Nursing

Its Hidden Agendas

Maya Jolley

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780340557266
• eBook ISBN: 9781000154344
• Edition: 1
• Topic: Arquitectura
• Subtopic: Arquitectura general

This book uncovers some of the hidden agendas which have inhibited nursing and nurses from making their full potential contribution to health care, and stimulates new and positive initiatives. It explores nurses' behaviour patterns; employing, psychological, educational and political perspectives.

1 Out of the past

You are not here to think Nurse

(Anon)

An American nurse journalist writing of socialisation within a profession commented that

If the heritage of nursing is considered to be an important vehicle for professional socialization, guidance for the present should be based on lessons from the past … Many current norms of practice and professional behaviour are perpetuated and enacted without a full understanding of their emergence in history, or their relevance for today’s practice.

(Wheeler, 1985)

Though Wheeler was writing of the North American context, her comments are equally applicable to the British situation. This chapter seeks to provide a very brief background sketch of where nursing has come from; identifying influences which have contributed to its tradition, structure, relationships, and development, (the seedbed of elements constituting the modern hidden agenda) which will then be addressed in depth in the chapters that follow. It is not intended to be definitive, or to include a whole range of potentially relevant data, but hopefully to stimulate the reader’s interest to explore further in to his/her professional past.

Modern nursing, as it is currently conceived to be, was born in the second half of the nineteenth-century. Institutions and professions reflect, within their own structures, the society in which they have their being; including prevailing norms, attitudes, beliefs and values. Early pioneers in nursing have been frequently, and occasionally bitterly, criticised for their part in formulating and transmitting a tradition, in many of its aspects now seen to be inimical to professional development and progress in nursing in the modern era. Like Tevye in ‘Fiddler on the Roof’ tradition has sometimes been thought to be ‘the most important thing in life’.

However, to endeavour to attain any understanding of how this tradition, in its multiplicity of facets and influences, came to be shaped and moulded in the way that it did, it is necessary to consider in a little detail the social structure and cultural context of the period. Political and economic, as well as social and environmental factors, exerted powerful influences then, as they continue to do in the present era, and nursing in common with most other occupations is not immune to these.

The nineteenth century is sometimes referred to by historians as a century of progress, and as a century of scientific discovery. The industrial revolution was still in progress; though the term ‘revolution’ here could be seen as something of a misnomer, as violent and bloody change so often associated with that term was not a dominant feature; indeed the process of industrial change was fairly slow. However, the factory system continued to develop as new industrial technology was introduced, despite employers’ fears of increasing financial costs, and employees’ fears of ‘wage slavery’.

The extention of industry was accompanied by the uncontrolled growth of towns, which in turn spawned housing, sanitary and health problems of some magnitude. These difficulties were further exacerbated by a marked population growth through the period. In 1801 the census recorded a population of 9,000,000. This doubled by 1851 and was to double again by 1901. It was essentially a young population, where in 1850 75 per cent were under the age of 45 years. Married persons constituted 36 per cent and single persons 60 per cent of the overall population.

This period also saw the beginnings of women’s emancipation and, despite opposition from landed interests, the extention of the franchise in 1832 to the rising entrepreneurial wealthy middle class merchants and manufacturers. Further reform acts were to follow which would eventually enfranchise the whole of the male population. The right to vote was not extended to women however, before a long, bitter and sometimes violent struggle had ensued, spanning several decades, before its final achievement early in the twentieth century.

Queen Victoria ascended the throne in 1837, and the period following, until her death in 1901, is often referred to as the ‘Victorian era’; frequently associated in the popular mind with images of wealth, progress, extention of Empire, invention, exploration, and also with a cluster of dominant norms, attitudes, values and beliefs, sometimes referred to collectively as ‘Victorianism’. The period was also linked to accusations of complacency, narrow mindedness, prudery, dullness, and resistance to social change. All these elements played a significant part in the early shaping of nursing, and will be referred to again later in this chapter and others.

The Victorian era was not, however, a period of uniform prosperity. Prior to the repeal of the Corn Laws in 1847 there was much rural poverty, with labourers starving, minimum wages fixed in most counties, and considerable unrest. The unrest, sporadic violence and the Chartist movement caused unease among the ruling classes who, mindful of recent events in Europe, feared revolution. Repeal did not, however, bring agricultural ruin as had been feared by some, and the three decades that followed saw increasing prosperity and the more extensive adoption of improved methods of cultivation first introduced a century earlier.

