1.1. Lay knowledge
Lay knowledge is that which goes back to periods when a group of people used knowledge when that group did not yet exist as a corporation. It is knowledge that is not necessarily shared collectively and not yet standardized. People who needed this lay knowledge to carry out their occupations were not aware that they had common knowledge and shared it with others. They only did their work in conditions that were sometimes close to hospital slavery. There were still no schools and structured training in the age of lay knowledge. However, and this is an important discovery, those who performed their duties needed to pass on their knowledge to those who would replace them. Everyone was alone with the hospital managers of the time. The hospital governesses, maids and servants took an oath to perform their duties in exchange for a salary in kind and in cash. They mobilized tacit knowledge in action, domestic knowledge, knowledge necessary to run a household, take care of a family, mobilize knowledge related to the characteristics of gender, the woman, the mother, the governess and her servant or mistress of the house. In any case, there was a household to organize!
There were no new roles, new knowledge or modern nursing without reference to previous knowledge. Just as it is difficult to talk about advanced practice without knowing what ordinary practice consists of, we cannot value the role of Florence Nightingale without understanding why she suddenly appeared and was talked about in the mid-19th Century. There is always a before. There were treatments before her. The evolution of knowledge is always an improvement of previous knowledge. And this, even when the latter does not give rise to extraordinary words, to writing and its visibility. Ancient knowledge can even prove to be timeless. It is still part of the care practice. For example, practices of moving around in the hospital or collective hygiene practices have survived for centuries. They still prevail, and we can prove it. What has changed is the environment and the characteristics of the space in which we move. Lay knowledge is not to be contrasted with professional or scientific knowledge. It has simply not yet reached this stage of standardization and recognition. This was much earlier.
The knowledge of the age of lay knowledge was heterogeneous, disparate, vulgar, tacit and implicit. This knowledge had little to do with medicine. But it was in line with local knowledge of experience related to the exploitation of a domain, efforts to ensure survival and representations about health. We do not recognize them because we do not talk about them. Those who used this knowledge did not even exist. They had no status other than that of a servant conferred by the patricians of a city or the hospitalâs Board of Directors. An existence to be enjoyed in some way. Women had no existence in the medieval hospital. Yet there was no lack of work! Women were still excluded from collective identities in the age of lay knowledge. The most literate even found it difficult to publish under their real names. In fact, âthe lay knowledge of healthcare was structured according to the history and culture of the group from which it originatesâ [DAL 08b]. It is modestly and with difficulty found in the category of women, domestic servants, housekeepers and hospital maids. However, it must be recognized that this is the group from which nursing originated. As you can see, we come from very far away!
Even at the level of hospital archives, it happens that the traces of domestic work were those of the working classes and maids, and no effort was made to list, classify and identify them. What was the point? Thus, we can sometimes find whole bundles of forgotten hospital parchments or books of accounts which concern precisely care in the secular period.
The sources of knowledge on aid to daily and institutional life are sometimes found abandoned under the stairs of a museum or in the civil defense shelters of a town hall, because there has not yet been time to inventory them. This is how, for example, the history of medicine comes before the history of knowledge about care.
However, let us recognize that there are certainly more medical historians than there are nursing historians. The research budget in nursing faculties on this topic is probably lower than the budget that has long been spent in history faculties for medicine.
1.2. A difficult history for an ordinary experience
The daily care routine can be both a lure and a necessary detour. You have to learn to navigate between the two. The lure lies in the fact that the perceptions, sensations and emotions of caregivers cannot be reached by todayâs historian. Servants who were both wives and servants did not write! Therefore, any projection into the past is to be forgotten. However, it is still interesting by this necessary detour to try to reconstruct their working world from the traces of their activity in the daily life of hospital care. The geographical space, the job descriptions and rules, the relationship with the powers in place, their living conditions, the capacities demanded in the use of care equipment, the relationship with things and people and the use of their work spaces at least allow us to question their living conditions, the knowledge required for their occupations and the reality of their careers.
During 1970â1980 or so, work on the history of the nursing profession gained momentum within the French-speaking community with the work of historians and/or anthropologists intrigued by traditions relating to the body, health, the dimensions of care and the practical and identity-related conditions of those who provided it. Marie-Françoise Collière, then professor at the Ăcole internationale dâenseignement infirmier supĂŠrieur de Lyon1 (EIEIS), paved the way for reflection in 1982 by publishing a historicalâanthropological work on care, a work that was noticed by the profession at the international level [COL 82]. Ten years later, she identified with great foresight the difficulties encountered by researchers in nursing sciences when they were interested in the history of their profession.
