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78 November 19th , 1928: First snowfall. The first time I gave a bed bath. Gave one to Mr. Van Camp—a young flirt. I told him to finish the bath and he said he didn’t need to. The sap. Complimented me to Miss Alson. —St. Luke’s Trainee, 19281 ontemporary nursing leaders have rallied around the idea of caring, claiming this as the core of nursing practice and thus the field’s“special knowledge.” Consistent with professionalization theory, identifying , developing, and successfully laying claim to special knowledge is viewed as crucial to establishing nursing as a full-fledged profession.2 As elaborated in a frequently cited article in nursing, a profession is “distinguished by a domain of inquiry that represents a shared belief among it members regarding its reason for being.”3 Moreover, two prominent nurses assert,“It is the common link to caring that brings nurses together.”4 Another leader adds, “Caring is the central, dominant and unifying feature of nursing .”5 The titles of well-known, contemporary works in nursing highlight the claim to caring: Nursing as Caring; Care: The Essence of Nursing and Health; The Primacy of Caring; and Nursing: The Philosophy and Science of Caring.6 The argument for caring is generally legitimized by asserting its historic basis. This argument typically proceeds as follows: “Care forms the basic core of nursing actions. Traditionally nurses have described the act of administering to patients as care behaviors.”7 Yet the nurses upon whom this view is based are frequently omitted from such descriptions. In other words, caring as the essence of nursing is assumed. When nurses from the past are cited, they tend to be from the professional elite. For example, the words of Isabel Stewart underpin a warning in the Journal of Professional Nursing that “caring is slowly disappearing” from nursing. Stewart is quoted as insisting:“The real essence of nursing . . . lies not in the mechan5 Laying Claim to Caring C Olson_CH5_2nd.qxd 1/13/2004 2:23 PM Page 78 ical details of execution, not yet in the dexterity of the performer, but in the creative imagination, the sensitive spirit, and the intelligent understanding lying back of these techniques and skills. Without these, nursing may become a highly skilled trade, but it cannot be a profession.”8 Even in those accounts that draw on information from rank-and-file nurses, the assumption of caring is imposed on historical subjects rather than discovered in their records. In one of the best-known works on nursing history, the conclusion that nurses were “ordered to care” is reached without really questioning the underlying premise that equates nursing and caring.9 However, when we first suggested examining this premise, we were chided by one nurse historian who remarked that we could not possibly be questioning the relationship between nursing and caring. She added, “I infer that what (actually) intrigues you . . . (is) to spell out and verify the conflicts and tensions (around) . . . being a caring nurse.”10 For her, the two terms were synonymous. Another nursing scholar acknowledged our intent accurately but insisted that to understand nursing and caring we would have to “go back to the original source—Nightingale,” rather than relying on the statements of ordinary nurses.11 In the field of intellectual history such an argument might be normative but a social history such as this study relies precisely on just that—the experiences of ordinary nurses, as best they can be recreated from extant records. In current discussions, the claim to caring is frequently linked to feminist ideas put forward in the theoretical debates of the1980s that placed women at center stage instead of in the periphery of society. As a wellknown nursing author explains in the American Journal of Nursing, “women’s caring work,” nursing, must be esteemed by society if we are to “move away from the masculine dream toward a new feminine future.”12 The fact that society “systematically undervalues care,” according to another account, is the primary reason for nursing’s difficulty in becoming “a woman-valued work group.”13 This construct ignores the negative consequences for women of being seen as “natural” caregivers, such as their economic dependence on men and their low status in the hierarchy of paid work.14 Glazer, a sociologist, clarifies the gender divide that tends to frame such discussions of caring: the “view of the relative passivity of women finds a complement in feminist views of women as more cooperative and relational, more caring and less...


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