An analysis of the historical context of liberal education in nursing education from 1924 to 1939

An Analysis of the Historical Context of Liberal Education in Nursing Education From 1924 to 1939 KATHLEEN

S. HANSON,

This study examines in historical context the liberal education theme in nursing education as expressed in nursing literature from 1924 to 1939. The specific questions addressed are: What is the nature of liberal education as presented in the literature of the time? What did nurse educators believe would be the effect of the liberal education of the nurse on the profession of nursing? To what extent did the articulation of beliefs regarding liberal education parallel the development of nursing education at the collegiate level? The data include literature published in the major nursing journals, the proceedings of the national professional nurslng organizations, and the major studies of nursing by various committees. The literature was examined for central themes. The study concludes that during this period, nurse educators believed the purposes of a liberal education for nurses to be the development of the individual and the citizen, the acquisition of cultural knowledge, the development of critical thinking, and the possession of a strong science background. A nurse with these abilities would be able to meet the changing demands of practice at a professional level. The college and university continued to be viewed as the optimum site for this education. (Index words: Nursing education; Philosophy; History; Liberal education) J Prof Nurs 7:34f-350, 7997. Copyright 0 1991 by W.0. Saunders Company

F

the years from 1893 to 1923 had

been a time for generating

changing

focus of nursing

education,

these ideas.

this process.

of the individual, the development

regarding

education

literature

the

needed to fa-

of ideas on the

of the nurse were an essential

of liberal

edge, education

systems

The elucidation

Four themes

of the nursing

ideas regarding

roles, the nature of nursing

and the educational

liberal education nature

RN*

In the following change

years,

part of

beliefs about the

were identified

in a study

thoughts

literature

questions

from

addressed

What nursing

subtly This

into the beliefs

of the nurse as presented 1924 to 1939.

of liberal

of training

literature

The specific

education

as presented

and in the

of the time?

What have nurse educators

believed

effect of a liberal

on the profession

and practice To what tional

in

were:

is the nature

the nature

would

and events.

of the inquiry

about the liberal education nursing

beliefs

education

to be the

of nursing?

extent

systems

did changes

in the educa-

for nurses parallel

lation of the liberal education

the articu-

theme in nurs-

ing education? The

publishing

study of nursing preparation

of the education

of the United

Rockefeller

Foundation

at the end of 1923 and the States for entry into World

War II in 1939 were chosen as the parameters study.

Sources of data include

nual reports cation

writings

of Nursing

of the National

for this

published

(the Journal);

League of Nursing

Nurses, Patients and Pocketbooks,

Nursing Schools-Today NLNE

curriculum

Nursing, 1927,

Edu-

Nursing and Ntirsing Education in the

(NLNE);

United States, 1923; the reports of the Grading mittee,

in

the an-

and Tomorrow,

Com-

1928,

and

1934; and the

A Curriculum for Schools of

guides,

and A Curriculum Guide for Schools of

Nursing, (Curriculum Guide),

1934.

of the time: the development

the acquisition for citizenship of critical

of a general

knowl-

and social reform,

thinking

(Hanson,

Historical

and

1989).

*Postdoctoral Research Associate/Acting Regional Coordinator, College of Nursing, Quad-Cities Program, University of IIlinois at Chicago, Rock Island, IL. Address correspondence and reprint requests to Dr Hanson: College of Nursing, Quad-Cities Program, University of Illinois at Chicago, Suite 202, 2525 24th St, Rock Island, IL 61201. Copyright 0 199 1 by W.B. Saunders Company 8755-7223/91/0706-0010$03.00/0

Journal of Profarional

these

to reflect current

study is a continuation

the American Journal

OR NURSING,

cilitate

PHD,

Overview

In 1923, the Rockefeller

Foundation

concluded

its

S-year study of nursing education and published its findings in a report entitled Nursing and Nursing Education in the United States (Committee for the Study of Nursing Education, 1923). The report was highly critical of the present system and methods of preparing nurses. Leaders in nursing education hoped that after reading the criticisms of the present system of

Nursing, Vol 7, No 6 (November-December),

1991: pp 341-350

341

KATHLEEN S. HANSON

342

nursing

education,

of lesser quality or combine

operating

schools

close their schools

with other schools to offer a more com-

plete program. timated

those hospitals

would voluntarily However,

the strength

that hospitals

these leaders had underes-

of conviction

could not be operated

the

and schools of nursing.

ity of the programs organizational

without

a student

the committee

offered

consistent,

increase

were as diverse

ing education were varied.

arts and science

fledgling

4-year

education

in the university

university

there

were some

programs;

there ma-

(University

profession

Rockefeller

Foundation

education

nursing

nurse schools.

