A Postmodern/Poststructural Exploration of the Discursive Formation of Professional Nursing in New Zealand 1840 - 2000

Abstract

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, that is, 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 to the nursing discourses overturned previously held assumptions about what constituted a nurse. Each historical 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.