History of Nursing in Pacific Canada

[Publications/Speeches by Lyle Creelman] Creelman, Lyle, 1908-2007 Jan 1, 0001

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Full Text

 Canadian Nurses Association
Message from WHO
Members of the Canadian Nurses' Association and guests* it gives
me great pleasure to be on this platform today and to bring you the
greetings of the Director-General of the World Health Organisation on
this your fiftieth anniversary. In saying this I almost feel as though
I am congratulating myself because I am a member of the CNA. To be a
member of this Association is something of which eveiy one of us may
well be proud.
But I must remember that for a few moments I am representing the
World Health Organisation* I want to tell you officially how much we
value the support of the CNA. You may not all be aware of this but your
officers have responded many times to requests for information. Your
contribution to the Technical Discussions on Nursing at the Ninth World
Health Assembly was one of the best, (in fact Pearl Molver who assisted
us in the preparation said it was the best. That is not for the press.)
We read of the conferences you hold* the research you are carrying on*,
your recommendations and findings assist us in our work of helping to
improve nursing. We frequently call on the Canadian nurses who ar©
members of our Expert Panel on Nursing* And last but not by any means
least we appreciate the contribution made by Canadian nurse members of the
staff.
The real contribution of WHO in nursing* as well as in other programmes*
the want ©f
is at what for/a better term we call the project level. Working in the country
with the people of the countiy.  Nearly -%%  of the project staff of WHO
are nurses* Of our present staff of ....j ..... are Canadian. In all «#.#
Canadian nurses ar© either serving or have served on the staff of WHO. We
recognise that institutions at home have made a sacrifice to release these
nurses - but we think they have gained something also. That is they gain
when the nurse returns - we have our problems with marriage in WHO also.
As you know WHO is celebrating its Tenth Anniversary this year^J We look
tormtd to the wisdom which the 50th Anniversary will bring. We are sure that
 ~ 2 -
when that time comes and you are having your 90th Anniversary* you will
still be in the forefront giving guidance* encouragement* and support to
whatever the nursing programme in WHO may be at that time.
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 r
OUR RESPONSIBILITY TO WORLD NURSING
ALtA»d&*iA
Lyle Creelman, Chief Nursing Officer
World Health Organization
I would like to make my remarks, not only as an international worker, but
also as a North American.and to indicate what I believe some of our responsibilities
are as citizens of the United States or of Canada to nursing in the world.
As I reflected on these responsibilities my thoughts centered around the
foreign nurses who come to study and observe nursing in North America and
particularly of the many who come from developing countries.
What are some of the conditions in these countries which pi^Liiulairiy in-
fluence the cfoualr/pmcnt of nursing?
Everywhere there is a sense of urgency. Edward Murrow during a visit to
Africa in January referred to "this determination to explode into the second
half of the twentieth century, «thio oeftoe mi..uygfflgy^" ^ ^ They are trying to
accomplish in five to ten years what has taken one hundred years in some other
countries in a slower ago MvfPr>\ m.. Mi nil<i»i1riT^^i^ivF^
nf Tnirtin gftjflg "fr^m nm iin^m^Amfwrn^^
 •2-
t^fcSMi^^^^fe^H^^^^iftS h 1)41x^4^1 tei'a'CV "rate a«4-*-aasa3gec»p
o€^^nlpav4b0ufe^6Q*»4^^We must accept that this same sense of urgency will be
manifest in Ac .dowe 1 ofitaeiit c>f~ nursing.
Many of the diseases or conditions of ill health with which the nurses must
deal are hardly known in North America *  i i i 1     ■nue.:  ww1aiii?r^~-fe^
fcf^hflrzigfrp'gj  nrttm +<r-*m^iim  Fy^hfriJ  fnrrr pwj  Jym»»*-pT"f|flr ,     Perhaps the most
prevalent auudJQJJTn,  and one which demands much of the nurse,  is malnutrition.
Wog every child between oner^andr four-years of--age^-who-4ies—of malnutg3^on^a---fehe
tffiifced States,   three hundred'die in some countries 6fnGairn"~AM^ricaT"" j£^™^fchree-
/    Az
ea-o-f the world1 a populatiou^-iuoxe Lhau fifty  per eenfe-ofe^kM^eat^^Btrcur
-years^f-Tagg~^^ thatr
terLj^eX-~Jieiit^^^
in manjjL-countries, means less purchasing power and little
J^jL^overty\
money available for facilities for education, teachers, buildings; for health
services and personnel; for good nutrition, jrii oome countries» a-6k414ed^worker
pust work mom th^th fourHEnyorrs to purchase two pounds of mea&y compared wittr a
^ffi&tAJ^ (^<rWtAAX^xLA
s in -a—developed cuuuLiiy.    £a-a rice-eating country, wherr an eggnc'Sh
?be sold to buy enough—riee for a family—fur l\ ujueJ!^    ,   it is useless- to advise the
(mother to give her growing child an egg even once a week.
