The American Medical Association on the Case for Teaching Racism: Afrocentric Literary Pedagogy in Nursing Education and Clinical Practice

By Francis Kwarteng

The public lynching of George Floyd re-exposed the rotten underbelly of America and this, together with the disproportionate impact of COVID-19 on Black and Brown communities, the global Black Lives Matter protests, and the racist, xenophobic demagoguery of Donald Trump, resurrected the old debates about medical racism, race relations, implicit bias, vaccine nationalism/vaccine imperialism, structural inequality, police brutality, vaccine hesitancy, unethical human experimentation, vaccine diplomacy, qualified immunity, conspiracy theories, and social justice. Then in 2020 the American Medical Association formally declared racism a public health crisis, defined racism as a social determinant of health, and embraced the idea of medical schools teaching medical students about racism. Alas, the nursing curriculum is somewhat silent on these questions. Decolonizing the nursing curriculum, long overdue, is therefore imperative. This book explores the question of decolonizing the nursing curriculum from the angles of postcolonial theory, critiquing the Western literary canon, American history, literary criticism, African literature, cultural criticism, Afrocentric theory, democracy, African-American literature, and critical race theory.

• Language: English
• Publisher: Xlibris US
• Release date: Apr 26, 2021
• ISBN: 9781664170872

Book preview

Copyright © 2021 by Francis Kwarteng.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Rev. date: 08/11/2021

Xlibris

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I

dedicate this book to:

My family,

Which never stopped loving me despite my shortcomings

Dr. Tammy Spencer, Prof. Katherine Foss, Dr. Fara Bowler, Dr. Teresa Connolly, Prof. Pamela Prag,

Who inculcated in me that light always shines at the end of the tunnel

Dr. Molefi Kete Asante and Dr. Ama Mazama,

My greatest mentors and idols and inspirers in the entire universe

Dr. Jack Henning, my former biology professor,

You taught me so well

Dr. Kosuke Niitsu,

That great friend who gave me another chance at life

Dr. Dione Miller, my former chemistry professor,

You were one of the most qualified few to reveal to me some of the innermost secrets of nature

Dr. Kwame Akonor,

A brother, teacher, mentor, and friend who passed on before this book became a reality

Consciousness precedes unity…Cognitive hiatus unavoidably leads to the expression of contradictory statements and/or actions. Contradiction is a combination of mutually exclusive statements, ideas or actions…There is help that is needed to get rid of the cognitive hiatus, because there is a gap. You cannot go from A to B to C and then jump to G without missing something.

—Ama Mazama, A Radical African Discourse on Overcoming Cognitive Hiatus

As a people, our most cherished and valuable achievements are the achievements of spirit. With an Afrocentric spirit, all things can be made to happen; it is the source of genuine revolutionary commitment.

—Molefi Kete Asante

Contents

Foreword

Author’s Note

Chapter 1 Nursing School As a Bootcamp for the Mind

Chapter 2 Intersectionality: Implications for Nursing Group Projects

Chapter 3 The Subject Matter of Patient Manikins

Chapter 4 Racism & Implicit Bias in Nursing Clinical Practice

Chapter 5 The Patient- and Family-Centered Method

• Introduction: The Power of the Patient-Centered Clinical Method

• An Interesting Case Study

• My Hypothetical Reaction

• Concluding Remarks: Hypothetical Solutions

Chapter 6 Henry David Thoreau and the Myopic Lazy Nurse

Chapter 7 Social Power in Interprofessional Education for Nursing Clinical Practice

Chapter 8 The Implications of Arauz’s An American’s Resurrection for Mental Health Pedagogy

• General Introduction

• Important Background Information

• The Empirical and Physiological Utility of Choice in the Human Condition

• Complicating Variables in the Multivariate Equation of Mr. Eric Arauz’s Environment

• Diagnosis

• Additional Variables in Mr. Eric Arauz’s Character

• Medical Treatment Modalities

• The Resurrection of Mr. Eric Arauz: A Psychological Treatment Modality

• Eric Arauz: An Open Mind

• Some Critical Perspectives: A Critique

• Concluding Remarks

• Communication With Nursing Professors

Chapter 9 Theresa Brown’s The Shift: The Complex and Challenging Nature of Nursing Practice

• Theresa Brown: Some General Information

• The Nature of Clinical Practice

• The Inevitability of Medical Errors in Clinical Practice

• The Hospital as a Paradox

• Comparative Literature & the Human Condition

• A Few Pointers on Ms. Brown’s Literary Techniques: A Critique

• Concluding Remarks

• Miscellaneous Information

Chapter 10 Lisa Genova’s Still Alice: The Intimidating Case of Alzheimer’s Disease

• Alice’s Evolving Medical Dilemma

• The Complicated Journey of Alice’s Chronic Neurogenerative Disease

• The Significance of Lisa Genova’s Literary Techniques

• A Family’s Emotional Crisis

• Alice’s Immediate World Collapsing

• Some Critical Perspectives

• Food For Thought

• Concluding Thoughts

• Miscellaneous Information

Chapter 11 Clinical Progression & Afrocentric Literary Pedagogy in Nursing Education

Chapter 12 The Trump Presidency: Public Health & Racial Ecology in Crisis

• Trumpian Democracy: A Powerful Language of Deception

• The Problem of Politicizing the Coronavirus Pandemic

• The Polarizing Nature of Western Democracy

• Agent Provocateur Trump: A Scheming Likeness of the Colonizing Missionary

Chapter 13 The Race Question: Neocolonialism, Transcultural Nursing, & the Health of Nations

Chapter 14 Celebrating Women in Nursing Education

Chapter 15 The Controversial Question of Patient Manikins in Simulation-Based Education

Chapter 16 Community Health & Sexuality Politics

Chapter 17 The Critical Voice of Afrocentric Theory Versus the Culture Care Theory

Chapter 18 The Culture Wars: America’s Knee-to-Neck Restraint on Blackness, Afrocentric Literary Criticism, & Other Matters

• The Culture Wars: An Epistemic Language of Constructive Dissent

• Corrective Historiography and Historical Justice: Which Cultural Space Does Nelson Mandela Truly Belong?

