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Closing the Lid on Pandora's Box January 28, 2000

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Delivered to the Texas Youth Commission Executive Leadership Assembly, Austin, Texas, January 28, 2000

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For ten years I have worked in the "trenches" of a hospital emergency department, functioning as a kind of family doctor for the forgotten victims of our violent culture. In that capacity, I have cared for an endless parade of tragically torn and battered human beings - mostly children and young adults - who continue to suffer from injuries that are, to an astonishing degree, preventable. Something's missing. Can we, as a society, be content with waiting at the bottom of the cliff for children to fall off and then trying to pick up the pieces of their broken lives? In these troubled times, it's easy to become preoccupied with counting the number of stretchers at the bottom of the cliff instead of focusing on educating ourselves and the next generation in how to build the fences to keep children from falling off in the first place.

In Yuqui: Forest Nomads in a Changing World, anthropologist Allyn Maclean Stearman describes an isolated, remnant band of foragers in the Bolivian rain forest who became separated from their main tribe in the 16th century and gradually, over the course of several generations, lost much of their cultural heritage - even their ability to build a fire. Like the Yuqui, we are in danger of losing the art of nurturing our children. Unspeakable tragedy can kindle a passionate interest in prevention. Our very survival as a nation may depend on our ability to shift the fundamental focus of our communities toward nurturing children as a top priority.

Why should we nurture children first? What does nurturing children have to do with preventing violence? What's wrong with the traditional "I'll get mine" approach to the lifeboats on the foundering ship of our society? In Principle-Centered Leadership, Stephen Covey emphasizes that significant historical breakthroughs, such as those brought about by Copernicus or Semmelweis, are often made possible by courageous departures from traditional ways of thinking. Centuries of incremental improvements can suddenly give way to quantum leaps in progress by virtue of a "paradigm shift" - the establishment of a new frame of reference.

Henry David Thoreau observed that, for every thousand attempts to strike at the leaves of a problem, there is one blow delivered to the root. I am convinced that the root of the current epidemic of violence in our society is a missing paradigm: children have never, to this very day, been nurtured as a first priority in our society. Mountains of research point to the link between inadequate nurturing and later violent behavior. In the words of a great champion of children, Victor Hugo, "There is nothing so powerful as an idea whose time has come." Sometimes the solution to an enormously complex and difficult problem turns out to be surprising simple: nurture children first.

I do not mean to downplay the prodigious amount of work necessary to transform this simple concept into accepted cultural practice. Reformulating the fundamental premise behind our national strategy for promoting health - indeed, changing the very raison d'etre and unifying curricular principle of our entire education system - will be no small task. As Thomas Paine observed in Common Sense, "A long habit of not thinking a thing wrong gives it a superficial appearance of being right and raises at first a formidable outcry in defense of custom."

Yet we must take courage in knowing that there can be no more far-reaching preventive mission than teaching children the art and science of nurturing – how to be good mothers, good fathers, good husbands and good wives. By teaching children not only how to count but, more importantly, what counts, we will give them an indispensable preventive inoculation against the epidemic of violence in our society. In passing on to the next generation a clear understanding of the preeminent importance of focusing on what's best for children, we will be engaging in the activity with the most power to promote the well being of our society. Mastering the art and science of nurturing children is like earning a double degree, because the same principles apply in nurturing a spouse, a friend, or a coworker. We are all, in a sense, children on this earth - some of us just a little closer to death than others.

Simply stated, we have forgotten, as a culture, that it is precisely through continued sacrifice in behalf of and service to all our children that we are best served. But there is more at stake. If there is any lesson still to be learned from all of history, it is that an injustice to any child within society represents a threat to the continued existence of that society. This is the paradigm of prevention now so tragically absent from our textbooks and technology. This is the compass that we need to place in the pocket of every schoolchild, in the hand of every aimlessly drifting adolescent, and in the hearts of the undervalued multitudes of maturing men and women who so desperately need a cause to carry on: nurture children first.

How do we shift the fundamental focus of society toward nurturing children as a top priority? We must begin long before children even come into the world, preparing future parents with an appreciation of not only the physical, emotional, social, and intellectual developmental needs of children, but also an understanding of their higher ethical and spiritual needs. First among these must be what Albert Schweitzer called "a reverence for life." Building on this strong foundation, we can then instill in our youth, early on, a desire to do what is best for children. This will require a concerted effort by peers, parents, teachers, members of the community, and leaders of society - consistently imparting through the example of their own lives the principle of nurturing children as the highest preventive priority. We must nurture children not only in principle, but also in practice. We must develop a healthy intolerance of socially toxic environmental influences that are harmful to children. This integrity must be reflected in the calendars and budgets of our homes, in the policies and programs of the workplace, and in the laws and customs of our society. If we can train the best fighter pilots in the world, there is no reason why we cannot equip a future generation of world-class parents with state of the art knowledge and skills so that, before they are even capable of conceiving a child, they are literally experts in the science of nurturing children.

