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The social construction of the history of nursing

José Siles González
Departament of Nursing. University of Alicante, Spain

Index de Enfermería [Index Enferm] 2004; 47:7-10 (original version in Spanish, printed issue)

Cómo citar este documento

Siles González J. The social construction of the history of nursing. Index de Enfermería [Index Enferm] (digital edition) 2004; 47. In: </index-enfermeria/47revista/47e7-10.php> Consulted

The difficulty to define the social and historical image of the nursing comunity is not only one great challenge but also something like the sword of Damocles over the trajectory of the nursing group. Thus, the starting point of this paper attempts to cover the following points:

-To make a reflection on the relationship between the lack of identity in nursing and the capability to create (build up) and manage its collective memory.

-Analyze the relationships between the social construction of history, ideology, power and social system.

-Describe the main causes that traditionally have hindered the development of nursing as a professional group as well as the creation of its collective memory.


Social construction of history and culture. There are two traditional ways to conceive the social construction of history: history as the result of the interpretation of the man within its culture (the social construction of history has always existed); and history as the result of the influence of all the people, groups, elements and factors that participate in the social dynamic of an inclusive culture.

Both interpretations coincide to underline the importance of culture in the process of social construction of history. Thus the study of cultures could be seen as a necessary steep to understand this process of social construction. There are many meanings for the term culture, but following the essentialist perspective we could argue that each human group has its culture and therefore culture could be defined as "the group of behaviors, thoughts and sentiments involved in the process of satisfying the needs of a human group" (Siles, 2000).

This mechanisms to satisfy human necessitates -whether physiologic, social or psychological ones- results on "The man as an animal suspended from the nets of the meaning created by himself" (Geertz, 1989). In other words, the behavior of a group gives that group its meaning. The group of nurses still has not defined its own profile and thus nurses have troubles to get to a consensus regarding nuclear (historic) problems. This has to do with the problem of this group to interpret under the same parameters chronic problems that still have not been solved.


Historical perspectives and the treatment of time. History is a science that goes over erudition since those groups that have developed their own history are very well structured socio-professional and scientific groups. There are therefore three ways to interpret the passing of the time -history-:

-Traditional history covers great events (military conflicts, etc.) that are told by journalists. From this historical perspective, time was analyzed punctually since facts would not be examined until the moment they would occur. An example of the traditional vision of the history of nursing could be the role of the Florence Nightingale in the War of Crimea, since it was an event embroidered by of the "heroism" of the historical protagonist.

-The current perspective of history, that emerged in the first quarter of the XX century with the French school of Annals (Siles, 1999) represents a longer lasting analysis of the events allowing a more global examination of the studied phenomenon (economic, social, political factors, etc), even if the fact depends on cyclic changes. A good example of the structural vision of the history of the Spanish nursing is the case of the condition of nursing during the II Republic.

-The most dilated historic approach in terms of the treatment of time is that presented by what is known as structural history. According to this perspective events resist the passing of the time (Vilar, 1980) allowing the analysis of their evolution according to the influence of different factors (ideological, political, economical ones, etc) that affect it. Religious or domestic nursing are a good example of the structural vision of the history of nursing.


Interpretations of the concept of history, historic-existing dialectics and social development. If we are trying to clarify the process of socially building up the history of nursing, we should first of all give an understandable and essential definition of the concept of history. There are as many definitions of history as historians. However, I have opted to choose two because their characters combines essentiality with universality: "the temporal quality of all what exists and its empiric manifestation (Arostegui, 1995). "The only simultaneously dynamic and global science of society" (Vilar, 1980).

History has always been seen as a synonymous of social existence: nothing exist without a history. In order to understand this interpretation of history we have to ask ourselves the following question: what would society be without history? Societies would not have a voice, would not evolve and their ideological, social, economic and political structures would remain the same. Oral tradition would then be the only responsible for maintaining the cultural patrimony of society (a society without a written history).


