the year between

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wordpress tells me it’s been a year since i posted on this blog, and indeed my last post contained the news that i had just been appointed as the Andrew W Mellon Faculty Fellow for Nursing and the Humanities at Emory University in Atlanta Georgia. as you can imagine, the year between then and now has been tumultuous. i have been so busy getting through the days, doing what i needed to do to make the move happen, to get through US immigration, to arrive in atlanta, find somewhere to live, move into my office, meet all the people, learn how to drive on the wrong side of the road, negotiate american supermarkets, american winters, american bureaucracy. you dont need the details – sometimes it’s been great and smooth and easy and fabulous and sometimes its been heart wrenching and lonely and scary and overwhelming. some days i love it here in ways i never loved living in australia. some days all i want to do is run home to the beach and the mangoes and the dogs and my family.

but i am still here, and i will still be here a year from now, because i know this is where i’m meant to be. i wanted to take the time today to just make some notes about what i’m working on now, and plot out the way forward. the last year has been a bit of a fog but its starting to lift now.

the first question for me, and often the abiding one, as i think about what i’m doing at Emory, is ‘what does it mean to be a Mellon Fellow’? (or a Mellonhead, as i am sometimes affectionately called). there are two really important things that were said to me on my first day here that stay in my mind, and i try to make them into my beacons, when i’m feeling lost. i asked one of my vice provosts what did the Mellon Foundation want from the position, and the first thing he said to me, without hesitation, was ‘for you to flourish’. we talked a little about what that meant, and it was, and still is, music to my ears. my friend Alison in australia even stitched it into a cushion for me. i repeat it to myself sometimes, like a mantra.

i have never had anyone in australian academia say that to me. that’s the kind of question that gets you rote parroting about citation indexes and impact factors. so i hang onto that for dear life, because it’s why i came here.

the second thing he said was ‘there is a growing recognition that current approaches to health care are missing the point. the humanities give us a way to ask new questions’. and with that, really, my fate was sealed. i have been thinking a lot lately about what sort of person i am. moving across the planet to a culture so familiar and so entirely different really does ask you to know thyself, to get to the root of who you think you are, what do you stand for, what are your values, how are you going to handle this? so when i think about what kind of work i want to do, it is work that makes a difference. it matters to me that i address issues of social justice, that i reveal something critical about the way we approach health care in the west. a lot of people write history for its own sake and that is an important task. but when you are working in a school of nursing, there are a lot of other people who want to know why history matters. i’ve written about it in a few places, and i think anyone with half a brain knows why the history of health matters to contemporary practice. if not, please just do yourself a favour and read the birth of the clinic.

so the task for me is not to just use the Mellon grant as a way to hunker down and write two books in three years (although i am trying to do that too). its to find active and meaningful ways to bring history alive for nursing students, to show them why the history of what they do matters to the people they do it to today, and why the society they do it in effects the very health outcomes of ordinary people. i think you can probably see the link to bioethics there, and i am very pleased to have been offered an association with the Emory Center for Ethics as a Senior Faculty Fellow, because if i think history has anything to offer nursing in particular, it’s in the exploration of the ethical dilemmas that have been at the core of nursing practice in the past, and continue to be so today.

yet we see nursing schools continue to push shorter curriculums, more accelerated programs, higher level technical skills, biomedical and scientific research, and i cant help but feel anxious about that. these are all important and significant areas to focus on, but they can not be the sole focus. there is something unique and different about nursing, and it lies in the debate about CARE. to hitch one’s wagon too closely to the biomedical model is to run the risk of not being able to ask new questions, to not be able to be critical, to start experimenting on people without their permission because science is more important than the people it’s meant to serve… and thus, we are back to history.

so i am working on a number of things here now to try and make this connect between past and present, between politics and practice. my first manuscript is still being written, it’s a book about the development of psychiatric nursing as a distinct practice in the context of the Cold War, and the second manuscript which is still in proposal stage is about the relationships between race and mental health institutions in the american south. this year alone i have been to archives at the Radcliffe Institute at Harvard, the University of Pennsylvania, the National Library of Medicine in DC, the Gottlieb archive in Boston and the Carter Presidential Library here in Atlanta. I am about to start the process of applying for money to get to archives here in Georgia, in Alabama and Mississippi, and probably back to Philadelphia, DC and Boston (one can not go to Boston too often really). i am thrilled to have academic publishers interested in both projects, i am beyond thrilled to have been asked to present some of this work at the Harvard History of Psychiatry Colloquium in December of this year.

but all of it will mean less to me if i cant find a way for nursing itself to value this knowledge, if i cant work it into the classroom, if i cant hold up that mirror and ask nurses to think about the ethics of what they do, the power of their profession, if i cant ask them to think about why they do it that way, and to think about their patients as people, trying to do the best they can in a society that’s stacked against the poor, the coloured, the unwell.

history has the power to change people’s lives. it would easier to write history for its own sake and not care about the health and social justice part. but im not that kind of academic. im not that kind of person. this last year in the US has made that clearer to me then ever, and i hope its my driving force for many years to come.

north and south

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so months fly by and when i look up everything is about to change. i will start with the news, which is that i have been recently been appointed as the Andrew W Mellon Faculty Fellow for Nursing and the Humanities at Emory University in Atlanta, Georgia. this is an assistant professor, tenure track position, and involves a long term move on my part from the south, ie here in australia, to the north, ie, the USA, except to the south of the north!

i was flown over to emory at the end of june, and spent 4 days meeting everyone. i do mean everyone. in the process, i fell completely in love with emory, its staff, atlanta, and The South. someone told me before i went, an american, that of all the places she’d been in the US, georgia was the most like new south wales, my home state, and georgians most like australians. from what i saw she was right. i felt at home before we’d even landed, flying in over rolling hills of trees and green. there was hardly any cleared industrial type landscapes from the air, like im used to with the big US northern cities, so in that respect it was like flying into sydney. except for the ocean, of course. on the ground i think atlanta is smaller than sydney, a smaler CBD, smaller suburbs, separated from each other by green corridors, less obvious built up sprawl. it was hot, and humid, like brisbane, but mitigated by the trees and shade and the regular afternoon thunderstorm. i drank ice tea, was taken out for lunch and had fried chicken, grits and peaches, out for dinner to a professors house, a whirlwind of meetings and giving a presentation and more meetings and hypothetical appointment discussions, followed a week later by a phonecall and a not hypothetical offer of appointment. which i accepted. i start november 2.

