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THE MIND A PREY TO FALSE ASSOCIATIONS
Sometimes a nurse reminds a patient of some one in the past who has complicated her life in an unhappy way, so she distrusts or dreads her or is made constantly uncomfortable in her presence. In such a case, if the nurse reports her patient as resistive, or fearful or cringing, or distrustful, she is really misrepresenting her; for under another's care that patient may show an entirely opposite reaction.
The nurse can only sense the strength of the influence of heredity and environment and habit of thought, which would give the explanation of many things in her patient's attitude. Nor can she realize just what shade of meaning certain phrases and words have for her charge. To the nervously overwrought person the most innocent reference—father, sister, wife, home—may bring concepts that are unbearable. The association of the word may make for deep unhappiness, of which the nurse knows nothing. But she can learn that all these things do influence attitude, can appreciate the difficulty of her patient's effort at adjustment, and do all in her power to make that adjustment possible. If the patient is reasonable she can appeal to her reason. If she is too sick for that, the nurse can use happy suggestions. If the mind is deluded and obsessed she can use firm kindness. She can learn what loss of privileges will affect the rude and unco-operative patient, and may be allowed to try that. She can sometimes help the patient to self-control by making her realize that after each outburst she will be constructively ignored.
But the point we wish to make is this: There are some sick reactions which the nurse, if she recognizes as such, can help the patient to transform into wholesome ones. At the very least the wise nurse can learn to simplify her own difficulties by accepting the unpleasant patient as possibly the result of her illness, and refusing to allow her trying attitude to get on her nerves. The patient may be reacting normally to the stimulus her untrained and toxic brain received. And when the nurse can see into the other's mental workings, get her point of view, she is ready to give fundamental help.
CHAPTER XII
THE PSYCHOLOGY OF THE NURSE
The mind can be as definitely developed and strengthened as the body. The man who has suffered for years an organic disease will never have the same force as he who has never been seriously ill; but his constitution can be built up and made as efficient as possible within its limitations. Many a man or woman who has an organic heart disorder, through treatment and the proper exercises gradually increased, can very often approximate through many years the output of a normally strong person. The individual weakened by a tuberculous infection can frequently, by following a prescribed regimen for a time, by wise, scientific diet and rest treatment and the help of the out-of-doors, then by carefully increased physical activity, finally live the useful, average life. But it takes scientific care to evolve the weak body into a strong one; and in some cases, at best, it can never stand the same strain that the uninjured one carries with ease. However, even damaged bodies can be made very productive within their limited spheres. Also the naturally perfect physique can quickly become unfit through neglect or infections or misuse.
In the same way, and just as definitely, can the mind be developed and strengthened. Some are by nature keen, alert, brilliant. They may develop into masterfulness; or they, too, may degenerate, through abuse, or from the effect of body infections, into uselessness. The germ-plasm has foreordained some individuals to psychic disorders; but training and mode of life can modify many of these defects. And the average mind, like the average physical organs, can be made more efficient through partaking of the proper mental food, through careful training and wise use.
No more urgent necessity faces the professional woman than this of training her mind to its highest productiveness. Argument is not needed to convince intelligent people today that the accomplishment of life depends upon mentality.
Let us look into the very A, B, C's of mind development, and as nurses undertake to equip ourselves to master our profession from the ground up. The first essential is ability to think clearly.
Steps to Clear Thinking:
1. Accurate perception, with attention to the thing that reason chooses.
2. Association of ideas.
3. Concentration, acquired by the help of emotion and will.
4. Emotional equilibrium, which refuses to allow feeling to obscure judgment by leading reason astray.
5. Self-correction.
6. Automatic habits, which free the mind of all unnecessary crowding.
ACCURACY OF PERCEPTION
The beginning of learning is perception. Keen, accurate perception at the time of first introduction of a new fact or thought, and the linking up of that new material with something already in consciousness, insures in the normal mind the ability to remember and use that fact or thought again. The things casually perceived and not definitely tied up with something else are soon forgotten by the conscious mind.
You pass a florist shop where a score of different flowers and plants are displayed. If your thoughts are intently on your errand you may glance in, see flowers, color, perhaps a riot of colors only—and beauty; and you feel a glow of pleasure from the sight. But a moment later you cannot name the blooms in the window. Perhaps roses come to mind because you have very special feeling for them; or carnations, or sweet peas. But the window as a whole you perceive only as flowers, and color, and beauty. You cannot describe it in detail, for you gave it only passive attention.
But if you went to that window to know its contents; to find out what the florist had in his shop, because you are very interested in all flowers and plants, then you can tell minutely what is there. You had a purpose in perceiving the window; your will held attention upon each object in turn; and your love of flowers (an emotion) eased the effort of volition when it might have tired.
Perception, then, is of three kinds: passive, incited by interest, and directed by will. And the perception which is the basis of accurate knowledge is one of keen interest, or of will, or of interest plus will.
TRAINING PERCEPTION
The nurse who demands of herself that she perceive accurately paves the way for accurate, deft service in her profession. There are constant means at hand for training in the art. Suppose you try to get so definite a picture of each ward or room you enter, in a swift but attentive examination of its furnishings and their locations, and of the patients, that you can reproduce it to yourself or a friend some days later.
