Nursing is a humanitarian
enterprise. The emphasis placed on scientific and technical knowledge is
indispensable to the development of the craft - but it is imperfectly achieved
without the intellectual skills that are the special province of the humanities.
The humanities invite both introspection and participation. Poet, novelist,
essayist, storyteller - all provide the language of memory and anticipation, a
sharing which belongs to each alone but speaks in a voice heard and understood
by many. The written word is a lifeline to the historical past, and with it the
rediscovery of reality as described and celebrated by the creative spokespersons
of their times. Here is recorded how human beings have confronted their world,
some of it intimate and familiar and some of it strange and foreign. Expressions
of human experience are transmitted across generations to speak their mysteries
again and again.
But these voices have been silent in the eduction of nurses. Racing through
curricula which seek to be all-inclusive, there is seldom time for courses in
philosophy or literature or history or music. However efficient the education of
nurses in disciplines of science, a large void remains. Nurses are adept in
their practice, but do not have the language and reading and thinking skills
that are the basis of a liberal education. This failure, a failure of literacy,
not only deprives the individual of precious gifts, but it isolates nurses from
other professional health colleagues, and ultimately limits the depth and
meaning of the profession itself.
Nursing education skirted the humanities, using what was deemed essential in a
superficial way. While ethics, nursing history, and philosophy have had a
foothold in the nursing curriculum, their impact has been meagre and
restrictive.
"Ethics" has been a part of the curriculum ever since Nightingale regaled the
probationers of St. Thomas with her homilies, a practice imitated in many
schools of nursing afterwards. But ethics were really rules of etiquette - how
proper young ladies behaved on the wards and in the halls of their residence.
For years, pupil nurses were closely monitored by straight-laced house mothers
who prowled the floors of the residence to be certain all was in order. The
professional Code of Ethics was actually a code of etiquette. In 1968, the first
of several revisions sought to eliminate the rules of etiquette and finally
emphasize the ethical responsibilities of the nurse.
When an overwhelming technology transformed health care practice, the ethical
issues that faced practitioners could not be ignored. Nurses were swept into the
bioethics movement, following the lead of the ethicists at Georgetown University
and directly into the philosophy of John Stuart Mill. The bioethics literature
is a dialectic of dilemmas, and nurse authors adopted the dilemmas as a nursing
ethic. But the issues of nursing ethics are not dilemmas. Dilemmas demand a
choice, posing two equally unsatisfactory answers. The utilitarian doctrine
advocates the "greatest happiness for the greatest number" - a doctrine in
which, obviously, some will be excluded. In providing nursing care, exclusion is
rarely permissible. Mill is not the only philosopher with a message for nurse
ethicists. But the paucity of nursing experience in philosophy has limited the
progress of nursing ethics.
Nursing history was taught, but never accorded much importance, by either the
instructors or the students. A minor course that had little relevance to their
daily experience, the history of nursing was a casual interlude for tired
students. But even more disheartening, the history of nursing institutions was
not valued. The official papers that recorded the meaning and the purpose and
development of the organization were not viewed as archival materials - but
discarded - a history tossed away without a second thought. Efforts to recover
the history of an organization was sometimes undertaken by alumnae associations,
and, while the collections are valuable, they were undertaken by devoted alumnae
not schooled in historiography. They were seldom catalogued in libraries and
many were lost. When the Illinois Training School for Nurses (Shryver, 1930) was
closed the remaining copies of its alumnae history were placed in the attic of a
building at the University of Chicago, and upon request were sold for 10 cents
each by Professor Nellie X. Hawkinson.
Nurses cherish the icons of its beginnings and its past, and yet the wisdom and
experience of great nurse leaders - Lavinia Dock, Isabel Stewart, Katherine
Densford, Janet Geister, Katherine Faville, and, indeed, Nellie Hawkinson and
many others - was imperfectly recorded for later generations. Lacking the
historical record, the profession is poorly informed of nursing's actual role in
the development of the health care system, in the creation and management of
hospitals and public health agencies, and in defining the role of the
professional nurse. Such a void in self-awareness critically affects the stature
and growth of nursing as a vital, essential public service.