 -3-
AiAm%Ll<riljdZ^^ re 1 atod-to—tiixriiffoiKmilc duv u lo pmeirtr~ofi=ar
cmmmwy ■ -^Que■■ off^uu^Wor Id Health Organization nursel wrote of her public health *
nursing students walking two to four miles to visit in the villages. In a country
where nearly every public health nurse has a car we tend to take availability of
transport for granted.
Opportunities for education vaj^^rantly, - In some countries only ten to
twenty per cent of the population is literate. In some African countries onlyTr^.
fifteen to thirty per cent of the child population of primary school age is enrolled and enrollment for secondary education does not exceed four per cent of
the children of that age. ^JaaLe»^er.a^
i&LQ^Le£LT&Z^
aiEfl-~fre^W%fcferate. Think what this means in terms of educational requirements for
nursing and especially in countries where boys a4 given the preference for the
available educational facilities.
A paradox in many countries is the status of women and the emergence of
women. In Afghanistan, where only three to four years ago women were in purdah,
there is now keen competition for them as air hostesses, secretaries, telephone
operators, and, of course, these occupations pay much more than nursing.
 -4-
Closely linked with the status of women, but yet separate, is the status of
nursingr Ffr a class itr-a school «ofc nuroing-there were sixteen applicants. Fifteen
had the required educational qualifications. Only six reported on opening day.
The main reasons why nine decided ag&in8£-~trare&ng were .&*«#efe^fe««^«^«^^«ed general
non-acceptance of nursing as an honorable career for educated young women of the
better families," and -ij^p'iti? -&fciEe competition from commercial companies.,
jBkBdr fl?■ Ti'mTf. illTiff fri"1   n   f TT -""ft*™ *"u °  ** -m* ny n£zZLA n "* ^^-y-^^-^^fa^^-^^^^ a H^^t~iaiHff^^
m^eit-gsps^
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Many values and customs peculiar to a culture affect nursing^; The kind of
things like the value people put on time and, therefore, how they use time; and
linked with this, what appears to us as a lack of appreciation of the need for
planning. North Americans, to whom time is almost an obsession, find this difficult
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A World Hea4*th Organization nurse reported, "It is entirely foreign to the
culture of this country to undertake home visiting. It was a long time before
>   the two national counterpart public health nurses who come from particularly en-
f lightened families Ian different parts of tho counferyr could bring themselves to let
Itheir parents know that they actually visited patients in their homes."(3)
 -5-
The supply and qualifications of nurses and, indeed, of the various members
^UxJLa ^
of the health team, ie one of the moral' significant^difleieucea affecting nursing.
In North America the ratio of nurses to population ranges from 1 to every 300 to
500 persons;*in Asia this ratio is nearer one nurse to 4,000 to 6,000 persons,
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m<£drry^mmm
^j^^l^^ftf-poaady  lOjOOOj  000 p^npTfl'T*  And ±iG \mammy countries there are
more doctors than nurses.
Thai diagroiiii tn whi rh  ffl  rm in fry-am at depe^  fla^OTlji°u1 "■''*'"j1  |W'*M"^   *"» i"1'1'1^0
J^ mm xdfe(w i^/JAu  Ctuc^^f-
n most developing countries fkure -auxiliaries are not «■*■■•*'
fTtUrZ^AZ
4u6£<Kftt auxiliaries as we like to think of them,  i.e.,  being taught by and wording   iUU)LjuAm.
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under the supervision of professionals.    They are doing what we would consider the
work of the professional nurses or midwives;  they are substitutes for the professionals.
%bmr--mm!L*^^
tj^rBaBfies^skmild be mentiettedt Stai5rHBretl^^
d^yfi^pp^d   ^nuJTLfc^i^g j     aiTQ,   r\i vmrlratA,.Amp^Qv-mr%T.m-.l..--fl|jfofr. jftft^x^^m^my^mt^^
cijun L iy w11 u  Mlilkiu^.tegj.s latSaa.~to^^ -ofc-aay
Everywhere, including in North America, the stress is on the shortage of
leaders j-teachers, supervisors, and administratorspand in most countries there
 -6-
is an appalling lack of facilities to prepare nurses for leadership. For example,
outside of South Africa, for the whole continent of Africa which has thirty-
eight countries and is five and a half times the size of the United States, there
is not yet one nursing programme which prepares ^eachers, siipervisuis, and
§itoi^>istrators.
There are many positive influences such as the tremendous desire to learn*
a-mA m £*->,*? rf^aify ^,^1.0^^^ ^f- n]i jpypi^  Someone put a notice in a shop
window in Katmandu stating that he would give English lessons in the evenings to
anyone interested. There were a thousand applicantsl Recently a doctor who had
been in the Congo told me of a little boy who came to her and asked for a book.
"What Mnd of book?" she inquired. "Just any book. You see, I haven't any."
