges for nurses
Helen Keleher
School of Health and Social Development, Deakin University, Burwood, VIC
PP: 184 - 184
Article Text
The women's health movement is characterised by the 'by women and for women' philosophy and its advocates for the health of women. The social health framework is fundamental, challenging normative constructions of the identity of women as primarily located within reproductive family structures, manifest in biomedical, positivist research and ideologies. Nursing has a long history of symbiosis with biomedicine, even though contemporary nursing theory claims distinction from medicine. The social health model is in tension with the biomedical model, particularly for nurses working in hospitals, manifest in public health services focused on body parts such as breast or cervical cancer screening programs. Such a surveillance of women's bodies challenges nurse practitioners endeavouring to practice within women-centred philosophies.
The 1995 National Women's Health Conference provided valuable information about the involvement of nurses in women's health. Presentations at one forum profiled the provision of women's health services across Australia, highlighting issues for nurses. Two very important issues were raised which should be actively debated by nursing. The first involves nurses (necessarily midwives) working in remote areas as women's health co-ordinators, who are involved in public health work such as health education and the delivery of screening services. In vast, sparsely populated areas, nurses' personal safety must be compromised. Burnout and high staff turnover are inevitable. Are current women's health service models appropriate? How could information and services be better provided? How can nursing as a profession better support the efforts by women's health nurses working in those areas? Further, nurses in remote areas are frequently employed on short term contracts initially funded by the National Women's Health Program. In a political environment not necessarily sympathetic to the philosophies and practices of women's health, continuing employment is not secure.
The second major issue I want to raise, involves the employment of women's health nurses in a diverse range of workplaces and the definition of nursing practice for registration. Nurses are employed for the diversity of their knowledge, skills, competence, adaptability and commitment to primary health care. Nursing it seems, is achieving some reorienting of educational programs towards primary health care. In terms of women's health, nurses are managing health centres, delivering services, providing training and education, creating talking space for isolated women, engaging communities in consultation, advocacy, lobbying, referral, community development and information services. This leads into a challenging political issue that pertains to definitions by nurses' registration boards about what are registrable health practices. Anecdotal evidence suggests that not all state registration boards consider those areas of women's health practices listed above, whether conducted in remote, rural or metropolitan environments, to qualify as nursing work for registration purposes. Women's health nurses practising from a broad definition of 'health' and 'work' have to defend this to registration boards who seem to have narrower definitions of nursing work. A stronger research base is essential to establish to what extent this is a common experience in women's health, and therefore a professional issue for nursing.
Models of service delivery currently used to structure the work of women's health nurses in remote parts of Australia are a cause of great concern. Similarly, definitions of women's health practice as nursing practice also present opportunities for advocacy and public policy development by the nursing profession. The adverse health and social circumstances of women's lives, which the health movement seeks to overcome, may inadvertently be hazardous for some nurses-a paradox for nursing to resolve.
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