The lost heroes of nursing
Thompson , D. R. (2019). The lost heroes of nursing. Journal of Advanced Nursing, 75(11), 2267-2269. https://doi.org/10.1111/jan.14145
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Download date:25. Sep. 2021
Editorial
The lost heroes of nursing
David R Thompson PhD RN FRCN FAAN FESC
Professor of Nursing
School of Nursing and Midwifery
Queen’s University Belfast
Belfast
United Kingdom
Correspondence: Professor David R Thompson, School of Nursing and Midwifery,
Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL,
United Kingdom
E‐mail: [email protected]
ORCiD: 0000‐0001‐8518‐6307
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A new book covering the first 85 years of DNA and culminating with the discovery of the double helix by James Watson and Francis Crick recounts how this was only possible because of the pioneering work of many others, often unknown or forgotten (Williams,
2019). Watson and Crick won the Nobel Prize in Physiology or Medicine in 1962 with
Maurice Wilkins, but Rosalind Franklin, whose key contribution ‘Photograph 51’ enabled
Crick and Watson to unravel the double helix structure of DNA, tragically died in 1958 before the Nobel Prize was awarded (it is not awarded posthumously). As noted by
Wilkins’ son, the structure of the DNA double helix emerged from the twin strands of the conceptual model and experimental rigour (Wilkins, 2013).
Upon reading the book I was struck by the subtitle – ‘Lost Heroes’ and two quotations: ‘We stand on each other’s shoulders’ and ‘A science which hesitates to forget its founders is lost’ attributed respectively to Rosalind Frankin and Alfred North
Whitehead. This made me reflect on modern nursing and its lost heroes.
I have had a long‐standing interest in science and nursing, the former inspired largely by reading The Double Helix (Watson, 1970) and later the three original papers in
Nature on the structure of DNA (Watson & Crick, 1953; Wilkins et al., 1953; Franklin &
Gosling). I was fortunate to meet Watson in 1992 whilst attending a lecture he gave and
Crick whilst visiting my university PhD supervisor in the mid‐1980s. On both occasions they were extremely gracious and I was impressed by their modesty and humility
(characteristics for which I gather neither of them are particularly known) as well as passion and energy. Reading their biographies one is struck by their ability to get to the
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heart of an issue, to provoke and debate ideas dispassionately and persevere in the face of repeated obstacles, setbacks and disappointments. Meeting them instilled in me the virtues of a concatenation of vision, drive, tenacity and perspicacity tempered with patience and resilience.
I was also fortunate for over 20 years to have known as a dear friend the late Sir
James Mirrlees, winner of the Sveriges Riksbank Prize in Economic Sciences (informally called the Nobel Prize in Economics) in 1996, who offered to help me with an economic evaluation of cardiac rehabilitation. I, perhaps embarrassed and feeling unworthy, declined his kind offer realising that he had more important and pressing matters to attend, including, amongst others, advising the Prime Ministers of Australia and India and the Premier of China.
The reason I mention these individuals is that each was considerate, open and receptive to new ideas, willing to engage in discourse with all and sundry and, above all, unassuming. I was struck by their excitement at pondering research ideas, formulating hypotheses or posing questions.
As a nurse (since 1976) academic (since 1988), I have been fortunate to know and be inspired by luminaries such as Virginia Henderson, Jean McFarlane and Ada Sue
Hinshaw and, especially in my field, Susan Gortner, Kathy Dracup, Erika Froelicher and
Debra Moser. Again, all modest but visionary people, great thinkers unafraid to ask difficult questions and take risks. As I work primarily in the field of cardiovascular nursing and rehabilitation, I have also been privileged to meet and work with some
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great medical scientists (and I use this term advisedly), including Bob Anderson, David de Bono, Iain Chalmers, Desmond Julian, George Pohl, Dave Sackett, John Swales and
David Weatherall, all of whom had a profound impact on my thinking and practise and were unfailingly courteous and respectful with incredibly sharp minds. I invariably came way from meetings with each of them feeling inspired, enthused and emboldened.
