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| Julie Hunt RN, Intensive Care Cart BN(Hons), MC(NSW) Clinical Nurse Specialist, Intensive Care Unit St Vincent's Private Hospital |
This paper explores the ideologies and principles of feminism and its Influence on the evolution of nursing practice. The exploration highlights some of the benefits the feminist movement has provided ID nursing, and draws parallels between nursing knowledge and feminist philosophy.
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The consequences that an understanding of feminism and feminist methods offer to the practice of nursing are far reaching, placing nurses in the ideal position for instigating a change towards, and a revaluing of, women's work, caring, ethics and knowledge. This paper explores the ideologies and principles of feminism and its influence on the evolution of nursing practice. The exploration will highlight some of the benefits the feminist movement has provided to nursing, and will draw parallels between nursing knowledge and feminist philosophy.
Feminism and feminist methodologies are defined by using a historical approach to explore feminist theories, subsequently providing a link between feminist history and the history of nursing. The act of becoming a feminist is examined, including an exploration of the behavioural changes and consciousness raising that takes place during, and following this formation. Ageism will also be discussed, an issue some women feel has been ignored by feminism. An analogy is often made between the socialisation and oppression of women and that of nurses, this analogy is examined along with nurses' caring, gender bias, patriarchal values, professionalisation, the patriarchal power base and the inalienable right of a male centred view of the world as the traditional and 'right' one.
Exploration of this topic includes a need to understand why nurses have not always aligned themselves with the feminist movement, why feminism has not always included nurses, and how apposition with the feminist movement has, and will continue to influence nursing.
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Feminism is defined "as a world view that values women and that confronts systematic injustices based on gender" (Chinn & Wheeler, 1985: 74). Feminism provides a way of viewing women from the context of their own experiences, it is not only feminism's influence on women that is paramount, but women's influence on feminism. It is women's experience and vision, women's knowledge and ways of knowing that has shaped feminism, and this same knowledge is used by nurses, being mostly women, to form the theories that influence practice (Chinn, 1988).
Women have many different ways of knowing, they are not a homogeneous group. A women's world view is influenced by her history and differences such as social class and ethnicity, also sexual orientation and economical and political factors will effect her values, beliefs and experience. These inherent differences between women, which influence their experiences, their knowledge and their thinking, also need to be addressed by feminism.
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The four main orientations of feminist theory include the liberal feminist view, Marxist feminist theory, radical feminism and socialist feminist theory. The liberal feminist view was developed in the nineteenth century, it alludes to women's lack of rights and opportunity as paramount to their oppression. It criticises social inequalities based on family, gender, race, religion, and unequal distribution of wealth and opportunities for women (Chinn & Wheeler, 1985; MacPherson, 1983; Speedy, 1987). Liberal feminists claim that women can achieve equality within the present economic structure by employing reforms and education, whilst at the same time acknowledging that "women currently have little power to change or control anything" (Pohl & Boyd, 1993: 200) and no mechanism for change.
Marxist feminist theory asserts that women's oppression was precipitated by the introduction of private property. This lead to the development of class systems from which emanated sexism. Marxist feminists believe sexism will disappear when there is a revolution to redistribute the property, and its means of production, to society as a whole (Chinn & Wheeler, 1985; MacPherson, 1983; Speedy, 1987; Curthoys, 1994).
Socialist feminist theory assesses cultural institutions such as the patriarchal family, motherhood, housework and consumerism, using a system of class analysis. This theory takes into account problems faced by poor, working class and third world women, including women of colour (Chinn & Wheeler, 1985; MacPherson, 1983; Speedy, 1987).
Radical feminist theory derives its principles from a woman centred world view, challenging patriarchal systems, instead conceiving its principles from the perspective of women. The oppression of women is believed to take place in all cultural institutions, and can not be remedied by changing those institutions. For oppression to be overcome institutionalised gender discrimination and gender roles must be abolished (Chinn & Wheeler, 1985; MacPherson, 1983; Speedy, 1987).
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These orientations, although challenging the oppression of women on the grounds of inequality and based on family, gender, race, religion, wealth, class, property and opportunities, fail to address oppression on the basis of ageism. Pohl & Boyd (1993) state that as women age their powerlessness increases and many end up impoverished and they charge both feminism and nursing of not adequately addressing these issues. Pohl & Boyd (1993) implore nurses to bring discussions dealing with health politics to the fore. Discourse that recognises the injustice of investment of the majority of the health dollars in technological improvements needs to be highlighted. A relatively small amount of the health care dollar is invested in preventative measures or the improvement in conditions of those people suffering from chronic conditions which are not afforded the publicity or funding that acute illness are, needs to be discussed, publicised and recorded by nurses and other health care workers.
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The perception of nurses by society has long been influenced by men. Colliere writes "women need to become aware that their own recorded history was written by men. Men decided upon what might be transmitted..." (1986: 96). It was in this way that men were able to define our roles, first as women then as nurses, according to influence of their patriarchal views on society's structure. Women received the knowledge which men thought they should have; "priests, clerks, and then doctors strove for centuries to bar women's access to writing" (Colliere, 1986: 96).