You come into a large ward, with a row of beds on either side of the door, and a wide central space between. How many beds in each row? There is a table at the far end of the room, opposite the door, and a nurse in white is writing there. Why does she wear white? What is her name? To your right is a closet-like room opening from the ward. That is a medicine-room, you are told. How many windows has the ward? You glance from bed to bed with a rapid passing in review of the patients. Which ones seem to you very ill? There is a large white screen about one. You are told that when treatments are given the screen is put there, or that when a patient is dying the bed is screened. You look for the ventilators, and see how many are open and how they work. You see a room-thermometer, and ask at what temperature it is kept. The nurse explains that a certain degree is ordered, and that, so far as possible, the ventilators are operated to insure that.
If your attention has followed all these details with careful, accurate perception; if you have grasped them clearly, one by one, at the time, you will be able to answer quickly next day when some one asks how many patients the wards accommodate, and how many beds are vacant. You can describe the lighting and ventilation, the room temperature, etc. And later on you will quickly see to it that a screen is properly placed when you know treatments are to be given.
ASSOCIATION OF IDEAS
After the first few years of life practically nothing enters consciousness that cannot by some likeness or contrast or kinship be connected with something already there. Were it not for this saving economy memory would be helpless. So the nurse who is in earnest and eager to master her new work will not only perceive carefully each detail of arrangement, but in two or three days at most will know each patient there; she will have worked out a system of associations, remembering not a meaningless name, but an individual with certain characteristics which she ties up with her name, and so gives it a definite personality. She thereafter recalls not merely a patient, but a very special patient; and as she comes to mind she brings a title with her, which is her symbol. Likewise when her name is spoken or thought, she herself comes into the nurse's immediate consciousness. A bed in a certain part of the room will be no longer merely a bed, but Mrs. Brown's bed. Remembering can be made easy by using some such method as this:
The first bed to the right as you enter is Mrs. Meade's. She is the woman with the broken hip. The next is Mrs. Blake's, that blonde, big woman who wants more attention than any one else. The third is Mrs. Bunting's. She has wonderful, curling black hair, and a nice response to everything done for her. The next beyond is Mrs. O'Neil's. She looks as Irish as her name sounds, and you will remember her by that. So each bed comes to mean a certain patient, and each patient comes to suggest the ones on either side of her—her neighbors. Blondeness and bigness together call Mrs. Blake to mind. Broken hip means Mrs. Meade, etc. Each individual on that side of the ward becomes associated with a name which stands for definite characteristics.
Then you begin at the left bed nearest the door and follow the occupants back on that side. You may remember better by jotting them down in order of the beds, with names and a brief comment on each patient. Keep that list on a small card in your pocket for reference for a day or two, then depend on memory entirely. I have personally found this an excellent method.
You are expected to be able to turn quickly to any medicines needed in emergency, and you soon learn to remember them and where they are placed by the arrangement into classes or kinds, which most hospitals require. Cathartics are together, hypnotics together, etc. So when you want cascara you associate it with cathartic and turn to that shelf. You learn very soon that poison medicines are kept apart from the others, and quickly associate the poison label with danger to patients, necessity of locking safely away and hiding the key from any but those responsible for the care of the sick.
Learning to look closely at the patient's face, instead of casually glancing at her when you care for her, makes it possible for you to note changes of expression, heightened color, dilated pupils, a trace of strain, etc. Then try to find the exact word that will express what you see. Such experiments in perception and attention, association and memory, repeatedly demanded of yourself—i. e., the being able to recall and describe in detail the room- or ward-arrangements and to place the patients accurately, as we have just described—will prove invaluable practice, helping you to attend to every change in your patient's demeanor and expression, which may prove significant symptoms. And remember that while the mind can only contain so many isolated facts, yet there is no limit to its possibilities when the power of association of ideas is employed.
Your first step to clear thinking is accuracy of perception, with attention to the thing reason chooses; your second is association of the things perceived, a grouping of them to fit in with each other, and with what is already in the mind. And both imply the third—concentration, aided by emotion and will. For passive attention and haphazard associations assure the opposite of clear thinking.
CONCENTRATION
How to Study.—You learn sooner or later from experience that the quickest and best way to learn anything new is to give it your undivided attention at the moment; to perceive one thing at a time and to perceive it as something that is definite, or as some quality that is unblurred. One of you will spend three hours on an anatomy lesson, another two hours, while a third nurse may give it a half-hour of concentrated study and know it better than either of you, if you have been day-dreaming, or talking, or rebelling at the "luck" which keeps you indoors learning about bones, when the tennis-court is so inviting. True, some minds have better natural equipment and some have better previous training than others. But the average mind could learn a lesson well in much less time than is spent upon learning it poorly. Few people hold their attention strictly to the task at hand if something more interesting beckons, or if they feel tired, or "blue." But you can learn to do it.
Put aside a certain amount of time today for study; hold your undivided attention on your lesson, regardless of how many pleasanter things appeal. When your eyes or your thoughts wander from your note-book, bring them back forcibly, if need be. Your first task is to keep your eyes there, instead of letting them follow your roommate's movements, or resting them by watching the street below. But it is easier to do this than to make your mind grasp the meaning of the things you see. You may read two or three pages, and not receive one idea, not even be able to recall any words from the context. Your eyes are obeying your will and seeing the words, but your mind is "wool-gathering." Now take yourself in hand firmly. If you are really a bit fagged, try some deep-breathing exercises before the open window, bathe your face in cold water. Then read a paragraph, close your book, and write, if you are not alone, or repeat to yourself aloud, if your roommate is out, what that paragraph says—its meaning. If you cannot do it, read it again with that end in view. Repeat the process, and hold yourself to it day after day, if necessary, until finally will has won the battle, or, better still, your will to learn has been reinforced by an interest in the very competition with yourself, if not yet in the contest. Then, as you learn some facts from your notes, use your imagination to apply them in real life.
