Nurse Education In Chains

We publish this  as a matter of interest .

It was written 20 years ago, by Lenin Nightingale, in response to the then proposed Project 2000 for nursing, and applies to the UK. Nurse education remains under question, facing possible re-structuring yet again.

There are early references within this piece of course, due to it’s early creation and also due to the necessity to research history. Note recurring themes of propaganda, and  indoctrination.

During recent ‘in service’ meetings, that sought to clarify the content, methods, and intentions of the Project 2000 (Student Nurse) Curriculum, I became aware that this curriculum was a potential vehicle of indoctrination and propaganda. I sought to clarify my thoughts on this subject, to focus on the distinctions between indoctrination, propaganda and teaching, so as to be better professionally prepared to make insightful contributions to discussion forums , concomitantly being more enabled to effect the content, methods and intentions of the ‘Project 2000’ curriculum.

The term indoctrination is a nebulous one, Wilson (1964) contends that there has bee a historical failure to clearly demarcate between teaching and indoctrination/propaganda: The Samual Johnson dictionary (1756) equates the verbs ‘to educate’ and ‘to bring up’. Thus, the word ‘indoctrination’ was often used previously to refer to the processes of getting a person to learn something. However, there is now in use a range of terms, including ‘education’. ‘training’, ‘conditioning’. ‘propaganda’ and ‘indoctrination’ and thus these terms are deemed to identify the distinctions in content, methods, and intentions between these concepts. For instance, the words ‘indoctrination’/’propaganda’ generally refer to particular intentions that some ‘educators’ have in mind, for example, to get people to think without reason, or in an unshakable way.

Following such preliminary investigations, I sought to pursue the distinction between teaching and indoctrination / propaganda to greater levels of abstraction by analysing a wide range of relevant literature, and by engaging in dialogue with colleagues. From such processes of ‘triangulation’, where limited perspectives would not provide the evidence, the following journal entries emerged;
“The distinction between teaching and indoctrination / propaganda is not solely determined by the content of a curriculum in that, as Hosper’s contended, both the teacher and the indoctrinator /propagandist may present information /beliefs as undeniably true ‘facts’. As Wilson (1964) points out, few things we teach are ‘absolute certainties’. (3.04.94)
“The distinction between teaching and indoctrination /propaganda does not depend on the methods to convey the curriculum, since however unimaginative ad uninteresting teaching methods are, however much they are the product of the teacher, teasching from conviction , or are not grounded in rational argument, it is not necessarily the case that such methods purposefully seek to eradicate rational evidence”. (3.04.93)
“It is the intention which determines whether a process is indoctrination /propaganda. The intention to close the mind to reason is taken first” (5.04.93).

Clearly, the pivotal role of intention in indoctrination /propaganda is confirmed- the dual intentions to close the mind to reason and to fill the mind with beliefs (presented as facts). To these ends, far from encouraging the use of evidence and reason to validate their proposals, the indoctrination / propagandist seek to suppress all evidence contrary to their beliefs. Thus, the curriculum of the indoctrination / propagandist contains neither breadth nor balance; is bereft of progression in learning, with beliefs presented as static entities; and thus, learners are not facilitated to develop analytical perspective.

Such narrow learning opportunities are indicated of a world- view representing the ‘scientific’ paradigm, within which individuals can be ‘conditioned’ (in the ‘operant’ sense ) by to indoctrinal stimuli, reinforced by the ‘reward’ of being accepted as a fellow partisan, to support the particular beliefs of the indoctrination / propagandist. Such support takes the form of a ’blind’ adherence to the beliefs being promulgated, as it is a central element of the ‘successful’ indoctrination /propaganda that recipients are unaware of being ‘conditioned ‘—- at the initial stage of the recipients exposure to the indoctrinator / propagandist or as a product of ceaseless repetition of ‘the message’, which, according to Perry (1966) becomes;
“An irresistible spell which binds the mind in a state of hypnotic fixation”. (p.131).
It is not, however, only through the process of repetition that particular beliefs can be inculated- alternative view points can be suppressed and disparaged through the subtle strategic of innuendo and insinuation; the use of a gesture and a disparaging tone of voice, the telling of a racist / sexist joke; it was propounded by Mussolini (1037) that such uses of self have the potential to make the most seemingly innocuous subjects the vehicle for spreading partisan beliefs. These beliefs will also be further promoted if their recipients can not voluntarily select from a pool of educators those whom they wish to educate them, as opposed to being the recipients of a narrow, ‘single source’ perspective.

