BRINGING HISTORY BACK IN: A NETWORK OF NURSING HISTORY IN CHILE HAS STARTED LIFE

TRAZENDO A HISTÓRIA DE VOLTA: UMA REDE DE HISTÓRIA DA ENFERMAGEM NO CHILE COMEÇOU A VIDA

TRAER LA HISTORIA DE NUEVO: UNA RED DE HISTORIA DE ENFERMERÍA EN CHILE HA INICIADO VIDA

ABSTRACT

Objetive

this article narrates the process of institutionalisation of history as a worthy subject for nursing in Chile.

Method

this is a discussion paper that reflects on the characteristics, resources and potential of the network as well as the future agenda to achieve its consolidation.

Results

there is an increasing interest in learning history in Chile. Although recent and somewhat disconnected from larger contemporary debates, this initiative can fruitfully contribute to the nursing curriculum in the country. Likewise, the growing interest in social and cultural history becomes apparent, seeking to understand different social realities that inform nursing.

Conclusion

the Chilean Network of Nursing History has come to put history forward as a transformative approach for the nursing community. Its short-term contribution to identity-building and professional empowerment can further enlighten the understanding of broader societal processes such as the differentiation of women’s work in the public sphere. It is important to strengthen its institutionalization in academe and connect research topics with local, national and global histories as well as history collaborations elsewhere, so as to develop agendas, epistemic communities and methods. Nonetheless, this process is marking a turning point in nursing discourses and scholarship in the country.

DESCRIPTORS
Nursing history; History; Nursing research; Nursing education

RESUMO

Objetivo

este artigo narra o processo de institucionalização da história como disciplina digna da Enfermagem no Chile.

Método

trata-se de um documento de discussão que reflete sobre as características, recursos e potencialidades da rede, bem como, a agenda futura para alcançar a sua consolidação.

Resultados

há um interesse crescente em aprender história da Enfermagem no Chile. Embora recente e um tanto desconectada dos debates contemporâneos mais amplos, essa iniciativa pode contribuir de forma proveitosa para o currículo de Enfermagem no país. Da mesma forma, torna-se evidente o crescente interesse pela história social e cultural, buscando compreender as diferentes realidades que envolvem a profissão.

Conclusão

a Rede Chilena de História da Enfermagem propõe a história como uma abordagem transformadora para a comunidade de Enfermagem. A sua contribuição a curto prazo à construção de identidade e capacitação profissional pode esclarecer ainda mais a compreensão de processos sociais mais amplos, como a diferenciação do trabalho das mulheres na esfera pública. É importante fortalecer a sua institucionalização na academia e conectar tópicos de pesquisa com histórias locais, nacionais e globais, bem como, colaborações de história em outros lugares, de modo a desenvolver agendas, comunidades epistêmicas e métodos. No entanto, esse processo tem representado um ponto de inflexão nos discursos e saberes da Enfermagem no país.

DESCRITORES
História da enfermagem; História; Pesquisa em enfermagem; Educação em enfermagem

RESUMEN

Objetivo

este artículo narra el proceso de institucionalización de la historia como materia digna de la enfermería en Chile.

Método

se trata de un documento de discusión que reflexiona sobre las características, recursos y potencialidades de la red, así como la agenda futura para lograr su consolidación.

Resultados

existe un creciente interés por aprender historia en Chile. Aunque reciente y algo desconectada de debates contemporáneos más amplios, esta iniciativa puede contribuir de manera fructífera al currículo de enfermería en el país. Asimismo, se manifiesta el creciente interés por la historia social y cultural, buscando comprender las diferentes realidades sociales que informan a la enfermería.

Conclusión

la Red Chilena de Historia de la Enfermería viene a plantear la historia como un enfoque transformador para la comunidad de enfermería. Su contribución a corto plazo a la construcción de identidad y el empoderamiento profesional puede iluminar aún más la comprensión de procesos sociales más amplios, como la diferenciación del trabajo de la mujer en la esfera pública. Es importante fortalecer su institucionalización en la academia y conectar temas de investigación con historias locales, nacionales y globales, así como colaboraciones históricas en otros lugares, para desarrollar agendas, comunidades epistémicas y métodos. Sin embargo, este proceso está marcando un punto de inflexión en los discursos y la erudición de enfermería en el país.

