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.