• Decolonizing the Nursing Curriculum: The Role of the Texts of Lift Every Voice and Sing and the Nightingale Pledge

• Africa, American Politics, and the American Healthcare Industry: Implications for Caring Science

• On the Question of Literary and Racial Bifurcation: The Politics of Dehumanization

• Exposing the Hideous Crimes of History: Implications for the Ethics of Apology, Forgiveness, Silencing the Past, Politics of Memory, & Medical Ethics/Bioethics

• Sins of the Fathers vs. Moral Engagement: Great Lessons from Dr. Tammy Spencer

• An Apologia for Multicultural Inclusion: The Painful Demise of Allan Bloom’s The Closing of the American Mind

Chapter 19 Lessons from the Knowledge Production of African Literature: Reimagining Consciencism in Nursing Education, Curriculum Development & Clinical Practice

• Treading With Caution: The Dangers of Unsubstantiated Allegations

• Asking Soyinka to Assist in Rehabilitating Nkrumah’s Intellectual Legacy

• Consciencism: The Critiques of Asante, Soyinka & Habtu

Chapter 20 Critical Race Theory (CRT) and the Question of Perspective

Chapter 21 Is An Alternative Curriculum in the American Knowledge Economy Necessary?

Epilogue

Ama Mazama Quote

Molefi Kete Asante Quote

Author’s Note

Selected Bibliography

Synopsis

Foreword

I can still recall the moment when I met Mr. Francis Kwarteng very clearly. Back in 2018, I was working as a Psychiatric Mental Health Nurse Practitioner at the Campus Health Center located at the University of Colorado Anschutz Medical Campus (CU Anschutz). Francis was an undergraduate nursing student at CU Anschutz back then. When I went to the waiting area to greet him, he stood up right away, smiled back to me genuinely, and responded back to me respectfully with his soft-spoken voice. As we shook hands, I felt like I was able to connect with him right away.

As we sat down on the chairs in my office, we casually exchanged a few words, which was more than enough for us to build a rapport. After that, he talked. He talked, talked, and just talked. He had years of stories that he had to keep inside of him. All I could do at that moment was to listen, listen, and listen. I listened to his stories as attentively and mindfully as I could. As the readers will learn in this book, Francis has experienced not just one but also numerous challenges and adversities. Apparently, being a Black man living in the United States has brought him additional significant difficulties, obstacles, and barriers. Despite such challenges, I really think he has demonstrated such a high level of resilience.

I also received my nursing education in the United States. Graduating from a nursing program can be very challenging for anybody. However, as a non-White male nurse who speaks English as a second language just like Francis, I can totally relate to the difficulties that he experienced in his nursing program. As he explores in this book, racism, implicit bias, and other related issues do exist in the nursing curriculum in the United States. Now, I’m on the other side as I currently serve as an Assistant Professor. It has been such a great pleasure for me to teach my nursing students with multi-cultural backgrounds. This book written by Francis is a good reminder for me to recognize my own values and biases and stay humble to show cultural humility to people around me.

A few counseling sessions later, he disclosed to me that he had been writing. He told me that writing is very therapeutic for him to sort things out and make sense of the world. In this book, he writes about his experiences with his nursing instructors and professors who also encouraged him to write and supported him. He quoted my words in Chapter 18: Forgiveness is certainly a very difficult skill, but I think it’s an incredibly important step for a healthier relationship. Then, he continued, What this tells me is that for all these years it never occurred to me that I have been carrying in my heart an active volcano of pain, hurt, and anger against someone who had woefully mistreated me in the past not knowing this person has long since been dead and buried, buried unapproachably far away from the emotional, psychological and physiologic epicenter of my active volcano of pain, hurt, and anger. It is truly humbling and such a great pleasure for me at the same time to realize that what I said to him has contributed to his healing process and his desire to make a positive impact in this world. Through this book, he is brave enough to break his silence and share his experience as a nursing student in the United States with you.

I was recently informed that Francis successfully received his Bachelor of Science in Nursing (BSN) degree from CU Anschutz, passed his National Council Licensure Examination (NCLEX), and officially became a Registered Nurse (RN). Congratulations, Francis! I am sure he will continue inspiring people around him and providing compassionate and kind care to his patients in a culturally sensitive and respectful manner. I hope readers will enjoy learning about Francis’s perspectives as a resilient individual living in the United States, and I wish him the best.

Kosuke Niitsu, PhD, ARNP, PMHNP-BC

Assistant Professor

School of Nursing & Health Studies

University of Washington Bothell

Author’s Note

I owe it to Ghana for giving me high-quality and enduring education. I was very fortunate to be educated in Ghana by some of the most qualified, honest, and disciplined teachers any good student would ever wish to have. Acquiring an advanced certificate in science and then going on to earn a bachelor’s degree in mathematics constituted a difficult but fulfilling journey. Therefore, I should say what I am today stems largely from a collection of dedicated individuals whose special gifts of teaching and mentoring and strong presence and personality in my life, both academic and extracurricular, played an important function in my characterological and intellectual formation.

