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sociology in the College of the City of New
York, died on July 22. after a long illness.
For many years he had been associated with
the Bureau of Social Research of New York
and had shown brilliant leadership in the field
of immigration.



LITERATURE



CHILD HEALTH IN SMALL COMMUN-
ITIES Bulletins describing the Common-
wealth Fund child health demonstrations in
small cities and rural counties. No. 2, Marion
County, Ore. No. 4, General review of four
demonstrations. No. S. Fargo, N. D. No. 6,
Rutherford County, Tenn. Mailed free on
application to Director of Publications, Room
1648, 370 Seventh Avenue, New York.

EAST BY WEST A special number of Sur-
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ground for the newspaper despatches of to-
day. Original price 50 cents now 25 cents
a copy. Survey Graphic, 112 E. 19th St.,
New York.



568



THE SURREY

EDUCATING NURSES
(Continued from page 538)



August 15 September 15, 1927



dramatic battle for the patient's life. Recently the idea of
the nurses as "health missioners" has been taking hold of
the public imagination and nurses are being used much more
for scouting and intelligence work than heretofore and for
education toward prevention of these costly battles.

There has been a prevailing idea that the nurse's work
is largely a matter of skill of hand and technical efficiency.
While none of us would wish to underestimate the impor-
tance of manual skill and good nursing technique, it is very
important that we should recognize the large intellectual
and social element in all good nursing service and the neces-
sity for knowledge, judgment, and social insight as well as
trained muscles and trained senses. We must remember that
the physical environment and physical causes of disease
which have engrossed our attention in the past, are only
a part of the whole situation, and that the social and psychic
factors in the cause and treatment of diseases are demand-
ing greater consideration. The patient is being seen more
and more as a whole, with mind and spirit as well as body
to be nourished and cared for.

WHEN the dominant function of the nurse is religious
and spiritual ministration as it is still in some groups
physical care is regarded as of infinitely less importance than
spiritual comfort and consolation and the teaching of re-
ligious doctrine.

Perhaps this function and gift of spiritual ministration
needs to be revived in nursing, though the assumption of
ecclesiastical functions by lay nurses surely would bring
some undesirable complications. With the newer concep-
tions of education and mental hygiene, we shall probably
see that even ministration is not always and in all condi-
tions the best service the nurse can render her patient. Like
the good mother and the good teacher her object should be
to make her charge independent of her as rapidly as pos-
sible, and to make him constantly stronger and better able
to help himself.

There has been much discussion about what we mean by
the fundamentals of nursing education.

Many people speak of the basic course in nursing as if
it were the lowest possible minimum of theory and practice
on which any kind of a nursing structure could be raised.
Such a conception is humorously described by Abraham Lin-
coln in a discussion about the education of laborers as the
"mudsill" theory of education. "By the 'mudsill' theory it
is assumed that labor and education are incompatible, and
any practical combination of them is impossible. According
to that theory, a blind horse upon a treadmill is a perfect
illustration of what a laborer should be all the better for
being blind, that he could not kick understandingly. Ac-
cording to that theory, the education of laborers is not only
useless but pernicious and dangerous. In fact, it is, in some
sort, deemed a misfortune that laborers should have heads
at all. Those same heads are regarded as explosive mate-
rials, only safely kept in damp places, as far as possible
from that peculiar sort of fire which ignites them. A
Yankee who could invent a strong-handed man without a
head would receive the everlasting gratitude of the 'mud-
sill' advocates."

The mudsill standard is not my conception of either a
basic or a fundamental preparation. A foundation suggests
something solid and substantial, not a few tent pegs to hold



a temporary shelter. It must be strong enough and broad
enough to support a structure that will stand up stoutly
during the nurse's whole professional life.

I think of the basic preparation of the nurse as a one-
story building which is spacious enough to accommodate the
general workers in all fields of professional nursing. Lead-
ers and specialists, organizers and administrators, teachers
and supervisors must have further preparation, and it should
be possible for them to add a second and perhaps a third
story to that original structure without going back to put
in new foundations. At present, many of our able and am-
bitious women in nursing find themselves unable to go ahead
because their basic training has been so flimsy and super-
ficial that they would be obliged to build almost from the
ground up to prepare themselves for leadership.

