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Dialogues@RU is published annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume One
Spring 2002
Removing
Cultural Stereotypes to Find Real Differences
Between Doctors and Nurses -
Page 6
by Jon Laor
Woodward still hopes for respect for the unique individual patients. "Expressive caring," the care given from a nurse who feels empathy for the patient, can make a "qualitative difference," or improvement, but the trend still heads in the wrong direction away from expressive caring towards "instrumental activities." "Instrumental activities" seem to be reserved for doctors, according to Woodward, but this attitude may be a dangerous one, since an educated nurse can use "instrumental activities" to increase efficiency and leave more time for "psychosocial" considerations, which the male nurses in Willis' case study agreed was important. "Seamless care demands attention to the psycho-social aspects of the patient's chronic conditions. The ideology of efficiency supports this as does the ideology informing 'care' in nursing" (Willis 305). However, with increased instrumental activities, more time must be devoted to actions not determined by interaction with the patient, and this could lead to predetermined "nursing action." Predetermined "nursing action" hurts the patients by treating them as objects rather than attending to their psychosocial needs (Woodward). Woodward fears that the technical aspects and loss in religious values decreases expressive caring and "many examples of less than optimum care (Kelly & May 1982)" (Woodward) result, while "contemporary, egoistic pre-occupations (May 1990) provide evidence to support her notion" (Woodward).
A well-rounded nurse would better understand the effects of "nursing actions" on the individual, holistic, psychosocial patient thereby giving the patient improved care without sacrificing the "expressive caring" aspect of nursing.
Woodward explores differences in ideology between nurses and doctors without too much reference to gender, but she does not specify ways of reaching new conclusions about changing ideology or solving the problem of the shift in nurses' ideology and patient care away from optimum care. Woodward, then, against Martin's warning, leaves in place many of the assumptions Smoyak has used by not offering a way to understand nurses' perspectives and instead importing cultural perceptions of nursing as a basis for scientific understanding. Carl May and Christine Fleming, who wrote "The professional imagination: narrative and the symbolic boundaries between medicine and nursing" take an opposing stance to Woodward, stating that the ideology of nursing has not changed, but only the action of nurses as they are oppressed by the institutions they belong to. In addition, they state ways of studying the relationship between doctors and nurses, as well as proposing their own method, the study of the different types of professional literature. Clues about the motivation for different types of care could be found in the assumptions made in different types of professional literature. Their solution resembles Martin's study of biological literature, in its search for the importation of culture and societal bias into scientific knowledge. Rather than revealing social and cultural stereotypes about gender, as in Martin's essay, studies of professional literature in the medicines could display the opposing assumptions about how care should be given and perhaps open the door to giving more power to nurses whose ideology of emotional involvement is being overshadowed by the institutions they work for (May and Fleming 1095). May and Fleming deal with the changing relationship of nurses and patients, stressing that while nurses are becoming more technically skilled, they still have a unique perspective reflected in their writing which differentiates them from the biomedicine to which their ideology is subjected and doctors to which they are subjected. Nurses concentrate on the human aspect of medicine and prevent it from becoming a mechanical operation where the practitioners are isolated from the patients.
In place of scientific reductionism there have been attempts to restate the importance of the experience of illness, and to try to apprehend the patient not simply as the object of clinical procedures and practices, but as a psychosocial self- disaggregated by biomedical knowledge and practices. (May and Fleming 1096)
The misconception that "scientific reductionism," the idea that one can find a single isolatable source for every illness, can trace the cause of every illness and then destroy that illness, prevalent in the literature of doctors, seeks to "disaggregate" the patients or treat the patients as merely an aggregate of physical parts, and it considers them "simply as the object of clinical procedures and practices." This approach is now being challenged by a holistic approach that appreciates the "psychosocial self," which requires, beyond medicine, psychological and social support. Beyond looking at the legal aspects and at individual cases of how decisions are made between nurses and doctors, one can approach the understanding of patient care through reading the different types of analysis created from each pole.
Discourses or grand narratives are also suggestive of the professional imagination. Here, they reflect the creative impulse that must lie at the intellectual core of any occupational group. While medicine is able to focus on scientific understanding and technical advances as the site on which its imaginative impetus is exercised, nurses represent themselves as being in a different business altogether. They care about-and get attached to the patient-while doctors stay detached and seek a cure. (May and Fleming 1097)
The "professional imagination" represented in the discourses of professionals is very similar to Martin's idea of scientific myths. Both bring to light social ideas imposed on scientific literature. May and Fleming say that this imagination is not only necessary, but it "must lie at the intellectual core of any occupational group." Martin would probably disagree, and would indicate that the main purpose should be to aid the patient and ignore the social ideology. As will shortly be shown, however, the "institutional ideology" that Woodward writes of has a direct affect on the patient, and therefore the science and social aspects of medicine are too closely intertwined to differentiate and to expel the culture. Rather than expel the culture, it is important to open dialogue, study cases that do not fit the stereotype as in Persuad's article and Willis' essay, and explore the constraints culture places on the institutions that unite doctors and nurses. By doing this, it would be possible to awaken "sleeping metaphors," which are especially prevalent in defining gender roles (Martin 104).