Despite these improvements though, the drift from the land began among the rural working class, and by 1881 there were 100,000 fewer farm labourers. The last quarter of the nineteenth century showed a reverse trend in agriculture, with depression replacing prosperity. Poor harvests, outbreaks of cattle disease, as well as increasing competition from abroad meant mounting losses for farmers, many of whom became bankrupt. Reduced wages drove many farm labourers to seek employment in towns, and much land went out of cultivation. The forces of industrial and agricultural change brought about an increase in those seeking employment in an urban setting. Factories had been, and were still being organised on a principle of laissez-faire, and were subject to few regulations. The guiding principle was profit making for the factory owners, and health and safety of employees was not a prime consideration. Women and children were employed in considerable numbers as they were generally cheaper than male labour, while conditions of child labour were often little short of slavery. Wages were low, and working hours were long, with methods of coercion amounting to cruelty sometimes employed.

A series of Factory Acts, designed to ameliorate the worst aspects of the system were enacted, the first effective piece of legislation being passed in 1833. Resistance inevitably arose, with protests that industry would be adversely affected by restricting child labour. Resentment of what was viewed as State interference was much in evidence, as was the so-called pseudo-philanthropy that suggested that work could only be provided on existing terms, and was therefore preferable for all concerned. Southgate (1965) draws attention to perhaps somewhat unexpected opposition to factory legislation from the Women’s Rights movement. He comments:

Women of the upper and middle classes resented their exclusion from the franchise and from the learned professions, and some who were agitating for the removal of these disabilities saw in the limitations imposed on women’s work in factories further examples of injustice to their sex.

As mentioned earlier, growth of the factory system was also accompanied by unregulated urban development. Poor housing, overcrowding, defective sewage and refuse disposal systems, as well as contaminated water, adulterated food, and a generally low standard of hygiene all contributed to epidemics at frequent intervals. John Simon, later to become medical officer to the General Board of Health, commented that ‘it was no uncommon thing, in a room 12 feet square or less, to find three to five families styed together … in the promiscuous intimacy of cattle’.

In 1842 Edwin Chadwick, sometimes known as the ‘father of English Sanitation’, published his famous ‘Survey into the Sanitary Condition of the People’ (Briggs, 1983). This has been described as the death blow to the ‘let things alone’ party. Chadwick was an untiring worker for the setting up of a Sanitary Commission, which he was eventually successful in establishing, leading on to the first Public Health Act 1848 (adoptive only). Other individuals in the field also worked tirelessly to improve standards of health, hygiene and sanitation, including Dr Thomas Southwood Smith, founder of the ‘Health of Towns Association’ and the aforementioned Dr John Simon who was influential in the institution of sanitary inspectors, and the introduction of measures to improve drainage, housing, and other related ills of the time. However, the general tenor of public feeling was not particularly favourable to the efforts of such reformers, as was reflected in a comment in The Times newspaper of the period ‘we prefer to take our chance of Cholera and the rest rather than be bullied into health’ (Briggs, 1983). Progress was slow, but further epidemics of cholera, and outbreaks of diphtheria, smallpox and typhus ensured eventual victory for the reformers with the passing of the great Public Health Act of 1875.

Poverty among both the rural and urban working classes remained a problem throughout the Victorian era. A Royal Commission to study the workings of the Poor Law was set up in 1832, resulting in the Poor Law Amendment Act of 1834. The Act was what would now probably be described as draconian, producing harsh changes which undoubtedly must have inflicted considerable suffering upon the poor. Workhouses were designed to be places of dread, where the principle of ‘less eligibility’ ensured the grimmest of conditions for the luckless inmates. Expenditure on relief to the poor was reduced by harsh application of the provisions of the Act, but poverty was not reduced thereby, nor employment found for those willing to work. The poor continued to live in fear of unemployment, sickness and old age until well into the twentieth century, when more humane and positive approaches were made in addressing the underlying causes of poverty.

