Esther Lucile Brown - A Memorial JulieneG. Lipson Esther Lucile Brown, who died in 7990 at the age of 92, was a social anthropologist at the Russell Sage Foundation for more than 30 years. Among her contributions were ground-breaking studies of the professions and stimulation of the development of medical social science. Her research on nursing stimulated professionalization and nursing education’s move into the university. Theaccuracy of her research findings on nursing and psychosocial aspects ofpatient care led many to assume that she was a nurse. This memorial focuses on her contributions and personal impact on friends and colleagues.
* sther Lucile Brown was a true anthropologist whose research and writing integratediverse sourcesof knowledge into a broad perspective. With superb observation and interviewing skills and the ability to convey a convincing picture of the whole, her insights on the nursing profession and the psychosocialbasis of patient care were so keen and current that many assume that she was a nurse. At the age of 92, she had only recently decreased her professional activities and traveling; she continued her social activities and writing until the day of her death, July 6, 1990. This memorial focuses on Brown as a person, her career and contributions. Since her death, she has been appreciated through a Resolution of Tribute by the American Nurses’ Association (September 1990),and remembered in the major nursingjournals and newsletters (including one from Japan), the Anthropology Newsletter, the New York Times and the San Francisco Chronicle. This memorial is based on several sources: Brown’s close friends, her writing, the letters and comments of those at her memorial service, and her own words from my meeting with her three weeks before she died. My meeting with Dr. Brown was encouraged by Lucile Petry Leone, to whom I had mentioned my interest in the “great grandmothers” who brought about the productive relationship between nursing and anthropology. We met in Dr. Brown’s apartment in the Sequoias, a model urban retirement community. Her living room contained an enormous red antique Persian rug and was decorated with fine art objects from around the world, and bookshelves from floor to ceiling. Tall, slender and elegant, she appeared and sounded far younger than 92. Dr. Brown began our meeting by interviewingme with incisive questions,e.g., “How much progress do you think has been made in applying anthropologicalconcepts in nursing?’ Because of our limited time together, she suggested that I obtain historical information from her books and the annual reports of the Russell Sage Foundation. She chose to talk about nurses’ difficulty doing what is basic to nursing - talking with patients and obtaining a psychosocial profile. She stated that nurses have focused on her study of the nursing profession and neglected her work on patient care, e.g., nurses sometimes refer to her book Newer Dimensions of Patient Care as Newer Dimensions of Nursing Care. IMAGE: Journalof NursingSchohrship* Volume 24, Number 4, Winter 1992
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* History and Contributions Esther Lucile Brown was born in 1898 in Manchester, New Hampshire. In 1920, she obtained her bachelor’s degree in English from the University of New Hampshire, which she said “helped with my writing.” The following year she enrolled for graduate study in anthropology at Yale University. On completing doctoral course work, she spent three years teaching social sciences at the University of New Hampshire. In 1929, she received the PhD degree in social anthropology from Yale, the first woman to do so, with dissertation research on Nordic myths. Brown spent the next year in Paris doing research sponsored by the Social Science Research Council. Although, the depression was underway when she returned to the United States in 1930, she was invited to join the staff of the Russell Sage Foundation in New York to do research on comparative aspects of several professions, including nursing. Later she became director of a newly created Department of Studies in the Professions. In 1948, she became a member of the administrative staff of the foundation with responsibility for cultivating opportunities for sociologists, social psychologists, and social anthropologists to undertake teaching and research in medical schools, university schools of nursing, and schools of public health. She remained a program executive of the Russell Sage Foundation until her retirement and move to San Francisco in 1962. Brown was an indefatigable researcher, traveling around the United States, Europe and Asia, interviewing and observing health care providers and patients in a variety of settings. Four areas of contributions are mentioned here: 1) research on the professions, 2) influence on the development of medical social science, 3) studies of the nursing profession, and 4) research on patient care. JulieneC.Lipson, RN, PhD, FAAN, Alpha Eta is Associate Professor, School of Nursing, University ofCalifornia, San Francisco. The Author says, “thank you to Lucile Petry Leone who arranged the meeting with Dr. Brown, encouraged me to write this paper and made many important suggestions. Ruth Stimson provided much information and encouragement and even helped edit. Deborah Gordon and Susan Folkrnan read the paper, clarified several points and provided helpful critique.”Correspondenceto Dr. Lipsor: atthe Departmentof Mental Health, Communityand AdministrativeNursing, UCSF, San Francisco, California 94143. Accepted for publication June 16, 1992.
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Esther Lucile Brown - A Memorial
Research on the Professions
Brown was adamant that her field was “anthropology of the professions” and strongly objected to being known only for her studies of nursing. Of her education, she said, “Although my degree was in anthropology, I was so influenced by sociology that I don’t know where one stopped and the other started. I couldn’t have done anything better to prepare me for my work at the Russell Sage Foundation.” Brown’s early research resulted in publications on social work, medicine, and engineering. Her five-year study of the legal profession resulted in three books. Following World War II, her research, writing and teaching focused on health care, patients and providers, with several books on the nursing profession. As Lucile Petry Leone noted in Dr. Brown’s memorial service: “I often have wondered if she were born an anthropologist. The Russell Sage Foundation asked her to do a study of several professions, then other professions that had not been studied wanted her to study them.”
