Nurses, Nursing and the Media
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VIRTUOUS, INVISIBLE AND UNCONCERNED: NURSES, NURSING AND THE MEDIA. MARTINA BALAAM A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy QUEEN MARGARET UNIVERSITY 2017 Abstract This study, underpinned by a hermeneutic methodological strategy, investigates how British nurses make sense of representations of nurses in the popular media, and their perceptions of the potential implications of media representations for nursing as a profession and their own sense of self. The study was designed because of a number of factors: the popularity of hospital dramas and the increasing prevalence of hospital based ‘fly on the wall’ television programmes, a plethora of press coverage about the poor quality of nursing care, concerns from the nursing profession that the media representation of nurses have a detrimental effect on the nursing profession and nurses’ sense of self, and a scarcity of research which has explored nurses’ perceptions of representations of nurses in the popular media. Twenty-five nurses from a broad spectrum of nursing areas were recruited to the study. Eighteen participated in focus groups and a further seven nurses were interviewed individually. A thematic analysis of participants’ descriptions, perceptions of, and emotional response to the representation of nurses in the media, revealed that nurses hold diverse, contradictory and ambivalent views of media representations. Whilst the way nurses describe representations in the media is consistent with previous research, which argues that nurses are represented by a number of stereotypes, there are novel and significant findings presented in this thesis, which may have implications for the nursing profession. The study reveals that some nurses hold a virtuous understanding of the profession and secondly, that some nurses hold a stereotypical understanding of nurses. Despite participants dismissing the media as ‘just entertainment’, having no consequence to the status of the profession or their sense of self, they nonetheless expressed concern at the ‘negative’ way they were represented in the media. Consequently, there is a need for nurses to challenge both existing media representations and the way they talk about nurses and the profession. Keywords: Nursing, Nurses, Stereotypes, Image, Media, Representations, Recruitment, Television Hospital Drama ii Acknowledgements I would like to take this opportunity to thank those who have helped me during the process of writing this thesis. Firstly, I would like to thank the twenty-five nurses for giving up their time and participating in this research. My sincere thanks to my supervisory team; Dr Richard Butt and John Docherty- Hughes from the School of Arts, Social Sciences and Management and Dr David Banks from the School of Health Sciences, for their guidance and feedback throughout the years. In addition, I would like to thank Dr Shona Cameron from the School of Health Sciences who was my supervisor in the earlier years. Special thanks to all my friends and family for their ceaseless support and encouragement, especially Jane, Danielle, Wyness, Wendy, Julie, Lindesay, Laura, Morvern and my proof readers Shiona and Andi. Last but not least, thank you to Derek and my three wonderful inspiring girls, Poppy, Scarlett and Ruby who have provided constant encouragement and have helped me be the best I can be. iii Contents ABSTRACT II INTRODUCTION 1 CHAPTER ONE: REPRESENTATIONS OF NURSES IN THE MEDIA: A LITERATURE REVIEW 17 The Social Construction of Gender: Nursing Stereotypes 26 Nurses who are Men 57 Changing Representations 63 CHAPTER TWO: IMPLICATIONS OF MEDIA REPRESENTATIONS FOR NURSING AND NURSES: A LITERATURE REVIEW 72 Recruitment 74 Career Choice 83 Recruitment and Men 91 Implications for Nurses’ Sense of Self 96 Nurses’ Perceptions of Media Representations 112 CHAPTER THREE: RESEARCH DESIGN AND METHODS 122 Epistemology 122 Theoretical Perspective 125 Methodology 128 Research Methods 133 iv Ethics 144 Data Analysis 145 Reflexivity 150 CHAPTER FOUR: HOW NURSES TALK ABOUT REPRESENTATIONS OF NURSES IN THE POPULAR MEDIA 157 Stereotyping and Visibility 159 Gender, Sexuality and Nursing 193 Change and Continuity 206 CHAPTER FIVE: NURSES’ PERCEPTIONS OF AND EMOTIONAL RESPONSE TO NURSE REPRESENTATIONS. 157 Criticism and Approval of Media Representations. 