Jecker and Self laid out three goals for their article (1)identify factors that contribute to viewing care as the the exclusive province of nurses; (2) fine tune the concept of care by exploring alternative forms of care; and (3) illustrate, through the use of cases, diverse models of caring.

Gender-Based Explanations of Professional Stereotypes

A current view regarding the medical profession is physicians are "said to focus on the cure function, while nurses focus on the care functions" (Jameton, 1984, p. 10). The article provides three gender-based explanations for this view. The first explanation deals with the "association of danger with intimacy [being] a more salient feature in the fantasies of men than of women" (Gilligan and Pollak, 1989). This helps create care and cure stereotypes because if the attitudes of men and women differ towards attachment and separation, then the differences in how they perceive medical occupations will also differ. Another explanation is related to detached objectivity of scientific fields which discourages females entering medical school. A different line of thought looks at our culture and how we associate ethics and humanism with femininity rather than masculinity. The article goes on to say that the American Journal of Nursing published articles on ethics in 1901, whereas it was not until the 1970’s that ethics was incorporated into the medical school curriculum.

This last statement lends itself to professional stereotypes and leads to "men who do enter nursing are more likely to be in positions where their presence and influence is felt (Rowland, 1984). However, there has been a recent change in the gender constitution of medical professions. This is partly due to the Association of American Medical Colleges revising the Medical College Admission Test to include more ‘humanistic’ skills in selection physicians, candidates for board certification need to have more compassion and respect for patients, and more men are willing to challenge prevailing stereotypes and enter nursing.

Three explanations of a historical nature show how professional stereotypes first started. The first is that "nursing throughout the colonial era and most of the nineteenth century took place within the family" (Reverby, 1987, p. 5) and that "care of the sick was part of the domestic economy for which the wife assumed responsibility" (Starr, 1982, p. 32). A final explanation is that a physician’s job was to offer advice or perform medical procedures, while the nurse carried out the physicians’ instructions. Along the same lines, physicians needed to gain authority and status to set themselves apart from laypersons and to do so required a new language, technique and theory. "This put physicians at odds with activities, such as patient empathy and care, that call upon abilities of engagement and identification with others" (Jecker and Self, 1991, p. 62).

The common stereotypes need to be justified. Separating care and cure assumes that care and cure are distinct, non-overlapping ideas. The Oxford English Dictionary states that cure means ‘to care, heed, concern’ and the Latin word curare means ‘to care for, take care of.’

The article’s final section lists the types of cases which occur and gives an example to illustrate each. The cases include: caring for and about a patient; caring for, but not about a patient; caring about, but not for a patient; and caring neither for nor about a patient. The definition of caring for being the activities which help a patient and caring about is the manner in which these activities are carried out.

It has been found that "as more nurses become engaged in administrative and supervisory roles, they may do less caring for patients…it is misleading to accept the traditional stereotype that ‘nurses care’" (Jecker and Self, 1991, p. 66). Also, the traditional stereotype obscures the fact that there are nurse who do not care about their patients and many physicians do care about their patients.

I found that Jecker and Self relied too heavily on what other people had to say instead of using their own ideas on the basis of nurse and physician differences. Because they used quotes from extraneous sources they had to elaborate greatly in order to get the points across, creating boredom and long-windedness. I also found their points to be statements rather than explanations. Putting the criticism of the overall article aside, the following is a critique of the points made.

The first point about physicians curing and nurses caring would have made more sense if the definitions for care and cure would have been given here or in the introduction, instead of at the end. The word ‘presumably’ is used to explain this point, but one cannot give details about an explanation through presumptions.

Danger related to intimacy is a good explanation for gender-based biases. It shows how the thought characteristics in men and women are different. It would have been interesting to know how this difference presented itself and why it occurs. It could be due to the nature of the genes in individuals or to the nurture qualities these individuals received while growing up.

A second great reason for gender-based biases is about determent of women entering medicine. But why does this occur? Is it because of the expectations culture has of females being caring and not having the intellect or is it due to females wanting something more out of life, namely a career and time for their families?

Their third explanation is linked to their second explanation only now that I extrapolated the reasons for its finding. It states that caring qualities are associated with women rather than with men. Again, I must ask how they came upon this finding and what are the reasons behind it? The background information about ethics in nursing in 1901 and ethics in medicine in 1970 to support the explanation is important and well placed.

It is interesting to note that Jecker and Self note that their information is only relevant if the information given is historically accurate. If you are not sure of the accuracy of your information then you shouldn’t print it.

They go on to state statistics on the number changes of women entering medicine and the numbers of men in supervisory positions in nursing in relation to the numbers of women. This is excellent information and is well worth the point that men who enter nursing are more likely to be in positions of influence and that women are making up more of the medical profession. They elaborated by giving good reasons for these occurrences.

The historical explanations regarding women doing the nursing at home is well warranted with supporting information from historians. Although, during the first world war, it was the men who did the nursing so it is not entirely true that nursing has always been a female dominated area.

I liked their rethinking the concept of care section because it evaluated their points from the alternate perspective. They did this by looking for other sources with opposing views, such as the dictionary and root meanings of words. I also enjoyed their paragraph on how the changing of a position to that of a supervisory nature does not mean that a person becomes less caring and that not all physicians are only cure oriented.

I generally agree with the arguments presented in this article, however, I disagree with the presentation and supporting material. I feel that culture has played a large role in creating gender-based differences. From my own experience I have found when asked "what do you want to do?" and I reply "go into medicine," their response is "oh, you want to be a nurse." It is automatically assumed that because I am a female, I would be a nurse and not a surgeon.

My female peers, also do not understand my goal of being a surgeon and believe that women should be mothers and take care of husbands. I believe that women can be mothers, companions, surgeons and at the same time be caring.

I feel that the issue of ethics was introduced into medicine at such a late date due to medicine having only focused on procedural aspects of medicine and it is only recently that other aspects have been incorporated because it has been found that physicians now take on more of the care roles.

Men entering nursing has increased because of the changing views of society that men can be compassionate and are aloud to show emotion in public. The reason for the greater number of males in supervisory positions may stem from our culture’s beliefs.

In conclusion, I am in accordance with the authors that "regardless of whether physicians care directly for patients, they usually assume a stance of caring about patients. Attempting to cure a patient is ordinarily an expression of a physician’s caring about the patient. It is unfortunate, as well as confusing, then, to assume that doctors cure, as opposed to care" (Jecker and Self, 1991, p. 67).

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Jecker, N. S., Self, D. J. (1990). Separating Care and Cure: An Analysis of Historical

and Contemporary Images of Nursing and Medicine. Journal of Medicine and

Reverby, S. (1987). A caring dilemma: Womanhood and nursing in historical

perspective. Nursing Research.

Rowland, H. S. (1984). The Nurse’s Almanac.

Starr, P. (1982). The Social Transformation of American Medicine.