its so exciting. i cant even really comprehend that its happening yet. if i had had any apprehension i think it was dispelled when i met some of the fantastic nursing faculty who took me out for lunch and dinner on the sunday. and then monday, i met the people i might be working with across the rest of emory and i felt that tingle of excitement that comes with the realisation that the work you might do, that it might be extraordionary.

the nature of the position is really unique. the first three years are funded by a grant from the Mellon Foundation, and the explicit remit is to make active and meaningful research and teaching collaborations between the school of nursing and the rest of the university. this means i will be affiliated with the centre for ethics, the college of arts and sciences, and the centre for the study of human health. i felt the potential from my first meeting with the amazing Professor Paul Root Wolpe of the Centre for Ethics, and we talked about the ethical dilemmas facing nursing, the idea of personhood in patient-centred care, issues of power over bodies, art and literature and critical theory … with the college we talked about feminist theory and nursing, with the history department we talked about histories of the idea of health…. in the school we talked about reflective practice, patient centred outcomes, PTSD, therapeutic recreation, exploring the history of mental health and health disparities in the South…so many opportunities for me to work across so many different spaces in an environment that’s committed to making that work. it gives me goosebumps.

i love the job i have now. i do really great work in reflective practice and i’ve just totally revamped my subject and am loathe to hand it over. i am well supported by the school and by external grants to keep working on my psychiatric nursing, trauma and the cold war history. in fact, i spent two weeks after my time in atlanta up at radcliffe at harvard buried in the Peplau boxes (more about that in a separate post). but there is a real issue around the humanities at my current university which is reflective of a political environment, a prime minister, who called this ‘silly research’. he wants a cure for dementia. my university wants to commercialise everything to do with science, and doesnt care how it gets there, doesnt value anyone outside of that realm.

this is not unique to australia. at the risk of making a sweeping generalisation, i think it reflects the current generation of power holders’ concerns with their own impending mortality. as professor goldberg has written so eloquently elsewhere, the obsession with the biomedical, neuromolecular gaze, means that debates about research funding are already blinkered. the terms of the argument are set by ‘we need to find cures, but which cures do we prioritise’.

i am not convinced this is the right question. cures are one thing. but i think they are an easy thing. not to find, but to research, because they feed into that hero complex of the physician or scientist who thinks that saving lives is the end all and be all. i am more interested in questions about the way we live now. is it ethical to spend millions of dollars on finding drug based treatments for anxiety, or depression, or (to lesser extents) cancers, when we arent even questioining what’s normal? we’re very keen to call things ‘disease’ and to posit a mind and body that is lean and disease free as normal. but really? what if there is NO human normal? what if normal IS disease, and oddity, and peculiarity and difference?

in my presentation to emory, i said that we have forgotten, and would do well to remember, the WHO definition of health, written in 1946: “health is a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”.

it is this definition that will guide the critical questions i ask as a researcher, and teacher, at emory. these are questions you can only ask (and not even answer) when you make links between history, philosophy, sociology, ethics, politics and science. i’m not looking for answers. but i am looking to ask a whole lot of different questions, and i cant wait to get started!

DrK

we called it talking with patients

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again, too long between posts. i no sooner returned home then descended into the teaching abyss. not just the regular one, but the one where you go away for three months over the break and come back with about 10 days in which to totally redesign your subject including all new learning materials and assessments. i think i’ve pulled it off, but only just. my first iteration of this new approach to reflective practice, using a framework of critical reflection, is being evaluated while we speak, so i will know if it actually worked from a student perspective shortly. the thing i liked about it most was that we moved students through cycles of reflection from descriptive, to dialogic, to critical, and in each part we focused on concepts like ‘self’, ‘others’ and then ‘social change’. in the last part i got to introduce the idea of history (for these students i broadened it to “social and historical contexts”) and i floated ideas like ‘social determinants of health’ and ‘nurses as agents for social change’. because that’s what i think they are.

so it seems fitting that i would write a post today, because its tuesday, may 12, and that makes it ‘international nurses day’. may 12 is florence nightingale’s birthday, and there will be lots of focus on her, and her role as an agent of social change can not be underestimated. but i will leave other people to talk about her. i want to talk briefly about the main object of my historical study, hildegard peplau.

hilda

again, a lot has been written about hilda and i’m not going to rehash that, but i want to use something she said as a thinking point for how we conceptualise modern nursing practice. that is this idea of ‘talking with patients’. that quote comes from peplau’s oral history that she recorded with professor patricia d’antonio in 1985, and is housed in the peplau collection at the barbara bates centre for the study of the history of nursing at the university of pennsylvania (oh how i miss that place).

peplaupapers

in this history, peplau talks about the way she tried to institute her particular approach to psychiatric nursing in the late 1940s. originally hired to establish the graduate program at teachers college at columbia university in new york city,

Teachers_College

peplau reacted to her war experience of experimental psychiatry (which left her profoundly uncomfortable) and was more determined than ever to develop psychiatric nursing that was more than the handing over of drugs. she explained it like this:

“…we called it 1:1 and then we called it talking with patients and then we called it counselling and then we called it therapy. And that took from 1948 to 1960. It was going to be our own model. We did not have physicians do any of the teaching or the supervision”.

this hardly sounds revolutionary, but for a nurse, in 1948, it was. for a nurse to dare to decide that she knew anything about therapy (which Peplau actually did, as she had a BA in psychology from Bennington, where she had studied with Harry Stack Sullivan and the Fromms), or that she could initiate nursing care that was therapeutic, not only flew in the face of medical orthodoxy but also in the face of existing models of nurse education.

she goes on to explain how her cohort of students worked, and how they needed to keep their approach secret:

“..I set it up so that the total clinical experience was a semester of nursery school, and then this clinical work with the patient, one hour, and we spent the rest of the time going over the data. And they wrote down everything they said, everything the patient said. We called it 1:1 Relationship Studies. We put it on the basis that they needed to know how extensive the psychopathology was in order that they could appreciate how difficult was the physicians work. I thought that was neat. And then in private, in our own little session, we told them they were moving in the direction of psychotherapy. And not one nurse let the secret out. That’s the important part”.

