THE PROFESSIONAL DEVELOPMENT OF BLACK SOUTH AFRICAN NURSES 1908–1994: A HISTORICAL PERSPECTIVE by JOHANNA MARIA ESTERHUIZEN submitted in accordance with the requirements for the degree of MASTER OF ARTS in the subject HEALTH STUDIES at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GH VAN RENSBURG CO-SUPERVISOR: MRS JE TJALLINKS November 2012 To Ian, Francois and Jo-Anne Student number: 3009 5158 DECLARATION I declare that THE PROFESSIONAL DEVELOPMENT OF BLACK SOUTH AFRICAN NURSES 1908–1994: A HISTORICAL PERSPECTIVE is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. ___________________________ 14 December 2012 Johanna Maria Esterhuizen Date THE PROFESSIONAL DEVELOPMENT OF BLACK SOUTH AFRICAN NURSES 1908–1994: A HISTORICAL PERSPECTIVE STUDENT NUMBER: 3009 5158 STUDENT: JOHANNA MARIA ESTERHUIZEN DEGREE: MASTER OF ARTS DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GH VAN RENSBURG CO-SUPERVISOR: MRS JE TJALLINKS ABSTRACT The early professional history of black South African nurses has not been the principal focus of local historians. Consequently, a qualitative historical inquiry was conducted into the available literature on the economic, social, political and cultural factors that influenced the professional development of black South African nurses from 1908– 1994. Non-probability, purposive sampling assisted in assembling a corpus of historically rich data for analysis using time-specific a priori codes. The findings revealed that; culturally, black South African nurses had to adapt to a Western- dominated scientific health view; educationally, they had to master specialised formal Western terminology presented in a ‘foreign’ language (English) and, socio-politically, they had to adapt to being regarded as an elitist middle-class in the black community while remaining marginalised in the white-dominated workplace. Recommendations include expanding the historical research base, designing more effective strategies for promoting cultural sensitivity, and prioritising the focus on teaching and student retention. Key terms: Black South African nurses; nursing history; historical inquiry; a priori periods; 1908– 1994; socio-economic, cultural, political, and professional development; nursing students. ACKNOWLEDGEMENTS I wish to thank the following persons for their contributions to this dissertation: • My husband, Ian, for his unwavering support and patience during the past three years. I am your greatest fan. • My children, Francois and Jo-Anne, for allowing mommy “quiet time”. • My parents, for the solid foundation you provided all my life. • My heartfelt thanks you to my supervisor, Prof GH van Rensburg, for her willingness to listen to my ideas, direct my thoughts and encourage my writing. • A special word of thank you to my co-supervisor, Mrs JE Tjallinks, for her words of personal support and professional encouragement when I needed it most. • My colleagues, for sharing my enthusiasm when I discovered the ‘newest’ old book or article. • My students, for awakening my curiosity. • My dear friend Phyllis, for helping me understand South African legislation. • The staff of the South African Institute of Race Relations’ archives, for providing the archival documents used in chapters 3 and 4 of this dissertation. • The staff of the UNISA library in Pretoria, for finding the literature requested. • Mr A Harold, the editor, for his expert editing of this dissertation. i Table of contents Page CHAPTER 1 INTRODUCTION TO THE STUDY 1.1 INTRODUCTION ................................................................................................................................ 1 1.2 BACKGROUND TO THE RESEARCH PROBLEM ............................................................................. 2 1.2.1 Source of the problem ......................................................................................................................... 2 1.2.2 Background to the problem ................................................................................................................. 3 1.3 RESEARCH PROBLEM...................................................................................................................... 6 1.3.1 Problem statement .............................................................................................................................. 6 1.4. AIM OF THE STUDY .......................................................................................................................... 7 1.4.1 Research purpose ............................................................................................................................... 7 1.4.2 Justification for the selected historical period 1908–1994 .................................................................. 7 1.4.3 Research objectives ............................................................................................................................ 8 1.5 SIGNIFICANCE OF THE STUDY ....................................................................................................... 8 1.6 DEFINITION OF CONCEPTS ............................................................................................................. 9 1.7 FOUNDATIONS OF THE STUDY ....................................................................................................... 10 1.8 RESEARCH DESIGN ......................................................................................................................... 11 1.9 RESEARCH METHODS ..................................................................................................................... 11 1.9.1 Population ........................................................................................................................................... 11 1.9.2 Sample selection ................................................................................................................................. 12 1.9.3 Data collection .................................................................................................................................... 12 1.9.4 Data analysis ...................................................................................................................................... 13 1.10 DESIGN VALIDITY ............................................................................................................................. 13 1.11 ETHICAL CONSIDERATIONS ............................................................................................................ 14 1.12 SCOPE AND LIMITATIONS OF STUDY ............................................................................................ 15 1.13 CONCLUSION .................................................................................................................................... 15 ii Table of contents Page CHAPTER 2 METHODOLOGY 2.1 INTRODUCTION.................................................................................................................................. 16 2.2 RESEARCH DESIGN .......................................................................................................................... 16 2.2.1 Research problem ................................................................................................................................ 20 2.2.2 Research purpose ................................................................................................................................ 20 2.2.3 Research objectives ............................................................................................................................. 21 2.3 RESEARCH METHODS ...................................................................................................................... 21 2.3.1 Population ............................................................................................................................................ 21 2.3.2 Sample selection .................................................................................................................................. 23 2.3.3 Data collection ..................................................................................................................................... 25 2.3.4 Data analysis ....................................................................................................................................... 28 2.4 DESIGN VALIDITY .............................................................................................................................. 31 2.5 ETHICAL CONSIDERATIONS ............................................................................................................. 35 2.6 CONCLUSION ..................................................................................................................................... 37 CHAPTER 3 NURSING UNDER CONTROL OF THE MEDICAL COUNCILS: 1908−1944 3.1 INTRODUCTION.................................................................................................................................. 39 3.2 HISTORICAL RESEARCH CONSIDERATIONS EVIDENT IN THIS CHAPTER ................................ 40 3.3 THE BIRTH OF A PROFESSION ........................................................................................................ 42 3.3.1 Nursing history before 1908: the British influence ................................................................................ 42 3.3.2 Voluntary registration