Book

Nursing and Globalization in the Americas: A Critical Perspective

IN PRAISE OF

“As the reality of the global village approaches, nations of the Americas need to learn more about one another to foster cooperative movement toward a common good. This is as true in health care as in other areas of society. In attempting to further our understanding of the structure and substance of health care across the Americas, this book is truly unique in its scope and breadth of treatment. As such, it is a “must read” for health practitioners, policymakers, and researchers and students in nursing and other disciplines.”
—Janet C. Ross-Kerr, R.N., Ph.D., Professor Emeritus, The University of Alberta, Edmonton, Alberta, Canada

“In this day and age of national and international nursing and healthcare politics, the valuable information contained in this book is germane to social scientists and to all professionals in healthcare practice and education. Knowing the history of nursing’s past as well as the present milieu is extremely important for understanding its future, both nationally and internationally. Importantly, the text is international in scope and discusses nursing in each country from a political and historical perspective. There are few, if any, texts that compare and contrast nursing from this frame of reference. This text gives the reader an opportunity to appreciate each country’s history of nursing and the political impact on the educational process.”
—Sandra Brennan, Ph.D., PHCNS-BC, Public Health Clinical Nurse Specialist, University of Phoenix On-Line Faculty, School of Advanced Studies, Doctor of Health Administration Program, North Salem, New Hampshire

“This well-timed and unique book examines nursing not solely in traditional biomedical and clinical settings but also in a much broader social, economic, and political background. From Latin America’s historical focus on social justice in health care to North America’s transition from value-based health care to a more market-driven system, nursing in the Americas has been caught in and shaped by radical and sometimes conflicting social and political changes. With a critical perspective, the contributors examine the evolution of nursing in Columbia, Chile, Argentina, Brazil, Mexico, Canada, and the US in political and economic contexts. In addition to providing historical and geographic background information on nursing in each of these countries, the authors especially illustrate and analyze the impacts on nursing and health care in the recent economic globalization ignited by neo-liberalism in the economy. Chapters particularly explore nurses’ roles in the political arena and the restructuring of nursing and health services in the 21st century. Definitely a precious addition to the nursing literature. Summing Up: Essential. All academic levels/libraries.”
—A. Y. Lee, George Mason University, CHOICE, June 2010

ABOUT THE BOOK

Nursing is vital to millions of people worldwide. This book details the ebb and flow of its fascinating history and politics through case studies from Brazil, Argentina, Chile, Colombia, Mexico, Canada, and the United States. Authors from across the Americas share findings and explore new thinking about Western hemisphere-specific issues that affect nursing and health care. Using economic globalization as an overarching framework, these cross-national case studies show the strengths and contradictions in nursing, elucidating common themes and examining successes. The partnership of authors shapes a collective understanding of nursing in the Americas and forms a basis for enduring hemisphere-wide academic exchange. Thus, the book offers a new platform for understanding the struggles and obstacles of nursing in a climate of globalization, as well as for understanding nursing’s richness and accomplishments. Because politics, economics, health, and nursing are inextricably linked, this volume critically explores the intersections among political economies and nursing and health care systems. The historical and contextual background allows readers to make sense of how and why nursing in the Americas has taken on its present form.

Intended Audience: Graduate and undergraduate faculty and students in nursing, social sciences, health social sciences, and the health professions.

TABLE OF CONTENTS

Preface
Merrill Singer

The Context of Nursing and Globalization
Karen Lucas Breda

Nursing in Colombia
María Claudia Duque-Páramo and Martha Cecilia López-Maldonado

Nursing in Chile
Patricia Jara Concha, Veronica Behn Theune, Nestor Ortiz Rebolledo and Sandra Valenzuela Suazo

Nursing in Argentina
Maria Alejandra Chervo, Eduardo Miguel Arzani and Teresa Isable Micozzi

Nursing in Brazil
Maria da Gloria Miotto Wright, Maria Cecília Puntel de Almeida, Maria Itayra Coelho Souza Padilha, Helena M.S. Leal David, Gelson Luiz de Albuquerque and Jaqueline Da Silva

Nursing in Mexico
Lucila Cardenas Becerril, Maricela Sanchez Gandara, Beatriz Carmona Mejía and Beatriz Arana Gómez

Nursing in Canada
Susan E. French and Jessica D. Emed

Nursing in the U.S.A.
Karen Lucas Breda, Evelyn L. Barbee and Maria Zadoroznyj

Synthesis of Case Studies: Implications for Global Nursing and Health
Karen Lucas Breda

Epilogue: Excerpt from "Canto General"

