In the diary of Louis XVT. . .one can indeed read, "July 1789: 13th, Nothing. 14th, Nothing."
During the night of the 14th-15th, the King was awakened by the Duke of Liancourt. As Grand-Master of the Wardrobe the Duke had the right to enter the King's bedroom at any time. His visitor related what had happened. Louis XVI was astonished. "It's a revolt," he said. "No Sire, it's a revolution." (Pernoud & Flaissier, 1960, p. 45).
Curious, isn't it, all this talk about "revolution" among our "best and brightest" faculty? Where once an assignment to the curriculum committee by your dean was a clear indication that she had only a touch more hope for you than she had for the others relegated to the Siberia known as by-laws revision, today curriculum committees are quickly becoming the plum spot to be and a sign of deaconal favor. Curriculum committee members are debating ideologies, talking about oppression and freedom, returning from workshops and conferences humming Tracy Chapman songs; and writing their own variations of the diary entry: "July 14th: I took the Bastille" (Pernoud, 1960, p. 31).
In the midst of all this excitement, however, there is a reactive tendency to dismiss this talk about revolution as merely a bit of mid-life hysteria and nostalgic rabble rousing from a group of leftover '60s radicals. Those who have secured academic positions of privilege: positions on graduate faculties that, although not as cushy as were the halcyon days of old when soft monies flowed, are nonetheless in comfortable spots from which to call for revolution. Comfortable lives when compared with the revolutionary struggles in South Africa, with the lives of the women in Nicaragua, or with those of the babies and the kids here in our own country living somehow within the despairing visions of drug dependent communities.
True enough, that the "curriculum revolution" draws a great deal of its fire from the passions of those who came to adulthood marching and working for civil rights or for a woman's right to an abortion; or against the war between the governments of the United States and Vietnam. That it draws from the experiences of those who chose, with hope and enthusiasm, the academic setting as a place to create their life projects but who, instead, find themselves feeling increasingly as did Edward Cavan in Sarton's (1985) Faithful are the Wounded, as "having the sensation of screaming in a high wind" (p. 70). True, too, that the curriculum revolution draws from the ideas of those who testing the idealism of their youth in academic settings find, here again, feelings of dispersion and alienation; and who, rather than surrender to the temptation of an intellectual cynicism, are drawing together as did the characters in Virginia Woolfs (1941) Between the Acts, under new banners: "What we need is a center. Something to bring us all together."
Rather than trivializing our efforts, however, those who brand us as aging hippies provide a historical context that helps us see more clearly the relationships between our work as nurse educators and our commitment to progressive social change. Tb cavalierly dismiss the curriculum revolution as simply a group's attempt to re-create their college days is to miss some very significant aspects of the current phenomena. Clearly, as deduced from the writings and the speeches and the feelings expressed, this phenemona is, as said the Duke of Liancourt to Louis XVI, not a "revolt" but a "revolution" - that is, a change in nursing's world that will be as radical as was the change in Louis XVTs. Specifically, this curriculum revolution is a loud and resounding call for dramatic transformations in health care; the intention of nursing education; the substance of nursing education; the praxis of nursing education; and the graduates of nursing education programs.
Transformations in Health Care
Much has been written about the need for transformation in our health care system and it is difficult, if not impossible, to find anyone who is pleased with the current situation. Nurses have never been happy with the medically dominated health-care system; and consumers are increasingly dissatisfied, as any poll shows. Those who pay, whether the government, insurers, employers, or consumers themselves, are increasingly insistent that services be reorganized so that costs are contained. And most recently, as evidenced by editorials, briefs, and letters in a range of medical journals, even physicians - secular gods of their secular religion - are calling for reform.
Of even more concern than the huge financial costs, however, are the huge human losses as a result of the current health-care system. Were we to review any of the usual health indices, such as infant mortality and life expectancy, we would fall achingly short. There is a danger we need offset, however, as we hear again and again how health care is failing our people and our children and their expectations of the opportunity to be healthy; a danger that the incessant litany is deadening our moral outrage. Suffice it to say, in Steinbeck's (1939) words from another era: "There is a crime here that goes beyond denunciation. There is a sorrow here that weeping cannot symbolize. There is failure here that topples all our success."