And then I immigrated to the United States, the so-called Land of Opportunities, of the Land of the Free and the Home of the Brave. To put it mildly, the Brave certainly was for me but not the Free.

But, then again, my focused and persistent attempts to attain a practical existence born of a comfortable continuum that usefully linked my imported educational backgrounds in science and mathematics with a suitable professional vocation in the US, however, proved unsuccessful.

It was as if my non-American educational experiences had no use in the body of my American existence.

However, I did not give up and continued to soldier on hoping that I would hit the jackpot someday. That someday never came. Pursuing that someday instead turned into a revolving door of cyclical frustrations and a society-driven existential exercise in a shattering of serial hopes and dreams. I continued to wallow in one low-paying, dangerous job after another since one door of hopeful opportunity after another slammed shut in my frustrated face at every turn. What astrophysicist and science communicator Neil deGrasse Tyson insisted (Browne, 2014) that we make available to all in society, equal opportunity or a level playing field, instead became the scheming shadow of an unconscious ghost in my world, a world hexed by the bad magic of social inequality.

Realizing that nothing was working for me by way of job opportunities, I settled on a last-ditch decision to obtain a graduate degree in engineering. I studied Operations Research at Boston’s Northeastern University. It was an interesting program of study in that my science and mathematics became immensely useful. I invested all my energy and resources in the program knowing that it would open up new possibilities of gainful employment that had been hidden from me for far too long.

It was yet another dead dream, another comical pipe dream I invested so much in. I went back to work as a security guard even with my graduate education. And yet I did not have a criminal record. And yet I have never had a criminal record. Was I an illegal immigrant? No. Have I ever been an illegal immigrant? No. Did I have immigration papers? Yes. I am even a US citizen. So what was and is the problem? This is a trillion-dollar question only America can answer. Eventually, depression and hopelessness insidiously crept in. I began to lose the healthy state of my once vibrant mind in incremental smallness. It was during these difficult moments of my existence that a sibling, one of six, who lived in Colorado, advised me to relocate. He had made this important suggestion on a number of occasions to me before but I always ignored him.

I describe this and many more of such in my other book The America That I Didn’t Know Existed: Immigrant Experience in American Education. Readers may consult it for additional information.

So, I arrived in Colorado more hopeful than ever that my protracted problems and bad, haunting dreams and serial moments of hard luck were finally over, thus once again deceiving myself into eating from another threadbare bowl of fairy tales for which you, the reader, might think otherwise, but nothing could be further from the truth. In Colorado, I began working in another low-paying job in healthcare, an experience that would force me to consider enrolling in nursing school to become a professional nurse. Unlike most of my classmates, I would pay my way all through nursing school. I am yet to know or convince myself whether I made the best of decisions.

And while in the program, Prof. Katherine Foss, Dr. Teresa Connolly, Dr. Fara Bowler, Dr. Tammy Spencer, and Prof. Pamela Prag gave ear to my endless nagging complaints and frustrations about my experiences in America even while they also closely worked with me throughout the program, to make the experience of my nursing education worthwhile. The first four also encouraged me to write, with Prof. Foss advancing the strongest argument in favor of why I should write. She suggested that I write about my nursing education experiences especially, in fact suggesting useful ways I could go about formulating, structuring, and composing this arduous task.

Even before I had completed my baccalaureate nursing degree Dr. Spencer, a resourceful and cheerful personality, was already steering me toward a doctoral program in nursing given her direct familiarity with my voracious appetite for knowledge, and, as a result, she put me in touch with an advisory contact in the graduate department to assist me in that direction. Dr. Bowler was another great human being. More so even after my graduation, she checked on me to see how best I was preparing for the NCLEX. Since then, her unwavering moral support put me in a better psychological and spiritual frame of existence—culminating in a pronounced decluttering of my immanent congestion. In fine, she mentored me throughout the program whether or not I was her designated professor for a particular course. Dr. Dailey-Vail assured me of her availability if I ever needed a recommendation letter.

I propose in this book that Afrocentric theory be incorporated into the nursing curriculum to enrich the professional and clinical experiences of professors and clinical instructors alike and the educational experiences of students, thereby broadening their cultural, scientific, epistemological, and gnoseological understanding of the cultural, sociopolitical, historical, and economic underpinnings of health disparities, medical racism, implicit bias, and racism and extending their vistas of the epistemic, moral, and sociopolitical utility of marginalized voices in matters of self-advocacy as well as of the marginalized’s legitimate pursuit of and demand for health equity and social justice, given the absence of critical oversight in the nursing curriculum on how to dismantle medical racism and implicit bias.

Finally, Prof. Prag worked with me closely to bring my Community Health course and its accompanying clinical component to a successful end. I believe they also made the time and the necessary effort to read the manuscript. I thank them for their time and generosity. This is why I dedicate this book to them, hardworking women of great intellect. I want them to also know I owe them and that this is my small way of showing my appreciation. These great women will forever remain in my heart for as long as I live on this great planet.

Once again, some of the best and most reliable people I have surrounded myself with over the many years I have been living in this country came to my aid when the need arose. I should here mention Dr. Molefi Kete Asante, Dr. Dione Miller, Dr. Ama Mazama, and Dr. Jack Henning. I discussed my decision with them and they seconded it. Each of them offered to write a recommendation letter for me. They all penned recommendation letters for me except perhaps Dr. Mazama who, if I remember correctly, was out of the country and therefore could not write me one. But incurring her blessings was all the impetus and morale I needed to pursue this dream.