The triceps muscle. What is it for? Your notes inform you, and then it is really interesting to see how it performs its function. What origins and attachments must the triceps have to make it extend the arm? Your notes say that a muscle tends to draw the part to which it is attached toward its origin. This triceps muscle straightens the arm. In that case it must oppose the flexion at the elbow. How is that likely to be done? The triceps must start somewhere above the elbow, and quite far above, too, to be able to make a straight angle of an acute one; it must start toward the back in order to draw back the forearm; and be attached to the back of the bone below. Also it must be quite a long muscle. So much reason tells you. Now let me see how it is done, in fact. And you find that the triceps has three origins high above its one attachment as a tendon, to give it a good strong pull. These are in the outside of the humerus and in the scapula. That is logical, and you will remember it.
Now how does the arm bend? What pulls against the triceps? And you are interested before you know it.
There is nothing, good, bad, or indifferent, but has some points of interest if the mind turns its entire attention to it. But our tendency is to grow tired of calling back our wandering thoughts again and again to the thing that is hard, dry, or stupid. And we need more incentive than just the doing of the duty because it is to be done. We need a compelling interest in the goal to encourage our wills to concentration on the less interesting. Let us first think out the why of knowing anatomy if we are to be nurses. And if the profession of nursing is the goal, let anatomy become just the next stretch of the road that leads to it.
Concentration can be acquired. It may require three hours at first to learn your lesson; but later on you will do it in two, then in one, and perhaps in less. And when you can sit down with your notes and learn them with voices about you—perhaps; with some one else in the room; with a party an hour ahead; when you can disregard all but the work at hand, then you can concentrate, and the big battle of your life as a student is won. Study is no longer drudgery. Lessons occupy much less of your time and leave you more free hours. Because you give them your whole mind you learn them in a fraction of the hours hitherto wasted upon them, when you studied with divided attention. When you are doing clear thinking on the thing at hand, satisfactory results are assured.
SELF-TRAINING IN MEMORY
Hand in hand with clear thinking goes reliable memory. But so many of us have it not, and feel its need so strongly that we shall consider for a moment some means of training it.
William James holds that brain-paths cannot be deepened; that memory is not strengthened in that way. There is a natural retentiveness with which some of us are born—the men of colossal intellect—and they remember and are able to use infinitely more things acquired in the past, because they have a brain substance of greater tenacity in holding impressions than others possess. James compares some brains to wax in which the mark left by the seal is permanent; and others he compares to jelly which vibrates at every touch, but retains no dent made in it. From our study of the subconscious we know that the dent did leave an impression on the brain; but it was in the subconscious. So we beg to change the figure and liken, in all mankind, that part of the brain that handles the subconscious to wax, while granting that in some rare cases parts handling the conscious material also hold impressions, as does the wax.
Consequently, according to this theory, we do not strengthen our memories by repetition of facts, lines, or phrases. We cannot grave any deeper the memory paths which nature has provided at birth. But the attention to the thing to be remembered, which repetition has required, has made a larger number of connections of the words with each other, of thought with thought, and of the new with the old. So we have tied the new together with the old by that many more strings, as it were; and any bit of the new tugs at other bits; and the old to which it is tied brings the new with it when it comes to the fore. In other words, careful attention, at the time, to the new stimulus, and its association with the already known, together with repetition, will form a whole system of relations in the mind, and the newly entered material soon become so well-known that it will be difficult to disregard it.
When, in spite of determined effort to remember, the thing is forgotten, especially in the nurse's case, it is usually because the emotional reaction to weariness or to some like obstacle has interfered with proper attention. James advises us if we would improve memory, to improve our thinking processes; to pay more and keener attention, so that we will link things closely together. This in itself will help to arouse interest in the thing to be remembered; and keen interest alone, or careful attention at the time of introduction of the new, and repetition of the thing to be retained, with a will which holds the attention fast, will assure a good, workable memory in any normal mind.
CHAPTER XIII
THE PSYCHOLOGY OF THE NURSE (Continued)
EMOTIONAL EQUILIBRIUM
Suppose that when you first enter the ward you are wishing with all your heart you had never decided to become a probationer. Perhaps the white screen and its possible meaning has so frightened you that your thoughts refuse to go beyond it. Suppose the very sight of so much sickness has agitated you instead of strengthening your determination to help nurse it. That is, suppose your emotions, your feelings, so fill your mind that perception is necessarily inaccurate and blurred. Then tomorrow your account of the ward will be hazy, and your desire will probably be against returning to a place where so many unpleasant feelings were aroused.
The emotional balance which refuses to allow feelings to obscure judgment by leading reason astray is a necessary safeguard for the work of the nurse. There is little place in the profession for the woman who is "all sentiment," but perhaps there is less for the one without sentiment.