Such crimes as these, such sorrow, and such failure are bewildering, frustrating, and debilitating to all involved with the system unless and until we expand our level of analysis. We have been myopic in our view and failed, too often, to question as has Callahan (1989) "whether our ultimate problems with health care are not moral rather than practical, more about our chosen ends than our managerial means" (p. 32). But there seems to be a growing recognition that the failures of the health-care system are manifestations of the moral failure of a dominant world view within which caring values and nursing's work are positioned, at best, in the margins and the shadows of the patriarchy's reality but which, more usually, are invisible (Benner, 1990; Moccia, 1988; 1990; Reverby, 1987; Roberts, 1990; Tanner, 1990; Watson, 1990). We have finally realized that the fundamental challenge facing us in health care and higher education is an ideological battle with the forces of a patriarchal world.
The curriculum revolution is about enabling individuals to prepare themselves for the task identified by Watson (1990): "the system can no longer be patched up; we must come to grips with the dominant ideology of health." More than the just the '60s revisited, the curriculum revolution is about rewriting this tragic and failed experiment we call a health-care system by challenging the patriarchy's values of dominance and control.
The Intentions of Nursing Education
There are radical differences between the intentions of traditionalists in education and those involved in the curriculum revolution. In his short story, You Must Know Everything, Babel (1915) paints a vivid picture of what traditional education has meant. He tells of an exchange between an aging grandmother and her grandson where she, with no family and no hope for her future but her grandson's potential, exhorts him:
"Study!" she suddenly said with great vehemence. "Study and you will have everything - wealth and fame. You must know everything. The whole world will fall at your feet and grovel before you. Everybody must envy you."
Education for Bable's old grandmother was a means to social dominance. In the process of becoming fully educated, one was to hold his- or herself above the more human experiences of community membership - whether that meant lending money or falling in love. But the curriculum revolution is not talking about education for such an end; but rather education to overturn such a world of class privilege.
For those involved in the curriculum revolution, the intention of nursing education is to create and extend an educational community focused not on reproducing relationships of dominance, but on transforming existing power relationships (Bevis, 1989; Moccia, 1989; Wheeler, 1989). The intention of such a nursing education was outlined in the frequently cited resolution from the NLN 1989 convention: egalitarian, cooperative communities with the abilities to critique and transform the health care system (Tanner, 1990). The intentions are fully developed by Bevis and Watson (1989) as "the elegance of liberation," wherein communities of individuals prepare themselves to assume responsibilities as "compassionate, scholarclinicians."
As the curriculum revolution advances, the intentions of nurse educators are to create and extend an educational community that will foster three fundamental feelings for all involved: a sense of agency, a sense of responsibility and accountability, and a sense of connection.
A sense of agency reflects the belief that individuals can and do have an effect on moving things from now to the future. More specifically, the feeling is that what the individual does or does not do is a significant factor in how things will develop or not develop; that our actions have some tangible and observable results.
A sense of responsibility and accountability that reflects a belief that we, as individuals, are accountable for our actions to ourselves and our communities whether that community is perceived to be the profession or local, national, and international networks.
A sense of connection, perhaps the most difficult to achieve, that pushes against the widespread and increasingly pervasive fragmentation, specialization, and alienation of our society. A feeling of relationships with our communities, of connection to a shrinking global consciousness, of oneness with nature and unity with the cosmic order.
In short, as the curriculum revolution takes hold, the intention of nursing education will be to create for both faculty and students a sense of agency, a sense of responeibüity and accountability, and a sense of connection.
The Substance of Nursing Education
Where once the debate was about what to include in a nursing curriculum, now the question is "what to leave out" (Waters, 1989). Increasingly, educators have embraced the idea that, rather than information, the content of nursing education is actually the interactions that take place between faculty and students (Bevis, 1989; Diekelmann, 1989; Moccia, 1989). Process has become substance.