However, this has not been a universal experience and there have been instances where
I have encountered nurse academics who impart varying degrees of a sense of self‐ importance, entitlement and even aggrandisement, often in inverse proportion to their actual contributions to the academy and the profession.
I do believe it important to the history and development of nursing that we acknowledge the significant contributions made by our predecessors and contemporaries – to my mind true nursing heroes. A sense of selective amnesia seems to pervade our discipline where we either forget or are ignorant of those who exerted a paradigm shift in nursing and inculcated a spirit of real scholarly inquiry. Most nursing students nowadays are likely taught about Florence Nightingale, probably Mary Seacole and possibly Ethel Bedford‐Fenwick and their legacy, but I suspect comparatively little of those who followed them.
Since my nursing career began in 1972 as a student in the UK I have witnessed or participated in a series of fads and fashions: nursing theories and models; the nursing process; nursing care plans; task, team and primary nursing; evidence‐based nursing; and successive government Chief Nursing Officers launching to great fanfare ‘new’ – but
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often superficial and unevaluated – initiatives, few enduring and impactful. This rapid turnover of initiatives has hardly imbued the nursing profession with stability and confidence or nursing with science.
In the 1970s nursing theorists such as Callista Roy, Dorothea Orem, Martha
Rogers, Hildegard Peplau and Jean Watson attempted – with varying degrees of success
‐ to provide some sort of scientific basis to their work and a contribution to nursing. As an aside, and to illustrate the impact of such theories on nursing practice, I recall asking a university student nurse what she thought of nursing models, to which she replied “I think if nurses want to parade in a bikini then that’s up to them”. So, real impact.
Virginia Henderson, an influential nurse, researcher, theorist and author made probably the greatest contribution to nursing since Nightingale, including her extant definition of the nature of nursing and her influential textbook Principles and Practice of
Nursing (Smith, 1989). Her work endures today, primarily through her 14 components or activities of daily living.
The University of Edinburgh established Europe’s first academic Department of
Nursing Studies in 1956 (directed by Elsie Stevenson, who also was founding editor‐in‐ chief of the International Journal of Nursing Studies – a major organ for nursing research
‐ in 1963), appointed its first chair/professor (Margaret Scott‐Wright) and established the first Nursing Research Unit (directed by Lisbeth Hockey) in 1971.
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In 1974 Jean McFarlane was appointed the first Professor of Nursing in England at the University of Manchester where she developed a degree course and established the country’s first academic Department of Nursing and Professorial Nursing Unit, both of which flourished and produced many influential nurses and initiatives. McFarlane
(1974) had been instrumental in establishing the influential Study of Nursing Care project which had three main objectives: to develop techniques for measuring the quality of nursing care; to involve nurses fully in the study; and to develop a pattern for this type of preparation of nurses to take part in and to understand research procedures. This project had a significant impact on nursing care, workforce planning and research development and produced 12 individual studies, many well‐known even today, published as monographs by the Royal College of Nursing (Smith & Crookes,
2012). The development of the project was due to the support of the Ministry (now
Department) of Health, primarily its Nursing Officer (Research) Marjorie Simpson, and the Royal College of Nursing.
In 1977, a degree course in nursing studies launched at Chelsea College (now
King’s College), London led to the rapid growth of the Department of Nursing Studies
(headed by Jack Hayward) and the launch of a Nursing Education Research Unit
(directed by Caroline Cox). Soon other universities established academic department of nursing studies, notably: the University of Surrey (its first professor, Chris Armstrong‐
Esther, succeeded by Rosemary Crow who established a Nursing Practice Research
Unit); the University of Wales College of Medicine (now Cardiff University) with its first director and later professor Christine Chapman and its RCN Nursing Research Unit
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(directed by Jill MacGuire); and the University of Hull with its Institute of Nursing Studies and its first director and later professor Margaret Clarke).
Around this time James Smith launched and edited the influential Journal of
Advanced Nursing – another major outlet for research ‐ in 1976.
