Nurses and Nursing
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Nurses and Nursing

The Person and the Profession

Pádraig Ó Lúanaigh, Pádraig Ó Lúanaigh

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eBook - ePub

Nurses and Nursing

The Person and the Profession

Pádraig Ó Lúanaigh, Pádraig Ó Lúanaigh

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About This Book

This textbook draws on international contributors with a range of backgrounds to explore, engage with and challenge readers in understanding the many aspects and elements that inform and influence contemporary nursing practice. With a focus to the future, this book explores the challenges facing health services and presents the arguments for a nursing contribution and influence in ensuring safe and quality care.

Readers are supported to explore how, as individuals, they can shape their personal nursing identity and practice. The structure of the text is based on the belief that an individual nurse's professional identity is developed through an interaction between their personal attributes and the influences of the profession itself. Reflecting this approach, the authors engage in a conversation with the reader rather than simply presenting a series of facts and information.

Organised around a series of topical and pertinent questions and drawing on perspectives from policy, education and practice, the book explores a diverse range of topics such as:



  • how historical and popular media representations of nursing hold back nursing practice today;


  • the opportunities presented through education and nursing role development to increase the nursing contribution to health services;


  • the economic and political influences on nursing and health care;


  • how the professional regulation of nurses and core values informs your practice;


  • ways to define and develop your own strong nursing identity.

Central chapter questions provide ideal triggers for group discussions in class or online and equally as discussion topics between colleagues to support ongoing professional development.

There is an emphasis throughout Nurses and Nursing on challenging thinking to recast nursing practice for the future by encouraging the reader to explore and create their emerging nursing identity or re-examine previously long held views. This text supports the reader to better understand health care, nursing and most importantly themselves as nurses.

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Information

Publisher
Routledge
Year
2017
ISBN
9781317280927

Part I
Understanding nursing and nurses

1
Nursing’s Public Image

Toward a professional future
Sandy Summers and Harry Jacobs Summers

Why this chapter is important

The media in all its forms is a powerful influencer of public opinion and understanding. This chapter explores how nurses and nursing have been portrayed in the news, on television, in films and online. Through the use of real-life examples from the media this chapter helps the reader to understand how they themselves and the public may understand nurses and their work. From the angelic angel to the battle-axe matron or sex-crazed naughty nurse, the inaccurate portrayal of nursing through the media has had an impact on nurses' ability to be taken seriously, respected for their expertise and professionalism or influential in policy decision making. The chapter provides useful suggestions on ways individual nurses and collectively the profession can work to ensure that an accurate representation of nurses and the work they do is conveyed to the public.
Chapter trigger question: Does the media portrayal of nurses and nursing have any actual influence over nursing practice and the strength of the profession?
Key words: image of nursing, media, public understanding of nursing, influencing policy

Introduction

This chapter examines nursing’s public image, especially as reflected in recent media, explaining why the image matters and proposing ways to improve public understanding. Readers should consider the gap between the skilled, autonomous nursing profession they know and the feminine stereotypes that remain common. Of course, both image and reality have evolved since the time of Florence Nightingale, when the idea of nurses' unassailable virtue helped to establish the modern profession in a world in which physicians held sway. Yet as we'll see, nursing’s image is still plagued by stereotypes that reflect the limits of these roots, including the unskilled handmaiden, the naughty nurse, the battle-axe, and the angel itself. Nursing’s future depends on closing the gap between these images and the life-saving reality of the profession.
Consider the kind of nurse you want to be. Don't you wish your idea of that excellent nurse clinician, educator, research or advocate was featured on TV, or at least that society better understood the real nursing role?

Reflect 1.1

  • Spend a few moments thinking about how nurses are portrayed in the media and reported in the news.
  • What kind of words and descriptions are used to describe nurses in the press?
A 7 September 2016 story in the New York Times, ‘Doctors in Aleppo Tend to Scores of Victims in Gas Attack’, reported that as talks between the warring factions in Syria continued, ‘doctors in the city of Aleppo were still treating people in intensive care’ after an apparent chlorine gas attack sickened more than 100. According to the piece, ‘doctors said they believed’ that the house of one victim had been struck directly and ‘doctors were still working to confirm the final death toll’. There was no mention of any specific health workers but physicians. Other elite media have taken a similar approach to Aleppo stories. In a BBC item on the 29th of that same month, ‘Aleppo doctors facing Armageddon’, the noted British volunteer surgeon David Nott conveyed his concern for the ‘doctors and surgeons’ with whom he had worked. Whether the idea is that only physicians are providing significant care, that only their experiences and views matter, or that ‘doctors’ is a convenient shorthand for all health workers, the result is to remove nurses from the scene.
Even when nurses appear in such media reports, it may reinforce stereotypes. Consider a 13 August 2016 CNN website report headlined ‘Aleppo’s angel: A nurse’s devotion to Syria’s children'. The ‘angel’ was Malaika, a young head nurse in the neonatal unit at the Aleppo Children’s Hospital. In addition to context on the war, the piece described Malaika and a physician trying to perform CPR on a dying infant who had lost his oxygen supply after a government airstrike on the hospital. And the nurse got a few powerful quotes, including her description of the strike as ‘a war crime’. Yet readers are most likely to remember that she is an ‘angel’ characterised by ‘devotion’: the classic imagery under which nursing skill, knowledge and strength is buried. As the report made sure to note, ‘malaika’ means ‘angel’ in Arabic. And even in a piece partly about a nurse and her sacrifices – Malaika has kept working despite her own shrapnel wounds and the departure of her family – a key point was that ‘only 35 doctors’ are left in Aleppo. How many nurses are left? Does that matter?

