After I graduated from secondary school, I decided to study nursing for my tertiary education. My parents were unhappy about it. They feel that I should choose a better occupation. I recalled a conversation I overheard my parents had with one of their colleague at a party organised by their company. When this colleague asked my parents what I studied for my tertiary education, they paused for quite sometime before replying. I could feel that they felt embarrassed. In Singapore, nursing course is still not regarded as a popular choice of course to study, especially among the males. Patients in Singapore addressed the nurses as “missy”. This term sounds more appropriate for a female, a male nurse nursed, they call him male “missy”. It was often viewed as the dumping ground for those who did not attain good grades for their secondary education or as a choice that are more suitable for the females. Very often, when I tell people that I am a nurse, I would receive questions that are phrased as such: “why do you want to be a nurse? It is such a dirty job! Do you clean backside everyday?”
Analysis
As depicted above, till today, nursing is still seen as a job for woman and is viewed as an occupation with low status. In Singapore, there was no mention of nurses till the nineteen-century, when the nuns from the French convert arrived from France to start work at the Civil General Hospital in 1885. Since then, the recruitment of nurses was all females until after 1946. Recruitment of male nurses was used to address the shortage of nurses. (Ministry of Health, Singapore, 1997) This could be used to explain the phenomenon why the males shun nursing.
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The society is responsible for constructing the difference in roles between males and females. Woman’s roles are prescribed with responsibilities that revolve around the home. Hughes (1990) explained this with her ideology of domesticity. Hughes (1990) cited the analogy between the role expectation of women in the home and the role expectation of nurses in the hospital from Ashley’s work. Ashley analysed that (secondary citation from Hughes 1990:28) that “if women were given responsibility for the moral and aesthetic environment of the home, then nurses were given no less responsibility for the moral and aesthetic environment of the hospital. If the needs and comfort of husbands and children were women’s primary responsibility, then the needs and comforts of physicians and patients were nurses’ primary responsibility. If women possessed innate qualifications for their domestic role, then nurses clearly possessed innate qualifications for their occupational role.” This analogy has focused on the role of woman, therefore suggesting that man is not qualified for it. Brennan (2005) suggested that the society constructed femininity attributed to the nurturing instinct of a woman. The responsibilities of a woman is to care and give treatment to the sick, they are michael lee Page 2 8/14/2012and this should extend to caring for any others who are ill. Therefore, nursing has always been seen as a woman’s job, something the paternalistic instinct of a man could never be able to fulfil.
“The historical social construction and devaluation of what is perceived as woman’s work…has resulted in low levels of status being associated with nursing” (Brennan, 2005). Hughes (1900) pointed out that, for nursing to attain a higher status, the society must be able to recognise the values and worth of the aspects of caring. This is akin to Brennan (2005) who stated that unless the core aspects of nursing are re-valued, nurses are people who just nurse.
Scenario 2
I was on duty with Senior Staff Nurse (SSN) Goh when this incident happened. SSN Goh has been working as a nurse for more than five years. It was during an afternoon shift when this incident happened. A 50 years old man who was eligible only for C class treatment was transferred to our ward from the B class ward. He was lodged at the previous ward because there was no empty beds at our ward on the day he was admitted. There were many discharges that morning at our ward, hence patient was able to transfer to our ward for his treatment. When patient arrived, I realized that he was a patient we had nursed a few days ago. He was attention seeking on his previous admission. Always pressing the call bell to ask to speak to the patient and sometimes act very ill when he was fine. Within half an hour after he arrived at my ward, he pressed the call bell. SSN Goh and I went to attend to him. We saw patient sweating profusely and he complained of pain in his stomach. I told SSN Goh that I think patient is exaggerating his condition to seek our attention. SSN Goh did not think so. She did an ECG for patient and although all his other vital signs were normal, she phoned the doctor to review patient. She knew patient was going to arrest and indeed he did. A few hours later, when I asked her how she knew patient was going to arrest. She could not give me an explanation. She said she just knew it.
Analysis
SSN Goh had anticipated what would happen to the patient, however, when asked to explain how she knew, she was unable to article an explanation. According to Benner (1982), SSN Goh was able to predict what was going to happen to the patient based on her intuition. Intuition knowing which is also experiential knowledge can be draw from Carper’s (1978) fundamental ways of knowing. The four fundamental ways of knowing is the empirics, ethics, esthetics and personal knowing. The derivation can be substantiated by Clements (2005: 270), who stated that “(t)he aesthetic way of knowing is experiential..”
