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The creation of spaces conducive to healing is a critical aspect of the provision of good nursing care. The nursing sisters of the British Army, having trained in the British hospital system would have been well versed in the need to create and maintain and environment in which healing could take place. The zones into which they were posted during the Second World War and the spaces they were given in which to care for their patients, were however, rarely either favourable to health or to the ‘serenity and security’ needed for recovery. Extreme weather conditions, limited water supplies, equipment and electricity combined to hinder all aspects of patient care. The often hostile places in which nurses worked demanded that they develop clinical skills and the ability to improvise and innovate in order create healing spaces for their soldier-patients. However, as the chapter argues it was the highly feminised home-maker work that created these spaces, which the nurses themselves credited to be an essential aspect to the healing process in which they were the critical performers.

in Negotiating nursing
Open Access (free)
in Negotiating nursing
Open Access (free)
Nursing work and nurses’ space in the Second World War: a gendered construction

The introduction contextualises the Second World War and the position of nurses within it. It argues that the developments in weapons’ manufacture and transport technologies created a war in which mass killing and maiming could be achieved across the globe. The injuries and diseases caused by the mobility of troops and modern weaponry demanded a highly responsive medical service close to the action. This introductory chapter therefore provides a frame for the book within the historiography of wartime medical services, women’s participation in war and that of nurses more specifically. Negotiating Nursing uses written and oral testimony to explore the work and experiences of nurses on active service overseas. The introduction examines the nature of the sources and the value of personal testimony to the history of Second World War military nursing.

in Negotiating nursing
Open Access (free)
British Army sisters and soldiers in the Second World War

Negotiating nursing explores how the Queen Alexandra's Imperial Military Nursing Service (Q.A.s) salvaged men within the sensitive gender negotiations of what should and could constitute nursing work and where that work could occur. The book argues that the Q.A.s, an entirely female force during the Second World War, were essential to recovering men physically, emotionally and spiritually from the battlefield and for the war, despite concerns about their presence on the frontline. The book maps the developments in nurses’ work as the Q.A.s created a legitimate space for themselves in war zones and established nurses’ position as the expert at the bedside. Using a range of personal testimony the book demonstrates how the exigencies of war demanded nurses alter the methods of nursing practice and the professional boundaries in which they had traditionally worked, in order to care for their soldier-patients in the challenging environments of a war zone. Although they may have transformed practice, their position in war was highly gendered and it was gender in the post-war era that prevented their considerable skills from being transferred to the new welfare state, as the women of Britain were returned to the home and hearth. The aftermath of war may therefore have augured professional disappointment for some nursing sisters, yet their contribution to nursing knowledge and practice was, and remains, significant.

The chapter examines the changes to the dominion of nursing work on active service overseas. The chapter first explores the extensions to the nursing role, most particularly the care of wounds and burns. This is followed by a discussion of the expansion of nursing duties into those that had hitherto been the domain of medicine. These roles include the commencement and management of blood transfusions, surgical work and anaesthesia. Finally the chapter considers ‘new work’, the most critical of which was the administration and use of penicillin. The constantly shifting requirements of war nursing prevented Army nurses from remaining in a professional comfort zone of accepted roles and regimes. The experience of living with uncertainty may have caused anxieties for some, but the active participation in new treatment modalities suggests that nurses who went to war were keen to move beyond the normal boundaries of nursing practice and many relished the opportunity to do so. The chapter argues that the developments in practice and the increased confidence nursing sisters displayed with this new work altered their working relationships with medical officers from one of deference to one of collegiality, enabling more productive decisions for their soldier-patients’ care.

in Negotiating nursing
Open Access (free)

Military success in war was contingent on men sustaining a determination to fight. Persuading men to continue fighting or returning them to combat after illness or injury depended on maintaining their morale. The use of female nurses in upholding this resolve was integral to the war effort. The chapter explores the value of the presence of women in hospital wards and in social environments on active service overseas. It considers the occasional antipathy of military authorities and male colleagues to the location of female nurses in war zones. However, it is argued through the provision of expert clinical care, domestic acumen and the use of their ‘female-selves’, nurses were able to salvage men in readiness to return to battle. Nursing sisters thus created a space for themselves in frontline duties. However, the chapter argues, this was not without its difficulties. As single, white women in far-flung places, this position situated nurses in a liminal place between the respectable European colonial wife and the ‘biohazardous’ local women. The chapter acknowledges these difficulties, but also demonstrates how the nurses negotiated their way through these contradictions to their advantage and for those in their care.