Feeling, we found, is the first expression of mind—feeling which in the early months is entirely selfish. The happiest baby you know is not sweet and winning to please you, but because he feels comfortable and happy and cannot keep from expressing it. His universe is his own little self and you exist only in your relation to him. If you give him pleasure he likes you; if pain, he does not want you. His mother often fails to please him, but satisfies him so much more frequently than anybody else that he loves her best. Then comes nurse or father—if he proves the satisfactory kind of father, or she a nurse he can love. To the baby whatever he happens to want is good. What is not desirable is bad. And such emotional responses are altogether normal in early months, yes, even until the child is old enough to use reason to choose between two desires the one that will in the end prove more satisfying. But they are defects in adult life.
The nurse who would always act as her first feeling dictates would not be in training many days. Unpleasant sights and sounds, the fear of making a mistake which might harm a patient, the undesirability of long hours of hard work in caring for patients who frequently only find fault with her best efforts, would early decide her in favor of another life-work. Comparatively few so-called "grown-ups" are guided only by feeling; and most of those are in institutions that are well safeguarded. But a great many mature men and women allow feeling to unduly influence their thinking. The sentimental nurse, for instance, may find it very difficult to give an ordered hypodermic. The patient dreads the pain and the nurse fears hurting her. Suppose she were to fail to give it on such grounds. This is an almost unthinkable case. But the very nurse who agrees that such an emotional weakling should not be allowed to train, will help her patient, even when recuperating nicely, to grow inexcusably self-centered, by sympathizing with every complaint, warning her at every turn, by allowing her and even encouraging her, perhaps, to discuss her illness and suffering in the minutest detail. This nurse is more damaging than the sentimentalist who fails to give the hypodermic; for that slip is easily discovered, and the transgressor must immediately reform and obey orders, or be dismissed. But the second nurse may take perfect care of the sick body, and the doctor never realize that she is developing the sickness idea in her patient's mind.
In both of these instances reason has followed the leadings of feeling. It is unpleasant to hurt the patient, and she is disagreeable, too, when you insist on carrying out the orders. It is easier to agree with her ideas and sympathize with her troubles, much easier than to find some other avenue for her thinking, or to search for feeling substitutes. It is pleasanter right now to allow her mind to slip unmolested into sick reactions than to lead her, unwilling as she is, into the ways of health. Reason follows feeling's logic, which suggests that it is much better for the patient to talk of her ills than to keep them pent up inside; and judgment is sadly obscured.
The emotionally balanced nurse hears the story once, that she may have the material for helping the need. Feeling, perhaps deep and genuine sympathy with a real trouble, is aroused, and rightly. But this brings a keen desire to help the situation. Reason insists that talking of sufferings, real or fancied, only makes them more insistently felt; that there must be some better way to meet them. It suggests various methods to divert the patient's attention, to change the train of thought until she is able herself to direct it into healthful channels; judgment weighs the propositions and decides upon the one which will lead toward establishing a health attitude.
The nurse is continually meeting the necessity of acting contrary to fear and discouragement and weariness of spirit. How can she secure emotional equilibrium for herself?
Keep in mind the fact that most sick people are very suggestible; that you have a definite responsibility to make your suggestions to your patient wholesome; and that your mood is a constant suggestion to him. Remember that he needs your best. Then, if your own trouble seems too great to bear, determine that, so long as you remain on duty, you will not let it show. Try an experiment. See if you can go through the day carrying your load of sorrow, or disappointment or chagrin, with so serene a face that the sick for whom you are caring will not suspect that you have a burden at all. That is a triumph worth the striving. Then—if you can let it make you a little more comprehending of others' pain, a little more gentle with the sickest ones, a bit more patient with the trying ones, more kindly firm with the unco-operative, realizing that each one of them all has his burden too—you have not choked feeling, but you have fulfilled reason's counsel: that sick people are not the ones to help you in your stress; that a good nurse should rise above personal trouble to the duty at hand. Your judgment has compared your reasons, and decided that you should act before your patients as you would if all were well. And will holds you to emotional equilibrium. Such a thing can be done in a very large measure; and no better opportunity for emotional control will ever be offered than the necessity of being calm and serene before your patients, no matter how you feel.
But, while reason and judgment teach us to control the expression of certain feelings, they urge that this control be exercised in transforming those feelings into helpful ones and giving them an adequate outlet. Such a substitution has been suggested above. Let us not forget that nothing in existence is of personal value until it gives some one an emotion; that feeling is the beauty of life; that living, without the happy, wholesome affective glow, would not be worth the effort; that beauty and strength and sweetness of feeling make for a worthy self. Remember, too, that feeling is the curse of life. It is feeling that would make us give up the whole struggle; and ugliness and weakness and bitterness of feeling make for a despicable self.
Hope lies for us all in the realization that we can choose our feelings, our responses. We can be utterly discouraged, and bitter and depressed at failure; or we can recognize it as a sign-board telling us that the other way than the one we just followed leads to the goal. And we can follow its pointing finger with faith in a new attempt because, now, we know at least how not to go. We can learn despair from all the bitter and the hateful and the mean; or we can learn that they never could be called so if there were not the sweet, the lovable, and the generous with which to compare them. You can learn to search as with a microscope for all the undesirable traits of your patients, or you can calmly accept all that assert themselves as undeniable facts, but use your microscope to find their desirable characteristics which offer possibilities of being brought to the foreground.
