Contemporary feminism, concerned with issues of human justice and equity, comprises a vast, largely untapped reservoir for intellectual growth, activism, and empowerment within nursing. In confronting the socially constructed and gendered aspects of nursing reality, feminism seeks to explain many of nursing's collective experiences as consequences of patriarchy and the subordinate social status of women. Feminist theory, moreover, offers graduate students the opportunity for professional re-visioning at the juncture of deepening personal involvement in the cultural life of nursing.
A fundamental contribution of feminism to nursing is the insight and clarification it affords regarding the traditional image of nursing in terms of family roles and mothering, all indicative of influences of patriarchy on the evolution of nursing. Women's roles and activities in the traditional family underscore their subservience and marginality, and in turn, reinforce a societal view of motherhood that mininiizes women's full potential and achievement (Degler, 1980; Ehrenreich & English, 1978; Kalisch & Kalisch, 1987). Most notably, traditional socialization denied women direct political expression. In Adrienne Rich's words, "Women's lives in all levels of society have been lived too long in both depression and fantasy while our active energies have been trained and absorbed into caring for others" (1986, p. 247).
Nightingale herself is a compelling voice speaking out against the eclipsed and limbo-like circumstances of women like herself in rigid Victorian society. In Cassandra: An Essay, written at age 32, she concluded that the institution of family contributed neither to the well-being nor quality of any of its members:
. . . The family? It is too narrow a field for the development of an immortal spirit, be that spirit male or female. The chances are a thousand to one that, in that small sphere, the task for which that spirit is destined . . . will not be found (Stark, 1979, p. 37).
Thus, the fingering iconography of nursing as an empathetic and caring mother surrogate is actually both a carry-over from traditional images of women's subservience and a reinforcing emblem of powerlessness. Ashley likewise observed how the American hospital was characterized historically in explicit patriarchal family terms: Physician/father dictated to nurse/mother, who in turn was expected to care tirelessly and diffusely, and for small remuneration (1976). In all, such patriarchal conceptions of family life and hospital care socialize women to manifest qualities of compassion, generosity, sensitivity, and selflessness - qualities characterized at once as feminine and otherwise as oppressed group behaviors (Roberts, 1983). Such images of caring strengthen the notion of nursing as a patriarchal extension. As such, caring can be only a part of the complete gestalt for contemporary nursing as a distinct health service advocate and provider.
The Feminist Solution
Feminist momentum in nursing holds the potential for converting nursing into a global network of competent, caring, activist healers united in their commitment to ecological well-being. While realizing how patriarchal influences have eroded the quality and style of nursing's contributions to society, students also realize the rich legacy that they inherit as members of an indomitable presence in the history of care and human service. This taproot supplies the core of renewal and growth, a basis for meaning and identity, an antidote to pessimism and alienation.
An optimal picture of actualized feminism is advanced by Belenky, Clinchy, Goldberger, and Tarule in their concept of constructivist women:
. . . Constructivist women aspire to work that contributes to the empowerment and improvement of the goal of others . . . address burning issues of the day and contribute as best they can . . . integrating feeling and care into their work . . .in human service careers, environmental concerns . . . and efforts to humanize their cities . . . (1986, p. 152).
A "constructivist" model of nursing would indicate a fusion of personal thought and doing into a meaning-filled unity of collective action. Feminist theory thus might enable nursing to expand its social identity to incorporate themes of decisiveness, influence, and energetic activism within a restructured health care system driven by compassionate health policy.
The epistemologie framework, Women's Ways of Knowing" (Belenky et al., 1986), advances a model whereby students can evaluate and track the varied stages of knowing in their own experience. The stages are conceptualized as silence, received knowledge, subjective and procedural knowledge, and optimally, constructed knowing. With attainment of a disciplined habit of constructed knowing, nursing might realize its unique identity and create new knowledge.
Feminism introduces core epistemologic/methodologic issues and ushers in a critical reappraisal of dominant traditions in scientific discourse (Harding, 1986). Likewise, its grounding in phenomenology and critical theory upholds interpretive strategies such as paradigms, exemplars, and thematic analysis to fully comprehend the of nursing experience (Benner, 1985). Feminism also focuses on issues of gender. Beyond biologic singularity, a concept of gender enables elaboration of distinct social, cultural, and spiritual dimensions of experience as woman or as man, crystallizing in realization that living as a woman and living as a man are singularly parallel and separate realities (Schaef, 1981). Moreover, given the emphasis on holism and individuality of human experience (Chinn, 1985), gender will remain an enduring issue in nursing inquiry and practice.