It is the important part, because it speaks to the tensions within nurse education, and between professions, that persist today. nurses still have to fight to be heard over the din of the testerosterone fueled medical profession. in australia, the main barrier to the idea of the nurse practitioner is of course the australian medical association. why is this? because they’re trying to protect their own profession? or because they dont trust nurses?

Recently, nurses have been named as Australia’s most trusted profession. This happens in other parts of the world too. But what is it that makes nurses trusted by the public? It’s not because people appreciate the level of skill and techno-medical knowledge nurses acquire at university these days. I teach in that curriculum, and I can tell you it is demanding.

I would argue that nurses are trusted because of the relationships they build with their patients. If you think of a good nursing experience, what is it that you remember? How well she worked out the dose to put in your IV? I mean yes, but you expect that. As you should. But its the other stuff people talk about. The fact that she remembered your name, asked how you were, maybe held your hand, or even sat and listened. The fact that she TALKED to you.

In 1952, Peplau published her seminal text “Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing”. Interpersonal relations is NOT a mental health nursing text. She explicitly states that this is a book about how nurses can and should relate to ALL patients, because a nurse’s role is to facilitate a patients journey through illness in such a way that they can limit and help resolve any trauma caused by the illness experience.

Huh. Who would have thought it. I think this IS a revolutionary idea. I think the best nurses today do this both conciously and subconsciously. This is why you trust them. These are the nurses you remember.

And this is emotional labour. It’s demanding, draining, frustrating. It takes theory and skill and knowledge and training, its takes empathy and compassion, and it takes a particular world view, a particular way of conceptualising health. It’s a very hard thing to teach, and current nurse education curriculums are crowded with task based, competency scales that work against this kind of care. There are good professional and safety reasons why this is so, and in today’s under funded and over stretched health care systems, ‘talking’ is seen as a luxury, not actual work.

but in the rush to professionalise, to be taken seriously, to escape the wage-limiting gendered assumption that caring is instinctive to women (and so why would we value it, to quote Susan Reverby here); to jump on that science-is-god, techno-rational, bio-medical model, has nursing lost the very essence of itself?

I would hate to answer that categorically, but it is food for thought. I do know that if i could change anything about the current nursing curriculum, i would make the first subject they took, the first book they read, Interpersonal Relations.

but i’m a historian. i would say that, wouldnt i?

so i will just say happy international nurses day to all those highly skilled and under valued health care professionals, and to all my wonderful school of nursing colleagues, who make going to work every day a real pleasure, who i learn so much from, who i admire and respect and who i now class as some of the best friends i will ever have.

DrK.

Credit: all quotes from the Hildegard Peplau Papers, MC59, Barbara Bates Centre for the Study of the History of Nursing, University of Pennsylvania. Research for this project was enabled by the award of the Karen Buhler Wilkerson Fellowship for 2014 from the Centre, for which I am extremely grateful.

Well travelled

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it is one of the great blessings of my job that I get to travel, and I have been on the move a lot lately. And as I wrote that sentence I thought it’s not really my job, it’s not even really my career, it’s my life. Yes I know there is more to life than work and I have that too, but doing what I really love has always been my goal and I’ve worked really hard for it, and now I have it. Most people who follow me on Twitter know where I’ve been the last few months but I thought it timely to summarise and to take the chance to reflect a little.

The last time I posted here I was about to start grading last years assessments. This week I have been connecting with a whole new set of students as we start the new academic year here, and a lot has happened in between. First, I went to Philadelphia. Well, actually, I went to New York and New Jersey before then but that was holiday time. Work time started early January when I headed back to the University of Pennsylvania to take up the second part of my fellowship at the Bates Centre for Nursing History. It made me very happy to get back into the archives.

vanpelt

This time I was working with the papers of other psychiatric nurses from the 50s and 60s, having done so much work with the Hildegard Peplau papers last time. I wanted to look at records from Dorothy Mereness, Claire Fagin and Mary Starke Harper, and I got completely bogged down in the Mereness papers.

mereness papers

She wrote a lot that was relevant to what I was looking for, which was really to try and understand psych nursing practice in relation to anxiety and trauma in the context of the Cold War, and Dorothy had quite a lot to say about that.

mereness words

One of the conditions of the fellowship was to present a seminar about my research, and that was scheduled for February 10. So I had about 5 weeks to try and find what I needed and write something meaningful. This meant that my archive technique was somewhat primitive – I ended up typing about 50 pages of notes as I went rather than taking photos, which was slow and laborious. But I really needed to understand what was there as I went, not leave it till later. And as I took notes I was comparing what Mereness said to what I already knew Peplau had said, and mentally filing things that were the same or different. It was an interesting comparison, and a fruitful one I think.

But there came a moment when I realised I was running out of time and there were whole collections still untouched, so I decided to spend the last week looking at the Mary Starke Harper collection. Mary was an a amazing person, born and raised in Alabama, she went on to advise four presidents about minority and elderly mental health. The Washington Post does her far more justice than I ever could. Her archives were a gold mine, but one of those mines that you fall down and get lost in for a hundred years.

mshpapers

Basically when she died in 2006, everything in her filing cabinets, everything she’d ever read or written, was lifted into boxes, the boxes sealed, and then transported to UPenn storage. The finding guides weren’t exactly clear, but gave me enough to know which boxes to start with, but the Centre decided too order them all up and re-catalogue them. I don’t envy the archivist who has to do that

mshfile

But I will be eternally grateful to them when I go back in October to work my way through this more systematically. Honestly, there is a whole book just in Mary’s story, and the counterpoint she brings to the history of psychiatric practice gave me goosebumps.

mshcontents

You know that feeling when you realise you’ve stumbled on something that no one has written about before? That recognition of something potentially paradigm shifting? That.

So it was with great reluctance that I returned to Australia mid February. I don’t want to leave that work. Not just because I love it but because it’s important. But now I have teaching to do, and that’s important too.

Before I left I decided to revamp my Relfective Practice subject entirely. Instead of focusing on clinical events that raised research questions, I’ve taken a more practice development approach, trying to get health practitioners to step back from the bedside and understand the broader context of their practice. I want them to examine their own values, what they bring to their practice, analyse the assumptions that underpin health narratives, understand how broader social and historical influences impact their practice.

ways

This meant a complete rewrite of the subject. New learning outcomes, new learning materials, new assessments. I tried to do some of that before I left, and then some while I was away but it was really hard to shift my thinking from the archives to the pedagogy of learning design! So when I landed back from the US there was a mad dash to get everying ready in a week.

