Contents
"Manifesto for
Nursing" by Lynne Bentley
"Your
Presence
is Requested: A Metaphorical Manifesto" by Linda Smith
YOUR
PRESENCE IS REQUESTED:
A
METAPHORICAL MANIFESTO
Linda Smith, Doctoral Student, University
of Colorado School of Nursing
You
are invited to a dinner party.
You don't want to go.
The invitation that arrived in the mail indicated your attendance was
mandatory.
The actual invitation was crisply white and formal in tone. On your
calendar were several important engagements that would clearly conflict with the
date.
They will need to be reshuffled.
The good news is, it is not necessary to 'RSVP'.
You are expected and you will arrive at the appointed hour.
Greeting
you at the door, your host and hostess seem friendly enough.
While you have never met these people, you are aware of the seamless
attention to detail in the preparations made.
Even though they don't know you, you sense their interest in you as a
person. Some guests have already arrived.
Some cluster in small conversational groups, some seem somewhat distant
and maybe even anxious.
You
notice that your host and hostess are extraordinarily attentive to the needs of
each guest.
Before a glass is empty, it is refilled.
Hors d'oeurves are plentiful. Before the small quartet finishes their
number, the couple approaches to ask that another popular piece be played.
Still, the tone is somber.
The music does little to lighten your mood.
One
guest that you recognize approaches.
You have met this person before.
He seems rushed and doesn't have too much time to spend with you.
He tells you in a hurried but respectful manner what will happen here and
then, must excuse himself. Meanwhile, the host and hostess present themselves to
ask about your experience at the party thus far.
You hadn't noticed they were anywhere near. You tell them that you are
dismayed about the invitation, about having no choice and wished you had more
information.
They listen and look you in the eye.
They seem to understand something of your concern.
Caterers,
musicians, bartenders and wait staffs serve in their respective capacities.
Your host and hostess continually check in with them.
They are supportive but seem to have clear expectations of these
individuals.
In the kitchen, too much noise from pots and pans catches their attention
and you notice them go into and out of the food preparation area. There is a
subsequent decrease in the confusion as they check in on a different party
participant.
The
hour is getting late.
The quartet carefully packs their instruments while the catering crew is
seen rushing about taking inventory of the remaining foodstuffs.
The bartender gathers his supplies and collects his tips from the tray
placed discretely at the far end of the credenza.
The host and hostess remain in attendance making sure each functionary
respects the space of those in attendance.
The doorbell rings, more guests arrive.
The telephone must be answered.
Some of the earlier guests are making preparations to leave.
Others appear to be staying for awhile. . . they have suitcases in the
hall closet.
You
wonder about this host and hostess.
How can they be so gracious and seemingly interested in the needs of so
many people?
How are they able to anticipate what is needed and look people in the
eye? Will they ever get to lock the door?
People keep arriving and the guests already there, (like yourself),
require their ongoing attention.
What does it take to host a party that no one wants to attend?
Characterizing
illness as an invitation no one wants to receive and metaphorically presenting
nursing as in the above scenario may be one way to convey our sense of the
discipline.
With acceptance of the narrative as written by patients, an opportunity
exists to present the stories of nurses as they host their healing enterprise.
Rather
than engage this struggle alone, we can enlist the persons who receive our care
as active members in the corps.
The nursing manifesto document notes that "(H)aving found these
authentic bonds as nurses, we realize we can rely on each other as we seek
conscience-based action. ."
We do not have to rely on each other exclusively. Enjoining our patients
and those in public governance to listen to real life stories may be one appeal
that is worthy of attention.
In
the interest of preserving confidentiality, nursing has taken on an aura of
mystery and is outside the awareness of the patient as consumer. So much passion
and heroism that is daily applied in the care of people goes unnoticed.
How can we expect others to appreciate what the discipline offers if it
is never made public?
Until the accidental guest arrives at our party, our work is strictly or
largely invisible.
The caring embedded in the tasks we perform is unsung and undocumented.
Celebration of the uniqueness of each person and nursing's vigilant
nurturance of that uniqueness is not in the public awareness.
