Portal de Periódicos da CAPES

Feminism, nursing and education

2002; Wiley; Volume: 39; Issue: 2 Linguagem: Inglês

10.1046/j.1365-2648.2002.02289.x

1365-2648

Webb Christine,

Nursing education and management

Following the activity of feminist groups in the United States of America (USA) in the 1960s, particularly among students, Women's Studies began to be set up in universities. Together with other social movements of the time, particularly anti-Vietnam war and anti-racist campaigns, this marked the beginning of 'the politicization of the university'. Mary Evans defines Women's Studies as 'a self-conscious determination to show that both the content and form of existing knowledge is (sic) related to the unequal distribution of social power between men and women' (Evans 1997, p. 18). However, the establishment of such courses in universities was surrounded by debates. One of these concerned the role of theory, and Evans believes that: The case against theory makes a great deal of the distinction between the production of theory and action which seems to suggest a theory of knowledge in which thought and action have no effect on each other. The view invokes a picture of human beings as headless chickens: the head, full of theory, lies inert and ineffective, while the headless body, empty of directions, rushes around in mindless circles. This dichotomy between theory and practice leads to some bizarre conclusions about the social world: that 'action' or practice is in some way separable from thought and that theory is always the soft option and action the role of the true believer. (Evans 1997, p. 20) A parallel is obvious here with the seemingly endless – and I suggest headless chicken-type – arguments in nursing about the theory–practice gap and its inevitability or how to remove it. Each side caricatures the other and we read about out-of-touch academic nurse theorists and researchers in their ivory towers who could not give a bedpan vs. hard-working practising nurses who are disillusioned by the amount of academic study needed to qualify as a nurse today when what is most important is being a 'good nurse'. The possibility that theory and practice might have beneficial influences on each other is only recently being considered in terms of evidence-based and reflective practice. Another issue linked to the introduction of Women's Studies in universities concerns professionalization. Feminists who were against this move claimed that it was a sell-out by academics, who thereby acquired comfortable and secure jobs and incomes, which they could augment by publishing books and articles. Evans' counters this by saying: A few – a very few – women have grown rich by writing feminist, or quasi-feminist books…But…other feminists do not, of course, write best-sellers. We toil away in more prosaic and limited ways: proposing courses on Women's Studies, attempting to do feminist research or to encourage women students to set their sights above the given limits of female achievement…in most cases our professional interests would be best served by keeping well away from Women's Studies, let alone feminism. (Evans 1997, p. 21) This certainly has resonance for me. In the 1980s, when I was a nursing lecturer in a United Kingdom (UK) university, I introduced two 2-hour sessions on women and education and race and education. Some students considered that this was inappropriate and the head of department was also uncomfortable with it. A decadelater,in the early 1990s, I set up a module called 'Feminism and Health care' on a post-registration nursing degree programme. This used a participative approach and began by looking at feminist theory and research and moved on to student-chosen topics related to health care. The group was small,withonly about eight participants each year, but participation was active and enthusiastic. The module was consistently positively evaluated, with statements such as 'This module has been more useful to me than all the nursing modules'. One student gained her first publication based on a small piece of research done for an assignment on the module (Meachin & Webb 1996). A number of students used discussion sessions to talk about personal issues in relation to what we were covering in the module, and one left her husband. I looked at the literature on Women's Studies and found that it was not unusual for students on such courses to decide to make a life change that had probably been considered for some time. The new ideas allowed students to understand and justify their dissatisfactions and the support of colleagues gave them the strength to move on. Yeatman (1997 , p. 139) believes that critical disciplines such as Women's Studies need the legitimacy that a university gives them for critical reflection but also that 'the professionalization of modern university-based knowledge is required for this critical theorizing to be possible'. The norms of practice as a university academic give legitimacy to disciplinary experts, but Yeatman considers that accountability for this expertise should be to 'extra-university constituencies' (p. 140). In the case of Women's Studies this constituency is other women, but in the case of nursing it is to service users, professional colleagues and health service managers. This different form of accountability is bolstered for us by the legitimacy that the university gives when it provides a warrant for our expertise and that of our students. This accountability is a moral one, as well as technical and financial, and there is thus a clear difference here between nursing and