to the recommendations Study,

leaders

to begin

the sections training,

dealing

Report,

a project

to grade

they hoped

to use

and the implications generated first report

of this project was soon overpicture

for nursing

by the data collected. published

in 1928,

of nursing education

practice that were

The contents entitled

tients and Pocketbooks,were astonishing

in

education,

movement.

ways,

including

way in which people dealt with health and illness.

the

During

this period

curriculum

of the

Nurses, Pu-

(Committee

on

the Grading of Nursing Schools [Committee on], 1928). Nursing literature of the first two decades of the 20th century had stated over and over the concern regarding the shortage of nurses. The report concluded that a shortage of practicing nurses did not exist, that the majority of graduate nurses were not employed in hospital settings but in private practice, and that most hospitals with training schools expected the student body to carry the entire nursing load of the hospital. The study pointed out conclusively that until the economic advantage to the hospital in oper-

the NLNE

in the mid-1920s

revised

and again

1930s in an effort to keep the guide League’s objective ucation.

of raising

Both revisions

League was interested

in the schools of lesser quality. intention

later in the article

education

in many

society

ment

by the general

findings

to the educa-

The economicprosperity of the ear/y and mid-1920s affected

ment

The original

The

directly

with issues of liberal

and the higher

heightened public awareness of the quality of education offered in the various schools to curtail enroll-

shadowed

education.

that related

and,

were strongly

and of the

ie, Goldmark

In this manner

These two

Schools,

the lack of response by the health care sector and even the nursing

health,

tion of nurses will be discussed

programs with “in-namein nursing

health.

programs

course with 2 years

in which students

affiliation

1928). This wide diversity

to collegiate-level

from both reports

but did not receive a de-

gree; and there were diploma

and public

princi-

in general,

degree

degree

programs

in nurs-

The types of uni-

courses;

bachelor’s

were 3-year diploma

hygiene

that the

include

areas were often viewed as areas of specialization related

were bachelor’s

of liberal

ples of mental

of ser-

(Committee

suggested

of all nurses should

in num-

1926). The

movement

the 3-year professional

basic preparation

opinions

in nursing

and possible solutions

on, 1934). The recommendations

existed

Even in the midst

to grow.

like nursing

There

crite-

on problems

at least in the area of public

was glaring.

continued

versity affiliations,

prompted

but also the considered

members

were in-

instructors

of this chaos, the higher education

only”

not only facts and figures related to

education,

offerings

bers from zero to four or more (Burgess, lack of standardization

as the

Admission

curriculum

and qualified

in both

The scope and qual-

forms of the schools.

ria were wide ranging,

triculated

mowow, contained nursing

1920s saw a steady

Nursing Schools-Today and To-

The second report,

the belief

could be lessened,

reason to expect them to close.

vice and education

Instead,

combining

there was little

behind

labor force. hospitals

ating the poorer schools of nursing

of nursing

higher

learning

standards

addressed

education (NLNE,

in the mid-

in line with the in nursing

the growing

within

1927,

its book on

ed-

move-

institutions

of

1934). Although

the

in the needs of these schools,

it

was not able to devote as much time and effort to their particular schools

problems. joined

Collegiate

level”

education (Goodrich,

1933,

to form

Schools of Nursing.

velop nursing giate

In January

together

20 of these

the Association

of

Their aim was to “de-

on a professional and colle1933). Both organizations

were concerned with the nature of these collegiate liaisons and the quality of both the general and professional

education

that was delivered. SOCIETAL FACTORS

While trends within society in general, such as the changing role of women, the increasing level of education among the general population, and advances in medical sciences, continued to influence nursing, the economic conditions of the late 1920s and 1930s con-

343

NURSING’S LIBERAL EDUCATION THEME: 1924 TO 1939

tributed

to some of the more

nursing

practice

during

dramatic

this time

changes

period.

nomic prosperity

of the early and mid-1920s

society

in many

ways,

people

dealt

with

health movement many

including

health

home.

illness.

diseases

weeks of nursing

Patients

The

decreased

of the communicable

ously required

affected

the way in which

and

had greatly

that

had previ-

service in the private

were more frequently

multiphysician

clinics

or were sent

receive nursing

care, thus creating

for nurses or, more accurately, nurses.

However,

tee on,

there

problems 1934).

a demand

were already

among graduate

The widespread

unemployment

American nursing

public

the depression

not only stopping but in actually By 1937,

were

the number

1,937

schools

The educational

student

nurse

was also improving:

pattern

the number

graduate

nurses

and Graduate

1937).

for the financing

of health

on the nature them

bedside

and public

Koechig

noted

ences, but particularly

that

of the nursing

curricula

not only on the

and graduates,

needed

a better-educated

(1924)

ser-

that

nurses to have more knowledge

was expected education to be changed

student

of they to

and public.

the advances

the medical

but also

sciences,

required

and understanding.

