Discourses and practices in institutionalised nursing in South Africa: Challenges for care

Abstract

ABSTRACTSouth African nursing remains a largely feminised and devalued profession, further undermined by the popular construction of nurses as indifferent and the healthcare systems as hindered by multiple challenges. Over the last 20 years of democracy, multiple efforts have been made at the level of policy, practice and knowledge production to address the challenges of the primary healthcare sector where nurses are such central role players. There are clearly resource challenges in South Africa which may undermine caring practices; however, this article also foregrounds the dominant discourses that shape international and local nursing, and which arguably mitigate against care that is democratic, socially responsive and sensitive to the diverse care needs of communities and individuals. Drawing on Tronto's political ethics of care and on Foucauldian frameworks, the paper analyses the processes currently shaping the experience of nurses and practices of care. Key themes are the hierarchical, regulatory framework of surveillance in nursing, the dominance of biomedical discourse and the mechanistic framework that fragments nursing practice. These aspects not only disempower nurses and deny them recognition but, together with institutional disregard for the need for self-care, also reproduce a system that is inherently unable to provide humane healthcare.