Oppression in nursing practice
Edmonton, Alberta, Canada
Oppression is the dehumanization of another and is often viewed as a negative result of power. It occurs when there are efforts to reduce, confine, and discipline people into subordination.1 Oppressive behaviours are noted in nursing practice today but are often not questioned; instead, they are accepted as innate truth and the reality of nursing.
According to Michel Foucault, power is productive; “it induces pleasure, forms knowledge, [and] produces discourse.”2 Power relations are part of society; all types of power can act upon each other and create influence.3 This view of power can be described as a web as opposed to the depiction of power as a pyramid. The analogy of a web suggests multiple power sources influencing truth and shows how each power source are interconnected and affect one another. Foucault describes different types of power. One in particular, disciplinary power, underlies nursing oppression.
Disciplinary power and power/knowledge
Disciplinary power can mold individuals into instruments to control and train.4 It can be viewed as power over another and can be associated with authority. The result of disciplinary power is normalization of behaviours desired by the dominant group. Disciplinary power provides the foundation to power/knowledge.
Power/knowledge is knowledge that exists due to the presence of power arrangements.2 Examples include perceptions of normal and standards of health. Standards of normalcy and health are not questioned to whether they are true; rather, they are accepted as fact. Knowledge, in this sense, has no clear origin and a historical analysis can identify the origins of how that knowledge was accepted as truth.2 Oppression in nursing can be viewed as power/knowledge because there is no question to why it is there, rather, its existence is simply accepted.
Views of women: early 1900s
During the early 1900s, women were considered to be less intelligent than their male counterparts and this led to the belief that females were innately suited for domestic duties.5 Adelaide Nutting, the first professor of nursing, stated nursing “consisted of expert housekeeping on an enlarged scale.”6 Nursing is one of the first female occupations outside the home and thus, societal views of women became associated with nursing. Attributes of women based on their role as nurses included “patience, respect for authority, and above all, putting others’ needs ahead of one’s own.”7 However, questions about female intelligence and the proper societal role of women suggested that nurses needed to be trained and disciplined to ensure proper behaviour. It is important to note that first-wave or maternal feminism had its origins in the late 19th and early 20th century and the focus was on extending the female role outside of the home through the suggestion that women were mothers to society.8 Maternal feminism’s efforts to find a role for women outside the home impacted the view of nursing as the word nurse came to imply the idea of “nurturer,” “milk-giver,” and, essentially, mother.9 At the turn of the century, nurses were equated with women, but as Fiedler points out, on an “even profounder mythological level,” women were equated with nurses.9 Views of women and the focus of maternal feminism contributed the power/knowledge of nursing oppression; however, nursing oppression was to be further influenced by nurse training.
Beginnings of lay nurse training
The Florence Nightingale model was the first lay nurse training program. Situated at the St. Thomas Hospital in London and opened on July 9, 1860,10,11 it was based on the religious sisters’ approach to nursing.5 Religious orders are associated with discipline and service and these qualities became the main undertone to the philosophy of the Nightingale school. The role of discipline and service in the Nightingale school impacted the power/knowledge of nursing oppression.
The first school in Canada
The first hospital school of nursing for lay women was opened in St. Catherines, Ontario on June 10, 1874 by Dr. Theophilus Mack, fourteen years after the opening of the first nurse training program opened at St. Thomas Hospital.12,11 Mack set up his school according to the Nightingale model and had two Nightingale-trained nurses as directors.10,12 The model did not last long as hospital administration realized that having a nursing school equated to supplying a continuous stream of young, cheap laborers. This impacted the type of training received by students as education was secondary to the primary concern of hospitals, which was service to the sick.11
Standards of education
Historically, male physicians felt they had the right to control the standards of nursing education or training.13 The standards were minimal as nurses were perceived to be “better off with a little education offered by physicians but not too much to make them bored with the mundane tasks of caring for the sick.”5 Rather than improve knowledge, the schools of nursing served to train nurses into subservience.14 Even the word “training” implied the oppressive nature of education and how it served to reinforce the domesticated view of nursing prevalent during the early 20th century. Male physicians had convinced society that nursing needed to be subordinate to medicine for the greater good.15 They were so skilled at this propaganda that nursing almost had to assume the role of subservient opposite. Sarah Dock, a prominent nursing leader of the time, stated, “No matter how gifted she may be, she will never become a reliable nurse until she can obey without question.”16 Historically the nurse was the tool of the physician, further indicating the role of disciplinary power in shaping the nursing profession.
