Without the humanistic perspective of nursing, the uniqueness and justification of existence of the nursing discipline becomes lost. Nursing is bound to the humanities and formally should recognize this bond" (Donaldson, 1983, p. 40).
Undergraduate students often bring limited life experience to their study of people in health and illness and to their role as health care professionals. The nature and pressures of the traditional nursing curriculum offer little room to broaden this perspective, often forcing students to focus on technical aspects of care. The totality of human experience is difficult to capture in a textbook or even through clinical practice as a student. One way to increase students' understanding of this broader world view is through planned use of the humanities in the nursing curriculum.
In the Spring of 1986, the faculty in our undergraduate psychiatric/mental health nursing course at the University of Kentucky designed a learning activity that involved reading selected literature related to psychiatric/mental health issues. The goal of this activity was to broaden the students' exposure to Uterature as a means of understanding the human condition. Students selected a novel that was related to a psychiatric/mental health issue. Examples of books that students chose included The Bell Jar (Plath, 1971), / Never Promised You a Rose Garden (Green, 1964), Ordinary People (Guest, 1976), The Prince of Tides (Conroy, 1986), The Handmaid's Tale (Atwood, 1986), and A Reckoning (Sarton, 1978). Students were asked to read and react to what they had read. Emphasis was placed on reflection, analysis, and increasing awareness of the human experience as it was portrayed in the reading. The linkage of classroom and textbook content with the experience of the character depicted in the fictional reading was evident in the students' written reactions.
This activity also served to increase students' sensitivity to their patients' unique experiences. For example, reading about hallucinations in a text provides students with a theoretical understanding of this experience. Working in a clinical practicum with a patient who hallucinates provides more depth. However, after reading / Never Promised You a Rose Garden (Green, 1964), students truly understand how hallucinations develop and how powerful the voices are in a person's life. The reading rounded out the learning experience.
During the Fall of 1989, films were selected as another means of enhancing student learning. For example, Shattered Spirits (Greenwald, 1991) depicts the effects of alcohol abuse on a family system. Watching the film gave students the opportunity to place themselves in the experience of a family struggling with alcoholism. This exercise enhanced the students' understanding of the complex psychological dynamics of the alcoholic family. Discussing the film encouraged the students to take a more active role in learning, as compared to receiving a lecture on the dynamics of the alcoholic family, a passive method of learning (Peterson, 1988).
The humanities provide information about people, particularly the subjective human experience. It is anticipated that exposure to Uterature and films will increase the undergraduate student's sensitivity to human suffering and will foster an appreciation of humankind's worth and dignity. "Undergraduate students are understandably sometimes more concerned with the clinical/technical focus of the curriculum and their ability to learn the skills involved in direct care of clients. Thus, the faculty need to examine ways of helping students integrate the liberal, humanistic components of their university education with the scientific and the technical so that the nursing of individuals is viewed more holistically and in the context of the family, community, and society" (Germaine, 1986, p. 84).
The humanities, films, Uterature, works of art, and music provide for students an experience of such depth that it could not be experienced in the traditional clinical setting (Bartol, 1986). They can also be used "to bridge the gap between the nurse and the patient when the nurse's experience is inadequate to do so" (Bartol, p. 22). Literature and film permit students to stand back and vicariously experience and examine the struggles of chents facing health problems (Germaine, 1986, p. 85).
Integration of the Humanities
In the Spring of 1990, our undergraduate psychiatric/mental health nursing faculty developed a competitive proposal and received a small internal Innovative Teaching Grant from the University of Kentucky College of Nursing. The first goal of the proposal was to use consultants to help us refine the ideas we had generated. Two individuals who had developed programs and published Uterature in the area of integration of the humanities in nursing education were identified and contacted as potential consultants. The first consultant was an expert in the area of theater and had previously taught a humanities course to nursing students. She provided us with suggestions about the use of art, recommended plays, and identified other resources available within the university setting that might be helpful.
The second consultant had written extensively on the use of the humanities in nursing education. She helped us identify Uterature, especiaUy short stories and poetry, that might be helpful to us. The consultant also assisted us in reviewing how we had integrated the humanities in the undergraduate psychiatric/mental health course and suggested methods for additional expansion. She also provided a short workshop for all of the nursing faculty on the use of the humanities in nursing education.
After the consultant's visits, the real work started for the faculty. AU students were asked to read the same fictional work, The Prince of Tides (Conroy, 1986), as the reading for the reaction paper. As a means of evaluating this activity, each student was asked to address in their reaction paper the following question: "How I am different as a result of reading this book?" One student's response follows:
You can reaUy feel what it is like to be a part of a dysfunctional family after reading The Prince of Tides. I never knew what to expect from the parents from one page to another, just like the children never knew how their parents would react to a particular situation. It made me very anxious to not know what would happen next. And this is how these children had to Uve minute to minute, day to day. I couldn't help thinking at least I can put this book down and escape, but these people cannot escape; this is their life.
