Dr. Ruby Dunlap’s Uganda Fulbright Blog
Nurses in Uganda, like nurses in the United States, are struggling with questions of professional identity and what or even whether a bachelor’s degree in nursing adds to the nurse enough to justify its additional expense, time, and academic labor. “I don’t want my nurse to quote Shakespeare,” said a non-nurse friend, “I just want her to give me my shot.” We were discussing whether nursing education should include humanities. I’ve forgotten the friend who said this; the comment has stuck in my memory, an iconic summary of all such questioning about what it means to be a nurse and what entails an appropriate education for such a profession.
“I don’t want my nurse to quote Shakespeare; I just want her to give me my shot” expresses a common perception about bachelor’s prepared nurses in Uganda, especially, my students tell me, those of a majority of physicians. They don’t want nurses who can quote Shakespeare; they just want nurses who can and will follow their orders.
The comment trivializes both Shakespeare and nursing. It trivializes Shakespeare by the implication that quoting him is the primary use to be made of Shakespeare. Shakespeare quoting ranges from the mercenary to the reverential but what Shakespeare can do for nursing goes far beyond any kind of quoting him. Similarly, the nurse administering a shot is doing far more than inserting a needle into human flesh.
A significant understanding of the medication, of the patient, of the disease process for which the shot is intended to be therapeutic, of the pain and anxiety the patient is likely to experience, of the goals of health and healing for which the action is taken, and of the range of healing responses the nurse may select in order to support the patient and the family toward those goals are all implied in the act of the professional nurse giving a shot. Shakespeare standing at the elbow of such a nurse surely contributes to at least a few of these understandings.
Perhaps a better appreciation of what is at stake can be illustrated by patient care when such understanding is absent. My students and healthcare professionals working in Uganda have told me many stories which can serve this purpose. One clinic happened to have a large supply of a single medication. Because of the supply, everyone who showed up at the clinic got that medication no matter what the presenting symptoms. Diagnosis was deferred; treatment was based on random dispensing of the medication at hand and nothing else. I leave it to those readers familiar with Shakespeare to speculate on the dramatic uses he might have made of this situation.
Seven of my graduate students, themselves nursing educators, labored over multiple revisions of the first chapters of their masters’ theses this semester. Agnes is interested in how prepared Ugandan nurse midwives are to respond when faced with a woman with an unwanted pregnancy. Faith is curious about what motivates nursing students to fail to observe standard precautions in their delivery of patient care. Grace would like to know if exposure to a simple template of nursing documentation will make any difference in how working nurses perceive integrating a written record of patient problem, nursing action, and patient outcomes into their work.
Moses wants to know what sorts of stressors families caring for mentally ill loved ones face and how they cope. Mercy would like to know what sorts of cultural assessments are included in the care of women in labor and whether these make any impact on the care given to these patients. Elizabeth questions how well Ugandan midwives assess and intervene to prevent premature births. Keren intends to investigate the challenges faced by new graduate nurses in their first year of practice. I have watched these splendid Ugandan nurses’ sense of their own power to stand among nursing scholars around the world grow as they test their assumptions and refine their questions. Their ability to imagine possibilities for themselves and their profession and to communicate these imaginings in language dressed for the occasion was developed in their learning with the humanities long before they began this semester’s work.
Whether at the bedside delivering direct patient care, whether teaching nursing students, or whether navigating the complex mix of politics, ethics, science and art required to produce the disciplined insights acquired through nursing research, dealing with the dramatic situations of human life is part of nursing work. There is hardly more narrative suspense than that of waiting for a biopsy report (or test grade). There is hardly more character development than among those tending to the last, long hours of the dying patient or among those bent under the weight of a chronic disease or crippling injury (or completing a project). Nursing work cannot escape its dramatic narrative and since it cannot, let those who must enter that narrative at least understand what narrative entails and its power over human lives.
More than just imagining future possibilities, works of drama and fiction also can provide imaginative capacities for recognizing and weighing types of evidence in the present. Several of my students intend to use qualitative methodologies in their research. The acts of comparing like with like or contrasting unlike with unlike are similar whether the raw material is Shakespeare or transcripts of research participant discourse. What constitutes corroborating evidence is similar in both sets of words if Shakespeareans will forgive me for calling his work “a set of words.”
It may be that what calls itself a nurse in the future will be shaped by economic and social necessities beyond the power of nursing itself to control. Patients and their families may have to settle for technically minded pill dispensers and shot givers who do not have time to notice cues their patients are sending them which require narrative adaptation to the situation at hand. For now, though, nursing in Uganda is engaged in a strenuous effort to re-define itself as a profession educated in colleges and universities with all the capacities this represents. Shakespeare and his kin, for now, still serve at the elbows of this small but growing number of bachelors and masters prepared nurses in Uganda.
The seven are now at Bethel University, Minneapolis, to work on the next chapter of their theses, the literature review. They will return in March; I am looking forward to seeing a Minneapolis winter through their Ugandan eyes.