AztAA0 ^zza dAdJUJL
I would like now to mention some reactions which^foreign students mim..pay
Jad6ff^> M
fXA^tA&A*     «uunl2Ti<K» have about us and our nursing.  But before doing so I must say how much
0  yjLxZJ    t*ie World Health Organization appreciates the contribution made by nurses in
mt<AA*&        Universities and schools, in hospitals and public health nursing services, to
AAAAtzxA      t*le success of programmes for nurses on World Health Organization fellowship study.^s
lA      *
a ctMXCiZmL^m Some of the reactions I am going to mention were expressed only after a great
Jt^r*n*' deal of "drawing out" in conversation with many nurses who have visited and studied
'sUa^A^ AJL**aZAg^
yvLA2x^*(       in North America. Some undoubtedly are because of particular circumstances, and
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^^^^jfc^not generally held; but,  nevertheless,  I think it is good for us to know how a^azta^UxZ
^Ap/^xJLfi^^  A^MkjAA^AXt7 ^ZTA^iAyxJ
y       Waaky  feel some times; it helps us to be aware of things which ama  important
to them.
First, they are most appreciative of the opportunity to come fee ue to
A
observe nursing and to study. They are sometimes overwhelmed with the friendliness and hospitality. They have read and heard a great deal about <£fee~
IpiTiliinpumnM in nursing in our countries. They have read about our leaders and
look forward to meeting them. They look to North AmericajjKiiMiiiaieG to give leadership in nursing.
When they come they listen and they observe new developments and are concerned as to how these can be adapted to their country with quite different
conditions and frequently a lack of adequate facilities. They are interested
in team nursing, in progressive patient care, in the use of ward secretaries.
Too often they are unduly impressed with our mechanical equipment.
As we place a great deal of emphasis on university preparation for nurses
they feel we are too theoretical. They think we have lost something in our
emphasis on the academic; in order to meet the university requirements we have
had to sacrifice something of nursing. They feel our students have to take an
 F
enormous proportion of theory,  and practice is too limited.    Tho  lafrhiLE i • iicma
ton thorn, ifao ig tan ir i ff t=«&i^wi o il>a^eH&e-'-*ragdg^f^g^^
Many foreign students give much thought to the dependance of a good
educational programme on the clinical services in the hospital and public
health fields. In their countries all too frequently the 'school' exists
to provide service to the hospital. They want help with this problem, but
they feel we may have swung too far in the other direction. Thoy feel the
/—-—
The foreign students, as well as we, are confused with the different
/  forms of preparation and levels of nursing. The nurse seems to be far
removed from the patient - the aide is all too frequently the 'nurse.1
A few say that sometimes we seem to be on the defensive about our way
of thinking and doing things. We seem assured that our way is unquestionably
right. On the other hand, others have referred to our refreshing open-
mindedness.
Some of the ¥**y thoughtful students feel that what we say and write
is not demonstrated in practice. One said. "We are being taught this, but
this is what we see." For example, we talk a lot about the value of good
communications. A visiting British doctor, referring to communication between doctors and nurses had this to say: "Nor is time 'wasted' on the doctors,
 -9-
iK
The convention of escorting derctgrg' around the wards has long since lapsed .......
Indeed, I was there for a long time before I saw a doctor or a nurse speaking to
each other. A large notice reminded all comers that verbal orders were on no
account to be accepted. The doctors wrote orders for the nurses, who in turn
wrote reports for the doctors, and each stood around reading each other's writing
(4)
with never a word exchanged."
This same observer had some pertinent comments on our jargon and wordiness -
real problems for many foreign students. We sometimes think their trouble is
lack of English comprehension. The doctor said he "attended a conference the
purpose of which in simple terms was, "to find out how to get people to work
better for you." But it was stated as, "to in^^ease supervisory effectiveness JLn
the development of hujaan potential among members of work groups, and to improve
abilities in diagnosing and treating human relations, problem situations and
organization."'-*'
In most of our hospital services the foreign nurses note a lack of family
involvement in patient care.  Some of them may feel that this lack is advantageous^
at least from the point of view of the nurse and the doctor, and they may hope
to make changes when they return home. We need to help them to see the values
in the practice in some countries of admitting the mother with the child, and
<3
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can rock it
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having the baby in a bassinet hanging at the foot of the mother's bed where she
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 -10-
Finally, we apparently do not always convince foreign students that we
are really interested in them, in their country, in nursing in their country.
One in commenting on this said that it was really understandable since we did
not know enough about their country to ask questions. A World Health Organization
nurse from North America who took a year off to study at home told me that the
Parent-Teacher Associations were more interested in what she had been doing
z z L i , „ a g *» i -^ ^^=^2^^^
abroad than were her fellow nursing students, 'vj^"""^    _~ .J£   —, -—~^4J- ~     ""^
*^^    What, then, are our major responsibilities to etc.. foreign visitors and
to world nursing.
A first responsibility is to nursing in our own country. We must find a
.7n**A>>*fi <fu><smm/xs
way or ways, that will motivate and permit the professional nurse to return to
A n
the bedside. In some places this is being done with gcca* success and it will
demonstrate to the foreign students as well as our own what "nursing" really means.