Appendix A: Abbreviations and Acronyms

Appendix B: Country Comparison of Nursing Titles & Educational Preparation

Appendix C: Questions for Discussion and Dialogue

PREFACE

Merrill Singer
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This book is exceptional in a number of different ways. Nurses are the largest group
of health care providers within the broad domain of biomedicine and one that
is absolutely vital to its functioning locally, regionally, and globally. Nursing
immediately impacts people’s lives by shaping the quality of health care that patients
receive. As anyone who has ever been in hospital or been the recipient of home
care knows from personal experience, in response to the uncertainty of illness and
the fear and vulnerability that it invokes for patients and their families, the role
played by nurses in both recovery and coping with chronic symptoms is profound.
Yet, as Karen Breda, a leader in the social science of nursing, aptly comments in the
opening chapter of this edited volume, although much ink is spilled in the analysis
of biomedicine—concerning its nature, function, impact, and social position—with
only a relatively small number of exceptions, “nursing as a discrete entity is rarely
[a] topic of study” (p. 5). Most books about nursing are by nurses and they are for
nurses. Many are practical, some explore the underlying philosophy of nursing,
most have an educational mission, but few are theoretically driven analyses of the
practice of nursing in varied social contexts. This book is an exception to this pattern.
The analytic perspective that the authors bring to their task is critical political
economic theory, the framework historically derived from the work of Marx and
Engels that draws attention to the fundamental importance of the exercise of power
and structures of inequality in social process. More precisely, the book is framed
by and its chapters organized around the perspective of world systems theory,
as informed by anthropological attention to on-the-ground local diversity. This
provides the book with a balanced approach that draws attention to the unique
aspects and histories of local social worlds while attending to the ways cross-cutting
forces like commodification, the global market and profit-seeking, the neoliberal
restructuring policies pushed by international lending and governing institutions
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(e.g., privatization of health care), and strategies of capitalist labor control transcend
separable national cases. In other words, this book brings social science insight to
understanding the intricacies of unique local histories and social configurations of
nursing in the countries of Colombia, Chile, Argentina, Brazil, Mexico, Canada,
and the United States, while never losing sight of the fact that nursing in all of these
places is impacted by common global changes and social and economic processes.
Notably, physicians don’t write books about nursing. They do, however, write
volumes about the nature of doctoring and the experience of being a physician.
While the authors of such books may seek to address and influence those in the
process of becoming doctors, many physicians who write books about doctoring
have a broader audience in mind than just those relatively small number of individuals
who will ever have M.D. inscribed after their names. What doctors know and
experience, it is assumed, is of interest to everyone. This is not generally assumed
about nursing. A purpose of this book, and a second way in which it is exceptional,
is that it seeks to speak to a broad audience—one that includes but extends beyond
those directly involved in the discipline—about the nature of nursing, as a domain of
work that has struggled in multiple local contexts to overcome common structural
challenges, including subordinate social status within an evolving and globalizing
biomedical health care system, underpayment for increasingly professional labor,
and poor and increasingly deteriorating working conditions. In this, an aim of this
book is to make nursing an essential arena for understanding our changing world.
Like physicians, health and other social scientists (except those who are themselves
nurses) also infrequently write books about nurses. They do, however,
routinely write books about physicians and about other kinds of healers. Herein
lies the dilemma of nursing from a scholarly perspective. While, as noted, nurses are
undeniably central to the functioning of Biomedicine everywhere (a day without
nurses would be a day without Biomedicine), at least within the bibliography of the
social science of health, they are somewhat invisible. Like those who fill other
social roles that are vital but which we take for granted, they are hidden in plain
sight. To the degree that nursing has come to the attention of social scientists, there
has been, as the book stresses, a tendency to under analyze it by narrowly viewing
nurses relative to their subordination to doctors (often seen as a playing out of more
general gender inequalities) and nursing as a field as a compliant handmaiden to
biomedical hegemony. Avoiding this kind of reductionism too is a final way in
which Nursing and Globalization in the Americas: A Critical Perspective is an
exceptional book. Its focus is the critical social scientific analysis of nursing as a
type of labor in cross-cultural and historic contexts. Its intention is to significantly
expand social science understanding of nursing, but, also, the nature of Biomedicine
generally by “unhiding” nursing. The book’s focus, as its title indicates, is only on
a part of the wide world of nursing, the Americas, the sector of the world system
that is most immediately under the political, economic, and medical influence of
the United States. The reason for this narrowing of the investigative lens is to
increase analytic precision, while facilitating communication among the book’s
contributors, and avoiding some of the complexities and page length needed for
a volume that was fully global in its scope. As a result, the book elevates to a
historically appropriate level a vast, complex, and intriguing region that often,
relative to the Unites States, has been as obscured as nurses have been to doctors.
While the explanations might differ, there is a broad agreement that health care
is in crises. Most notably, even in the wealthiest country in the Americas, the
United States (but not, by contrast, in Canada), a huge percentage of the population,
most notably the poor and working classes, lack health insurance and hence good
access to quality health care. In many of the countries of Latin America, economic
inequality and structural adjustment policies have combined to make health care a
consequential arena of social disparity. Moreover, health care costs have increased
dramatically, further distancing the poor and working people from the kinds of
health care available to wealthier social strata within and across countries. Further,
nursing shortages have become common in many countries. Simmi Singh, a wellknown
health care information specialist, has written of a nurse friend who likes
to joke that there are no Irish nurses left in Dublin because they are all in Boston, and
no Filipino nurses left in Manila because they are all in Dublin. Labor pools within
the healthcare professions, including nursing, have become global in nature, with a
medical brain (and skill) drain producing a diaspora of health care professionals.
In this light, a final message of this book concerns the future of nursing and the
role of nurses in creating and improving the future of health care in the Americas.
Simply put, to borrow an old saw about generals and war, health care is far too
important to be left to economists, private insurance companies, the pharmaceutical
industry, hospitals, or even doctors to decide. Moving quality health care from a
privilege of the few to the right of all will require the participation of nurses within
the communities they serve.