As we have reflected on the choice of reading, we realized that assumptions were made about the students that were not necessarily true. As a faculty, we assumed that all students liked to read and that the reading of fiction would be a pleasurable experience. The Prince of Tides (Conroy, 1986) is a lengthy book and, for students who were not fast readers, it became a source of stress. While all students agreed that reading the book was valuable, many said that it was too long.
As a result of this discovery, the decision was made to aUow each clinical group to select their own fictional reading from a list provided to them. This gave students an opportunity to consider individual pref erences for book length, subject matter, and time constraints. Students were then expected to participate in two learning activities related to the reading. They were to write a reaction paper to the reading and prepare a 10-minute presentation of the reading to the class. The entire class gained from their fellow students' reactions and responses to the fictional reading. It was unusual for two clinical groups to select the same reading. When this did occur, the presentations provided two perspectives for students to consider.
Another example of the integration of the humanities involved students and faculty attending the play Extremities (Masterosimone, 1978), which was staged by the University of Kentucky Drama Department. The play is about an attempted rape and its effects on the victim and the victim's friends. Students attended in clinical groups with their clinical instructor. After the play, clinicians from the local Rape Crisis center discussed the rape experience, its aftermath, and legal responses. Lecture content related to violence was arranged to coincide with attending the play. Two actors and a stage manager also met with the class to discuss their roles and responses to Extremities. To evaluate the effectiveness of this activity, students were asked to write whether they felt that viewing the play was helpful and how. Student responses included:
Viewing Extremities was valuable because it brought me into a situation I don't particularly want to think about and forced me to form opinions about how I felt about rape/ attempted rape, who was to blame, and was the victim not only a victim of the act but of our legal system also.
Seeing Extremities was valuable to me in that the characters portrayed a realistic picture of what a person goes through and feels like when raped. It helps increase your awareness of how to talk to and treat a person after they have gone through such an experience. To me they must feel terribly helpless and lonely.
Seeing Extremities was valuable to me because it helped me to realize the strong emotional impact rape has on the victim and significant others. So many feelings surface when rape occurs, not only in the victim but in those close to her. Feelings such as fear, suspicion about the victim causing the rape to occur, or sadness about remembering personal experiences that involved rape.
Implications for Nursing Education
Evaluation of the effectiveness of the humanities as a method for teaching psychiatric/mental health nursing continues to evolve. Qualitative responses to the experiences have been the primary mode of evaluation. Students have been asked to participate in discussions of selected experiences, to present book critiques for the class, to responses to one or two questions about the activity on note cards, and to write more formal responses in reaction papers. The most significant evaluation criterion for integration of the humanities is in students' responses to the value of various activities. Overwhelmingly, students beUeve that these opportunities for understanding the human condition are crucial elements of their nursing education that expands beyond traditional classroom and clinical experiences.
Stories of people's lives that are presented in books, films, poetry, and drama are important. Stories are important as students interact with patients and as we interact with our students. By listening and understanding each other, the artificial gaps between us begin to narrow. We believe that the use of the humanities as a method of teaching psychiatric/mental health nursing will foster the ability to Usten and empathize. A quote from The Call of Stories (1989) by Robert Coles illustrates the value of stories.
The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story (p. 7).
Our adventure into the world of the humanities has enriched our teaching and enhanced learning opportunities for our students. Nursing is both an art and a science. In our quest for the advancement of the science of nursing, the integration of the humanities in the educational process helps us maintain a balanced view of the human condition.
- Atwood, M. (1986). The handmaid's tale. Boston: Houghton Mifflin.
- Bartol, CM. (1986). Using the humanities in nursing education. Nurse Educator, 11, 21-23.
- Coles, R. (1989). The call of stories. Boston: Houghton Mifflin.
- Conroy, P. (1986). Prince of tides. Boston: Houghton Mifflin.
- Donaldson, S.K. (1983). Let us not abandon the humanities. Nursing Outlook, 31, 40-43.
- Germaine, CP. (1986). Using literature to teach nursing. Journal of Nursing Education, 25, 84-86.
- Green, H. (1964). / never promised you a rose garden. New York: Holt, Rhinehart, & Winston.
- Greenwald, R. (Producer & Director). (1991). Shattered spririts Film]. Vidmark Entertainment.
- Guest, J. (1976). Ordinary people. New York: Viking Press.
- Masterosimone, W. (1978). Extremities. New York: Samuel French Company.
- Peterson, L.C. (1988). Literature and music: An educational strategy in psychiatric mental health nursing. Journal of Nursing Education, 27, 374-377.
- Piath, S. (1971). The bell jar. New York: Harper & Row.
- Sarton, M. (1978). A reckoning. New York: Norton.