Een schets van de professionalisering van de wijkverpleging in Nederland in de laatste vijftig jaar (1950-2000)

Abstract

This article describes home nursing in the Netherlands between 1950 and 2004. The developments in this period are described from the theoretical perspective on professions of Andrew Abbott: 'professions are exclusive occupational groups applying somewhat abstract knowledge to particular cases.' In 1950, home nursing was an all-round profession providing home nursing care and preventive care to all categories of patients, mainly in their own homes. It was - and still is - a profession situated in the 'periphery' of the health care system, where care and support to patients with pain, suffering and disabilities because of age or chronic illness are considered as belonging to a separate task domain, relatively independent of the mainly curative activities that are performed in the 'medical centre' of health care, especially in the academic hospitals. Typical compared to other countries is that an extensive network of private initiatives, in the form of Cross Organisations of different denominational signatures, existed in the Netherlands until 1990, covering the whole country with home nursing services. In that year, the provision of home nursing and home help were integrated and most home nursing organisations merged into large, regional home care organisations. In this article, six main social developments are described, that influenced the development of home nursing and resulted in the profession as it is now: a differentiated profession divided into different levels of care, working in an organisational, largely bureaucratic setting of home care organisations, where managers and external regional assessment organisations (RIO's) decide on the care to be provided. They now find themselves in a transmural setting, where boundaries between different forms of care no longer exist, and co-operation with other professionals, such as home helps, specialist nurses, GPs, and hospital physicians, is frequent. Currently, their professional autonomy and independent decision-making regarding diagnosis and therapy is affected, and elements of bureaucratisation and managementism (for example aspects such as time-writing) affect their daily work. However, home nursing can still be characterised as a relatively exclusive and independent profession, solving particular cases in the homes of patients by performing activities that are based on abstract, methodical knowledge.