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OPINION

'There is no need for a warning label when it comes to education'

  • 51 Comments

I faced a moral dilemma this week.

Buying a birthday card for the child of a friend, I found one with the badge saying “I am 2” – an essential for a child who has just stopped being 1 – only to find on the back of the badge a sticker that said “Not suitable for children under the age of 36 months”.

Legally, where do I stand? More importantly, could I fall out with my friend of more than 20 years if I give her daughter the badge and the child stabs someone in the head with it? Will my friend point to the sticker and say: “It says very clearly in small writing she is not old enough for this. What’s the present? Bombay Sapphire Gin? A bazooka?”

So, I opted for a sticker instead. You can’t go wrong with a sticker. Unless the crazy child eats it but it clearly said “Do not eat” so it’s not like everybody wasn’t warned.

We live in litigious times, so manufacturers everywhere are afraid of being sued. The last time we bought an iron, it came with the warning “Do not iron garments while wearing them”. And our new fridge-freezer (we’ve just moved house; it’s chaos, thank you for asking) has a sticker saying “Do not stand on this appliance”. Apart from making you waste 25 minutes trying to imagine the circumstances in which you may stand on the fridge and manage to iron the trousers as you are wearing them, this simply tells us that everyone is scared of being sued. Everyone feels defensive.

Nurses know what defensiveness in practice can mean. I wonder – against a backdrop of low morale, a lack of political respect, lowering public goodwill and variable leadership – how able they feel to protect against it? Because defending oneself against complaint can shape the way we practise, can’t it?

This is particularly so in a culture that is being taught to almost resent public servants for holding together services that are being eroded. And nurses know it. As a friend of mine remarked recently: “Sometimes it’s just about getting through and trying to keep people safe.”

Someone else asked me recently – on finding out that I taught nurses for a living – if I was one of those who filled their heads with rubbish. “Probably,” I said, ever anxious not to appear defensive. “Too many books, not enough nursing,” he said, managing to design a sentence that is so wrong it requires a new word to be invented that describes extreme wrongness. “No such thing as too many books,” I offered, as neutrally as I could. “Too much thinking, not enough doing,” he said. “In the old days, nurses didn’t need all that nonsense.”

Which begs the question: what is “that nonsense”? Thinking? Education? Ideas? I’m not convinced there was ever a time when those things were not helpful to nursing and I believe one of the great myths of modern nursing is that developing the ability for critical thinking or helping to discipline and inform the nursing mind is anything less than essential.

Indeed, I wonder if there is an ulterior motive to those who oppose a full and intellectually disciplined education for nurses? Something to do with reducing the voice and influence of nurses? Returning them to a position of demure handmaiden and marginalising the key qualities they make manifest?

Nursing is being forced onto the defensive, defending not only standards but also jobs. Critical thinking skills can only help nurses protect themselves from the pitfalls of defensiveness and, with luck, may even help them from the back foot and on to the front one.

Mark Radcliffe is a senior lecturer and author of Gabriel’s Angel.

  • 51 Comments

Readers' comments (51)

  • Tiger Girl

    'I believe one of the great myths of modern nursing is that developing the ability for critical thinking or helping to discipline and inform the nursing mind is anything less than essential.'

    Does that myth really exist ? Or is it that medicine and nursing are now very complex, and that some people are over-compensating against the obvious dangers of lack of co-ordination and confusion which can arise if too many people are independently making decisions, by trying to remove decision-making from nurses ?

    Which fits in with your 'quieter voices for nurses' point - but it is paradoxical to train nurses increasingly academically, and to then expect nurses to be at all happy if they are prevented from thinking !

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  • Interesting point: so are we thinking there are some cultural constraints that limit nurses from contributing critically or more obviously from exercising power in difficult circumstances? And if so, what might we do about it?

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  • Interesting article!

    At my University, some students have faced issues for opting for the more scientific course at the University of Glasgow than at Glasgow Caledonian's course (such as being told on their first day how they 'don't like' Glasgow students and prefer Cale), and that's just from other nurses and mentors. Truth be told, I've had little issues from patients - most are ignorant of nurse training really, though I'm always happy to tell them if they ask about my course! Though, I've seen attack after attack on Nursing in the media - and few positives.

    I agree that Nursing needs a stronger voice, now more than ever - and while I see the merits of practical training (I much prefer placement over theory) I understand why academic training is so important.

    I think it's important to avoid defensiveness too, but the question is, how do nurses move forward? Many of our challenges are due to low staffing, something that certainly can't be remedied in the near future. There are nurses who don't care - but how many of them started out that way? How many are just burnt out from all the reasons you've listed? There's low morale, but how can you raise it in the face of so much opposition?

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  • tinkerbell

    yes you need theory but experience is the greatest teacher, actually doing. "Ihear and i forget, I see and i remember, I do and i understand". With the practice comes the understanding.

    When i had a new oven it came with the warning that i should not try to sit on the over door, this put the idea in my head, that i otherwise would not have thought of and wondered whether i should give it a try. I have so far managed to resist the urge.

