literature by consumers for nursing

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by Mary Ann Ruffing I t T E R AT U RE by consumers for nursing paramount and perpetual concern of the nursing pro- A fession must be the promotion of sensitivity, commit- ment, and compassion on the part of its members in their transactions with the persons who receive their services. To avert the persistent threat of depersonalization in client re- lationships, there is need for continual reaffirmation of the bedrock of humanism which underlies the “caring” essence of nursing. Such an orientation - upholding man’s dignity, enterprise, and perfectability -- emanates from, among other things, an allegiance to liberal education. Liberal education, long acknowledged as vital to a fully- conceived profession, has, according to Russell (1959), three purposes: “1 ) Attainment of sufficient knowledge of the NURSING FORUM 87

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by Mary Ann Ruffing

It T E R AT U RE by consumers

for nursing paramount and perpetual concern of the nursing pro- A fession must be the promotion of sensitivity, commit-

ment, and compassion on the part of its members in their transactions with the persons who receive their services. To avert the persistent threat of depersonalization in client re- lationships, there is need for continual reaffirmation of the bedrock of humanism which underlies the “caring” essence of nursing. Such an orientation - upholding man’s dignity, enterprise, and perfectability -- emanates from, among other things, an allegiance to liberal education.

Liberal education, long acknowledged as vital to a fully- conceived profession, has, according to Russell (1959), three purposes: “1 ) Attainment of sufficient knowledge of the

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world, past and present, to assure a broad understanding of life; 2) Development of intellectual skills; 3 ) Cultivation of qualities of character such as a sense of personal worth . . . [and] a commitment to the well-being of mankind.” With particular relevance to Russell’s third objective, Berry and Drummond (1970), in discussing the role of humanities in nursing education, emphasize that the consumer has a two- pronged expectation of the nurse as both competent and understanding. Further, such understanding is to transcend mere intellectual recognition of “frustrations, anxieties, alien- ation, emptiness, and uncertainty” which pervade the spec- trum of human existence. Convictions are to be translated into resourceful nursing acts, recognized and valued as such by their recipients.

Florence Nightingale identified observation as a nurse’s most necessary skill and cautioned against the misleading “habit of taking averages,” of overgeneralizing. Continuously, one integral tenet of nursing practice has been to forestall judgment and decisions when information is incomplete or inconclusive. One major recourse for validation has been the standard activity, “reviewing the literature.” In referring to the literature, one seeks to confirm one’s individual observa- tions with the support or stamp of legitimacy from recognized or, at least, published members of a given field.

While the activity of reviewing literature is a valid one, the term, as such, is narrow and misleading. Too frequently in the jargonese of scholarship, “the literature” refers ex- clusively to writings found in scientific and professional pub- lications of a specific field - at times, to a subcategory within a given field. Professional literature, however, is but a fraction of any civilization’s written output. In its fullest concept, literature encompasses the entire written heritages

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of Eastern, Western, and Third World populations, past and ongoing.

A dangerous elitism attends any profession that designates readings within the confines of specialization to the exclusion of the contributions by other disciplines and interest areas. The ongoing, refineable, interactional context of professional practice demands widening latitude in literature resources. Within nursing, there is a progressive and substantial broad- ening in the scope of readings. There are numerous texts and anthologies which reinforce and advance the natural and behavioral science foundations of nursing.

Still there is need for continued expansion of the concept of authorized and relevant literature for nursing. This article urges the incorporation of literature from hitherto non- standard sources into the nursing curriculum in order to ac- centuate the humanistic foundations of nursing practice. Such literature serves also to enhance clinical practice and facil- itate the rapport between nurses and clients. Recognizing that education is a lifelong process, it follows that students as well as practitioners at any point in their careers might refine their sensitivity and insight under similar strategy.

Several trends underscore the timeliness of expanding the scope of relevant literature for nursing. Increasingly, health and illness are approached conceptually as one continuum rather than as distinct and polar phenomena. Nursing faculty have reorganized and revised curricula in order to provide a more holistic approach to the study of man in health and illness. Likewise, emphasis is placed increasingly on the ex- periential uniqueness, continuity, and fullness which charac- terize each stage of life.