Most of that madness was because I flew to Hong Kong on the 24th of Feb to teach this brand new subject in the master of nursing we offer there.

sino

So not only was I experimenting with new methods and new assessments, I was experimenting with a whole different cohort of students. So there was a lot of work on the fly, a lot of discussions with the team there about what would or wouldn’t work, a lot of reflecting in practice as I watched a group of non native English speakers try to get their heads around these complex concepts. Not everything worked how I would like, but some of it went really well, and ultimately the thing I always do well won out, which was to build honest rapport with students and open the lines of communication.

I am very open with my students, I am just always myself. I never pretend to be an expert, I told them we were experimenting, I asked for their patience and input, and for the most part I think I got it. We still have a lot of work to do together, and I also start working with my 100 or so onshore students now too. We have a lot of fast work to do to get the technology working how we would like (thank you to my university for introducing new learning platform tools with absolutely no support whatsoever) but thankfully I work in a school that’s committed to doing whatever it needs for students, so I will have plenty of help and support. I also get to work with a great teaching team and I’m looking forward to what we will be able to do together.

In my workshops in Hong Kong I tried to get students at the end of each day to tell me something they had learnt. One day, a student asked me what I had learnt. I laughed and thought about it for a minute. Then I said that I had Iearnt that I talk too fast and I need to slow right down. I said that I needed to rethink all my own assumptions about what students understand, all the assumptions I make about language and philosophy and ways of thinking about the world. I said I learnt that people all around the world seemed really different but fundamentally humans are the same everywhere. And I said I had learnt Sun Lin Fai Lok, which is Cantonese for happy new year, and this bought laughter and a round of applause. Then we took photos and said goodbye and I was sad to leave.

If I think about it a bit more, that Hong Kong experience has taught me a great deal about being a good teacher. It’s taught me the value of preparation, and the necessity for flexibility. It’s taught me how well I know my subject now, how much I love it, how much I have invested In it, how much I believe in it.  It’s taught me how to be confident, and how much I still have to learn. And it’s taught me how much I loved Hong Kong, and how much I can’t wait to go back.

nathanrd

But first, I have unfinished business in the US. While I was in Philadelphia, I was awarded a small grant from my university that will pay for me to go back to Penn as well as more archives at Harvard. I was also awarded a Rockefeller Archives Centre grant that will pay for a month in New York. So come September I am on the road again. More interesting times ahead. Right now though I need to catch up on some sleep!

DrK

reflection redux

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i am about to start marking the final assessments for my postgrad reflective practice subject, and i thought before i started i would just take the time to breath, and be mindful about what i’m about to do.

ok, so im procrastinating….

seriously though, it’s been a long time since i posted here and this gives some indication of how full on work has been this semester. i have no intention of complaining about that, i love my job more than ever right now, but the end of the academic year has many pitfalls that await the early career researcher who also has a substantial teaching load. and really, my load is light compared to some.

i have tried really hard this semester, while teaching, to get some outcomes from my US archival work. it has taken me the best part of this 13 weeks to come up with a full draft of a first article, from which i had to cut an excess of 3000 words, but at least that’s half of article two. and final assessment time also coincides with a number of grant application deadlines. i have three in the works: one to the Rockefeller Archives Centre for a project called ‘philanthropy, psychiatry and nursing in the cold war’, another to my university’s internationalisation committee called ‘a history of trauma in mental health nursing: an international comparison’ and the final one due this thursday to my faculty, called “approaches to the treatment and care of PTSD in australian nursing after 1945”. you can see my attempts to build a coherent body of work here using a whole heap of archives in australia and the US, and if these all come off i will have the money and leverage to spend the better part of 3-4 months overseas next year.

but first i must get through this year. i have 4 weeks of work time left before i go on annual leave (forced somewhat, as i have too much accrued) and 4 weeks and 3 days before i am on a plane to new york city. i have lots planned, a few days off, shopping, museums. a meeting with co-editors and our book publisher in there somewhere. then christmas and new year in the snow in  new jersey and massachusetts ( i am even thinking of hiring a car!) and then another 4 weeks work back at the university of pennsylvania in philadelphia, including presenting my work in a seminar (eeep!).

so lots to look forward to. but first i must finalise the grades for 78 students in reflective practice 1. so i will be locked up here for a while.

markinghell

i am going to try hard not to whinge while i do this. i am pretty pleased with the participation and engagement from most of my students and i’ve had some really great feedback from some of them. online learning is hard, we only have 3 face to face sessions and there is always too much to get through. and everytime i teach this subject i want to teach it entirely differently. because it is a core subject to all our postgrad degrees, i need to run it every session, so i dont get a lot of down time to plan or reorganise. but this will be the last session that i have to read a 2500 literature review that considers the implications for practice arising from a reflection about a practice event. i inherited this subject and its assessments, and it takes a long time to get changes to subject outcomes and assessment tasks through a university system, but this year our masters programmes have been through AQF validation, so the time was right.

we have succeeded in making two significant changes to this subject. one is a complete rewrite of the subject outcomes, so they are now not about preparing students to identify research questions and undertake research, nor are the assessment tasks related to the development of research skills. we have taken a stand and said Reflective practice is NOT a pseudonym for either evidence based practice or research preparation. so we’ve also been able to rewrite the assessment tasks, to move them away from research to more creative approaches to reflection. we’ ve been helped in this cause by finally having a whole subject dedicated to research preparation, so there is now no need to replicate that in ‘reflective practice’, but i think we’ve also been successful because the old coordinator and i have formed a team and worked really well together.

my school took a big risk to employ me. im not a nurse. im a historian. yet they saw in me the capacity to achieve significant research outcomes that benefit the school, and in my historical sensibility, they saw better than i did at first, a natural alignment with reflective practice. i love this subject so much. i see so much potential for it to be, as siobhan nelson called it, a radical technology. so our new outcomes and assessment tasks ask students to specifically engage with themselves as mindful, critical practitioners (drawing on ways of knowing), but also with the social, political and historical context of their practice.

this isnt easy for us of course. its a whole new approach to the subject i will have to put together while i’m away (yay moodle), with all new teaching and learning materials and a completely different approach to the assessment. we want to move towards mahara to enable creative portfolio building for students, but with me being away for the summer we dont really have the time to get that happening – and also i dont think our uni is really up to the plate yet re supporting mahara, or developing clear guidelines for assessing creative portfolios.

but jo and i have some ideas (which i cant really share just yet!), and we are looking forward to seeing how they work across the three instances of the subject delivery (on campus, distance, and then in hong kong). so some challenges ahead, but also i am really excited that this will be the last time i need to read 2500 words on how these 10 articles about hand hygiene make me a better nurse! (kill me now).

speaking of which….