Medical Social Science
In 1948, the Russell Sage Foundation was reorganized and its program changed. Dr. Brown described her work on this new project : “I was to put on a demonstration project of what the social sciences could do in the professions. I took the health field and a colleague took the law field. For 10 years we worked to find places that wanted social scientists and then had to find the right social scientists to fill those places. I was able to place 12 to 15 social scientists in medical schools, schools of public health and university schools of nursing. I could have encouraged many more departments of psychiatry and public health to accept people, but I never succeeded in getting someone into the surgery department of a medical school.”
The Russell Sage Foundation funded the social scientists for a period of three years, requiring them to write a book in the process. It was hoped that the professional school would appreciate the worth of this endeavor and thereafter hire the scientist. Brown described her first success as follows: “I knew the dean of the University of Colorado Medical School, a remarkable man, who told me that 50 percent of the county hospital patients and 25 percent of the university hospital patients were Spanish-speaking and there were no Spanish speaking personnel to help them. Could I help? I went back to the foundation and said that I wanted to go to Arizona, New Mexico and Texas to see if I could recruit someone. At New Mexico, I met Lyle Saunders by accident when I asked for information in the sociology department, and we spent the whole morning talking. I found excuses to spend three days there and went to his classes. He never caught on that I was interviewing him. This was one of the most dramatic cases of finding the right person. He was frustrated at Colorado at times; they didn’t move fast enough in incorporating social science, but he worked with internal medicine, pediatrics, public health, and the school of nursing. He would give individual help to teach nurses how to do research. He spent 10-12 years at Colorado, then went to the Ford Foundation to work on population matters.”
From the late 1930s, Brown had urged nurses to pay attention to patients’ cultural backgrounds and the effects of their environment on their well being. Through the foundation program she was able to recruit a social scientist into a university nursing 314
program which was far ahead of its time in the 1950s. Regarding this success, Dr. Brown said: “The Cornell University Dean of Nursing was an open and remarkable person. She wanted to broaden the clinical courses by integrating social science materials into the curriculum and to develop research. I convinced her to provide a position and persuaded Frances Macgregor to go there.”
While at Cornell, Macgregor wrote Social Science in Nursing: Applications f o r Improvement of Patient Cure and developed a successful program that ran for 15 years. Brown’s emphasis on the importance of patients’ cultural backgrounds in providing appropriate care and Macgregor’s pioneering work in nursing education were furthered by the first nurse-anthropologists who received their doctorates through the 1960s Nurse Scientist training program, such as Madeleine Leininger, Agnes Aamodt, Elizabeth Byerly and Oliver Osborne. During the memorial service, Lucile Petry Leone stated Dr. Brown “match-made, and things happened.” She influenced the development of such pioneer medical anthropologists and sociologists as Saunders, Macgregor, Marian Pearsall and Benjamin Paul by placing them in health teaching environments where they focused their work on health and health care. Thus, her “matchmaking” made a major contribution to the development of medical anthropology and medical sociology. In fact, George Foster described Brown as the “mother of medical anthropology” (“Deaths,” Anthropology Newsletter, Sept. 1990, p. 4). According to Leone, “A number of these sociologists and their “professional children” visited her at the Sequoias. One of her goals was to find out “how to make doctors more human.” By the end of this 10-year Russell Sage Foundation Project, the federal government had begun funding social scientists in health science settings and Dr. Brown took two years leave from the foundation to write. The Nursing Profession
Brown was asked to reevaluate the nursing profession following the nursing shortage in World War 11.Her intensive 16-month study, Nursing f o r the Future, sponsored by the National Nursing Council and the Carnegie Corporation, was based on more than 50 visits to schools of nursing throughout the country and numerous meetings with educator groups, health care professionals, hospital personnel, advisory groups and three conferences. The study’s original goal was to reorganize the structure of the six national nursing organizations but it evolved into a study of schools of nursing. In 1946, only 6 percent of some 1,200 schools of nursing were based in higher education. Publication of Nursing f o r the Future led to major changes in nursing education. This landmark study, known as “The Brown Report,” encouraged nursing schools to situate themselves within universities as professional schools. Virginia Cleland, speaking at Brown’s memorial service, remembered: “I was a student at the 1948 ANA convention in Chicago where Dr. Brown was the keynote speaker on the occasion of the publication of Nursing for the Future. There were about 10,000 people at that meeting. It was essential that she was not a nurse and that she was an anthropologist who did her study in a qualitative way. She picked up information from many nurse leaders and recast it in a new light. lMAGE:/ourna/ofNursingScho/arship*Volurne 24, Number 4, Winter 1992
Esther Lucile Brown - A Memorial
She could take data from here and there and put it together. She talked about socially undesirable nursing schools and distinguished ones. In 1949, there was a follow up survey, with a 99.8 percent response rate. At this time, a list of good nursing schools was published and the bad ones weren’t listed. After her report and the follow up survey, nursing moved into the main track of general education.” The report was so positively received that the National League for Nursing Education immediately formed a committee to implement her recommendations. After Nursing for the Future was published, Brown was made an honorary life member of the National League for Nursing. Although Brown retired from the Russell Sage Foundation in 1962, she continued to study, write and teach about nursing and patient care, with her last publications appearing in 1978. She called for the preparation of nurses in academic settings as clinical specialists, administrators, teachers and researchers. Her two-volume set, Nursing Reconsidered: A Study of Change, sponsored by the National League for Nursing, was published in 1970 and 1971. The first volume examined recent developments in nursing practice in hospitals, extended care facilities and retirement homes, noting the dual trends toward specialized technical nursing and professional clinical nursing. The second volume examined nursing roles and practice (e.g., nurse practitioners) in outpatient, home care, mental health services, neighborhood health centers and group medical practice. The goal of these volumes was to describe “evolving nursing roles that might provide clues or even models for greater future effectiveness” (Brown 1971, p. ix).