As mentioned earlier, the experiences of the 1960s are thought to be significant factors in this curriculum revolution and what was learned then can now provide some guidelines to the nature of the process that will take the place of more traditional content. In a recent follow-up study of those 1,000 trained volunteers who went to Mississippi 25 years ago in the summer of 1964 for the purpose of registering black voters, McAdam (1988) identified several unanticipated results that, I think, have significance as we reform our curricula. The Student Non-Violent Coordinating Committee's campaign was a success in registering voters and forcing the national spectacle of the Democratic Party locking out the delegation of elected black representatives of the Mississippi Freedom Democratic Party at the National Convention in Atlantic City, New Jersey; McAdam argues that the campaign was even more effective in several other areas of long-term significance for life in America since then.
First, Freedom Summer made private experiences public issues and brought particular incidents to community, national, and possibly international attention. Second, it looked to personal experiences for the content to be studied; and as the point of intervention and potential transformation. Third, it depended on community for its structure, relevance, and personal meaning.
With the experiences of Freedom Summer as a model, the substance of curriculum revolution will be developed by addressing the social construction of race; class, and sex bias at both the structural and the interpersonal level.
The Praxis of Nursing Education
The way we will teach in the curriculum revolution is close to the idea of praxis as defined by Wheeler and Chinn (1989) "thoughtful reflection and action that occurs in synchrony with transforming the world" (p. 1). Greene (1975) provides the specifics that are essential aspects of an educational praxis committed to progressive social change:
Certain acts must be performed, certain tasks must be accomplished if individuals are to be enabled to choose themselves as free. They are acts involving the posing of problems and the referring of such problems to the context of action. They are acts having to do with the assessment of contexts, reflections on the taken-for-granted, decisione on what is worthwhile, commitment to what ought to be. Attentiveness must be fostered, as such acts are undertaken, an attentiveness to the concreteness of lived situations; since it is within concrete situations that meaningful tasks are accomplished (p. 11).
Acts! Thoughtful and critically reflective - but acts. The significance of this position, which differs from what we know, cannot be overstated. They are acts! Such education does not accept the separation of theory and practice into individualized moments. Instead, it insists that if education is to promote the process of moving to a fuller understanding of what is real, theory and practice must each include the other in a theory-practice moment. If education is to be successful in allowing individuals to develop the abilities needed to transform the health care system, it must take place within the context of people's lives.
The challenge of the curriculum revolution is to return nursing education to the practice setting, but to the practice setting redefined. More specifically, to those practice settings where the faculty, students, and patients can feel a sense of agency, a sense of responsibility, of connectedness.
The goals of the curriculum revolution include establishing nursing education where people live their lives. We will not teach our students, as we did earlier in our history, only in places where people go to be sick. Nor will we teach them where we have been most recently, where we have retreated to think.
But instead, the praxis of the curriculum revolution will expect that we teach and learn with our students in those places where people live: in homes, in their communities, in long-term care facilities, on the streets, in shelters.
The Graduates of Nursing Education Programs
How would we recognize the graduates of such nursing education programs as these? First, it is important to note that "the graduates" of such programs will include not only the students but also the faculty themselves transformed by the praxis of such a nursing education. Secured by a new sense of agency, guided by a new sense of responsibility and accountability, and nurtured and sustained by a new sense of connection, who would these new nurses look like? What would we think? Where would we be found? What would we be doing?
To the degree that we blow away the blue smoke and mirror tricks; expose layers and layers of patriarchal obfuscation to see the relationship between public policies and private fives; to the degree that we are successful in these attempts; then we will be in the tradition of Dock, Sanger, and WaId. We will be found in those activities where definitions of health and health care are being challenged. We will be found in the politics of challenging the ideology of the health-care system and the structure and function of the delivery system.
We will take on the challenge of Rich (1986): "The problem is to connect, without hysteria, the pain of anyone's body with the pain of the body's world" (p. 100).