We have an obligation somehow to help the foreign student appreciate the
real worth and purpose of academic study, of a liberal education, for nurses -
not just toreceive the magic piece of paper they all want - and indeed which
many of them need - but in the final analysis to improve the care of the pa4ieixt^;{
There are special obligations which service agencies, schools and universities
have when they agree to accept foreign students. First, that additional staff
AAA^Jtz? mm{AxAUA        jAA&^Or^J
will be rfq"*•'"Ht rHfmfmYTT~frf-• hfhfh-fc££n_femm4 fhaf foreign students require more
 -11- AfL
faculty and staff time than do national students.
The receiving educational institution or agency has an obligation to provide an appropriate orientation for the foreign nurse. One nurse with a
university degree from her own country commented, "it took many weeks and
months for me to find out about some of the terms, the meaning of which is
taken for granted, such as "high school," "supervisor," "p^^&pweteNa," "professional
nurse," "accreditation." This is not a language problem in the ordinary sense.
It is a problem of understanding the »iconcept. Rjayjiammplc, qftnat the "supervisor"
does must be seen to be understood.
More than professional orientation is needed.  Some help must be given in
understanding this new culture. Here, great sensitivity and tact are required,
SSHIhI I f irttj, lest the foreign student feels she is being treated as a poor relation,
or considered immature, or, that by the questions asked, her country is thought of
as backward or underdeveloped (even though it is economically underdeveloped and
cAtenr*dmmA r
may have many of the conditions I described earlier) . rfeiia^fi some ofcgfefag^'
QsireCTta tti Oii'«c ouldrH^**^^ -and -ae&oisd&Bg* ■ ticQMMaicU^
Public health nurses on the staff of agencies receiving foreign students
for field experience have a unique opportunity not only to give an appreciation
of good public health nursing practice but to show the foreigner what North
Americans are really like. By seeing people in clinics, visiting in homes, and
 -12-
talking with the nurse on her rounds she gets to know our culture.
jiiy with tih» uimhli;^dk^^ tshafe ^inTCST "cTvTvid^
PJmdUmWAZass££^
jXitl^y  bleader
This is a two-way process. Some of you who receive foreign students have
said that you learn as much or more than you teach.  Certainly these personal
contacts with our world neighbors in nursing are of real significance and of
mutual benefit culturally and professionally.
Over one hundred and twenty of the nurses working abroad with bi-lateral and
international agencies are from North America. This does not include those with
church missions and under other private auspices. We have a great responsibility
for the kind of nurse we send to foreign assignments. Studies have shown that
nurses make a fairly good adjustment in foreign countries; but some nurses have not.
We need ways of identifying the characteristics we believe are necessary for success
£^jf Am^AyUrmAtAAAI^-dl
as an international worker. In addition to technical skirH overseasmanship requires
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a sense of dedication, cultural empathy, creative ability, sensitivity, energy,
endless patience, and above all, flexibility.
In preparation for overseas service it has been said that a first step is
*a liberal arts education adequate to the needs of the world in which the dividing
line between "domestic" and "foreign" affairs has been permanently blurred; the study
of foreign cultures and foreign languages should, therefore, be a rule rather than
an exception."(6)
 -13-
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We recognize nj^w that all nurses whether they go abroad or not, tuJod -a
liberal education. I believe we have not put adequate emphasis on §ke»
nu: iiirr i Uy w r includin^J a foreign language mi that education; Coming from a
part of this continent which has two official languages, but in practice relatively few of its citizens can speak both of them. I have a strong personal
conviction that all nurses who are university graduates should be fairly fluent
in one language other than their mother tongue. Nurses working abroad who have
learned to communicate in the language of the country undoubtedly make a greater
contribution, Jdute at the same time have greater personal satisfaction than those
not able to speak the language. A World Health Organization nurse who has learned
(JzULjAmJLAAxJL
to communicate in frfasjwuJLarifl^ working—saM, "When
you can speak their language, you are accepted as one of them, and they accept
what you have to say."
Dr. Morrison, of the Rockefeller Foundation, has spoken of the need for
"new types of excellence." "..; we are now living in a world in which
almost every one of our actions has in some way an affect on almost everyone
else in the world.
n   (7)
We need new types of excellence in nursing at home and
for service abroad. We cannot have it in the latter without the former.
TjE haa Jhoon said fhat "mcdinal sclenrr is fho finraf inafrnmrnf ypf
rifYig*H   fnr  hroalHng  Anjar.   ir.tmrns.ti nnal   harr-?<*rs   "(o) We  have   a   responsibility
 -14-
wig to a profeflBioir whi^
Dr. Candau, Director-General of the World Health Organization, eB^the
oeea«i4>n~of-4^^4^ ye&£
iV*-4
said, "All medicine is in a sense world medicine, for there is scarcely any
advance in medical knowledge that does not affect the practice of medicine
throughout the world."(9)
In conclusion, I would say simply that "all nursing is world nursing."
North American nurses have made a definite contribution to world nursing.
Whatever we do in the future will continue to affect nursing practice throughout the world.
^^(a^ca^AL
^Hax^A,
 REFERENCES
1. New York Times, January 29, 1962.
2. Unpublished W.H.O. Report
3. Op Cit.
4. Jennetc, W. Bryan. "Taking the Nursing out of Nursing." The Lancet.
July 8, 1961, pp. 95-96.