Feminist theory upholds personal lived experience as the basis for analysis, theory generation, and activism. Heightened self-awareness thus becomes a pivotal research skill that transforms women from object to subject and exponent of science (Reinharz, 1983). By integrating the traditional division of masculine/rationality and feminine/ emotionality, the unique "voice" of the discipline emerges, articulating and elaborating the mosaic of nursing practice. The development of a scientific discourse regarding the ways of doing and of being nursing would readily dispel notions of women and nurses as helpmates or accessories to scientific undertakings (Schiebinger, 1990).
In its promotion of cultural consciousness within nursing, feminist inquiry validates and potentiates data generated from personal experience, notably introspection addressing injustice, ambivalence, trauma, conflict, and invisibility. Other themes contribute to a full operationalized process of constructed knowing:
* Critique - rejecting, revising, and reformulating traditional androcentric methods and interpretations;
* Validation - experience of daily life and the "taken-forgranted" provide data for theoretical/methodological discovery and reinterpretation;
* Double consciousness - an individual's sensitivity to his or her paradoxical, dual orientation as both a member of a traditionally oppressed group (woman/nursing) and a privileged group (scholar/graduate student) (Cook & Fo now, 1986; MacPherson, 1983).
In all, a feminist process fosters a spiralling of inquiry from "known" realms of context and meaning into ever deeper and broader interrelations. By enabling students to examine consciously their stages of knowing and their value-laden premises (and contradictions) within nursing, they gain the facility to frame and "own" an individual definition of practice. Feminism thus can promote both rigor and unity within nursing regarding its praxis imperatives, ultimately contributing to the formulation of a societal agenda of complex services with multiple levels of intervention.
Three feminist themes served as foundation for learning activities of a core course, "Nursing in Larger/Macro Social Systems": multiple strands of experience; nursing history revisited, and feminist group process. Integrated with readings and other course content, the themes raised student consciousness regarding patriarchal context in nursing practice and, more emphatically, provided a process whereby students created their "corrected" and empowered visions of nursing.
Multiple strande of experience
To alter nursing's collective image to that of a singularly competent and caring professional, nurses themselves must re-envision and demonstrate both decisiveness and commitment. Feminist theory introduced students to a model of feminist learning that depicted a braiding together of three major strands of ongoing life experience: student experience of the course, specifically including readings, structured theoretic content, films, speakers, and ongoing small-group process; experiences in the role of a nurse; and individual experience as a person with distinct age, gender, racial, and ethnic identity (Figure).
The feminist learning model, along with the Women's Ways of Knowing framework (Belenky et al., 1986), provided students with a way to deconstruct, examine, rebuild, and expand their own personal visions and foundations of commitment to nursing. To cultivate a personal "voice," they considered their ongoing life experience as student, nurse, and person of singular age, gender, racial/ethnic, and class attributes. Each strand was characterized as a "bank" of past and unfolding experience, amenable to review and then to reconsideration and insight development regarding the realm of nursing experience. In this way, students initiated a critique of personal experience in relation to other class content.
Nursing history revisited
Although feminism acknowledges women's abuses of power, deficiencies in moral behavior, and the sentimentalization of women's concerns (Vance, Talbott, McBride, & Mason, 1985; Vendler, 1990), its historic emphasis is on helping students realize how restricted and thwarted has been women's full participation in society as artists, healers, politicians, scientists, and entrepreneurs. Moreover, the fact that a majority of nurses have been women has indeed made all the difference to the evolution and organization of professional nursing. For most students, some historic revision and reconstruction of past and ongoing circumstances within nursing was prerequisite learning toward a re-envisioning of the profession. Feminist themes essentially reinforced the view of contemporary nursing as a continuity of activism and effort.
Personal biography enabled a counterbalancing recovery of the legacy of strength and indomitabüity within nursing. Excerpts from writings and autobiography (Breckinridge, 1981; Coss, 1989; Daniels, 1989; Goodrich, 1973; James, 1985; Sanger, 1938; WaId, 1915) attested to early political activism by nursing. Likewise, it was critical to expand and correct the historic record of contributions by African-American nurses (Carnegie, 1986), as well as the legacy of contributions by men in nursing. Such readings retrieved and restored an otherwise erased, lost, or trivialized legacy of social consciousness - a key nursing reality in the "corrected" image. Likewise the literature promoted fuller comprehension of the remarkable models of independent, community-based service systems (Armeny, 1983; Cook, 1977; Davis, 1983; Katz, 1986; Sullivan & Friedman, 1984).