DESCRIPTORES
Historia de la enfermería; Historia; Investigación en enfermería; Educación en enfermería

INTRODUCTION

This paper reports how work done at multiple network levels is changing the perception of history as a valid and worthy subject matter for nurses in Chile. The relatively recent development of nursing networks in Latin America has uncovered two important aspects relating research and education. Firstly, it has highlighted the heterogeneity in skills and interests among researchers, especially in areas that have long been missing1 albeit not closely linked to the clinic, such as the humanities. And secondly, developing those areas has shown how atomized research efforts are, which although moving forward, are often disconnected from one another and are difficult to consolidate as research traditions, as argumentative dispersion suggests2.

The aim of this report is to illustrate the recent development of a research interest, which has timely become a self-convening assembly: the Chilean Network of Nursing History3. While discussing its development and telling the way it has unfolded and grown, the report gives an account of its resources and potentialities and suggests strategies for consolidating this network in light of national and supranational debates. Overall, it accounts for the institutionalization of history as a worthy subject within nursing scholarship. Resumed recently by a few authors, nursing history research was not only nearly completely abandoned during the past five decades, but the teaching of nursing history was reduced to a scant number of lectures within the standard curriculum and using an equally scant literature, oftentimes relying on a rather speculative basis2. Socio-political processes that are national, continental as well as global can certainly explain this problem, which makes history a unique speciality in both identity and development.

However, it is important to consider that given this omission in such an important subject matter, it is necessary to remedy the disconnection from wider debates about the history of nursing, the history of medicine and the history of health more broadly. The importance of history to nursing is that by researching the past, the realities that affect the present can be ‘historicized’ and ‘denaturalized,’ and thus be understood as constructions of a time and place; in other words, those realities can be challenged and transformed. Therefore, a historical consciousness has a great transformative potential for a profession that has been historically affected by pervasive socio-political realities1.

This shift towards history cannot be understood but by looking at wider processes, which albeit not specific to nursing, have consequences for nursing. Among them are, for example, the increasing democratization of society leading to greater individual agency - a continuous process of individualization of society - and as a result, a lesser influence of institutions over the individual; another process gravitating into this is the consolidation of social history and cultural history as specialities within universities4^-5.

In revitalizing the study of the past worldwide, nursing history is being revisited, re-examined and rewritten. And to a lesser extent, it becomes demasculinized, deinstitutionalized and decolonized. This has led to rich varieties of sources and histories, and of course, to a closer link with local history, national history and international history. As this interest has grown in Chile, nursing history increasingly differentiates itself from other subjects, especially through yearly research events3, theses and dissertations arising from postgraduate study programs6, different research projects being undertaken, applications to research funds in the area of history - largely disregarded in the past - and research articles that enter into dialog with broader epistemic communities7^-8.

In illustrating the development of the network, the paper is structured in four main sections. The first section outlines the way the collaboration in Latin-American nursing has transformed. The second section introduces the Chilean Network of Nursing History. The third section presents the first fruits of the networks and the main research topics. The final section sketches a future agenda by drawing on the network’s resources and potentialities.

Overall, it is necessary to consolidate the progress that has been made with a view to institutionalizing nursing history as a research speciality. Supporting this research area is key to understanding the social realities that affect nursing as a collectivity and nurses as social subjects as well as to supporting nurses’ civic consciousness as citizens.

Collaborative work: the beginning

From the mid 2000s onwards, Nursing in Latin America has witnessed important changes in modes of collaboration. Even though the first steps towards international collaboration during the past century were restricted to a few groups, typically around academic elites connected to North American universities and the Rockefeller Foundation the turn of the century would witness the reconfiguration of the ‘exclusivity’ pattern into networks of horizontal exchanges. Such change was no superfluous development, for it came to transform the way actors interact. Networks are characterized, at least in spirit, by flat structures that balance knowledge asymmetries and the direction of change, which in hierarchical structures rather depend on the figure of the ‘expert’. At the same time, networks allow new members to access different decision-making arenas.

At an international level, different instances have promoted nursing networks for both practice and research. One of such instances is the International Nursing Networks for the Americas (Redes Internacionales de Enfermería de las Américas)9. Given their nature, such networks have been thought of as a strategy to improve communication, relationships, cooperation and synergy between individuals, institutions and organizations, where the focus is care practices, management, research, information and education. The values of networking differ from those of more traditional forms of work organization - they require a cooperative, horizontal, interdisciplinary, intercultural and trustful approach.

