There is a need for Critical Socio-Political awareness among undergraduate student nurses.
“For the remainder of this century, the most worthy goal that nurses can select is that of arousing their passion for a kind of political activism that will make a difference in their own lives and in the life of our society.” (Peggy Chinn).
When I read this I almost literally fist pumped (I’m British, so we don’t actually do that – a bit too flamboyant!). I’m a lecturer in the UK teaching mainly from a public health/sociological perspective. I’ve noted that various writers have suggested or implied that politics and political awareness and knowledge is, or ought to be, a component of nursing knowledge and advocacy, if a rather neglected one. Nancy Roper referred to it as one of the 5 factors influencing the Activities of Living, while also lamenting its lack of application. Jill White developed Barbara Carper’s patterns of knowing to include it, Jane Salvage argued that it needs to be understood and acted upon. Celia Davies had written about the gendered nature of nursing and its ‘professional predicament’ and Micheal Traynor has written a whole book on politics and the profession.
Other writers include Adeline Falk Rafael, and Kath Melia long ago illustrated the contextualised pressures on student nurses while more recently Alexandra Hillman and colleagues have described how patient care can be compromised by the systems nurses work within. Alec Grant suggests politics is implicit in some qualitative research methods such as autoethnography. I have argued it is explicitly part of the sustainability agenda for nursing, while the social determinants/political determinants of health approach are predicated upon it. Other health concepts such as Barton and Grant’s health map, Lang and Rayner’s ecological public health domain and Ottersen et al’s focus on ‘global governance for health’ centre it for health care delivery and outcomes. The inequalities in health literature, for example “Fair society Healthy Lives” refer to health being a matter for social justice and fairness. Some authors have highlighted the health policy role for nurses, although advocating for nurse involvement in public policy making does so probably within accepted frames of reference devoid of critical concepts such as Foucault’s ‘governmentality’ or deeper analyses of, for example, managerialism, neoliberalism and the ‘capitalist class-command dynamic’.
In the education and curriculum development literature writers such as Stephen Sterling and David Orr suggest that teaching and learning should go beyond skills teaching in an instrumental fashion to address personal growth and social transformation. Others discuss ‘emancipatory pedagogy’ in nurse education which accords with aspects of ‘provocative pedagogy’ as advocated by Peter Morrall. The sociological literature, for example critical social theory, marxism and feminism of course, are wholly socio-political in nature. For nursing, each has also something to say about the interplay between health, illness, society and gender.
It is my contention that undergraduate nursing education is one in which politics is largely absent in nursing curricula and fails to equip student nurses with tools of analysis that renders them blind to social and political systems that are often unfair, unjust and oppressive. It also fails to politically socialise them. It is a self marginalised education denuded of any critical importance and largely ignores the vast sociological literature on health and illness. Nurse educators themselves, beyond a few ‘individual enthusiasts’ lack the requisite skills or concepts to engage, resulting in the lack of politics or health policy in nurse education. This is not to say nursing education, as it currently is, lacks importance as the requirement for clean, kind and compassionate care will be emphasised daily in seminars, lectures and tutorials.
This assertion might be supported if it can be shown that student nurses lack a critical understanding of the socio-political context in which they work. This is not to say however that student nurses are not political or are not interested in politics. Rather that their interest and understanding especially in relation to health (power, social justice, indigenous rights, post-colonialism, funding, inequalities, access, outcomes and determinants) may be lacking and only slightly better than their peer groups. Further, that any student nurse who is active, interested and knowledgeable is so despite not because of nursing education. I take it as self evident that this matters and not merely for the reason that it suits the capitalist executive and political power elites to have a huge number of health workers (600,000 registrants in the UK alone) ignorant, confused, uninterested and inactive in regards to the eco, social and political determinants of health. We have nurses schooled in the biomedical aspects of health delivery (or rather disease treatment), but rather less in the EcoPoliticoPsychoSocial (EPPS) approach to health. Student nurses are introduced to a BioPsychoSocial (BPS) model to health however, the curriculum process and learning experiences may often dilute this, emphasizing the Bio at the expense of the Psycho-Social while ignoring the Ecological. BPS becomes Bps.