5. Op Cit.
6. Cleveland, Harlan; Mangore, Gerard J; Adams, John Clarke. The Overseas
Americans, McGraw-Hill Book Company, Inc., 1960, p. 192.
7. Morrison, Robert S. "The Need for New Types of Excellence." Proceedings
of the American Academy of Arts and Sciences, Vol. 90, No. 4, Fall 1961,
pp. 764-781.
8. Morrison, Robert S. "Medical Overseasmanship - Obligations, Opportunities,
Operations," The Journal of Medical Education, Vol. 36, No. 3, March 1961.
9. Candau, Dr. M.G. "Epidemiology and World Medicine." Public Health Reports,
Vol. 76, No. 9, pp. 793-796, September 1961.
v_
 mm HEsroNaaanj'TT to m>rld mbseng
Lyle OreeXwan, Chie'f Nursing Officer
'World Heal^^lteaniaatxon
i I would like to mate my remarks, not only as.an international wxker, but
also as a North American and to indicate wftat I believe sorae of our responsibilities
are. as citizens of the United States or of Canada to nursing in the ws>rld*
As 1 reflected on these.responsibilities ray thoughts centered aroiiBi the
foreign'nurses "who come to study and observe nursing"in North America and
particularly, of the ma,ny i4iof comenfrom, developing countries♦
&u&fv3
>r conditions of ill health with
what are some of the concn.ta.ons 3J|pp|
progress of nursing?
Eivervwhespte there' is a soti^jq of ur^^ssi©^
half of the. twentieth c^tuzy%.>~'      They a
ten years what, has taken erne IiuMrad ye ar s |
Many of the diseasj
deal are harolj^|j^^
which demands much of" the nurse, is malnutrition,\
in many rountries ifisana :i£ss iptoiefaasiig. po^er7atf j
facilities for activation, teachers, btiiidingsj -fa:
for good nutrition* In a rice^eating country, whei
enough for a-family for a week, it is useless to a<
growing .child- su egg even once a week*
of A IwbrM Health Organization nurse wrote of he]
s wixcn. xmJoasBDe zjxb
urrow durirg a visit topple do Into the second
p accomplish in five to
er countries in a slower
yse nurses must
alent, and one
* "public b
an be sold to Iftjpl
aether to giirs.her
salth nursing students
talkingf|wo to four miles to visit in the villages*    In a country where* nearly
every public health nurse has a car li tend to take availability of transport
for grante$lfy
 .:Oprjorti;aii:tie:s for Nation vary greatly*.   ltx^Am eou: only t^|
twenty per cent of the population is literate©   _ln some African countries only
fifteen to thirty per cent of the; child population of primary .school, age is
enrolled ai
soondary educe
the children f^gthat age*    Think what this
mentis for nursing and especially; in couxttri
for the • available educational facilities.
* % escc e e ci
dueatioml require«•
is now keen competH
operator% and,, of c
Closely linked.
these occupa
is the status oi
-.nursing Itself* i^'or a new class there %iem sixteen applicants* Fif
ixacx *yiii' 'v.^eQtuip«'^^8f^^wa^S5'paJt -caia jLaic...a.a a jc& ti-n- $> f^ • n^-y &ru£ r opor t*<£ ci oxi o
The main .reasons why nine decided not to enrol were.-, "general non-aced
nursing as an honorable career for educated young'
and "competition f rem - commercial companiesn„4^f
Many values and customs peculiar to a cuiturij
reported,   ?JIt isentirely. lb reign to thegcaliure
home v^<fli*|^^
health n n ses.imo1coifeafromcm enlighte^
to let theaJa^ i^-ents Icnow that they actually vleij
Also the kind. of. things like the value people put
they use time3 and linted with this, what appears
of the need for- plannii^p. North Americans, to wh«
fixri this difficult and e;<caspe rating. Ore xaorsdxg
I turned on the radio and heard, n6 <laya, k hours]
the World1 £ J^ir« I •
of the better families,j
cfect m
y nurse
smselve
»i(3J
as a iaclc. of apprec
hhoiHj a moi
nutes to tu
 - 3 -
The supply a rd qualifications of
ox  vile./ i&>^«Lun rw.:''-j.'«..itij., .i><«cc £y^nxx xc an w *
population
every 300 to £c
1, of the various m&aberj
/he ratio. of nurses to
in Asia.iliis ratio is
, CIO C I/O m*-*-     yiZLl&i i   X
of the worker*
of them, i»e#J
.ntries auriliari
are by far the most mux
midijiv€
leaders Z teat:
is an appallir
prepare nurn
a,dership#
mj&   C:i'.i.e   tiJLZ. 0  o
Some one-put; a,
English lessor
±1&   bm
who came to her and asked icr a book*    rriifaat kind of book?n she inquired*    "Jus
any boc^^^^^Hi^^^j^ven't i$Jy.!I
I hope, this has given an idea of scpe .concHnolons:whi ch influence nursling i
countries from "which many foreign students' come*
I -would now like to mention some reactions which these foreign student.? he
about us and our lifersirjg.    But before doing so I must say how much the World
Healths Organization appreciates   the contei iuHffjj^||My by nurses in University
and schools, in hospitals and public health nursipg services, to the success oj
programmes foi' nurses   on World Healtli/'Grganisation fellofehi    study*    I say ti
 txons 1far
in conven
in North America*
me reactions undoubtedly t
cause of partic
ular
circi
ip
stances, and are
not
generally
held'j but-, neve]
-thaless, 1 think it
X©     P'j"=w
IPlllllllii      xiQ icno.W'.-ixow some
fore
Ign students feel sostetis*
fajpips us to I
@/awi
things which see:
a a-.;.                 First & ~ tliov
ortant to.