In particular, Dr. Henning always encouraged me to go for a doctorate in nursing after my baccalaureate nursing education. He believed so much in me that he sporadically invited me to come over to his school and share my American and educational experiences with his batch of newly admitted students. Among his many responsibilities, Dr. Henning has closely worked with an organization, named the Minority Association of Pre-health Students, for so many years. Educated in South Africa among other institutions of learning in the US, Dr. Henning tended to approach his African and African-American students with the utmost respect, with understanding, and with a strong sense of multicultural disposition. He and I used to discuss Cheikh Anta Diop and other Afrocentric scholars, writers, researchers, and activists as well as some of the programs featured on Gil Noble’s Like It Is. And he, if I may add, was very accommodating of alternative views on almost every topic that came up for discussion. I learned a lot from him as the years went by.

I recall Dr. Yaw Nyarko, founding director of New York University-based Africa House and one of America’s leading economists on Africa, advising me to go back to school for a doctorate when I told him I had a graduate degree in engineering but found myself working as a security guard because I could not get a job commensurate with my degree. We had met by chance at a garage in Manhattan, New York, where I was stationed as a security guard. Dr. Nyarko was there to rent a car. We have become friends since then. I assured him in 2020 that his advice was still on the table. This advisory trajectory from him to Dr. Spencer to Dr. Henning to Dr. Mazama to Dr. Asante is clear.

And yet, Dr. Asante and Dr. Mazama were not too far away from the epicenter of my nursing education. Even in the nursing program, I continued to read some of their publications and doggedly followed what they were doing in the American Academy. I particularly took great interest in the articles they published on the website of Afrocentricity International (A1). I also watched some of their YouTube videos from time to time to keep me abreast of new developments in the field of Afrocentric research, publications, and scholarship. For instance, Dr. Asante’s The Global Intercultural Communication Reader became the most reliable reference Bible on intercultural communication theory and practice I would avail myself of throughout the full course of my nursing education. Many of my important assigned nursing-related online discussions and critical rejoinders benefited enormously from this book and their other writings.

This book in particular and the Theory of Afrocentricity followed me throughout the program.

Thus whichever spatial topology I found myself inhabiting, the great wisdom and long reach of Dr. Mazama’s and Dr. Asante’s intellectual activism and the Theory of Afrocentricity have admirably been, too.

Finally, both Dr. Mazama and Dr. Asante painstakingly read the draft manuscript for this book and offered useful constructive criticisms. The American Medical Association On the Case for Teaching Racism: Afrocentric Literary Pedagogy in Nursing Education and Clinical Practice looks at my struggles in nursing school as well as the shortcomings of my nursing education. Let me also say I changed the title of the book from its original Clinical Progression and Afrocentric Literary Pedagogy in Nursing Education in response to the American Medical Association’s formal declaration of racism as a social determinant of health in tandem with its public acknowledgment, so late in coming, that it was high time racism should be taught to medical students. The book also makes a case for making the nursing curriculum more inclusive. To my potential readers and nursing curriculum developers, I hope I have been able to advance enough cogent arguments that should force radical changes in the professional development of students and nursing curriculum development to benefit the nursing professoriate and students from different ethnic, cultural, racial, religious, and national backgrounds.

Dr. Kofi Kissi Dompere and Dr. Emeka Nwadiora were instrumental to the success of this project as well. Dr. Nwadiora even went a step further and bought me a copy of Caroline Davis’ African Literature and the CIA: Networks of Authorship and Publishing, shipped it to me, and then asked me to use it as a reference for this book. This important gift is the foundation of Chapter 19. He also bought me Frantz Fanon: Alienation and Freedom. Indeed, my book benefited enormously from his knowledge, experience, and scholarly input.

From the bottom of my heart, I thank them sincerely for their time and their support for and dedication to my success in everything I set my eyes on.

Also, while American philosopher of Ghanaian ancestry Kwame Anthony Appiah (2020) has advanced an interesting argument that both Black and White be capitalized, a proposition some do not accept, myself included, I have decided to follow the position of the Associated Press (AP) to capitalize only Black (Bauder, 2020).

As an aside, I want to make it clear that I completed this book and its prequel months preceding the murder of George Floyd, a man whose death came to symbolize global resistance against racism, police violence, state terrorism, and white supremacy. Floyd’s unpardonable public lynching broadened the scope of the discussion around the state of race relations on a global scale. I merely incorporated facets of his ghastly murder and unfolding legacy in this book to provide additional contexts for my own unique set of harrowing experiences in America. The harrowing moments of his anoxic seizures and agonal breathing under the weight of a blood choke must have been a painful experience for him in the lead-up to his historic demise. I should also add that Nina Simone’s classic Why? The King of Love is Dead is what I remember whenever the George Floyd name makes a presence in my consciousness.

The lynching of Black Americans (Equal Justice Initiative, 2017, 2010) remains an indelible stain on America, but unfortunately, it continues today in subtle and not-so-subtle manifestations. Way back in nursing school, I began wondering and asking myself why racism was not an integral component of the curricular superstructure of the nursing curriculum. And so, from time to time, I began the long journey of sharing my experiences with racism and implicit bias in healthcare (and outside healthcare) with some of my professors, social workers, psychiatrists, classmates, and an important non-faculty staff member in charge of student affairs and diversity. I had medical insurance from the State of New York and yet struggled to get medical attention in the Bronx, while my white colleagues and friends with similar insurance never had to endure any such hassles in their pursuit of medical attention in their mostly white communities of Manhattan and elsewhere in New York, but a rather more surprising aspect of this narrative is that many of my Black and Brown friends share my story (see The America That I Didn’t Know Existed). Could you imagine if I did not have insurance at all?