Institutionalization of training
Institutionalization is “to cause a practice or custom to become accepted.”17 Institutionalization served to create the routinization of nursing practice. This can be seen in hospital procedure manuals that were developed to perfect skills and were used, at times, to replace instructor-based bedside instruction.18 Routinization is an institutionalized process that serves the dominant power because it made certain acts automatic, resulting in the ease of supervision2 and essentially reducing individuals into instruments. Nurses of the time stated there was a procedure on bed making, walking patients, and so forth;19 in other words, institutionalization created a formula for every aspect of care. Institutionalization also affected the hours worked in service to the hospital. In 1932, the working conditions of student nurses were so appalling that Weir, an educator commissioned to investigate nursing education in Canada, stated, “no other profession would tolerate such working conditions” and compared it to slavery.20 The oppressive hours expected of nurses were evident up to 1960 as student nurses were often working five straight weeks of night shifts.21 This practice was not questioned, further perpetuating the power/knowledge of oppression.
In addition to the type of training, the aforementioned societal views of women impacted the selection of nursing students, as the role of the female gender was linked to nursing. Women selected to be nurses were to be pleasant and of good character.5 A proper woman in nursing was one who did not question the physician, but rather “occupies no independent position in the treatment of the sick person” and if she is “well-trained” will “have no opinions and no thoughts.”22 This expectation was a means of normalization in the form of personal character as one would be a bad nurse and woman if they questioned the physician, further indicating the power/knowledge of oppression in nursing.
Through a brief genealogy one can begin to understand the various power influences inherent in nursing that have created the power/knowledge of oppression. The identification of these influences is the beginning of the pathway to overcoming them. As mentioned, power, as part of relational human existence, is productive; it is inherent in every situation and in every person. By viewing power as such, one can begin to resist the position of powerlessness. From this knowledge, the profession of nursing can begin to move beyond its own power/knowledge of oppression.
Denise would like to extend her gratitude and thanks to Dr. Olive Yonge for her guidance, wisdom, and support.
- Kendall, J., 1992. Fighting back: Promoting emancipatory nursing actions. Advances in Nursing Science 15(2), 1–15. Retrieved from http://www.aspenpublishers.com
- Foucault, M. (1980) Power/Knowledge: Selected interviews & other writings 1972-1977 (Gordon C., ed.). New York, NY: Pantheon Books.
- Foucault, M. (1982). The subject and power. In: H. L. Dreyfus, M. Foucault, & P. Rabinow. (Eds.) Michel Foucault: Beyond structuralism and hermeneutics. (pp. 208-226) Chicago, IL: The University of Chicago Press.
- Foucault, M. (1979). Discipline and punish: The birth of the prison. Retrieved from http://solomon.soth.alexanderstreet.com.login.ezproxy.library.ualberta.ca/cgi-bin/asp/philo/soth/documentidx.pl?sourceid=S10021788
- Kirkwood, L. (2005). Enough but not too much: Nursing education in English language Canada (1874-2000). In: C. Bates, D. Dodd, & N. Rousseau (Eds), On all frontiers: Four centuries of Canadian nursing. (pp.183-195) Retrieved from http://site.ebrary.com.login.ezproxy.library.ualberta.ca/lib/ualberta/docDetail.action?docID=10145622
- Christy, T. E. (1969). Cornerstone for nursing education; a history of the Division of Nursing Education of Teachers College, Columbia University, 1899-1947. New York, NY: Teachers College Press, Columbia University
- Richardson, S. (2005). Unionization of Canadian nursing. In: C. Bates, D. Dodd, & N. Rousseau (Eds), On all frontiers: Four centuries of Canadian nursing (pp. 222-233). Retrieved from http://site.ebrary.com.login.ezproxy.library.ualberta.ca/lib/ualberta/docDetail.action?docID=10145622
- Devereux, C. (2005). Growing a race: Nellie L. McClung and the fiction of eugenic feminism. Retrieved from http://login.ezproxy.library.ualberta.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cat00362a&AN=neos.5627852&site=eds-live&scope200=site
- Moss, E. L., Stam, H. J., & Kattevilder, D. (2013). From suffrage to sterilization: Eugenics and the women’s movement in 20th century Alberta. Canadian Psychology, 54(2), 105-114. doi:10.1037/a0032644.