A

more advanced theoretical knowledge base would give them the background to determine what and why things must be done as practice situations changed. At the quired sional service

Stewart summarized

changes

of society and their

impact

paper read before the 1936 Annual NLNE.

She characterized

dynamic

modern

same time, developments in public health rethe nurse to become a generalist in a profespractice oriented to the family as a unit of (Welsh, 1936).

bethe

on nursing

in a

Convention

of the

society as intensely

with a swifter pace of life: There would

fewer babies and more old people, municable

disease,

problems,

fewer

acute

a need to safeguard

illness,

and a continual

and

practice

among

getting

the best professional

professions.

more

health

shifting

throughout

She felt society nursing

that

to use a skilled person, unskilled

physicians

limited

systems

sized the mechanical

that implied thought

of education

and technical

practice

ment

education.

in nursing

about

of by the

and limited

was dependent

not fundamentally

different

the rest of education”

Improvethe audi-

of education

of nursing

and to

education

from those that

(Stewart,

the

on improve-

She challenged

the purpose

1936,

an that

overempha-

of the mind and creative abilities.

ment in nursing ence to think

code

towards

in care only through

changes were actually

Present

expansion

It

such as the

of nurses

system of communication

physician.

be

the use of the nurse’s intelligence:

Nurses could suggest changes elaborate

was not could

labor. The outdated

the behaviors

of

of factors.

nurse,

regarding

all

of the boundaries

was uneconomical of ethics

chronic

and more mental

offered. The reasons were a combination to perform

be

a decrease in com-

stages of the life cycle, less physical

are

govern

p. 154).

Literature Anaiysis While

much

of the literature

of this time

period

from 1923 to 1939 focused on the factual information by the Committee

ing Schools,

on the Grading

there was considerable

aims and purposes

of education,

of Nurs-

discussion

of the

the professionaliza-

tion of nursing, and the placement of nursing education in institutions of higher education. An analysis of the literature still having

in all sci-

this:

this type of practice?

in-

health

became

needed by the graduate

ginning

garnered

of the practice

Nursing

accommodate

The

to both those in nursing

students,

and the nature

received.

for em-

care.

nurse educators

realize that the “principles

education.

of schools,

facing

was the knowledge

funds became more

These social forces had an impact quantity

By

employing

Opportunities

available

for both

also changed:

The

by 55 per cent (Students

increased as government

vice and nursing

100

work.

of nursing

ployment

nurses was encouraging

of the

Nationally,

in hospitals

increased

creased demand

with

background

The question What

the suggested

of programs.

4 years of high school and 15

of schools

Nurses,

in

schools,

compared

1 or more years of college

of employment

1937,

The

to pay for the

of nursing

in 1929.

per cent had

nurses.

needed.

2,286

per cent had completed

depression

aided the profession

the proliferation decreasing

there

unem-

an already exist-

unable

services it so desperately

In general,

serious

nurses (Commit-

among

was simply

to

demand

for student

economic

problem

seen in

to hospitals

a greater

that began in 1929 only exacerbated ing

public

the impact of

instead

ployment

in

The eco-

indicates

were having

an increasingly

liberal education, education

that

nurse

educators,

to justify the need for nursing professional

as separate

difficult

while

education,

time discussing

education,

and nursing

entities.

Taylor (1934), newly appointed dean of the School of Nursing at Yale University, identified nursing as the most human of professions. Nurses, by virtue of their contact with all degrees of human tragedy and despair and by their responsibility for increasing scientific interventions, needed an education-a professional education that included the sciences and the

KATHLEEN

344 liberal

arts. The questions

dress became how much

for nurse educators liberal

was needed,

what

should

this

education

grated

with

the professional

content

should

component,

precede,

should

Many

in the liberal

theory course,

education

and which

claim

at the University

ing literature,

history,

foreign

The outcome content

precedes

practitioner.

of nursing

with

of educational

standards

upgrading

might

the enrollments

He concluded required

and that,

frankly,

mathemat-

practice

that

in which was a

that not all levels level of

society could not afford

to pay nurses a salary commensurate

Third,

with professional

articles

education

effacing

service,

practical

the annual

Association,

convention

addressed

of the Cur-

wrote a series of the historic

utility,

reviaims of

or rraining,

self-

and technical

effi-

education

was in need

on her background

in educa-

Stewart explained

that accepting

aim of education

meant

“adjustment”

that education

changing

to the idea of democracy. for the personal

so-

It included

growth

of the indi-

as well as service for the common

aims such as training

as the

was a process

people for life in a rapidly

art, 1935a). Education

good (Stew-

in this sense could include

past

(the fixing of habits and skills by

the process of repetition),

discipline,

and service,

but

each of these had to be supported by the intelligent use of knowledge. With this understanding of the differences

of the Amer-

the members

of pro-

and professional

chairperson

nursing

to

she selected the term “adjustment.”