Thus far, central themes of the concepts of indoctrination / propaganda have been identified, and, essentially :
“These terms are representative of a deliberate intention to ‘condition’ people to accept beliefs, presented as facts, that are not supported by evidence or reason”. (Learning Journal 20.3.93).
However, as much as these terms are used synonymously, sharing common themes, there is an additional, political dimension to the concept of propaganda that needs to be identified, in that :
“The individual educator may seek to indoctrinate others with his/her own personal beliefs, where as indoctrination becomes propaganda when the object of establishing those beliefs is to establish someone in power for whom the propagandist acts as agent. In this sense, propaganda is an undertaking by political partisans “. (A Reflection o the Contentions of Gransci (1934), Personal Journal 2.4.93).
Such political partisanship, according to Althuser (1972) is represented in ‘ ideological state apparatuses’ (I.S.A’s)- including the educational I.S.A, and so insidious is the ideological influence of the educational I.S.A that it is difficult for people to see it in operation. It is so taken for granted and has become so internalised in teachers outlooks that it appears to be no more than a manifestation of human nature.

Colleagues, alternatively stated that we do not live in a totalitarian, one-party state, so it can not be possible that any curriculum can be the product of a single ideological force, but must, rather, be the product of pluralistic dialogue. After consideration of this point, analysing relevant literature, and continuing to hold, and reflect upon, dialogue with colleagues, I suggest :
“ That for propaganda to occur it is not necessary that there should be totalitarian one-party rule, it is not only necessary that ideological competition should be so unequal as to give overwhelming advantage to one side against another “.
So as ;
“To protect, maintain, or advance a social order based on minority power. This is the process of authoritarian control over culture, which Gramsci (1934) identified as being the prime task of the dominant (capitalist) social order, a task accomplished through the institutions- schools, nurse education establishments , (I.S.A’s) – that they control “ (Learning Journal 11.4.93).
In order to determine whether the Project 2000 Curriculum is a vehicle by which the dominant social order seeks to promote its values through its partisans within nurse, education, it is necessary to establish what these values are so that they can be recognised, or not, as essential contents of the Project 2000 Curriculum : If such values were present it would suggest that further enquiry as to whether they are promoted through methods of curriculum delivery suggestive of a deliberate and organised attempt to convey propaganda would be worth while to the focus of this enquiry.
To identify the values of the ‘dominant social order’ (the terminology of today would designate this group the title of ‘the new right’) it is instructive to consider the role that the concept of absolute values played in the metaphysical consideration of Plato. To such as Plato, absolute values are forms of idealism contained in such concepts as ‘goodness’. ‘truth’ and ‘justice’, which are the supreme authority in society because they represent ‘ultimate reality’ and as such, are removed from criticism.
In the hands of ‘the dominant social order ‘ that which, as ‘ultimate reality’ can not be criticised is a tool of social control, requiring a person to associate a course of action with certain absolute values (Schofield, 1973); for instance , a student nurse may encourage a patient to be ‘a productive member of society ‘ if such a prescription represents what the student nurse conceives, through being subject to recent propaganda or, alternatively through developing the prescriptions during an earlier formative period, as representing ‘goodness’, ‘truth’ and ‘justice’.

