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THE FUTURE OF NURSING
45
Letters
to
the Editor
THE FUTURE OF NURSING
SiR,—I hope that Dr. Ritchie Russell’s letter will not which I wrote to you on a similar alarm at the trend which I thought was already apparent. The fact that what I then said elicited no response was a great disappointment to me, for it suggested that the medical profession no longer felt a sense of concern regarding the training of the nurse. Yet the steps which are now being taken, or are contemplated, may result in a few years in the lowering of nursing standards in all hospitals with body of specialist interests. A comparatively small " officer class " women will have passed through a form of training and will have little concept of the true needs of hospitals. The specialist hospitals will then have to depend in the main upon nursing aides and orderlies whose training may often be indifferent. In my last letter I advanced the view, which I still hold, that nursing as a vocation should be allowed to develop only in line with the needs of the doctor and of the public whom we both serve. Yet every doctor who works in hospital is aware that much of the training which the student-nurse must now receive is more in keeping with a training for some kind of junior houseofficer. A perusal of the examination papers which they are required to pass, and a knowledge of some of the things they are asked at oral examinations, make such an assertion quite proper. It has been my own recent experience to be informed by a sister tutor that the nurses would require to have lectures (a) on the social aspects of infectious diseases by an almoner or social worker, and (b) on occupational therapy in tuberculosis by an occupational therapist. Since the hospital at present boasts of neither of these officers I asked if I could not give (a) and the chest physician (b). The answer was " no " ; and when I asked if a perhaps second-rate lecture by some unknown persons would be preferred to lectures by doctors who were regarded as highly knowledged in these subjects, I was told that the regulations ought to be followed. Now, of course, it may be alleged that this sister tutor was merely being stupid, but it must be pointed out that she was a properly qualified tutor. Does it not need to be stated very bluntly that the seniors in the nursing profession who contemplate these new changes are motivated by what would be properly called snobbishness ? As the numbers of nurses required increase, they see more and more applicants who do not come from the social grades which were the usual source in the past. Rather than give encouragement to such entrants, they say, let us constitute some higher grade which alone can carry the unqualified title of " nurse." These repositories of much half-digested learning will be better able perhaps to follow the discussions of the consultant physicians regarding differential diagnosis, interpretation of laboratory reports, or definition of treatment. But the poor patient will depend for his " nurse " nursing on individuals whose claim to the title " " must be qualified by the words " aide " or auxiliary or assistant." One might wonder whether it would not be more proper to retain the word " nurse " for the person who really nurses and find some new title for this officer grade Meantime, thousands of girls pass nursing by-girls who in a more sensible world would find the nursing care of sick folks a rewarding career. The loose statement is often made that hospital medicine today needs more highly trained nurses. The fact is that this statement requires careful interpretation-for what is wanted are many many more ordinary nurses and a few who by postgraduate training have the capacity to take charge of
suffer the
same
fate
as
one
wards, operating-theatres, &c.
The latter group is
a
very
proportion of the former. May one suggest that the time is ripe for a new Lancet Commission on Nursing which would allow the medical profession to redefine in terms of the 1950’s the kind of ’1 nurse this country requires ? small
THOMAS ANDERSON.
April 23, 1953, when I voiced
HEALTH FROM THE HEALTH SERVICE 8 represents
SiR,-Dr. Joules’s statement of Dec.