Patient Care Brown’s research, writing and teaching concentrated on patient care in the hospital and community. In the mid-1950s, she collaborated with Greenblatt and York to study the environment of the psychiatric hospital. Their work led to the publication of From Custodial to Therapeutic Care in Mental Hospitals, a classic field study that influenced the development of the community mental health movement. Brown keenly observed and described the situation of being a patient and what patients need to make them more comfortable. Three monographs entitled Newer Dimensions of Patient Care were published between 1960 and 1963 and focused not on nursing, social work or medicine, but on the patients that these professions have in common. This description is embarrassingly current. The first volume discussed the use of the hospital’s physical and social environment for therapeutic purposes. For example, Brown’s knowledge of architecture was evident in her observations of how the hospital environment reflects care providers’ insensitivity to its effects: “These rooms are set up initially to be convenient for giving nursing care. Once arranged, a bed or table is rarely moved, even though with some small change the patient might be able to look at trees or enjoy the sunset ... [Tlhe more important problem perhaps is that of rigidity of thinking about what changes would give some relief from boredom, or some comfort and satisfaction to the patient” (i%l, p.34). The second volume focused on how patient care providers might increase their motivation and competence. The third volume described patients as people - when they are ill and IMAGE:journal of Nursing Scholarship- Volume 24, Number 4, Winter 1992
when providers try to help them keep well. During my visit with Dr. Brown, she talked about the message of this book in particular: “It is so simple. Before you can give good care you first have to get a psychosocial profile of the patient. But nurses have such a hard time doing that. It’s hard for most nurses to do what is most basic to clinical practice, just talking to people. They have to know so much technology, but they don’t do what seems simple. In a workshop for nurses I gave at UCSF years ago, their assignment was to visit a patient as a friendly visitor, no uniforms. Two of them had to wear a lab coat, they just couldn’t go in without it”.
In the mid 1960s, Brown saw the significance of the hospice movement as it was developing in England through the work of Cicely Saunders. She and Dame Saunders became good friends and together worked to promote the development of hospice programs in the United States. Brown’s networks in the health field were a vehicle for encouraging the establishment of hospices as a means of improving patient care.
The Memorial Service On July 26, 1990, Brown’s memorial service was held in the auditorium of the Sequoias, where she had lived for 14 years. Attended by nearly 100 people, it was organized and led by two of her close friends. They asked people to talk about their memories of Dr. Brown if they felt like doing so, as in a Quaker meeting. This was a celebration of her life rather than a sad occasion, the kind of gathering that she would have enjoyed with her friends. For 90 minutes, those present shared memories and stories. Several letters were read aloud. Then wine and cheese were served because Dr. Brown liked to serve them before entertaining guests at dinner. People shared their memories of Brown’s personal impact as well as her professional accomplishments. They mentioned how they treasured her beautifully written letters and postcards. Throughout her life, she maintained an active worldwide correspondence with personal and professional friends. Several people commented on Dr. Brown having been a very private person; Lucile Leone said: “She had more networks than anyone else but a passion for anonymity. I was always stumbling on someone who knew her from another network.”
Leone described how Brown was born and raised in New Hampshire, a Unitarian who attended church every Sunday. She never married yet had many lifelong friends who were her “family.” Brown had two “god-daughters,” Elizabeth Lin, a physician living in Seattle, and Deborah Gordon, a medical anthropologist living in Italy. People talked about Dr. Brown’s love of travel. She traveled independently into her 90s. Once, a customs official who examined her passport kept staring at her. When she asked if there was a problem, he said, “Oh, you couldn’t have been born in 1898.” A nurse administrator from Los Angeles described how, in 1985, “Esther nearly walked me to my knees in Tiburon and she wasn’t fazed” and later, in 1986, “We drove from San Francisco to Carmel and Monterey. After visiting the Monterey Aquarium we sat in a little park and enjoyed a lovely lunch prepared by Esther.” 315
Esther Lucile Brown - A Memorial
Letters from friends, including one from a professor of public health and another from the former dean of a prominent medical school, mentioned Brown’s impact on public health and nursing. The first wrote:
Another Sequoias resident said, “I knew her less than two years, but was most impressed by her sensitivity, intense concern for humanity, her modestly keen mind, her deep warmth.” Lucile Leone said:
“In the development of public health knowledge, the years 1945-65 can be called the period of influence from the social and behavioral sciences. The public health baby needed this nourishment and Esther Brown provided it - with the right amount of sugar so that it tasted good. Her injections of social science were never pedantic or abstruse. They were practical and down to earth. Through the Russell Sage Foundation she provided fellowships to young sociologists who were keen on applying their skills in the health field.”
“As a Sequoian, she was sensitive to the needs of people. She always noted a needful person and unobtrusively tried to meet that need, even to the point of holding someone’s hand when death was near. She talked a lot about President Carter’s Center on Conflict Resolution. She saw herself, in a way, as a conflict reducer. She may have had some publications on conflict resolution had she lived a few more years.”
The other wrote: “She was not a nurse, but in her work she saw the need for much change in the nurses’ responsibility in the medical hierarchy. It was her active interest and impact-writing, talking, and prddingthat was so very important in bringing about the changes in nursing scope, nurse practitioners for one, that have come about in the last few decades.”