INTEGRATION STRANDS IN FEMINIST LEARNING
Graduate students continued their comprehension of the full spectrum of nursing voices across historic and cultural timeliness through recourse to contemporary historical/ feminist films (Baer, 1990; Gillespie, 1990; Hott & Gary, 1988; National League for Nursing, 1990) as well as recent historic examinations of nursing's past (Ashley, 1976; Melosh, 1982; Reverby, 1987). Contemporary nursing exemplars of social and environmental activism were also available in published firsthand accounts (Mason & Talbott, 1985). The goal was that students further clarify and construct their personal images of an activist professional: at once complex, ecologically-identified, caring, and competent.
Feminist group process
Community, a paramount theme, likewise refers to issues of connection and relatedness within nursing, regrettably often noted by their absence. Traditional society and institutionalized roles have separated and alienated women from one another. While misogyny can manifest in hospital and health care settings, withingroup conflict and alienation among nurses have been the major undermining blocks to solidarity and cohesiveness (Clark, 1986; Katzman & Roberts, 1988).
Group experience operationalizes the notion of "connected learning" in the Women's Ways of Knowing framework (Belenky et al., 1986, p. 123), promoting an orientation toward learning as shared understanding and truth. Scheduling small-group sessions as a component of class time offered students a laboratory in building solidarity and bonding among peers. Unique to feminist group process was the principle of consensus, agreement by the total collective, and themes of safety, valuation, and validation among group members (Frye, 1983; Wheeler & Chirm, 1984).
Reinforcing the feminist emphasis on knowledge derived from personal biography, one's own and others' experiences provided the matrix for caring relatedness in groups. Common understandings were reached through shared reflection on experiences in the gender-specific roles of parent, spouse, child, and sibling. Continued speculation addressed the multiple aspects of gender bias in nursing roles, enacted within contexts of political and social inequity, and ultimately opting in favor of male authority and privilege. Through such exchanges, group empathy and cross-validation were generated, reinforcing s elf- valuation, both personally and professionally.
In-class writing encouraged students to synthesize the multiple strands of experience, further developing a personal voice and commitment to an activist, largersystem role for nursing. Describing critical contexts of practice also constituted an experience in feminist aesthetics (Lenk, 1986); students identified and extolled the sources of meaning they had personally discovered in the practice of their chosen life work.
Students were encouraged to cultivate a ritual of keeping and reviewing a journal, and to construct a repertoire of vignettes from prior experience illustrating course content.
Essentially, journals were viewed as private repositories from which students might elect to draw material to incorporate in class assignments (Ruffing-Rahal, 1986). Various writing opportunities permitted students to detail dimensions of doing nursing and of being a nurse, thereby extending the foundation of personalized and constructed knowing (Belenky et al., 1986; Heilbrun, 1988).
The intention was that students elaborate and clarify the multiple realities of practice. Specific assignments focused on "peak" experience in practice, ethical conflicts, optimal practice scenarios, physician-nurse conflicts, and sexual harassment.
In-class writing exercises were followed with class discussion relating course content to a summary of salient themes in writing obtained through content analysis. By sharing their writing, students were able to give their own enthusiastic, affirmative statements of nursing that were noteworthy for their incorporation of the meaning-grounded elements of practice. It also strengthened consensus regarding core professional values and identity. A turning point was marked with students' recognition of nursing in terms of shared diversity and collective resources and its farreaching potential in the arenas of health care ethics and policy.
Nurses enter graduate school as witnesses and survivors of various forms of patriarchal dominance. Feminist methodology provides them with a discourse and process for critical reinterpretation of their experiences and, in turn, the potential for redefining professional identity and practice in activist and global terms.
The most liberating aspect of a feminist curriculum is the permission rendered to name and confront experiences of gender-based inequity in practice, such as nursephysician conflicts and sexual harassment. But it does not stop there. From insight and understanding of their own professional circumstances, students move to the consideration of populations fettered by repressive social structures. A value-laden feminist process enables nursing to confront, celebrate, and transform professional issues into compassionate advocacy and activism on behalf of the disadvantaged.
Observed outcomes of feminist course content have been that students become initiating, proactive, energized, enthusiastic, and curious. The self-disclosure in their writing and analysis of course themes in relation to specific life experiences consistently provides arresting evidence of knowledge gained. One outstanding realm of student response has been the ethical revisiting of prior nursing acts in relation to the long-range implications of care.
Students frequently realize that health policy, or its absence, can further the oppression of clients. An example is the "double bind" of a premature infant, resuscitated at great cost, who lives to become a school-aged, institutionalized, nonresponsive patient requiring total care.
