Article: Nursing as a Profession

                                                        Why is nursing important?

          Nursing is different today from what it was decades ago. Rapid modernisation has brought the field of nursing to divulge further and deeper into finding its core meaning and job scope. Therefore, this paper is going to argue and compare the works of three authors, namely Hughes, Henderson and Carper, with reference to other authors as well, specifically Brennan and Butts. Their individual ideas and thoughts explain and interlink with each other in distinct ways, elaborating the development of nursing over the years. This sets a standard for comparison and improvement for nurses today. Besides that, experiences from our professional work are drawn and used to relate in corresponding to the words of the authors. As a whole, this effort will describe how the nursing field transcends from a domestic based work into achieving a status of a profession, providing a form of service in today’s society. Not only that, it critically explains the importance of aesthetic and ethical knowledge necessary in moulding this profession into a comprehensive, unique and one of a kind occupation. Basically, this work portrays a sense of affinity to the words of the authors that relates to the daily work style of nurses today.

 

          Nursing is and most probably will be seen, as a female dominated field of health sciences for many more years to come. In fact, it is relatable to its prior history during the aftermath of World War II, when nursing was first initiated by women domestically. Yes, women were seen as the caretakers who nurture and bring up their families with traditional values and discipline. Women held the obligation in sculpting a society of values and discipline, as family is the nucleus that builds a society. Hughes (1990) stated that the moral stability of a community is directed solidly to woman as their main responsibility. This undeniably portrays the innate caring nature of women.

 

        Even though nursing was derived from a feministic home- based occupation, it is arguable that the perspective of nursing as a domestic field of work has changed.

       

The first point relates to the evolution of nursing that has been growing congruently with rapid global modernisation. In today’s society, people are more knowledgeable than they were decades ago. However, the majority of people still uphold a preconceived notion that nursing is domestic based and a low paid job for women rather than accepting it as a profession. Hughes (1990) describes that the decision for a certain job or occupation to be categorized as a profession is not made based on a specific individual’s perspective, but as a society in whole. Hence the question, what was the first step that nursing took to evolve and be deemed as a profession?

       The answer to that lies in its history. Evidently, Brennan (2005) points out that although Nightingale had contributed to nursing tremendously, she however might have implemented a system where nursing is controlled by doctors, based on their scientific medical paradigm. Subsequently, we were perceived as assistants who merely carry out doctor’s orders obediently as our duty, without seeing the crucial need to question or think otherwise. Relevantly, Henderson (1964) agreed, whereby she explains her negative nursing experience gained while she was still a student nurse as an authoritative, regiment-based and text-book based care. Her work is pertinent to prove on how the condition of nursing was back in the 20th century as her student nurse experience was approximately 19 years later after World War II. This era was when the society began to depend on the knowledge and skills of professionals.

         Clearly, medical practitioners were upholding a higher control over the works of nurses which in turn affected the way society perceived nursing. It is contestable that the only cause that created a gap between caring and treating was the application of scientific approach by the medical practitioners. In fact, the caring approach practiced by nurses wasn’t regarded highly by society because it was not scientifically proven. 

         Hughes (1990, p. 30) cites the work of Reverby (1987) who insists that because caring is considered as a woman’s responsibility, it is not a prominent element that defines a profession. Relatively, the art and beauty of care wasn’t appreciated by society at that time. This was probably due to the restrictions of how and what people considered as art in that era, which were concrete displays of drawings and pictures by artists. But, caring isn’t just the duty of women, it is an art. As Wiedenbach (1964 as cited in Carper, 1978, p. 17) expresses the transformation from a patient’s behaviour to a perception that identifies the needs shown by that behaviour, is what the art of nursing is. Regardless of gender, nurses have the ability to read and understand patient’s needs just by observing their behaviour. Not only that, they are able to apply their experiences with different types of patients to provide the best patient centred care possible. 

        Concurrently, the emergence of industrialisation and the aftermath of the World War II provided a breakthrough for society to develop critical thinking about the how’s and why’s of certain things. The key word grasped here is knowledge. 

      Well, it was at this stage that knowledge, in the form of scientific approach towards understanding anything and everything played a vital role in reasoning. This proved and provided a new found gateway for innovations and unique ideas. The point where the nursing field began to question and think otherwise based on the scientific approach emerged. The urgency for nursing to reach a professional status similar to medical practitioners as rapidly as possible introduced the application of scientific positivism, which eventually paved its way to evidence based practice. Literally, it was obvious that what nurses needed as a stepping stone was education. Henderson (1964) contended that, for nurses to practice nursing independently, they needed education that is provided only in units and colleges. During her time, a college education was considered as a higher education. But in comparison to today’s modern times, a degree or master’s qualification in a university defines a higher education. Comparatively, the article by (Butts, Rich & Fawcett, 2013), written just three years ago, disputed that with the amount of knowledge expected now, a post baccalaureate education, mainly a Doctor of Nursing Practice is required in the nursing expertise. 

        Realistically, the bar is raised higher and higher in time as the quest for higher academic qualifications is somewhat turning into a competition among nursing alliances. Furthermore, the primary objective of nursing, which is patient care, is sadly diminishing as more nurses opt to move towards academic nursing rather than bedside nursing. Besides that, paper qualifications are still considered as essential requirements in every job scope to gain promotions or a raise in salary, particularly in the field of nursing. Factors such as, higher pay, amount of responsibilities, question of having respect from colleagues and employers and finally, the potential in career development are fuels that drives nurses to think that an educational qualification is the only way to move up the career ladder. It is arguable that, the strong grasp of the scientific approach in nursing, from the 20^th century till now, influences the amount of importance given to the education level of nurses rather than the quality of care given to patients. 