An increasing cadre of nurses have prepared themselves as historians, and their
influence is gradually being felt. There are several academic centres which have
established nursing archives as well as an international society for nursing
history and the publication of nursing history research that is increasingly
sophisticated.
To American nurses a "philosophy" was the preamble to the curriculum required
for accreditation by the National League for Nursing. Faculty committees
anguished over the preparation of the "philosophy" and their labour invariably
produced a mundane listing of "We believe..." Since few of the faculty ever
studied philosophy, they had a vague notion of what a philosophy was. Those
fortunate nurses whose parochial education required that they study theology and
sometimes philosophy as well were outnumbered by the unschooled faculty bound to
the traditional pattern that dictated the school's "philosophy."
Graduate nursing students choosing elective courses met considerable resistance
in registering for philosophy courses from both the nursing and philosophy
faculties. But some graduate nursing students succeeded in choosing a major or
minor in philosophy, and some seized upon a single philosophical corpus and
sought to make it into nursing dogma. In the absence of a knowledgeable
audience, efforts to "use" philosophy in nursing are subjected to few
restraints, so that advocacy of "alternatives" such as transcendentalism or
mysticism finds few nurses capable of rebuttal. Perhaps the influence of the
Institute for Philosophical Nursing Research at the University of Alberta will
create a more sober approach to philosophy in nursing.
The inadequacy of nursing's grasp of philosophy was especially clear in the
impact of theory on nursing. Philosophy should drive theory, but it is rare that
theorists make explicit the philosophy that influenced their theory. More often,
the philosophical roots are vague, the antecedents to identifiable philosophies
barely recognizable. Instead, a "philosophy" is contrived - usually in a
critique - from assumptions and propositions offered by the theorist. It is
characteristic of nursing theory that the antecedents are not clearly
identified, philosophical or otherwise. Nurses have always developed processes
or procedures and a posteriori sought to explain their provenance. Unhappily
that has also been the pattern in the development of nursing theory.
Those few theorists who claim philosophy as the basis of their work tend to
choose generalizations rather than identify a specific author. Others select a
philosopher but limit the influence of - and in some instances misuse - the
concepts they select. Seizing upon the idea of a "lived life," the
phenomenologists have promoted their own science of nursing - a "human science"
- and dismiss the scientific method as reductionist and mechanistic. They cite
Heidegger, Sartre, Merleau-Ponty, Buber, Marcel, and others as if there were no
differences between them. An informed audience might have objected, but, as
Stevens (1979, p. 37) suggested, theorists may have benefited by "nurses who
mistakenly assume that any theory must have merit if they cannot understand it."
The nursing penchant for finding a "practical" use for every area of learning
seriously hampers the introduction of humanities into the curriculum. And yet,
the gifts awaiting the student of humanities are practical beyond measure. The
questions that the humanities ask insist on the cultivation of habits of
analysis and reflection, introspection and self-examination - the uses of the
mind that create a thinking person. It is no small task to confront Descartes,
or Shakespeare, or John Donne, to identify new perspectives, to enter their
thoughts and find personal meaning and direction. A liberal education is a
consequence of acquaintance with the creative imagination of the writers, poets,
artists, and musicians who have celebrated their lives. And it enriches the life
of the student, demanding discipline in reading critically and discovering the
structure and style and beauty of the message of the artists. It develops a
respect for language and what words mean, and how they are used appropriately. A
liberal education enlarges the life space of the individual, offering horizons
previously hidden and unexplored.
Must it be the price of a professional education to forswear a liberal
education? The expectation that every subject must demonstrate its usefulness
has excluded those that enlarge the intellectual and aesthetic abilities of the
individual. The nurse is witness. There should be no limits placed on the
knowledge and sensitivity brought to the tasks of nursing. The humanities
promise a tempering and a gentling of the relationships between patient and
nurse.
Nursing education has finally established a firm foothold in academia, and the
resources for the broadening of nursing education to include studies in the
humanities are readily available. A liberal education encourages the potential
to become all that the individual wishes to be. It is, ultimately, a possession
that cannot be compromised or lost. It is singularly personal, a selfish
achievement with its own private dimensions. And therein lies the true wonder of
a liberally educated nurse: that in experiencing the joy and exaltation of
discovering the self, there is stored the compassion and wisdom that can be
readily shared with others.