Students readily draw from practice experience to describe similar cases, all evidence of their own awareness of how care options frequently give clients only a greater or lesser degree of penalty, deprivation, and dehumanization.
The power of nursing in future health care systems may well be founded on holistic wellness, removed from the traditionally patriarchal bureaucracies of sickness care (Clark, 1986). Feminist consciousness enables a fuller and more hopeful depiction of such systems of nursing services. Over two centuries, the feminist movement has fostered woman-identity and initiative throughout society. Likewise within nursing, feminism provides the impetus toward an empowered professional identity with full awareness of its core and complexity. Concomitantly, feminism enables practitioners to articulate the questions whereby nursing will continue its evolution into the next century.
Feminist ideology transforms the caring ethic of nursing into political activism in behalf of the rights and wellbeing of client populations (Vance et al., 1985). Because it ultimately addresses global oppression and inequity, feminism provides the springboard toward a worldwide agenda advocating social justice and ecological well-being among all living entities. At a global level, feminism strives to create a world where the concept of power is not uppermost through employment of qualitative processes:
It is the platform toward the design of a new world view. At a global level, feminism strives to translate the alleviation of gender bias to a world agenda of peace and harmony. As a replacement to power as the central societal value, there is need to restore the idea of human felicity in its largest and deepest sense (French, 1985, p. 444).
The need is to cultivate nursing's participation in the design of qualitative planetary policies to avert disaster, mobilize resources, and promote health on a world-wide scale (Diamond & Orenstein, 1990).
Jean Baker Miller, writing of women's singular ethical perspective, characterizes woman's identity as "being in relationship," that is, of person indivisible from her dynamic mesh of ongoing relationships with others (1986). Women's drive for connection and responsibility for others is their formidable strength, paralleled in nursing by a steadfast tradition of activism and care.
Nursing's transition to full autonomy and competency is therefore hinged on the creation of an activist concept of global caring and justice. Along with fostering new attitudes, the global activist model calls for new and critical socialization experiences at all levels of nursing. There is a pressing contemporary drive for advanced professionals to integrate and manifest a creative blend of autonomy with caring, of assertion with altruism, of advocacy with justice. Ferguson (1984), differentiating optimal political activity from bureaucratic manipulation, characterizes it as an active, self-creative process that permits the evolution of new concepts that enable the world's populations to evolve and achieve together what no single faction alone might do. It is clearly a time when nursing, as a predominant and feminist women's profession, harbors decisive energy toward creation of a world order with justice and caring as its hallmarks.
- Armeny, S. (1983). Organized nurses, women philanthropists, and the intellectual bases for cooperation among women, 1898-1920. In E.C. Lagemann (Ed.), Nursing history: New perspectives, new possibilities (pp. 13-46). New York: Teachers College Press.
- Ashley, JA. (1976). Hospitals, paternalism and the role of the nurse. New York: Teachers College Press.
- Baer, E. D. (1990). Editor's notes for Nursing in America: A history of social reform [Video] (National League for Nursing Publication No. 41-2342). New York: NLN .
- Belenky, M.F., Clinchy, B.M.V., Goldberger, N.R., & Tarale, J.M. (1986). Women's ways of knowing: The development of self, voice and mind. New York: Basic Books.
- Benner, P. (1985). Quality of life: A phenomenological perspective on explanation, prediction, and understanding in nursing science. Advances in Nursing Science, 8, 1-14.
- Breckinridge, M. (1981). Wide neighborhoods: A story of the frontier nursing service. Lexington, KY: The University Press of Kentucky.
- Carnegie, M.E. (1986). The path we tread: Blacks in nursing; 1854-1984. Philadelphia: J.B. Lippincott.
- Chinn, PL. (1985). Quality of life: A values transformation. Advances in Nursing Science, 8(1), 7-9.
- Clark, CC. (1986). Wellness nursing: concepts, theory, research, & practice. New York: Springer.
- Cook, B.W. (1977). Female support networks and political activism. Chrysalis, 3, 43-61.
- Cook, J. A, & Fonow, M.M. (1986). Knowledge and women's interests: Issues of epistemology and methodology in feminist sociological research. Sociological Inquiry, 56, 2-29.
- Coss, C. (Ed.). (1989). Lillian D. WaId: Progressive activist. New York: Feminist Press.
- Daniels, D. (1989). Always a sister: The feminism of Lillian D. WaId. New York: Feminist Press.
- Davis, A.F. (1983). American heroine: The life and legend of Jane Addams. New York: Oxford Press.