Finally, I included a suggestion in the first manuscript that race and racism be taught in nursing schools more than a year before the American Medical Association officially declared they should be taught to medical students. This is why more than anything else, I have placed African literature and African-American literature at the center of the critical discourse on curricular transformation, an antithesis of the racist view that African literature and African-American literature were not literature but instead a subset of social anthropology (Shurbutt & Hoffman, n.d.). The burden of responsibility weighs heavily on us now to question the negating implications of the Pan European Academy for a genuine inclusive, multicultural response to the errors, lies, racism, distortions, and aggressive centralizing of curricular hegemony in knowledge construction (Asante, 2020). Ngugi wa Thiong’o (1993) proposed his moving the center theory as a countervailing response to Eurocentrism. But even more importantly, other marginalized groups can learn from this as well.

In the main, I also updated the original manuscript with new information on the U.S. Capitol insurrection and the potential implications of the insurrection for spreading the coronavirus, the failure of the Trump administration to put a national strategy in place to fight the coronavirus, and how as a result, this almost overturned the American healthcare system due to the abysmal failure of the Trump administration to lead by example, leading to the death of hundreds of thousands of Americans. The COVID-19 pandemic has radically changed the way we learn and educational systems around the world. More particularly, though, nursing and medical education will never be the same.

But after all is said and done, How many people will choose whiteness over democracy? author Isabel Wilkerson quotes her friend in her famous book Caste: The Origins of Our Discontents (Harvard T.H. Chan School of Public Health, 2021). My experiences in America, as recounted in The America That I Didn’t Know Existed, speak to these manifestations. Furthermore, the accidental presidency of Donald Trump made the situation in America even worse. Under the post-truth, apocalyptic and divisive presidency of Donald Trump, the world witnessed with unmitigated horror how Francis A. Schaeffer’s A Christian Manifesto and Andrew Macdonald’s The Turner Diaries (Pineda, 2021) came alive. The violence displayed at the U.S. Capitol on January 6, 2021, an indelible blemish on the American national conscience, seems to partially answer this most important of questions that has been left hanging in the past 500 years. This is an extremely important question which I also wrestled with in my book, doing so from the unique point of view of every major aspect of American life. It is also an important question at the heart of the corporate American curriculum.

Please join me as I explore this question and many others.

Francis Kwarteng

February 29, 2020

CHAPTER 1

Nursing School As a Bootcamp for the Mind

Education produces mindsets for individual and collective behaviors over the social decision-choice space. Different mindsets are produced by different consciousness and historical awareness which are the results of curricula and methods of information transmission. The mindsets simplify the individual and collective decision-choice behaviors within themselves and to one another. This mindset controls the individual and social preferences over the decision-choice activities and the problem-solution behavior in terms of activities over the goal-constraint space…

There are many types of education where each type is defined by a goal-objective element. Every educational type is transmitted by instruments of either formal, informal or both. In all contemporary societies, the practice of education is a combination of formal and informal in nature, where the formal dominates the informal in social acceptance and approval of behavior.

—Kofi Kissi Dompere, p. 510

Nursing school is a boot camp for the training, streamlining, and hardening of the mind, soul, and spirit.

Let me simply call nursing school an academic boot camp.

The turbulence of my nursing and clinical education, if I can put it more bluntly, has, perhaps, tested me in radical ways that I cannot say is typical of my other personal life experiences. Nursing school has tested my physical, psychological and emotional sufferance, my capacity for interpersonal communication and critical listening and public speaking skills, and my relationship with others in a manner that is often difficult to fully describe or capture in a comprehensible language of situationist theory.

Thus, the physical, psychological, physiologic, and emotional demands that directly and indirectly accrued from the sanctioned rigors of nursing and clinical education taxed the intrinsic wealth of a student’s capacity to freely engage in purely non-academic and extracurricular activities—at least as the situation was in my particular case for as long as I was a student nurse. This is why I am always quick to tell anyone who cares to listen that nursing school is not for the timorous when this is viewed unbiasedly in terms of the height of a student’s disposable emotional, psychological and intellectual resources and physical strength, but, as happened in my special case, additional burdens such as insomnia and depression and hebetude sapped my physical and emotional wherewithal to the extent that I seriously questioned myself whether I was doing the right thing.

Nursing and clinical education requires the weight of an unburdened mind to make room for new, revolutionary, influential, or untried tenants of ideas—in the main, clinical and didactic data.

I have experienced the weight of psychological stress before while studying mathematics and engineering. Courses such as topology, computer programming, and abstract algebra made heavy demands on my psycho-emotional resources and this interfered with my sleep hygiene in a way I never anticipated prior to enrolling in these programs. Spending sleepless nights and countless hours writing computer codes or algorithms that ended up not accomplishing their full executable objectives as scrupulously described in assignment templates drastically lowered my morale. I shied away from pursuing academic investment in software development for this principal reason.

I passed my graduate computer programming course but it was not an undertaking I achieved on a silver platter.

Some of my other nursing courses would prove equally stubborn—mentally taxing.