Benner (1982) state that from a novice to an expert nurse, there are five levels of proficiency when acquiring and developing generalist or specialised nursing skills. According to Benner (1982: 405), SSN Goh “…has an intuitive grasp of the situation and zeros in on the accurate region of the problem…” Even if SSN Goh tried to explain her actions, it would be difficult for the novice to comprehend. This is because she initiates based on a deep understanding of the situation.
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From the above, we understand that to explain the epistemology of nursing is a difficult task. This is because nursing is often described as an art and a science (Schultz and Meleis (1988). Health (1998) cited from Schon that the art of nursing can be described as the swampy lowland of practice and the science of nursing can be described as the high hard ground. It is usually more challenging to explain how nurses know of the information from the swampy lowland. Liaschenko and Fisher (1999: 40) justified this by stating that because in nursing, “…much of the work is not scientific…” Estabrooks, Rutakumwa, O’Leary, Profetto-McGrath, Milner, Levers and Scott-Findlay (2005) explored the sources of nursing knowledge and they found out that experience is one of the important source of practice knowledge for nurses. This is akin to Benner (1982) who state that the expert nurse use “…past concrete experiences much like the researcher uses paradigms”. Hence to say, the expert nurse draws knowledge from her past experience to execute her actions. The other nurse draws her knowledge from the expert nurse. This is mentioned by Berragan (1998) that among the variety of sources nurses acquire knowledge, expert nurses are one of them.
Scenario 3
As a nursing student, each time after a clinical attachment, we would have to attend a sharing session conducted by the clinical instructor. I remembered that during one of the sharing session of my first clinical attachment, many of the student nurses who are from China feedback that nursing in Singapore is different from China. They went on to explain some of the differences. When I went to Australia for Overseas Industrial Placement Programme during my last year of diploma in nursing, I noticed that there are also some difference in the nursing practice in Australia and Singapore. After I started working, the teams of nurses I worked with comprised of many nationalities. They also illustrated to me how nursing in Singapore differs from their home.
Analysis
Many findings show that nursing is conceptualized differently in different cultures (Pang, Wong, Wang, Zhang, Chan & Lam, 2004; Lowe & Struthers, 2001; Fawcett, Lovoie & Shyu, 2007; Shin, 2000; Wong & Pang, 2000; Lee, 2001). For example, the nursing practice by the Koreans in Korea and the indigenous people of United States (the Native Americans) differs. This is because the Koreans and Native Americans have different perceptions of health. The insights of health of the Koreans are influenced by the philosophies of Buddhism, Confucianism and Taoism. (Shin, 2000: 350) Whereas the Native Americans have a holistic insight of health, viewed with much interconnectedness among these seven aspects: caring, traditions, respect, connection, holism, trust and spirituality. (Lowe & Struthers, 2001: 281-282) Therefore the goal of nursing in Korea is to bring out the harmony of yin and yang (Shin, 2000) Whereas that of the Native Americans “…depicts dimensions, characteristics, and components that relate the essence of Native American nursing practice.” (Lowe & Struthers, 2001: 282) The scholarly dialogue by Fawcett et all (2007) also demonstrated the notion of the differences in nursing practice in different cultures. This is illustrated by the different views Canada and Taiwan have on nursing and healthcare in the year 2050.
Since different cultures exist in different countries and nursing practice are originated from where it is practiced, can nursing theories be imported from one country be pertinent in another country? (Lutzen, 2000). Can theories developed in the western context be applicable in the eastern context and vice verse? Shin (2000) argued that by “western standards, which are quantitative and linear” the idea of nursing a patient concentrating on balancing the harmony of yin and yang will not be applicable to the western context and to apply western ideas in Korea, direct translation will not be applicable. This is further supported by Pang et all (2004: 667) that the “Chinese nurses articulate a version of nursing that is grounded more in their cultural understanding of health than the translated versions from the West.”
Interestingly, many countries has been influenced by American nursing (Lutzen, 2000). The nursing textbooks used in China comprise of nursing definitions which are translated from the western literature (Pang et all, 2004). The works of many western theorist has being translated from English to French in France and used as teaching material (Major, Pepin, Legault, 2001). The prevalence of the western medicine influence is as significant as the prevalence of being white. (Puzan, 2003)
It makes me wonder why is Asian medicine a complementary treatment to the western medicine and not the other way?
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