Women's Studies because the government is our paymaster. Its increasing involvement in curriculum specification in the UK is a different matter and is potentially problematic. The democratization of universities has also been seen as a proletarianization or `dumbing down', with a trivializing of what is taught and grade inflation both at the level of individual students and inquality assurance exercises. Competency-based curricula have been criticized as leading to fragmentation and non-transferability of learning and as failing to consider underlying cognitive, affective and critical thinking skills. We must be alert to the possible consequences of these trends towards curriculum control if nursing is to hold on to the benefits of belonging to a university, in terms of the authority it gives to critical thinking, or we may risk losing what we and Women's Studies have gained by entering the university. In the United States of America, Canada and Australia, in the past 10 years or so, articles have been published on feminist pedagogy in nursing education (e.g. Montgomery 1994, Beck 1995, McAllister & Ryan 1995, Banister & Schreiber 1999). These focus mainly on curriculum processes, and characterize feminist pedagogy in terms of sitting in a circle, student participation in topic selection and awarding grades, journal keeping and non-hierarchical communications. Feminist pedagogy as it is described in the literature seems to match what in the UK we tend to describe as andragogy, after Knowles (1970), and reflection in learning and teaching (Schon 1983, Burns & Bulman 2000). These also de-emphasize formal teaching methods and advocate student participation in deciding content and evaluating learning outcomes. Weyenberg (1998, p. 351), an American nurse and feminist believes that feminist pedagogy is 'an appropriate pathway for nursing education' but regrets that it is 'much under-theorized' and lacks evaluation. The same can be said for some of the parallel processes being used in the UK, even if they are not designated as 'feminist'. Another issue in nurse education that might benefit from a feminist analysis is horizontal violence, defined by Duffy (1995) (p. 9) as 'overt and covert non-physical hostility, such as criticism, sabotage, undermining, infighting, scapegoating and bickering'. Examples of horizontal violence are discussed by Randle (2000) in her doctoral thesis on self-esteem and Project 2000 diploma students. One student interviewed said, for example: I wouldn't do it over again, no, not this. If I knew what it was going to be, I don't know, but I definitely wouldn't do this again. I never thought nurses could be so bitchy. I'm a grown woman and they've made my life hell, really… They're just bullies, to other nurses and to the patients as well. They ought to be sacked. I can certainly remember incidents from my own training that resonate with this and caused me to retire in tears to the sluice, and I found similar negative attitudes towards patients when I studied gynaecology nurses in the mid-1980s (Webb 1985). The explanation I put forward then was of oppressed group behaviour, which occurs when one group finds itself the subject of demeaning treatment and transfers this same behaviour and attitudes towards those over whom they have power. The same suggestion has been made repeatedly over the years by many nursing writers (for example, Mackay 1993, Davies 1995, Duffy 1995, Farrell 1997, Freshwater 2000, and Randle 2000). So what can we do to try to change this oppressive and depressing state of affairs? The gendered nature of work in health care has been widely agreed to be one of the root causes, but race and social class must not be ignored as contributors (Davies 1995). The problems are compounded, of course, by the fact that these divisions are often cross-cutting in western societies in general and in health care in particular. A number of writers have put forward specific suggestions on how to deal with the situation (Mackay 1993, Davies 1995, Farrell 1997, Freshwater 2000, RCN 2001) and their suggestions include multiprofessional learning, reflective practice, clinical supervision, and using strategies via professional organizations, such as the RCN's Working Well Initiative against bullying and harassment at work. Some of these ideas should be viewed with caution, however, and they certainly will not provide instant solutions. Reflection and clinical supervision may slow down change by keeping activity at the talking level rather than leading to action (Farrell 1997)– the familiar moaning and exchanging atrocity tales that we seem to indulge in so much in nursing. Multiprofessional education may reinforce rather than break down stereotypes (Mackay 1993), and there is no research demonstrating that it leads to sustained changes in behaviour in practice settings. Freshwater (2000 ) discusses the potential of 'transformatory education', built on the ideas of Freire (1970 ) about 'conscientization'. Her article is not specifically written from a feminist perspective, but the feminist idea of consciousness-raising is similar. Blackford & Street (1999 ) have written about their use of 'feminist praxis' in an educational process to raise the consciousness of a group of Australian nurses about their approach to caring for migrant women. It may be that the introduction into nurse education of these ideas from feminist action research ( Lather 1984 ) could help to develop approaches and skills to begin to tackle horizontal violence by taking feminist pedagogy beyond the classroom and into clinical settings.