Professional groups, power and communal memory: the case of nursing. Communal memory brings an identity to a social or professional group; without power, communal memory of a group does not exist (socialization deficit). It is thanks to the power of the group that its own memory is managed (State, profession, soccer team) (Perez Garzon, 1999). This dynamic between professional groups, power and communal memory, in the one hand develops by the action of the historic discipline that acts as the deposit taker of the collective memory of society, group or institution. On the other hand, the historian assumes the duty of creating and managing the memory of the group/community that is being studied.

Nursing is going through a constructive crisis due to its lack of power and capability to put itself across its own communal memory. The crisis is the result of the difficulty of the emerging memory of nursing to reabsorb the previous communal memories that are now limited to the domestic sphere -care based in the alimentary system that connects mother and child (Siles, 1999). As a result, the challenge of the modern process of construction of the history of nursing is to make the effort to deconstruct old clichés (Derriba, 1998). This would easy the evolution process from the traditional coordinates of gender and domestic work to new limits where nursing would be framed within the confines of science and professionalism.


History versus authentication of society and its structures. History is in charge of studying the mechanism developed by the social structures over the time in the different existing cultures. A structure becomes an institution from the moment history demonstrates its functionality over different historic stages; this is the case of the family, because of its social structure, because of being a primary institution and because since the Neolithic is responsible of socializing society. The family has been legitimized over the time and because of its capability to always survive. One of the bigger obstacles for the professional identification of nursing is related to its past and history as well as to the importance of traditional domestic structures. To legitimate is thus the main element for the social, scientific and professional order of society, establishing a hierarchy that is protected by the law and controlled by the power of society, science and other spheres of power. Family, school, health and social services, police, etc., are organized within a hierarchic order according to the interest of the elites that have been able to obtain the higher levels of legitimating.


The social construction of history versus the capability to explain phenomena with inventions: the origin of myths. The frontier between what is natural and unusual was crossed by the primitive man with his imagination. His creativity cast in the other world a space inhabited by immortal people that, even though their divine character, behaved in a mechanical way similar to that of mortal people. Gods eat, drink, hate and make love, are loyal and infidel, love and kill each other; and all this is typical human. These similitudes between the divinity and mortal people could be related to the fact that goods and the immortal world in general, are the result of the scope of life after death. This is the result of the need of man to explain what is inexplicable: the mystery of death, natural disasters, plagues, illnesses, etc (Siles, 1999). The early Greek historians used to invent as a way to go from reality to idealism, and this exercise permitted the survival of myths. Herodotus saved the myths from obscurity by adapting them from oral tradition to written history, while Hesiodus in his "Teogony" saved myths by introducing them in the collective memory of Greeks. AT the same time, Hesiodus describes in his work "The words and the days" the daily life of Greeks allowing gods to enter the human sphere of everyday work.

As a result, the social construction of history has been connected to the capability of man to explain and organize phenomena by inventing (mainly those issues related to illness and death). Without imagination and myths, it would have been harder for human beings to go over the crises they have experienced over the passing of times. From a constructive and functional perspective, Kant argued about the ability of myths to model the intellect of the individual, the community and the world (Kant, 1999). The same way the importance of myths is summarized in the following sentence by Malinowski: "Protects the human being from the horror of disasters, illnesses and death" (Malinowski, 1988).


The Anthropology of death and the creativity of the man of Morin. In "The man and the death", Morin (1974) develops the theory of the anthropology of death. This idea reveals that death is or could be, the result of the social construction of man (Berger and Luckman, 1986), and because of the ability of man to interpret and assume treatments and rites. At the same time, the relationship between religion and the capability of humans to adapt to the will of nature, death as the most important example -parents desperately keep some sort of memory of their children with a picture-, the ability man have to socially construct and the growing importance of technology in that process (Gonzalez Faus, 1998). Morin distinguishes in his work three elements in relation to the greatest mystery of mankind: consciousness of rupture that leads to death; the suffering caused by that understanding; and finally, the desire for immortality. The individual tries to use his creativity as an instrument to fight against death. In order to do that he elaborates a concept of death within a bipolar context.

