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Poverty, Chastity and Obedience the Foundations of Community Nursing in New South Wales

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Poverty, Chastity and Obedience the Foundations of Community Nursing in New South Wales aó('3"q1 POVERTY, CHASTITY AND OBEDIENCE THE FOUNDATIONS OF COMMUNITY NURSING IN NEW SOUTH WALES. Karen Francis A thesis submitted in fulfilment of the requirements for the award of Doctor of Philosophy from The University of Adelaide Department of Clinical Nursing 1998 Table of Contents TABLE OF CONTENTS Table of Contents lll Acknowledgments vii Abstract viii CHAPTER ONE 1 INTRODUCTION TO THE STUDY 1 CHAPTER TWO 5 STUDY DESIGN AND METHODOLOGY 5 THEORETICAL PERS PECTIVE 5 AN INTRODUCTION TO FOUCAULT'S V/ORK 8 METHOD AND STUDY DESIGN t2 DEFINING COMMUNITY NURSING l5 CHAPTER THREE 17 THE DECISION TRAIL 17 RECORDING DECISIONS 17 THE JOI.IRNEY BEGINS 18 BEGINNINGTHE SEARCH 18 THE WORLD HEALTH ORGANISATION'S CHALLENGE FOR NURSING 19 AHUNCH 20 SEEKING CLARIFICATION: WHAT IS THE ROLE OF COMMLINITY NURSES IN NEW SOUTH WALES? 2I UNCOVERING THE NEXUS BETWEEN COMMUNITY NURSING AND THE AUSTRALIAN HEALTHCARESYSTEM 22 THECURSE 23 CLIMBING OUT OFTIIE BLACK HOLE 24 MY GUIDINGLIGHT 25 HAVING A BREAK AND FINDING OUT WHY I NEEDED TO CONTINUE THE QUEST 27 THE PLOT THICKENS 29 FINDINGATITLE 32 THE METHODOLOGY BECOMES TRANSPARENT 33 CHAPTER FOUR 35 POVERTY 35 INTRODUCTION TO PART ONE: POVERTY 36 CHAPTER FIVE 3 9 ENGLAND: THE SOVEREIGN NATION 39 BACKGROUND 39 POLITICAL CONTEXT 40 ECONOMY 4t ENGLISH SOCIETY 44 THE POOR LAV/S 45 PROTESTANTISM, PHILANTHROPY AND THE ESTABLISHMENT OF PROTESTANT COMMUNITIES OFV/OMENRELIGIOUS 47 HEALTHCARE 54 HANDY V/OMEN, PRIVATE NURSES AND OTHER HEALTH CARE WORKERS 55 MEDICINE 57 PROFESSIONALISATION OFMEDICINE 57 THE VOLUNTARY HOSPITALS 59 THE EMERGENCE OF A PROFESSION 60 CONCLUSION 6I u Table of Contents CHAPTER SIX 6 3 IRELAND: A TROUBLED COUNTRY 63 BACKGROUND 63 POLITICAL CONTEXT 64 ECONOMY 67 IRISH SOCIETY 68 EDUCATION: A STRATEGY FOR OPPRESSION 70 THEPOOR 7I THE CATHOLIC CHURCH'S RESPONSE TO GRO}VING NUMBERS OF CATHOLIC POOR.73 IRISH CATHOLICISM 74 THE CATHOLIC RELIGIOUS COMMI.INITIES 75 IRISH PROTESTANTISM 77 PHILANTHROPY 7'7 HEALTHCARE 78 HOSPITALS 79 MEDICINE 81 NURSING 82 CONCLUSION 84 CHAPTER SEVEN 86 NEW SOUTH WALES: A PENAL COLONY 86 BACKGROUND 87 TRADMONAL TIEALING 88 POLITICAL CONTEXT 90 THE ARRTVAL OF BRITAIN'S CONDEMNED 9t COLOMAL SOCIETY 92 THEIRISH 94 COLONIAL PROTESTANTISM AND CATHOLICISM 94 THE IRISH WOMEN RELIGIOUS LAY THE FOTINDATIONS OF SKILLED NURSING PRACTICE IN NEW SOUTH WALES 100 THE STATE AND HEALTH CARE 102 MEDICINE AND THE SYDNEY INFIRMARY 1,02 NURSING PRACTICE 105 PROTESTANT PHILANTHROPY IN NEW SOUTH WALES t0'7 CONCLUSIONS 110 CHAPTER EIGHT 113 CHASTITY 113 BACKGROUND TO PART TIWO: CHASTITY 113 CHAPTER NINE 118 THE LADIES STAND DEFIANT 118 BACKGROUND 118 THE ROLE OF WOMEN IN lgth CENTURY ENGLISH SOCIETY r20 VICTORIAN FEMINISM 122 FLORENCENIGHTINGALE t23 PHILANTHROPY AND FEMINISM 124 SANITARY REFORMS r26 DISTRICTNURSING t29 HEALTHVISITING t3t INFANT WELFARE MOVEMENT r35 CONCLUSION 136 lv Table of Contents CHAPTER TEN 138 THE NEW RELIGIOUS LADIES 138 BACKGROUND 138 THE IRISH POOR LAWS 140 ASSISTED IMMIGRATION TO TIIE COLONIES r4r WOMEN'S ROLE IN IRISH SOCIETY t4t THE IRISH CATHOLIC CHURCH'S DEVOTONAL REVIVAL r43 WOMEN RELIGIOUS AND PHILANTHROPY 143 HOME VISITING