Anthropology of Nursing

Exploring Cultural Concepts in Practice

Karen Holland, Karen Holland

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781317431152
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This book aims to introduce nurses and other healthcare professionals to how anthropology can help them understand nursing as a profession and as a culture.

Drawing on key anthropological concepts, the book facilitates the understanding and critical consideration of nursing practice, as seen across a wide range of health care contexts, and which impacts the delivery of appropriate care for service users. Considering the fields in which nurses work, the book argues that in order for nurses to optimize their roles as deliverers of patient care, they must not only engage with the realities of the cultural world of the patient, but also that of their own multi-professional cultural environment.

The only book currently in the field on anthropology of nursing, this book will be a valuable resource for nursing students at all academic levels, especially where they can pursue specific modules in the subject, as well as those other students pursuing medical anthropology courses. As well as this, it will be an essential text for those post-graduate students who wish to consider alternative world views from anthropology and their application in nursing and healthcare, in addition to their undertaking ethnographic research to explore nursing in all its fields of practice.

1

PRINCIPLES OF ANTHROPOLOGY FOR NURSING AND HEALTH CARE

Karen Holland

Introduction

This chapter establishes an understanding of anthropology as a discipline with its own body of knowledge that can enable us to utilise it as a lens to study nursing and health care. The key concepts that anthropologists have used to explain their understanding of how people live in various societies will be explored and it will set the scene for the other chapters which draw on these concepts to explore nursing in more depth. It is noted that we need to look at both anthropology for nursing (how anthropological concepts can help us in understanding the work that nurses undertake) and also the anthropology of nursing, where the focus is on nursing as a culture in itself which can contribute to the anthropological literature. They are in fact intertwined, as culture is itself a major anthropological concept. These differences will become clearer as the chapters unfold.

Principles of anthropology

What do we mean when we talk about anthropology? There has been much debate since anthropology came into its own as a recognised discipline as to what knowledge can be considered ‘anthropological’. Lavenda & Schultz (2010, p. 3) note that historically anthropology ‘has been divided into four major subfields: biological anthropology, cultural anthropology, linguistic anthropology and archaeology’. The main focus in this book is on cultural anthropology or as many define it: social and cultural anthropology (Monaghan & Just 2000; Eriksen 2015). Others such as Bueno (2012) and Lavenda & Schultz (2010) point out that these two actually relate to the two main countries where anthropology developed, namely cultural in the USA and social in Great Britain. There is also a close link to studies about cultures in the discipline of sociology (Bueno 2012), and in some of the chapters such as that on ritual and transition (Chapter 5), there is clearly an enhanced understanding of various aspects of nursing as a culture through an exploration of both disciplines.

We will, however, touch upon knowledge from one or two of the other anthropology subfields, in particular to what has become known as a major area of study in relation to health care, that is medical anthropology. This field of study focuses on factors related to health and illness or as Pool & Geissler (2005) state: ‘Medical anthropology describes, interprets and critically appraises the relationships between culture, behaviour, health and disease, and places health and illness in the broader context of cultural, social, political, economic and historical processes’ (p. 29). Given that medicine and nursing co-exist in similar contexts, there will be examples where this causes dissonance, such as in the care of the patient and also the wider setting of their professional domains.

As the book focuses on social and cultural anthropology, we need to establish what are the core areas of the discipline to focus on as they relate to nursing, as it is an impossible undertaking to discuss all the issues and debates pertaining to such a vast topic. It has already been stated in the Preface that the key areas will focus on nursing as care and nursing as work, both of which have their own areas of literature and critical debate.

The first and major concept to consider is that of Culture, which again has a number of aspects related to nursing (see Chapter 2), whilst others such as ritual, time, space, organisation of society and work, beliefs and values arise from how culture is viewed both inside and outside of its boundaries. The second major concept is how cultures were and are studied: ethnographies or ethnographic research. This is the focus of Chapter 3.

