Andrew McKie

Exploring clinical wisdom in nursing education

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to ‘clinical wisdom’ itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.

‘The Demolition of a Man’: Lessons From holocaust literature for the teaching of nursing ethics

The events of the Holocaust of European Jews (and others) by the Nazi state between 1939 and 1945 deserve to be remembered and studied by the nursing profession. By approaching literary texts written by Holocaust ‘survivors’ from an interpersonal dimension, a reading of such works can develop an ‘ethic of responsibility’. By focusing on such themes as rationality, duty, witness and the virtues, potential lessons for nurses working with people in a variety of settings can be drawn. Implications for the teaching of nursing ethics are made in the areas of the virtues, relationships, professional ethics and the moral community of nursing.

Using art and literature as educational resources in palliative care

This case study outlines a staff seminar programme that used art and literature as vehicles to explore personal and professional dimensions of palliative care. Participating staff found the learning experience interesting and insightful.

One Day in the life of Ivan Denisovich (1962): Alexander Solzhenitsyn.

It is almost fifty years since the publication of the Russian writer Alexander Solzhenitsyns first novel (hereafter One Day). Although it may be overstating the case to give this Nobel Prize laureate ‘neglected writer’ status, Solzhenitsyn is currently not popular in the West and certainly not within his own homeland, even since his death at the age of 89 in August 2008. Nevertheless, Solzhenitsyns literary, moral and political stature during the second half of the twentieth century is not in doubt. Terms from two of Solzhenitsyns titles have entered popular usage: the ‘one day in the life of...’ interview feature of weekend newspaper supplements and, more importantly, the term ‘GULAG’, acronym for ‘Central Camp Investigation’, from his magisterial three-volume ‘experiment in literary investigation’ into the network of labour camps set up across the Soviet Union under communism entitled The Gulag Archipelago 1918– 1956 (1974). One Day is a sparse, tersely written narrative of a single day of the ten-year labour camp imprisonment of a fictitious Soviet prisoner, Ivan Denisovich Shukhov. Its publication authorised at the highest political level by President Khrushchev for its glimpse into one aspect of Soviet life under Stalin, One Day is a harsh, brutal, but often uplifting, account of everyday conditions experienced by political prisoners in one labour camp. Over one hundred and forty pages in length, One Day’s narrative, beginning with Shukhovs early reveille and ending with his bedtime reflections of ‘almost a happy day’ at dusk, is presented without chapter or section break from first page to last. I read One Day as my first ‘serious’ novel as a teenager in 1974. Tolstoy and Dostoyevsky, Solzhenitsyns literary mentor, followed later. Since then, I have returned to One Day at regular intervals, its simple narrative style standing in sharp contrast to reading the unrelenting details of prison life and legal procedures in even the briefest sections of The Gulag Archipelago. In the novel, Shukhov is forced to address the serious realities of life as presented, firstly, in the ordinary events of camp life and, secondly, through his engagement with other prisoners. In the first aspect, this experiential dimension to camp life is summarised in classical Socratic terms by Tiurun, the leader of 104th team: “Hey, you gents, take on my little brother as a learner. Teach him how to live”. If ethical living can be considered in terms of the end, or pursuit, of the ‘good life’, Shukhov explores this through the exigencies of camp life itself: camp hut searches and repeated roll calls by brutal guards, hard labour in plummeting sub-zero conditions and sparse food. But even within such conditions, Shukhov derives some meaning and value: resisting an early morning temptation to go on sick leave to find pleasure in doing a job well, enjoying the ‘sacred moment’ of eating a simple meal, obtaining extra tobacco, hiding a recently discovered small hack-saw and engaging in soulful camaraderie with fellow prisoners. The virtues of truthfulness, honesty and integrity are

Book review: Johanna Shapiro, The inner world of medical students — listening to their voices in poetry, Radcliffe Publishing: Oxford, 2009, 268 pp.: 9781857757521, £29.99 (pbk)

What themes constitute the experience of undertaking a medical school education? Shapiro, a medical humanities scholar, explores this question through a content analysis of poetry written by American medical students. The result is a fascinating insight into the ways in which writing poetry can promote reflective practice.