- Degler, CN. (1980). At odds: Women and the family in America from the revolution to the present. Oxford: Oxford University Press.
- Diamond, I., & Orenstein, G.F. (Eds.). (1990). Reweaving the world: The emergence of ecofeminism. San Francisco: Sierra Club Books.
- Ehrenreich, B., & English, D. (1978). For her own good: 150 years of the experts' advice to women. New York: Anchor Press.
- Ferguson, KE. (1984). The feminist case against bureaucracy. Philadelphia: Temple University Press.
- French, M. (1985). Beyond power: On women, men, and morals. New York: Ballantine Books.
- Frye, M. (1983). 77ie politics of reality: Essays in feminist theory. New York: The Crossing Press.
- Gillespie, R. (1990). Handmaidens and battleaxes. Los Angeles, CA: Silver Films.
- Goodrich, A.Q. (1973). 77k? social and ethical significance of nursing: A series of addresses. New Haven, CT: Yale University Press.
- Harding, S. (1986). The science question in feminism. Ithaca, NY: Cornell University Press.
- Heilbrun, C (1988). Writing a woman's life. New York: W. W. Norton.
- Hott, L.R., & Garey, D. (1988). Sentimental women need not apply: A history of American nursing. Los Angeles: Florentine Films.
- James, J.W. (Ed.). (1985). A Lavinia Dock reader. New York: Garland Publishing.
- Kalisch, P.A., & Kalisch, B.J. (1987). The changing image of the nurse. Menlo Park, CA: Addison Wesley.
- Katz, M. B. (1986). In the shadow of the poor house: A social history of welfare in America. New York: Basic Books.
- Katzman, E.M., & Roberts, J.I. (1988). Nurse-physician conflicts as barriers to the enactment of nursing roles. Western Journal of Nursing Research, 10, 576-590.
- Lenk, E. (1986). The self-reflecting woman. In G. Ecker (Ed.), Feminist aesthetics (pp. 51-58). Boston: Beacon Press.
- MacPherson, K (1983). Feminist methods: A new paradigm for nursing research. Advances in Nursing Science, 5, 17-24.
- Mason, D. J., & Talbott, S.W. (1985). Political action handbook for nursing: Changing the workplace, government, organizations, and community. Menlo Park, CA: Addison- Wesley.
- Melosh, B. (1982). The physician's hand: Work culture and conflict in American nursing. Philadelphia: Temple University Press.
- Miller, J.B. (1986). Toward a new psychology of women (2nd ed.). Boston: Beacon Press.
- Mitchell, J., & Oakley, A (Eds.). (1986). What is feminism? New York: Pantheon Books.
- National League for Nursing. (1990). Nursing in America: A history of social reform [Video]. New York: NLN.
- Notes on nursing: What it is, and what it is not. (1969). New York: Dover Publications.
- Reinharz, S. (1983). A contribution to feminist research. In G. Bowles & R.D. Klein (Eds.), Theories of women's studies (pp. 161-191). London: Routledge & Kegan Paul.
- Reverby, S. (1987). Ordered to care: The dilemma of American nursing. Cambridge, MA: Cambridge University Press.
- Rich, A. (1986). Of woman born: Motherhood as experience and institution. New York: W. W. Norton.
- Roberts, S.J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursing Science, 5, 21-30.
- Ruffing-Rahal, M.A. (1986). Personal documents and nursing theory development. Advances in Nursing Science, 8, 50-57.
- Sanger, M. (1938). An autobiography. New York: Dover Publications.
- Schaef, A. W. (1981). Women's reality: An emerging female system in a white male society. San Francisco: Harper & Row.
- Schiebinger, L. ( 1990). The mind has no sex? Women in the origins of modern science. Boston: Harvard University Press.
- Stark, M. (1979). Florence Nightingale's 'Cassandra'. Old Westbury, NY: Feminist Press.
- Sullivan, J.A., & Friedman, M. M. (1984). History of nursing in the community: From the beginning. In J. A. Sullivan (Ed.), Directions in community health nursing (pp. 3-43). Boston: Blackwell Scientific Publications.
- Vance, C, lalbott, S., McBride, A., & Mason, D. (1985). An uneasy alliance: Nursing and the women's movement. Nursing Outlook, 33, 281-285.
- Vendler, H. (1990, May 31). Feminism and literature. New York Review of Books, 36, 19-25.
- Wald, L.D. (1915). The house on Henry Street. New York: Dover Publications.
- Wheeler, CE., & Chinn, PL. (1984). Peace and power: A handbook of feminist process. Rochester, NY: Margaretdaughters.