The psychology of nursing

Front matter

THE PsycHOLOGY

NLM OS2a4554 3. ia

NATIONAL LIBRARY OF MEDICINE

Foreword

THE trained nurse, like cloisonné, is made up of many ‘precious things.’’ Virtue upon virtue, gift upon gift, power upon power, the ideal nurse possesses. That she must be a psychologist has been recognized since the days of very early nursing.

In the old Hindu records we read that those caring for the sick should be ‘“‘clever in reading the face and understanding the patient,’’ which is only another way of saying that these nurses should know something of the science of the mind. Vincent de Paul gives in his teachings to the Sisters of Charity many hints of practical psychology.* In order to helpthe sisters in going about their nursing among the poor more intelligently, he taught them much concerning suitable methods of approach, the importance of understanding how their patients took things into the mind, the effect of manner, the place of suggestion in their work, the means of developing attention—all set forth in the simplest manner so that he might be understood by these nurses whose education was limited.

t Preserved in seventeenth century private edition, Bibl. Nat., Paris. v vi Foreword

Florence Nightingale gives many illuminating reminders in her writings concerning attention to the mind’s laws in nursing—for example:

‘‘Nurses have to do with living bodies and no less living minds . . . for the life is not vegetable life, nor animal life but it is human life—with living, that is, conscious forces . . . .” Thus, here and there, throughout the history of nursing, we find recognition of the fact that good nursing includes knowledge of human behaviour, but not until the present day has psychology been given a definite place in the nursing curriculum.

The Committee on Education of The National League of Nursing Education now recommends that psychology be included in the first year of a nurse’s study. The objects of the course as stated by this committee are:

“1. To attempt to state the fundamental principles underlying human conduct.

‘“*2. To give the student practice in considering people’s actions with impersonal understanding and sympathy.

‘*3. To develop certain principles of dealing wisely with patients and others in professional relations.

‘a. To help the student toward self-mastery and good sense in the relationships of private life.

‘“‘5. To provide a basis for subsequent courses in psychiatry or ethics.’’?

At last, this important science is compelling a

Standard Curriculum for Schools of Nursing, p. 38.

Foreword Vii place that is definite in the instruction of nurses. The time will come, inevitably, when all training schools of high standing will include the subject in the course of study, and, as a result, the power of nursing will increase immeasurably. A large proportion of nurses’ blunders occur because they do not possess a working knowledge of psychology. Psychology should not be considered as a subject which may be included in the nursing curriculum, but as one which cannot be omitted.

‘“‘Tf only they would send us nurses who know how to get at us!”’ This outburst, from a woman of the Mission district in San Francisco, is echoed by many of the poor and suffering we are trying so earnestly to help. Let us hope that the time is not far distant when public-health workers will be required to pass certain tests in psychology before they are given free rein in dealing with other people’s needs and problems. The department of public-health nursing as well as every other branch of the profession, needs women who know psychology and how to apply it according to individual experience.

Nothing complex in psychological learning is needed. Fundamental practical conceptions— old as human nature—are what contribute to professional skill. It is not the purpose of this book to set forth the elements of psychology from A to Z, but, rather, to dwell upon the principles which are the direct concern of the nurse. We shall not get lost in a maze of technical expressions.

viii - Foreword

Nevertheless, let the student not forget that she is studying a science. Alertness of mind, constant analysis, fine discrimination are essential in acquiring a working basis of psychology. Such study should increase tenfold the nurse’s interest and efficiency in every phase of her service.

Talks upon psychology, together with various exercises for study, given at The Stanford School for Nurses, form the nucleus of this book. For the convenience of the nurse, necessary definitions and references are quoted directly from recognized authorities upon psychology. If the busy life of the nurse will permit a more extended study, so much the better. The purpose of the book in hand is to aid the nurse in laying hold of certain elementary principles of psychology that will be of practical use to her every day of her life. Whatever is included, is given with the hope that the nurse will be helped in making the care of the sick “fone of the fine arts.”

I am indebted to E. P. Dutton & Company, to W. B. Saunders & Company, to Henry Holt & Company, and to Edward L. Thorndike for permission to use various standard explanations of psychological terms.

A. C. H.

SAN FRANCISCO, CALIFORNIA

CHAPTER I PAGE THE PLACE OF PsyCHOLOGY IN NURSING . ‘ 3

Necessity fora radical changeof mind, concerning the place of psychology in training schools—Why the nurse needs psychology for herself—Psychology a help in re-education—Self-criticism necessary—The understanding of what is to be done must be definite—The vision of the new self a stimulus to effort—Why the nurse needs psychology for the patient’s sake—A working definition of psychology necessary—The power of teach- - ing one’s self essential—Definitions of Psychology— Questions for study—Questions for re-education.

