I was fortunate to be involved last night in a twitter chat on the subject of ‘basic’ care (#nurchat for you tweeters), this followed on from the recent Care Quality Commission’s report on Dignity and Nutrition which does not make pleasant reading. The issues are current and will be for a long time. I have to agree with Colin Holmes’ observation: “My theory is that these are deep-seated archetypes, established and maintained under the influence of powerful but subtle psychological and social forces, and although not completely impervious to change I don’t think that reiterating the facts of the matter will have much impact on them”.
The nursing archetype referred to is the ‘altruistic caring mother figure’ the implcation is that the graduate technically proficient nurse challenges this deep seated view. The archetype is founded upon gendered and class role perceptions and is addressed in the sociological literature (see for example Peter Morrall Sociology and Nursing 2001). Cognitive psychology teaches us about how we think, how we are prone to cognitive biases, Logic in philosophy teaches us the many logical fallacies we engage in when arguing and the advertising industry is accessing new and sophisticated means of persuasion (see George Monbiot on this “Sucking Out Our Brains Through Our Eyes” http://www.monbiot.com/) which bypass our critical reasoning skills. Thus the public understanding and public policy is not founded on clear and reasoned argument.
My perspective on this is that the “subtle psychological and social forces” will continue to work their ‘magic’ upon the public’s imagination because the public lacks the ‘sociological imagination’ required to excise the base gender/class archetypes. What is required is a Khunian paradigm shift within the public’s understanding of nursing, and this will only come about as the anomalies in thinking are constantly revealed in narrative and political action until a tipping point is reached.
This reinforcess my belief that resistance to the dumbing down of entry gates to graduate nursing and educational provision has to continue and that the nursing community must learn new ways of networking and communicating (social media such as twitter?) to build up the body of anomalies to challenge a hegemonic view of nursing practice. The anomalies include the research evidence of course, but this is much more than clearly communicating what we do and what nursing is based on: it requires stories, narratives, emotion etc, it requires political activism as well (I mean politics in the broadest sense).
Thanks to Peter Morrall I am reminded of Antonio Gramsci’s ‘hegemonic dominance’ which relies on a “consented” coercion. Gramsci was of course analysing class relations in capitalist society in an attempt to understand why the working class accepted the values of the capitalist class as “common sense values for all”. Not until the cultural hegemony of these ‘common sense’ values are revealed for being merely class values, do we reach a a “crisis of authority” then the “masks of consent” slip away, revealing the fist of force.
In our context the public holds ‘common sense’ values about what nursing is, many nurses may hold onto those self same values, both groups not realising that these values locate nursing within a particular social construction of gendered and class understandings of work (e.g. nursing as emotional labour, ‘basic’ caring not requiring professional education etc) which are not common sense at all! Society does not value female labour in the same way as male labour, society does not value old age, why else do we shut them away in institutions that struggle to pay for enough expert staff to care for them? Western societies can find trillions to support an ailling financial system but public hospitals and care homes struggle to pay for enough skilled care in a classic Galbraithian ‘Private affluence-Public squalor’ allignment. That is a toxic mix allied to the archetypes Colin discusses.
So to address poor quality care:
1) value and pay for care – women’s care work is not ‘basic, it is not female work it is human work.
2) value and pay for the elderly – the old have intrinsic worth not economic ‘value’. Capitalism must pay for all its members and not focus rewards on (often mythical)’wealth’ creators.
3) develop staff, supervise staff, educate staff
4) sack or retrain failing staff
5) sack or retrain managers
6)….over to you.