enlightened opinion. The real achievement in preventive medicine should not screen our failures. Dr. Joules argues that the public health of young people is of such an order that we should reorientate our attention to the later decades where physical illness is our most urgent problem. Nevertheless, what we know of the setiology of lung cancer, hypertension, ischeemic heart-disease, and peptic ulcer suggests the causative factors are established in the habitual activities of people while they are young. The suggestion that the greatest enemy of the middle-aged man is his wife, who, in compensation for some other inadequacy, is over-indulgent in dietary attention, reminds us that people usually marry when young, and excess body-weight may be the ultimate reward of protracted matrimonial disharmony. Information on school-leavers declares that physique has never been better, but their subsequent
and matrimonial adjustments are uncertain and confused. Can it be that the foundation of physical disorder in the 50s and 60s stems from the emotional faux-pas in the 20s ? With neurotic disorder omnipresent in urban populations, we can assert that we have a youth physically equipped but emotionally unprepared for the world in which they must adjust. Is this not evidence that we have not even begun to approach a general state of mental well-being Can we be sure that physical and mental well-being are separate problems Prof. 0. L. Zangwillcan say of psychology that it has so far " failed to produce anything resembling a coherent and generally accepted body of scientific theory ... every psychologist has perforce to create his own psychology." Prof. H. J. Eysenck,2 speaking of data available, states they " do not prove psychotherapy to be valueless, but rather that they fail conspicuously to show any positive consequence following its use." But what does Dr. Joules say of this terrifying situationI " Mental health, in an acquisitive and densely crowded society, can come only from a wise education by which endeavour is canalised along routes likely to bring harmony rather than internecine competition." Would it be more honest to admit that we are unable to usefully predict our future, to acknowledge our ignorance, and to recognise mental health as our great problem wherein lies the opportunity for a tremendous advance Should we be disappointed to discover no connection between mental health and the physical illness of the 50s and 60s, at least we can ensure that our potential longevity is worth having, and is not- increasingly terminated in suicide, or in the chronic mental hospital.
occupational
J. D. PAULETT. DANGEROUS CONTAMINANTS IN STORED BLOOD
"
SIR,-Deaths
are
best
prevented by eliminating
com-
In transfusion one estimates that hepatitis kills 1 recipient in 10,000-15,000 ; serologic incompatibility 1 in 4000-10,000 ; bacterial contamination something like 1 in 350,000. Dr. Aidin (Nov. 17 and Dec. 22) wants us to do a special test to eliminate the 1 death in 350,000, forgetting that the hurry and worry of the extra test may increase the 35-90 deaths due to mon
1. 2.
causes-not
rare ones.
Zangwill, O. L. New Outline of Modern Knowledge. London, 1956; p. 168. Eysenck, H. J. Use and Abuse of Psychology. London, 1953; p. 199.
Letters
to
the Editor
THE FUTURE OF NURSING
SiR,—I hope that Dr. Ritchie Russell’s letter will not which I wrote to you on a similar alarm at the trend which I thought was already apparent. The fact that what I then said elicited no response was a great disappointment to me, for it suggested that the medical profession no longer felt a sense of concern regarding the training of the nurse. Yet the steps which are now being taken, or are contemplated, may result in a few years in the lowering of nursing standards in all hospitals with body of specialist interests. A comparatively small " officer class " women will have passed through a form of training and will have little concept of the true needs of hospitals. The specialist hospitals will then have to depend in the main upon nursing aides and orderlies whose training may often be indifferent. In my last letter I advanced the view, which I still hold, that nursing as a vocation should be allowed to develop only in line with the needs of the doctor and of the public whom we both serve. Yet every doctor who works in hospital is aware that much of the training which the student-nurse must now receive is more in keeping with a training for some kind of junior houseofficer. A perusal of the examination papers which they are required to pass, and a knowledge of some of the things they are asked at oral examinations, make such an assertion quite proper. It has been my own recent experience to be informed by a sister tutor that the nurses would require to have lectures (a) on the social aspects of infectious diseases by an almoner or social worker, and (b) on occupational therapy in tuberculosis by an occupational therapist. Since the hospital at present boasts of neither of these officers I asked if I could not give (a) and the chest physician (b). The answer was " no " ; and when I asked if a perhaps second-rate lecture by some unknown persons would be preferred to lectures by doctors who were regarded as highly knowledged in these subjects, I was told that the regulations ought to be followed. Now, of course, it may be alleged that this sister tutor was merely being stupid, but it must be pointed out that she was a properly qualified tutor. Does it not need to be stated very bluntly that the seniors in the nursing profession who contemplate these new changes are motivated by what would be properly called snobbishness ? As the numbers of nurses required increase, they see more and more applicants who do not come from the social grades which were the usual source in the past. Rather than give encouragement to such entrants, they say, let us constitute some higher grade which alone can carry the unqualified title of " nurse." These repositories of much half-digested learning will be better able perhaps to follow the discussions of the consultant physicians regarding differential diagnosis, interpretation of laboratory reports, or definition of treatment. But the poor patient will depend for his " nurse " nursing on individuals whose claim to the title " " must be qualified by the words " aide " or auxiliary or assistant." One might wonder whether it would not be more proper to retain the word " nurse " for the person who really nurses and find some new title for this officer grade Meantime, thousands of girls pass nursing by-girls who in a more sensible world would find the nursing care of sick folks a rewarding career. The loose statement is often made that hospital medicine today needs more highly trained nurses. The fact is that this statement requires careful interpretation-for what is wanted are many many more ordinary nurses and a few who by postgraduate training have the capacity to take charge of
suffer the
same
fate
as
one
wards, operating-theatres, &c.
