Primary sources: Reference to archive material

The researcher’s dependence on primary sources in the data collection and analysis phases of the historical inquiry necessitated literature searches in more than one South African archive. Archives such as those of DENOSA, the University of the Witwatersrand and the University of the Free State have valuable documents that shed light on the history of South African nursing (and other) organisations. However, the use of primary sources from these different archives became problematic because the researcher could not use the exact same reference style for every historical source. The problem occurred because each archive has a unique classification system and therefore the information available for use in the list of references differs. To strengthen the truthfulness of the research findings and to ensure that other researchers could also find the archival material used in the research narrative, the reference guidelines of Burger (1992:111- 113) were applied.

3.4.1.6.1 Unpublished archival sources

Unpublished archival sources were organised by referring to the name of the archive first. Furthermore, documents from the same archive were organised in chronological order. Burger (1992:112) suggests that each document’s date must be written at the end of the reference because the date is often part of the historical document’s title. For the sake of consistency in reference style, the researcher stated the date at the beginning of each reference; irrespective of whether the date was part of the document title or not.

3.4.1.6.2 Sources from a private collection

Referencing historical documents in a private collection posed a unique problem, as most reference guides are silent about the correct reference technique to use. The researcher recorded these documents on the list of references by using the author, the corporate author or (in the absence of a clear author) the title of the document. At the end of each entry, reference is then made to the owner and whereabouts of the private collection.

Sub-section 3.4.1 of the chapter explains the methods that the researcher implemented to establish trustworthiness in the research. Table 3.2. summarises the discussion and illustrates how the principles of trustworthiness were applied in the research:

Table 3.2 Trustworthiness

Principle Criteria Applied in research

Credibility Researcher expertise  Research methodology was also used in master’s degree studies

 This chapter illustrates growing understanding of methodology Prolonged engagement

with research

 Previous historical research (Master’s degree)

 Four years researching the topic and writing the narrative

Reflection  Acknowledged the existence of multiple truths as guided by critical realism

 Used the cyclical nature of the methodology to reflect on findings

 Methodology and philosophical principles guided the writing of a truthful narrative  As new data emerged, reflected on the

correctness of the already written narrative  Reflective diary kept

Bracketing  Used philosophical principles to place structures (e.g. culture) within a social context

 Retroduction first  Then retrodiction

Dependability Research design  Historical inquiry’s cyclical nature encourages reflective understanding  Gathered data until crystallisation occurred Philosophical principles  Thick descriptions led to insight

 Obtained invulnerable insights from vulnerable insights

 Only thereafter made judgements

Researcher expertise  Researcher familiar with topic of interest: prolonged (25 years) engagement in South African nursing

Confirmability Research data  The nature of the data is more important than the researcher’s position in the research process

Principle Criteria Applied in research

Reflection  Cyclical nature of methodology  Philosophical principles

 Reflective diary

Referencing  Accurate referencing of primary archival sources

Transferability Purposive selection of data sources

 Selected informative primary and secondary sources

 Selected context-sensitive primary and secondary sources

Thick descriptions  Of historical events within a social context  Considered historical uniqueness

Authenticity Feelings and emotions of historical figures

 Use of quotes

 Checked authenticity of historical documents

External criticism  Checked if the historical document was real Internal criticism  Identified primary sources

 Terminology understood in historical context

 Decide: historical fact, probability or possibility

(Cope 2014:89; Lincoln & Guba 1985:300)

3.5 ETHICAL CONSIDERATIONS

Ethical clearance for the research was obtained from the University of South Africa’s Department of Health Studies (note Annexure A). The codes of ethics that guided the research are those published by the American Association for the History of Nursing (AAHN) (Lewenson & Hermann 2008:168-172) and the ethical (research) standards for nurses published by DENOSA (Brink et al 2012:48-51). Table 3.3 explains how the ethical codes were applied in the research: the ethical standard is stated in the first column while the application thereof is explained in the second column.

Table 3.3 Ethical standards applied in the research

Ethical standard Applied in research

Research was conducted in accordance with the ethical principles of justice and beneficence

 Careful consideration was given to the inclusion/exclusion of historical information: the historical truth was revealed without causing harm to participants’ reputation or legacy.