Reflect 1.2

  • Was the image of the nursing ‘angel’ one you thought about in the previous Reflect?
  • What are your views on the portrayal of nurses in the way detailed – does this help the public to understand the work nurses do?
Stereotypical images affect not only nurses' sense of professional identity but the respect and resources they receive for their work. Public health research shows that the popular media, even fictional television, has a real effect on society’s health-related views and actions. And because real nurses play such a critical role people across the globe suffer adverse health outcomes when nurses lack the resources they need (Truth About Nursing, 2008). We have only 16 million nurses across the globe, instead of the 75 million we would need to achieve adequate nurse-to-population ratios. Current nursing staffing ratios are dangerous – leading to errors, deaths, nurse burnout, and other ill-effects of the undervaluation of nursing, which is inherently challenging and stressful.
Nurses should explore ways to address this problem. These include projecting the image of a policy-oriented professional, educating health care colleagues, and shaping global and local media content, through a wide range of advocacy and creative efforts.

A brief history of nursing’s image

The most enduring stereotypes of nursing are one-dimensional notions of femininity – the angel, the handmaiden, the harlot, and the battle-axe. All these stereotypes can be traced to the roots of the modern profession in the mid-nineteenth century, when reformers like Nightingale organised groups of females to provide intimate care to strangers. To be accepted, those early nurses had to be virtuous and non-threatening to physicians; if nurses failed to conform, it was a problem.
The most common vision of nursing well into the twentieth century was the angel of mercy, an image that often carried a maternal tinge. Many examples can be seen in Pictures of Nursing, a collection of historic postcards assembled by nurse Michael Zwerdling and curated in a 2014 exhibit at the US National Institutes of Health by media scholar Julia Hallam (Hallam & Zwerdling, 2015).
As the twentieth century progressed, nurses were increasingly portrayed as the faithful and even heroic assistants of physicians. In Frank Borzage’s 1932 film A Farewell to Arms, based on Ernest Hemingway’s 1929 novel, nurses were virtuous love interests of military men in World War I; strict head nurses enforced morality and deference to physicians.
After World War II, nurses tended to be presented as deferential assistants of expert physicians. In the 1950s and 1960s, according to communications scholar Joseph Turow, the American Medical Association actually vetted scripts, ensuring that Hollywood products presented physicians in a good light. (Turow, Playing Doctor: Television, Storytelling, and Medical Power, 2010). The ABC television show Marcus Welby (1969–76) featured a lead character who handled even psychosocial aspects of care nurses traditionally regarded as their own. Health scholars Beatrice and Philip Kalisch dubbed this ‘Marcus Welby syndrome’ (Kalisch & Kalisch, 1986). The post-War era did produce a popular series of youth novels about Cherry Ames, a bright, adventurous young nurse who travelled from job to job solving mysteries (Wells & Tatham, 1943–1968).
Social changes following this era included sexual liberation and more career opportunities for women, who began to enter medicine. Popular views of nursing seemed to retreat toward feminine extremes, including the naughty nurse and the battle-axe, that reflected male fantasies and fears. Sexualised nurse characters became a staple in pornography and eventually in advertising. And the idea that nurses were mainly looking for romance with physicians took root. In Robert Altman’s 1970 film M*A*S*H, based on Richard Hooker’s 1968 novel, military nurse Margaret ‘Hot Lips’ Houlihan was a rule-bound martinet who suffered sexual mockery from the film’s cynical surgeon heroes. Milos Forman’s 1975 film One Flew Over the Cuckoo’s Nest, based on Ken Kesey’s 1962 novel, featured the notorious Mildred Ratched, a sociopathic nurse who tortured patients in the psychiatric unit she controlled (Truth About Nursing, 2014).
In the final decades of the twentieth century, some media did present nurses as serious, competent professionals. However, even the best of it tended to reinforce the idea that nurses were skilled, reliable assistants to the physicians whose work mattered most, many of them now female. This was true in everything from the elite news media to influential television dramas, like NBC’s St. Elsewhere (1982–88), the BBC’s Casualty (1986–present), and NBC’s ER (1994–2009), all of which offered relatively realistic views of gritty urban hospital care.
Early twenty-first century media products have given some cause for hope. Some news media sources have run powerful, accurate reports on nurses. In an October 2014 Guardian piece, three nurses gave long first-person accounts of their work caring for Ebola patients in West Africa. And several television shows focused on nurses have appeared, most notably Showtime’s Nurse Jackie (2009–15), about a troubled but expert present-day New York emergency nurse, and the BBC’s Call the Midwife (2012–present), about nurse midwives providing autonomous care for the poor in post-World War II London. Other shows set in the distant past have offered fair portrayals, such as PBS’s US Civil War drama Mercy Street (2016–present). Even some non-health care shows have included strong nurse characters, including the time-travelling Claire Randall on Starz’s Outlander, assassin Mary Morstan on the BBC’s Sherlock, and nurse-to-the-superheroes Claire Temple, who appears on recent Netflix Marvel shows such as Luke Cage (Truth About Nursing, 2016a).
But a few helpful products and characters are not enough. Most influential current entertainment media that includes substantial portrayals of modern health care still reflects the idea that nurses are at best skilled assistants to heroic, expert physicians. That is true in shows that focus on health care and those that do not, which can still include deceptively influential portrayals. Extreme recent examples of Marcus Welby syndrome include ABC’s surgical soap Grey’s Anatomy (2005–present) and Fox’s diagnosis-focused House (2004–12), which lack nurse characters. But even shows that do have fairly strong nurse characters, like NBC’s Chicago Med (2015–present), generally revolve around the physicians who dominate in clinical matters. And sitcoms often mock nursing, notably the egregious Fox/Hulu OB/GYN show The Mindy Project (2012–present), whose regular nurse characters are mostly stooges (Truth About Nursing, 2016b).
The nursing image should be much better …