A friend remembered Brown in this way: “Her mind ranged widely over so many aspects of life, but her pragmatic bent and human caring prevailed. When my son was hospitalized and I was upset by the nurses treating a 26-year-old man like an infant, I called Dr. Brown and she sent two of her books to the nursing administrator to try to humanize the care. She was pragmatic but very compassionate.” Another friend described how Brown had seen in her the strain of visiting a resident in the Sequoias health center: “She sat with the woman to help save my energy. She made lots of tactful suggestions to the nursing administration here.” A hospital administrator said, “She was a formative influence on my approach to hospital administration.” Others said: “We enjoyed many cocktail hours, discussing art, architecture, civil rights and, of course, nursing.” “She greatly enjoyed arranging picnics in the park.” And “She was a woman of great mind and spirit. What she leaves behind is her compassion.” Dr. Brown was a champion of human and women’s rights. After World War 11, using her own resources, she helped many individual refugees from the Nazi regime to begin a new life in the United States. Barbara Nichols recalled meeting Brown in the 1970s, when Nichols was president of the Wisconsin Nurses’ Association: “I invited Dr. Brown to be the keynote speaker at our conference. I spent 72 hours with her. We had good rapport right away because we are both New Englanders, and we argued about Maine or New Hampshire being more beautiful. She mentored and prodded me, saying there are few Negroes in nursing leadership (in the early 1970s that’s what we were called) and I must continue to push myself and others to be leaders.”
A close friend said: “She saw strength and pushed it,” and then described a Thanksgiving dinner at her house, where before dinner it was customary for each person to state what he or she was thankful for. Dr. Brown said “for the progress women have made in the 20th Century” and then went on to give a perfectly phrased speech on the topic. 316
Elizabeth Lin, one of Dr. Brown’s “god-daughters,” described how Dr. Brown had met her father, a young psychiatrist from Taiwan, on a site visit to the Massachusetts Mental Hospital in
1950: “She learned that he had a family back in Taiwan, and his wife was interested in pursuing graduate studies in social work, in order that she could return to Taiwan and start the field. But she couldn’t come because of the expense. A few weeks later, Esther informed my Dad that there was a scholarship for my mother. When I came to the Bay Area for Medical School, Esther and Lucile Leone took me out to lunch. What began as lunch with one of my parents’ friends evolved into a godmother-goddaughterrelationship. There was such a loving and caring aspect of Esther that may not be readily apparent. Esther wanted so much to teach me about life! She used every opportunity to convey her values, opinions and observations gained from years of experience. Years ago, when I had difficulty writing my first journal article for publication, Esther made a trip to Seattle, and sat with me like a private tutor until the first draft was done. Of course, she made perfectly clear her distress that medical schools don’t teach doctors how to write well. She was such a confidant and so supportive.” Esther Lucile Brown’s friends paint a consistent picture of a warm, caring, pragmatic person behind the acutely perceptive researcher and commentator on the professions in general, on nursing, on patient care, and on the American health care system. She lived and enjoyed her life fully, with close friends, travel, theater and beauty, until the day she died. The memorial ended with the reading of a moving letter from Deborah Gordon, Dr. Brown’s other “god-daughter,” who currently lives in Italy. Anne Davis had introduced them in the late 1970s when Gordon was a doctoral student in medical anthropology and they maintained a very close relationship until Brown’s death. Dearest Esther, As I feel the bounty of your presence that I and so many others have received from you, may I at least thank you for your wonderful being these years: -for your enthusiasm, your endless, fundamental enthusiasm for every detail of life, every period of history, species of animal, human development, new piece of information; -for your unswerving purpose that put whatever you had or did to some good and that wasted nothing; -for your exacting dedication to this world, to live each and every moment you are here, and accept that things are finite as well; IMAGE: journal of Nursing Scholarship Volume 24, Number 4, Winter 1992
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-and for your balance, like the architectureyou so loved, between work and travel and other interests in life, allowing one to nurture the other; -for your discipline, your steady, mature acceptance that one cannot have or do everything, and so carefully selecting the most important and working to realize that and doing it excellently; -for the microscopic vision you shared with us, your keen, keen eye that took in the subtlest movement that gave you a clue to one of the many puzzles you were trying to decipher; -for your sweeping panoramic vision, you astute alertness to identifying trends and your commitment and belief in human ability to really make an impact, to guide our history intelligently - your living proof that this is possible; -for the stories, the hundreds of stories you followed over time, places and people, meticulously updating them with whatever tidbit of information you could get your hands on, and ever circulating them as treasured pearls among friends; -for your “serious”, “good”, inspirational conversation, and your uncluttered, nurturing, intelligent listening; -for your writing, for the classics you have left us, wrought with a wisdom, clarity and deft sophistication that make them ever fresh and accessible; -and for the many simple pleasures we shared with you, the picnics, simple, but, as you would say, “simply delicious”, with big blue plastic cups preserved after use, local bread hard crust! - cheese, and red wine, and a nice little spot... -for these and many many other things you leave with us. “Places and works of art are friends to me,” you once said.And so, together with all your dearly loved friends: -Together with your beloved statues of Donatello, pictures of Pier0 della Francesca, Leonardo, Simone Martini, Botticelli, Brunelleschi’s ambitious dome, the subtle, disciplined perfect