AND PASTORAL CARE 145 MISSIONARY ACTIVITY 148 THE SISTERS OF CHARITY'S AUSTRALIAN MISSION 148 CONCLUSION r49 CHAPTER ELEVEN 152 THE BEGINNING OF A NEW NATION 152 BACKGROI.]ND 152 GROS/TH OF THE COLONY 154 IMMIGRATION r54 PATRIARCHY, 1VOMEN AND SOCIETY 156 THE DILEMMA OF WOMEN TRANSPORTEES 158 THE CATHOLIC CHURCH IN NEV/ SOUTH WALES MISSION BLOSSOMS 160 THE SISTERS OF CHARITY MEET THE COMMTINITIES NEEDS 163 ILLEGITMATE CHILDREN AND FALLEN V/OMEN 164 THE FIRST DOMICILIARY MIDWIFERY SOCIETY r67 AN APOSTOLATE OF CARE 168 THE BEGINNING OF HOME NTJRSING r70 ADVOCATES FOR HEALTH CARE REFORM 17t THE STATE'S CONCERN 172 CONCLUSION 173 CHAPTER TWELVE 176 OBEDIENCE t76 BACKGROUND TO PART THREE: OBEDIENCE 176 CHAPTER THIRTEEN 180 PROFESSIONAL COMMUNITY NURSING PRACTICE 180 BACKGROUND 180 WAR, RECRLIITMENT AND NURSING PRACTICE 182 ADVANCES IN HEALTH AND WELFARE REFORMS 183 TIEALTH VISITING 184 DISTRICTNURSING 188 TIIE NIGHTINGALE LEGACY 190 PROFESSIONALISATION OF NURSING: THE NURSES REGISTRATION ACT 191 MEDICINE DOMINATES TTEALTHCARE t92 CONCLUSION 194 CHAPTER FOURTEEN 196 IRELAND: THE BIRTHPLACE OF A GLOBAL TRADITION 196 BACKGROUND 196 THE CATHOLIC CHURCH OF IRELAND r91 MEDICINELEADS THEV/AY 198 CLIMCAL SCHOOLS OF MEDICINE 200 TRAINED NURSES OBEDTENT, COMPLIANT AND INDISPENSABLE 201 THE MARGINALISATION OF COMMUNITY NURSING PRACTICE 202 CONCLUSION 203 Table of Contents CHAPTER FIFTEEN 204 THE STRUGGLE 204 BACKGROIIND 204 IRISH CATHOLICISM AND POLITICS 206 CATHOLICISM AND HEALTHCARE 207 THE BENEVOLENT SOCIETY OF NEW SOUTH V/ALES EXPANDS ITS ACTIVITIES 210 MEDICAL PRACTICE 2t2 MEDICAL EDUCATION AN OCCUPATION FOR THE SONS OF THE PRIVILEGED 216 REGULATION, ORDER, AND OBEDIENCE: TIIE FOTINDATIONS OF COMMUNITY NURSING IN NEW SOUTH WALES 2t6 AUSTRALIA THREATENED 222 MATERNAL/CHILD HEALTH 223 THE PROFESSIONALISATION OF NURSING NEW SOUTH V/ALES 230 COMMUNITY PRACTICE AS PASTORAL CARE: INSTITUTION BASED NURSING AN AREA OF SPECIALIST PRACTCE 232 CAREER OPTIONS FOR TRAINED NURSES 233 COMMUNITY NURSING IN NEW SOUTH WALES 234 CONCLUSION 236 CHAPTER SIXTEEN 238 MAKING SENSE OF A COMMON HERITAGE 238 SILENT VOICES OF THE PAST AWAKEN 238 THE RENAISSANCE OF NURSING IN ENGLAND 239 NIGHTINGALE SILENCES TIIE IRISH V/OMEN RELIGIOUS' CONTRIBUTION TO MODERN NURSING 240 COMMUNITY NURSING: A SPECIALIST AREA OF NURSING PRACTICE 240 MODERN NURSING AND THE IRISH WOMEN RBLIGIOUS 241 THE MARGINALISATION OF COMMUNITY NURSING BY THE IRISH RELIGIOUS NURSING ORDERS 242 THE IRISH WOMEN RELIGIOUS' INFLUENCE EXTENDS 242 TTIE BIRTH OF A PATRIARCHAL I{EALTH CARE SYSTEM IN NEW SOUTH WALES 243 THE CATHOLIC CHURCH SUPPORTS MEDICAL DOMINATION OF HEALTH CARE 245 THE FOUNDATION OF MODERNNURSING IN NEIW SOUTH WALES 246 CONCLUSION 247 REFERENCE LIST 251 vt Acknowledgments ACKNOWLEDGMENTS I wish to thank my supervisor Professor Alan Pearson for his support and encouragement during my journey. Professor Pearson guided me throughout the four years of my candidature, giving me direction when it was required and the freedom to pursue answers to the many questions I asked. He in turn asked questions of me which stimulated in me a desire to find the answers. I will be forever grateful to Professor Pearson for the encouragement, the support and the friendship he has willingly provided. This journey has been arduous and on many occasions I thought that the journey would continue after I no longer walked this earth. My deepest gratitude to