Reflect 1.3

  • Think about the range of film and television examples mentioned. If you have previously watched any of these, had you considered how nurses were portrayed?
  • Do you think that the media portrayal of nurses has a real impact on actual nurses and nursing?

Why the nursing image matters

The media strongly affects our health-related views and actions, including those related to nursing. There is abundant evidence of the media’s general influence on society. One study found that after cable television was introduced in certain areas of rural India, women reported having more autonomy and less bias against female children (Jensen & Oster, 2009). And a study found that death rates from female-named hurricanes were far higher, evidently because people respected and feared those with female names less and failed to get out of their paths (Jung, Shavitt, Viswanathan, & Hilbe, 2014). Of course, a hurricane name, like a television drama, is basically a fictional description of something real.
Those in the field of health communication study and manage health-related messaging in the media. In a 2002 report for the Kaiser Family Foundation, scholars Joseph Turow and Rachel Gans explained that media products from news coverage to fictional television affect what people believe about the health care system. Indeed, they argued persuasively that fictional media may be even more influential, since it generally reaches a larger audience with more compelling dramatic themes (Turow & Gans, As Seen on TV: Health Policy Issues in TV’s Medical Dramas. Available at http://bit.ly/2eRpPil, 2002). Thus, health advocates often work with the entertainment media to improve what the media tells the public about health issues. In October 2013, American Public Media’s Marketplace radio show reported that the University of Southern California’s Hollywood, Health & Society had received a grant from The California Endowment to persuade television shows to do plotlines about the Affordable Care Act (Obamacare) (Posel, 2013).
Some research has measured the effects of the media on views of nursing, particularly nursing careers. In 2000, JWT Communications did a focus group study of 1,800 primary and secondary school students. The study found that the respondents got their strongest impression of nursing from the popular television drama ER. Consistent with that show’s overall depictions of nurses as skilled but peripheral physician subordinates, the youngsters believed that nursing was a job for girls, that it was technical work ‘like shop’ and that it was not appropriate for private school students, who were expected to aim higher (JWT Communications, 2000).
A 2008 study by researchers at the University of Dundee (Scotland) examined the views of academically advanced primary school students. Again, respondents got their main image of nursing from television. The Dundee study found that the media discouraged these students from pursuing nursing and suggested that a nursing career would not be ‘using their examination grade to maximum benefit’. One student noted: ‘In Casualty some nurses are portrayed as brainless, sex-mad bimbos out to try to romance doctors and get a doctor for a husband’ (Neilson & Lauder, 2008).
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