TYPES FOR STUDY IN THE PSYCHOLOGY OF NURSING : f : d : Facualae Wg

CHAPTER II Conscious FORCES : ; i ; cee SF

The way the five probationers ‘‘take in’’ the first glimpse of the hospital—Differences in each ‘‘stream of consciousness” —The knowledge of probationers concerning their conscious forces—What the nurse needs upon entering training—Questions the young nurse should ask herself—The modern aim of education—The aim of the nurse’s education—What the nurse is able to make of herself dependent upon training of conscious forces—Definitions—Questions for study—Questions for re-education.

ix x Contents

CHAPTER III PAGE HuMAN ADJUSTMENT. ; ; ; pee

Stimuli under the direct and indirect control of the nurse— Adjustment—‘“‘ Marks’’—The nurse’s room, a reflection of behaviour—Care of equipment—Accidents, due to faulty adjustments—The adjustment of the human organism to the social environment—What “getting on” with people means—Working as one of a unit—Complete education necessary for satisfactory adyustment—Aim of education to help us to make perfect adjustments—Definitions—Questions for study— Questions for re-education.

CHAPTER IV INSTINCTS . : i : ; R Rone Wf

Mechanical modes of behaviour—Individualistic instincts as manifested in the sick—Fear—The repulsive instinct — Self-assertion — Pugnacity — Adaptive instincts — Inquisitiveness — Manipulation — Play — Constructiveness — Imitation — Emulation — Migration — Acquisitiveness — Anti-social instincts— Teasing—Bullying—The predatory instincts—Shyness—Sex and parental instincts—Social instincts— Gregariousness—Rivalry—Religious instincts—Aisthetic instincts—The rhythmic instinct—Appreciation of the comic—The law of transitoriness of instincts—Study of instincts necessary for the nurse in her work—Modification of instincts—‘‘Instincts of possibility” —The nurse’s own instincts—Imitation on the part of the nurse—Emulation—The right kind of curiosity for the nurse to have—Why the nurse needs to preserve the instinct of play—Collections, as expressive of the nurse’s tastes—Control of the retractive instinct—What a nurse should fear—Self-assertion a draw-back — Borrowing — Shyness— The mother instinct in the nurse—The kinship of service—Team-work—Religion in the life of the nurse

Contents xi

PAGE —Definitions—Questions for study—Quotation from Dunton’s Occupation Therapy—Questions for re-education.

CHAPTER V HaBIT . ‘ ‘ : ; ; ; nae OE

Thestamp of habit—‘‘ Only the man is free who has fought himself free’’—Habits the nurse may transfer to her work—Power to develop habits necessary to the profession of nursing—Re-education—Self-analysis—Steps to be taken in altering a bad habit—Application of steps to be taken in altering wrong habits of posture— “The practical curve and its plateaus’’—What brings about plateaus?—The habits of patients—Points to be observed in helping patients to form habits—The ability to form new habits—The need of flexibility for the nurse—Definitions—Questions for study— Questions for re-education.

Chapter VI Sensation And Its Meaning ; ; «3; 483

Classification of sensation—Gradual development of discrimination—The need of more sensation—The use of sensations—The nurse’s use of the sense of sight— The patient’s sense of sight—The nurse’s sense of hearing—The patient’s sense of hearing—The nurse’s sense of taste—The patient’s sense of taste—The nurse’s sense of smell—The patient’s sense of smell —The nurse’s sense of touch—The patient’s sense of touch—Kinesthetic sensations—Organic sensations —Intensity of sensations in the sick—The patient, a bundle of sensations—Magneticforces—Definitions— Questions for study—Questions for re-education.

Chapter VII Taking Things Into The Mind ., : 2 108

Perception and apperception—Differences in the way the five types of nurses take things into the mind—Onexii Contents

PAGE

ness of group thought—A complete inventory of another mind impossible—‘‘ Meanings are individual ’’— What happens to the new impression—The mental ““buyer’’—The keeper of the mind—Human resistance is universal—Importance of keeping the mind alert, hospitable to new ideas—Catholicity of interest— Points for the nurse to remember concerning taking things into the mind—Points upon apperception helpful in directing the nurse with her work.