DrK

why science needs history

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yet again, its been too long between posts. life has this annoying habit of getting in the way of the thinking and writing i want to do. but i have been inspired to post today because of something i found yesterday, and something that’s coming next week.

these two things are related, and they are related to the idea that science needs history, and why it’s so hard get money for that. the something that i found yesterday was this newspaper sheet that professor julie fairman gave me when i was working at the Bates Centre at UPenn in July:

sciencematters

we were talking about how hard it was for our discipline, nursing history, to garner any recognition, any funding, in regular academic systems. julie told me how she had just given a talk to a group of senior science academics at UPenn about the importance of history for understanding both science and medical theory and practice, and she had quoted from this story (original here). it was interesting to have this conversation with her in philadelphia, a city so steeped in american health and medical history, with the mutter museum, the college of physicians library, the pennsylvania hospital and it’s amazing archive, the presence of the agnew clinic, even dr benjamin rush’s house:

benrush

maybe because i was looking for it while i was there, but i felt like medical, nursing, psychiatric history, was everywhere in philadelphia. being at the bates centre, part of such an active and aware group of scholars, with dedicated space for nursing history – within a school that absolutely knew and valued and celebrated it’s history, it was a revelation. it has been an awful shock to come home to the butchering of australian history yet again for political purposes, and as we approach 100 years of the gallipoli debacle, to see all nursing history yet again subsumed into the national myth making that is Anzac. it’s disheartening.

it’s also hard not to be disheartened by being the sole historian, actually probably one of only a few with a humanities background, in a faculty of science, medicine and health. nursing doesnt fare well in that hierarchy at the best of times. to be a historian in nursing…well, that brings me to the thing that’s happening next week. we are headed into the silly season of grant applications and i am thinking very seriously about how i play this game, again.

this is my dilemma: while i was in philadelphia, julie and i talked about the possibility of me applying for a fulbright, and that if i did the bates centre would ‘love to have me for a year’. i cant, i dont even need to tell you, what that means, to have heard that, to think that might be possible. i have always thought a fulbright was where i wanted to go, but to get there. well, its a bit like climbing everest i guess. you stand at the bottom and think there is no way i am going to make that summit. but everyone gets to the top of these things one step at a time. my first step was being awarded the karen-buhler wilkerson fellowship at UPenn. but that fellowship will come to nothing if my own university doesnt recognise my worth and won’t come to the party with some early career funds. not just early career, but i am also new staff. in less than a year here i have hit all the markers for a research active scholar. my work will be counted for school outputs in the next ‘excellence in research australia’ audit. but i have paid for all of that work by myself. i have used my own earnings to fund my research trips, to fund those countless hours in archives, the lost weekends of writing grant applications and papers in order to build some track record. and despite the fact that i have an explicit job description that asks me to build an independent body of work in nursing history scholarship, and to integrate that work into the curriculum, i have not been supported by my faculty (my school is incredibly supportive), to do that work.

when i applied last time for funds, i was unsuccessful. there was enough money in the pot to give me something. maybe not all of what i wanted, but something. instead it went to the physics, biology and chemistry ECRs. nothing to my school. nothing to me. one of the pieces of feedback i got were ‘well we didnt really have enough money to go around. chemicals cost a lot you know’. yes. i know. there never is enough money for this frivolous history stuff is there, when you’re busy saving lives?

i am going to apply again though, and i am going to try yet again to make my case for why history matters for the sciences. as you can see in that article, if you read it, you would have to be living under a rock to not realise that medical and scientific achievements were and still are historically and socially constructed. all so called scientific advances are contingent on the historical forces that allowed some decisions to be made and others not, some avenues followed, others closed down. this is still happening today.

for nursing, history matters because of nursing’s history. more than most other health professions, nursing theory and practice has been forged at the intersection of social and political forces such as gender, work and race. health discourses now carry the halo of morality about them, and this facilitates the idea that some who are sick are more deserving than others. this in turn affects the attitudes and judgements of the nurses who’s job it is to ‘care’, no matter what. people tend to see nurses as angels, as the most trusted profession, but i teach them, and they are not. they are just human, like any other health professional. yet they deal with a whole person, not just a symptom, who must be understood in the context of their own history.

in mental health nursing (my area of research) stigma, judgementality and unethical treatment such as seclusion and restraint continue to run rife. the ideas that surround systems of deinstitutionalisation and pharmacotherapy, the rhetorics of personal responsibilty, these all impinge on the ability of nurses to understand and practice true person centred care. the barriers to person centred care are historical. understanding them is the first step to changing them.

this week i rewrote the subject outcomes for my postgrad reflective practice subject. for the first time ever that subject now has an outcome that is explicitly related to understanding the ‘local and global’ historical context of specific health care practices. i’m about to start designing the learning activities and assessment that will support that outcome. yes that’s right, im making health practitioners do some history work.

so i will try yet again to convince my faculty, run by academics from the hard sciences, that understanding the history of mental health nursing theory matters, that understanding why nurses think and do what they do, matters for the quality of care they are able to provide today. understanding your discipline’s history, knowing why you believe those truths and not others, understanding why you’re taught what you are, and how to question that, as a scientist, as a physician, as a nurse, it can and does save lives.