Historical participants’ recorded words (in documents) are represented with consideration of the participant’s privacy, worth and dignity

 The researcher reflected about what historical information to include, why it should be included and how it should be recorded in the narrative

 No private or personal details were included The relevant historical research

methodology was applied

 Historical inquiry: data collection, data analysis, reflection and writing the narrative continued for four years

 Chapter 1 defines and differentiates between primary and secondary sources

The research purpose, objectives, methods of data collection and the benefit(s) to society are transparent

 Chapters 1-3 provide detail about the research purpose, objectives and philosophical

underpinnings that guided the research Research findings were communicated

honestly. Misrepresentation of historical events is regarded as academic

dishonesty

 Rich, thick descriptions of historical events and source references ensure transparency and honesty

 Bracketing was applied by means of a reflective research diary

Throughout the research process the researcher demonstrated integrity

 Ethical clearance was obtained before commencing with the research

 Consent was obtained from archivists before accessing archival documents

 Archivists’ requests and rules about the handling of historical documents were

respected. No historical records were altered, removed or destroyed

 A self-evaluation check list was completed and signed at the end of the study (Annexure C) The effect of biases on recorded history

was recognised and managed

 The influence of South Africa’s socio-political history on nursing’s professional organisations was acknowledged and discussed in the narrative

 Academic debates with the research

supervisor prevented presentism and ensured neutrality

 A section of the research was presented at a research symposium for discussion

Ethical standard Applied in research

The research is meaningful and contributes to nursing’s body of knowledge

 The 100-year history of South African nursing organisations and its influence on the

development of the profession has not yet been recorded; nor analysed

Within the confinement of available resources, the historical truth is represented

 Critical realism guided the historical inquiry to reveal the historical truth

 Data collection and analysis continued until crystallisation occurred

 A detailed resource list ensures transparency History is represented in a responsible

manner

 Consideration was given to historical

terminology that might be considered offensive in modern day South Africa

 Such terminology was limited and only used in unique quotes

The work of others is valued and acknowledged. Reasonable requests from other historians to have access to documents were honoured

 Quotes and references acknowledge the work of other academics

 A comprehensive reference list enables fellow historians to access historical documents Historical records were valued, not

tainted or destroyed

 Archive material was handled with care.  Historical documents were photographed, thus

limiting the use of writing material that might cause damage

Recognition that historical research creates a golden thread between the present, the past and the future

 The researcher identifies the hidden factors that influenced the development of the nursing profession in the period 1914 to 2014

 Based on the research findings,

recommendations were made for the future

3.6 SUMMARY

Chapter 3 has explained the research methodology applied in the thesis. The researcher illustrated how her understanding of historical inquiry changed over time and how the philosophical underpinning of the study informed the research methodology.

The next chapter is the first of five chapters that represent the data collection and analysis phases of the research. It provides rich, thick descriptions about the circumstances and historical events that necessitated and enabled the establishment of the first professional nursing organisations in South Africa.

CHAPTER 4

ESTABLISHMENT OF THE FIRST PROFESSIONAL NURSING

ORGANISATIONS

4.1 INTRODUCTION

To illustrate the influence that nursing organisations had on the development of professional nursing in South Africa, the researcher had to understand the society in which these organisations functioned. Before 31 May 1910, South Africa was a British colony (Spies 1993:45-47) and so the British influence (Searle 2001:9) on South African society must be considered. Victorian notions of family structure, where men were in a position of dominance and women were expected to be subservient (Esterhuizen 2012:43-44), had a significant impact on the health-care system’s hierarchy, the doctor- nurse relationship and consequently, the professional status of nurses.

This chapter illustrates how the changing role of women in society and international socio- political changes influenced South African society and its nursing community. There was an international drive to establish nursing organisations, to create a professional nursing image and to obtain professional status for nurses. The narrative describes the factors that hampered the establishment of a South African nursing association in the late 19th and early 20th _{century. Once established, professional nursing organisations such as} SATNA played an important role in creating South African nurses’ professional image. The chapter concludes with a summary of the vulnerable insights (informed by critical realism) obtained from the historical data discussed.