women caregivers and the history of the profession are also available in bookstores. This history is sometimes local, with a short periodical time, rarely long term, as is the case with medicine, for example. Indeed, as Canadian historians note [BAT 05], “while medical historians trace the origin of their profession to Greek and Roman antiquity, nurses present a historical perspective with nursing dating back to Florence Nightingale” [BAT 05]. Before referring to Anglo-Protestant care models, we might wonder how care was provided in the ancient nations, for example, before the French colonists imposed a Franco-Catholic model on the Aboriginal or Métis populations, as well as on themselves. The Outaouais, Stadaconeans and other Hochelaguians were never asked about their pre-colonial conceptions of “caregiving”. The questioning of the status of the nursing discipline was not on the agenda. “Little is known about the nature or extent of healthcare practices in the Amerindian nations” [COH 02]. This shortcut around Florence Nightingale and the values of the English aristocracy does not really help in understanding the foundations of the discipline of care and the construction of its identity. Care practices and their knowledge existed long before Florence Nightingale. With contemporary North American researchers systematically referring to the English heroine Florence Nightingale to mark the beginnings of the discipline of nursing, and a discipline that bears the name nursing science, we are still far from identifying the real foundations of the knowledge that underlies the discipline in question.
Why present a book that focuses on the history of knowledge within the nursing discipline rather than on its actors? Because this knowledge, like the discipline itself for that matter, continues to be inaudible. The actors are known, symbolically at least. What they know or what they experience is still sometimes a form of angelism. We certainly talk about nurses, but little about their discipline. Even in the era of nursing faculties, universities and doctorates in nursing, the discipline is still seen as something that allows nurses to do, in a general way, “a little bit of everything, anything and nothing special”, as one Canadian nursing professor famously put it [ADA 79]. Admittedly, this formula does not really help the professional or scientist to build a unique identity through successive socializations, and does not really tell society what nurses bring to it in terms of skills and costs. The nurse is not an interchangeable pawn on the health chessboard. What is her own discipline made up of, what is the locus of discourse, what are its foundations, what is its purpose, what is its scientific identity and what is it used for?
The different types of knowledge produced within the discipline are fragmented knowledge, just like the places where knowledge is produced, without links between them, without an epistemological foundation that would be in continuity with the traditions of language. Without links between them, knowledge struggles to ensure its visibility. However, these fragmented parts of knowledge can still be linked to each other in a fragile way over the long term. The knowledge that guides practices is arranged in different layers of sedimentation. The separation between the layers is blurred and varies in time and space depending on the region of the globe. It should also be noted that the discipline is still orphaned in terms of identity. The research methodologies are multiple and the scientific frames of reference are also used. Knowledge is scattered and volatile, applied research, sometimes called “clinical” research, proliferates and basic research is at a standstill.
Should nursing research be exclusively at the service of the profession’s four fields23 of practice, or is it possible to envisage, for example, basic or free research for the nursing discipline? In the absence of basic research, we often have a partial picture of the nursing discipline. An overview and a homogeneous synthesis of knowledge built up over the long term is sorely lacking. Moreover, the vocabulary used has often been so mixed up in meaning that the origin, values and profile of the care professional (nurse) are not recognized today. This knowledge, produced and instrumented over the long term by groups with different value systems, as can be seen in Figure 13.1, does not always reveal its origins. A distinction must be made in terms of values between religious knowledge (French-Catholic or Anglo-Protestant) and lay knowledge. The activity at the Hôtel-Dieu differs from that of the civil hospital. The foundations of the discipline lie not in the natural sciences such as medicine, but within the human and social sciences. In the long term, the medical profession, since it has been authorized for practice in the hospital, often delegates new knowledge to nurses in order for them to develop advanced practices. However, each time advancement presupposes a higher requirement in terms of knowledge and not specialized knowledge specific to the discipline in order to clarify ordinary practice.
1 1 There are a multitude of ways to approach the notion of discipline. The place of language traditions in the constitution of a discipline must be taken into account and allows us to see the discipline as “a historically rooted articulation of composite elements that can make sense in a sustainable way and constitute a rational instance of knowledge” [BER 04]. However, the notion of discipline “is irremediably associated with the development of the university, of which it is an organizing principle” [FAB 13]. Today, it is known that the “epistemological analysis of the theoretical bases of nursing science shows the anchoring points around which the body of scientific knowledge belonging to the discipline is organized and defines its object according to four concepts: environment, person, care and health” [DAL 08a]. For Pépin et al., a discipline is also “a field of investigation and practice with a unique perspective or a distinct way of examining phenomena” [PÉP 10]. But we also know “that it is impossible to deal with the disciplinary question today without associating it with the political dimension of scientific activity. Discipline is an operation of domination before being a structure of knowledge production” [FAB 13].
2 2 In order of appearance: 1) care practice, 2) teaching practice, 3) management practice, 4) research practice.
3 3 Practice is a human action that is controlled and guided by symbolic elements included in a cultural system (knowledge, values, ideologies). Practice, even if it is only healthcare practice, “is then a consequence of the translation and understanding of values into norms of action” [NAD 93].
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Role of History
1.1. Lay knowledge
Lay knowledge is that which goes back to periods when a group of people used knowledge when that group did not yet exist as a corporation. It is knowledge that is not necessarily shared collectively and not yet standardized. People who needed this lay knowledge to carry out their occupations were not aware that they had common knowledge and shared it with others. They only did their work in conditions that were sometimes close to hospital slavery. There were still no schools and structured training in the age of lay knowledge. However, and this is an important discovery, those who performed their duties needed to pass on their knowledge to those who would replace them. Everyone was alone with the hospital managers of the time. The hospital governesses, maids and servants took an oath to perform their duties in exchange for a salary in kind and in cash. They mobilized tacit knowledge in action, domestic knowledge, knowledge necessary to run a household, take care of a family, mobilize knowledge related to the characteristics of gender, the woman, the mother, the governess and her servant or mistress of the house. In any case, there was a household to organize!
There were no new roles, new knowledge or modern nursing without reference to previous knowledge. Just as it is difficult to talk about advanced practice without knowing what ordinary practice consists of, we cannot value the role of Florence Nightingale without understanding