You cannot constructively help yourself or your patient by denying the existence of the less worthy traits; but you can resolve to call out the something better. And if you do not find it, as may rarely be the case, you can refuse to let it make you skeptical of finding it in others. Let us remember always that, "It is not things or conditions or people that harm us; it is only the way we respond to them that can hurt." This one great truth, if really believed and made a part of all our thinking, would save scores of people from nervous wreckage. It is a favorite saying of a wise man who has helped a great many people to endure and take new courage when life seemed too hard to meet.
That big, broken-arm case on the ward cursed you yesterday because you would not loosen his splints. And you rushed from the room angry and humiliated, wishing you could quit nursing forever, and asked to be moved because you had been insulted. But that man cannot harm you. He has never known a real lady in his life before. His training from childhood has been to regard women as chattels to do man's bidding; his experience in life is that they usually do what he asks—women of his kind. Moreover, he has never had a serious pain before, and it is not to be endured.
Of course, the man must be dealt with and made to realize the distinction between his new surroundings and the old. Probably the intern or the doctor is the one to do it. Also he must be brought to apologize, or leave the hospital, perhaps. But he did not hurt you. Your own reaction did that. For outside things or people cannot damage what we are in ourselves. The way we respond to them does the harm. When you can control your expression of anger and humiliation, and substitute for your intense feeling a desire that such a patient may learn that pain is often the gateway to healing; that some respect for women may be kindled in him, so that eventually such an outburst in the ward may be impossible for him or for anyone who heard it; then you are choosing between emotions the one of helpfulness, for the one of justified indignation; and feeling has followed reason, rather than leading reason astray. The judgment which decides you to try methods which will shame or inspire some manliness into the patient was one influenced by a well-balanced emotional life.
If we would really acquire emotional poise, there are a few practical, proved methods we might adopt for ourselves.
When we can hold back the expression of the almost overpowering impulse or passion of anger and resentment and hurt; absolutely shut tight our lips until we can think; then wait until we can think without the strain of intense feeling, we will not only keep ourselves out of trouble, but will be able to calmly state our position, right the wrong done us if wrong there was, or recognize that we ourselves were wrong. For we seldom analyze the situation properly under the influence of strong feeling. If we want to accomplish anything with our words, let us wait until we can speak them without having to choke down our sobs or cram back our hot anger, or forcibly restrain ourselves from tearing things or slamming doors. After all that "wild fire" of emotion is gone, judgment will lead us to wisely reasoned action.
SELF-CORRECTION
Accuracy in work, a primary essential to the nurse, can become automatic if she will demand of herself accuracy of perception, and concentrate on learning and doing until details almost take care of themselves; if she will correct her own work by the standards taught her, and recognize just why and wherein she falls short. Not that she can always do things with the nicety in which they were taught. She cannot give eighteen ward patients in eight hours the same detailed care her private patients would receive if she had only two of them for the same length of time. In such a case she must often sacrifice refinements of detail in service; but there is no excuse for sacrificing accuracy in the necessary treatments of her charges. The nurse merely chooses between the multitude of things which can be done for her ward, the important ones which must be done. Because she is rushed is no excuse for giving a poor hypodermic injection or a careless bed-bath. Accuracy in doing the essential things should be so automatic that it takes not a whit more time than inaccurate doing; and such accuracy is chiefly dependent on constant self-correction when the task is still new, and on never letting up in practice until the details of the doing become practically automatic.
TRAINING THE WILL
There is no better opportunity for will-training than the hospital affords the nurse. The constant necessity of acting against desire, of doing tasks which in themselves cannot be agreeable, calls for a developed will, while it gives it constant exercise. Moods of discouragement and depression cannot be indulged. The nurse must do her work no matter how tired or blue or "frazzled" she feels, if she is not too sick to be on duty; for all time lost, she knows, is to be made up to the hospital before training is completed.
Can this will to do, despite strong desire to the contrary, this mood control and the ability to disregard physical discomfort, be acquired; and if so, how?
It is a law of the mind and of the body that any task becomes easier by repetition. We found that automatic habit eases much of the strain of action. What seemed repulsive service to the probationer on her first day in the hospital, she forced herself to do because she wanted to be a nurse. She may go on through her three years unreconciled to these particular duties, yet holding herself to them because she likes other features of her work, or because she must earn her living and this seems the best avenue open to her, or because her will to become a nurse is strong enough to make her act continually against desire. And finally, for almost every nurse, the interest in the end to be attained overshadows the unpleasant incidents in its way. The tasks are actually easier by their constant repetition, and her feeling of repugnance becomes only a mild dislike. She has strengthened her will by continuing to act against desire. But there is a better way to the same goal.
The woman who has thought out the reasons for and against taking training; who has considered it carefully as a profession, and has chosen to put up with any obstacles in the way of becoming a graduate nurse, can find a happy adjustment to the disagreeable incidents it involves. Realizing that the paths of learning are seldom thoroughly smooth, she can resolve to use their very roughness for firmer footholds, as a means to self-control, as a fitting for the sterner hardships of self-support, of nursing the dangerously ill, alone, of meeting suffering and death in her patients with quiet courage and faith. In other words, she can meet the thousand and one personal services which in themselves might be disagreeable and prove pure drudgery, not merely with the stern will to do them because they are a necessary part of obtaining a desired end, but also for the sake of adding to the comfort and well-being of each patient in her care. The emotion of interest and kindly desire will ease the strain which will undergoes in demanding that she not shirk the disagreeable. For there is little stress in doing what we wish to do.