them*
hospitality^    Th<
Thev "look "to ^Sor*
iSl concerned as to 1
38 adapted to the
ies«    They are
intei
in team nursii^,.
in progressive patient care, :
use of ward se
cr&ts
Too often, they a3
xty -preparat ion
| for
nurse
they feel we are
theoreticf
)2«    They think:!
e  iOB.u. SOTO© uO-XX
our
01^ eiophasison the I
ive
had to sacrifice
i"*" :Btuc.ient s have
enormous proport:
f theory,
and practice is
too 1
.XltiX u&Q-m
k  Margr foreign
j touch thought to the
dependence of a
a good
■ educational prog?
raimna
on the clinical services :
zax the
hospital and i
health ^^|
fields*   • In theii
\ cou
ntries all
school" exists
to pa
a   serviceato the hospit
al*  • They
want helpgwi&h 1
roblem, but the
>ther direction*
 <ns pa
i
different forms
On
demonstrate
xL stud^ste feel that
urfit
XS  XaKOO
vxsxtxng iSrxtxsii doe
had this to say: ,fNd
escorting them aroux)
notice rescinded all
The doctors wrote or
and each stood aroujd
dft on
taw a doctor or a nun
>nvention of
,0 each oth<
icount to to
-.Jalge
?ctors
real probls
purpose of
better for
in the deve
improve -Abq
«(5)
and oiuard^ati k
In most of our hospital services th
involvement in pat-lent care*    Soiae of th
at least from!""
+.H
^nce the
>te a laclt
l tne nurs
ioctor, an
the practice in so*;b countries
 the baby in
to some tore:
are really ±1
One in coxssaei
$ays convxnce
cDuntxv
it lit
nurse
icrld nur
have when
wall be re
and staff
specxai obligatxons mxich' £
agree -to accept foreign sti
d* Studies- have shown that
than do national students*
aohools and
students r<
 The receiving educational institution or agency Iiae an obligation to provide
an appropriate orientation for the foreign nurse.    One nurse with a university
degree from her own country commented,   rfit took many weeks and months for me to find
out about some of;the ;terns,, the meaning of which is taken for granted,  suchs    s
as Bilghschool, '   ?superviser%,.. <professional nurse1,   %accreditation5 *n   This
is not a language problem in the ordinary sense*    it is a problem of under-*
standing the concept*    Miat the "supervisoru does must be seen to be understood.
More than professional orientation is needed*     tome help must le given in
uiider-staxidirig; this :oew. cultu:ee0 ..Here, great sensitivity and tact are reqim°ed,   .
lest "the. foreIgn sti.id.eiTb feels she is being- treated.-, as' a poor relation,  or
considered imiriature,  or,  that by the questions asked, her eountry is thought of
as backward or -underdeveloped (even though It is economically underdeveloped
OlJuX uxUXxb   J.   Qs
roblie he alt h' nore e s on the staff of agenolefireceivin^"^ '.;
for; field experience have a unique opportunity not only toogive-, ani appreciation
of good public health.' nur sirg practice but to show the :foreigner;-what North
Americans are really like.    By seeing people in clinics, vlsitirg- in home's,. and
taLkiig with the nurse on her rounds she gets. to know our cult ure*
This is a two-way process,   -Some of'yea who receive foreign' students have
said that you learn as much or more than you;teach*'   Cerfccanly these personal
contacts. with our world •neighbors> in nursing ar^^f^eal significance and of
mutual benefit culturally- and professionally.
Over one hundred and twenty <§|ythe nurses working abroad with hi-lateral
.and international agencies are. from North America,'   This does not include those.
with ehtorch missions and under'- other.' private auspices,    We have a great respond.
sibility for the kind of nurse we send to f or elgn as sig nme lib s, a -Studies have
.shown that nurses make a fairly good adjustment in foreign countries^    but some;
nurses have not* ;.. ¥e ne ed- ways; of identifying the characteristics we -believe
are necessary for success as an international "worker.    In addition to technical
 and-prof essional skills, overseasmanship requires a sense of dedication^ cultural
empathy, creative ability, sensitivity, energy, endless patience, and above all,
flexibility.