between

it was never ican Hospital

continued

the development

as discipline

education

cluded that it was possible president

nurse might

work.

of the NLNE,

She suggested

both opportunity

physicians and hospital administrators balked at the upgrading of educational standards in nursing.

and

might

tional philosophy

vidual

Dr Lewis A. Sexton (1932),

educated

both liberal

of a new aim; drawing

ciety committed

there werefour reasons why

nurse

with the process of curriculum

nursing ciency.

of physicians

nurse educators

In 1935, Stewart, Committee

and less

or take over aspects of the

on the physician’s

dealing

Sec-

the nurse was

educated

and encourage

of preparing

education.

. . .

to the demands

the highly

grams that incorporated education.

First,

of nursing

in her actions

role. Last, a highly

write about

at the

in nursing.

background

compete with the physician physician’s

why

balked

labor would be decreased.

sion. In one of these she described

man.

The result

a professional

reduce

likely to be obedient

riculum

includ-

curriculum

the practice.

practice

the

Discipline

was a cultured

combined

technical

upgrading

In spite of criticisms, in

were four reasons

administrators

pass judgment

the aim of pro-

languages,

in a professional

the theory

of

of California,

a course of studies

Skill was developed

education

and

with that of liberal education:

by pursuing

there

more likely to be independent

for profes-

first was skill and the latter was discipline.

that

and hospital

schools so that student

at the 32nd Convention

He compared

was developed

ics, and science.

concluded

physicians

institu-

His topic was recent developments

fessional education

(1928)

life of that society? Titus

ond, with more educational

In 1926, Edwin A. Lee, director

education.

to the sociopolitical

be bal-

for the general this

the nurse educators

of the NLNE.

sential

patients.

disputed

education

professional

skilled

what

and practice

have responsibility

sional education. addressed

or be inte-

of study,

components?

nonnurses

vocational

follow,

course

be included

anced in the professional tions

to ad-

education

were the aims of this education,

how should

professional

or general

S. HANSON

at

in 1932. His message was that

1935b). The nursing general

possible literature

trend of thought

and training,

to overtrain

to overeducate of this time

she con-

the nurse,

but

her (Stewart, indicated

that the purposes

the

of the lib-

every year new subjects were added to the nursing curricula until they were bulging with courses for Such emphasis was given to the general education.

eral or general education of the nurse were the possession of a strong science background, the acquisition of cultural knowledge, the development of the indi-

need for general knowledge that nurses were no longer interested in providing “menial care of the sick.” He concluded that it was possible to educate a person beyond his sphere of usefulness. What was so unusual about upgrading the educational background of one group in a society in which the concept of universal education was considered es-

vidual, the development of citizenship, and the development of critical thinking and judgment abilities. THE POSSESSION OF A STRONG SCIENCE BACKGROUND

By the mid-1920s, the American love of science was reflected in the increasingly strong statements

345

NURSING’S LIBERAL EDUCATION THEME: 1924 TO 1939

made by nurse educators nursing

background,

they usually

with comments

followed

guide, said:

the

used

ie,

the NLNE

the

need

of the student.

is the foundation

to She

of our whole

is weak, all the sub-

1925,

p. 215).

Goodrich

the nurse as the instrument

for the

of science to the daily life of the individ-

ual. It was inconceivable

that any nurse should grad-

uate from any school without

acquiring

a knowledge

of both the basic and social sciences. To open the door to this knowledge An education

was also to open the door to beauty.

rich in knowledge

sound professional life experience of vision,

preparation,

would

wealth

Logan (1931) the appropriate

develop

institution

for nursing

to provide

Nursing

public

education

as be-

education

that emof human

were sociology,

hygiene,

as psy-

and the courses

ie, anatomy,

physiology,

and bacteriology. could lead to sev-

nurses valued

that which was

able to identify

practice. Second, science background

were more direct,

He emphasized

cultural

content.

His

inside and outside

Con-

six fundamen-

for nurses.

The first

for nurses should conreasoning

nurse was first of all a woman

was that

the

with a life to live both

her profession.

Schools for nurses do not train nurses; they train women who are to follow the profession of nursing. Consequently, it is perfectly clear to me that some attention must be paid in a course to those things which will enable her to live a happy life as an individual apart from and in contact with her vocation (Charters, 1926, p. 136).