        Ironically, the term evidence based practice is a practice that is already engraved in the minds of nurses and student nurses. Even though many decades have passed since the birth of scientific knowledge in nursing, it still remains as the main mode of nursing education and practice in the 21^st century. Evidence based practice only plays a small role in the broad context of nursing knowledge, but why does it still considered the major form of knowledge in nursing?

       

Apparently, ‘nursing has inherited a “legacy of positivism” which promotes objectivity and reductionism and which excludes subjective meaning and the personal from the research process. In part, this has been due to the powerful influence of the medical hegemony’ (Playle, 1995 as cited in Brennan, 2005, p. 284). It is agreeable that a higher priority is given to the evidence based practice, as it was introduced through the authoritarian form of nursing practiced in the past where medical practitioners held the power. Consequently, Butts et al. (2013) firmly stands on the effectiveness of empirical based knowledge in guiding the nursing practice and disapproves a fusion of knowledge through interdisciplinary framework. She believes that this would lead to the destruction of the nursing field. However, if we were open to acknowledge the uniqueness of aesthetic and ethical aspects in the definition of our work, this fear of interdisciplinary invasions and ambiguity in our roles would never be a problem in the first place. In fact, aesthetic and ethical elements are what differentiate nursing from other healthcare professionals. It is unfortunate that scientific knowledge is greatly stressed upon as the fundamental basis for nursing to reach its professional status.

           Secondly, in a broader perspective, nursing as a field in healthcare, has to portray an image to prove that’s its more than just a scientifically specialized knowledge field for society to label nursing as a professional work and not a domestic work. Hughes (1990) claims that, the use of scientific methods alone isn’t the main factor to acknowledge an occupation as a profession with fame and potential. Specifically, the nursing occupation has to show that it is not just a mere empirical based knowledge job, but an occupation that has a harmonious blend of aesthetics and ethics as well. Carper (1978) disputed that there is a sense of unwillingness to acknowledge elements that aren’t scientifically proven as knowledge. It is arguably true by evidence nursing still pursues a more concrete scientific pathway in education, research and practice rather than abstractive. What society fails to realise is that nursing is beauty in itself. Nurses need to find a way to approach different types of patients in their own distinct unique and creative styles, with the notion to deliver the best care possible for them. It is a form of art that only nurses can portray as we put ourselves in the shoes of our patients.

        

   In other words, empathy is a great quality only nurses could master through experience by communicating with patients. The invaluable encounter with patients everyday helps nurses to develop various approaches to deliver a good quality of care. According to Carper (1978), nurses can develop and think of new ways to provide an effective and pleasing patient care service in their own style, through their experiences in dealing with people from diverse backgrounds, and by learning to identify and empathise with them. For instance, through the experience in dealing with death of patients, nurses could make the death of a patient as comfortable and peaceful as possible by providing a serene environment during death and encouraging the presence of family and relatives to stay alongside patient during this time. Maintaining patient’s hygiene and grooming as well as planning a safe and dignified death by carrying out advance care planning with the patient and family members before his or her death are ways that nurses assist patients to a peaceful death. Not only that, Henderson (1964) asserted that nurses have the ability to maintain the aesthetic aspects surrounding a patient’s death and to use their nursing skills to make the patient as comfortable as possible, without stressing on scientifically based approaches. Moreover, the potential of nurses to articulate, in order to provide the best of both the scientific and the aesthetic world is beyond comparable. Yet, this quality has failed to reach a comprehensive understanding in the nursing field.

        Thirdly, the ethical aspects in nursing also play a vital role in providing meaning and depth to the nursing job scope that not many professions prioritize. Basically, the main aim in nursing care is to ensure the quality of recovery and the health of patients. This responsibility solely lies in the hands of nurses as they have to make personal moral choices to differentiate right and wrong for the benefit of patients. For instance, operation theatre nurses have to constantly assess surrounding circumstances to maintain sterility at all times. This is to prevent contamination of the sterile area and the site of operation, which would otherwise predispose patients to severe infections. As Carper (1978) explains “the moral code which guides the ethical conduct of nurses is based on the primary principal of obligation embodied in the concepts of service to people and respect for human life” (p. 20). Although sterility and infections are evidence based, the integrity and act of nurses to designate ways to adhere by it proves the importance for ethical knowledge as well.

      

Therefore in conclusion, the nursing profession has journeyed through myriad obstacles to achieve what it is today. Our field of work is still striving to acknowledge other components of knowledge that are able to shape our nursing as a holistic and uniquely rich profession. More research, theories and ideas are essential to improve and advance the nursing field. Hence, the best place to start lies with us. In order for society to view nursing as a profession with prestige and recognition, we as nurses must first try to incorporate that knowledge and portray it in our deliverance of care to our patients. Till then, we should be receptive in learning, implementing and analysing the core meaning of our novel profession, for it to even exist as a profession in the near future.

By,
Jessica John Posko

References :

1.                              Brennan, D. (2005), The social construction of woman’s work. Journal                                           of Nursing Management, 13, 282-285.

2.                              Butts, J. B., Rich, K. L., & Fawcett, J. (2013). The future of nursing: How important is discipline- specific knowledge? A conversation with Jacqueline Fawcett. Nursing Science Quarterly, 25(2), 151-154. doi: 10.1177/0894318412437955

3.                              Carper, B. A. (1978), Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-24.

4.                              Henderson, V. A. (1964), The nature of nursing. American Journal of Nursing, 64(8), 62-68.

5.                              Hughes, L. (1990), Professionalizing domesticity: A synthesis of selected nursing historiography. Advances in Nursing Science, 12(4), 25-31.