Among our graduates will be women such as LeSueur (1990) wrote of during the Depression of the 1930s: "The women have learned something. Something is seeping into them that is going to make a difference for several generations. Something is happening to them" (p. 145).
LeSueur presents a clear and classic description of the connection between public policies and private lives:
That's the way it is with women. They don't read about the news. They very often make it. They pick it up at its source, in the human body, in the making of the body, and the feeding and nurturing of it day in and day out. In that body under your hands every day there resides the economy of that world; it tells you of the ruthless exploitation, of a mad, vicious class that now cares nothing in the world but to maintain its stupid life with violence and destruction. . . . You know everything that is happening on the stock exchange. . . . You don't have to read the stock reports in Mr. Hearst's paper. You have the news at its terrible source" (p. 172).
Among our graduates will be individuals like those described in an early Alice Walker (1976) novel Meridian, those for whom the struggle for individual identity is grounded in larger political events.
But at other times her dedication to her promise came back strongly. She needed only to see a starving child or attempt to register to vote a grown person who could neither read nor write. On those occasions such was her rage that she actually felt as if the rich and the racist of the world should stand in fear of her, because she - though apparently weak and penniless, a little crazy and without power - was yet of a resolute and relatively fearless character, which, sufficient in its calm acceptance of its own purpose, could bring the mightiest country to its knees" (p. 201).
Among our graduates will be women such as Sethe, the major figure in Toni Morrison's (1987) novel, Beloved, who would kill her own children rather than have them returned to slavery where:
anybody white could take your whole self for anything that came to mind. Not just work, kill or maim you, but dirty you. Dirty you so bad you couldn't like yourself anymore. Dirty you so bad you forgot who you were and couldn't think it up" (p. 251).
Still others of our graduates will live such lives as does the African American revolutionary Assata Shakur ( 1987), who was raised by her grandparents with clear expectations established:
the lessons that they taught me, more than anything else i learned in life, helped me to deal with things i would face growing up in amerika. . . .she (her grandmother) would glare at me and say, "Don't let anybody mistreat you, you hear? We're not raising you up to be mistreated you hear? i don't want you taking no mess off of nobody, you understand?" (p. 20).
While in prison, Assata learned that one of her imprisoned comrades was pregnant. Assata says:
I was glad about her pregnancy and sad at the same time; she was facing 25 years. Although I tried to be cheerful, I guess she could see the concerned expression on my face. "Don't worry," she told me. "These people can lock us up, but they can't stop life, just like they can't stop freedom. This baby was meant to be born, to carry on. They murdered Homey, (the baby's father) and so this baby, like all our children, is going to be our hope for the future" (p. 88).
As new graduates of the curriculum revolution, we will find ourselves in the company of remarkable women who live their lives with a politically sophisticated kind of caring that is more than kindness, more even than an educated kindness. We will find ourselves side by side with those who have developed the "street-smart caring" that is necessary to be successful in displacing current ideologies of domination and control.
Summary and Conclusions
In much the way 18th century France was ripe for a revolution, so are the two social systems within which we live and work: health care and higher education. In health care, too many are suffering so that a few might live lives of luxury. Higher education is structured so as to reproduce a social order of class privilege and patriarchal values.
For a complex set of reasons, (some known to us, many more beyond our consciousness) we have chosen higher education and nursing education as our arena - as the place where we might contribute to the world order, to our society, to individuals and communities who are striving to be healthy. Our project, then, is to enable others so that they might enable still others: to teach and learn with our students who are our colleagues in creating a future; to teach and learn in caring ways that will serve as prototypes for caring communities.
To those who would dismiss the curriculum revolution as a fad and those involved it as aging malcontents, I refer them to the diaries of Governor Morris, an American guest of Marie Antoinette who was at Versailles during the months before the fall of the Bastille on July 14, 1789:
Yesterday, it was the Fashion at Versailles not to believe that there had been any disturbances at Paris. I presume this Day's Transactions will induce a Conviction that all is not perfectly quiet (Pernoud, 1960, p. 45).
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