I did not approach, mayhap, the nursing program with the same degree of enthusiasm, interest, or excitement as I did with the other programs. If this were the case, then I had only got myself to blame. Surprisingly, I found myself struggling with basic dosage calculations and unit conversions during my nursing and clinical education despite my broad formal training in general mathematics, applied mathematics, and engineering. Notably, I was living outside the immediate scope of my mind in the computing language of mathematical academese and comfort of logical reasoning.

And yet Dr. Gail Armstrong, one of my professors, did a fantastic job teaching dosage calculations and unit conversions. What could I have done wrong? I found myself struggling with rudimentary calculations and unit conversions that should not have posed any problems for some of the children I had tutored in New York before relocating to Colorado. I took nursing exams on dosage calculations and struggled with the wording or phrasing of some particular questions and answers, leading to dire situations of frustrating entanglements where I found myself vacillating between two answers that appeared too similar in terms of the implied strength of the correctness of their applied and clinical applications.

Of course, one of the alternatives in the logical couplet of competing answers always seemed correct, but every so often I found myself gravitating toward and choosing the wrong answer instead. This became a constant personal struggle from the point of view of my immanent sanity. By the way, many months later after graduation, I was practicing sample NCLEX questions and came to this particular question, an interesting one at that, whose four possible answer choices, the one that I believed to be correct violated the subject-verb agreement principle, correct because it clearly communicated convincing assumptions of intersectional validation of the physiological, the psychosocial, and the clinical ideas of patient-centered care and standard precautions, standard didactic and clinical assumptions required to answer the question correctly, only for me to pass over it thinking its violation of the subject-verb agreement principle was enough to invalidate its correctness. It turned out to be the correct answer despite its problematic wording. The item writer and the test-administering company could have at least set up an internal corrective algorithmic mechanism to deal with the likes of this needless but patent oversight.

It was even paradoxically difficult getting two nursing textbooks on the same nursing course to agree on the same basic subject matter, the same as Kaplan, UWorld, and Hurst NCLEX review programs. Interestingly, clinical and didactic opinions on the same nursing concepts sometimes differed from one professor or clinical instructor to another even when they taught the same course. You are taught in nursing school that a patient gets to take a maximum of three nitroglycerin (NTG) tablets for angina/chest pain, five minutes apart, that is, a total of fifteen minutes for three NTG tablets, but then the nurse is required to instruct the client to call emergency (911) as part of patient education if the condition does not get better or worsens five minutes after taking the first NTG tablet. And then, you pick one of these highly recommended NCLEX RN practice tests, and you, the future or student nurse, are told otherwise that the client should rather be instructed to call 911 if the condition does not get better or worsens five minutes after taking the first NTG tablet.

It did not matter that I chose these wrong answers only to experience inexplicable yet sudden flashes of the correct answers as I thoughtfully drove home in the deadening quiet of my car after my dosage calculation exams. I began questioning the health of my mind. However, the déjà vu of this stream-of-consciousness ambiance bordering on a mechanism of experiential flashes became something of a haunting fixture, of the troubling wavelength of a burdening preoccupation, that is, along the structured jagged-edge contours of my strained life of material and spiritual existence.

Beyond the scourge of dosage calculations, no other nursing class terrorized the relative sanity of my mind and emotional comfort as Medical-Surgical, or Med-Surg. Med-Surg came in two parts—taught in two consecutive semesters. I took the first Med-Surg class with Prof. Stacey A. Seggelke and Dr. Susan Bonini, the second with Dr. Teresa Connolly. Each of these classes came with its own set of offsite clinical assignments and arrangements and a separate module of clinical rituals undertaken in the claustrophobic ambiances of the Clinical Education Center (CEC) and Simulation Center (Sim), for sure.

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Then five of my classmates from the same group, Group N, and I traveled to Loveland, Colorado, for our four-day offsite clinical assignments. We rented four rooms in a private house and spent the first couple of days working on and completing exactly two days’ worth of clinical assignments. We took Care of the Older Adults final before embarking on the trip to Loveland. Dr. Kelly Henrichs taught this class. We then drove back to Loveland again after a few days in Aurora and used the remaining two days to complete the remainder of our clinical assignments.

We drove back to Aurora again extremely exhausted—and in line with syllabus requirements—we took an exam conducted under the strict proctorship of Dr. Bonini and Prof. Seggelke in the morning the following day. Both made time for us, students, where some of us faced the difficulty of trying to understand and master the material prior to taking the exam. But then again in my particular case, mental exhaustion was primarily to blame for my lack of physical and emotional conditioning for the exam. I benefitted from their time, wisdom, and kindness nonetheless.

The Med-Surg offsite clinical experience brought back haunting memories of another terrifying experience I had during one of my offsite Mental Health clinical assignments. My rickety GPS froze on my way to my Mental Health clinical facility and accidentally landed in the unexpected embrace of the mountain ranges of Colorado. I almost wept that day. I did not know my way around Colorado and blamed myself for this shameful act of geographic illiteracy. I found my car sitting in the middle of three or four imposing mountains, with my car and my garbled mental topography and the tripartite or quadripartite mountains submerged in the forlorn silence of pre-dawn blackness. In most cases, I made sure to reach my offsite clinical destinations an hour or two prior to the commencement of my clinical assignments in the mornings because then I did not have to put myself in a situation, particularly for the nonce, where I had to explain myself when taxed with tardiness.

I did not want to justify a charge of tardiness.

