If I have seen further than others, it is by standing upon the shoulders of giants. (Sir Isaac Newton)
Isaac Newton’s famous quote captures Bertha Harmer’s contribution to nursing and to the legacy of McGill University Ingram School of Nursing (ISoN) for she was the giant upon whose shoulders we have all been standing on. She was a brilliant thinker and educator and it is her writings and thinking about nursing and about how to educate nurses that set the foundations for the ISoN as well as for the entire profession. Her philosophy and beliefs about nursing and education have permeated the ISoN for the past 95 years to the extent that her ideals and ideas are so ingrained in the ISoN’s culture and ethos. They have influenced and continue to do so in the writings of both past and current faculty and students and in our pedagogical philosophy and approach to teaching. Most are unaware of their origins.
Bertha Harmer succeeded Flora Madelaine Shaw as the second Director of McGill University, School for Graduate Nurses (1927-1934). She published her seminal and acclaimed textbook in 1922—The Principles and Practice of Nursing, building on Florence Nightingale’s treatise on Nursing in Notes on Nursing. Harmer’s book informed generations of teachers, students, and nurses of what nursing was and the nature of its practice. She wrote three more editions of The Principles and Practice of Nursing (1928,1934) and Methods and Principles of Teaching the Principles and Practice of Nursing (1928) until her untimely death in 1934 at the age of 54. The fourth and fifth edition of The Principles and Practice of Nursing was revised and updated by Dr. Virginia Henderson under the authorship of Harmer and Henderson (1939, 1955) and remained as such until Henderson, in 1966, wrote The Nature of Nursing: A Definition and Its implication for Practice, Education, and Research, in which Henderson’s definition of nursing was adopted by the ICN. What is less known is that Henderson’s thinking about nursing was deeply informed by the writings of Bertha Harmer.
On Nursing: Harmer begins her 1926 edition of The Principles and Practice of Nursing with a discussion of the object of nursing—what it is and what it includes. For Harmer “Nursing is rooted in the needs of humanity and is founded on the ideal of service. Its object is not only to cure the sick and heal the wounded but to bring ease, rest and comfort to mind and body to shelter, nourish and protect.” She continues.... “to prevent disease and to preserve health.” Harmer sees nursing as having a global mandate. “The nurse finds herself not only concerned with the care of the individual but with the health of people”.
Harmer outlines the desirable ideals and point of view (i.e. qualities) that nurse needed to have that amongst others included a cheerful and optimistic spirit; trustworthiness and reliability; a professional spirit; a scientific spirit; a critical attitude towards one’s own work; a spirit of appreciation that includes appreciation of esthetics, human nature, intellectual thought.
Harmer also espoused that nurses required a sound but broad knowledge including knowledge of oneself (i.e., self-knowledge); the biological and social sciences; household sciences (e.g., management, dietetics); methods used in disease prevention and preservation of health; disease and treatment. Moreover, good nursing required that nurses have training in manual dexterity; training of the senses (as the basis of astute observation); a mind quick at grasping; foresight, judgement, reasoning (i.e., clinical reasoning); interest in people to be able to understand and influence them etc.
Bertha Harmer recognized that teachers needed knowledge to help students learn to nurse. She wrote a companion textbook for teachers-- Methods and Principles of Teaching the Principles and Practice of Nursing (1928) --in which she outlines her pedagogical philosophy and values. Her ideas were passed on and have become enshrined in the ISoN’s beliefs and approach to teaching and learning and most are unaware of their origins.
Harmer’s ideals and ideas of education were formed at Columbia University Teacher’s College where she completed a Bachelor of Science in Administration and Teaching in Schools of Nursing in 1918 (Boschma, Davidson, Bonifacio, 2009) and at Yale University, School of Nursing—where , as a faculty member, she helped to establish the first degree in nursing at a university in 1923 before accepting the directorship at McGill University in 1927. Her thinking about the nature of pedagogy was heavily influenced by the writings of the philosopher John Dewey and Edward Thorndike, a psychologist who specialized on learning processes and who taught at Columbia University Teachers College.
On Education:
Approach to curriculum development: Harmer stressed the importance of: situating the program in the aims (purpose) of the school before developing the curriculum; using a programmatic approach to curriculum development; building a curriculum of interrelated, interconnected, sequenced courses with nursing at its heart; focusing on developing habits of thinking, feeling, and doing needed for purposeful endeavor, good judgement, and reliability; undertaking a study of resources, difficulties and weaknesses that need to be strengthened or altered that would contribute to a strong program of study.
Creating learning environments: Harmer’s book Methods and Principles for Teaching the Principles and Practice of Nursing she stressed the importance of creating conditions that enable the student to help themselves by setting out clear expectations; teaching underlying principles; providing opportunities to practice what has been taught; by developing “research-mindedness”, “seeing the patient as a whole person, a human being, a member of a family and of the community” (pg3) and not the disease; developing a constructively critical attitude. She writes: “Students can’t help themselves and will make little progress in learning unless the environment and the situations which we create around them provide the opportunity, the stimulus, encouragement, and practice in meeting and solving problems by their own thinking, their own initiative, and their own responsibility as far as the patient’s and their own welfare permits.” (pg4)
Importance of correlating theory and practice: Harmer believed in the integration of classroom and practice as she wrote: “The course in the classroom and wards should be considered, not as separate subjects, but as one organic, interrelated whole, each supplementing and incomplete without the other.” (pg5)
Application of the laws of learning. Harmer defined teaching “as the art of helping students to help themselves.” (pg33)… “We teach in order that students may learn” (pg 36). To accomplish this ideal, Harmer, influenced by Thorndike’s research, believes that methods of teaching should be in accord with Thorndike’s Laws of Learning but adapted to the study of nursing. These laws include: Laws of Readiness, Mind-Set-To-An End or Purpose; Laws of Effect or Satisfaction (or Success) or Annoyance (or Failure); Laws of Exercise (Repetition) or Use or Disuse; The Law of Association.
Teaching and learning through practical experience (use of projects, case studies, scientific method of study). To help students learn to nurse, teachers should choose methods of teaching that are guided by and in accordance with the Laws of Learning. Using an experiential approach to teaching, that closely ties Dewey’s notion of learning by doing grounded in theoretical and practical knowledge, Harmer outlines activities, that she calls projects, “to be carried to completion in a natural setting….the students learn by doing and have the satisfaction of seeing the results of their activities” (pg48).
When Sir Isaac Newton penned “If I have seen further than others, it is by standing upon the shoulders of giants”, he had people like Bertha Harmer in mind. McGill University’s ISoN, a beacon of enlightenment in nursing thought and education for 100 years, had a strong foundation laid by Bertha Harmer who stood on the shoulder of Florence Nightingale. Bertha Harmer’s enormous contribution to nursing has not received the recognition nor the credit that she rightly deserves. It has been a travesty that her name and contributions have been lost and gone unrecognized—hopefully until now!
By: Laurie N. Gottlieb
January 27 2020