Chapter VIII Responses Of Patients : : : . 202

The influence of disease upon responses—The four natural groups of patients—Responses of patients who must die—How the nurse may help this group—The responses of patients who are going to get well—The responses of patients who are at a standstill, indifferent about living—The stimulation the nurse must give such patients—The responses of patients who are incurables—The nurse’s part in helping to salvage what is left of such lives.

CHAPTER IX PuTTING Two AND Two TOGETHER : .. 242

Association of ideas—The law of contiguity—The law of similarity—Effect of associations upon the attitude toward objects—The effect of prejudices—Effect of wholesome associations—The law of frequency—The law of vividness—‘‘ Congruity of Emotional Tone’’— Control of associations—How associations may be formed and controlled—Points to be remembered by the nurse concerning the way patients put two and two together—Definitions—Questions for study— References—Questions for re-education.

Contents xiii

CHAPTER X PAGE ATTENTION AND INTEREST. ; : igs

First lessons in active attention—Distinction between active and voluntary attention—The attention of the nurse—The attention of the patient—Patient’s attention mostly spontaneous—‘‘Natively interesting” things interest patients most readily—Patient’s new interest must be connected with something he is already interested in—The rhythmic character of attention—It takes the patient longer to get started than the individual in health—The patient’s power to “stick to things’’—Five factors to be considered in determining what the patient will attend—Patient must not be expected to attend what is really the nurse’s duty—Definitions—Questions for study— References—Questions for re-education.

CHAPTER XI MEMORY. é ; : ‘ < ae

The art of remembering—Good memory depends upon the number and persistency of associations—Work necessary for the development of good memory— Helpful questions in trying to remember—How things may be stamped upon the mind—Importance of the nurse’s memory—How may the nurse know that she knows?—The test called the ‘‘method of retained members’”—The “test for right associates’’—The method of reconstruction—The saving method— Test for permanent memory—How may the nurse guard against ‘“‘falsification of memory’’?—Filling in reports with details of typical cases as studied in class—The need of relying only upon her own impressions—The dangers of suggestion—Making a good story—Forgetting unpleasant experiences— Points to be remembered in connection with the patient’s memory—Patient must not be asked leadxiv Contents

PAGE

ing questions—Taking the patient’s statements “with a grain of salt’’-—The nurse a memory prop to her patient—Utilizing the influence of old associations in restoring memory—The part ‘‘forgotten’’ experiences play in illness—The nurse’s obligation to be silent about the wanderings of the delirious mind—Testing a patient for memory when teaching him occupation—Definitions—Questions for study—References—Questions for re-education.

CHAPTER XII How To Stupy . ; : é j . 264

A résumé of psychological laws and hints concerning study—Recognize principle of natural resistance as applied to study—Select place most conducive to study—The resolution to develop new method of studying—Don’t stop to thinking whether the subject is interesting or not—Be thrifty with time—Making a bayonet attack—Establish a tempo of study— Train your mind to associations concerning subject outside of books—Make over the material studied— Search for examples of principles—Use of routine— Thefacts concerning economical learning—Keeping up concentration—Pass by words you do not understand —Find out wherein preliminary knowledge is deficient —Studying without books before you—Keeping note-books—Aristocracy of mind—Definitions and quotations — Questions for study — References — Questions for re-education.

CHAPTER XIII THINKING IN IMAGERY . ; : : Sy 2

What is imagination?—The power of the mind to project itself into the future—The reality of imagination— Experience the test of practicality—Imagination in large achievements—Imagination a help in comprehending people—Imagination an aid to cheerfulness

Contents XV

PAGE

—Fancy—Why the nurse needs imagination—Imagining herself in the patient’s place—Imagination a help in meeting the patient’s needs—A help in sustaining ideals—To think in images is to forewarn— The nurse’s fancy—The patient’s imagination—Helping the patient to see himself in health—Imagination a factor in arousing confidence—The danger of setting the patient’s mind going in the wrong way—Effect of disease upon thinking in imagery— Unusual imaginative experiences of patients—Definitions—Questions for study—References—Questions for re-education.

CHAPTER XIV REASONING . ; ; ‘ ‘ , s+ 983

Thinking with a purpose—Thinking not a simple process— How judgment develops—Solving problems by the rational method—How may we learn to reason?—The nurse’s use of her reasoning powers—The nurse not a marionette—The expression of the nurse’s initiative— The physician and the nurse interdependent—Special need of the nurse’s reasoning powers in newer fields of work—The patient’s use of reason—Definitions —Questions for study—References—Questions for re-education.