Most significantly, there has been a conceptual metamor- phosis of the traditionally horizontal and passively-inclined

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patient into an upright, active, and assertive client whose values and choices are to supply a major thrust in determin- ing the course of health care. It is from the client’s point of view and from within the context of his environment and culture that health services must be planned and provided. Accordingly, there is renewed urgency for health profes- sionals to understand the identity of clients and the par- ticulars of their human situations. Literature by the con- sumer is what nursing must now attend to.

A concept of relevant literature for nursing today includes a vast range of contemporary writing, largely non-fictional in nature. This literature is especially pertinent to learning objectives of the affective domain which promote the ad- vancement of certain attitudes, values, and appreciations. It is generally recognized that affective objectives are not achieved as a necessary and natural concomitant to the ful- fillment of cognitive objectives. (Kratwohl et al., 1964) Hence, deliberate learning opportunities must be planned and provided. One way might be to balance the authoritative writings of health care specialists with accounts by lay persons of their health, their illnesses, their injuries, and the like.

Nursing educators have taken innovative strides in their incorporation of non-traditional sources of literature and other forms of self-expression as aids to teaching and learn- ing. (Driscoll, 1973; Holdsworth, 1968) Psychiatry, Psychi- atric and Mental Health nursing have perhaps the most firmly established precedent for including both fictional and auto- biographic accounts of individual stress and recovery in the planned curricuIum. (Menninger, 1972; Lerner, 1973) In terms of affective learning potential, the specific intention for adding such works is to promote empathy for persons under similar circumstances.

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One major contribution of literature by consumers, both actual and potential, is the cultivation of optimism and re- sourcefulness in one’s approach to individuals whose diag- noses might otherwise serve to stigmatize, stereotype, and overwhelm. Perhaps intellectual impairment would not be as readily linked and confused with muscular dystrophy after reading the autobiography of Christy Brown or any of his other works based on life experiences. Similarly, the short book, The World of Nigel Hunt, demonstrates the capacity of a retarded youth for the sustained industry of writing and typing a manuscript. in which are captured his own striking reminiscences of family travels and the loss of one of his parents.

Self-awareness is one notable element in many of the in- dividual recountings of illness, disability, and other life crises. Each writer has passed through unique events, leaving him/ her singularly changed and, in the subsequent recollection and writing, with singular insights to transmit to the attentive reader. McIlwain writes of his years of increasing consump- tion of alcohol and the eventual period of therapy received in a private institution for alcoholism. He tells of learning to live responsibly and comfortably without alcohol. Written for a lay readership, the book is informative and discerning about the experience of alcoholism. One of his emphases con- cerns the essential nonassertive, passive, and compliant per- sonality of many alcoholics - and their need to change their behavior in order to conquer alcoholism.

MacKenzie’s book, Risk, is a brisk account of open heart surgery and its aftermath. Rather than being a favorable resolution to progressively disabling heart disease, the surgery is the first of many setbacks. Her memories of days spent in the intensive care unit are especially scalding - and al-

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though staff members denied the transgressions she per- ceived, there was indirect validation nevertheless that they had taken place. The reading of this book, and others which contain less than positive vignettes of health care received. might be viewed as a sensitizing activity. It is a means of alerting health professionals to outsiders’ sensations of over- whelming strangeness, fear, and disorientation in settings and situations to which the professionals have become perhaps overly acclimated. Moreover, in many narratives of disruptive experiences within the health care system, there are instances where nurses can share both pride and chagrin in accounts of efforts made by other nurses to ameliorate the fragmenta- tion, confusion, and neglect. (Cook, 1974)

Literature about death and dying is a substantial category of consumer literature. A recent book about a man’s con- scious awareness of his shortened span of remaining life is Stay of Execution by the late journalist, Stewart Alsop. As well as recollections of a full life, Alsop describes “the strange, unconscious, indescribable . . . process whereby one comes to terms with death.” Living With a Man Who Is Dying is an Englishwoman’s account of her husband’s ter- minal illness, noteworthy to American readers because the setting is that of a national health care system other than the American one. (Evans, 1971) As to the experience of bereavement, A Grief Observed, written by C . S . Lewis under a pseudonym, is a valuable work. A collection of private out- pourings following the death of his wife, the book has been a source of hope for many persons enduring or attempting to endure similar loss. One special insight concerns the writer’s distressing inability to concoct a mental picture of the deceased spouse during the acute stage of grieving. Later in the book, however, the dismay is reversed: “And suddenly

