The tyranny of caring

Abstract

Current professional education generally includes theoretical content regarding reflection and reflective practice and a number of models of professional behaviour based around holism, caring and therapeutic use of self. These aspects run as a theme through curricula for theoretical and practice based learning, assessment and personal development. As a doctoral student I was interested in these concepts, in particular the relationship between how professionalism was taught and the reality of practice. I took as my focus hospital based adult nursing from 1945 -1955 and specifically explored the discourses around nurse education and the ways in which ‘good’ nursing were described and talked about. This research into the history of nurse education is used here as a case study to argue that the discourses present within nursing continue to exert a powerful influence on the behaviour and practice of nurses. A number of gendered discourses around obedience, loyalty and vocation make up an image of the ‘good nurse’ which has its origins in the 19th century but can still be identified today. However the traditional discourse is mediated in current practice with more contemporary discourses in which nurses are required not only to care ‘for’ patients but to demonstrate their caring ‘about’ (Swanson 1981) through cultivating reflective practice (Johns 2004) and the use of emotional labour (James 1989). Whilst the research which underpins this discussion was conducted with nurses, the tensions it reveals have application across all professional education. Current policy in health and education sectors simultaneously espouses a ‘customer’ led ethos, a business model of operation and evidence based practice. It may be argued that within this climate discourses around emotional engagement, reflection and continuous self improvement encourage people to see themselves as ‘not good enough’ and are thus a controlling rather than liberating force. In order to address these issues firstly the research will be outlined and the findings presented. This will be followed by a discussion examining the implications for current professional practice