CHAPTER XV FEELING. P : ‘ 4 ‘ <i 280

Feelings an accompaniment of sensations—Feelings pleasant or unpleasant—Feelings complex, emotions— Differences in degree of feeling—The nurse’s need of feeling—Her feeling for her patient—The sick-room not the place for the nurse to show emotion over her personal affairs—How the nurse may overcome repugnance in caring for revolting cases—The importance of getting in the bodily attitude that characterizes the feeling desired—The nurse’s observation of feelings and emotions—The effect of the mind upon the body—The effect of the body upon the

Xvi Contents

PAGE mind—How the nurse should deal with emotions— Study of temperaments—Definitions—Questions for Study—Questions for re-education.

CHAPTER XVI WILLING AND DOING . : ' i . Os

How are actions controlled?—Actions due to interest— Actions due to duty—Choice—Will, the ‘‘sum of the conditions of choice’’—The precipitate and the obstructed types of will—How the nurse deals with the two types—The balky patient—Two types of inhibition—Inhibition by substitution better for the patient —The red-tape of willing—Building up the will—A system of ideals—Helping the patient to act up to the knowledge he possesses—Questions for study— Definitions—References— Questions for re-education.

CHAPTER XVII NurSING TECHNIC : : : : So gts

What is technic?P—Form—Execution—Guiding points in securing good technic—The nurse must do her best all the time—A tempo as rapid as consistent with careful work should be established—Useless movement should be eliminated—Deftness essential as well as quickness— The best work cannot be done under tension—Muscular control necessary—Good technic achieved by infinite care.

Appendix

DIRECTIONS FOR MAKING THE OCCUPATIONAL THERAPY SCRAP-BOOK : : Be

THE NurSE’s HEALTH INDEX : : } , ; a 333

Chapter I The Place Of Psychology In Nursing

WHEN a young woman enters training to become a nurse, her mind is centred, naturally, upon learning how to care for the sick. This skill cannot be acquired, obviously, without the knowledge of certain facts which she expects to learn from the study of various physical sciences. It is important that the young nurse should realize at once that another science is needed—the science of the mind. The average young woman does not think of psychology as having anything to do with her. Psychology, she thinks, is something for the consideration of teachers, or, perhaps, a study to dip into during college. Such a thing as considering the knowledge of this science as a part of her equipment, as part and parcel of her daily life, does not occur to her. A radical change of _ attitude toward this subject is necessary to the student entering a training school for nurses.

First of all, why does the nurse need psychology for herself?

Without the study of psychology, the nurse cannot carry out successfully the physical and mental re-education of herself which is a necessity if she learns to give the highest service in her profession. Difficult though this task of re-education may be, it is fascinating because it imbues the pupil nurse with a sense of infinite possibility. What may not be accomplished by a human being disciplined and trained to greatest demands? To become ‘“‘a perfect instrument of service’’—this is worth the struggle of breaking away from ideas and habits that are wrong.

Usually, the rigid physical examination an applicant undergoes before her acceptance into the training school brings sharply to her mind the fact that good health is essential to the nurse. She should know, as definitely, that health of the mind is to be considered as well as health of the body. She should be willing, not only to train her body to perfect control, to eliminate weaknesses, to achieve co-ordination, but to train her mind as well—to clear it of waste thought, perverted responses and blind purposes. Indeed, she must realize that the body cannot be developed to its full power without the accompanying discipline of the mind.

In order to bring about the re-education of body and mind, the nurse must be able to judge what making over is necessary for herself. In other words, she needs to become an intelligent impersonal self-critic. All the willingness in the world to become an ideal nurse will not take the place of a practical knowledge of how to go about re-education. It is not enough to see one’s own faults and deficiencies. They must be understood as well. Faults and deficiencies that are analyzed may be dealt with by direct attack. Capacities must be recognized before they may be developed properly into power.

A nurse who had tried very hard to succeed in public health work and failed, sought in her deep disappointment the reason for her failure.

‘‘Why is it I have failed?”’ she cried. ‘‘Certainly I have given all I have.”’

Yes, she had done that—but she had not studied herself as a working power. She could not judge herself impersonally as a producing force. She could not see in herself the characteristics that were keeping her from success, much less could she eliminate them intelligently. Hers was what Stevenson terms ‘‘the itch of ill-advised activity.”’ Like so many women, burning with the desire “‘to do something philanthropic,’ struggling ‘‘to find themselves” in some form of public work, she omitted the most important preparation.

