Professionally oriented education prepares the neophyte to function in the particular profession of his choice. In order to accomplish this commission, the educator for the profession must identify and analyze the realities that confront the practitioner in his daily practice The identified and analyzed realities then must be translated into a curriculum which will indeed enable the neophyte to assume the role of the professional.
McClothlin, in Patterns of Professional Education, states that the basic goal of professional education has two related aims: ( 1 ) to supply enough professional persons, and (2) to assure society that these professionals are competent. * In curriculum planning the second stated aim is of primary importance and should guide educational decisions concerning the professional program. In explaining this second aim McGlothlin states:
Professional education is expected to start the student on the road toward achievement of this objective. As a professional man, he will be expected to manifest in his professional social life:
a. Competence to practice his profession with sufficient knowledge and skill to satisfy its requirements.
b. Social understanding, with sufficient breadth to place his practice in the context of the society which supports it, and to develop capacity for leadership in public affairs.
c. Personality characteristics which make possible effective practice.
d. Zest for continued study which will steadily increase knowledge and skill needed by practice.
e Competence in conducting or interpreting research so that he can add to human knowledge either through discovery or application of new truths.
To what sources can the educator look to discover components for a curriculum which will result in these objectives? And more precisely, to what sources can the nursing educator look to discover components for a curriculum which will result in similar objectives for the professional nursing curriculum? As a basic preparatory core for the teaching and learning of quality nursing care, the nursing educator will certainly look to the liberal studies, the source and approach to all knowledge. The ability to think effectively, with logic and imagination; the ability to communicate thoughts; the ability to make relevant judgments relating the range of ideas to experience; and the ability to discriminate among values are potential outcomes of the liberal studies. A close examination of McGlothlin's subobjectives enables one to discover that social understanding, personality development, and scholarship are woven into the fabric of the liberal studies core and reinforced and interwoven into the profesional core.
In order to probe the effects and benefits of liberal studies even more, let us look at a few fields of liberal studies and hypothesize their benefits to professional nursing education and practice. In literature, for example, authors vivify everyday experiences so that the reader sees his day-by-day living in a new perspective. The author's description of mankind can open the reader's eyes and sensitize his mind so that his capacity for observing the reactions of others is increased. In his work, Arts and the Man, Edman explains this point when he writes, "One moves with them (characters of fiction) in lands where one has never been, experiences loves one has never known, and this entrance into lives wider and more various than our own in turn enables us more nicely to appreciate and more intensely to live the lives we do know." 3 Certainly we all covet for our students in nursing this intensification of living and the grasp for the realities of life which otherwise only maturity can provide. The encapsulation of years of experience within a work of fiction provides the reader with patterns of response to situations which he has not yet encountered but which he will encounter in future experiences. For example, the young reader usually has not faced separation from close relatives and friends through death. Literature provides many response patterns to this situation. From these patterns the reader may reflect on and identify with a pattern or create a new pattern of response to the reality of death. The preparation of the student to respond to the reality of death appropriately and therapeutically both to self and to others is one of the many problems which face the nursing educator.
But literature is only one part of the liberal study base. A knowledge of history makes the student conscious of the developments and trends of the past which have led to situations in the present. Historical analysis permits students to understand what is happening around them and helps them to think and act more intelligently as adults. Alfred North Whitehead, in The Aims of Education, states that an understanding of the past assists us to understand the present, the insistent present, to which new understanding and ideas are to be applied. 4
Liberal education courses provide nursing students contact with students from other fields and with other interests. It is through this contact that a cross-fertilization of ideas is fostered. These ideas may take the form of vague and nebulous thoughts which later develop into a recognition of a problem to be solved. Relevant to ideas Richard Weaver, in Ideas Have Consequences, states that indirection, veiling, and withholding are a part of ideas, and "it is our various supposais about a matter which give it meaning and not some intrinsic property which can be seized in the barehanded fashion of a barbarian." 5
Also speaking of ideas Alfred North Whitehead, in The Adventure of Ideas, emphasizes that "Human life is driven forward by its dim apprehension of notions too general for its existing language. Such ideas cannot be grasped singly, one by one in isolation. They require that mankind advances in its apprehension of the general nature of things so as to conceive systems of ideas elucidating each other." The revelation of the operation of ideas in the human mind and the experiences of this revelation constitute a vital element of the life of the professional nurse as well as of the life of nonprofessional persons. It is this revelation of the operation of ideas and its experience which is part of the student's experience in general education courses where cross-fertilization of ideas is more likely to occur.