DrK

 

the philadelphia connection

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its been a while since i posted here because the last few months of my life were beyond hectic. the house i was living in got sold and i was given 3 months notice, which co-incided with my planned trip to the US so i decided to pack it all up and put it in storage. that was stressful enough. at the same time i was still teaching, and supervising, and organising a research school, and publishing, and writing conference papers, which actually didn’t get written until the very last minute (one of them literally 10 minutes before presentation time) at the conference i went to in banff: philosophy in the nurses’ world. it was a fantastic conference, lots of critical theory, a few history presentations (mine included), a good focus on mental health, and a great time with my colleague joanne including a really interesting and thought provoking discussion and final keynote with gary rolfe about the nature of nursing science and reflective practice. all of that is still whirring around in my brain and will affect the way we reconfigure our reflective practice subjects at home over the next few months.

but right now, i am not at home, i am in philadelphia. here, to be precise:

school

the school of nursing at the university of pennsylvania. i think i mentioned i was awarded the Karen Buhler-Wilkerson fellowship here and the tiny bit of money that came with it didnt even cover the air fare. but it wasnt about the money. it was about the chance to work here

bates

in the barbara bates centre for the study of the history of nursing.

my three weeks here so far have been amazing. i have been so well looked after, and welcomed, and given access to the most amazing collections, at the centre, and other places at UPenn, here at the Van Pelt library in particular

vanpelt

where they deliver things to me from storage in new jersey

books

and i get to spend a day next week with the archivist at america’s first hospital, the pennsylvania hospital (i will get better pictures when i am actually allowed inside!)

pennhosp

my application project to come here was called ‘the idea of trauma in american nursing practice after 1945’ and my particular interest is a ‘history of ideas’ approach, taking a few hints from foucault about the archeology of knowledge, and how we come to understand certain terms in certain ways. i didnt expect to find nurses talking about trauma, in the way we talk about it now. that’s the whole point. but i also didnt expect to find what i have found. i will try and explain it as simply as possible without giving too much away, because i think its the beginnings of something really big.

working

my broad interest is about the ways that mental health nursing practice has evolved, in the context of significant shifts in thinking about psychiatry and mental health, and how this happened on a global scale, related to quite distinct social changes. if my basic theoretical approach is a biopolitics one, that health discourses are used to control, know, observe, discipline and surveille human behaviour, then how do nurses negotiate these discourses in mental health? is there an inherent, always already, tension in nursing practice, that says it seeks to help but is also part of the political, power-over-bodies project of ‘public health’? i am not a fan of public health, already. and what i have found here reinforces to me why.

what i’ve found is two fold. firstly, no, mental health, or psychiatric nurses didnt talk about ‘trauma’ in that they didnt use that word. for nurses, even after world war two and its profound psychological impact, the word trauma meant extreme physical injury or illness. usually injury or a catastophic physiological event – the trauma of surgery, the trauma of heart attack. but they did talk about things that SOUND like trauma. the more i read the more i find this word: anxiety

anxiety1

it is at the basis of everything mental health nurses talk about in the immediate years following world war two. i have founds lots of nurses talking about it, not just the ones i came here to study. i have found old nursing text books about it

anxietytexts

it takes up whole chapters in general psychiatric text books. its the basis of all the ways they were thinking about issues and problems with human behaviour and how to solve them. there is something significant in this, and i’m still struggling to find the words to articulate it. it’s something to do with abstracting people from the social contexts of their ‘trauma’ and placing the blame for mental illness back inside the individual, something about self-control, something about neurosis…

it’s also related to the second thing ive found, which is that my hunch about mental health nursing being as much about social control as any other kind of health discourse, was right. but not quite in the way i expected. in 1958, hildegard peplau, the main nurse i have come here to study (she wrote the seminal text in mental health nursing really) wrote that “mental illness is the greatest social problem of our time’. why would she say this? as someone who had been a nurse in the field of war, a psychiatric nurse no less, working in UK army hospitals with famous psychiatrists from the tavistock clinic, trained by erich fromm himself, maybe it’s not surprising that this is her focus.

but it’s not as simple as that. hildy, as i am calling her (apologies), has been called ‘the psychiatric nurse of the century’. her influence on mental health nursing is completely immeasurable. new theories, new models, they come and go and they give themselves new names, but they all owe a debt to her, whether they like it or not. and the mental health nurses where i come from know this. they all know her. they all believe in ‘interpersonal relations’ ‘psychodynamic nursing’ ‘the therapeutic use of self’. but for hildegard, and for the nurses around her at the time, and for psychiatrists as well, there was more to this than just treatment and care. i have found myself confronted with the idea that hildy, and her compatriots, believed in the idea of PREVENTION. obviously, this isnt a new idea, per se. on the shelves of the van pelt, i found this journal

hygiene

and this is an old idea, the moral notion of mental illness. that you could clean your psyche somehow. we can laugh about it now. but i also found this journal, still being published today.

ortho

no, this is not about the mental health of your bones. orthopsychiatry means preventative psychiatry. in this period, say from 1945 to pre vietnam war, there was a very profound idea that mental health nurses could help to prevent mental illness. i know, right? this was a revelation to me. i am not a trained mental health nurse, but you would think this idea had been well and truly abandoned as we learn more about brain and cognitive function. but i have a hunch that the IDEA of prevention still affects how we think about mental illness, and therefore how we treat  it. and how we treat the mentally ill. and this idea of prevention is at the root of public health discourses, and it is everything that is wrong with public health, because it puts the responsibilty for that prevention back in the lap of the individual. and so now i have a plan. it looks a little like this

plan

and i cant give much more away, but its a plan for a book now, not just a paper or two. its about really using that theory, that biopolitics idea, to scrape away the layers of rhetoric about help and person-centredness and recovery, and get to the heart of what’s going on in health discourses, in nursing practice, the holy sacred reign of medicine and science, and this interminable incessant interference with the body of the Other.

i havent got through half of what i wanted to get through this time in philadelphia, with only about 10 days left, but i will be back. and what i have so far has been worth every stressful, exhausting, brain-draining, injury-inducing, euphoric, exhilarating moment.

