The Sociocultural Factors That Influenced the Professional Development of Black South African Nurses

Purpose:

The purpose of this presentation is to illustrate the social and cultural challenges black South African nurses historically had to overcome in order to join and practice in a profession which is dominated by a Western health view. The presentation confirms the need for culturally sensitive education and management strategies.

Methods:

A qualitative study that explored nursing literature by means of historical inquiry was conducted in order to identify the economic, social, political and cultural factors that influenced the professional development of black South African nurses in the period 1908–1994. For the purpose of this presentation, the focus with be on the sociocultural factors identified in the study. The researcher used a priori periods to guide data collection and assist with the writing of the narrative:

• 1908–1944: Nursing under control of the medical councils
• 1945–1970s: Statutory independence for nursing and the influence of political apartheid ideology
• 1970s–1994: South Africa’s, as well as the South African nursing profession’s, striving towards democracy and unity

Results:

On 7 January 1908 the first black South African woman, Cecilia Makiwane registered as a professional nurse after writing and passing the entry examination (Sahistoryorgza, 2015). Her registration heralded the start of professional nursing by black persons in South Africa and Africa. By 1990, two thirds of the approximately 150 000 professional nurses registered with the South African Nursing Council (SANC) were coloured and black persons (Breier, Wildschut & Mgqolozana, 2009). This rapid increase in numbers prompted the question: What factors historically influenced the professional development of black nurses in South Africa?

Historically, especially during the first two a prioriperiods, cultural taboos and traditional African beliefs greatly influenced the entry into nursing. Young novice nurses were expected to study anatomy and physiology in the classroom and, in practice, come into contact with blood. From an African perspective, these biological concepts of Western health care were difficult to accept and contributed to a high attrition rate.

The Western-styled health environment, with its emphasis on independent decision-making, contributed to the high dropout rate that was evident as late as the 1970s–1994. In traditional African culture, the male elders in the community were the decision-makers and it was culturally unacceptable for young females to fulfil this role. Yet, in the Western health care setting, young professional nurses were required to make independent nursing diagnoses and plan appropriate nursing care for their patients. This difference between African and professional nursing practice placed young black nurses in situational conflict and created the notion that black nurses were reluctant to make patient related decisions.

In the last a priori period, black women were readily able to enter the workplace (even as married women) and pursue a professional career. However, culturally they were still expected to perform most of the domestic duties, with little or no assistance from their husbands. The burden of full-time nursing and domestic duties was a heavy one.

Historically, the development of professional black nursing in South Africa chronicles the courageous struggles of men and women in the face of overcoming overwhelming odds. Culturally, they had to adapt to a Western dominated health view, with its focus on science. Socially, they had to adapt to being regarded as the elitist middle class in the black community, but marginalised black persons in the white- dominated work place. This marginalised position was due to the system of so-called separate development which dominated life in South Africa during the entire period discussed in this dissertation – first evident in the days of being a union under British domination; then formalised during the days of political apartheid.

Conclusion:

The value of historical inquiry lies in its ability to inform the current generation of nurses about their past and therefore history has the potential to guide future decisions. Considering the sociocultural factors that influenced the professional development of black South African nurses it is recommended that cultural diversity training should be offered to South African nurses and that clinical practice develop protocols to accommodate a fusion of Western and traditional African religious and cultural practices at the bedside.