In order for the fruits of the liberal studies to have the full potential effect the nursing educator, the adviser in the nursing education program, must be fully convinced of their benefits and must be able to relate the learnings in the nursing courses to those which preceded in the liberal studies. Lip service alone to their benefits will not reap the full potential effect of the liberal studies.
Thus far, we have spoken only of the last four subobjectives proposed by McGlothlin, and we have not directed our attention to the first subobjective - competence to practice his profession with sufficient knowledge and skill to satisfy its requirements - the competence to practice nursing so as to provide quality nursing care. We would readily admit that the liberal study core alone cannot provide that competence, and some educators, I for one, regard with scepticism the appropriateness of the professional courses we are presently offering to the student for beginning professional practice competencies. The nursing educator, like the educator for any profession, must identify and analyze the realities which confront the nurse practitioner in her daily practice and then translate those realities into the appropriate curriculum, which will best prepare the neophyte to practice in the nursing profession. Since the components of the professional curriculum must be dictated by the nursing service expectations of today and tomorrow, it also follows that the often quoted and assumed dichotomy "Nursing Education or Nursing Service" is invalid. The real issue - the pressing question -confronting each of us is the establishment of the continuum, nursing education for nursing service. This task- the construction of this continuum - cannot be accomplished by unilateral action by the workers at either end of the continuum; it can be validly and successfully accomplished only through bilateral, unified, concerted, and cooperative effort by both types of nurse practitioners. Neither nursing educators nor nursing service practitioners can consider themselves independent of the other in the pursuit of a definition of quality nursing care. Their existence, development, and progress are interdependent upon one another.
Before discussing the construction of this continuum of nursing education for nursing service more fully, let us first consider some of the phenomena which make bilateral and cooperative effort between practitioners at either end of the continuum difficult. Independent unilateral action in the construction of the continuum by either group leads only to false hopes, misunderstandings, and disappointments and results in escalating defensive antagonism. It is such unilateral independent planning that has been seen and is still seen in some nursing education projects today.
The apparent lack of communication between nursing groups can be attributed to several recognizable phenomena in our times. First of all, nursing educators frequently possess more intensive educational preparation than their colleagues in nursing service. This situation may be the result of supply and demand and the pressure of the national accreditation program for schools of nursing. The second phenomenon relevant to this communication gap is related to this educational characteristic and consists of the nursing educator's greater ability to verbalize her ideas. This relative verbalization ability usually exists when the two groups are compared, although exceptions do occur, and the nursing service practitioner becomes a silent partner.
In a third phenomenon, the practitioner in both education and service may find difficulty in maintaining an up-to-date working knowledge in the nursing field because of the knowledge explosion on all of its boundaries. The rapidity of change within the biological, physical, and medical sciences staggers even the specialist in the field. How much more does this rapidity of change challenge the practitioner in a field so directly affected by so many dynamic specialties.
Another phenomenon which affects the communication process between the practitioners at either end of the continuum is found in the rapid transitions in nursing education programs which makes experimentation, testing, and validation of curricula unlikely, if not impossible. Nursing service practitioners very often cannot use their own particular education program as a point of reference in establishing communication with the nursing educator. Nursing educators, therefore, need to verify and communicate in exacting terms what they are endeavoring to do and why they have chosen this course of action to do it.
These barriers to communication between educators and service practitioners have generated distrust and suspicion, consequently increasing the barrier. Thus, we must endeavor to remove these barriers and to seek answers to our questions through bilateral, unified, concerted, and cooperative effort by both types of nurse practitioners in constructing the continuum nursing education for nursing service.