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  • tinkerbell | 21-Mar-2012 8:21 pm

    Good grief! Instruction manuals are amazing nowadays, poor translations apart. Must be all the fault of those EU regs. again!

    I wanted a digital coffee machine that makes every type of coffee. Before making my decision on this state of the art and very costly machine I tried to find information about it on the Internet. I came across a 100 page instruction manual, mostly safety instructions and by the time I had scrolled through all the pages I was so frightened of all the dangers I never purchased it. That two industrial machines had also blown up in local cafés was also not very remeasuring but I have saved myself a lot of money and my guests have to put up with Nescafé.

    I bought a new vacuum cleaner and read through several pages safety instructions before I discovered how to switch in on and what it would actually do for me and how. Don't do this, never do that, if you do this xxx will happen, if you do that yyy could happen. By the time I had finished reading all this I was almost too scared to even switch the machine on, let alone use it.

    Other instruction manuals you can't even get a printed copy unless you download it and print it yourself which could be very costly for those which run to 100 or more pages. I find it so difficult to read large volumes on a computer screen that I now tend to ignore them. Most safety instructions are common sense and repetitive anyway - such as don't immerse your electronic apparatus such as your plasma screen TV in water, don't leave in bright sunlight - danger of explosion, don't stick your fingers in your new electric fire or oven, etc. Anything new I now just tend to muddle through and learn by experience with the minimum of studying of the instructions. Unfortunately there are often few profis. available to offer support and if there are it is at the end of a costly phone call. The last one cost me £25 for a few minutes - shame I hadn't read the small print properly before hand!

    I don't think the government, or managers for that matter, appreciate nurses who think critically! Patients and the public don't seem to either although I think they would appreciate it a lot less if we didn't and don't really understand our role and what we really do. I suppose you don't really need to thing terribly critically just to serve a cup of tea or give out the bonbons!

    I am amazed and shocked at many of the comments, and sometimes vicious arguments, in the press from the public who often feel free to criticise whilst demonstrating very little or only superficial understanding of the role of nurses and also show little tolerance of our needs to enable us to be successful in our jobs.

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  • tinkerbell

    Anonymous | 21-Mar-2012 9:08 pm

    I think we are meant to be kept in a perpetual state of fear. Religion apparently no longer cuts it, so it has to be something else no to keep us all compliant.

    When faced with a long, drawn out instruction manual i will resort to just trying to work it out for myself, there was a book about the same called 'Zen and the art of motorcycle maintenance'.

    It will then consist of mostly trial and error and pushing buttons and seeing what happens.

    If you buy a bag of nuts you will also be warned that 'this product may contain nuts'
    Well i should bloomin well hope so.





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  • Nut allergy? No one had that when I was a kid!
    A few years ago some Yankee doctors invented a 'superfood' for malnourished children containing sugar, powdered milk and peanut butter which has saved tens of thousands of lives, with not one death by anaphalaxis! When asked why, the head Dr said that nut allergy just isn't a problem in Africa. Ipso facto, no problem anywhere!

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  • I am a nursing student on a post graduate two year course, which means a lot more time spent out in practice compared to the classroom (I'm not complaining too much!). I've found I have learnt a vast range of skills from all the people I have had the opportunity to work alongside. But there has to be a balance, academic practice allows the development of knowledge as to why certain tasks are being performed. Not sure about anyone else but I would rather have a nurse that knew why they were performing a task than someone that does it because thats the way its always been done.

    As for critical thinking... I'm not sure that training nurses to be able to make decisions in a logical manner and have the ability to question and reflect on the decision making process is such a bad thing.

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  • tinkerbell

    Hmmm, critical thinking. Most children are born with this innate ability, aren't they? Always asking questions because they want to learn. It is programmed into us. Maybe as we become older we learn to stop questioning and just get on with life then need remindig that we should still be asking questions, reflecting and retain this ability to be more creative and innovative. Use it or lose it.

    In one of the 'home alone' movies he's asked by an adult 'why do you ask so many questions' and he replies 'i'm a kid, that's my job'.

    Now we have to dress it all up as 'critical thinking' being able to ask a question and reflect on it and see if there's a better way of doing it. Forgive my temerity but isn't that what we should all be doing anyway?

    How would we ever have progressed if we didn't have the ability to do this anyway?

    I don't need someone to teach me how to ask a question, reflect on the answer and see if there are other options, at least i don't need a year to ponder it all at university.

    I remember a nurse telling me once that doing something the old way 'never did me any harm' and me responding 'but did it do you any good?'

    She just stared at me blankly.

    We have been given a writing pad at work, each of us, to write down a GOB. Glimpse of Brilliance. Oh bloody hell, what has become of us? I ask.

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  • tinkerbell

    redpaddys12 | 22-Mar-2012 3:54 am

    don't think i ever ate a nut as a child, but then the tories were mostly in government throughout my childhood, so nuts would have been a luxury. I managed a few strawberries whilst out picking them in the fields with me mammy. Never did me any harm, oh actually they did, gave me raging diarrhoea as i overindulged.

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