Politics can be defined simply as ‘the process of influencing the scarce allocation of resources’. The Royal College of Nursing’s ‘Frontline First‘, while laudable, is also a very narrowly focused campaign which is about resource (staff) allocation. However, this does not go far enough as it fails to engage with more critical analyses of power and the legitimacy of the exercise of power, concerning itself with more ‘mundane’ issues of resource allocation within uncritically accepted frames of reference.
Politics is much more than knowing the manifestos of political parties or the internal machinations at Westminster/Washington. Political action is much more than the 5 year placing of crosses on ballot papers. Engaging in politics requires at least a critical understanding of power. Tony Benn, a UK Labour party stalwart now no longer with us, outlined questions to ask the powerful: We should know who has power, what power they have, where did they get it from, in whose interest do they wield it, to whom are they accountable and how do we get rid of them? This does not apply only to Westminster and the Whitehouse, but in every organisation including a hospital.
To test the hypothesis that student nurses lack a critical understanding of an EPPS approach to health, a survey of student nurses in two or three HEIs in the UK could be undertaken. There is a handy online tool called ‘political compass’ (https://www.politicalcompass.org) which is a self test indicating where one sits across two axes: Authoritarian left/right and Libertarian left/right.
Siobhan Mccullough undertook a survey in Northern Ireland in which 81% of nursing students claimed ‘not much knowledge’ of politics and 60% claimed either never or less than once week to follow politics in the media. Of course a caveat in this must be that politics in this context may mean ‘party/Westminster/Stormont politics rather than political issues. Bear in mind that Northern Ireland had been a highly politicised society suffering the ‘troubles’ since the 1960’s in which the Irish Republican Army fought a guerrilla/terrorist/resistance war against the British.
If Russell Brand’s website, The Trews, is any guide, many people are very interested in politics, just not the dominant media fed variety of political talking heads, and the representatives of mainstream political parties. If we widen the definition of politics to include social movements around health, climate change and human rights, then according to Paul Hawken there is a global ‘Blessed Unrest’ involving millions of people, a global ‘environmental and social justice movement’ that does not appear in the mainstream media.
This will be a disparate group politically, nurses are not to be treated as an homogenous group for political purposes. For example, the free market nurse think tank Nurses for Reform (NFR):
“….long argued that the NHS is an essentially Stalinist, nationalised abhorrence and that Britain can do much better without its so called principles“.
Whether this group actually has a huge number of nurses supporting it, has been questioned. Nonetheless the point remains that nurses probably voted for all parties, and none, at the last 2015 election in the UK. I was recently informed by a colleague that while in the United States he visited a Nursing Faculty and discovered that many nurses in the Faculty voted for Donald Trump. If my memory is correct the figure was over 50%. He put it down to ‘localism’ and ‘regionalism’ – a distaste for the remote Washington elite. That, I can understand.
The close vote for Brexit in the UK is a paradox, given the reliance by the NHS on EU citizens for the day to day delivery of health care. We have no idea how many nurses voted leave, all we do know is that the leave voter is more likely to be older (55+), living in rural environments and in the smaller towns and cities outside the major metropolitan cities such as London, and white. The leave vote crossed party lines. They were affluent Eurosceptics, the older working class and a smaller group of disadvantaged anti-immigration voters.
The current context of rising ethno-nationalism, if not fascism, isolationism, nativism and tribalism within a world threatened by climate change requires an urgent response by everyone. We cannot be anything other than political. Stating ‘neutrality’ is still a political position. Disinterest, disengagement and disillusionment are political positions by default. However they are not viable positions for student nurses to take given the social, ecological and commercial determinants of health.
To what degree nurses are part of the Paul Hawken’s ‘blessed unrest’ is unknown, Siobhan Mcculloghs small survey does not answer that question. Perhaps we should start asking?