One of the great controversies at present is whether or
not any preventive or social elements are to be included in
the basic nursing course. To some of our friends, this seems
like building a new wing on the house something of a
luxury not to be afforded by practical people. They argue
that the basis of all nursing is sick nursing or what is often
called bedside nursing, and that health nursing is a specialty
to be taken up after the basic training has been completed.

This shows a misconception of the meaning of nursing,
which is fundamentally health conservation. To prepare a
real nurse, prevention and cure should both be built into the
structure from the foundation up; and the human and so-
cial aspects of nursing as well as the physical and technical
aspects. If the nurse is essentially a teacher, as we know
she is, consciously or unconsciously, her fundamental train-
ing should include at least the elements of teaching, so that
beginning with her patients in the hospital, and especially
with the mothers and children, she may learn to teach as
she works in homes, factories, schools, and clinics wherever
her duties carry her. This phase of the nurse's education
has been almost entirely ignored ; it is only by chance that
we have managed to develop a few nurses who can teach
even moderately well.

A PERENNIAL bone of contention among conservatives
^^j^ and progressives in nursing education is on the question
of theory and practice. The former group lay almost every
weakness in the nursing sisterhood (and there are many) to
the fact that we have had too much theory and too little
practical training. Yet a committee of physicians in New
York State, becoming alarmed about the excessive require-
ments for registration, studied the New York state syllabus
last year and found that out of every one hundred hours
prescribed, about seven were given to class work and ninety-
three to practical work! They concluded that the danger
was not perhaps as great as they had feared. While prac-
tically all other recognized professional schools give from
two to four times as much theory as practice, nursing schools
even of the best type rarely give more than about one-tenth
as much theory as practice. This is not because there is
any dearth of knowledge about nursing, or any lack in the
nurse's own desire for understanding, but largely because
of the exacting demands of the practical training.

Without under-estimating the value of practical training
for nurses, we believe that practice without intelligent under-
standing of its purpose, is not only wasteful but dangerous.
Nursing is not only an art, it is an applied science; with



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the growing knowledge of the human body, the dangers
which beset it and the means to be used both for prevention
and treatment, the nurse of today must keep pace with the
advances both in her own field and in medicine. The best
nurses have always been those who stand well in both
practice and theory.

While anatomy and physiology, bacteriology and chem-
istry, seem to me fundamental in the education of the
nurse, I think we have tended to neglect the social
sciences which deal more especially with the human side of
our work. The time is coming, I believe, when sociology and
psychology will be considered just as basic in nursing as
anatomy and physiology. The nurse is not a social worker,
but she must know people of all kinds and the conditions
under which they live and the influences which move them.
She is not a physician, but she must know a good deal about
the diseases that her patients suffer from and the treatment
and prevention of these diseases. She is not a dietitian or
a sanitarian or a psychiatrist, but she needs a much fuller
understanding than she now has of diet in relation to both
lealth and disease, of hygiene and sanitation, of mental
lygiene and behavior disorders.

THE only way to discover what preparation the nurse
needs is to make a study of her present duties and
responsibilities, and then to build up a curriculum of theory
and practice which will help her to understand what she
is doing and to do it better. No one wants to overburden
her with unnecessary studies or to divorce her from the



practical realities of life. Clinical experience is essential ; it
must be strengthened rather than weakened. We need par-
ticularly, more experience in the care of children, in com-
municable and in mental diseases. In the hospital laboratory,
we have the richest possible field for teaching student nurses.
Our main difficulty is in finding the time and the teaching
staff to give the individual instruction which should be go-
ing on constantly in every hospital ward and clinic.