It is psychologically possible to find genuine pleasure in the meanest tasks if the doing is backed up by a strong desire to make life count as much for others as possible. The nurse who comes to realize the waste involved in carrying out against desire what reason proposes and volition dictates, will try to secure the co-operation of desire, and save will-force for more worthy accomplishment.
A constant opportunity for will-strengthening comes to many a nurse during the early weeks and months of training in the necessity of going on despite the sheer tiredness, the weary backs and swollen, tender, aching feet. The one who means to "see it through" disregards them as far as possible on duty, gets all the out-of-doors her time permits, takes special exercises to strengthen weak spots, and relaxes her body while she reads or studies or visits in her off-duty time. In the end, not only does her body adjust itself to the new work, but her will has become a better ally for the next demands upon it; her endurance is remarkably increased.
When she can accept hardship, drudgery, weariness of mind and body and perhaps of soul, the nagging of unco-operative patients, and the demands on her sympathies of the suffering; when she can meet these as challenges to develop a strong will—a will not only to endure, but to find happiness and give service through it all—then the nurse has learned the art of making every circumstance a stepping-stone to mastery and achievement.
CHAPTER XIV
THE NURSE OF THE FUTURE
The student of life and of the sciences which deal with the origin and development of the human race, and with the relations of man to man and nation to nation—such sciences as biology and anthropology, sociology and ethics and history—comes to the conclusion that life exists for the development of mind. And mind is not merely intellect, but the only gateway we know to character, to soul. The deepest students of human science see no reason for life except as it "evolves" a perfect mind—man's goal, his ideal. And this visioned perfect mind is one which adjusts itself without friction to the body, making it fulfil the laws of health that it may help and not hinder mind's progress; one which adjusts itself to people and things, co-operating with other minds to develop manners and customs and laws of the most satisfactory community living; one which forces things to be servants of its will; one which makes harmony of life by fulfilling the laws of the soul as well as of the intellect and of the body.
If we believe that life exists for the development of mind into a force of intellect and character and soul, then we need not ask why a nurse should know something of the laws of mind. She does not ask why she should know anatomy or pathology. Her work is dependent upon such knowledge. But if the center of life, the thing which makes the body a living, moving, acting agent instead of a clod, is mind; if the one thing which makes a difference between animal life and mineral and vegetable life is consciousness, i. e., mind; and if everything that affects that body, its organ, affects mind also—then surely no nurse can afford to learn only the rules of repair or of keeping in order the instrument of consciousness, without knowing what effect her efforts have on the mind itself. It is as though an ignorant maid accepted a piano as merely a piece of furniture to be kept clean and shining, and in her zeal to that end scrubbed the keyboard with soap and water which, dripping down into the body of the instrument, swells and damages its felts, rusts and corrodes its keys, and ruins its notes. When she knows that she may thus make impossible the beautiful sounds she has heard it give, and that the more carefully the keyboard is handled the more sure is the beauty resulting, her care is to keep it as free as possible of dust, to see that the top is down and the keyboard covered when she sweeps—and to clean it hereafter in such a way as to never injure its tone.
The nurse has a much greater function than merely to help in saving the body and keeping its machinery in order. If the aim of life is the strengthening and perfecting of the mind—that "urge" of life, then surely the nurse's big aim will be to help establish such health of body as leads toward health of mind. In the average man or woman this vital urge becomes temporarily blocked by the very weakness of the body it urges. The body must give the life-flame some fuel, or it dies out; but with very little fuel it flickers on, waiting, hoping for the more that it may burn strongly again. In the cases the nurse handles very often the "vital spark" has been poorly fed by the disabled body, and so discouragement or depression, or "loss of grip" results, or the flame continues to shine brightly with whatever little sustenance it receives, and so encourages the body to greater effort for it; or sinks into embers, glowing steadily though dully; or it burns wildly, recklessly—it becomes what we call "wild fire," that has no direction and no purpose save to burn up everything it can find.
In other words, the nurse deals with those in whom the "urge" is weakened—the depressed and discouraged; with those whose spirits never flag in their steady shining—those brave souls we could almost worship; and those others who hold grimly on with quiet grit and courage, but with no cheer; and with the unstable ones of neuropathic or psychopathic tendency who become hysteric or maniacal.
What will the nurse do for them all? Will not an understanding of how to recall the ambition to live, the will to get well, and the grit to see the thing through, be an incalculable asset.
THE NURSE OF THE FUTURE
The nurse of the future will not be merely a handmaiden to care for the sick body by deftly carrying out the doctor's orders. She will do this almost automatically as a matter of course, and skilfully; but it will be the merest beginning of her mission. That mission itself will be to eliminate the causes of disease; to teach the ways of health, to supervise the sanitary conditions of city, town, and country. Practical ways and the wise means to this end will be taught in her hospital, which will become a community center with clinics, teaching through its doctors and nurses the way to health, instead of merely treating and advising the cases as they come. But the greatest contribution of the nurse of the future will be a wide-spread desire for health and will to health, rather than a desire and will to avoid discomfort and pain and danger of death. This will to health will doom in the sane mind the disease-accepting attitude. It will do all that common sense and applied medical science can do to strengthen the body; then it will take what life brings in the way of unavoidable disease and weakness and inability, with an uncringing mind. It will hold the mind's attitude to serenity and poise and accomplishment within the necessary limits of its disordered body. It will be master of its dwelling and make the most of the little the body can give, and force all bearable weakness and pain to be stepping-stones to endurance and will-strength and cheer. It will not accept physical limitations as final things. If life must be lived in a prison-house it will be its own jailer, and fill the rooms with flowers, music, friends, and happiness.