In preparation for overseas service it has 'been said that a £Lrst step' is
I a liberal arts education adequate to the needs of the world in which the
dividing Hur  between 9domesti^.«nl 'foreign1 affairs has been permanertly
blurredj the study of foreign cultures and foreign languages should, therefore,
SlSlkSgaV , . 111-C; fi-PS ^SSft'
be a rule rather than; an. exception, "•     \
liberal educatior^'I believe we.have not put adequate:emphasis on includirg
a foreign language,;   Coining .i^ of this continent which ies; two official
languages,f^ut in practice relatively few of its citisens can speak both of than.,
I have a strong personal conviction that; all nurses who are university graduates
| should be fairly fluent in one language other than their mother torsgue.-  Nurses
working abroad who have "le arned to  eommunicate in'., the. lamuage of the country
undoubtedly make a greater contrlbution, and at the same time have greater
personal satisfaction than those not. able   to.'-speak the language,';   A World
Health Organisation nurse who has learned, to. communicate in Chinese said,   "Mien
you can speak their language, you are accepted as one of them, and 'Oney accept
what you have to say,n
Dr Morrison, of the Rockefeller Foundation, has ;spoS:8:n of the need for
"new types of excellence"•    He said,   "We are now living In a world in Aich
almost eYery one of ipur actions has in sorae way an effect .on almost ;" everyone
AaAAA: -imuma ';.uifi;     -•  ' • aypll
else in the wrld."gfjSg We. need new types of excellence in nursiqg at home and
[for service abroad. - We cannot have it in the latter without the former.
 Dr Candau, Director-General of the World Health Organisation, 'fpid,
"All medicine is in a sense  var Id medicine,  for there is scarcely any advance
I in medical knowledge that does not affect the practice of medicine throughout1
the world. "^/ ^^111
In coned u.sion, I .would..csa^; simply thatd;"ali x^ :nurslng?^;;
Whatever we do in the future will continue to affect nursing practice through)
the world,;.  A     - ■■       mMz-
 5*
 OUR AZAAZFAlZITZzXl TO S
DHID_ ixzz^ZZZXD    ...
JkAjmiim    \Jx LA\&Jm£,»&3&&jiA     L/LZLaaJL     ' 1   ififf  1        f ta    Ttrjlcftw' w »A
1 "would like
to
mate my remarka, not only
aa an international worker, but
" also as a North American and. to. indicate rfiat J^elieve some.of our responsibilities
are as citizens oj
rn these Tespcrteibilities s
:da to nursing 1b the world®
[br@M narses Mk
I j particularly, of t3
•'.1- 'What are.:, som*
Africa in clarruary;
' half of the twent:
i centmy". w      They are 1
ri^ii^ %o accomplish in five to
ten years what has
izen om -hundred years in i
xrue other countries in a slower
^gw,       *.*»?  iuUiiU -ciCC/*
rency will be manifest in rrorsirg®
Manytof the (
a&ses or conditions of-111
nea-i-"Dn wxon _wn-.oft -une nurses mussc,?..
deal are hardly k
i In Eorth America*    Berhai
e the moot prevalent, <4uad one
—' which demandB muc]
i4^&W :SOS^*m^ = .ly%£f Vfe?^* CX -~yli?$xy8m^£4i "f?3£X& (aZa
in many coimtrie s
facilities for edi
iron, teachers, -h          g&j
£ot health services and personnel3
for-gooci niitriiioa
In a riceMsating country,
when an egg can be sold to buy
•■  . enough for a fami*
for a x^eek, it Is useless 1
o advise the inother to give her
p;r^v?rii^^*B^-^^^kj|^^j
..even once a week*
A World Ileal-!
>tganisation nurse wote of her prblic health nua^ng students
walking two to £o\
dlss: to -visit' In the villa
iges.    In a country where nearly
every public heals
take availability of transport
for|teuxbed.
 'ayyags        », 0 **
or edui
■* ous           onlv
ten to '-
a verity per oariu of tl
alatt.on.is. literate®    j
utrsLcsan countrxes -: only
fifteen- to - thirty pe
of the child populatlc
>f priiaaay school ag
enrolled and enrolM
ant for secondary education c
the^^ildren of that
age*'
think what.." this means
an.
terms ox.-. -e      r&xons
- ments for nursing an]
sially in go «arteries ltd
*re
boys
may be given t
for the available:ed
rial facilitil^g
operatorB^ and,; of- c|
Cicely - llftk&d' '
oarate$ is the
status of;
nursing itself*   For
had the   required eri
oal qiiallf^lcut'io'^* - tl
; i^XsSg^.   'Iv-^Py © a
fifth;.