Why cry, ‘‘Oh wad some power the giftie gie us’’ when, with study, we may develop the ability to see ourselves perhaps more intelligently than others see us? It cannot be maintained that, without fail, psychology will transform the student into a scientific observer of herself or of others, but, as demonstrated, more than any other study, it will help to bring this about.

Merely telling a nurse that she should not do this or that is unsatisfactory in bringing about desirable results in development. She may listen attentively to the list of her shortcomings as her superior sees them—she may even reach the point where she feels no resentment at this recital—but this method of getting a nurse to realize her faults will never take the place of self-criticism. ‘The active habit of taking stock of one’s own self is the very heart of development. Obviously, to get this power of self-analysis, the nurse must first wnderstand her mental life. Before she can set about to control her mind, she must comprehend the means of control. She must become acquainted with the reasons for mental facts. Once aware of herself, considering herself impersonally, understanding what is to be done, naturally she feels that she has a big task before her. To avoid discouragement at this point, she needs to comprehend the possibilities of controlled power. If she can picture vividly the scope of her re-educated self, this will be incentive enough. It is too often a fact that the nurse has no well-defined conception of how gloriously her everyday life would be altered by the process of re-education. If this be the case, although the nurse may understand thoroughly what needs to be done, it seems invariably too great a task. She slips easily into the habit of ‘‘glossing over” her faults. She looks about her and sees many other nurses with just as many faults as she herself frankly owns. Since she does not suffer particularly by comparison, she reasons, why not disregard the work of making herself over? To obviate this possible state she must have the vision to see the possible new self in what is truly another world. The possibilities, once grasped, cannot fail to kindle her desire, to strengthen her will.

How is psychology to help the nurse in this making over process?

Suppose she has never mastered bodily control. Much of the fatigue of nursing may be obviated by physical power, based upon the laws of co-ordination. The performance of nursing procedures is harmful to the nurse only if the body is not moving in harmony with the laws governing bodily control. In John Dewey’s words:

‘True spontaneity is not a birthright, but the last term, the consummated conquest of an art— the art of conscious control.”’

The knowledge of such co-ordination cannot be complete without a basis of certain psychological facts.

Suppose she has been in the habit of admitting that she ‘‘can’t remember things five minutes’’; or, that she is the sort of girl who has never been able to take things out of books and apply them in her daily life; or, that she has no idea of how to form a habit, to develop by system any capacity she may have—through the study of psychology she may learn how to remedy these defects and weaknesses. If she has found study a burden, if she ‘‘dreads Materia Medica” and ‘‘loathes Chemistry,’ if getting lessons is a strain—this state, so disadvantageous to the student, can be changed. A new attitude toward study, making it pleasurable and easy, can be developed. The word “‘inhibit’? may mean little to her in the beginning, but it will prove useful indeed in harness. She can learn how to do all her work, both physical and mental without that painful dragging effort— that pushing-a-cart-uphill feeling. Her existence will be illuminated by the practical truth that she can create her own world. ‘‘Aitention’’—let her ring out this command to herself and fix her mind upon what she wills. Immediately she will find a new inspiration in her work. Eventually she will become a master hand at living.

In all this, and more, as we shall find, the study of psychology will help the nurse.

And now, why does the nurse need psychology for her patient’s sake?

Minus the revealing laws of the mind, the nurse cannot meet adequately the constantly varying problems she has in dealing with her patients. Without this science, she can never attain the most satisfactory professional relationships. The nurse is often confused by trying ‘‘to be professional,” and, at the same time, sympathetic in her attitude toward her patients. She can learn to be impersonal in her judgments of others and to show a fine sympathy, based upon intelligent analysis. Professional poise is not to be put on and off like ‘‘Sunday clothes.’’ Itis developed primarily from an understanding of psychological laws. By the use of rudimentary knowledge of human behaviour, the nurse may save her patients untold discomfort. In all the detail of her work the nurse may be helped by the use of psychology.

“‘T am going to sit up tomorrow,’ announces a wilful patient.

‘‘Oh no, you are not—of course you will not be able to get up tomorrow,” responds the nurse. She is complacently ignorant of any method of management except by ‘“‘blocking”’ crudely the patient’s desire. For the hysteria which follows, she does not hold herself at all responsible.

The nurse who uses her little stock of professional phrases indiscriminately—as if all words have the same meaning to all patients—is merely amused at the terror of the ignorant mountaineer when she tells him that he must have a lavage. It does not occur to her to explain to him in simple words, such as ‘‘washing out the stomach,” so that he will understand. She traces no connection of his terror over what is going to happen to him and his effort to escape from the hospital. She gives no thought to choosing her language in accordance with her patient’s power of perception.

