genese og struktur af klinisk medicin og klinisk sygepleje

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GENESE OG STRUKTUR AF KLINISK MEDICIN OG KLINISK SYGEPLEJE DEL IV: ENGELSK RESUMÉ, KILDER OG LITTERATUR 16 English Summary This dissertation for the Ph.D. is a broad sociological with in nursing science study of the origin and structure of nursing and medicine as occupations and disciplines, and their respective educational evolution in Denmark. The study focuses on two periods; medical development between 1736-1937 and nursing development between 1863-1957. The main thrust of the dissertation has been on what today is referred to as clinical medicine, and what has, during the last 20 years, been called clinical nursing. The two are complementary, bound together, but with different practices and discourses. They are nevertheless homologous and connected one with the other. The leading idea is that it is a completely new understanding of the clinical - that binds the two respective disciplines and occupations together. The thesis has been inspired by the work of the French philosopher Michel Foucault, who in his book The Birth of the Clinic, develops the idea related to France and partly for other European countries of how medicine and medical education evolved in a new direction after the French revolution, and how completely new developments took place in medicine - clinical medicine was born. This thesis endeavours to ascertain how parallel developments have been evinced in Denmark and whether Foucault’s notions are found applicable to Denmark. Foucault states that there are periods (epochs) in the development of medical science prior to and after the French revolution, when a third period (epoch) began. For the analysis is utilised the work of the French sociologist Pierre Bourdieu’s Homo Academicus is utilised. As well as Bourdieu indicates an homology between the societal order and the academic scientific field. Homo Academicus presents an analysis of medicine, or more specifically medical professors. Finally, Foucault’s discussion on the State, in his book Birth of a Clinic, and complementary with this, and on equal terms Bourdieu’s latest work on the theory of the State - together provide a more integrated theory of modern society. The question asked in this dissertation is: whether the changes in medicine which Foucault and Bourdieu showed in France are the same in Denmark? Foucault and Bourdieu do not include nursing, as does this dissertation, which accepts the challenge and responsibility of attempting to elucidate whether a similar development is applicable to nursing, and if this is the case, at what later point in time it occurred. It is possible to do this because one has as a working hypothesis that medicine and nursing are not only in kinship with each other, and are assumed to run parallel, but are dependent on each other. The thesis goes a step further and provides the working hypothesis; that in certain situations is it necessary for clinical medicine to contribute to the establishment of modern nursing as an essential part of its own enterprise. Which, perhaps can be interpreted as though nursing, even today, has not developed as an autonomous field. The approach taken when working with historical analysis and interpretation has been inspired by Bourdieu’s field theory. Bourdieu’s analysis of the academic field includes, as previously named, medicine. In the dissertation nursing is included in the medical field as a type of sub-field. The question is - are similar ideas as observable within nursing as in medicine?. The investigations of both are kept separate because they are, despite everything, not identi- 222
GENESE OG STRUKTUR AF KLINISK MEDICIN OG KLINISK SYGEPLEJE cal, but at the same time the hypothesis proposes that there is a connection between the internal development of both. The findings of the study are that the epoch of classified medicine commenced in Denmark in 1736, when a new state regulated education was founded with a teaching hospital under the jurisdiction of the state, and with the appointment of a physician as medical director. Clinical medicine was founded and organised in Denmark from 1841 until first in the 1870s, with education under the auspices of and regulated by the university, organised and connect to hospitals with many patients, and with links and controls from the university. In 1937 medicine was founded together with a stable and well structured organisation - controlled and directed by a State Medical Board, and a professional medical organisation - where medicine had the monopoly of treatment of sick citizens, and provision of the education of practical experts. That is to say, that in Denmark we have: Classificatory medicine commencing from 1736 Clinical Medicine, established from 1841-1873 Stabilization from 1937 This entails, that the epoch of clinical medicine was established approximately 50 years later in Denmark than in France. These different medical epochs - the classificatory and the clinical modern - all arose after a series of years. The precise year when classificatory medicine was established in an organised and structured form is difficult to ascertain from the material forming the basis of this dissertation. Clinical Nursing as a discipline and occupation was devised by medicine at a time when medicine itself had become clinical - round about 1863-1897. At that point in time access to disease required accessibility to sick patients who were a prerequisite for observations of the course of disease in sick patients - thus the necessity and discovery of the nurse. The nurse should help the physician observe and register symptoms of disease during the course of the patients illness. Thus the necessity for the creation of the nurse. This implies a regular division of labour between the nurse and the physician. During the classificatory period the physician observes, treats the patient, administrates medication, monitors, serves, and advises the patient - etc., etc. In the clinical medical period the nurse participates in parts of this process; for example - observing the patient and thereafter reporting to the physician. The disciplines and occupations are closely related to each other on a number of levels - they are homologous. In part they have the same theoretical knowledge base from which to learn during education - although occurring on different levels, and separately, they share a common tradition of arranging and compiling their curricula. Both curricula are composed of theory and involve practical bedside assignments, apart from this, education takes place in the different medical specialities and on both theoretical and practical levels. Every time medicine discovers a new practical speciality or pursues a new theoretical subject, the same subject is concurrently incorporated into nursing theory (texts) and/or practical learning assignments. The transformation from working as a physicians assistant in the clinical period to working from 1933 to the end of the 50’s - and embraces many medical practical specialities. That is to say, nursing as a discipline and occupation has a relationship with medicine as a discipline and occupation. And it is clinical practice which connects the two disciplines and occupations. However, on one essential point they are not homogenous, namely, the status of their education. Medical education is practical - theoretical 223
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genese og struktur af klinisk medicin og klinisk sygepleje

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