proportions of Florentine architecture, the understated statues of Santa Trinita bridge in Florence; -Together with the canals, the shifting lights, Torcello’s ancient church, and unabashedly elaborate San Marco of Venice; -Together with your dearest Chartres cathedral, luminous St. Chappelle, the unicorn tapestries of Cluny, and the romanesque churches of France whom you visited so devotedly, returning all times of the day to track their varied aspects through different lights; -Together with the cherry blossoms around Willard Street, the rhododendrums in Golden Gate Park, your oleanders, roses, sweet little wild flowers, quotidian chrysanthemums, and the many many flowers you would spot with bursting delight; -Together with your beloved Bay area, steady companion for 30 years, the Golden Gate bridge and the fickle curtains of SanFranciscoBayfog, steadyfriendMt. Tamalpais, lovely Camel, and fascinating pantheon of fish and animals at the Monterey Aquarium; -Together with your many other treasured pilgrimages; -Together with all the many, many, many people you IMAGE:)ournal of Nursing Scholarship Volume 24, Number 4, Winter 1992
Esther Lucile Brown - A Memorial
helped so deftly, anonymously, and unremittingly, always sharing whatever extra bit you had to spare, be it food, money, resources, time, ideas, strength, or company; -Together with all the patients, family members, nurses, and physicians who benefitted from your unswerving vision, painstaking work, and support of what you considered to be a positive trend; -Together with all your friends, your family, your family of friends you wove together, even though some have never actually met; We thank you for all these wonderful years of your passionate and boundless interest, your adoring, studious, intelligent, disciplined attention. We all blossomed with your love i d grew inthe light of your enthusiasms and we will all miss you dearly. Such a devoted and impeccable lover of life -with all its angles -the world rarely enjoys. Like a good musical performer, you left us, even after 92 years, still wanting more! PublicationS by Esther Lucile Brown Brown, E.L. (1935). Social work as a profession. New York Russell Sage. Brown, EL. (1936). The professionalengineer. New York: Russell Sage. Brown, E.L. (1936). Nursing as a profession. New York Russell Sage. Brown, E.L. (1937). Physicians and medical care.New York Russell Sage. Brown,E.L.(1938).La~ersamlthepro~tionofjustice.New York RussellSage. Brown, E.L. (1945). Preface.. In E.R. Schweinberg Law training in continental Europe: Its principles and public function. New York Russell Sage.
Brown,EL.(1946).Theuseofresearehbyprofessionalorganizationsindeterminh g program and policy. New York Russell Sage. Brown, E.L. (1948). Law Schoolsand the pubtie service.New York Russell Sage. Brown, EL. (1948). Nursing for the future.New York Russell Sage. Brown,E.L.(1954-55)Reportofthesubeommitteeonnursingofthemedi~affalrs committee. (pamphlet).New Haven: Yale UniversityCouncil. Greenblntt,M, York, R. & Brown, E.L. (1955).From custodialto therapeuticcare in mental hospitals New York Russell Sage.
Brown,E.L.(1956).Nursingresearchforthefuture.InM.Cowan(Ed.)Theyearbook of madern nursing 1956. A source book of nursing.New York G.P. Pu!nam’s sons. Bro~EL.(1958).Theuniversity’sresponsibilityfornursing.InM.Cowan(Ed.)The yearbook of modem nursing 1957-1958A source book of nursing. New York G.P. Putnam’s Sons, 59-60. Brown, E.L. (1958).The role of university schools of nursing in the improvement of patient care and health guidance: A statement presented by deans of seventeen university schoolsof nursing. New York Russell Sage. Brown EL. (1961). Newer dimensions of patient care: Part 1: The use of the physical and social environment of the general hospital for therapeutic purposes. New York: Russell Sage. Brown, EL. (1962). Newer dimensions of patient care: Part 2: Improving staff motivationand competencein the general hospital.New York Russell Sage. EL. Brown (1964). Newer dimensions of patient care: Part 3: Patients as people. New York: Russell Sage. Brown,E.L.( 1%5).Meetingpatients’psychosocialneedsinthegeneral h0spital.hJ.K. Skipper&R.C.Leonard.SoeialinteradiwPndpatient~.Philadelphia: Lippencott. Brown,EL.(1966).Nursingandpatientcare. In F. Davis, V. OlesentE. Whitaker,The nursing profedon. New York John Wiley and Sons. Brown, E.L. (1970). Nusing reconsidered. A study of change: Part 1: The professional role in institutional nursing.New York Russell Sage. Brown, E.L. (1971). Numing reconsidered: a study of change: Part 2: The professional role in mmmunity nursing.New York Russell Sage. Brown,E L (1975).Meeting patients’psychosocialneeds in the general hospital.In T. Million, (Ed.),Medicalbehavioralscience.Philadelphia: Saunders. Brown, EL. (1978). Psychosocial needs of the aged: What nurses can do. In E. Seymour, (Ed.), Psychosocial needs of the aged: a health care perspective, Los Angeles: Univ. of So. CaliforniaPress. Brown,E.L. (1978). External social pressures and the culture of denial. In One step beyond Shock or reality?New York National League for Nursing.
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Assistant Director of Nursing Research The Medical College of Virginia Hospitals and Virginia Commonwealth UniversityhledicalCollege of Virginia School of Nursing, Richmond, invites applications for the position of Assistant Director of Nursing Research. This is a split-fundedposition between the Hospital and the School of Nursing. Responsibilities include, but are not limited to, the provision of leadership in developing and coordinating Nursing Research activities for Nursing Services at the Medical College of Virginia Hospitals and serving as a facilitator for the school faculty and student research in tertiary care. The successful candidate will possess an earned doctorate (Nursing major preferred), Master's degree in Nursing, successful experience in grant writing, two years formal teaching experience, two years clinical experience, one to two years administrative experience prefened, and evidence of scholarly research. Current experience working in a culturally diverse setting is preferred. Candidate should submit letter of application and curriculum vitae by mail or FAX to Lauren Goodloe, Chairperson, Search Committee, Medical College of Virginia Hospitals, Nursing Research and Development, Box 73,Richmond, Virginia 23298,FAX (804) 371-6479,or call the Department of Nursing Research and Development at (804)786-0418. Application deadline is January 4,1993.