The nurse who chats thoughtlessly while she is giving her patient his bath, wonders why he is “all tired out.”

The nurse “‘can’t get’’ her patient to take his medicine. She does not realize that she is ignorant of the first principles of approach.

The patient is sulky. Does the nurse concern herself with the significance of the impressions responsible for such a state? Every day the patient has a fit of melancholy. Does the nurse feel any responsibility in warding it off?

The nurse gives her patient a drink. She does not know that the reason he drinks so little is because his head is thrown forward too far, the drinking cup held at the wrong angle. Execution —what does she know of it scientifically?

The patient is inattentive to certain instructions concerning a prescribed treatment. Does the nurse know how to help him to fix his attention adequately ?

An endless list this—the list of blunders made by nurses ignorant of the fact that psychology has to do even with such details as giving a drink of water, listening to the patient’s tales of woe, entering a room. So much has the science of the mind to do with the minutest care of the patient that the nurse might well call her note-book upon psychology ‘‘How to Make My Patient Comfortable.”’

At the outset, let the nurse get a definition of psychology that means something more than so many words to her.

The Place of Psychology II

What is psychology?

An acquaintance with the definitions by wellknown authorities will help the nurse to formulate in her own mind a practical working definition.

‘“‘T wish psychology had another name,’ the probationer sighs. ‘‘It would be so much easier to start.”

With the word psychology there is a struggle usually before its friendly acceptance in the mind. How much greater would be the general interest in the subject, if the facts of mental life were assembled under another name—an altogether alluring term, a short word with a nice sound of holding something for everyone? The mind has to ‘“‘break’”’ even the commonest psychological expressions before they are connected as they should be with everyday movement.

Call psychology anything you like, only choose a name that helps you in learning how to do your work, in living so that living counts. Many a college student with a grade of A in Elements of Psychology, Psychology of the Crowd, Criminal Psychology, and all other available courses in the science, wanders forth in life in the same old unintelligent way, his knowledge of no vital use because he has never learned how to apply it. On the other hand it is possible to study psychology and to make daily use of its principles without labelling them by their technical terms.

A dear little old nurse who was graduated before training schools had a well-established curriculum, treasured a note-book that she kept during her practice. The title reads: ‘‘Human Antics” and the book contains a wealth of psychological suggestions in homely quaint phrasing. The first page reads:

“Don’t tell my patient more than one thing at a time—his knack of taking in things is weaker than a healthy person’s. Stand facing him when I speak to him—otherwise I add to the strain of listening . . . Even my little finger has to be taught to mind me in my work. . . . Just because my patient ohs and ahs over her orange dessert, I’ll not keep on giving it to her until she stops oh-ing and ah-ing. . . . Mr. B. couldn’t understand about the tube the doctor put into his side, until I showed him a picture and explained at the same time in short easy ‘words. Unless patients are too weak, they take in ideas quickest by seeing. . . . I must learn to remember different details for each patient if I satisfy them. Nothing is too insignificant to remember. Mrs. C. demands attention to a list of things a yard long— mostly little things, such as pulling the shades just so, putting her husband’s picture where she can see it without lifting her head, arranging her flowers in certain ways—the irises in the grey and orange bowl, the pansies in the old blue squatty one, the roses in the crystal jars. She says roses nauseate her when they begin to turn that dismal magenta, so I must get them out of the room before they fade. She always wants her cap with ribbons on her head before the doctor comes. She is cross if she isn’t ready for his call. She pretends it is something else, but I can tell. If she starts out cross in the morning she is never satisfied with her food all day long and eats hardly anything. So I always do my best to get that cap onin time. . . . Mr. J. is as stubborn as a mule, but I get around him by never saying outright that he can’t do things. . . .”

This wide-awake observer of human behaviour did not know that her gleanings had any bearing upon psychological truths. She would have been appalled by the scientific facts to which her observations are related. So, let us repeat, make up another name for psychology if you like. If the word psychology does not find a cosy place in your mind, seek until you find a term that will be sociably at home with your stock of ideas.

One point never to be forgotten—no matter how the subject may be taught in the training school, the student must teach herself to a great extent. This power of teaching one’s self, is one of the elementary essentials in acquiring useful knowledge of this science. In no other way can the nurse lay hold of working principles exactly adapted to her own use. She may have a good instructor to help her, or, she may have none at all. The main thing is to realize the need of psychology and to set to work to get it. Want it! Get it! Use it!