PubMed · 247983
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C M Lewis. 1978. Nursing - by what right?. https://pubmed.ncbi.nlm.nih.gov/247983/
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The purpose of this paper is to temper over-optimistic expectations about the degree to which Project 2000 training will improve the quality of psychiatric nursing care. The paper commences by citing evidence that, to date, psychiatric nurses have tended not to adopt therapeutic approaches towards their patients. Curricular innovations aimed at encouraging them to do so have had little effect. It is argued that the effects of the latest education reforms may be similarly compromised. The reasons for mental health nurses not engaging in therapeutic care are as much to do with the institutions they work in as with the training that they receive. As long as nurses feel that it is part of their role to maintain institutional order, their therapeutic role will be compromised; while the latter requires social proximity, the former demands social distance. Moreover, because it is informal, rather than formal, therapeutic interactions that patients value in their dealings with nurses, it is not clear that the sort of knowledge that Project 2000 curricula are designed to impart will be therapeutically effective.
The effectiveness of a brief clinical and basic science seminar on pain for 1st year medical students was examined by comparing attitudes about pain prior to the seminar to attitudes 5 months after the seminar. The 6-h course combined written materials conveying facts about behavioral, social and biological aspects of pain with clinical observations of an acute and a chronic pain treatment team. Examination of responses to a questionnaire assessing attitudes toward pain patients revealed that medical students have limited personal experience with pain and medications for pain, and limited knowledge about pain. Pre-course attitudes toward pain patients were dominated by perceived negative characteristics of pain patients and the belief that working with such patients is difficult. Attitudes measured 5 months after the course reflected increased complexity, greater emphasis that pain is real and not imaginary, and stronger belief that working with pain patients is rewarding. Five months after the seminar, students reported more accurate estimates of the frequency of problems with addiction stemming from acute pain treatment and exaggerated the prevalence of pain problems in the society. The importance of integrating clinical and basic science experiences in order to influence long-term clinical attitudes and produce lasting changes in clinically relevant knowledge is discussed.