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EEO/AA. Women, minorities, and persons with disabilitiesare encouraged to apply. A member of the University Hospital Consortium.
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1MAGE:journal of Nursing Scholarship- Volume 24, Number 4, Winter 1992
* sther Lucile Brown was a true anthropologist whose research and writing integratediverse sourcesof knowledge into a broad perspective. With superb observation and interviewing skills and the ability to convey a convincing picture of the whole, her insights on the nursing profession and the psychosocialbasis of patient care were so keen and current that many assume that she was a nurse. At the age of 92, she had only recently decreased her professional activities and traveling; she continued her social activities and writing until the day of her death, July 6, 1990. This memorial focuses on Brown as a person, her career and contributions. Since her death, she has been appreciated through a Resolution of Tribute by the American Nurses’ Association (September 1990),and remembered in the major nursingjournals and newsletters (including one from Japan), the Anthropology Newsletter, the New York Times and the San Francisco Chronicle. This memorial is based on several sources: Brown’s close friends, her writing, the letters and comments of those at her memorial service, and her own words from my meeting with her three weeks before she died. My meeting with Dr. Brown was encouraged by Lucile Petry Leone, to whom I had mentioned my interest in the “great grandmothers” who brought about the productive relationship between nursing and anthropology. We met in Dr. Brown’s apartment in the Sequoias, a model urban retirement community. Her living room contained an enormous red antique Persian rug and was decorated with fine art objects from around the world, and bookshelves from floor to ceiling. Tall, slender and elegant, she appeared and sounded far younger than 92. Dr. Brown began our meeting by interviewingme with incisive questions,e.g., “How much progress do you think has been made in applying anthropologicalconcepts in nursing?’ Because of our limited time together, she suggested that I obtain historical information from her books and the annual reports of the Russell Sage Foundation. She chose to talk about nurses’ difficulty doing what is basic to nursing - talking with patients and obtaining a psychosocial profile. She stated that nurses have focused on her study of the nursing profession and neglected her work on patient care, e.g., nurses sometimes refer to her book Newer Dimensions of Patient Care as Newer Dimensions of Nursing Care. IMAGE: Journalof NursingSchohrship* Volume 24, Number 4, Winter 1992
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* History and Contributions Esther Lucile Brown was born in 1898 in Manchester, New Hampshire. In 1920, she obtained her bachelor’s degree in English from the University of New Hampshire, which she said “helped with my writing.” The following year she enrolled for graduate study in anthropology at Yale University. On completing doctoral course work, she spent three years teaching social sciences at the University of New Hampshire. In 1929, she received the PhD degree in social anthropology from Yale, the first woman to do so, with dissertation research on Nordic myths. Brown spent the next year in Paris doing research sponsored by the Social Science Research Council. Although, the depression was underway when she returned to the United States in 1930, she was invited to join the staff of the Russell Sage Foundation in New York to do research on comparative aspects of several professions, including nursing. Later she became director of a newly created Department of Studies in the Professions. In 1948, she became a member of the administrative staff of the foundation with responsibility for cultivating opportunities for sociologists, social psychologists, and social anthropologists to undertake teaching and research in medical schools, university schools of nursing, and schools of public health. She remained a program executive of the Russell Sage Foundation until her retirement and move to San Francisco in 1962. Brown was an indefatigable researcher, traveling around the United States, Europe and Asia, interviewing and observing health care providers and patients in a variety of settings. Four areas of contributions are mentioned here: 1) research on the professions, 2) influence on the development of medical social science, 3) studies of the nursing profession, and 4) research on patient care. JulieneC.Lipson, RN, PhD, FAAN, Alpha Eta is Associate Professor, School of Nursing, University ofCalifornia, San Francisco. The Author says, “thank you to Lucile Petry Leone who arranged the meeting with Dr. Brown, encouraged me to write this paper and made many important suggestions. Ruth Stimson provided much information and encouragement and even helped edit. Deborah Gordon and Susan Folkrnan read the paper, clarified several points and provided helpful critique.”Correspondenceto Dr. Lipsor: atthe Departmentof Mental Health, Communityand AdministrativeNursing, UCSF, San Francisco, California 94143. Accepted for publication June 16, 1992.
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Esther Lucile Brown - A Memorial
Research on the Professions
Brown was adamant that her field was “anthropology of the professions” and strongly objected to being known only for her studies of nursing. Of her education, she said, “Although my degree was in anthropology, I was so influenced by sociology that I don’t know where one stopped and the other started. I couldn’t have done anything better to prepare me for my work at the Russell Sage Foundation.” Brown’s early research resulted in publications on social work, medicine, and engineering. Her five-year study of the legal profession resulted in three books. Following World War II, her research, writing and teaching focused on health care, patients and providers, with several books on the nursing profession. As Lucile Petry Leone noted in Dr. Brown’s memorial service: “I often have wondered if she were born an anthropologist. The Russell Sage Foundation asked her to do a study of several professions, then other professions that had not been studied wanted her to study them.”
