Chapter 24
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.