The fundamental issue in nursing education is economic.
Nursing schools are practically always established by hos-
pitals, primarily as a means of getting their nursing work
done and only secondarily for the purpose of offering a pro-
fessional preparation to prospective students of nursing a
system established more than fifty years ago on the older
basis of apprenticeship whereby the student's services are
exchanged for such education as the employer may agree to
give. The great weakness of this system is that the educa-
tion of the nurse is too frequently sacrificed to the urgent
and incessant demands of the hospital. As a rule the school
has no funds of its own ; it must depend entirely on what
the hospital can spare from its limited resources. The re-
sult is that nursing schools are incredibly poor, they have
little or no freedom to determine the conditions under
which they must operate, to establish new policies, or to
extend the scope of their educational work. The low stand-
ards of admission in many schools, the long hours of student
service, the circumscribed curriculum, the lack of teachers
and supervisors, and many other unfortunate conditions can
be traced to this system. While other types of schools are
endowed or have public subsidies, nursing schools are ex-



(In answering advertisements please mention THE SURVEY.)
569



cLlnitif rsit ) of Chicago

Clir (Sratmate erljool of Social s>fruirf 3 turn mst ration



ACADEMIC YEAR 1927-28

Autumn Quarter, October I December 23
Winter Quarter, January 2 March 23

Spring Quarter, April 2 7z/ne 13
Summer Quarter begins June 1 8, 1928

Courses leading to the degree of A.M. and Ph.D.
A limited number of qualified undergraduate and
unclassified students admitted.

For announcements, apply to Box 55, Faculty Exchange

THE UNIVERSITY OF CHICAGO



School of Social Work

SIMMONS COLLEGE
COURSES IN:

Medical Social Work
Psychiatric Social Work
Family Welfare
Child Welfare
Community Work

Address
THE DIRECTOR

18 Somerset Street, Boston, Massachusetts



MEDICAL AND PSYCHIATRIC SOCIAL
SERVICE TRAINING

Lecturef by members of the staff of

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SCHOOL OF HYGIENE AND

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Supervised practice work FAMILY WELFARE

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SERVICE DEPARTMENT, MEDICAL AND

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Two year course leading to M.A. Degree
Fr Social Economics circulars apply to Registrar

JOHNS HOPKINS UNIVERSITY

BALTIMORE, MD.



THE PENNSYLVANIA SCHOOL
OF SOCIAL AND HEALTH WORK



Graduate Training
for Social Work and Public Health Nursing



311 South Juniper Street
Philadelphia, Pa.



I pected to maintain themselves without any additional ex-
pense to the hospital, and in many cases, they help to main-
tain the hospital.

It is extremely creditable to the people in charge of these
schools, that they have been able to do so much. Definite
progress has been made. Hours are improving, though \ve
are still expecting student nurses in most schools to do all
their class work and study outside of the regular eight-hour-
day duty in the hospital wards. We are securing better living
conditions and gradually improving our methods of teaching.

Yet in spite of the attractions in nursing and the over-
powering needs of the field, we are not bringing enough
candidates into our schools and not always candidates of
the type needed to seize the new opportunities which are
pouring in on the profession today. The old system is too
inflexible to adapt itself to these new requirements. It is
like using a narrow country lane for the traffic of a busy
city street.

We cannot compel young women to enter nursing schools.
We must make them want that kind of education as much
as they now want college education. To attract them, our
schools must offer opportunities which compare favorably
with those offered in other professional schools. If the pub-
lic wants enough nurses of the best quality, it must help
make such schools possible. Hospitals have carried the bur-
den of nursing education long enough. They should not
be expected to assume responsibility beyond offering prac-
tical experience and cooperating with well-supported inde-
pendent schools. This whole question is fully presented by
Adelaide Nutting in her recent book, A Sound Economic
Basis for Nursing Schools (Putnam). It is analyzed in the
sound and comprehensive study which Josephine Goldmark
completed a few years ago, Nursing and Nursing Education
in the United States.

There is a great deal in our present system to be cherished,
but it needs to be strengthened, broadened, liberalized, and
brought into line with the best in current educational prac-
tice. If this is not done soon, we may expect, with the
increasing competition from other fields, a constantly dimin-
ishing supply of able young nurses. If we cannot attract
and hold the active-minded, free-spirited members of the
younger generation, the great opportunities which are now
in our hands may be lost for lack of workers who can de-
velop them and put them through. H. G. Wells declares
that in world history it has always been a race between
education and catastrophe. The situation in nursing is seri-
ous, but it is by no means hopeless. There are many signs
of a change one of them the widespread unrest and tension
which always precedes a readjustment. A movement has
already been started at Yale, Western Reserve, Minnesota
and other universities for independent, endowed or state
supported nursing schools, which make the education of
nurses for community service their chief purpose. Our hope
lies in such schools where there is opportunity for expansion,
for experiment, and for adapting our educational program
to the modern needs of the nursing profession.