- Fiedler, L. A. (1988) Images of the nurse in fiction and popular culture. In: A.H. Jones (Ed), Images of nurses: Perspectives from history, art and literature. Philadelphia, PA: University of Pennsylvania Press.
- Bramadat, I., & Chalmers, K. (1989). Nursing education in Canada: Historical “progress” — contemporary issues. Journal of Advanced Nursing, 14(9), 719-726. doi:10.1111/j.1365-2648.1989.tb01636.x.
- Paul, P. & Ross-Kerr, J. C. (2011). The origins and development of nursing education in Canada. In: J.C. Ross-Kerr & M.J. Wood (Eds.), Canadian nursing: Issues & perspectives. (5th ed.) (pp. 327-358). Toronto, ON: Elsevier Canada.
- Canadian Nurses Association (1968). The leaf and the lamp: The Canadian Nurses Association and the influences which shaped its origins and outlook during its first sixty years. (1968). Ottawa, ON: The Association.
- Kinnear, J. L. (1994). The professionalization of Canadian nursing, 1924-32: Views in the ‘CN’ and the ‘CMAJ’. Canadian Bulletin of Medical History, 11(1), 153-174. Retrieved from http://www.cbmh.ca/index.php/cbmh
- Sweet, S., & Norman, I. (1995). The nurse-doctor relationship: A selective literature review. Journal of Advanced Nursing, 22(1), 165-170. doi:10.1046/j.1365-2648.1995.22010165.x
- Ashley, J. (1976). Hospitals, paternalism, and the role of the nurse. New York, NY: Teachers College Press, Columbia University.
- Dock, S. (1917). The relation of the nurse to the doctor and the doctor to the nurse. American Journal of Nursing, 17(5), 394-396. Retrieved from http://journals.lww.com/AJNOnline/pages/default.aspx
- Institutionalization. (2013). In Merriam-Webster.com. Retrieved from http://www.merriam-webster.com/dictionary/institutionalize
- Toman, C. (2005). “Body work,” medical technology, and hospital nursing practice. In: C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 89-106). Retrieved from http://site.ebrary.com.login.ezproxy.library.ualberta.ca/lib/ualberta/docDetail.action?docID=10145622
- Toman, C. (2003). “Trained brains are better than trained muscles”: Scientific management and Canadian nurses, 1910-1919. Nursing History Review, 11, 89-108.
- Weir, G. (1932). Survey of nursing education in Canada. Toronto, ON: University of Toronto Press.
- Mussallem, H. K. (1960). Spotlight on nursing education; The report of the pilot project for the evaluation of schools of nursing in Canada. Ottawa, ON: The Canadian Nurses’ Association.
- M’Gregor-Robertson, J. J. (1898). The household physician: A family guide to the preservation of health and to the domestic treatment of ailments and disease, with chapters on food and drugs, and first aid in accidents and injuries. Retrieved from http://www.archive.org.login.ezproxy.library.ualberta.ca/stream/householdphysici00mgreuoft#page/n1159/mode/2up
DENISE PASIEKA, RN, BScN, grew up in Edmonton, Alberta. She completed a BScN in 2003 and is currently a nursing instructor at the University of Alberta. At present, she is working on a Master of Nursing with hopes of completion in spring 2016. Her thesis is investigating the historical evolution of nursing research at the University of Alberta from 1980 to 2000.