Hospitals became hierarchal systems with the doctors being at the top followed by nurses in descending level of importance. The repercussions of this are still felt by nurses, health care workers and patients today. Hospitals developed into job specific gender specific environments with male doctors and female nurses.
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A paradigm shift towards feminist methodology in the study of nursing science is described by MacPherson (1993). The women's movement and the women's health movement instigated a paradigm shift to include feminist theories in nursing science.
Cook and Fonow (1986) write that feminist methodology is more than just a feminist research technique. They state there are five basic principles of feminist methodology: an acknowledgement of the effects of gender on the socialisation of all peoples; an awareness of the importance of consciousness raising, not only for the research method and the potential of the research outcome, but also for the consciousness of the researcher and the researched; a necessity to reject the assumption of empirico-reductionist methods that the separation of researcher and the researched produces a more desirable (objective) result; acknowledgement of ethical concerns including sexist language, gatekeeping and withholding information from research subjects; and an emphasis on the empowerment of women.
Reductionism and objectivism employed by traditional empirical methods, to produce validity and reliability of research, creates issues for the feminist researcher who has few guidelines for use in providing reliability and validity. Human experiences are specific and unique and hence difficult to validate. "The basic premises of feminist perspectives emphasise this uniqueness and the contextualised nature of women's experiences and interpretations, rather than their standardisation and repeatability" (Hall & Stevens, 1991: 19). Feminist inquiry does not differentiate women's experiences from the circumstances in which they occur, and standards of rigor should be focussed on the whole inquiry, not on validity and reliability alone (Hall & Stevens, 1991; Webb, 1992).
Feminist research should be done by, for and with women and "in nature be cooperative; noncompetitive; supportive of women and other minority groups" (Keddy, 1993: 292). This may provide a dilemma for the nurse researcher whose clients and colleagues are of both sexes. A feminist researcher who examines the experiences of female clients, ignoring the males, may be perpetrating the same gender bias as the researcher whose methods are based solely on patriarchal values and ideologies. Indeed feminist research methods may leave the male feminist, who employs feminist methodologies, in somewhat of a 'no mans land' because some feminists believe a man, who cannot understand a woman's experiences, will be unable to view experiences from a women's world view. Alternatively, women who research males are in the same position if they are unable to understand the world from a male point of view. Dismissing research on the basis of the researcher's gender could mean valuable research is lost. As feminists, perhaps we should be more sharing and cooperative with male feminist researchers instead of assuming this is just another for men to take over and to continue to perpetrate the oppression of women. However, it could be said that all other research methodologies are patriarchally centred and therefore feminist methods should belong to women only.
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Nurses have not always embraced feminism, and feminism, in the past, has ignored nursing. There is evidence of nurses' opposition to feminism and feminist's disregard of nursing as women's work, and therefore of no value. Vance, Talbot, McBride and Mason (1985) examine the relationship between nursing and the women's movement. The latter is said to have overlooked the achievements of nurses, reinforcing society's stereotypical views and devaluing of nurses' work. Nurses have not always welcomed feminist ideology; reasons for this include nurses' attempts to fulfil the roles of the ideal 'nurse and woman' whilst these very roles are devalued as 'women's work'. The example of women as an oppressed group is used to illustrate why nurses are cohesive, or always supportive, of one another (Vance et al., 1985; Speedy, 1987). Feminism is cited as influencing and redefining women's health care while nursing research is seen as acknowledging the importance of perceiving the experience from a woman's point of view (Vance et al., 1985).
Speedy (1987) writes that a fear of feminism related to negative stereotyping and discrimination against feminist nurses, and the fear of losing nursing's 'caring' aspects, are some reasons why nurses do not want to be labelled as feminists. Ironically, this 'caring' aspect is thought to be the reason feminists have often excluded nurses.
Nurses are placed in a unique position, by their close contact with large numbers of the community, to challenge negative stereotypes of women and replace them with positive impressions. The idealised women espoused in many advertisements can be questioned: attractiveness is inherent in all people and not dependent on what is presently fashionable. Instead of continually attacking the negative aspects of a person's lifestyle or physique, the nurse employing feminist philosophies will reinforce the positive; "the nurse who truly values and accepts the individual will strive to focus on unique rather than stereotypical characteristics" (Sampselle, 1990: 245).
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According to Radsma (1994), caring, as with much of women's work, remains unseen. In fact she believes that "neglect is more evident than care" (Radsma, 1994: 445) and relates unseen and unacknowledged women's work back to the hospital environment. This is likened to the patriarchal family where the woman carries out her work which is ignored or devalued by the rest of the family.