Restoring the professional groupâs memory is not a matter of course. The writings of women caregivers are indeed quite rare. They have an oral tradition and have not left many traces of their activity. âEither they are not introduced to writing or they are denied access to it so as not to write their own writingsâ [COL 92]. Not very initiated to writing, this is the case of those who were presented as governesses, servants, hospital maids under the Ancien RĂŠgime2 and graduate nurses until the end of the 20th Century. We also know that historical sources relevant to the nursing profession and the history of women are not always kept in an official archive department. The public archives âwere constituted by men on the actions of men; women only appear in the background, when they appearâ [DIĂ 88]. Some hospital archives are rather difficult to access due to the lack of awareness of places of memory.
After the difficulties related to the sources of care practice, Collière also mentions the difficulties related to the subject itself. âCare belongs first and foremost to the history of daily life, of which it is one of the major components. Now, this daily experience is not spectacular; it is part of the mundane, the obvious, what is repeated, but which we cannot do withoutâ [COL 92]. Any elucidation of the history of care practices risks threatening the status quo established within the discipline, because it is representative of the place and role assigned to women caregivers by institutional authorities. If the nurse thinks that she is working in the natural sciences (medicine), discovering that this is not the case and that her discipline is more in the humanities can destabilize the constructed identity. Moreover, for Collière, historical works do not reach âthe deculturated mass of midwives, nurses who â with a few exceptions â are unaware of their publication, do not see the interest, do not feel concerned3. Moreover, this is not the concern of professional leaders who, for the most part, are unaware of history or fear its questionsâ [COL 92]. Nearly 30 years later, we can generally see that this statement still applies!
We can agree with some of the studentsâ concerns. History does not really help to heal. But it has never displayed that purpose! Nor does it help to apply an ordinary healing technique. It does not help to master the knowledge and daily gestures necessary to take care of people who expect service from nurses. This disillusionment among some students taking a history course when they are impatient to discover their future place of work so that they can finally âbe able to give injections or treatmentsâ, to use a clichĂŠ, means that the history resulting from fundamental research on the discipline does not provide them with any means of establishing their know-how. This is a fact. The impact of history has no relevance if the motivation to know the traditions of language and where one comes from is met with indifference or incomprehension.
On the contrary, history helps students to build an identity in order to position themselves among the many health professions. It allows them to emancipate themselves from the role attributed to them in the 18th Century by medicine and the ruling classes. âFrom the nurseâs aide, whose subordinate tasks are defined with industrial precision, to the âprofessionalâ nurse, who translates the doctorâs prescriptions into tasks for nursesâ aides, the status of nurses is that of uniformed servants in the service of dominant male professionalsâ [EHR 15]. We may agree with this view, but the word âdomesticâ perhaps deserves some attention. It had some value at the time it was introduced. It is then beneficial if the so-called domestic activity is seen as one that makes it possible, in the noble sense of the term, to take care of the life of the estate, the Domus, the house, the hospital, that is, of the living environment of care, of the languages required and of the first spaces of speech. Apart from this kind of representative alienation of women from domestic and free work, which is very present at the beginning of institutional care, it already requires some spatio-temporal skills to understand the organization required for a collective household to function.
History is the mother of all human sciences, Michel Foucault told us [FOU 66]. This is an important statement for the nursing discipline. Nursing is concerned with the human being, and therefore belongs to the human sciences. Are todayâs doctors of the nursing sciences aware of this? Now, the history of our language traditions is part of the first research to be carried out in order to imagine an identity for our discipline. âIt is indeed more important for a discipline to determine the identity of its knowledge than to question the identity of the people who refer to itâ [NAD 12a]. One does not become a nurse before using knowledge of the same nature as the proclaimed identity. History clearly shows that the title ânurseâ is a myth for lay people [NAD 12b]. It came into being before the conceptualization of knowledge took shape or before the ânursing metaparadigmâ and its theories became known. At a time when charitable and welfare institutions are growing and common sense is mixing their values or ideologies at the end of the 18th Century, it is important to rediscover according to which values and in which space of origin the activity of those who today are seeking a scientific identity to give to their own discipline began. In the French-speaking tradition, in the first half of the 20th Century, people began to call themselves ânursesâ after having been given an identity imposed by doctors. This was in reference to a Franco-Catholic model of care (nuns), but before having been able to give a name to the discipline and conceptualize theoretical conceptual models in nursing or...