One of the most important responsibilities facing all nurse practitioners is the improvement of nursing service and the implementation of quality patient care not only for today but for tomorrow as well. The curricula of today prepare the nurse practitioners for tomorrow. Nurses cannot be interested only in the quality of patient care for today; they must also be interested in the kind of nursing service which will provide quality patient care tomorrow. The questions which follow are, "What constitutes quality patient care? What learnings provide the abilities to expedite quality patient care? What limits does society place on the dimensions of our findings?" To arrive at answers to these questions, nursing educators and nurses engaged in direct service to patients must jointly and continually probe for ways to identify quality patient care, for ways in which they can improve nursing care, and for ways in which they can implement that improvement
Up to the present time, attempts to measure and identify quality nursing care have been relatively unsuccessful. The closest we have been able to come to the measurement of quality nursing care is through the measurement of patient welfare -a reflection of quality nursing care. Myrtle Aydelotte and her staff developed a set of ninepoint scaled measures of patient welfare 7 These measures consisted of scales of mobility, mental attitude, physical independence, and skin condition. It is by criteria such as these that nurses and other members of the health team judge an individual patient's progress toward recovery. The ability of the patient to be mobile, to be independent, and to be alert are ways in which the medical professional determines whether a patient is moving toward recovery and toward participative citizenship. It is very possible that the refinement, modification, reconceptualization, and testing of the Aydelotte instrument may provide a means of evaluating patient welfare and the more important reflected variable, quality nursing care, as well. In other words, the measurement of patient welfare may provide a key to the identification of quality nursing care. These indices would facilitate a more precise definition of the components of quality nursing care and could provide a means of testing whether ideas directed toward the improvement of patient care would indeed be an improvement or just another passing fanciful fascination. It is extremely important that we develop measures of quality nursing care for, at present, we cannot determine whether a new nursing technique, an administrative innovation, or a new kind of service really benefits the patient as claimed or hoped. The absence of these criteria has, I believe, deterred the progress of nursing and the implementation of potentially effective innovations. Thus, the need for testing objective measures of patient welfare and of quality nursing care cannot be overemphasized.
Nursing educators and practitioners in nursing service must not stop in their analysis of components of patient welfare and quality nursing care. They must go on to translate these components into dynamic curricula that will equip the neophyte practitioner to practice nursing with competence and skill. A student equipped to practice nursing by such a dynamic nursing curriculum of liberal studies and exposure to ideas and experiences will possess increased capabilities in understanding and applying the principles of quality nursing care, in implementing improvements in patient care, and in adapting to the changing world of medical care. Truly, the last decade has witnessed much progress in all fields of medicine, much change in sociological and educational thought, and many new developments in nursing education programs. The dynamism of all of these contiguous and interrelated fields presents a great challenge to the neophyte practitioner - the end product of the nursing education program -and presents to the nursing educator and nursing service practitioner a challenge to identify the components of quality nursing care and the learnings which will provide the abilities to expedite that quality nursing care.
The easiest choice of curriculum and course content for nursing education would be to select the traditional patterns, the tried and not so true patterns, and the path of least resistance. The explosion of knowledge, medical discoveries, and educational theory practice, however, should prevent us from making the choice of the traditional curriculum pattern. Rather an intensive, critical, and exhaustive investigation of the components of quality nursing care as well as an analysis of the expectations imposed upon the beginning practitioner should precede the selection of the most suitable curriculum for the program. Whitehead says, in The Aims of Education, "What education has to impart is an intimate sense for the power of ideas, for the beauty of ideas, and for the structure of ideas, together with a particular body of knowledge which has peculiar reference to the life of the being possessing it." 8 With this concept of ideas and with the facility with ideas derived from the various components of the educational continuum, a student will be able to stand apart from his task, be it academic or human service in the realm of nursing, and view that task with perspective and understanding. The student nurse will be more likely to perceive accurately the state of her patient, his real needs, and the nursing measures required to meet them. Furthermore, with this ability to use ideas the student nurse will be equipped to stand apart from her work, view it objectively, envision her place in the community, and then participate as a citizen and an adult by filling her place in that community.
A curriculum built on a core of liberal studies, and nursing course content drawn from an identification and analysis of quality nursing care, will equip the student in nursing for the expectations and needs of tomorrow, and it will establish the continuum of Nursing Education Today for Nursing Service Tomorrow.
- 1. William F. McGlothlin: Patterns of Professional Education, G. P. Putnam's Sons, New York, 1960, p. 2.
- 2. Ibid., p. 6.
- 3. Irwin Edman: Arts and the Man, W. W. Norton & Co., New York, 1939, p. 84.
- 4. Alfred North Whitehead: The Aims of Education, Mentor Book Co., 1955 (reprint of 1929 Macmillan Co.), p. 14.
- 5. Richard Weaver: Ideas Have Consequences, University of Chicago Press, Chicago, 1948, p. 26.
- 6. Alfred North Whitehead: Adventure of Ideas, The Macmillan Co., New York, 1933, p. 29.
- 7. Myrtle Kitchell Aydelotte: "The Use of Patient Welfare as a Criterion Measure," Nursing Research, 11:1, pp. 10-14, 1962.
- 8. Op. Cit., p. 19.