Historic perspective

You might say that Kylie Smith, Andrew W. Mellon Faculty Fellow for Nursing and the Humanities, is something of an outsider. What Smith brings to the Nell Hodgson Woodruff School of Nursing is a perspective largely absent from broader health care curricula: One that considers the profession’s past, its origins and influences, and its generally underappreciated role in American health care.

“It’s important for nurses, and especially nursing leaders, to know where they came from,” says Smith, a native of Australia, where she earned a PhD in history before relocating to the US on a fellowship with the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania. “They need to understand how and why their profession developed as it did.”

Nursing History for Contemporary Role Development, a collection of essays by Sandra Lewenson and Annemarie McAllister, edited by Smith, chronicles the evolution of nursing from the nineteenth century to the present— examining, among other things, nurses’ enduring role as a vanguard force for social justice. “Nursing students today want to know how they can do more,” says Smith. “So we tried, with this book, to show them that nurses have always been agents of social change—that more than being at the bedside, they’ve been, and continue to be, social activists, patient advocates, and innovators.”

Smith’s specialty is the history of psychiatric nursing. Her research focuses on the development of mental health nursing in the US from 1945 to 1980, and explores how American nurses negotiated competing ideas about mental health in what she calls an “anxiety-riddled age.” Indeed, as veterans of World War II struggled to reintegrate into civil society, psychiatry in the US exploded, and the newly established National Institute of Mental Health saw nurses as key to providing the complicated care vets needed.

One of the driving forces behind that development was Hildegard Peplau, an American nursing educator whose wartime experience at a field hospital in the UK informed her pioneering scholarship. After helping to reshape the nation’s mental health care system through passage of the National Mental Health Act of 1946, Peplau published her seminal text, Interpersonal Relations in Nursing, credited with revolutionizing the field.

“The history of psychiatry is dominated by doctors and these terrible images of nurses, like Nurse Ratched,” says Smith, referring to the antagonist of One Flew over the Cuckoo’s Nest, Ken Kesey’s 1962 novel.

Smith recounts an episode at a medical conference when Peplau stood up and declared that it was unethical for nurses to be involved in electroconvulsive therapy. A physician stood up after her and said, “What do you know, you’re just a nurse!”

“Peplau tried to encourage nurses to do more and be more, and psych nurses today really do see that relationship between themselves and their patients as the core of their practice—not just dispensing drugs,” says Smith, who has extensively researched Peplau’s life and work. “They call it the ‘therapeutic use of self,’ this idea that you, the nurse, are the treatment.”