Actively supported by the Pan-American Health Organization’s (PAHO) Regional Office for Nursing, many of the existing networks started life around 2006 after a Networks Meeting in Toledo (Spain) in 2005.10 That meeting led to an interest in organizing teams, preparing a master plan and elaborating a roadmap, which was furthered by different colloquia and symposia (2000-2007) notably supported by scholars based in Brazilian Universities.[¹] Also in 2006, the launching of an Iberian-American network on nursing history conglomerated individual national networks around the subject.

This transition, however, was everything but straightforward. For, contrary to available descriptions11, hierarchical ways of doing things and organizing tasks were embedded in work cultures, which often led to micro-disputes about who would be appointed as network coordinators and to seeking personal closeness with figures who either held or represented power.

After a decade of work with PAHO sponsorship, and with more results in some areas than others, nursing networks have been requested to seek continuity on their own. In February 2017, PAHO/WHO stops sponsoring the networks and requests members to implement all the strategies they deem necessary to continue to work, keep their contacts and further develop the work that had been done. Nonetheless, seeing the sponsorship terminate comes with the cultural baggage of having worked with people from different countries, settings and approaches, which paved the way for the current state of affairs.

Introducing the Chilean Network of Nursing History

Nursing history research, in turn, has been meagre, occasional and almost completely dependent on the individual efforts of faculty nurses. Most research about nurses and nursing in Chile has been undertaken from the vantage point of other disciplines, especially medicine12 and history13, but not nursing itself. At best, references to history within nursing narratives converge, predictably, in the influence of British nursing in Chile, although without using archival sources, which eventually results in an oral tradition and a strong focus on institutional and professional landmarks. Archival research is beginning to work its way through more dominant research approaches.

Yet the historical subjects, generally, used to focus on advances in practice and education - most authors were educators themselves - and to a much lesser extent, research. Such studies largely constituted chronological compilations that cover from the early institutionalization of nursing - notably the entry into academe in 1902 - through to recent times, which further emphasized the interest in the ‘pioneers’ (i.e., the first school, the first program, the first generation, and so on). Although useful as compilations, they do not constitute historiography per se14^-15.

Oftentimes, studies also sought to cover the ‘total history’16 of nursing, narrating events not as constructions but as facts that simply happened to occur in this or that time - often associated to a key figure - and without addressing their social context or the processes or even the anonymous individuals that made them possible. This added to the decontextualized and self-centric chronologies approach.

However, a nascent generation of nurse-historians grew dissatisfied with those narratives, especially because of the socially and culturally ‘aseptic’ nature of their conclusions (i.e., the social tissue was typically absent), the excessive focus on nursing’s internal dynamics (i.e., nurses’ leadership), and personalistic explanations of events (i.e., ‘our representative brought us where we are now’). Arising from this dissatisfaction, and provided that social history had become well respected in the country, writing and circulating the new nursing history became a necessity among different communities. One of them was the Chilean Network of Nursing History, created in late 2015, which awakened a latent interest. Interestingly, despite the earlier coupling of Chilean nursing academics with Brazilian scholarship, especially in qualitative research, the influence of initiatives such as the Portuguese-language journal História da Enfermagem is unclear, possibly because of a range of different epistemic communities to which nurses now belong.

After a networks meeting in Rio de Janeiro in 2015, it was stated that only two Latin-American countries did not have a network on nursing history: Bolivia and Chile. Some academics from Uruguay proposed ways in which one such network could be established in Chile; around the same time informal meetings were held in a place that did not have any institutional affiliation, such as the Gabriela Mistral Cultural Center, in Santiago.

Not least, in the capital as well as in other regions the right cultural ambience for this had form, owing partly to the demilitarization of history in the country, and also partly the subsequent interest in understanding the social milieu from a historical perspective among students. Similar developments had taken place among nurses, with a noticeable interest in trade associationism at many different levels, the interest to know the consequences of dictatorship along with the politization of problems such as employment precarity, among other issues nationwide17.