While
nursing did not impose the business model on health care delivery, it behooves
us to be fully present in the reality that economics are important in this
enterprise and will remain so for the foreseeable future.
Nursing can name and seek inclusion in the taxonomies of the more
specific interventions we daily perform such as empowering, enabling,
reconciling and replenishing our patients and their families.
The
following action items, then, are offered as suggestions to engage the
recipients of our care in the preservation of this most intimate and passionate
of disciplines:
*Nurses
with artistic and literary talent will present their stories in formats that
suit their unique abilities.
Protection of patient confidentiality will be mindfully respected.
*Opportunities
arising to interface with underserved persons using web-based communication will
be assessed and employed where possible as an adjunct to in-person or telephone
communication.
Resistance from nursing will be respected and addressed so that concerns
may be respectfully understood.
*Nurses
with a political imperative will seek the support of the consumers of our care
(including politically influential persons) in ways that fit their own
individual style.
*Working
within organizations, nurses will operationalize and name the ways of knowing
that are currently under-reported in documentation.
*Nurses
in administration and education can claim the passion of nursing and share it
with others.
Expecting passionate care from staff and students does not 'fly in the
face' of professionalism in the discipline.
It is our discipline.
*Nurses,
as the single largest group in health care delivery, will actively survey the
public and seek their opinions as to action agenda items they want implemented
in their care-
*Nurses
must seek to clarify the relationship with physicians from economic,
philosophical and practice perspectives.
Confronting an outdated model of physician-nurse interface may empower
both disciplines to pro-actively reconstruct care delivery.
Clearly,
this list is not exhaustive.
The language is concrete and more focused on action items than on the
passion that pervades the Nursing Manifesto.
Putting passion into public awareness is no small task.
Those who have been to our party report about their experiences; some
with disappointment and some with awe and gratitude.
Presenting in a visible way nursing's direct and invested role in health
care delivery will serve to heighten awareness of the possibilities and
expectations for real world, real time ministration.
The
discipline, at this moment, finds itself in the position to be either pro-active
or reactive.
What we do now will influence the possibilities for engaged, enlightened
care going forward.
Not many of our guests are happy to see us; they come with chronic and
emergent conditions, they come not knowing what we do or what to expect.
Most are anxious and overwhelmed.
This is a function they would rather not 'pencil' into their respective
calendars.
We
are not the band.
We will not function as the caterers.
Our charge is to assure that each guest has an experience that values and
nurtures his uniqueness. Recognizing the inherent potential for emotional,
physical and societal healing that presents each time a patient "knocks at
our door" we will share our stories.
We will report and document instances of caring and healing that
accurately portray nursing as invested and engaged professionals.
Technicians
cannot threaten engagement.
By definition, technicians do technical tasks.
Nursing takes responsibility for the preservation of the whole person; of
the fears as well as the gastrointestinal bleeding. . .of the pain as well as of
the delivery of the infant. What is at stake is the humanity of the persons we
serve.
Left to the perspective that persons as recipients of care are consumers
of healthcare and nothing more, nursing will fall below the 'poverty line' in
resource availability.
Open
the doors then.
Allow caring to be present in popular literature.
Educate potential patients and solicit their opinion.
We, too, will receive an invitation to the party someday.
It is our responsibility to assure that when the mailing arrives, our
reaction will be hopeful.
Linda
West
Spring 2000
Manifesto for Nursing
Lynne Bentley, Doctoral Student, University
of Colorado School of Nursing
Healthcare
delivery appears chameleon-like in the changing nature of this time.
Unprecedented technological advances accompany an attitude of invulnerability
and create a blind-spot toward the blatant degradation and decay of social
institutions along with our environment. Healthcare
continues to be primarily for the privileged; and the poor who can manage to
find access. Even for those for
whom healthcare is available, it is found to be lacking in an elusive
‘something’. Nurses, still
seeking a unified ontology, seem unsure of their role in this transient
environment. A courageous few are clamoring for a transformation.
The
transformation requires a bold move, an ‘out on a limb’ move.