IS VACATION ENOUGH ?

(Continued from page 564)

sickness is a privilege to which every one is entitled up to a
certain amount.

Rather, is not sickness a misfortune, both for the staff mem-
ber and the society? One to be met, I feel, with utmost
liberality on the part of the society, and one to be avoided by
every means in his power on the part of the staff member?



(In answering advertisements please mention THE SURVEY)
570



Further, the plan suggested ignores the basic need of health
h that the staff member who is frail or has had an illness is
eld to a minimum vacation, while the staff member who is in
obust health and, if we can deduce from that, not in need of
s long a vacation as the frailer member, is granted a longer

acation. .

Does not the premise upon which the article was based imply
hat illness is a matter of intent and that with good intention
t might be avoided? To a limited extent, of course, it can be
voided by good intent; namely, by care of teeth, tonsils,
lygienic habits, etc. But even when a staff is most conscien-
ious in this regard, there still arise instances of individual ill-
icss which must be met and for which I do not feel a staff
nember should be penalized by having a shorter vacation than
he person who was fortunate enough to escape the strepto-
roccus germ, or whatever else was afloat.

The way to reduce sickness charge is:
ist. Searching physical examination at time of induction, to-

gether with correction of any defects discovered.
>nd. Regular examinations annually or semi-annually.
jrd. Wholesome working conditions with regard to health,

safety, and comfort and freedom from over hours.
(.th. Salaries adequate to permit the maintenance of a com-

fortable standard of living and opportunity for recreation

and care of minor health needs, and cultural pursuits.

At least a month's vacation for each staff member, after

a period of one year's service.



ith.
'



ONE SHOW OF HANDS
(Continued from page 535)

Ruth Standish Baldwin, Evelyn Preston, Isabella Curtis,
Amelie Rives, Princess Troubetzkoy, Mrs. George W. Cole-
man, Mrs. J. Malcolm Forbes, Mrs. Howard Cans, Mrs.
Walter Weyl.

One of the most striking group telegrams was from a dozen
scientists from as many American universities and agencies
of research, sent from the biological laboratory at Woods
Hole, Massachusetts.

A committee of six presented the letter and signatui
to Governor Fuller on August 22 four from Massa-
chusetts, two from outside.* Of our hearing I shall perhaps
write another time. Let me say merely that we were con-
fronted by three hurdles. The suggestion was made that
our move was inspired from the camp of the Governor's
"enemies," our petition merely manufactured propaganda.
When this ghost was laid, we were told that such outsiders
as signed had not studied the evidence and had no basis
for judgment. When we pointed out that it was the com-
mission's own presentment that had failed to lay the doubts
of thoughtful people, we were confronted with the state-
ment that all the facts could not be made public. And for
one, I came away with the clear indication that the Gov-
ernor rested his verdict on assertions made to him in
secret, which the defense had no means for knowing or
challenging. t

The sheaf of telegrams we left on Governor Fullers
desk made one point clear that had been obscure before.
They bore witness to him and to the world of the inde-
pendent judgments of men and women whose concern for
American institutions is as keen as that of those who would
defend them right or wrong. They prayed for the lives
of two men, of whose guilt mankind was not convinced.
Their testimony stands.

. To! , n - Mo-= nf Bri=t)p member nf the Harvard Corporation; Waldo
Cook, of 'Springfield, who brought in also an independent petition with
signatures which had been telephoned to the Springfield Republ , can ; the
Rev Edward Staples Drown, of the Episcopal Theological Seminary, Cam-
bridge; John iTovejoy Elliott/of Hudson Guild; Dr. Alice Hamilton, of the
Harvard Medical School; and myself.




aN opportunity to prepare for a
position of responsibility and
leadership at the oldest professional
school of social work in the country,
presents itself with the opening of the
Fall Quarter, beginning October third.
% g 1? Graduation follows
the satisfactory comple-
tion of six quarters
of study.




The New York School of Social Work

107 Eon Twenty-Second Street
New York



$e.so



for both



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Online LibrarySurvey AssociatesThe Survey (Volume 58) → online text (page 128 of 130)