It may be deduced by analysing the acts of parliament and pronouncements of the present and former conservative government that the focal intent of their policies to foster conception of individuals as inherently being ‘productive’ and ‘independent’ (of the state) members of the society, who must be enabled by government to make choices in the directing of their life (Johnson, Jacobs, 1992).
Is such an ethos represented prominently within the philosophy of the project 2000 curriculum within the Place X nurse education departments’ ‘mission statement’ (Section 13:2): analysis clearly indicates that this is the case. The focal meanings contained within the statement of the curriculum’s philosophy were deduced through the process of engaging in dialogue with colleagues and reflecting on the outcomes. The focal meanings identified are represented by ‘Learning Journal’ statements that patients should engage in :
“Forward movement towards being a creative and constructive individual member of society “ (10.4.93).
With Nurses :
“Facilitating maximum independence “ (20.4.93).
With patients achieving :
“Inherent dignity and irrefutable freedom to make choices “ (20.4.93).
However, whether this singular world-view is represented in the project 2000 curriculum by chance, by it being naturally reflective of widely held beliefs, or by it being the intent of a dominant political order and its partisans to place it there, is open to question in the same way deducing the aetiology of beliefs given by students is. Similarly, neither does the finding (Nightingale, 1993) that the overwhelming majority of literature recommended to students reflects the ‘dominant ‘ paradigm indicate that intentional propaganda is taking place: Nor does the finding (Nightingale, Barnes, 1993) that essays and projects are (necessarily) reflective of ‘new right’ philosophy indicate intent to ‘transmit’ propaganda, Propaganda is not proven by the placement of (‘new right’) ‘political appointees’ (‘company men’, Jackson, 1990) within the higher echelons of nurse education, who:
“Appoint colleagues of similar political stance to fashion the milieu of nurse education colleges”. (Peterow, 1992).
It may be, as colleagues content :
“That the ideology of (‘new right’) ‘freedom’ is not deliberately perpetrated by a group of sinister (wo)men. It is simply generated historically by the changing state of the economy- when there is an economic ‘downswing’ the nursing curriculum reflects ‘the needs of society’. (Learning Journal, 2-/04/93
Other colleagues maintain that the nursing curriculum is generated by a ‘force of ideas’, independent of economic determination, in that :
Changing views on education reflect the spirit of the period in which they come to prominence (Karabel, Helsey, 1977).
My contention is that, when evaluated against the criteria identified in this enquiry, the project 2000 curriculum may not be a vehicle for transmitting propaganda, although there are some grounds to support further enquiry into this proposition.
There are stronger grounds for suggesting that the ‘spirit of the period’ has ‘birthed’ a ‘force of ideas’ (whether of economic aetiology or not) that support an educational milieu in which individual nurse educators promote their beliefs to the exclusion of others, and thus promote the opposition of conscious enquiry :
“Routine and capricious behaviour. The former accepts what has been customary as a full measure of possibility. The latter ignores the connections of our personal action with the energies of the environment “. (Dewey, 1916, p.146)
Such sentiments are echoed in the following ‘focal meanings’ given by the proect 2000 students during th course of discussions in their clinical placement settings. These statements are given with permission:
“Human beings have the right to contribute to the society that feeds them “. (10.10.92)
“The main goal of nursing is to get people back to work and their family as quickly as possible “. (15.04.92)
“People can only achieve dignity and self respect if they are independent of others and free to make choices “. (21.10.92)

It can be seen that the aforementioned statements are all interpretations of absolute values, that is, interpretations of ‘goodness’. ‘truth’ and ‘justice’, reflecting particular (to the dominant social order ) world- view, representative of ‘the protestant work ethic’ and its accompanying value of ‘anti-welfarism’: It is only through this philosophy that ‘freedom’ and ‘independence’ can be gained; account is not taken of patient’s cognitive, economic, physical and spiritual resources to meet such prescriptive goals, certainly not to the degree that any inability to do so would preclude, as of right (of asylum), their eventual/ inevitable ‘facilitation’ into the ‘community’.
“A curriculum that promotes conscious enquiry acknowledges that students engage in a creative enterprise between their self and their environment, co-creating meaning, rather than having meaning imposed into their being through the will of external agencies. That is, a curriculum that promotes conscious enquiry is reflective of the ‘naturalistic’ paradigm”. (Learning Journal , 2.05.93).
It is through such reflection on the themes inherent in this study, which have made me a more insightful contributor to the shaping of my profession’s curriculum ideology, that I feel both my personal and professional development has been enhanced. As Dewey contended,
“All that is the wisest (wo)man can do is observe what is going on more widely and minutely and then select more carefully from what is noted just those factors which point to something to happen”. (Dewey, 1916, p.146).
Lenin Nightingale copyright


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