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Professionalism, competitiveness, respect for work, and punctuality are virtues I cherish so much, virtuous qualities I have cultivated since childhood as a hawker of roasted plantain, chewing sponge, banana, and confections. The institutional rigor of nursing education reinforced these qualities during the clinical education and didactic instruction of students. My parents enforced these qualities as well, qualities they incorporated into a set theory of peremptory household principles which we children held inviolate. You were sharply disciplined or reprimanded one way or another if you rebelled against or stood in the teeth of the natural mandate of a parent to inculcate you with these basic virtuous principles of life. You had no choice but to stand firmly within this restrictive parental purview of moral instruction for your own good.

My parents are a mongrel of liberalism and conservatism, or traditionalism, as far as their parenting skills are concerned. The qualities they inculcated in me would inform my developmental psychology and my personal philosophy about filial responsibleness, about my fealty to professional obligations and relationships and training and education. For the most part, they allowed us to explore the possibilities of human potential for social, intellectual, and emotional development under the chaperonage—or oversight—of parenting modality as a social-cultural institution. I cannot overstate the fact that my social and cultural upbringing shares some important overlaps with the professional demands of my nursing and clinical education.

The modality of my parents’ parenting skills hardened the child psychologically and emotionally against the crushing vicissitudes of society, of nature, of human character and behavior, and of adulthood, a set of parenting skills that translated well in my childhood and have since become handy in my adult life. I brought the benefits of these parenting skills to bear on my didactic and clinical classes, including on Med-Surg. Yet, preparing sufficiently for and taking the exam which Dr. Bonini and Prof. Seggelke proctored was not an easy enterprise. My group had to conclude a special arrangement with Dr. Bonini to take this exam excluding the rest of the class, an exam I would take under an oppressive blanket of physical, emotional, and mental debility.

What’s more, taking a multiple-choice exam under this strained condition created an additional burden of worries for me personally. Under the constraint of time, I hardly could think sufficiently through serial question stems let alone make sense of corresponding answer(s) constructed to correctly match a given set of systemic informational assumptions, secreted away in the biauriculate context of these sometimes loaded serial question stems. Scientism, rationalism, and pragmatism, therefore, assumed a worrying state of impeachable remoteness from my mental resources—unlike the unquestioned physical distance between my nostrils. In this sense, the unbending oversight of time constraint somehow determined whether one became a resounding success or a crushing failure in life.

Once again, these exams required the magic of graphic recall and exhaustive processing of large amounts of informational data and their correct interpretation within the assimilated context of evidence-based reflection, tasks that must be accomplished on the basis of empirical or clinical corroboration of understanding medical-surgical cases and concepts from a real-world perspective, and with incredible speed due to time constraints.

Also, I must add, acquiring a measure of intimate familiarity with empirical and conceptual knowledge of medical-surgical cases prior to enrolling in nursing school or taking Med-Surg classes helped greatly. I had no such prior knowledge. In the end, peeling off structural decoys to reveal the true nature of didactic and clinical nuances and distractors concealed in the abstract reality of serial question stems tested the student’s mental stamina and knowledge of optimal strategies for effective test-taking skills under tremendous pressure and time constraints. All I could think of was William James’ The Ph.D. Octopus (1903) in those difficult moments of test-taking.

I usually could not go to the full extent of the kind of mental marathon required to take a multiple-choice exam in a state of mental lapse. Exam preparations did, however, tax my sleep hygiene in that it worsened my insomnia, concentration, and hebetude even more. For instance, I hardly slept in Loveland because living in unfamiliar environments was not something I was used to, and accordingly, the sticky fingers of this unsavory unfamiliarity robbed my sleep physiology and appetite with reckless abandon, further resulting in my physical and mental and emotional weakness. I could never adjust to my new environment no matter how much I tried. Restlessness took over me.

Furthermore, chronic perturbations in my sleep hygiene drained the immanent contents of my retentive colander. Retaining information became something of a herculean task. To catch up on the content of the exam material, I read during lunch breaks and during little opportunities I encountered between assignments during my Med-Surg offsite clinical. Standing on my feet for more than ten hours each clinical day while performing my hectic offsite clinical Med-Surg assignments, it turned out, did not help matters either. I do not think the harrowing experience of standing on my feet for eight hours straight in frigid winter as a security guard in New York prepared me adequately for this painful challenge. The sheer volume of emotional and physical expenditure accruing from the strenuous effort of studying while actively engaged in the execution of burdensome clinical assignments carried its own excruciating weight of psychic torture.

More than anything else, my mind simply refused to accept its natural designation as a white hole and leaked effortlessly. I became mentally blank even after lecture slides, textbooks, and professors had saturated my mental reservoir with information. My mind became an inveterate tabula rasa even in the face of the structured content of informational abundance from my didactic and clinical baptism. Instead, the spectral baggage of my American experiences colonized the state of my weary mind leaving no room for storing didactic and clinical knowledge.

That is, my inability to focus on my academic studies stemmed largely from my abject failure to detach myself completely from my constant flux of pain and bitterness and anger and hurt. My seemingly infrangible attachment to the gravitational pull of this shambolic baggage nourished my constant drift into and out of the kind of mind I needed so desperately to accommodate my lectures, readings, and studies. My long-term, short-term, and working memories hemorrhaged and suffered functional and existential stagnation from the ferocious greed of my auto-cannibalistic baggage. My brain no longer worked or functioned as it used to. It was as though my mind had been forced into a papoose board. I, therefore, sat in my lectures in the grips of moral and intellectual enervation—most of the time clueless as to what was actually going on around me.