Similar

sentiments

were expressed

1936 annual

direct apbecause the to nursing

it was easier to use this as

an argument to convince those wavering of the advantages of the higher education of the nurse. Third, nurse educators were themselves unsure of the benefits of courses other than sciences so they simply chose not to address them. Last, nurse educators did not see the need to address the nonscience courses because university requirements would ensure that such courses

by speakers

conventions.

parade

of speakers

urging

content

in nursing

curricula

This

at the

continual

the inclusion

of cultural

had some effect on nurs-

ing curricula. Gray,

a nurse,

submitted

In the paper,

she thought

ern languages,

level of think-

the usual basic sci-

more time to explaining

nurse should have a knowledge history,

the course work

a higher

She included

on scholarship

1927 issue of The

she described

would stimulate nurses.

and modern

a paper

in the December

English

sociology,

of ancient,

why the medieval,

and composition,

psychology,

mod-

and other kin-

dred subjects. The 1937 revision

of these statements

plications to nursing benefits of a broader practice

of knowl-

The courses she described

economics,

First,

tain

ences, but devoted

chology,

at the 1926 Annual

was that a curriculum

of the science

background

and were readily

criterion

ing among

a broad

eral conclusions.

of the NLNE.

and an ex-

a paper on curriculum

tal criteria for a good curriculum

skills and basic sciences,

providing

scientific

a different

of Chicago

presented

and adjustment

Journal.

not only technical

practice,

construction

was an art and, as such,

of the nurse a scientific

and response.

of the University

that was published

required

also an understanding

Charters,

the science course work

phasized

basic to nursing

breadth

also saw the college or university

to nursing.

The strength

to describe

experience.

pert in curriculum,

1930 and

in the nurse attributes

essential

chemistry,

used the same phrase,

background,”

scientific),

of approach.

cause of its ability

behavior

(heavily

and a varied extensive

of imagination,

edge, and sureness

but

other nurse educators

general

are plausible.

EDUCATION FOR A BROAD GENERAL CULTURE

vention

its curriculum

as a rationale

and if that foundation described

When

to revise

jects will suffer” (Stewart,

and

the social sciences,

the science background

‘I. . . science

(1925),

bacteriology,

and sociology.

intention

Stewart

application

However,

All four conclusions

type of educational

sci-

physiology,

its

structure

such statements

science initially

but grew to include

strengthen

be taken.

“broad

meant

psychology

announced

educators

ie, sciences basic to the medical

ences-anatomy, generally

nurse

would

on the need for a science background.

sciences,

chemistry,

many

of the need for a broader educational

To most nurse educators, “basic”

the role of science in

Although

education.

spoke frequently

about

reflected a changing ucation. a growing

of the NLNE philosophy

Curriculum

regarding

The curriculum

presented

sophistication

regarding

Guide

nursing

included

ed-

not only

the level of science

needed by nurses, but also growing awareness that the school of nursing, be it university affiliated or hospital based, had some responsibility

for the cultural

educa-

tion of the student nurse. One of the standards presented in the book was that nursing students should be qualified for study on a professional level and have a broad educational and cultural background. This standard was implemented by recommending that admission to nursing education be based on 1 or 2 years of education beyond high school. It did not specify

346

KATHLEEN

that this education

had to be academic,

but it should

civic

duties,

have been of college grade. The delineation

of specific

(1934),

courses for these 2 years was not encouraged

because it

education,

might

have been out-of-step

philosophy

that encouraged

jects attuned profession

abilities

that those seeking

have an introduction

of knowledge:

English,

mathematics,

statement

admission

science,

and economic

on cultural

fields sci-

religion,

background

of activity

of

of this pe-

for using

work. Education opportunities

THE DEVELOPMENT OF THE INDIVIDUAL

aim in the liberal education identified

of the nurse.

as such in the study

the period

from

1893

had been unable

education

most nursing

ued as an important

but

since

received,

in this period.

Bolton (1924),

a lay sponsor of improvements

ing education

and practice,

preparation faculties

(1989)

described

cultural

must prepare

mind,

the individual

and spirit.

one’s own abilities

alter the

for leisure included

the study

Another

as part

as

all the

Education

history,

ual.

(1935a)

Stewart

written

and

(1935),

much

development

historic aims of nursing

education:

Expanding

service.

that discipline

discipline

and self-

idea,

Goodsell explained

conformity

and obeContem-

focused on the individual

and desires and how they might

Crucial

dent’s ability

had been two of the

and authority.

in education

and his abilities maximized.

standards

that

University,

as an aim implied

to external

with the

in the individ-

under

on this

a professor at Columbia

forma-

of the individual.

character”

grouped

on character

effacing

character

had long been concerned

of the “right

to this was developing

to think

life’s demands.

for that place in life for

of

activities,

of the fine arts; and varied

development

dience

education

languages,

of the development

education

porary thought

in nurs-

the provision mental

group of writers included

In

1924,

and inclina-

that the wise use of leisure would

excursions.

it contin-

for life, the process of developing of the body,

of

nursing

to significantly

students aim

It had been

by Hanson

to 1923,

educators

was not a new

of nursing for leisure.

but a higher kind

for physical activities,

social science;

Nursing

of the individual

leisure not as inaction

Meader

increase the creative aspects of the nurse’s professional

tion

riod.