Women's acceptance of this undervalued role is partly attributed to the influence of the Church. "The traditional social and religious mores defined a legacy of duty for nurses that continues to persist today. The moral obligation of obedience and service was passed on to the generations of nurses to follow" (Radsma, 1994: 446). It was the priesthood that first developed writing and where doctors and judges originated. Doctors, with their access to writing, were able to develop and then document their knowledge. The lowly skill of caring for the body was left to the nuns whilst the priests got on with saving souls (Phillips, 1993).
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There are those who purport that the caring behaviours of nurses, influenced by their social and religious beliefs, may actually be seen as dysfunctional, and relate this supposed dysfunctional behaviour to the notion of codependency. The person suffering from this 'disease' is said to be in self denial and they think that by doing the right thing they will continue to be loved, appreciated, successful, accepted and secure. Codependency also has been defined as "an addiction to doing, activity, or taking care of another resulting in the alienation or segregation of one's public self from one's private self' (Sherman et al., 1989: 26).
Mallory and Berkery (1983) however, warn that this latest resurgence of literature on codependency which highlights a relationship to nursing, may be another ploy to devalue women's strengths. The definitions of codependency, originating from the reductionist milieu, are extremely narrow and succeed in pathologising women's experiences by not looking at them in a wider social context. Some of the behaviours attributed to codependency are descriptive of women in general "whose revaluing of relationships also provides the basis for empathy, altruism, unselfishness, and healing" (Malloy & Berkery, 1993: 16).
It is the fluidity of women's boundaries, from which women draw their strengths, which should be thought of as a positive attribute, and not pathologised as a disease.
Women's and nurses' ability to care for and to 'caretake' others can give rise to understanding and empathy, encouraging mutually empowering relationships (Drauker & Lannin, 1992; Malloy & Berkery, 1993). This fluidity of women's boundaries also can be related to nursing and to the context of holism. The behaviour of both patients and nurses can not be divided into "physically, cognitively or emotionally aimed actions" (Phillips, 1993: 1557). A patient is not a disease but a person who has many varied experiences. One of these physical experiences may be a disease, which may impact on their emotional and cognitive senses. This analogy also could be applied to the nurse.
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Nursing's apparent lack of professional status is related to the problem of the female sex role and socialisation. Professionalisation is defined by Speedy (1987) as the process an occupation takes to obtain a certain type of power, and that there are certain stages an occupation needs to pass through to obtain recognition as a profession. The traits required of a professional are very male orientated, directly opposing the traits associated with the female sex role and the socialisation of women (Speedy, 1987). In fact the very definition of a profession is gendered because it consists of the attributes of "...the successful professional projects of class-privilaged (sic), male actors at a particular point in history to be the paradigmatic case of profession" (Witz, 1992: 675).
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When nurses can embrace feminist theories and incorporate them into nursing practice they will be empowered to question the status quo, highlighting conflicts within the hierarchal hospital systems, and shifting the power base not only within hospitals but also in the wider community (Carter, 1994). To be able to achieve this nurses will first have to become feminist. Bartky (1975), who finds the traditional definitions of feminism restricting, says that to become feminist a woman first has to go through a major personal transformation and in the course of this transformation she will undergo behavioural changes which will lead her to make major changes in all aspects of her life. This transformation in behaviour leads to a new and altered awareness of self and others, and is termed a 'social reality' by Bartky (1975), who equates this social reality with the feminist idea of consciousness raising.
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The literature critiqued indicates that the feminist movement and nursing have had a somewhat turbulent history. Parallels can be drawn between the changing roles of women and nurses, reflecting nurses continuing struggle for recognition. The caring aspect of nurses' work has in the past been overlooked as it was considered women's work and therefore of little importance.
Nurses can see value in what they do. They are becoming conscious of their true worth, encouraged by a positive self esteem and self concept. Education informs nurses of their history, whilst feminist studies acknowledge women's oppression and provide theories to explain and overcome this tyranny. Most importantly, nurses must learn their history. They must know how their profession evolved and understand restrictions traditionally placed upon them by a patriarchal society. By gaining an understanding of these factors nurses will continue to undergo their own transformations and consciousness raising.
The traditional empirico-reductionist method of research, although still employed by many nurse researchers, is seen now as only one method of inquiry. Feminist methodologies, using qualitative research methods, more suited to the science and the art of nursing, are now frequently utilised either alone, or in combination with quantitative methods.
Feminism has provided nurses with a vehicle to question their roles, a means to research and develop nursing theory, to influence nursing practice and initiate change, to become involved in decision making and gain autonomy. Consequently a positive influence on the rights and roles of women and health care, finally leading to empowerment, will be achieved.
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In my opinion the women's movement has a long way to go before it gains equality for all women. When women do gain equality the implications will be paramount for nursing. Nursing is in a period of change, as nurses we are no longer 'trained' we are educated. We take this education back to our work places and share it with our colleagues, we network, we learn to question, to answer and to challenge; nurses have a voice and we are learning to use it. Most importantly we are realising our worth and our value. We no longer accept the devaluing of our knowledge and talents, me acknowledge the importance of our caring, we understand the significance of our knowing and our skills in performing the art and the science of nursing.
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