No nurse is competent to help her patient to overcome any curable physical weakness, and keep the mind serene in the face of the incurable, until she herself has learned that the will to health is capable of transforming disease of body, from disaster, into health of mind and soul.
The nurse of the future will know the laws of mind as she knows the course of disease; she will be dedicated to such wise care of existing disease as will lead to prevention of future disease; and she will be a sworn, trained ally of the health-accepting mind.
INDEX
Absent-mindedness, 64
Absolutes, 54
Abstract concept, 52 object concepts, 53 quality concepts, 53
Accuracy of perception, 141
Action cannot be separated from feeling, 68
Acts, compulsive, 106
Adaptability, 79 necessity of, 80
Amnesia, 103
Anesthesia, 101
Aphasia, 103
Apperception, 54
Association of ideas, 143
Attention, 79 of interest, 112 of reason and will, 118 root of disease or health attitude, 112
Autosuggestion, 84
Awareness, 15
Bad habits, 91
Beginning of reason, 69
Body and mind, relation of, 40
Borderland disorders, 107
Brain, 33 hind, 43
Censor, 31
Central and peripheral nervous systems in action, 35
Cerebellum, 43
Cerebrum, 43 functions of, 45
Clear thinking, steps to, 140
Compulsive acts, 106 ideas, 103
Concentration, 146
Concepts, 52 abstract, 52 object, 53 quality, 53 concrete, 52
Concrete concepts, 52
Consciousness, 15, 20, 21 definition, 15 flow of, 47 in delirium, 32 in sleep, 31 is complex, 29 organs of, 34 personal, 57
Delirium, consciousness in, 32
Deluded patient, 133 nursing of, 135
Delusion, 104 nihilistic, 104 of reference, 104 somatic, 104
Determination, 18
Development of reason and will, 71
Disease attitude, attention, root of, 112
Disorders, 95 borderland, 107 of emotion, 99 of functions of intellect, 96 of ideation, 97 of judgment, 99 of memory, 98 of perception, 96 of reason, 98 of sensation, 96 of will, 99
Disorientation, 103
Distractibility, 105
Effort, habit a conserver of, 90
Emotion, 18, 45, 49 disorders of, 99 the place of, 67
Emotional equilibrium, 152 reaction, normal, 77
Environment as cause of variation from normal mental processes, 109
Equilibrium, emotional, 152
False associations, mind a prey to, 137
Feeling, 49 cannot be separated from action, 68 from thinking, 67 from will, 68
Fixed idea, 103
Flight of ideas, 102
Forebrain, 43
Future, the nurse of the, 164
Getting other man's point of view, 126 patient's point of view, 124
Habit a conserver of effort, 90 bad, 91 hospital, 92
Habit-formation, 79
Hallucination, 101
Health and psychology, 79 attitude, attention, root of, 112
Heredity as course of variation from normal mental processes, 108
Hind brain, 43
Hospital habit, 92
How to study, 146
Hurt, 70
Hyperesthesia, 101
Hypersuggestability, 84
Hypochondriasis, 102, 108
Hysteria, 107
Idea, compulsive, 103 fixed, 103
Ideas, association of, 143 flight of, 102
Ideation, 52 disorders of, 97
Ideogenous pains, 103
Illusion, 101
Imagination, 58
Impulses, insane, 108
Inhibition, morbid, 104
Inorganic memory, 52
Insane impulses, 108
Insanity, 107
Instinct, 59
Instincts, list of, 61
Intellect, 18, 45 functions of, disorders of, 96
Interest, attention of, 112
Judgment, 56, 72 disorders of, 99
Life, mental, 14 conditions of, 19 phenomena of, 15
Mania, 107
Melancholia, 107
Memory, 51, 62 disorders of, 98 inorganic, 52 organic, 51 self-training in, 150
Mental disability, states of, 100 life, 14 conditions of, 19 phenomena of, 15 processes, normal, variations from, 95, 101 factors causing, 108
Mind, 14, 33 a prey to false associations, 137 and body, relation of, 40 functions of, 50 normal, 47, 77
Mood, 49
Morbid inhibition, 104
Motion, 26
Movement, 26
Mutism, 106
Necessity of adaptability, 80
Negativism, 106
Nervous systems, central and peripheral, in action, 35 sympathetic, 37
Nervousness, 106
Neurasthenia, 108
Neuropath, 108
Neurosis, 106 from psychosis, 82
Neurotic, 108
Nihilistic delusion, 104
Normal emotional reactions, 77
Normal mental processes, variations from, 95, 101 factors causing, 108 mind, 47, 77
Nurse of the future, 164 psychology of, 139
Nursing deluded patient, 135
Obsessed patient, 136
Obsession, 105
One thought replaced by another, 89
Organic memory, 51
Organs of consciousness, 34
Overactivity, psychomotor, 106
Pain, 69 ideogenous, 103
Patient, deluded, 133 nursing of, 135 obsessed, 136
Patient's point of view, getting, 124 what determines it, 124
Percept, 51, 52
Perception, 51 accuracy of, 141 disorders of, 96 training of, 142
Peripheral and central nervous systems in action, 35
Personal consciousness, 57 reactions as cause of variation from normal mental processes, 110
Personality, psychopathic, 108 shut-in, 104
Perversions, 95, 101