The development

on this criticism

the lack of education

such as classes in literature,

This was the most

education

especially

tions. She suggested

to the

natural

philosophy,

both their own and other countries. definitive

of sub-

the wise use of leisure.

a nurse, expanded

She described

and interests.

to the following

social

the arts,

and the social, political,

educational

a broad selection

with the students

It was suggested

ences,

with current

and

S. HANSON

and to adjust

The character

that of compassionate

desired

be

the stu-

intelligently

to

in nursing

was

intelligence.

which he was best qualified. THE DEVELOPMENT OF CRlTlCAL THINKING

Nursing

Bolton . . . described education as preparation for life . . .

veloping

educators an attitude

aim of education the individual

students.

patible

with contemporary

in a democracy.

to the

Such a characteristic standards

with de-

obedience of behavior

of the late 1920s and 1930s. Neither

this a desirable

characteristic

in

was not com-

for women

for was

who would

The development

of

be practicing

was related to both his contributions

to

world of health care. Urch, of Highland Hospital and later instructor at the College of Saint Teresa,

society and satisfaction objectives

of the individual

of unquestioning

nursing

the woman Titus tied the development

were no longer content

for individual

with life. She identified

seven

development:

Such a development calls for: 1) education for health, 2) education for worthy home-membership, 3) mastery of the fundamental processes such as reading, writing, and the like, 4) preparation for a vocation, 5) education for civic duties, 6) education for the wise and judicious use of leisure time, 7) development of ethical character (Titus, 1927, p. 958).

When nursing education was measured against these objectives she felt the preparation for a vocation was overemphasized at the expense of education for health,

Winona,

MN,

nursing

in the

increasingly

spoke at the 1932 NLNE

of the need to admit

a higher

caliber

complex

convention

of student:

If you ask what I mean by better students, my answer is, women who meet the commonly accepted requirements of professional practitioners, viz., cultural background for nursing with the innate capacity to learn how to solve problems, make judgements, and assume the responsibilities and risks of acting on their own judgments (Urch, 1932, p. 185).

Stimson, director of the Army Nurse Carp, was asked to address a 1935 meeting of senior students spon-

NURSING’S

LIBERAL EDUCATION

THEME:

sored by the Massachusetts cation.

nurse would

347

League of Nursing

She advised these graduates

social scene required

1924 TO 1939

versatility

Edu-

that the changing

and adaptability.

need the abilities

found

The

in the modern

First, she should be so well grounded in the fundamentals that she will not have a narrow one-track mind . that knows of at least two ways of doing things . . second, she should have that quality of mind that makes her a real part of the community. Third, she should have the ability to approach intellectually the problems with which she will be confronted and to strive for a solution unhampered by her emotions and personal bias. Fourth, she should be endowed with courage to face situations and, when she arrives at a solution, have the courage to act (Stimson, 1935, p. 841).

Beck (1934) described an attribute

critical

to know truth;

dependent victions

in thinking; as tentative

explanation. nation.

attitude observant,

holding way,

to the health

Nurse

educators

for citizenship

nursing

cautious,

and in-

could

considered

con-

for further make

of the individual

ity to society very seriously ucation

was open minded,

waiting

nurses

their

and the

their responsibil-

and maintained

that ed-

was an aim of both liberal and

education.

over fascism and totalitarianism educators

became

Dewey while taking

in her presidential

that the education would prepare Mill (1982)

stated

need to participate Goodrich

whether

education

profession

a high quality

velopment

of an education

profession

who felt citizenship practice

each individual

in a deto partici-

pate freely and intelligently

in the work and actions of

society.

program

A broad

cultural

bined with a sound professional the nurse to participate

of studies

com-

course would

enable

as a full and active citizen.