in Negotiating nursing

The chapter considers the civilian world into which the Q.A.s returned at the end of the war and explores the options they faced. It begins with the immediate aftermath of war and the opportunities for interesting and worthwhile work that would only exacerbate the nursing sisters’ difficulties on demobilisation. This is followed by a consideration of the return to Britain and the options open for professional practice. The chapter argues that for some the option of interesting work remained, either in the colonial service or the military. However the main professional opening for returning nurses was the crisis ridden civilian hospital system that wanted and recruited cheap, malleable workers; this was not an attractive choice for demobbed nursing sisters. The chapter argues that despite nursing being a female dominated profession, the ideology that encouraged women to return to the home in the aftermath of war had significant ramifications for demobilised nurses. The social structure precluded married women from working outside the home and funds for postgraduate training available to returning male doctors were not offered to nurses. As the chapter maintains, most nursing sisters married, leaving the profession without their considerable talents and new ways of practicing.

in Negotiating nursing

The chapter maps the nursing practices on active service overseas that recovered men including, body care, feeding work, the management of pain and support for the dying. These four areas of nursing practice are commonly associated with nursing work, yet, as the chapter argues, in war zones, they demanded complex gendered negotiations. Comfort care placed the single female nurse too close to the naked male body and feeding work was allied to mothering, rather than professional practice. In the absence of sufficient medical officers in a war zone, pain relief demanded the development of scientific skills of diagnosis and prescription. The chapter examines how the nurses managed these contradictions to develop an understanding of the critical role of fundamental nursing care and create a space for themselves as experts by the bedside.

in Negotiating nursing

This chapter analyses the emergence of clinical and public health concerns with non-infectious disease in Britain during the immediate post-war decades, and examines the implications for the expanding diabetes care team. It suggests that central government’s concern with chronicity during the 1950s and 1960s primarily related to the resource demands of the ‘chronic sick’ – a term used to refer to institutionalised populations of elderly and infirm patients. However, these decades also saw clinicians and public health practitioners begin to discuss chronic illness in new ways and with reference to different demographics. Spurred on by the creation of the NHS and the development of new investigatory techniques, public health doctors and service providers increasingly debated the social, economic, and medical challenges of chronic diseases in younger and middle-aged patients, and experimented with new forms of service organisation. In diabetes, clinics of the 1940s and 1950s responded to a renewed interest in the ‘social’ dimension of care by expanding educative roles for dietitians and nursing staff, and by attaching health visitors and district nurses to their teams. With expanded teams came greater emphasis on bureaucratic co-ordination within the hospital. Eventually, however, resource constraints and rising patient numbers encouraged more radical schemes of GP-based co-ordinated care into the 1960s and 1970s.

in Managing diabetes, managing medicine

This chapter traces the development of standards documents in British diabetes care from the late 1970s to early 1990s. It argues, firstly, that the nature of guidance shifted dramatically over this period, gradually encompassing process and outcome standards, and setting standards for care and audit that encompassed proxies of managerial performance. New instruments thus opened care to external management, and challenged traditional views about clinical decision-making. Secondly, the chapter suggests that the growing role of elite professional and international organisations in guideline creation and audit marked the beginning of a more fundamental shift in the organisation of British medicine, one structured by political, cultural, and social trends but nonetheless driven in part by medical practitioners themselves. Amid decades of academic, popular, and political critique of medical practice and professional accountability, bodies like the Royal Colleges and World Health Organization moved to more tightly manage local practitioners in pursuit of ‘quality’ care. Though not all rank-and-file practitioners supported the proliferation of standards or the increasing role played by elite agencies in their creation and audit, by the early 1990s a growing professional and political consensus was growing around their centrality in securing quality medicine.

in Managing diabetes, managing medicine