First fruits of the network

Currently, the Chilean Network of Nursing History is made up of members from different sectors within the nursing community, such as faculty nurses, retired professionals, nursing students, practice nurses and researchers. The network is a participatory project that pursuits the reconstruction of nursing history and the protection of the patrimony, stimulating research, education and knowledge socialization in different spaces of the profession so as to contribute to nurses’ identity and empowerment, and offer new perspectives on the present and past.

Within the network, the invisibility of the nursing profession, whether real or imagined, has also been a constant concern. All the more so when it comes to its contribution to public health from the early twentieth century onwards,17 a project that within nursing is said to have been interrupted during the military dictatorship (1973-1990)18. This process, it is perceived, accentuated the systematic delegitimation of women and of nursing as one of the most iconic female professions. Furthermore, there was the problem that the nursing curriculum was, and still is, largely focused on clinical matters without sufficient attention to nursing history or the social sciences1 as tools to forge a sociopolitical project for the future.It should come as no surprise, then, that among the first attendees were not only the academics who created the network but also nursing faculties affiliated to public universities and retired nurses who had participated in significant historical events and were still linked somehow with the Chilean Nurses Association.

The network was conceived not only to support historical research but also to furnish members with an opportunity for self-expression and storytelling about milestones they considered important for the history of nursing in the country. A very important aspect was the participation of students, more numerous than expected, which can be explained by processes pointed out earlier in this paper.

Another important prompt was an international research project led by Mexican nurses. The project uncovered that scarce research into nursing history had been undertaken by nurses.

In the following year (2016), and organized by the network, the first Nursing History Conference eventually saw the light of day. The subsequent years, the conference continued to take place, which addressed a range of different themes in an attempt to highlight the impact of the nursing profession on the development of public health in the country. It was also addressed the 20^th anniversary of the Health Act (this act explicitly acknowledges nurses’ role) and the postgraduate studies in nursing, generally perceived as a contribution to developing the nursing discipline and/or its public image, highlighting this was women’s achievement.

All the themes were looked at through a historical gaze. It was important that, having on board the head of a research school which also runs a journal, the idea of developing a nursing history area seemed appealing to the board, which could help further articulate the network’s resources. For one of the recurrent grievances among history authors is the shortage of suitable reviewers to assess nursing history articles. The goal is not just to make history an ‘interest,’ but also to institutionalize it as a research area within journals.

As the conferences have opened up room for collaborative reflection on the eventual effects of bringing history back in, the aims of the Chilean network are as follows:

• Documenting processes in which nursing has had a key role within the history of the health system

• Protecting nursing material and immaterial heritage in Chile, in ways that support research and dissemination relating patrimony

• Strengthening the teaching of history as a pillar of identity and empowerment of future generations of nurses

• Constructing nursing history with a forward-looking attitude, though relating to past processes, where history becomes a valid perspective to inform nursing’s ethos

These conferences have also uncovered a still emergent job done at history. The same became apparent during the International Symposium on Nursing History held in Chile in 2019. Even so, initiatives are being developed in the country’s north, center and south, which connects actors from different generations and enables continuity in the work that needs doing to strengthen, value and institutionalize history.

Lines of research have thus developed by regions, although not being exclusive to regions or universities. These are as follows:

Arturo Prat University (at Iquique): line of research about cultures of care among first nations (i.e., atacameños people), systems of care across the tri-border area (Chile, Peru, and Bolivia), first population health nurses in the far north, and altiplano’s history and culture.

University of Valparaiso: line of research about the naval history of the country with a focus on Valparaiso as a city with free port status and port of entry of major immigration waves in the nineteenth century. Currently, this school also stores and exhibits a collection of historical objects.

University of Chile: line of research about preregistration training, oral histories about the creation of the Chilean Nurses Association, the history of the University of Chile and its former regional divisions, primary care among other specialities within nursing, the entry of men to the nursing profession, and historical memory and human rights.

University of Santiago: line of research about nursing history across processes relating the history of healthcare in Chile, looking for convergences and differences.

University of Concepcion: line of research about nursing during colonialism and women’s history in the city of Concepcion.

University of the Frontier: line of research centered around its postgraduate program in nursing where research about the social history of professional nursing has been done; it also covers other topics such as the institutionalization of psychiatric nursing, rural nursing, nursing in emergency and disasters, and human rights.

