This study
examines the discursive formation of professional nursing in one country, as revealed
by the history of nursing in New Zealand.
Michel Foucault’s approach to historical research signifies a different
level of analysis from conventional approaches, focusing not on the history of
ideas but on an understanding of the present, a history of the present. Foucauldian analysis interrogates the
present by interpreting the conditions in which the subject, in this case
nursing’s professional project, is constituted.
Foucault’s concept of archaeology illuminates and explains the discursive framework of nursing at the commencement of the twenty-first century by analysing the history of past discursive regimes. Extending this analysis, a genealogical method derived from Foucauldian poststructuralism reveals how different understandings of nursing have occurred and have governed nursing practices and scholarship in different historical contexts.
The archaeological investigation in this study reveals two moments
of epistemic transformation; two intervals of mutation and discontinuity. The Nightingale era in the 1880s
precipitated the first epistemic shift - premodernism to modernism. The transfer of nursing education from
hospital based training to the tertiary education sector, followed by the
introduction of the baccalaureate degree, precipitated the second epistemic
shift in the 1990s, the advent of postmodernism.
Encompassing these two epistemes, six historical contexts are
identified, where significant disruptions occurred in the nursing discourses,
overturning previously held assumptions about what constituted a nurse. Each context is identified by specific
discursive constructs. The first is
colonial caring, the second the Nightingale ethos and the third heroic,
disciplined obedience. In the fourth
context, nursing is framed by, and within, discourses of skilled, humanistic
caring, in the fifth, scientific, task focused managerialism, and in the 1990s,
the sixth context, by multiple realities in an age of uncertainty.
This study
investigates the nursing discourses within each historical context, focusing on
nurses’ struggle for status as they acquire the knowledge and practices of the
particular context. The study also
investigates the emergent nursing organisations, revealing the competing
tensions and the power and domination of particular discourses with the advent
of a new professional organisation.
In the first four discursive regimes, an
individual nurse’s commitment to her professional organisation and conformity
to the prevailing discourse was rewarded by career advancement. The fifth discursive regime sees a
diminishing of the mechanisms of pastoral power as a means of control over the
professional advancement of individual nurses.
In the sixth discursive regime, in keeping with postmodern reality,
nurses demand inclusivity in their own governance. Structures of power and control in nursing destabilise and
weaken.
Changing discursive elements are identified and analysed using
Foucauldian concepts of archaeology, genealogy, governmentality, technologies
of power, surveillance and normalisation.