217 ‘It Doesn’t Bother Me’ 241 Representations and Recruitment 247 The Public Image of Nurses and Nursing 254 CONCLUSION 272 REFERENCES 286 v Appendix A: 301 British Television Hospital Drama and Hospital Based Comedy (1957-2016) Appendix B: 302 American Television Hospital Drama and Hospital Based Comedy (1952-2016) Appendix C: Participant Information Sheet (Focus Group) 306 Appendix D: Participant Information sheet (Interview) 308 Appendix E: Focus Group Guide 310 Appendix F: Interview Guide 312 Appendix G: Excerpt from Transcript (Interview Six) 314 Appendix H: Excerpt from Transcript (Focus Group Two) 316 List of Tables Table 1: Research Elements 122 Table 2: Interviews: Participant Demographics 142 Table 3: Focus Group: Participant Demographics 142 Table 4: Focus Group One: Nurse Lecturers 143 Table 5: Focus Group Two: Nurse Lecturers 143 Table 6: Focus Group Three: Fourth Year Nursing Students 143 Table 7: Focus Group Four: First Year Nursing Students 143 List of Figures Figure 1: Strasen’s Self Image Model for the Nursing Profession 103 vi Introduction This thesis concerns how British nurses make sense of representations of nurses in the popular media and their perceptions of the potential implications of media representations for nursing as a profession, and for their own subjective sense of self. This section will introduce the reader to the context, rationale and scope of the thesis, including where this work is positioned within the current professional and academic debate concerning the representation of nurses in the media and within contemporary understandings of professional nursing practice. This section also introduces the epistemological and theoretical perspective underpinning the formulation of the research aim and questions, and the methodological approach implemented. My interest in this field of inquiry came partly from my own awareness of the representation of nurses in the popular media. As a British student nurse, and later as a registered nurse in the 1990s, I felt that the media, television drama, comedy and the news polarized the representation of nurses in to two opposing categories of good and bad, representing nurses as either angels and/or handmaidens or whores and battleaxes. This was both undermining to my own sense of self and demeaning to the status of nursing as a profession. In particular, I felt strongly that the media representation of nurses did not reflect the diversity of nursing practice, nor the level of skill and knowledge required of nurses. On becoming a nurse academic in the year 2000, I began to reflect more fully on the representation of nurses in the media and I was increasingly conscious of the proliferation and popularity of hospital television dramas and ‘reality’ documentaries, as well as a plethora of press coverage about the poor quality of nursing care. Alongide the whore and battleaxe stereotypes I felt that accusations within the news media that some nurses were ‘bad’, contrary to the dominant nursing myths of ‘angels’ and handmaidens, was demonizing nurses in an over generalised, gendered and polarized way. This press coverage related particularly to media reports and a public outcry concerning above normal mortality rates at the Mid Staffordshire NHS Trust. This led to the Francis Report (MSNFT 2013), a Public Inquiry, which identified that nurses were providing poor quality nursing care. Acknowledging all this, two key questions troubled me: could images 1 of nurses have implications for recruitment into the profession and nurses’ own sense of themselves? As I started working on the thesis, it became apparent that my concerns were replicated in the academic literature and within the profession itself. I also observed that the attention that nursing has paid to the media representation of its own profession was far greater than other professions paid to theirs. As Darbyshire (2013, p.54) states, with other “pressing issues and concerns facing nursing and healthcare” why is the media representation of nurses constructed as an issue deserving of such attention? My supposition was that the nursing profession’s concern with the media representation of nurses derives from the assumption that their representation as a gendered and demonised occupation has significant consequence for the status of the profession itself. As Kelly et al. (2012) maintain, “Nursing’s own interest in its image evidences self-conscious introspection that may reflect a discomfort with professional identity that is bound with nursing’s humble origins as a form of gendered and class-bound domestic work” (Kelly et al. 2012, p.1804). As a nurse academic I share the concern that the representation of nurses may have consequences for the profession, particularly the way in which nursing is constructed as a form of gendered work, so my presence and outlook has undoubtedly impacted on the shape of this study and the position I have taken in relation to it. However I do not consider this a limitation of this work, for in assuming a hermeneutic perspective, this thesis is based on the assumption that, meaning is achieved through the interpretation of text, in this case the academic literature and the participant’s