:arailie%!? ;jg|
tgSfig^      and "competition fro;
srcial colonies",'fc
M) nurse   '   -
reported..   "It is ent
home visiting,    It w
to let their parents
K^fS**^  ^" *^S
mMj^j&ZMMxa)    foam
ttey use trtaiej    and '
of the need for plan
Horth Amiarlcansj to wl
I-1b -alBost an c
f IM thla difficult i
and ex
asneratinp,   0n$s mornij
A     *
M 'isionth' so'v jy
i a,o »^"t*' y 5 j*5
-   I turned on the radL
|isard,   "6 days, Ij. hour I
pu^es? to the oi
Am of ;||
tte^Kl^^tt^^i
 population ran
nearer one nor
CiOC m/AXtA    UXUmM   a J
In moat d
of the workers
of them, i*e*,
They are doing
is an   llid
O'Utpido Of • Spn
and xs rxve an
nursing progra
There are
English lessor
ccxiHtrlea aiixlli
litt2&
any book*   To l see, I haven't any,15
I hope thiss has given en idea of sou
countries from wtooh heiqt foreign student
1 woulc
which ihfl^iwe noreirr
Lfe to mention mm. reactions
about us and our nursing *    But before dolrag m
Health rTg;nr4 neti on. appreciates    the contrlbu
c&IXLl   v^vnOOXv-s,. XTli  x^mm- piLUa J..Q   and   pULOXXC*   U,efcA-i«Ui,:.   XI
s&yifl&wr much the World
orvxcefcS, -xc
 zz.cv.izzz eireus
eouxT
noimouB 'apportion -of theory* and tractice to too limited*.
'iSJ^tai
 visiting
had this
lacli
a doctor o:
>ur 3aiT
in
ls&xosi*£ and treatir
-   and ce                  a<h!d
auWhs$C;anUudh '  -'Wjkz ■■           'hfl^^^K^l   ovSil?'''       '■
In most of our hospital
services the    foro:
ZX~ nurses jaoDe <& ^altx* e.^, z.^-j.^yz^m     .
inrolveoent in ^                   .
Some of them may..
Teel that o*ix*i jLacis xl> acA^n^a,' aaovis$
at least from th© point of vi
ew of the nurse am
oa.iaps   Tfifttflft ^^niig^iy 1^111021; .^Ijffij.:,!y^^^fll£ffi
'      -   the practice in sera countri^
' ■        '                                           asssas-use"
elfliii              hu-'
  clonal instlw^^p^pMpi
te^k|^a^ #^^%3|^^-',^i^3^
'    an approprlate oriental!*]
^^^^^pfr^^^^prai^^^^
degree hi: oiii her cnan j
^|p^gp§iw|^^t %Qfci
[any weo«!&s anci mon^na* xor ins "&Q xxnct ;
out about some, ox the te:
pa, tho moaning of whicl]
as JMgh school, *  f super]
is not a language •|rob3Bi]
li In.- tire ordinarv sense*
standing 'the: concept,.  m
<?.;iU,o u    Lfe   .i'iv5C/cS.l    AA   & c? . ^Si^ZZz 5? yUv^
luiderstandlig-this aov d
ffjgfc      lest i:iie foreign student
.X. C' O'JU&>    v5.fiJ.v?    -Jtm&-' IJ^JZLisZ     V* *jiMIW§
..■    - conaideared:-Iimnatui^,-: or,
;j as taote&ra or: unclerdevell
|&    a^ad may-ha^e ;s.o^; of/the;]
ts^:^«&^^.,^;'#vs p
for -field e^jerience" havd
I a una que. or^ortanitgr' nq
of good pub2»; health r.ui
talking with the nurse 05]
m^t rounds sha - gets to
d3&tw%i ouTi jjp9*fiilire,
LicxjmCx. unaiD yoi^uXfej&^rs'ira§>.!=uixs
ii,   .oeroaxixiy. tresa personal
contacts' with our world ij
mutual benefit culturally
[ and professionally.
Over one hundred ..and
I twenty of the iv.
and intex^natlonal' agenoSi
!i^!|^^|p|^^^|p4Wl^lo a
L    This does not include those
with church misalons and-
gn..ni 11 ucr- lOr une'ici^id-0T".j
shown that mireeggmaks-a
nurses Jill
are necess
aracterxst
.-h
.arnica]
 and professional akllla,;,
■ a s'enae u£ dedication, cultural '-img
empafiiy, creative ability
ttdlass patience, and above all,    a
X AkhmA XX PX Xifc VJf ♦
" '^liberal arts eek'oatic
m adequate to the needs
a - s'-blurred; tho study of fta
-sign           eea and forei:
; xi ^ ^^u ife -^u e -3 quo LU^ti^r  vnc*^s^re ,
be a rule rather than an'
liberal education,    I be'J
a foreign laiguage.    Gem
.OiitiiiCiTXt 'id"' ^ on i^c feo official
^a^31JaSe,%  -iUt in- practi^
;0 relatively- few of.its'
■es who are aT&ycarsi'tgr gr&cfeatos'
should be. fairly- fluent-3
n their mother to^aue*   Mnrses
id rking abroad who have .3
personal satisfaction ths
-•ale the ii          s,    A World
Health Orgardsation narBe
h^i «^4>v -UiUvs s - ^h*^^i e^ua^^u^aci^i^a
aljiiDBtievery-'-ttnetQf: our u
:a efface on
lag-else i&gttie, i^rld,-®      si
Je need new types of exec
for service abroad.    We c
*er without the former,'
  3.
Op Cit.
m
Clev
XU3i? SAmXmAi'iSJ XJ\
Fanuasry 29,
■ TV
of the
lemy of Arts
>•■■ u,
Oppor
£3o.* 3i
Q        r/t<tt
andaUj

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