The Relation of Liberal Education to Professionalism in Nursing Nurses

continued

regarding

their

that nursing

of independence (1933,

p.

in the practice

14) noted

other professions training

training

of profes-

who considered

profes-

into

the

from all

practice

woefully

inadequate

He felt it was

and almost universally levels in content

of her

on the so-called

that nurses received.

below col-

and presentation.

editor of TheJournal in 1925, wrote that one

thought

of the editor

and interpret

these trends

them

of thought

She quoted

was to sense trends for her readers.

two

with

Flexner,

nursing

diverse

respect.

status of

opinions

from

According

was a “twilight

to Dr case” be-

cause of its semisubordinate relation to medicine. the other hand, Dr William Heard Kilpatrick stated that nursing,

service to society, pendent

capable

Kilpatrick current

saw little

Grading

Committee

like other pro-

Both Dr Flexner

of professional

system of preparing

On of

of “self-identifying”

ie, it was able to define

scope of practice.

of

One of

was the professional

she viewed

Abraham

was quite

to be the foundation

Horner

“differed

He went on to comment

scientific

College

the person

that nursing

is introduced

profession.”

of nursing.

in the speed with which a nurse in

fessions,

contribution,

arguing

focused their argu-

Teachers

for a

messages

Those

nurses and the lack

questioned who would

conflicting

status.

was not a profession

of the general

similarly

to receive

professional

ments on the system of preparing

sources

life.

was second to the

She questioned

or the person

and

the de-

for the 1935

meant

and to do

should prepare the individual

or citizenship.

philosophy

of the Cuw~culum Guide. Education

nursing.

of human

in the understanding (1934a)

on education

revision

preparing

of

College.

she wrote regarding

mocracy

all that

long ago that the need to acquire

make the fullest professional sional

emphasized

her to live as a good citizen

the skills of a particular culture.

address before the

of the NLNE,

of the nurse should include

her part in promoting

the writings

quoted his writings

in the article

of the functions Convention

with

course work at Teachers

democracy

Roberts,

EDUCATION FOR CITIZENSHIP

Logan (1925),

concern

overseas. Many nurse

acquainted

lege or university

31st Annual

Dewey and growing

as a scientific

needed to develop.

only to scientific

knowledge

In this

contributions

thinking

that nursing

A person with a scientific desirous

of John

Stewart (1935b)

college woman:

attitude,

of the writings

nurses.

its

an indeand Dr

standards

in the

The results of the

studies of nursing

acknowledged

sional practice to be an expression of his individuality? Citizenship took on new meaning with the onset of

that the majority of complaints made by physicians and patients about the professional status of nursing

the Depression. Nurses were in the position to not only contribute to society through government relief programs, but they were also on the receiving end of that relief. The increasing use of the terminology “education for democracy” also reflects both the influence

focused on the lack of a broad education on, 1928, pp. 153-181, 203-230). Stebbins necessarily dence

(1926)

identified

a profession.

on medical

sciences,

nursing

She noted but

(Committee

as an art but not nursing’s

as every

depen-

practical

art,

348

KATHLEEN S. HANSON

ie, medicine, science,

was dependent

on physical

this did not disqualify

sion. She proposed

that since nursing

women’s

field,

since women’s

assigned

great societal

denigrated

work,

through

women

chiefly responsible sity preparation Such behavior sionalism

own

standing

education

of the profession factor.

of their

nurses. They seemed to be content status of nursing

the hospital

an opportunity

of nursing

conducted

lack of whole-hearted education

into

There

viewed

cation was essential the Grading

professional

recognition

as a desir-

and university-level the

Committee,

of the strength of nursing

the professional

edu-

that goal. The work of 1935

revision

of the

efforts of The Jour-

before its readers all give of their conviction

among

status of nursing for the education

to place

the professions.

last area of effort was to secure public responsibility

was also a in nursing

Guide, and the incessant

the practice

nursing

the leaders

to reaching

nal to keep the discussion evidence

by nurses

that

able goal and that college-

Curriczhn

evi-

the process of professionalization.

is no question

education

the studies

for advancing

the university

factor impeding

While

factor was a crucial one, the

support

The

formation

The

recognition

of

and to secure public

the

it

it called

education;

nursing

had better

it

to other

professional

op-

affiliations

problems

addressed

zational patterns

with

could be explored. by this group

and autonomy

Some of the

related

pat-

began to focus

or liberal

to the professional

Should the liberal education

to organi-

the curriculum.

discussion

of the general

in relation

forum higher-

schools, budgetary

in planning

In the area of curriculum, component

another

associated

for collegiate

on the placement

of Collegiate

in 1933 presented

education

terns,

Association

problems

education

component.

courses precede,

be con-

current with, or follow the professional component? All patterns existed. At Yale, the liberal education component

preceded

admission

to the professional

curriculum

(Goodrich,

1934b).

At Duke University,

the liberal arts and sciences were integrated fessional

courses

University

in a 4-year

offered a 5-year curriculum eral education

(Soule,

for the Study of Nursing

(The Duke

in which a period of genand followed

the profes-

1938). Both the Committee Education

in Colleges

(1929) and the 1937 revision

before the professional

with pro-

1929). Other programs

both preceded

sional curriculum Universities

curriculum

School of Nursing,

riculum Guide advocated

of nurses.

policies;

to interpret

of the

in which

hold of

academic

broadwith stu-

for faculty;

cost of nursing

and graduates

Schools of Nursing

were harsh

in contact

portunities.