In the 1980s there was a real sense of excitement and dynamism in nursing with the advent of a draft of practice, and sometimes research, initiatives, such as the establishment of the Institute of Nursing in Oxford, directed by Sue Pembrey (1980), who had published a study on the organisation of individualised nursing. This was followed by Alan Pearson (1983) and Steve Wright (1989) establishing Nursing Practice
Development Units in Burford and Tameside respectively, much of which was influenced by McFarlane (created a life peer in 1979 as Baroness McFarlane of Llandaff).
The 1990s witnessed a steep rise in research activity, funding, publications and also influence. For instance, nursing research was starting to have a stronger voice at policy level and being invited to the high table, largely through the advocacy work of
Trevor Clay and Christine Hancock, successive General Secretaries, and June Clark and
Betty Kershaw as Presidents, at the Royal College of Nursing, Nursing Officers
(Research) at the UK health departments and the nursing press, notably due to Jane
Salvage at the Nursing Times. This was also a period of retrenchment with the merging and integration of former health service colleges of nursing with university departments of nursing. Though the number of academic departments and professors increased significantly (with former Directors of Nurse Education often being rewarded with – and
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not necessarily on merit ‐ automatic professorial titles), there appeared to be a diminution in the influence of nursing. In 1998 as the first Professor of Nursing Research and Development (R&D) at the Department of Health, I was tasked with influencing the national health R&D agenda, contributing to building nursing R&D workforce capacity and advising on methods of research implementation, work which resulted in Towards a
Strategy for Nursing Research and Development: Proposals for Action (Department of
Health, 2000).
The 20OOs was a period typified by calls for investment in nursing research, training and careers, led largely by Anne Marie Rafferty (2003) at the Centre for Policy in
Nursing Research at the London School of Hygiene and Tropical Medicine. This was vitally important when nursing research quality was being judged by the government higher education funding councils Research Assessment Exercises (in 2001 and 2008).
While nursing appeared to develop substantially in terms of number of journals, articles, professors and volume of research, the degree of its originality, rigour, significance, reach and impact on practice, education, management and policy was debatable
(Thompson, 2003a,b). This period witnessed many nursing professors and academic departments dropping the word nursing from their title – or adding or replacing it with, for example, health/health studies/sciences (Watson & Thompson, 2010a,b). This was exacerbated by poor academic leadership, mentorship and career development
(Thompson & Darbyshire, 2013), despite some notable exceptions (Darbyshire &
Thompson, 2014); the impression being often given that particular emphasis was placed on issues that are likely to guarantee personal promotion, recognition, reward or
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political expediency. The comparative growth in the nursing professoriate, while on the whole welcome, was not without criticism (Thompson & Watson, 2013; Watson &
Thompson, 2010a,b), especially with regard to research performance (Thompson &
Watson, 2010; Watson & Thompson, 2001, 2010; Watson et al., 2017), with academic nursing (Thompson, 2009; Thompson & Watson, 2001; Watson & Thompson, 2001), including schools of nursing (Darbyshire et al., 2019), at real risk of dumbing down at the expense of scholarship.
Notwithstanding these frustrations and disappointments I believe the state of academic nursing in the UK is generally healthy and I remain optimistic about its future and potential. My career to date has been rewarding and have been very fortunate to encounter many nurses apart from those already mentioned who, likely unknowingly, inspired me, including Margaret Alexander, Pat Ashworth, Annie Altschul, Senga Bond,
Jenny Hunt, Sally Redfern, Nancy Roper, Alison Tierney, Jenny Wilson‐Barnett and others too numerous to mention. All have, to my mind, made significant contributions to modern nursing.
In conclusion, I am not attempting to provide a comprehensive survey of the history of nursing nor equate developments in nursing with those in molecular biology, merely using the DNA story as a parable for nursing and its lost heroes. It is all too easy, especially in an era where citation counts and journal impact factor metrics dominate discourse, to forget or overlook the real and often profound contributions made by our predecessors. When I was appointed to my first professorship in 1994 I was excited to
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meet such luminaries, many of whom became and remain great friends and mentors, most warm and generous, some rather prickly and condescending, but all heroes of mine.
In the twilight of my career I have been privileged to have learnt much from their wise counsel. We will each have our own individual heroes. Let’s remember and acknowledge, indeed celebrate, them and their contributions. At the very least, let’s not forget them.
References
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