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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 7
by Jon Laor
This difference in approach, according to May and Fleming allows for a better understanding of the power structure of medical facilities and how they affect patient care. Power structures of medical facilities determine patient care by determining doctors as leaders and nurses as submissive thus favoring the dominance of one ideology over another rather than creating a mutual collaboration. The changing focus of medicine now, though, can influence the coming of a new moral focus that will shape the way medical systems run.
Commitment to moral agency (Blum 1980, Oakley 1992), could evolve and become established like any other institutional ideology, through legitimation and internalization of the relevant values (Berger & Luckman 1966). This process becomes functional if the existing ethos fails to support a profession's ideals and creates disillusionment. (Woodward)
What does Woodward mean by the "legitimation and internalization" of medical practitioners' values? She uses these words as means of optimistically enforcing the fact that the ways of the future will evolve by "commitment to moral agency", but they probably will be decided by the work of certain manipulative forces until the failure to "support a profession's ideals" becomes unbearable causing disillusionment. It seems the clash of two cultures into one institution followed by the domination of one of the other has caused nurses to become disillusioned with medical care. The "moral agency" to which Woodward says nurses should be committed can be compared to the complication of Martin's idea of cultural stereotypes stated earlier, meaning that culture is so intertwined in the administration of medical care that it cannot be expelled, but still must be looked at in terms of how societal bias affects the care of patients. In Woodward's essay there are many social factors at play, and they surely have an effect on the health of the patients! Whether the nurses become "'techno-academic'… with equal standing to doctors" or "expressive specialists in psychosocial dynamics and therapeutic relationships" (Woodward) plays a large role in deciding who will be spending time with the patients, trained professionals like doctors and nurses or less-trained people not consumed by paperwork and utilitarianism. The caring attitude pitted against the practitioner-centered ideology of the nurse and doctor also plays a part. "Caring is described by Benner and Wrubel (1988) as a moral art and motivating force which facilitates concern, involvement, attachment and connection with the recipient and transforms mere techniques and knowledge into caring. It is ethically desirable as it enables the practitioner to identify subtle changes in the patients, discern problems, find and implement solutions" (Woodward). Presently, the close human relations between nurses and patients are at risk, and this, for Woodward, translates as worse patient care. Because the two ideologies were born of different cultures, one male dominated and one female dominated, Martin might say that the entire discussion is slanted from either side- one saying that patients should be given high tech treatment with little human affection while the other says that the relationship between caregiver and patient is sacred and natural, but the "institutional ideology" (Woodward) has a direct effect on patients and the struggle for power between doctors and nurses is skewed in favor of the doctors following "scientific reductionism" (May and Fleming 1096). If doctors and nurses fuse their ideologies when collaborating on health care, the patient will receive the acute skill of doctors combined with the well trained and sensitive care of nurses.
The struggle between nurses and doctors produces similar results in various health institutions for a variety of reasons, including gender, socio-economic, and socio-political influences, and nurses are forced to behave certain ways because of the "normative pressures" of institutions (May and Fleming 1097). Literature often gives in to what Martin describes as "sleeping metaphors", like that of comparing medical systems to 19th century families (Willis 299) or comparing nursing to female servitude (Smoyak 77-78), and so scholars and administrators must be aware to avoid these social and cultural intrusions into the realm of science. Despite losses in the power struggle, the nurses are not conforming ideologically; it is important then, to analyze their distinction from doctors in the variety of ways, including how they approach professional discourse (May and Fleming 1094), how they approach patient care (Willis 305), how they see themselves whether they be male or female (Willis 305), their ideological beliefs (Woodward), and other carefully planned, scientific approaches. The biomedical approach of most doctors centers more on the practitioner's instrumental care while the holistic approach of most nurses deals with human aspects and trying to relieve the pain and suffering through cooperation rather than manipulation. Institutions attempt to enforce conformity of action, but a study of professional discourse will show the tension between assumptions on proper care (May and Fleming 1094). It is important to understand through observation of scientific literature the differences in culture between nurses and doctors. These cultural assumptions have an effect on ideology thereby affecting the behavior of the medical professionals and consequently influencing patient care. From either standpoint, gender issues, socio-economic issues, and religious issues enter into the field and try to influence their science by their unique variations on "professional discourse," but all of these are not science; they are tools of cultural imposition of which Martin has warned us. Understanding this, it may be possible to take valuable ideas from both sides in forming institutional ideologies, thereby creating a more effective collaborative environment.
Works Cited
Martin, Emily. "The Egg and The Sperm," Signs, v. 16, Number 3, Spring 1991, p. 485-501.
Woodward VM. "Professional caring: a contradiction in terms?". Journal of Advanced Nursing. 26(5):999-1004, 1997 Nov.
May C. and Fleming C. "The professional imagination: narrative and the symbolic boundaries between medicine and nursing". Journal of Advanced Nursing. 5(5):1094-100, 1997 May.
Persuad, Raj. "Doctor's Health Clinic." HospitalDoctor. 2 January, 2001. <http://www.hospitaldoctor.net/ hd_archive/hd_r efarticle.asp?ID=2114>
Smoyak, Shirley A. "Problems in Interprofessional Relations." Issues in Collaborative Practice. Ed. Jean E. Steel. New York: Grune & Stratton, Inc., 1986. 77-85.
Steel, Jean E. "An Overview." Issues in Collaborative Practice. Ed. Jean E. Steel. New York: Grune & Stratton, Inc., 1986. 3-14.
Willis, Eileen. "Time and the Labor Process: Construction of Masculinities in Nursing" Current Issues in Industrial Relations Volume 2. <http://www.mngt.waikato.ac.nz/ depts/sml/airaanz/conferce/ adelaide1999/ pdf/pdf/Willisn .pdf>