Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 165

You graduated about a year ago, as one of 10 male nurses in your class, and now work in the critical care unit of a major teaching hospital. Most of your work has been on the night shift. One evening, with a few nights off duty coming up, you go out with some friends from college. Talking with them, you realize that they don't have a clue about what you do. They joke that you must have entered nursing because of the numbers of eligible women. They have no idea of your responsibilities or your stress when at work. They don't know that a few nights back you diagnosed a probable pulmonary embolism and thus saved a young woman's life. They don't know that you calmed a hysterical man in the waiting room whose wife had just unexpectedly died. Most aggravating is their response when you tell them that you're planning to return to college for your doctorate—a PhD or a DNP, you're not sure yet—and they look amazed and exclaim “A nursing Dr.! Who knew?”

1 Aside from wishing that your friends would be subjected to a nurse's care sooner rather than later, how can you succinctly describe the knowledge base of nursing to them?

2 What would you say to them about the need for nurses with doctorates?

3 Discuss the history of men and other minorities in nursing.

Nursing history is the story of nursing care given through antiquity to the present day. The history of nurses and nursing can be fascinating but, with a nursing curriculum that is positively bursting at the seams, is history relevant and important enough to be included in all nursing educational programs? The answer is a resounding YES! Here's why: knowledge of nursing's history: (a) positively impacts patient care, (b) generates professional identity by reflecting the profession's history as well as the profession's current status, and thus contributing to career stability, (c) demands critical thinking, and (d) supports effective writing, a skill that is essential in nursing leadership. Additionally, the sheer fascination of reading nurses' notes written long ago or touching worn student nurses' uniforms—with patients' blood and students' sweat still visible on them—may be added to these reasons for studying the history of nursing.

Let's tackle these four reasons one by one, bearing in mind that they can't really be looked at separately. First, how can knowledge of nursing history positively impact patient care? One reason is that the patients' voices we “hear” through historic documents such as nurses' notes, or case studies, or in the meeting minutes of patient care committees, remind us that our patients are the raison d'etre of our work. In today's technological world this is sometimes forgotten. Another reason is that history is the basis for nursing practice research. For example, with current outbreaks of infectious diseases such as measles, nurses want to study ways to increase the percentage of childhood immunization. Yet any research on immunization rates would be flawed if nurses ignored the history of why parents had refused immunization for their children in the past. Historical research, such as that conducted by Lusk, Keeling, and Lewenson (2016), identified the critical interconnected variables of poverty, social class, ignorance, and fear of authority that was demonstrated during the forced smallpox vaccinations at the turn of the last century. Historical research provides the foundation for current nursing investigations

Second, nursing history generates professional identity, that is the public's understanding of what a nurse does, by reflecting the profession's history as well as the profession's current status, and thus career stability. Satisfying careers, whether in the arts or the sciences, usually have a history. Think of some familiar careers. Today's chemists or biologists or mathematicians proudly follow famed predecessors and carry part of their mystique. Likewise, artists of every stripe add to the acknowledged body of art that came before them. Knowing that nurses, too, have a long and rich history provides professional identity and commitment, thus leading to career stability. However, nursing history hasn't been adequately acknowledged, either within or outside the profession. Today's nurses and members of the public are not aware of nursing's rich and important past. That needs to change for everyone's benefit—including the patients. If nurses leave nursing because work that doesn't have a history isn't worth fighting for, then the nursing shortage continues and the patients suffer.

The third claim, that nursing history demands critical thinking, is based on the complexity of nursing's past. The history of nursing is not a linear progression from simple to advanced. For example, Florence Nightingale is revered as being the founder of modern nursing, but she was vehemently against registration for nurses. Taken at face value, that is probably shocking to most nurses today. Yet closer analysis of this issue by nurse historian Carol Helmstadter suggests that Nightingale had good reasons for objecting to nurse registration. Registration, Nightingale thought, would create an elite class of nurses who had the financial means to afford the requisite nursing education. Working‐class nurses, the vast majority of nurses at the time, would be excluded. Further, Nightingale wisely understood that registration would legally place nurses under the authority of physicians, typically male, and thus limit nursing's female empowerment. Lastly, Nightingale found the state registration proposals for credentialing inadequate. She believed that registration, if attempted, should be more rigorous (Helmstadter, 2007). The registration issue, as are most issues, was nuanced, requiring critical thinking. Attempting to understand historical complexities serves as excellent preparation for understanding the intricacies of our patients and their care.

Finally, the last claim, that nursing history supports effective writing that is clear and convincing, was made because history requires reading—history is not a series of numbers or bullet points. With longer reading comes better analysis and writing skills. It is that simple. So that when you need to develop and fight for a plan, or you need to argue that person A is right for a position and person B is not, or when you are on a board promoting a health care initiative, reasoning and writing skills are imperative. Indeed, the need for effective writing is more relevant today, in this electronic age, than ever.

This chapter will give you selected highlights of the history of professional nursing in the United States. Other parts of the world have their own historical stories. Nurses who have excelled in leadership and management covering a range of workplaces will be featured as case studies. Critical thinking boxes will pose overtly nuanced scenarios chosen to illustrate that nursing practice is complex. The chapter will start with a discussion of the founding of nursing in the years before nurses received any kind of specialized training and close with a review of nursing's historic contributions and future nursing challenges. Nursing's history was affected by the role of women and women's place in society, social forces, industrialization, scientific awakening, and discrimination toward race and gender (negatively impacting minorities, women, and men). As former nursing dean Helen Grace wrote: “The struggles reflected in the development of nursing as a profession…mirror the struggles of women through the ages in defining a position of equality and worth” (Grace, 1978, p. 17).