my husband Peter and children Daniel, Michelle and Nicole and to my parents Pam and Brian. With each passing day I have thought and often stated once I am finished with this work we will function as a family again. Without their support, encouragement and understanding I would not have been able to travel this path. In acknowledging those who have assisted me I must thank my fellow joumey persons. To all the present and past PhD students, I say thank you. In particular Mary Ebbott, I thank you for listening during the evening, early morning and throughout the day to my prattling. V/ithout you and Dr. Desley Hegney's continued support I would not have reached the final stages of this enterprise. I would also like to extend to Dr. Lyn Hemmings and the staff of the School of Health and Human Services, Charles Stutt University my thanks for their support over the past three years. To my dea¡ friend Ysanne Chapman, who worked so long proof reading and editing this manuscript, I express my sincerest thanks. Finally, I would like to acknowledge Dr. George Curry who urged me to continue when I questioned my ability to undertake this task. vll Abstract ABSTRACT Australian nursing claims a common history with Britain, yet an inconsistency exists in that community nursing in Britain is a highly valued area of nursing practice, whereas in New South Wales community nursing is of less value than institution based nursing practice. If credence is given to contemporary literature which argues nursing practice will be based more and more in the community as we move into the new millennium, it is essential nursing understand why this discrepancy exists and what strategies may be used to improve the profîle of community nursing in New South V/ales (Mahler 1987; Mitchell 1992). This study explains why community nursing in New South Wales is unlike community nursing in Britain even though hospital based nursing in New South Wales is very similar to the British system. The study posits reasons for this anomaly by unearthing the history 'Wales. of community nursing in New South In exploring community nursing's past it was necessary to trace the foundations of community nursing to Britain and to lreland. In this thesis I suggest that the origins of community nursing are both tied to England and to Ireland. In particular I argue that Irish Catholicism and Anglican Protestantism have played a major role in shaping and directing community nursing in NSV/. In telling this story the historical context is described, voices of the past are awoken and in the tradition of Foucault, language, social constructions and disciplinary powers are uncovered to reveal the dominant discourses which have influenced and directed community nursing. Vlu Chapter One: Introduction to the Study CHAPTER ONE INTRODUCTION TO THE STUDY Contemporary community nursing practice in New South'Wales (NSW) is an area of nursing practice which is not seen by the profession, other health ca¡e workers, the State or the wider community as a valuable area of practice in comparison with hospital based nursing (Eager in Baum, Fry & Lennie 1992; Wade 1995; Francis 1996). Eager (in Baum, Fry & Lennie 1992) argues that there has been a lack of career options for community health staff including nurses which has resulted in skilled staff leaving community health to seek promotion elsewhere.
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