Nursing, Healthcare, Violence, and Community
January 20, 2011
It is difficult to put together the best of our society with all its failings. The best of our advanced health care system with it being out of reach to so many. The civility and generosity that define our communities with the violence that continues to challenge our understanding. The miraculous recovery now in process of Gabrielle Giffords is evidence of the courage of those around her and the medical skills that met her in the hospital. It is the best of who we are. How do we reconcile all of this..how do we make sense of our own humanity to each other in the face of unnecessary tragedies?
When Florence Nightingale became aware of the grave conditions of the British Army Hospitals in the Crimean war, her call was to take care of the wounded, to get into action. The relationship between nursing and war has a long history. The ways in which nurses have long been sought out to tend to the wounded, the ill, to be at the bedside of those during epidemics, speaks to the core mission of nursing. Nightingale’s environmental interventions were, at the least, what changed the mortality rate so dramatically, from 42% to 2%. However, upon returning to Britain after the war, she expanded her work into public health and hospital construction and remained driven to improve the quality of healthcare, not just for a few, but for all.
What does this say to each of us about what we do amidst the tragedies in Tucson and, even more recently, the school shootings in Los Angeles? For me, personally, living according to the ethics of good works requires that I move past my own anger at the situation and their perpetrators into looking into my own community for how I might improve the environment and make it less opportunistic for violence and the hatred behind it. I am not great at this…busy schedule, the hustle of daily living and everything else that entails the hours of the day…forces me to carve out time to do something…anything…that points to a better world. I have come to the conclusion that the footprint of my life is not determined by my shoe size; rather it may well be determined by how far I am willing to go beyond the path laid out for me each day.
I was born in Detroit and this wonderful city where I received a stunning education, rich in history and music, has been plagued by violence and collective helplessness. Therefore, the ravages of violence are not foreign to me…although, I must admit that I find myself desensitized to current news rants that repeat over and over the many social and economic problems we are facing without any solutions.
Then, what is there for us to do? I offer this suggestion from author, Kurt Vonnegut, Jr::
“What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured.”
When we look at the isolation of disease, of poverty, of depression, of financial despair, the outcomes are a threat to the health of our communities and those who live in them. In each case of a mass murder, the perpetrator was isolated, seldom authentically integrated into healthy relationships. One could make a case for the community of gangs and terrorist cells, but I would argue that collective isolationism and despair can become a basis for group connectivity.
Nightingale knew of these social ills. She was most critical of her aristocratic colleagues who felt no responsibility for the poor and ill. She ventured into social work in her first position as the head of a home for ill governesses, adding to her task not only moving these women into recovery, but finding them work following their rehabilitation.
The times we live in are mired with controversies of values, economics, and over personal rights. In this week’s New England Journal of Medicine, an article discussing the need for nurse practitioners to no longer be denied their ability, skills, and competence in providing primary care services (“Fairman, Julie A., Rowe, John W., Hassmiller, Susan, Shalala, Donna E., . (2011) Broadening the Scope of Nursing Practice. New England Journal of Medicine 364:3, 193-196) was met with a response from the American Medical Association that was not helpful in defending a sole physician led model. I hope that both physicians and nurses join together to reconsider the model of care needed for an equally-accessible health care system clearly needed and called for at this time.
Clearly this month is one of confusion to me. My thinking is everywhere, touching on issues seemingly unrelated that, for me, are primary. I am not sure how it will be next month, but I invite you to consider what jumps out for you regarding priorities of consideration… I think confusion mixed with considered concern may be the best we can do.