The middle period of the Victorian era was not, as indicated above, one sympathetic to the disadvantaged or the weaker members of society. It was a period described by Briggs (1983) as being ‘proud, confident and prosperous’. England was the richest country in the world. There was a degree of social stability, even though tensions lurked below the surface. Economic, technological and scientific development was proceeding apace, and the concept of self-help, as epitomised in the book of the same title by Samuel Smiles published in 1850, was lauded. The Victorians valued such qualities as thrift, hard work, abstinence, strength of character and respectability.

Throughout the period Britain was governed mainly by a landed aristocracy, and social class divisions were fairly rigid. Ascribed status carried more weight than did achieved position, and social mobility was limited.

As the century passed its mid-point and industrial progress gave rise to a new power, that of the industrial middle class, there also arose new needs in terms of a more highly skilled workforce. Education therefore became an issue, giving rise to opposing viewpoints concerning the need for a more literate and numerate working class. The Church of England and the Non-Conformist Church, realising the increasing need for literacy among the poorer sections of the population sought to remedy the situation. Regrettably rival bodies were set up in the form of the Church of England National Society and the Non-Conformist British and Foreign Schools Society which opposed and frustrated Government efforts to establish a national system of schooling. Despite these problems the Forster Education Act was passed in 1870, ensuring non-denominational, compulsory education in the basic subjects of reading, writing and arithmetic to the age of 10 years for all children. This was raised to 11 years in 1893 and to 12 years in 1899. Education at this point in time was selective in content and structured according to social class position. Control of education was firmly in the hands of the ruling class, who viewed education for the working classes, if they did not actually oppose it, as enabling them to become ‘efficient machine minders’. Rudimentary education including religious instruction was seen as a means of ‘gentleing the masses’.

As the century progressed trade unionism began to develop from its rather tentative beginnings earlier in the period. Unionism in the 1850s and 1860s developed first among skilled workers, but the last quarter of the century saw it being extended to the unskilled also, for example in Ben Tillett’s Tea Workers and General Labourers Union, and the Gas Workers Union of Joseph Arch. Various acts of Parliament sought both to regulate activities and protect union funds. However, it was not until the twentieth century that trades union power began to assume significant proportions.

The second half of the nineteenth-century witnessed a developing social consciousness. There were indications of a growing religious tolerance, and evangelicalism and non-conformism grew. In the 1850s Oxford and Cambridge Universities began to admit non-conformists. Those of the Jewish faith were enabled to become members of Parliament, and greater freedom was extended to Roman Catholics. In 1878 William Booth founded the Salvation Army, bringing a practical Christianity initially to the east end of London, and thereafter to wider spheres of influence (Rundle, 1973).

The triumphs of commerce and industry however, along with the growing extremes of wealth and poverty, began to be questioned. The poet Matthew Arnold complained of ‘this strange disease of modern life with its sick hurry, its divided aims’ (Briggs, 1983) – a complaint which could perhaps be reiterated today.

There was no dearth of great social reformers during this period, one of the greatest perhaps being the Earl of Shaftesbury. Pioneers existed in many fields, including workhouse and prison reform, higher education, female emancipation, maternity and child care, and mental health, to mention but a few areas of activity. The progress of all these areas tended to be slow. Trevelyan described the period as being a liberal, outspoken age, with social customs and economic circumstances always in movement, changing, yet not completely, and not all at once (Trevelyan, 1946). Escott saw ‘old lines of demarcation’ being obliterated, ‘ancient landmarks of thought and faith removed … The idols which were revered but a little time ago have been destroyed’ (Briggs, 1983).

Disquiet remained in many quarters of Victorian society. Writers such as John Stuart Mill, and novelists such as Charles Dickens raised social questions that demanded to be addressed. The second half of the century saw the creation of the first socialist organisation in Britain, the Democratic Federation of Henry Hyndman in 1861. Later a group of middle class intellectuals were to form the Fabian Society in 1...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Preface
• Acknowledgements
• Table of Contents
• List of contributors
• 1 Out of the past
• 2 The psychology of attitudes and values
• 3 A sociologist’s view: the handmaiden’s theory
• 4 Hidden curricula in nursing education
• 5 Political influences in nursing
• 6 Nursing Values: nightmares and nonsense
• 7 Closing thoughts on hidden agendas - an epilogue
• Index