Culture and anthropology

Because of the various ways in which culture is now considered, it is important that we begin by examining one of the most established definitions of culture, which remains influential in determining how nursing has been considered in various research studies. The definition that influenced much of our early understanding of the work of anthropologists is that by E. B. Tylor in 1871, namely that culture is: ‘That complex whole which includes knowledge, beliefs, art, law, morals, custom, and any other capabilities and habits acquired by man as a member of society.’ We take it to mean that the use of the word ‘man’ in his definition takes into account both genders, where ‘man’ refers to a human being. This can of course be much debated. The main issue to take from this definition is that he saw culture as ‘a complex whole’, incorporating those aspects he defined, which would in fact remain the main definition for some years.

If we re-examine this definition from a woman’s point of view, which clearly reflected the period in history when men were the dominant sex in any discourse concerning art and science, then it could be argued that in any cultural ‘ethnography’ or report of the time that it was predominantly the male viewpoint that was explored and considered and not female. Women were also constrained by the wider society in which they lived, and were not at the time noted for their ethnographies.

However, we know, before 1871, that women were already making their voices heard in society, especially about nursing and care of the sick. Women such as Elizabeth Fry, Mrs Bedford Fenwick and Florence Nightingale each had their own agenda with regards to caring for the sick and training those who would care for them. Their work was set against the religious debates of the period in the middle 1800s, as well as the suffragette movement and the attempt to gain a vote for women. Bullough & Bullough (1964) writing about The Emergence of Modern Nursing, stated that by ‘the 1870’s the foundation of modern nursing had been laid and with it the foundation of the modern hospital’ (p. 112).

We can only gain an insight into the culture in which nurses worked and nursing developed during this period in history from the words that were left by those who were educated and able to access resources with which to get their writing published; women such as Florence Nightingale. She left many pamphlets or small books such as Notes on Nursing and Notes on Hospitals in 1859.

Others also wrote their accounts of life as they saw it; an interesting one called Eastern Hospitals and English Nurses, by A Lady Volunteer, states it is a narrative of 12 months’ experience in the hospitals of Koulali and Scutari (A Lady Volunteer 1856 – who was later found to be a lady called Frances Margaret Taylor: see https://archive.org/details/easternhospitals00unse and below). Her insights into this developing ‘nursing world’, through her observations and her experiences of literally ‘being in field’, bring to life the conditions at that time. Although not what we would now assign the title ‘an ethnography’, it raises the question: ‘does this work?’ and others like it meet the definition of ethnography as the ‘written product’, based on the result of fieldwork as defined by Van Maanen (1988). In other words – does it describe the culture (nursing), the people (nurses and others) and context (hospitals and war zones) so that those reading it can see this? Although of course Taylor at the time did not see herself as this ‘ethnographic fieldworker’ but sought to raise awareness in the public of the need for ‘a proper system of female nursing’ (Preface to her 1856 version) through her narrative. We will return to this debate of whether some of these early publications demonstrate qualities of an ethnography in Chapter 3.

Reading the publisher information about this unknown lady it appears that she was in fact one of Florence Nightingale’s earliest nursing recruits:

The author of this remarkable pseudonymous two-volume, eyewitness account of Florence Nightingale’s nursing in the Crimean War was really Frances Margaret Taylor. She was the daughter of an Anglican vicar, who served the poor in his Lincolnshire parish. In 1854 Taylor was one of the earliest nurses to be recruited by Nightingale, and her book is an account of the work she and her fellow nurses carried out for the war-wounded in the hospitals at Scutari and Koulali. She describes the original filthy conditions at the old Turkish hospital, and the problems that the Lady with the Lamp and her nurses had to overcome. (Naval Military Press 2009)

