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Nursing Matters: Critical sociological perspectives
Helen Keleher and Fran McInerney (eds)
ISBN: 0-443054-33-9 1998 194 pages Sydney Harcourt Brace
Jane Shoebridge
Nursing (Social Science), Faculty of Health Sciences, Flinders University of South Australia, SA
Most of these ten richly diverse case studies of Australian nursing are well worth reading.
Maria Zadoroznyj leads strongly. If professions are built up from marketable credentials, education, status and ethics, why are nursing's efforts to professionalise thwarted? Because the health labour force remains divided by gender and fragmented in myriad specialisations. Under these conditions 'deskilling' and 'enskilling' can only be marginally successful strategies for collective upward mobility.
In an understaffed, busy orthopaedic ward of a large teaching hospital Elizabeth Herdman (2) meets registered nurses who ask how come their work is so heavy, mundane, dirty, repetitive and boring when the ideologues of higher education promise them a skilled and richly rewarding professional life!
Helen Keleher (3) recalls how early twentieth century doctors recruited infant welfare nurses to teach mothers how to produce eugenically correct babies. Fortunately many mums avoided the bossier nurses, rigid rules and inevitable guilt; and sought out the "...few shrewd, humane nurses who fostered confidence in...working class mothers" (p.58).
Eileen Willis (4) re-visits the conflictual 'role relationships' between Aboriginal Health Workers (AHWs), Remote Area Nurses and District Medical Officers, and the communities and bureaucracies to whom each is accountable. Eileen had attributed the conflict to racism and alienation. Now she enlists Foucault's critique of social power arguing that AHWs and their communities resist change so as to maintain a social situation which, although antagonistic, operates in their favour.
Julianne Cheeks chapter (5) explores Foucault's ideas further telling us how doctors built up their expert knowledge and power through techniques of the clinical and panoptic gaze and through the disciplinary force of scientific discourse. But Julianne counsels nurse theorists against too much Foucault.
To Fran McInerney (6) the doctor/nurse/patient relationship resembles the patriarchal nuclear family. She stretches the analogy to the home economics of pain control. Just as the breadwinner expects his wife to feed and clothe his family within budget so the doctor expects his nurse to palliate his patients within the limits of the drug supply. As with an unjust economy generally, supply and demand seldom match. Some miss out.
Encouraging women and nurses to think critically, speak out against injustice and build safe strategies for changes integral to the transition to tertiary nursing education in Australia. Nel Glass (7) reports that women who trained in hospital schools and subsequently undertake tertiary education, often experience considerable personal change.
Stephanie Bates (8) discovers agency nurses facing difficulties in their everyday and every night shifts. The relentless trend towards employing casual and short-term contract staff raises profits at the expense of in-house worker solidarity and individual professional autonomy.
Finding that student nurses disparage aged care, developmental disability and mental health and revere surgical, intensive care and paediatric nursing prompts John Stevens and Mira Crouch (9) to be critical of the university curriculum and especially its clinical education.
The general transition from clinical to professional to corporate 'orientation' in nursing is exemplified in Ken Bridge's outstanding chapter (10). Bridge demonstrates the shift by Occupational Health Nurses towards a "corporate orientation" which contradicts and corrupts their clinical loyalty to workers and their professional defence of workers against injurious work practices. Bridge recommends OHNs defend their professional reputations by aligning with worker elected union representatives and health and safety officers.
This collection contributes to a much needed seriously critical literature from which all nurses, educators and researchers could benefit. I commend the book's logic and moral stance but alert readers that it needs more editing.
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