Nevertheless, besides the institutional frame that universities provide, it is important to mention that the network has also facilitated collaboration with historically minded researchers, notably in Germany, Belgium and Spain. From the latter country, the network has equally benefited from the influence of a doctoral program on ‘cultures of care’ and a journal of the same name, both run by the University of Alicante19^-20- several Chilean graduates have trained there. This aspect is important as the history of nursing in Chile has been better understood in light of transnational history, a process that has also enabled articulating the history of nursing in Chile with international academic debates, and in the process entering into conversation with other epistemic communities.

Future agenda

While things would seem to proceed logically guided by the historical awakening, the network is aware of the challenges it will be facing, and more importantly, the need to have a future agenda. Concerns are both academic and material. Keeping a network running on (or sometimes under) a budget can always lead to losing out members and result in unsuccessful research and development projects in the long run.

As mentioned, nursing networks no longer receive PAHO/WHO funds. On the other hand, the Chilean Nurses Association has expressed its disposition to vindicate the history of the profession within its own work. The association has, in fact, summoned the network during the celebrations of the 20^th anniversary of the Health Act and the activities of the Nursing Now campaign in Chile. And yet, the network has had a rather marginal participation, as it functions within very limited resources. If competing for the National Culture Fund, or even for history research grants, nurses would rank very low in terms of background and experience. Furthermore, unlike networks and scientific societies that are more clinical in orientation, this particular area is very unlikely to receive support from the pharmaceutical industry and other manufacturing companies. Equally, monetary donations, either solicited or unsolicited, are very uncommon in the country. Nonetheless, the universities with which academics are affiliated have eased up attendance to bimonthly meetings and/or financed the conferences partially. More time and resources for history could be negotiated with university managers.

The Chilean Association for Nursing Education (ACHIEEN) could engage in supporting nursing history as a subject matter that can strengthen the curriculum across the country. But that is yet to be seen. As has become apparent in the conferences, nursing students are an important audience; providing an education that tackles a sociopolitical dimension can increase a civic awareness as well as their own self-interpretation as future nurses. Finally, at an academic level, it is necessary to extend the history network and increase membership throughout the country. Not least, we need to entertain the possibility of collaborating more closely with neighbor disciplines through a structured plan and use different means available to show why nursing history matters. And not only to nurses.

CONCLUSIONS

In this report we have made the case of the Chilean Network of Nursing History. Arising from a former collaboration frame within PAHO, nursing networks in Latin America have grown independent and diverse. History being one recent interest relating wider sociocultural processes in Chile and elsewhere.

While working within very limited resources, building a long-term collaboration and staying connected is on the agenda for the future. Research-wise, there are several epistemic communities developing history projects both throughout the country and internationally, projects that, as nurses become more familiar with historical methods, increasingly focus on primary archival sources.

Overall, as the subject institutionalizes, we suggest that in order to consolidate history as a valid and worthy subject matter for nurses in Chile, work still needs doing at a whole range of different levels: the journals, the lines of research in postgraduate programs, the conferences on history, the teaching of nursing history, and importantly, the research funds. Institutionalizing history in other Latin-American countries could have, too, a transformative effect for the nursing community, not only in regard to professional identity but also for the social history of professional women more broadly.

There is an audience that is avid for sharp historical knowledge. This can be the beginning of a wonderful journey with them.

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NOTES

• ^[1]
  From 2007 onwards, the Iberian-American symposia showed a trend towards studying nursing history, developing links among researchers and expanding research subjects. This is thought to have prompted the creation of specific research clusters, a number of publications, well-defined lines of research, and even student participation, all of this despite that communication networks were still incipient.

NOTES

• ORIGIN OF THE ARTICLE

  Work derived from the collaborative construction of the network in the period 2015-2019.

• ACKNOWLEDGMENT

  Special thanks to Professor Patricia Grau Mascayano, an academic at the School of Nursing at the University of Chile, founder of the Chilean network of Nursing History and to the members of the coordinating team.

Edited by

EDITORS

Associated Editors: Mara Ambrosina de Oliveira Vargas, Gisele Cristina Manfrini, Monica Motta Lino Editor-in-chief: Roberta Costa

Publication Dates

• Publication in this collection
  09 Apr 2021
• Date of issue
  2021

History

• Received
  22 Mar 2020
• Accepted
  08 June 2020