Nursing observations: the need for Political inoculation in "Intro 101"
"Hockey's (1989b) typology of nursing activities as consisting of autonomous, derived and delegated elements suggests we should focus on the interventions which are initiated as well as undertaken by nurses. This is the core of nurses' work. It is what nurses do which is not done by other people. Nursing has always found it difficult to describe this core. Goddard's (Nuffield Provincial Hospitals Trust 1954) choice of the term 'basic' to describe this element of nursing work has had a disastrous influence not only on nurses' perceptions of the value of their work but also on the way in which nursing is regarded by other professional groups. It has been suggested that the term was used as a shorthand for 'fundamental' or 'essential' and that is has been systematically misinterpreted over the last three decades* by those who wish to use it to justify the horizontal division of nursing labour. Goddard demonstrated that basic nursing was undertaken by the least qualified and the lowest skilled. This observation might have sparked off a revolution in the delivery of nursing care but instead it has been and is used to justify the continued employment of unskilled labour in direct patient care." p.128.
*My emphasis: "... over the last three decades .." hence, since the early 1960s.
INDIVIDUAL
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INTERPERSONAL : SCIENCES
HUMANISTIC -------------------------------------- MECHANISTIC
SOCIOLOGY : POLITICAL
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GROUP
"The struggle between the twin poles of professionalism and bureaucracy is mirrored in that between the holistic, therapeutic approach in nursing, and that which is reductionist and functional (e.g. the task-centred approach to care). To work successfully in such a climate demands considerable skills of nurses, for they must seek to change the nature of the organisation, or at least to neutralise its effects so that they can concentrate on therapeutic practice. Amongst these skills must be those of change agency." p.107. | "Much of health care and particularly nursing is still organised along hierarchical and bureaucratic lines. To work professionally in such a system may in some way be seen as a contradiction in terms. The nurse may seek to exercise professional autonomy and make decisions about patient care (and indeed the organisation may seem to be encouraging him or her, at least superficially, to do so). Yet at the same time the nurse receives conflicting signals as others endeavour to exercise control over nursing practice such as doctors, senior nurses, finance directors, supplies officers and so on." p.107. |
In this book's final chapter: Paterson and Zderad's five Phases of Phenomenological Nursology.^
INDIVIDUAL
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INTERPERSONAL : SCIENCES
HUMANISTIC -------------------------------------- MECHANISTIC
SOCIOLOGY : POLITICAL
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GROUP
1. Preparation for the nurse knower coming to know. (Hodges' model as a template - 'clean slate' also facilitating unconditional positive regard - openness to a new encounter - whether the first or subsequent.) 2. Nurse knowing the other intuitively. (Intuition still has a role. A message: speak to a colleague - seek supervision!) | 3. Nurse knowing the other scientifically. (Reductionism is needed yet balanced with the humanistic esp. as the march (float ...) of the robots/AI follows apace.) |
4. Nurse complementarily synthesising known others.
(This is a purpose for Hodges' model, supporting the user to identify salient concepts and the relationships between them and their quality; then to reflect, think critically and move towards formulation.)5. Succession within the nurse from the many to the paradoxical one.
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| Nursing as Therapy |
(Tied to #4 above, but can emphasize health education, health literacy, co-production and co-creation with the patient - client. A collapse - in the synthesis with simultaneity of the individual and collective. Arriving at a conclusion and for the future of Hodges' model in theory and practice: an abstraction.)
Paterson J.G., Zderad L.T. (1976). Humanistic nursing. New York: John Wiley.
The conceptual scope of Hodges' model is demonstrated in how it can encompass other (all?) models of care and frameworks, including humanistic nursing.
^Chapter 8 - Breaking the mould: a humanistic approach to nursing practice. pp.170-191.
Bought secondhand, 'Nursing as Therapy' caught my attention as I have read and wondered about 'assessment as therapy' across disciplines.
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