Phenomena of mental life, 15
Phobia, 108
Place of emotion, 67
Pleasure, 69
Point of view, getting other man's, 126 patient's, getting, 124 what determines it, 124
Poor memory, 64
Power of suggestion, 84
Premise, 72
Protozooen, consciousness in, 15
Psychasthenia, 108
Psychology and health, 79 definition, 12 of the nurse, 139
Psychomotor overactivity, 106 retardation, 106
Psychoneurosis, 106
Psychopathic personality, 108
Psychosis, 107 neurosis from, 82
Pugnacious instinct, 60
Reactions, normal emotional, 77 proportioned to stimuli, 75
Reason, 56 and will, attention of, 118 development of, 71 beginning of, 69 disorders of, 98
Reference, delusion of, 104
Relation of mind and body, 40
Retardation, psychomotor, 106
Saving power of will, 93
Science, 13
Second-nature, 90
Self-correction, 160
Self-training in memory, 150
Sensation, 51 disorders of, 96
Sense of unreality, 104
Shut-in personality, 104
Sleep, consciousness in, 31
Somatic delusion, 104
Steps to clear thinking, 140
Stimuli, reaction proportioned to, 75
Stimulus, definition, 22
Stream of thought, 50, 57
Study, how to, 146
Suggestibility, 79
Suggestion, power of, 84
Sympathetic nervous system, 37
The unconscious, 23
Thinking, 49, 58 cannot be separated from feeling, 67 clear, steps to, 140
Thought, stream of, 50, 57
Thought-substitution, 79
Tic, 105
Training perception, 142 the will, 161
Unconscious, the, 23
Universals, 53
Unreality, sense of, 104
Variations from normal mental processes, 95, 101 factors causing, 108
Volition, 45, 50
What determines patient's point of view, 124 we attend to determines what we are, 86
Will, 50, 79 and reason, attention of, 118 development of, 71 cannot be separated from feeling, 68 disorders of, 100 saving power of, 93 training of, 161
A Short History
of Nursing
From the Earliest Times to the Present Day
By Lavinia L. Dock, R.N. Secretary, International Council of Nurses
In Collaboration with Isabel Maitland Stewart, A.M., R.N. Assistant Professor, Department of Nursing and Health, Teachers College, Columbia University, New York
12^o. Price, $3.00
This New Volume Has Been Prepared Especially for the Use of Student Nurses
It is, in effect, a condensation of the four volumes of the larger History of Nursing, prepared by Miss Dock in collaboration with Miss Nutting, a work which has been considered standard on the subject, but which, by its very nature, was too elaborate for class use. This condition has now been overcome by condensation into this single, comprehensive, inexpensive volume of all the salient facts of the larger work.
It is generally believed that the best place in the nursing curriculum for the History of Nursing is in the early part of the first year, when the student is just beginning to form her conception of nursing, and is being initiated into its traditions.
The Many Excellent Features of this Short History of Nursing
will inevitably bring it into use in a very great number of Hospital Training Schools; it should, of course, be in the library of every Hospital which does not maintain a Training School. It is believed that it will be found to be
The Best Volume on This Important Subject
(Over)
Some of the
Putnam Nursing Books
Maxwell and Pope's Practical Nursing Price $2.50.
Cadmus' Manual of Obstetrical Nursing Approximate price $1.50.
Dock's Materia Medica for Nurses Price $2.25.
Higgins' Psychology of Nursing Price $2.50.
Pope's Manual of Nursing Procedure Price $2.40.
Pope's Essentials of Anatomy and Physiology for Nurses 600 pages. Price $2.90.
Pope's Quiz Book for Nurses 485 pages. Price $2.50.
Dock and Nutting's History of Nursing In four volumes. Illustrated volumes 1 and 2, price $7.50. Volumes 3 and 4, price $7.50.
Dock and Stewart's Short History of Nursing One volume, 400 pages. Price $3.00.
Pope's Physics and Chemistry for Nurses 450 pages. Price $2.50.
Arthur W. Isca Medical and Nurse Books Besse Building Minneapolis, Minnesota
* * * * *
Transcriber's Note: Here is a list of corrected errors. Line numbers count from the start of the book itself not including the Transcriber's Note. Alternatively, use the HTML version, in which the errors are marked.
l780: ecstacy changed to ecstasy l1258: Missing full-stop in i. e. l1665: or changed to of l1766: pasttime changed to pastime l1867: strees changed to stress l1883: council changed to counsel l1994: , changed to . l2324: em-dash changed to hyphen l2588: hypochondrasis changed to hypochondriasis l2817: successfuly changed to successfully l3334: stubborness changed to stubbornness l4120: in changed to is l4198: weakenss changed to weakness
The inconsistent hyphenation of hypo-mania is as in the original.
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