Medical Social Science
In 1948, the Russell Sage Foundation was reorganized and its program changed. Dr. Brown described her work on this new project : “I was to put on a demonstration project of what the social sciences could do in the professions. I took the health field and a colleague took the law field. For 10 years we worked to find places that wanted social scientists and then had to find the right social scientists to fill those places. I was able to place 12 to 15 social scientists in medical schools, schools of public health and university schools of nursing. I could have encouraged many more departments of psychiatry and public health to accept people, but I never succeeded in getting someone into the surgery department of a medical school.”
The Russell Sage Foundation funded the social scientists for a period of three years, requiring them to write a book in the process. It was hoped that the professional school would appreciate the worth of this endeavor and thereafter hire the scientist. Brown described her first success as follows: “I knew the dean of the University of Colorado Medical School, a remarkable man, who told me that 50 percent of the county hospital patients and 25 percent of the university hospital patients were Spanish-speaking and there were no Spanish speaking personnel to help them. Could I help? I went back to the foundation and said that I wanted to go to Arizona, New Mexico and Texas to see if I could recruit someone. At New Mexico, I met Lyle Saunders by accident when I asked for information in the sociology department, and we spent the whole morning talking. I found excuses to spend three days there and went to his classes. He never caught on that I was interviewing him. This was one of the most dramatic cases of finding the right person. He was frustrated at Colorado at times; they didn’t move fast enough in incorporating social science, but he worked with internal medicine, pediatrics, public health, and the school of nursing. He would give individual help to teach nurses how to do research. He spent 10-12 years at Colorado, then went to the Ford Foundation to work on population matters.”
From the late 1930s, Brown had urged nurses to pay attention to patients’ cultural backgrounds and the effects of their environment on their well being. Through the foundation program she was able to recruit a social scientist into a university nursing 314
program which was far ahead of its time in the 1950s. Regarding this success, Dr. Brown said: “The Cornell University Dean of Nursing was an open and remarkable person. She wanted to broaden the clinical courses by integrating social science materials into the curriculum and to develop research. I convinced her to provide a position and persuaded Frances Macgregor to go there.”
While at Cornell, Macgregor wrote Social Science in Nursing: Applications f o r Improvement of Patient Cure and developed a successful program that ran for 15 years. Brown’s emphasis on the importance of patients’ cultural backgrounds in providing appropriate care and Macgregor’s pioneering work in nursing education were furthered by the first nurse-anthropologists who received their doctorates through the 1960s Nurse Scientist training program, such as Madeleine Leininger, Agnes Aamodt, Elizabeth Byerly and Oliver Osborne. During the memorial service, Lucile Petry Leone stated Dr. Brown “match-made, and things happened.” She influenced the development of such pioneer medical anthropologists and sociologists as Saunders, Macgregor, Marian Pearsall and Benjamin Paul by placing them in health teaching environments where they focused their work on health and health care. Thus, her “matchmaking” made a major contribution to the development of medical anthropology and medical sociology. In fact, George Foster described Brown as the “mother of medical anthropology” (“Deaths,” Anthropology Newsletter, Sept. 1990, p. 4). According to Leone, “A number of these sociologists and their “professional children” visited her at the Sequoias. One of her goals was to find out “how to make doctors more human.” By the end of this 10-year Russell Sage Foundation Project, the federal government had begun funding social scientists in health science settings and Dr. Brown took two years leave from the foundation to write. The Nursing Profession
Brown was asked to reevaluate the nursing profession following the nursing shortage in World War 11.Her intensive 16-month study, Nursing f o r the Future, sponsored by the National Nursing Council and the Carnegie Corporation, was based on more than 50 visits to schools of nursing throughout the country and numerous meetings with educator groups, health care professionals, hospital personnel, advisory groups and three conferences. The study’s original goal was to reorganize the structure of the six national nursing organizations but it evolved into a study of schools of nursing. In 1946, only 6 percent of some 1,200 schools of nursing were based in higher education. Publication of Nursing f o r the Future led to major changes in nursing education. This landmark study, known as “The Brown Report,” encouraged nursing schools to situate themselves within universities as professional schools. Virginia Cleland, speaking at Brown’s memorial service, remembered: “I was a student at the 1948 ANA convention in Chicago where Dr. Brown was the keynote speaker on the occasion of the publication of Nursing for the Future. There were about 10,000 people at that meeting. It was essential that she was not a nurse and that she was an anthropologist who did her study in a qualitative way. She picked up information from many nurse leaders and recast it in a new light. lMAGE:/ourna/ofNursingScho/arship*Volurne 24, Number 4, Winter 1992
Esther Lucile Brown - A Memorial
She could take data from here and there and put it together. She talked about socially undesirable nursing schools and distinguished ones. In 1949, there was a follow up survey, with a 99.8 percent response rate. At this time, a list of good nursing schools was published and the bad ones weren’t listed. After her report and the follow up survey, nursing moved into the main track of general education.” The report was so positively received that the National League for Nursing Education immediately formed a committee to implement her recommendations. After Nursing for the Future was published, Brown was made an honorary life member of the National League for Nursing. Although Brown retired from the Russell Sage Foundation in 1962, she continued to study, write and teach about nursing and patient care, with her last publications appearing in 1978. She called for the preparation of nurses in academic settings as clinical specialists, administrators, teachers and researchers. Her two-volume set, Nursing Reconsidered: A Study of Change, sponsored by the National League for Nursing, was published in 1970 and 1971. The first volume examined recent developments in nursing practice in hospitals, extended care facilities and retirement homes, noting the dual trends toward specialized technical nursing and professional clinical nursing. The second volume examined nursing roles and practice (e.g., nurse practitioners) in outpatient, home care, mental health services, neighborhood health centers and group medical practice. The goal of these volumes was to describe “evolving nursing roles that might provide clues or even models for greater future effectiveness” (Brown 1971, p. ix).