I had become invisible to myself, a dangerous phenomenology impossible to define in terminologic exactitude. It was as if I operated in or related to the external world outside the immediate comfort of my immanent verges. Either Geto Boys’ Halloween-inspired track Mind Playing Tricks on Me, a classic gothic rap in my opinion, or Michael Jackson’s gothic-horror title track Thriller became the major soundtrack to my life of existential contradictions and contrasts.

I struggled in the Med-Surg class due to my limited cognitive functioning and went to see Dr. Bonini about it—particularly about my poor performances on her exams. She suggested that I read the Med-Surg textbooks and their accompanying practice textbook with the aid of a dictionary. She also suggested that I devote at least five hours a day to studying the course. I was already spending twice that amount of time each day. Yet my tireless efforts and studious devotion to this class never reflected on exam scores the way I had wanted.

I passed the class eventually, paving the way for me to take its sequel—Complex Care Concepts—with Dr. Connolly, Prof. Patrick Luna, Dr. Tammy Spencer, and Prof. Theresa Nino the following semester. All four professors, especially Drs. Spencer and Connolly taught this class with admirable intensity, nonpareil mastery of the material, and devotional enthusiasm for producing nursing graduates who would be imbued with the tenets of professional and clinical competence. It was an interesting class but also complex.

Finally, Prof. Krista Ray would teach me Nursing Care of Children and Families, a course that deepened my understanding of children and made me appreciate developmental psychology even more.

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Drs. Spencer’s and Connolly’s class exposed me to the clinical implications of multitasking for improving patient outcomes. Professional accountability, knowledge of pharmacology and microbiology and rudimentary electrocardiography concepts and of the patient-centered clinical method, medication administration, trauma assessment based on accurate interpretation of triage protocols, patient advocacy, etiology and pathophysiology, critical-thinking skills, time management, quality improvement, and safety education for nurses, care for burn victims, discharge and post-discharge protocols, strategies of care prioritization, arterial blood gas analysis, dosage calculation, patient-and-family education, and evidence-based practice made up the theoretical cruces of this course. These threads of knowledge run the gamut of nursing practice.

Ultimately, then, health sociology and medicalization and medical technology remained central to the running experience of clinical practice and the content structure of this class. Thus, one achieved a conceptual grasp of the core content of this course to the extent that one also appreciated and acknowledged the nexus between theory and praxis. And yet, imparting theoretical knowledge to students meant more than a passing interest to Drs. Connolly and Spencer. The formal style of Dr. Spencer’s teaching methodology incorporated a progressive philosophy that bridged the threads of dense theoretical knowledge, educational psychology, contextual learning, focused reflection, and observational learning into a unifying linchpin of professional, leadership, and clinical formulation.

In a more limited sense, though, Dr. Karen L. Gorton’s Nursing Role and Practice class was a buttress of this progressive approach to nursing pedagogy and clinical education. However, for all the right reasons, Dr. Gorton’s expertise in matters of professional conduct vis-à-vis the practicing nurse and her high-caliber professorial tutelage are indubitably consistent with her teaching methodology and authority presence. I must say I truly enjoyed the democratic charisma of her class.

Dr. Connolly, on the other hand, arranged for private citizens to come in and share their experiences live with students. These private citizens included burn victims and victims of substance abuse. I would capitalize on these live presentations to investigate addictive personality for my own personal edification. Her guest speakers who spoke on various topics made a great impression on me. Profs. Luna’s and Nino’s clinical and emergency experiences with burn victims jibed with their engaging teachership on wound care and the pathophysiology of burn injury and, no doubt, Dr. Connolly’s vastly rich pre-doctoral experience as a professional nurse on a neuroscience floor in Massachusetts expanded her clinical expertise in and understanding of treatment modalities for such victims. This was substantially clear from the content of her lectures.

I strongly believe that this experience may have also broadly enriched her understanding of the neuroscience and pathophysiology of alcoholism—definitely. Dr. Connolly demonstrated profound theoretical and technical expertise in these areas during her Complex Care Concepts class. She demonstrated the same level of theoretical and technical expertise as well in other areas of her Pathophysiology for Nurses class. I must add that, finally, Prof. Nino’s and Dr. Marcia Gilbert’s Pharmacology and Dr. Catherine Kleiner’s Health Promotion Across the Lifespan complemented the Complex Care Concepts class so well, reinforcing the standards of a holistic continuum in pedagogic strategies that nourished the didactic and clinical instruction of nursing students.

I should point out that neither Complex Care Concepts nor the sequel of Med-Surg was a stand-alone course.

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These courses did not come into their own without borrowing heavily from other disciplines. Several pre-nursing disciplines from the natural sciences to the humanities lent themselves to the development and growth of these courses.

Even modern nursing as a profession grew out of many interlocking strands.

These strands include bioethics, engineering, mathematical modeling, kinesiology, cognitive and developmental and organizational and social psychology, operations research and management science, supply chain management, anthropometry, inventory control analysis, biomathematics, software engineering, economics, statistical quality control, computer science, ergonomics, sociology, psychiatry, behavioral science, neuroscience, pharmaceutical science, physical therapy and speech pathology, phlebotomy, law, nutrition science, cultural studies and linguistics, feminist theory and women’s studies, literature and critical theory, philosophy and history, acoustics, and political science.

In effect, nursing exists as an interdisciplinary academic discipline. I reached this conclusion through the varied experiences of my offsite clinical assignments and, although this conclusion may