Women such as Florence Nightingale had also taken an interest in what was happening in other societies, in particular, as Hagey (1988) described in her presentation of a paper entitled ‘Note on the aboriginal races of Australia’ that she gave at ‘the annual meeting of the National Association for the Promotion of Social Science, held at York’ (p. 1). Her paper, however, on reading it (Nightingale 1865: accessed at https://archive.org/details/nightingale) was in fact more akin to a narrative analysis of ongoing reports/documents from a Roman Catholic Bishop Salvadore who she communicated with as she sought to understand the impact possible training has on the improved health of Australian Aborigines. Her paper offers quote after quote (like a ‘tell it as it is’ narrative) from his report to her on all manner of his insights and experiences related to Australian Aborigines at that time in history, and her conclusion on the benefit of European civilisation on their lives and culture is a negative one as she agrees with Bishop Salvado in this statement which I include in so far as it illustrates the background to a cultural situation that has not been shared previously, was of its time in history and in fact still has lessons for today’s society when discussing integration and assimilation of culture and cultural norms of the more dominant population – as well as offering an insight into the colonial perception and views of race dominant at that time in British history which also impacted on the work of early anthropologists:

Upon the Australian races European civilisation (Christian in name, but far from Christian in reality) has come suddenly and with overwhelming force. It has found them utterly unable to hold their own against it, equally incapable of joining with and flowing onward with the advancing tide; and therefore these races have been, since the contact first took place, and still are, going down before and beneath its, to them, destructive progress. If their condition had been less degraded, or if the tone of our civilisation had been less overbearing, self-seeking, and oppressive, or even if the irruption of the one upon the other had been less sudden and less violent, the result might have been different. But it is vain to speculate upon what might have been; we know, too well unhappily, what has been taking place, steadily and surely, from the moment when Europeans first set foot upon the Australian continent until this present time. The native races sink down and perish at our presence. (Nightingale 1865)

This observation could be viewed as quite radical in its day, but Florence Nightingale was not one for holding back expressing her views or sharing others’, when it came to impact of how people lived, or how governments impacted on the health of nations. She wrote many publications and presented some of this forward thinking to the National Association for the Promotion of Social Science which, according to Huch (1985), during its time (1857–1886) made various important contributions to Victorian Health Reform. It must be remembered, however, that much of her early work was set against the Colonial period where Australia was a British colony and under British rule, so like many other similar countries in the same situation, there was the drive to ‘civilise’ Aboriginal people through ‘conversion to Christian beliefs’ and when Nightingale-trained nurses arrived in Australia there was ‘no thought of training Aboriginal nurses’ (Best & Fredericks 2014, p. 59).

This example of Florence Nightingale’s perspective on another culture and community offers us an insight into how social science was being recognised in Victorian times and also, from members’ writings, an insight into the culture of that period as it related to health. Florence Nightingale was, it could be argued, an ‘armchair’ anthropologist, who wrote and analysed documents about other cultures and their way of life, and made assumptions based on these from her perspective.

A paper by Sera-Shriar (2014) offers an excellent insight into this role which he identifies was part of the early development of anthropology in Britain in the 19^th century and which then led to the later ‘professional ethnographer and fieldworker’ (p. 28). He stresses that the role of an armchair anthropologist who relied on external data and no fieldwork, was not ‘a passive pursuit, with minimal analytical reflection that simply synthesized the materials of other writers.’ He also stresses that: ‘Practitioners in the 19^th century were highly attuned to the problems associated with their research techniques and continually sought to transform their methodologies (p. 26)’.

I am not making a claim here that Florence Nightingale deliberately set out to be an ‘armchair anthropologist’ but given what we can see from her writings and the interpretations of others of this work – such as Gourley (2004) in relation to India – it is evident that through her eyes we can now see in Geertz’ (1973) terms, ‘slices of culture’ or ‘thick descriptions’ of parts of a culture, and these focus on health and sanitation and education, especially of women. I will return to further discussion of these terms in Chapter 3.

An interesting foreword by Vogel (1989) in the renewed publication of Ruth Benedict’s The Chrysanthemum and the Sword: Patterns of Japanese Culture noted that Benedict (1946) at the time she started her study could not access the field of Japanese culture, because the USA was at war with Japan (1944). The impact this had on her work and other social scientists of the time, was to undertake to ‘study culture from a distance’ (Vogel 1989, p. ix), and she contends that the ‘method was not so different from what...