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at the very moment when, so far, I mourned least, I re- membered her best.” (Clerk, 1963)

The experiences of parents and families with handicapped or ill children constitute another sizeable genre of books providing a means of identification and support to families with similar stress. A Child Culled Noah is one father’s journal of his family’s process of reluctant realization that theirs was an “abnormal” child with a mixed and puzzling diagnosis of retardation and emotional illness. The parental guilt, family turmoil, and indefatigable efforts with a com- plex and frustrating health care system are cogently por- trayed. Emphasis is placed on the ultimate irrelevance to the parents of a precise diagnosis regarding their child of “other- worldly beauty.” (Greenfeld, 1970)

Library card catalogues contain countless entries concern- ing illnesses, disabilities, and other human experiences with which nurses are involved daily. Likewise, quotations and footnotes are often a fortuitous point of departure for at- tentive readers since many scholars regularly allude to a wide variety of literature sources.

Reading first-hand accounts of illness, disability, and other human crises prepares both the seasoned and the neophyte nurse for encounters with individuals coping with similar problems. The activity can provoke continuing insight, adding dimension and color to the special needs and concerns. More- over, as an activity which accentuates the humanistic founda- tions of nursing practice, the reading is both engrossing and memorable.

REFERENCES

Alsop, Stewart, Stay of Execution, Philadelphia: J. B. Lippin- cott Company, 1973, p. 299.

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Berry, Charles E. and E. J. Drummond, “The Place of the Humanities in Nursing Education,” Nursing Outlook, XVIII (Sept. 1970), p. 30.

Brown, Christy, My Left Foot, New York: Simon and Schuster, 1955.

Brown, Christy, Down AZl the Days, New York: Stein and Day, 1970.

Brown, Christy, Background Music, New York: Stein and Day, 1973.

Clerk, N. W., A Grief Observed, Greenwich, Connecticut: The Seabury Press, 1963, p. 37.

Cook, Fred J., “The Operation Was a Success But the Patient

Driscoll, Ann E., “A Teaching Aid for Endocrine Disorders,” American Journal of Nursing, LXXIII (Nov. 1973), 1944- 1955.

Evans, Jocelyn, Living With a Man Who Is Dying, New York: Taplinger Publishing Co., 197 1.

Greenfeld, Josh, A Child Called Noah, New York: Holt, Rine-

Holdsworth, Janet Nott, “Vicarious Experience of Reading a Book in Changing Nursing Students’ Attitudes,” Nursing Research, XVJT (March-April, 1968) pp. 135-1 39.

Hunt, N., The World of Nigel Hunt, New York: Garrett Publica- tions, 1967.

Kratwohl, David R., Benjamin S. Bloom, Bertram B. Masia, Taxonomy of Educational Objectives, Handbook 11: Affec- tive Domain, New York: David McKay Co., Inc., 1964,

Lerner, Arthur, “Poetry Therapy,” American Journal of Nursing,

MacKenzie, Rachel, Risk, New York: Viking Press, 1971. Menninger, Karl, A Guide to Psychiatric Books in English, (3rd

ed.), New York: Grune & Stratton, 1972, pp. 186-190. McIllwain, William, A Farewell to Alcohol, New York: Random

House, 1972. Nightingale, Florence, Notes on Nursing, New York: Dover

Publications, Inc., 1969, p. 120. Russell, Charles H., Liberal Education and Nursing, New York:

Bureau of Publications, Teachers College, Columbia Univ.,

Died,” New York, VII (Nov. 18, 1974), pp. 49-56.

hart, and Winston, 1970, p. 38.

pp. 19-20.

LXXIII (August, 1973) pp. 1336-1338.

1959, pp. 120-121.

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