The latter group is
a
very
proportion of the former. May one suggest that the time is ripe for a new Lancet Commission on Nursing which would allow the medical profession to redefine in terms of the 1950’s the kind of ’1 nurse this country requires ? small
THOMAS ANDERSON.
April 23, 1953, when I voiced
HEALTH FROM THE HEALTH SERVICE 8 represents
SiR,-Dr. Joules’s statement of Dec.
enlightened opinion. The real achievement in preventive medicine should not screen our failures. Dr. Joules argues that the public health of young people is of such an order that we should reorientate our attention to the later decades where physical illness is our most urgent problem. Nevertheless, what we know of the setiology of lung cancer, hypertension, ischeemic heart-disease, and peptic ulcer suggests the causative factors are established in the habitual activities of people while they are young. The suggestion that the greatest enemy of the middle-aged man is his wife, who, in compensation for some other inadequacy, is over-indulgent in dietary attention, reminds us that people usually marry when young, and excess body-weight may be the ultimate reward of protracted matrimonial disharmony. Information on school-leavers declares that physique has never been better, but their subsequent
and matrimonial adjustments are uncertain and confused. Can it be that the foundation of physical disorder in the 50s and 60s stems from the emotional faux-pas in the 20s ? With neurotic disorder omnipresent in urban populations, we can assert that we have a youth physically equipped but emotionally unprepared for the world in which they must adjust. Is this not evidence that we have not even begun to approach a general state of mental well-being Can we be sure that physical and mental well-being are separate problems Prof. 0. L. Zangwillcan say of psychology that it has so far " failed to produce anything resembling a coherent and generally accepted body of scientific theory ... every psychologist has perforce to create his own psychology." Prof. H. J. Eysenck,2 speaking of data available, states they " do not prove psychotherapy to be valueless, but rather that they fail conspicuously to show any positive consequence following its use." But what does Dr. Joules say of this terrifying situationI " Mental health, in an acquisitive and densely crowded society, can come only from a wise education by which endeavour is canalised along routes likely to bring harmony rather than internecine competition." Would it be more honest to admit that we are unable to usefully predict our future, to acknowledge our ignorance, and to recognise mental health as our great problem wherein lies the opportunity for a tremendous advance Should we be disappointed to discover no connection between mental health and the physical illness of the 50s and 60s, at least we can ensure that our potential longevity is worth having, and is not- increasingly terminated in suicide, or in the chronic mental hospital.
occupational
J. D. PAULETT. DANGEROUS CONTAMINANTS IN STORED BLOOD
"
SIR,-Deaths
are
best
prevented by eliminating
com-
In transfusion one estimates that hepatitis kills 1 recipient in 10,000-15,000 ; serologic incompatibility 1 in 4000-10,000 ; bacterial contamination something like 1 in 350,000. Dr. Aidin (Nov. 17 and Dec. 22) wants us to do a special test to eliminate the 1 death in 350,000, forgetting that the hurry and worry of the extra test may increase the 35-90 deaths due to mon
1. 2.
causes-not
rare ones.
Zangwill, O. L. New Outline of Modern Knowledge. London, 1956; p. 168. Eysenck, H. J. Use and Abuse of Psychology. London, 1953; p. 199.