DrK

it’s all about control*

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i havent had a lot of time to post lately, i won’t bore you with the details of the insanity that has been the last few weeks, because here we are in week 6 and i have no idea how that happened. i’m as stressed and overworked and freaking out as everyone else, but i am slowly working out strategies to prioritise and focus and getting better at saying no!

in good news, a couple weeks ago i was awarded the karen buhler-wilkerson fellowship at the barbara bates centre at the university of pennsylvania. it’s a tiny amount of money but it does pay the air fare, and it gives me full and official access to not just the centre’s collections but also UPenn’s impressive library. i also get to go back over christmas to do a bit more work and present a seminar. the project is looking at early mental health nursing approaches to trauma, including among others, the peplau, mereness and fagin archives. it is really a huge honour to be associated with such a great school and research centre. that little success spurred me on to apply for a small grant through the american association for the history of nursing. that grant would pay for an extension to this project, focusing more specifically on peplau’s extensive personal collection at the schlesinger library at harvard. oh yes, harvard.

harvard

once upon a time, many moons ago, when i was a wee thing reading emily dickinson poems, i thought about leaving these island shores and studying at harvard, or amherst, or brown, or one Those Places. then i found other things to do with my time. if i’m lucky, it may yet happen. fingers crossed.

in the meantime, i am trying to write the papers for the ‘philosophy in a nurses world’ conference in Banff. i’ve been so overwhelmed with other stuff i can hardly remember what i said i was going to talk about, so i thought this might be a good opportunity to refresh my memory and get some ideas out there.

one paper is pure history, well as pure as i can do it, because it always has theory in there somewhere. its about the idea of ‘self control’ in the history of mental health. i’m using the archives of this guy

fnm

frederick norton manning. he was the inspector general of asylums here from about 1870 to the early 1900s and oversaw the planning and the building of rozelle hospital:

callanpark

 

he was also instrumental in introducing the first mental health nurses (as opposed to attendants) and he was adamant that they be women.

Callan Park1

the reasons for this are complicated, and you’ll have to wait for the paper, but his affect on mental health nursing was profound. he trained then nurses himself, and had them attend lectures at sydney uni where he was a lecturer in ‘medical psychology’. he then worked to improve the conditions for mental health nurses and tried to have it recognised as a distinct specialisation within nursing.

but the interesting thing about him, for me, is the idea of ‘control’ in his approach. he really bridged the period between ‘moral treatment’ and the birth of modern psychiatry, by recognising that some illnesses were organic or biological, while others might be more ‘behavioural’ and that a person could be encouraged into ‘recovery’ through the exercise of their own self control. hence, one of the reasons why women as nurses were so important.

but see that thing about self-control? my argument in this paper is that this is one of the big and persistent tensions in mental health, and has issues for modern nursing practice because it creates an immediate conflict with the idea of person centred care.

firstly, how do you get a person with a mental illness to just control themselves? manning and his nurses used the arts of gentle persuasion, interpersonal relations, therapeutic use of self (again, the importance of women). but control was still coerced because it came with reward if exercised (freedom, privileges, nicer rooms, more entertainments) and punishments if not (seclusion and restraint) including hydrotherapy, dungeons and chains.

we think we’ve done away with that by closing down places like rozelle now.

hahawalls

but we really havent, and if you think we dont have padded cells anymore than what do we use psychotropic drugs for? and this rhetoric of self control runs very deep in the australian psyche (sorry!) in relation to mental illness. just get a hold of yourself right? pull yourself together. if you’ve ever had any kind of mental illness you’ll know how disempowering and insulting that kind of thinking is.

yet in my reflective practice subject, i get a lot of mental health students (some of whom are very experienced practitioners) wanting to just know how to get their patients to comply. take their drugs, dont be difficult. it takes a great deal of effort on my part to get them to think for a minute about how this idea of control is so much an assumed part of their practice. and if you are busy trying to get your patients to JUST TAKE THEIR DRUGS, you’re not really being very therapeutic are you? and you aren’t even thinking about person centred care. even just getting them to recognise that’s an actual person with rights can be a challenge. and then you get the good ones who care a great deal and work very hard to make a difference and i see how worn down and frustrated they get.

anyway, I was going to write here as well about how this links to the second paper i’m working on, which is called ‘history, critical theory and reflective practice’ but we just had a paper accepted by collegian about the way we use history as reflective practice, so i will be able to write more about that next time. and it’s very heavy on the critical theory, and i need to do a bit more reading and thinking.

right now, i need to turn what i wrote above into an actual presentation. using Prezi this time, i think!

DrK

* yes i have been singing janet jackson songs the whole time i’ve been writing this.

surviving week one

here we are into week two of a new academic year and i think my head has slowed to a gentle cycle spin. i am completely and utterly in awe of people who run schools of nursing. the volume of students and the requirements to get 350 new enrolments ready to go on clinical placements, to get them all in tutorial groups, deal with complaints and time table clashes and ‘oh i couldnt possibly travel to sydney for my placement’, to get learning materials ready (which are now also required to include an online learning environment, which means yes more work, because you still need to write the content first, let alone build your own site),

to wade in and out of endless meetings aimed at improving our research profile AT THE SAME TIME with no actual research funding, to set up a new honours program and then to want to make it available part time and oh my god i just cant even….

i am in awe of my head of school and the people who support her, and how well she manages to support us. last week she gave me a book that she’d remembered we’d talked about and it was out of print and she’d gone and looked for it and bought it and then just gave it to me, like that. curriculum

then again today. i had been nominated to give a presentation to the vice chancellor as an early career researcher from my school. he wanted to see one person from each school in the faculty and the school of nursing now sits in a science, medicine and health faculty. but as reflects the general broader cultural and social obsession with the wonders of modern science (because they’re saving lives and discovering things, dont you know), the scientists make the most noise and you sometimes have to slap them upside the head to remind them that science only matters in the context of the people its being applied to. you know, PEOPLE???

anyway, there were three of them today and one of me and it was totally i ntimidating and i felt like a complete outlyer – do you know how hard it is to stand up and talk about the importance of history after people who’ve been talking about measuring cosmic rays and M proteins and mass spectrometer reverse the polarity (bazinga!). i’ll tell you its really freaking hard and i broke out in a cold sweat and none of them used notes, so i had to leave my notes on the table in front of me and just wing it and i thought i was going to forget things and i spoke too fast. but my head of school just looked at me the whole time and smiled and nodded. and then the Vice Chancellor, and even the other scientists, asked me lots of questions and we talked about asylums and psychiatry and the power of touch.

it was great. he came up later and told me he’d heard me on the radio and i was doing great work. i’m pretty happy with that. i’ll be happier if he can approve some of my archive travel grant requests. or let me build a history display in a cabinet in the foyer of the building… anyway, you can read the presentation here if you want. not me talking just the slides.

i feel a bit more like i can breathe now. this presentation has been hanging over my head, even though it was a short one, and im relieved its over. today i got the actual galley proofs for a textbook i’ve contributed to and its exciting to see it in print, and to have worked well with chris to get that done.

proofs

it was chris that i did my mental health lecture for and he said its getting lots of views on the moodle and people are actually watching the whole thing, so i was happy to hear that.

i have another chapter due to the co-author next week for another mental health text book and its just such a huge gift to be able to work with people who are so open to having a non nurse contribute to nursing knowledge.

meanwhile my own subject is finally up and running and the students are chatting away in the forums, and i had my first two third year nursing classes last week about ‘evidence appreciation’. we talked about what constitutes evidence and i tried to remind them it was more than science!

i have my my honours student working hard on his person centred nursing in aged care project. i have one paper under review by an australian journal, a second one almost ready to send to an international journal. im waiting for the outcomes of one fellowship application and about to submit another. so again, a lot of DOING at the moment, and not much time for thinking, but i had these two books arrive the other day:

theory

im already halfway through the ‘working with theory’ one, and have two hours now before i have to be somewhere, so if you dont mind, im going sit quietly and read! next post i’ll write something about this theory and how its influencing the papers for canada in may.

hope all my other academic friends survived week one without too much bloodshed!

