The Training of Attendants in Certified Institutions
Correspondence.
Apropos of Br. Turner’s article on this subject in our last issue, we have received the following communication from Miss Price, formerly Superintendent of the London County Council’s Certified Institution South Side Home, Streatham Common, and now one of the C. A. M. W.’s Occupational Organisers:? “The syllabus set forth by the General Nursing Council for the training of nurses for the mentally defective certainly shows some lack of realisation of the needs of the patients and the lines upon which up-to-date treatment of such cases proceeds.
General sick nursing knowledge, while a useful adjunct, is of 110 more value in the work of the average attendant on the mentally defective than it is in that of anyone else responsible for the general welfare of a number of people, and if too much time is spent in an endeavour to acquire hospital nursing technique, it must hinder what is the essential part of the treatment, viz., the development of whatever potentialities for mental and physical growth which the patient possesses. But the loss of time involved is not by any means the only serious objection to such a course. As Dr Turner so clearly states, one of the chiel aims in the educational treatment of these patients is the creation of an atmosphere which will tend to develop self-respect in persons who are suffering from a marked sense of inferiority and is it reasonable to expect that this atmosphere will be successfully created by workers who are themselves suffering from a like feeling? For the technique of nursing cannot be successfully learnt in any institution foi defectives and the ‘ ‘nurses’’ trained there cannot hope to attain the status of the fully qualified hospital nurse.
Since this work is neither that of a professional nurse nor on the other hand, that of a professional teacher, but a combination of some of the duties of each with a considerable share of a parent’s duty added, would it not be possible to devise a course of training more definitely on these lines ? A satisfactory foim of tiaining does, undoubtedly, do more than anything else to attract the right type of candidate, but here we are confronted by a difficulty which, under present conditions, is very great. Hospital training, and training for the teaching profession, both lead to an assured career, but the training of the mixed type needed for the attendant in an Institution for defectives has 110 such definite and concise goal, and this consideration may have figured in the minds of those who drew up a syllabus which does not take into account the true needs and nature of the work. It seems as though this difficulty might be overcome by devising, as Dr. Turner suggests, a syllabus which demands, in those subjects a knowledge of which is really essential for the work, a more scientific training up to the standard required, and which shall then be supplemented by special subjects selected by the candidate. In the compulsory part of the syllabus the necessary knowledge as to ^e physical care of the patients should be adequately conveyed in a course of lectures on anatomy, First Aid, Home Nursing, Hygiene, Inlant Care, etc., taken UP to the British Red Cross or St. John’s Ambulance standard. This is a standard reached by many lay people who are responsible, in various ways, or t e p ysica welfare of others, and it need not be confused with hospital nursing proper. For the few candidates who decide to take nursing as the special subject for the 42 studies in Mental inefficiency.
Certificate in order to qualify for responsible work in sick wards, facilities for a period of hospital training, in addition, should be forthcoming. Subjects which might usefully have a larger place in the compulsory part of the syllabus in addition to the more technical ones are, domestic training, nursery training, kindergarten and other methods of education for young children, elementary handicrafts, physical drill, dancing, games and singing, storytelling, nature study, gardening, principles of scout and girl guide work and of club-work for boys and girls. Lastly some knowledge of speech training and of the correction of speech defccts should be regarded as of first class importance. It may be contended that candidates should possess a knowledge of many of the subjects indicated in the above list before presenting themselves for specialised training in an Institution, but be that as it may, the fact has to be faced that the majority of such candidates do not possess it, and that consequently facilities must be given them for acquiring it after their training has begun.
To provide competent teachers for a syllabus so varied would of course be a matter of some considerable administrative difficulty, but it is now the custom in most hospital training schools to appoint one specially qualified person whose sole duty it is to teach the probationer staff and doubtless some such plan will ultimately be adopted in the larger Institutions. In smaller institutions near large towns it might be possible to arrange with the Local Education Authority for the attendance of trainees at certain Evening Classes. Even in the larger institutions the co-operation of that authority in organising classes in nonmedical subjects held in the Institution itself, might, where the numbers merit it, meet a real educational need by providing for outside people whose work prevents them from attending classes held at other times and places.
Another plan which would be of great value, if the many formidable objections in the way could be overcome, would be to place probationers in the institution school for a few weeks before introducing them to the wards, for they would then start from the beginning with the idea that their charges were to be pupils to be trained rather than patients needing bodily nursing. One of the drawbacks of the recent method of training is that it tends to begin with instruction in physical care, leaving till later the educational aspect of the work, whereas it is important that the latter should be emphasised from the first.
It will no doubt be urged that to devote so much time to training probationers would be to impose too great an additional burden on an institution where the training of patients makes such all-absorbing demands, but in actual practice it will, I think, be found that this extra work is more than compensated for by the educational atmosphere in which it results. Moreover it has its indirect effect upon the patients, many of whom, especially amongst the restless high-grades anxious for liberty, will only really benefit from detention when they realise that they have a chance ‘ ‘to make good’’ and this realisation can best be conveyed to them by nurses who are themselves aiming high, conscious of their profession as a respected and recognised branch of social work.
Dear Editor,
I have read with much interest and warm gratitude Dr Turner’s article in the January number of Studies in Mental Inefficiency. I feel he has voiced with authoritative knowledge what many of us who have not had his experience want to say. The need for an examination on the lines he describes is very pressing. I have long been trying to find a way for people working in small homes like mine to have some recognition, which would induce them to go on with the work, but so far have failed.
During a period of more than twenty years I have had many hospital trained nurses on my staff. In sickness of the body they are all that can be desired, but in the general training of healthy though undeveloped minds and bodies they are not as a rule successful. I think the reason is that cure is the main idea in the nursing of sickness, whereas in the nursing of the undeveloped what the world calls ‘cure’ is rarely if ever attained, and people who aim for this get dissatisfied by their inability to achieve a definite end. With all due respect to brilliant exceptions, members of the medical profession find it difficult to make efforts to understand the needs of cases who from their point of view cannot be cured; but is it not well to stabilize our ideas, and realise that to bring a human being who is incapable of independent self-development to a plane where he is able not only to care for himself but, as Dr Turner says, “do his job in life,” is as great, if not a greater work than restoring to health the body of a normal self-active person ? Dr Turner says we want to keep the name ‘nurse.’ I heartily agree, as our schools must always be nurseries to some extent: it seems that our scholars arc never too old to have some undiscovered part that can be nursed into fresh life. Longfellow knew the kind of thing we need when he wrote:
And Nature, the old nurse, took The child upon her knee, Saying: ‘Here is a story book Thy Father has written for thee. Come! Wander with me,’ she said, Into regions yet untrod.’ ” I believe our nurses and their nurslings do wander into regions tiod by no other portion of the community. Yours truly, Margaret imacdowall. Avonhurst, Burgess Ilill, Sussex. G, March, 1924-.
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