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CURRENT CONTROVERSIES IN CRITICAL CARE |
During and immediately after World War II, a time of growth and development was experienced by medicine and nursing practice and education. An influential book titled The Education of Nurses: Historical Foundations and Modern Trends1 was written by Isabel Maitland Stewart, then professor of nursing education and director of the division of nursing education at Columbia University in New York. Stewart warned that a 2-tiered system of staff nurses, nurse managers, and educators would be a mistake for the profession. She preferred educators and leaders to be first highly skilled in clinical practice, and she understood that it was essential to keep the best and brightest nurses working in direct patient care.
She also understood the importance of the care of the social, sentient, and embodied person. Physiology itself is housed in the social body. She was prescient about the future need for patient care, as the following set of predictions made at the end of World War II make clear. Her predictions demonstrate a strong view of nursing as the care of the embodied person dealing with major human transitions that call for change and growth:
As in times past, nurses will be needed especially at the entrances and exits of the House of Life where helplessness as well as susceptibility to disease calls for increased guardianship. According to present indications, there will be proportionately fewer acute cases to care for and more chronic, fewer physical and more mental breakdowns, fewer sick-a-bed patients and more sick on their feet. There will be less demand for deluxe nurses to cater to the fancies of wealthy hypochondriacs, and more demand for community nurses to safeguard the health of families and workers of all groups. Accident and disaster services will undoubtedly increase unless man learns to control his machines and the mass destruction and mutilations of war. Though labor-saving devices and new therapeutic agents can be expected, there seems to be no prospect of technological unemployment in the nursing field. No gadgets have been invented to replace the human hand and no universal panaceas or preventives have been discovered that will keep the human machine from creaking and wearing out. A wider distribution of health knowledge through mechanical contrivances, such as movies, talkies, and radio can be predicted, but we cannot foresee the day when a television projector or electric eye or other mechanical device will soothe the fevered brow or keep the night watch at the bedside.1
We now know that many mechanical devices including those associated with body scans, mapping the genome, biotechnology, and information technology have outstripped the imagination associated with radio, television, and talkies. However, Stewart’s prediction about care of the social body that falls ill and becomes vulnerable rings true today, whether it is in a combat zone where nurses and physicians make lifesaving decisions daily and continue to offer reassurance and soothe worried brows, or whether it is in a pediatric intensive care unit where frightened children are comforted by parents and nurses.
As our population ages and as medical technology saves lives but renders many of the rescued technologically dependent, the number of chronically ill and non-bedridden ill has increased. Wise helping and coaching are still needed "at the entrances and exits of the House of Life where helplessness as well as susceptibility to disease calls for increased guardianship."1
Dependencies and interdependence call for well-developed communication and relational skills. Patients increasingly look for healthcare providers who will partner with them in regaining their health. Again we can turn to a past nursing thinker and leader. Lucile Petry Leone,2 formerly the chief nurse officer for the United States Public Health Service and founding director of the Nurse Cadet Corps, gave a vision for the centrality of the social and human relations reminiscent of a post–World War II consciousness:
The promotion of health has become one of the tools of peace. . . . The new worlds to win for health, however, are not all found in the geography book. The frontiers of new knowledge yield progressively to scientists and many of their findings lead to health and healing. A whole continent, whose perimeter we now penetrate but meagerly, awaits extensive exploration and its name today is Human Relations. . . . We are learning more every day about how to work together and how to learn together. . . . We try now not to do to people as if we were their custodians, not to do for people as if they were our dependents—but to do with people, leading them to independence and self-direction. . . . We know that feelings of inadequacy are lessened when problems are shared, not taken over. We are learning methodical ways of problem solving and how to help others approach their own problems. You can help me solve my problem whether I am your client or patient, whether I be a staff member supervised by you, or a student of yours, but I must solve the problem by myself; and you will not be wanting in understanding my true concerns.2
In an early study of curriculum development and nursing education at the University of Washington, Sand also cited the work of former president of the University of Washington, Leo W. Simmons3:
During the past half-century in our clinics and laboratories the medical arts have been integrated with the biological and physical sciences to the great benefit of mankind. This fusion of art and science has pushed medical knowledge to the point where persons doing research are aware that human beings should be studied in their day-to-day environments as well as in the laboratory and the clinic, and in psychosocial as well as biophysical perspective, if we are to understand fully the conditions and processes of both health and disease.3
The psychological, social sciences, and broader humanities were seen as a way of developing the nurse and physician, as well as providing a more enlightened base for caring for others. In a time when the amount of scientific information tends to prohibit wise deliberation, we still need the humanities and social sciences to guide us in developing and using our science.
Early nursing leaders, including Florence Nightingale, whose vision was "to place the body in the best position for repair" focused on health promotion and well-being. Nightingale did not view human nature as bad or good, but as malleable and having great potential that could be developed by proper exercise. She focused on providing the right opportunities for people to develop and express themselves, and feel satisfaction in so doing. Her maxim was: "The thing is to gain virtue not to root out a fault."1 Following the economist John Stuart Mill, she focused on the consequences of actions. She considered right or goodness "as that which causes well-being to man. . . . Moral right is the health of the mind, the state that befits the nature. . . . Wrong is invariably suffering or privation of man’s proper well-being."1,4 Nightingale considered the laws of God and the laws of science to be one and the same. In keeping with the first lesson to be learned is that "to be well is the purpose of all being." However, this well-being requires intelligence and problem-solving skills that each person must develop for himself or herself.1
A renewed focus on health and well-being, even in the midst of recovery, can open new avenues of support and growth. A focus on good human relations that does not dominate or take over the other’s freedom to solve their problems is as relevant today for everyday practice as it ever was. In this time of war and breakdown in human communication and understanding, it would be wise to explore that continent of human relations to restore peace and growth wherever possible.
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