It is time for a ‘return to our roots’ attitude and a move away from
the greedy, grasping mentality that pervades Western society. The core values of
the discipline of nursing from Florence Nightingale, and earlier, need
rejuvenation. Caring for the ill and injured has historically been a sacred
service, often filled with ceremony and ritual, prayers and even song.
Nightingale advocated that nursing adopt an attitude of reverence and
sense of duty in caring for the ill and injured.
Nursing in this postmodern time still carries this commitment and is
overdue to operationalize this in a way that is meaningful for the discipline
now.
Nursing has
strayed from it’s core, it’s heart. When
nurses are living the core values of the discipline there is meaning and
fulfillment in the work. The heart
of the discipline lies in the essential ethics of service to our fellow human
beings and to the Earth who provides sustenance for our very lives.
The return to
the heart of nursing begins with a clear and uniform understanding of our core
values, followed by a clear and uniform understanding of how to reinfuse these
values into our practice, research and education. As Dr. Jean Watson has so eloquently stated, the ontology of
the discipline of nursing comes from caring, not from the various techniques and
technology of our times. Living a
doctrine of reverence and sacredness in our work with a service orientation
focuses every task, every interaction and every technological tool with an
intentionality that exemplifies the ontological foundation of caring.
The heart of nursing today can be found in the artful authenticity of
caring.
Nursing has had
the same core values since it’s origins.
It has been side-tracked by the medical model power base which publicly
defines healing from a limited view. The
objective is restricted to measurable physical/cognitive/emotional change.
Nursing has a philosophical basis that values healing as an expansive,
multidimensional, transcendent system rather than hierarchically placing the
greatest value on the physical dimension of healing.
The dogma surrounding the value of cure is being questioned and patients
themselves are calling for change. Surveys abound documenting that spirituality
and prayer in healthcare delivery rank at the top of the ‘wants and needs’
list of patients. Connection and
humanness are missing and people are decrying the objectification by the system.
Instead, people want meaning and a sense of being cared for and about as
human beings. Nursing must
recognize this call and return to the truth of it's core values.
From
Nightingale to Watson and beyond, nursing has dedicated itself as a practice and
a discipline to easing the suffering of the ill.
Nursing has followed a power structure which honors a reductionistic
model that defines healing as curing, rather than developing the model based on
a heritage of sacred healing traditions. There
is an opportunity during this time of transition in our healthcare system for
nursing to herald in a radical change and reawaken the authenticity of the
discipline.
Nursing has
historically valued the intent to serve and assist the ill and injured.
Curing, while neither good nor bad, is a singular concept.
Caring is a relational one. Curing
objectifies the patient. Caring
views the world from the eyes of the patient; it is a subjective concept. Nursing also values and cares for the person as a
totality rather than as a combination of parts.
It is time to uniformly re-pattern our discipline to exemplify this.
To do this, nursing must transform and unify its precepts in education,
research and practice. Valuing the care must be foremost in nursing discipline
with the curing technology used to augment the care, not vice versa. Education
and role socialization is a start, but in the profound words of Margaret Mead,
when she was asked by a disheartened fan about where and how to begin change,
stated simply 'everywhere at once.'
Nurse leaders
are at a pivotal point where each decision may be transformational in
determining the direction of the discipline. Nurses educated first with a
baccalaureate degree in the humanities have been exposed to the art and beauty
of humankind and the sacredness of existence.
After a well-rounded bachelors education, a future nurse uses the
understanding of many ways of knowing to experience the patient and care from an
expanded perspective of healing rather than the limited view of curing.
This basis of humanism informs the how to of technological expertise that
is taught after the primary learning in humanistic studies.
Thus, the nurses who begin their practice will have the foundational
ontology and the technological expertise needed for a unique perspective and
system of values that define the discipline.
In
the purist tradition of Nightingale, nursing is a discipline of sacred healing
arts. Science is a marvelous tool
for nursing, however the ontology of the discipline is a deeper way of being in
relationship with those recipients of care. As nursing advocates for a radical
change in system structures, guidelines and goals of practice, and definitions
of healing and nursing care, the passion for service may again ignite within the
heart of the discipline.
Lynne
Bentley
Spring 2000
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