Comparativa entre experimentos

As established in chapter one, the appearance of cultural safety in nursing was in part driven by the intense radical change occurring in the latter half of the twentieth century. This was a time

where the values and assumptions, entrenched knowledge paradigms and regimes of truth underwent critical interrogation (McHoul & Grace, 1995). Kincheloe and McLaren (2005) observe that a critical analysis centering on notions of self and social structures informed by postmodernist, feminist and postcolonial discourses called for new understandings about technologies of power, the production of knowledge and the nature of social relationships in the social sciences, art and literature. Such interrogations touched the personal and public lives and relationships of people, becoming the focus of research, dialogue, and investigation in the social sciences, arts, literature, politics, and education (see for example Butler, 1987; Daly, 1978; Derrida, 1976; Foucault, 1980; Giroux, 1983; Heidegger, 1962; hooks, 1981, Lourde, 1984; Merlau-Ponty,1983; Morgan,1978; Sawicki, 1994, 1991; Warhol, 1962). Nursing was not immune to these shifts in thinking and, as in other health disciplines, the profession was challenged to examine its own assumptions and ideas about the practice and discipline of nursing. In Aotearoa New Zealand cultural safety became a vehicle for a radical rethinking of nursing, signifying a shift away from the more traditional humanistic frameworks of nursing knowledge development to a more critical stance, opening up ways for previously marginalised voices to contribute to the development of nursing ideas in this country.

Over the last 50 years, the discipline of nursing has utilised different philosophical underpinnings to develop coherent sets of ideas through which to guide the construction of nursing knowledge, research and practice. Campesino (2008) identifies three sets of ideas based in positivism, humanism and critical theory. Firstly, a positivist perspective attends to the assessment of health through objective measurement. This view alone, suggests Campesino, overlooks social and cultural differences, which influence professional relationships. Secondly she asserts that a humanist perspective focuses on “notions of equality and individual freedom, and operates on an assumption of sameness among people” (p. 299). One problem with this approach, she observes, is that when differences arise within nurse and client interactions, these differences are explained away as variations of cultural norms and values rather than as social categories that produce power differences. A humanist-based caring ethic, informed by a value of commonality among people, assumes that every person will be treated the same. Thirdly, Campesino identifies a critical lens as one that has the potential to transform nursing’s approach to cultural education

and practice [my italics]. Such an approach provides a way to interrogate, deconstruct and reconstruct assumptions about power and privilege to improve the delivery of health care. Gustafson (2005) asserts that critical theory can explain how social privilege operates to perpetuate power inequities in health care relationships and, a critical approach involves an assessment of pedagogical practices identifying how curriculum design and textbook discourse

reflect a dominant white middle class perspective. This she claims may silence or marginalise the experience of non-dominant populations. Gustafson argues that by not problematising race or other discourses of difference, racial categories will continue to be used as a tool for classifying people.

The shifting philosophies and competing paradigms identified in this chapter suggest that there are multiple interpretations and definitions of nursing and nursing work. In this next section I will consider a range of different interpretations by presenting the ideas of a selection of key authors. Current privileged explanations of nursing tend to focus on the caring qualities of nursing (see for example, Benner & Wrubel, 1989; Leininger, 1978; Noddings, 1984; Watson, 1990). Thorne and Hayes (1997) acknowledge the work of the above care theorists and credit them with making important dimensions of caring explicit, for example the moral idea of protection and enhancement of human dignity and moral principles inherent in caring relationships. They also argue that there is a problem with these theories as they are not able to accommodate all the dimensions of nursing. Thorne and Hayes consider that caring is shaped by the social structures of the institutions of care and cannot be viewed independently from these structures.

New Zealand nursing theorist Christensen (1990) was one of the first nurse theorists to articulate the stages of an illness trajectory by a person undergoing surgery. She identified this as the nursed passage and through using a grounded theory approach which named the work that the nurse and the client engaged in from admission to discharge. Her research positioned the nurse- person relationship as active and interactive with the nurse and the person for whom they provided care working through independent and interdependent processes. Nursing knowledge continues to develop over time and cultural safety is an original indigenous contribution to this development which emerges from the experience of the recipient of care.

Diers (2004) and Reed (2006) offer descriptions of nursing that have relevance for this research. Diers explains the work of nursing as being in touch with another human being, by being invited into the “inner spaces of other people’s existence without even asking” (p. 143). Within this space where there is “suffering, loneliness, the tolerable pain or cure of the solitary pain of permanent change, there is the need for the kind of human service we call nursing” (p.143). According to Diers the tradition of nursing is embedded in an explicit value of helping others do what they would “do for themselves if they had the skill, energy, or will, or when recovery is not possible, to assist in the act of dying and dignifying the person with their personal history,

idiosyncrasies, needs, values and desires” (p. 143). Reed (2006) on the other hand, proposes a definition of nursing which centres on nursing processes of well-being, that is where nursing involves a process that is developmental, progressive and sustaining and by which well-being occurs. This process is characterised by complexity and integration in human systems and it is not how nurses facilitate well-being but, rather “how nursing processes function in human systems to facilitate well being” (p. 127). Other theorists, such as Hatrick-Doane and Varcoe (2005), Peplau (1952) and Travelbee (1972), frame nursing within a relational framework.

Aotearoa New Zealand authors, Ryan, Carryer and Patterson (2003) note that while nursing work is focused on bodily issues experienced by a person, this experience is mediated by the psychosocial, cultural and political context of the person (p.53). They identify that an illness experience and identity are closely connected and the way in which illness is experienced transforms ones sense of self in the contexts of social meanings of sickness and health [my italics] (p.66). Diers (2004), Reed (2006) and Ryan, Carryer and Patterson (2003) provide constructions of nursing which integrate sociological, critical and humanist concepts as being the focus of nursing. Collectively they position nursing as a dynamic, relational endeavour requiring not only attention to the person but also to the socio-political contexts in which nursing takes place. The claiming of the relational as a core defining concept of nursing shifts nursing away from the more traditional humanistic frameworks of nursing knowledge development to a more critical stance because it takes into account the world view of the recipient of care. This shift opens up the way for previously marginalised voices to contribute to the development of nursing ideas in an Aotearoa New Zealand context and introduces a new praxis dimension to nursing in Aotearoa New Zealand, one which focuses as much on the provider of care as on the recipient of care (Ramsden, 1990). Kincheloe and McLaren (2007) observe that any theory of praxis needs to be purposeful and guided by critical reflection and a commitment to revolutionary practice. They assert that this commitment involves a rejection of the historical and cultural logics and narratives that exclude those who have been previously marginalised. The work of Campesino (2008), Kinchelo and McLaren (2007), Ramsden (2002) and Ryan, Carryer and Patterson (2003) collectively position nursing as both a politicised discipline and endeavour.