Academic elitism: do universities contribute to the patient-nurse divide?
It could be argued that the historical templates for the academic model were shadowy societies such as the Freemasons or the Pythagorean Brotherhood (Encyclopaedia Britannica, 2015) who considered themselves responsible for the guardianship and careful dissemination of powerful and secret knowledge to trusted initiates. This binary thinking, a division between those who have the knowledge and the ignorant who do not, may be replicated in perceived academic and intellectual divisions between doctors, nurses and service users (Davies, 2003).
The currently dominant biomedical model elevates specialist knowledge (Nettleton, 2006) and an aura of professional infallibility (Obholzer, 2003). It may serve to create a divide between service users and those responsible for their care (Hall, 2013). It may also be a factor in the development of a role divide between nurses and doctors (Ritchie, 2013) based on traditional patriarchal professional medical identity (Davies, 2003). A major challenge to the development of therapeutic patient-practitioner relationships may be the use of technical jargon and acronyms (Beattie, 1994; Charlesworth, 2003; House of Lords, 2000; Naidoo & Wills, 2010; Pyper et al, 2008). The nursing graduate course, heavily reliant on the completion of academic assessment may serve to encourage the use of such complex language, challenging professional boundaries between nurses and doctors but accentuating barriers between nurses and service users.
All nursing is becoming more technical (Stein-Parbury, 2009) with the result that nurses may need increased intellectual resources to integrate the required technical competence with traditional nursing skills (Beasley, 2011). Nursing has only recently become a graduate profession and detractors question the need for increased academic demands for nurses, arguing that this may impact on the care component of the nursing role. There appear to be no such questions, however, over the perceived levels of educational attainment required for doctors (Ritchie, 2013).
The growth of globalisation may present challenges to nurses (Hussein et al, 2011), requiring increased cultural competence to ensure the provision of appropriate, culturally-sensitive care (Gorton & Hall, 2013). Nurses are expected to advocate for patients (MacDonald, 2006) as well as acting as conduits for information between patients and doctors. User movements and the widespread availability of information via the internet are contributing factors in the increasing levels of patient sophistication which may challenge patient-practitioner power imbalances (MacKian, 2010; Florin et al, 2008; Kangasniemi et al, 2010), placing further demands on nurses to be able to engage appropriately with patients, answering questions relating to treatment and supporting patients to make informed choices about the care they expect or are willing to receive.
It appears that there is little question over the need for enhanced levels of educational attainment to allow nurses to fulfil the varied aspects of their role. Technical and cultural competence, the need to act as interpretive intermediary between doctor and patient and an ability to discuss treatment and care with often increasingly sophisticated patients or carers all indicate that the nursing field requires elevated levels of study and training. However, nurses may need to concentrate on finding a balance between the academic language supporting the specialist knowledge required to manage in an increasingly complex workplace and the need to be able to communicate and engage effectively with patients on an inclusive and equal level. Caution may be required to ensure that the linguistic elitism which may be produced by exposure to a graduate program with its focus on academic assessment does not ultimately create barriers between nurses and their patients.
Nik Holland Mental Health Nursing BSc (Hons) student
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