Who will orchestrate this fundamental shift in orientation toward nurturing children? No community-oriented prevention plan, however well conceived, can hope to bring about continuous improvement in the life of a child without a courageous person dedicated to the ongoing restoration of this preventive paradigm on an individual basis. Vital to the healing process is the development of a relationship with a person having a special kind of courage: the courage to care enough to take responsibility for an outcome.

Who has the courage to rekindle the flame of nurturing children as a top priority in our communities? We must look to the sons and daughters of the "oldest of the arts and the youngest of the professions," to those engaged in what Florence Nightingale referred to as the "finest of the fine arts" - the calling of nursing. No profession is more ideally suited to the task. Nurses have a historical tradition of compassion, competence, and courage. They are highly motivated by altruism and loyalty, and they are trusted by society. We must awaken to an appreciation of the critical importance of nurses in our communities. We must expand the purview of community nursing practice to enable the professional nurse to take a greater measure of preventive responsibility. By taking a larger share of responsibility for identifying children at risk, the professional nurse can play vital role in the community - a role parallel to and interactive with the physician's traditional responsibility for clinical outcomes. This new division of responsibility defines a larger area of authority for the professional nurse and represents a strategic departure from traditional practice - a new paradigm.

A better map - one that provides a sharp delineation between clinical and preventive responsibilities - has become a matter of practical necessity. It is no secret that physicians spend little time on prevention. In truth, there is no time: the physician's time is consumed by the urgent fires of injury and illness. Preventive guidance is relegated literally to the last few seconds of a well-child visit. The practice of clinical medicine has entered an age of increasing complexity, and the time has come to formally acknowledge the preventive responsibility and the commensurate authority of the professional nurse - if for no other reason than to relieve what has become an impossible academic and administrative burden for the busy clinician.

Much like two workers in a garden, one trained to pull weeds and the other to plant seeds, the primary care provider and the professional nurse must learn to combine their complementary talents and coordinate their separate responsibilities to form a synergistic professional partnership. Working closely with parents and teachers, the professional nurse can not only bridge the gap between existing community resources and the specific needs of children and their families, but also act as a catalyst for the development of new resources as local community needs become apparent.

Nursing could provide no greater service to our society than to transform our communities, by an alchemy of courage, into places of golden opportunity for the development of our children. The words nurture and nursing share a common Latin origin: nutrire, "to nourish." Now is the time for nursing to reach its fullest potential in nourishing humanity by taking a greater measure of preventive responsibility in our communities. This is the "finest hour" for the finest art.

We must stand beside and support our courageous nurses in this noble cause. They are in desperate need of reinforcements. We must generate sufficient revenue to pay them salaries that are commensurate with their professional stature, expanded role, and increased level of responsibility. The time has come for us all to draw a line in the sand and decide, once and for all, what's good for children and what isn't and then to muster the political courage to step across that line and tax the pursuits that do not help children in order to pay for those that do.

We must offer professional nurses the top-quality training and recertification that will enable them to orchestrate a successful long-term effort to promote the well being of children in our communities. Professional nurses can keep up with the latest scientific developments in nurturing children, and assist parents in developing the skills they need in order to be able to take responsibility for the outcome of their children.

We must also foster the humble recognition that we don't have all the answers. Elie Wiesel has said, "One can do without solutions. Only the questions matter." We must always ask the question, "How will this help all our children?" The professional nurse has the commitment and perseverance to continue to ask this question, as well as the conviction and legitimacy to challenge conventional practices of society that may not be in the children's best interest.

If we will listen, the "Lady with a Lamp" will teach us a cardinal lesson. In essence, the principle shared by all great religions - "It is in giving that we receive" - must become a guiding light for our society as a whole. Through the sacrifice of nurturing children as a first priority, our society will, in turn, be best nurtured in the wisest sense of all.

As we guide our children on their journey into the next millennium, we can illuminate their path with the powerful light of a new paradigm: nurture children first, and all else will follow. The best way for our children to learn this timeless truth is by the power of the example of our relationships with them. Example, it has been said, is not one way to teach: it is the only way. And through this example of service and sacrifice - from those who have lived longer on this earth to those who have longer yet to live - will the greatest preventive message of all be written on the hearts of our children. And if we begin, as it were, to dip our oars in unison - all rowing together toward a common goal - then perhaps a hundred years from now the world will be much different, because we as a society dedicated our lives to this one great purpose and decided for the first time in the history of humankind to take responsibility for our children. This is a dedication that involves not merely a strong feeling, but an act of courage: a decision to commit our lives completely, a judgment, a promise, a sacred trust - a way of life.

Courtesy of Texas Youth Commission

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Closing the Lid on Pandora's Box- January 28, 2000

- John Walker
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