Bruce is a co-investigator of the Partnership Grant, and co-chairs the Knowledge Mobilization Committee and the Intellectual Property, Agreement, and Ethics Committee. Our Project Administrator Anna Adjemian spoke with Bruce about his involvement in Strengths-Based Nursing and Healthcare, and his belief in the importance and potential of the Strengths-Based vision of health and healing.
Anna Adjemian: Please give us a short background/summary of who you are and what you do professionally.
Bruce Gottlieb: I’m a biologist, a geneticist. I hold a BSc and ARCS from Imperial College, London, and a PhD from McGill University. I started as a botanist, but I was always a geneticist – I began working with algae, for my PhD, and then I switched, because there wasn’t much future in terms of research for people interested in the genetics of algae. I became involved with a lab that was doing work on the androgen receptor gene. Eventually I set up a worldwide mutation database, which is still in use today, and heavily cited. That led me to start to work on the role of the androgen receptor gene in prostate cancer and then in breast cancer. I started off looking at sexual dysmorphism, and I’ve ended up working in cancer research for the last 20 years or so. I’ve been particularly interested in understanding what causes cancer, and I’ve written a number of papers in which I posit that the basic premise behind the causes of cancer needs to be modified based on the type of information that we’re now getting using new technologies. Based on this new information I’ve proposed a new hypothesis as to what causes cancer. Traditionally, the most important factor considered responsible for determining cancer is the accumulation of mutations. But based on my research, I have argued that mutations are not the most significant factors; rather what’s most significant is the selection of pre-existing mutations by changing tissue environmental factors. If you look at the most important factors to determine whether someone gets a cancer, environment, i.e. diet, lifestyle, etc. is statistically the most significant. Recent accumulated evidence has added much additional weight to this hypothesis.
Why did you get involved with this project?
You could ask, what’s cancer research got to do with Strengths-Based Nursing? Laurie and I began working together before SBNH [Laurie Gottlieb, developer of SBNH, is married to Bruce]. Laurie had been invited to be the featured speaker at a nursing conference. The Quebec healthcare system was undergoing a major reorganization with the introduction of the virage ambulatoire (a shift from in-hospital care to more ambulatory, out-patient services) and Laurie was asked to talk about the future of nursing in light of these changes. She knew what she wanted to say but lacked a framework to organize her ideas. In effect, she wanted to talk about not just the survival of a profession, but the conditions under which it would thrive. I suggested that she might consider an evolutionary framework. She asked me to write the principles of evolutionary theory and she described how these principles applied to the future of Nursing.
Based on this speech, we co-authored our first paper together, titled “How evolutionary principles can guide nursing’s future development”, which was published in the Journal of Advanced Nursing. That’s essentially how we started. We then co-taught the course Development Over the Lifespan at McGill. We developed the Development/Health Framework (DHFW) to organize the course, and from that course came the first major reconceptualization of the McGill Model of Nursing (MMN) of which Laurie was one of the major developers. The DHFW and the MMN eventually evolved into SBNH.
What does SBNH mean to you?
Everyone has strengths and deficits. We need to realize that ultimately, a person heals themselves. Let’s say you have an infection, you break something, something goes wrong – you can get rid of the infectious agent, you can repair a bone, you can clear a blood vessel. But the actual process of healing a tissue – that is all internal. There is no medicine you can give that can heal something directly. Healing is based on your strengths, the internal strengths within your system. If you can elicit those strengths, that’s going to help the healing process. Laurie has often said that this was a part of Nightingale’s work: people are self-healers and the role of nursing is to create and improve the environment of the patient; give them clean water, etc., and that is going to contribute to their healing process. It goes very well with my ideas about cancer. We now have a technique in which we can sequence individual cells. And what we’ve discovered is essentially every cell in our body has a different genetic makeup. This is called genetic heterogeneity. Genetic heterogeneity means that in most instances a majority of cells are of one genetic type; however, other minority genetic types are also present. The cells that are in the majority are because they are selected by a particular environment. If the environment changes, it will possibly select a different genetic cell type– which might be a cancer cell. The question is, how do we use this information? At the moment, we don’t understand very much about this situation except that it is clear that tissues are not structured the way that we originally thought they were, i.e., all the cells of a particular type within a specific tissue are all genetically identical. The principle behind SBNH is essentially the same. Not to ignore deficits – you have to tackle the deficits – but if you can identify a person’s strengths, and you can facilitate a patient’s ability to utilize them, this will allow a patient to promote their healing processes. This is the importance of understanding what individual strengths a patient possesses. Indeed, as Laurie has pointed out, sometimes something that is initially perceived as a deficit can eventually become a strength.
What does this project mean to you/what you hope to see come out of your work on this project?
I’d like to see a kind of revolution in the way we look at illness and disease, and the type of resources that we make available to improve health and treat disease, providing support for patients to utilize their strengths. There have been interesting experiments looking at patients that had limb amputations: if the patient had more intensive nursing and the nurse spent more time with them, the wound healed faster. We make the assumption that this is somehow in the ether, solely based on your mental condition – but your brain is connected to your immune system, indeed to all of the healing systems of the body. This is why SBNH, which can tap into such processes, can make a big difference in healing. For too long I’ve personally seen a discounting of what nurses do. The doctor comes in, they give the drug, they did the operation; the nurse comes in, and the attitude is, well, we’ve given the treatment, does it really make a difference what the nurse did? The truth is the nurse can make just as much of a difference to the patient’s recovery. It is very important to realize the valuable role that nursing really can play. I was in hospital once, in a ward with four patients. There was one patient who was being difficult, causing a struggle with the nurse. A new nurse came in, a young graduate. She was assigned to the patient and the same behavioural pattern started up. But she sat down and said to him “What’s really giving you problems?” They spoke for five minutes and suddenly he was able to do what he was asked, with no complaints. He was heard. This nurse was practicing SBNH. People have the strengths within them, they have the tools within them. One of the things we know about the efficacy of drugs is that the placebo effect is always significant. This tells you that a person’s mental state is playing a critical role in the recovery process, even in terms of drugs. By speaking with patients, listening to their condition, we can help them in the healing process; because it’s likely to allow them to stimulate their own immune system, and the things that go along with the healing process.