DrK

but where is the person?

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i havent had much time to write about work lately, it been mostly doing and not much thinking. this is my first time around as a full time academic at the beginning of the academic year and i am…stunned, i think is the word…at everything thats involved. its a bit different in a nursing school from a history one – the student load is much higher and the preparation requirements for them much more intensive, their coursework is more structured and outcome driven. i try to explain to my nursing colleagues what it was like teaching in humanities, that it was just mostly readings and discussion. here, we have tutorial workbooks and subject outcomes and intended learning objects and AQF and TEQSA requirements, and an actual curriculum document! i dont think anyone i worked with in the arts faculty even know what a subject outcome was (yes that was a bit harsh). my point is really that if you are nursing student you can be assured that a great deal of thought, care and preparation is going into the subjects you are about to undertake this year.

i am updating parts of my own subject (reflective practice), setting up our first ever more-than-one-student-at-a-time honours program (of which i am the co-ordinator), teaching in as well as being the back up co-ordinator for our third year evidence appreciation subject, and putting together lectures for other subjects about various moments in nursing history. this is the one i’m working on at the moment

slide

and its a lot of fun, but also really hard and pretty sad to see how very far we have not come. the aim here is to demonstrate to the third year students that ideas in their practice have a history, that science and drugs and medical psychiatry are not the end all and be all of mental health care and that good practitioners are empathetic ones. it’s hard to know what to tell them, what they will understand, but i think its important to try and challenge and stretch them a little. it helps that they’re all familiar with this

peplau

and i can bring in some of the ideas i’ve been working on as a result of my own research into Peplau and her ideas and methods. the more i read, the more i see that within ‘interpersonal relations’ is a really radical approach to person centred care. and its really only radical TODAY because its so far away from what actually happens in a health system that is in fact entirely service centred.

what do i mean by that? well i went to a one day conference on friday organised by our local health district but it attracted practitioners from all over the state.

program

it was fantastic really, and i learnt a lot. but as usual, there is a tension for me in the very idea of ‘health’ and ‘person centredness’. if you really think about it, there are people, scientists, ‘experts’ out there, deciding what HEALTH is. every day, we are bombarded with relentless messages about what it is to be healthy, what healthy looks like, that there is no greater goal than to BE HEALTHY. that it is in fact a MORAL IMPERATIVE to be healthy, and if you are not, you are in some way a bad person. i know health practitioners think they’re trying to help people, but there is no good that can come out of a discourse of health that is so unendingly critical and does nothing except normalise health and make deviant someone elses’ idea of ill health. when ideas about health are overlaid with morality like this, you get stigma. thats why public health campaigns miss the people they’re aimed at, because all they do is valorise the people who already dont do that behaviour and blame and shame the ones that do.

it makes me mad, because its also the case in mental health, and thats not funny. thats life and death, hanging on a thread. we’ve seen a lot about that lately, with celebrity suicides and drug overdoses. this week i was asked to moderate some essays from last year to see whether they’d been fairly marked. i was pretty harsh, especially when you get someone writing that restraint is required, is in fact therapeutic, because a patient is upset and irritable

restraint

it makes me cry, it really does. this is what we’ve come to. if you turn up in a health service, and you’re upset and irritable and maybe you get angry and maybe you feel like no ones listening to you and you dont sit quietly and play nice, you are at very real risk of being restrained in the interest of public safety. but where is the person in that? some other person has more rights than you do, in that scenario, and that person is the one who is compliant, where you are not. so you are the problem, not the system that is crumbling down around you.

also playing on my mind at this workshop was the emphasis on EVIDENCE BASED PRACTICE. to me, there is no greater tension running through nursing, and health care, than the tension between current conceptions of ‘evidence based practice’ and ‘person centred care’. if i go back to peplau for a minute, she writes about interpersonal relations as being the essence of nursing, because the nurse is themself the therapy. we talk about ‘therapeutic use of self’ in our current curriculum, but when you read peplau its like OHHHH, she means actual therapy, she means personality development, she means empowerment and agency and the patient as the expert.

in the afternoon we did a really great workshop on implementing evidence based practice in person centred ways. i was at a table with my colleague moira and rather than undertaking the prescribed activity, we found ourselves questioning the very nature of evidence based practice itself. as moira put it, the prevailing idea of evidence based practice assumes a  hierarchy of knowledge where the technical scientific biomedical knowledge is king, rather than accepting that the person with the lived experience is in fact the expert. i wanted to cheer. i wrote on my notes ‘is evidence based practice compatible with person centred care’ and she wrote on hers ‘is person centred care compatible with evidence based practice’. obviously there are questions here about what do we mean by evidence, and what do we mean by knowledge, and even what do we mean by person. so we’re going to write a paper together about it. i’m sure we wont be the first, and hopefully not the last.

so thats where my thinking is at, at the moment. this is a common theme in reflective practice, and in the mental health research: where is the person in all that care? i’m really pleased to have an honours student this year (who was in my reflective practice class last year) who’s looking at person centred nursing in aged care, and i think he will have a lot to contribute to this question, and to my own way of thinking.

so i sound a bit jumbled today but thats because things are swirling around in my head: reflection, mental health, history, critical theory, evidence, person centred…. it had better come together in time for the conference in canada, considering i’m giving a paper about it!

i just hope in the meantime i can keep encouraging my students, who are also practitioners, to be critical, to be mindful, and to always ask themselves ‘where is the person?’ in what they’re doing. if only the current health care system was set up to ask that as well….

DrK