1) Cosmomorphism: inspired by the rebirth of life in nature (death-resurrection o death-eternal rest)

2) Anthropomorphism: individualism through immortality: the immortal person remains alive thanks to his creativity (soul, superhero), or science (genome).

Therefore, we study death as the phenomena that worried the man the most, being even difficult to explain and hard to assimilate. Death is since prehistoric times the phenomenon that has attracted more imagination and creativity of humans in their attempt to survive their daily routine and the uncertainty of the future.


Characteristics of the "logic perversion" of myths and traditional history. All people have legitimized themselves as "historic" through myths. The purity of the blood was connected to a prototype (Garcia Castano y Pulido, 1999) and, at the same time, the "collective essences" of that group were ennobled (creation of great epic stories such as the one of Cid Campeador, The Song of Roland, The Nibelungue, etc.). They became the symbols of the cultural roots and idiosyncrasy of human groups. These myths have become part of the history of the people and have been exploited in order to introduce ideological elements in the interpretation of reality. This way social groups, nationalities, states and scientific and professionals group, find a way to justify themselves (Jimenez y Otero, 1990)

Professional groups that are well positioned in society consider themselves as key elements in the process of self identification, and use the media to underline the socio-professional role they play. These groups participate in the interpretation of events so that their presence is indispensable when trying to analyzed and find a solution for them. They have an important influence in the social construction of their image and they are programmed to provide information about the events according to their own interpretations:

-Prevailing religions (Protestant -Catholics / Moslems-Christians)


- Monarchs, emperors, leaders, relevant politicians.

- Reach, powerful, developed

-Male (sexual division of the hermeneutic work as an example of the control over the different responsibilities)

-Prestigious professional groups.


Characteristics of the societies where traditional history is created. Societies immersed in some specific cultural values determined by the dominant religion (in the supernatural sphere), the absolute monarchy, the dictatorships or authoritarianism (natural sphere) experience the empowerment of intolerant sector and the development of social barriers difficult to overcome. The social, professional and scientific role of nursing in these societies is limited by the technical reality. These societies are characterized by high levels of moral, religious, political and economic exclusion. An immediate consequence of the previous is the marginalization of those groups and people not integrated in the dominant cultural schemes. In other words, these types of societies practice the unilateral, monolithic and excluding discourse of the winner.


From the bi-unilateral construction of history and multiculturalism (mutual ignorance) to cross-cultural. The bi-unilateral construction of history is a typical process of societies composed by different cultural groups unable to develop a common history. They also have difficulties establishing the strategies needed to coexist sharing daily duties. Democratic societies that promote values based on transculturalism are empowering this way values such as dialog, mutual knowledge and understanding, tolerance and respect to each other. These values favor a multilayered interpretation of reality easing the process of history construction of reality by the different groups and people that are society. All groups have their right to have a "historic voice" and to interpret reality by themselves and to be critic about their own historic constructions. This result on a cross-cultural hermeneutic that promotes plural and creative symbolic projections of reality.

Within the frame of a democratic society culturally complex, history becomes the result of the contribution of all the members of that community. This plural process easier the common reflection of the group about economic, social, political, health problems, etc. The unilateral construction of history is almost ridiculous.

Finally, after all what has been said, we can enumerate a few conclusions:

-The biological roots that have a bearing on the sexual division of work are responsible for hindering the professionalization of care givers since they have traditionally been connected to the domestic sphere.

-The creation of new spheres for health care has faced ideological and gender barriers, making it more complicated for the creation of a collective memory not based on stereotypes.

-in order to make really effective the social construction of history, it is necessary to critically analyze the deconstruction process of the clichés that affect nursing.

-The social and transculturalism construction of history is only possible within democratic structures where the dominant ideology (at all levels: professionally, socially, etc) is in consonance with the political system. This is very important in the case of nursing because the professionalization of this work is only possible if we take into account the role of women in the educational, social and working spheres.


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