These

in this period gave ample

dence that the economic

educators;

of a lack of profes-

to lay blame for the

over schools of nursing.

was easier to administer

and

were better;

the students

dents of other fields; it was stimulating

provided

that goal.

on the economic

advantages;

of nurs-

the univer-

in the amount

the facilities

ened their social vision by being

to the actual

words, but they seemed to arouse little response from questionable

there were cultural

attention

must not hold

toward

to theory;

were

passivity

Those nurses without

any other

a

been

and since women

was more indicative

than

devoted

the importance their

for nursing

back the progress

tended to be strengthened

content

was primarily

for the uncertain

ing as a profession.

riculum

as a profes-

work had seldom

importance,

had themselves

and biologic

nursing

and

of the Cur-

2 years of academic

study

course.

Nursing Education in Universities and Colleges According

to Nutting,

schools of nursing leges (University ported

affiliated Schools,

in

1928

there

with universities 1928).

In 1938,

that there were 64 schools of nursing

were 45 or colSoule rein uni-

versities and colleges. This was considerable progress during a period of time when public attention was focused on issues of economic reform and relief. The attention of nurse educators began to focus more on the quality of the university relations and on the nature of the curriculum offered. The NLNE Committee to Study Nursing Education in Universities (1928) concluded that regardless of organizational problems, the advantages of even the slightest connection with institutions of higher education were many and varied. It was easier to maintain a high school graduation admission standard; the cur-

Hawkinson . . , believed the higher education movement should progress, but not too rapid/y . , .

While there was a distinct trend toward increasing the number of collegiate level schools of nursing, the movement did not have the full support of the profession. Stewart (1939) and other nursing leaders realized that the profession did not have enough qualified instructors available to teach at the collegiate level if all hospital schools closed and reopened as collegiate programs. Hawkinson (1935) believed the higher education movement should progress, but not

349

NURSING’S LIBERAL EDUCATION THEME: 1924 TO 1939

too rapidly,

since the nursing

strengthened caution,

and working

even though

plications

curriculum

conditions

improved.

well-supported,

for nursing

education

needed to be This

would have im-

through

the next sev-

entific knowledge The

blending

knowledge

of scientific

with

gave a growing

attention

Conclusions literature

nurse educators

from 1924 to 1939 suggests that

believed

of a professional

nursing

education

level and built

general-liberal

education.

this education

were the development

ual, the acquisition opment

of cultural

and

judgement,

and

identified

1923,

differences

society.

The

might

serve society best through

her own abilities

nurse,

to analyze

accordingly.

The

time seemed to dictate educators

1893

blending

of knowledge

in these

same

fessional

education.

was composed Advances

of both

in medical

a demoof

was given

and to adjust

conditions

that a liberal

science

of the education

and cultural

sciences required

of a collegiate

courses.

a depth of sci-

and skills gained conducted

areas of

through

during

education

continued

and general to make

tions of higher

education.

tions regarding

the sequence

and professional

components

of organizational

patterns

however,

this pe-

of professional

be

distress

and resistance

liaisons

No definite

with

were made,

nursing institu-

recommenda-

of the liberal

had begun

pro-

should

educators,

continued

roles

a sophisticated

level. In spite of the economic

education

acteristics

These fledgling

by colleges and universities physicians

education,

as know-

in both hospi-

began to assume

that nursing

of many

litera-

at least by nursing

required

of nursing

riod recommended experienced

individuals,

such an emphasis.

proposed

practice

of the time

Emphasis

social

health practice,

The studies

action con-

why was as important

level

within

in nursing

the nursing

was done. Nurses,

of the physician.

other

less

to accept this as-

to guide practical

It was expected,

tal and public

on

received

as a given

throughout

independent

new situations

unstable

ture of the time.

of critical

the development

and personality.

to the ability

Nurse

like

to be a theme

professional

as an individual

cratic

The use of knowledge tinued

leaders, that knowing

the service of the nurse to society and more emphasis on her development

tended

of a

appear

however,

education.

ing how something

themes from 1924 to 1939. There is less emphasis

cultural

to science. The con-

efficiency

education

the first four were

in the discussion

subtle

emphasis

as nurse educators

the devel-

the possession

While

of

of the individ-

knowledge,

the development

science background.

themes to

The aims and purposes

of citizenship,

thinking strong

should be

on at least 2 years of

and

was compatible

philosophy;

for technical

pect of professional Nursing

efficiency

educational

cept of training

been denied.

knowledge

technical

with contemporary nursing

eral decades.

nurses had frequently

education so a variety

to exist. Nursing

to take on some char-

education.

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KATHLEEN S. HANSON

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