The thesis views the development of District Nursing as a sub-profession or specialty within the nursing profession together with the emergence and evolution of a team approach to community care during the middle sixty years of the twentieth century (1919-1979). This takes in the period immediately following the Nurses' Registration Act (1919), through the inter-wa,r period and Second World War, the introduction of the National Health Service, up to the reorganisation of Community Healthcare culminating with the Nurses, Midwives and Health Visitors Act of 1979. By the end-point of the thesis the district nurse can be seen to have become an established member of the primary health care team within the community. Contextualising this period of change within the development of a community health team enabled the thesis to consider the relative importance of intra- and inter- professional tensions to the development of a sub-profession - in this case, district nursing. The study has included under this remit the extended professional roles, social and political professional issues and changing power bases, and the conflict between desire for recognised autonomy and for membership of a health care team. In addition, it has been possible to address issues of gender central to a profession largely composed of women throughout the period working alongside a medical profession largely composed of men. The subject has lent itself to a consideration of the degree of influence of medically-related technologies and of developments in communications and transport on the changing role, image and work-experience of the district nurse.
The geographical focus of the research has broadly encompassed England and Wales, within which three contrasting regions have been selected for more detailed study of their comparability. These were felt to provide a varied and demographically representative cross section of environments in England and Wales. Perhaps the most challenging, but also most innovative aspect of the thesis is the grass-roots view given of the district nurse obtained through employing the viewpoints of individual nurses based on oral history supplemented with personal communications and written, autobiographical accounts. A case study of one district nursing association in Lancashire has supplemented this 'bottom-up' view of the nurse's experience and changing role. And a study of imagery relating to district nursing, incorporating various forms of media and professional representations, examines changing cultural images and social stereotypes of district nurses. Underlying changes that were taking place in district nursing at micro and macro levels are here quantitatively illustrated, such as the shifting pattern of district nursing associations throughout the regions of England and Wales in the inter-war period, the changing numbers of district nurses of various grades employed, and their varying workloads. The thesis concludes with a brief forward look to consider how the changes that were to follow the 1979 reorganisation were to affect district nurses' professional relationships, roles and images in the decade to follow.
Permanent link to this resource: https://doi.org/10.24384/mnsn-a029
Sweet, Helen M.
Supervisors: Digby, Anne; Stewart, John; Ryder, Elaine
Department of History, Philosophy and CultureFaculty of Humanities and Social Sciences
Sweet, Helen M.
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