Patient Care Brown’s research, writing and teaching concentrated on patient care in the hospital and community. In the mid-1950s, she collaborated with Greenblatt and York to study the environment of the psychiatric hospital. Their work led to the publication of From Custodial to Therapeutic Care in Mental Hospitals, a classic field study that influenced the development of the community mental health movement. Brown keenly observed and described the situation of being a patient and what patients need to make them more comfortable. Three monographs entitled Newer Dimensions of Patient Care were published between 1960 and 1963 and focused not on nursing, social work or medicine, but on the patients that these professions have in common. This description is embarrassingly current. The first volume discussed the use of the hospital’s physical and social environment for therapeutic purposes. For example, Brown’s knowledge of architecture was evident in her observations of how the hospital environment reflects care providers’ insensitivity to its effects: “These rooms are set up initially to be convenient for giving nursing care. Once arranged, a bed or table is rarely moved, even though with some small change the patient might be able to look at trees or enjoy the sunset ... [Tlhe more important problem perhaps is that of rigidity of thinking about what changes would give some relief from boredom, or some comfort and satisfaction to the patient” (i%l, p.34). The second volume focused on how patient care providers might increase their motivation and competence. The third volume described patients as people - when they are ill and IMAGE:journal of Nursing Scholarship- Volume 24, Number 4, Winter 1992
when providers try to help them keep well. During my visit with Dr. Brown, she talked about the message of this book in particular: “It is so simple. Before you can give good care you first have to get a psychosocial profile of the patient. But nurses have such a hard time doing that. It’s hard for most nurses to do what is most basic to clinical practice, just talking to people. They have to know so much technology, but they don’t do what seems simple. In a workshop for nurses I gave at UCSF years ago, their assignment was to visit a patient as a friendly visitor, no uniforms. Two of them had to wear a lab coat, they just couldn’t go in without it”.
In the mid 1960s, Brown saw the significance of the hospice movement as it was developing in England through the work of Cicely Saunders. She and Dame Saunders became good friends and together worked to promote the development of hospice programs in the United States. Brown’s networks in the health field were a vehicle for encouraging the establishment of hospices as a means of improving patient care.
The Memorial Service On July 26, 1990, Brown’s memorial service was held in the auditorium of the Sequoias, where she had lived for 14 years. Attended by nearly 100 people, it was organized and led by two of her close friends. They asked people to talk about their memories of Dr. Brown if they felt like doing so, as in a Quaker meeting. This was a celebration of her life rather than a sad occasion, the kind of gathering that she would have enjoyed with her friends. For 90 minutes, those present shared memories and stories. Several letters were read aloud. Then wine and cheese were served because Dr. Brown liked to serve them before entertaining guests at dinner. People shared their memories of Brown’s personal impact as well as her professional accomplishments. They mentioned how they treasured her beautifully written letters and postcards. Throughout her life, she maintained an active worldwide correspondence with personal and professional friends. Several people commented on Dr. Brown having been a very private person; Lucile Leone said: “She had more networks than anyone else but a passion for anonymity. I was always stumbling on someone who knew her from another network.”
Leone described how Brown was born and raised in New Hampshire, a Unitarian who attended church every Sunday. She never married yet had many lifelong friends who were her “family.” Brown had two “god-daughters,” Elizabeth Lin, a physician living in Seattle, and Deborah Gordon, a medical anthropologist living in Italy. People talked about Dr. Brown’s love of travel. She traveled independently into her 90s. Once, a customs official who examined her passport kept staring at her. When she asked if there was a problem, he said, “Oh, you couldn’t have been born in 1898.” A nurse administrator from Los Angeles described how, in 1985, “Esther nearly walked me to my knees in Tiburon and she wasn’t fazed” and later, in 1986, “We drove from San Francisco to Carmel and Monterey. After visiting the Monterey Aquarium we sat in a little park and enjoyed a lovely lunch prepared by Esther.” 315
Esther Lucile Brown - A Memorial
Letters from friends, including one from a professor of public health and another from the former dean of a prominent medical school, mentioned Brown’s impact on public health and nursing. The first wrote:
Another Sequoias resident said, “I knew her less than two years, but was most impressed by her sensitivity, intense concern for humanity, her modestly keen mind, her deep warmth.” Lucile Leone said:
“In the development of public health knowledge, the years 1945-65 can be called the period of influence from the social and behavioral sciences. The public health baby needed this nourishment and Esther Brown provided it - with the right amount of sugar so that it tasted good. Her injections of social science were never pedantic or abstruse. They were practical and down to earth. Through the Russell Sage Foundation she provided fellowships to young sociologists who were keen on applying their skills in the health field.”
“As a Sequoian, she was sensitive to the needs of people. She always noted a needful person and unobtrusively tried to meet that need, even to the point of holding someone’s hand when death was near. She talked a lot about President Carter’s Center on Conflict Resolution. She saw herself, in a way, as a conflict reducer. She may have had some publications on conflict resolution had she lived a few more years.”
The other wrote: “She was not a nurse, but in her work she saw the need for much change in the nurses’ responsibility in the medical hierarchy. It was her active interest and impact-writing, talking, and prddingthat was so very important in bringing about the changes in nursing scope, nurse practitioners for one, that have come about in the last few decades.”
A friend remembered Brown in this way: “Her mind ranged widely over so many aspects of life, but her pragmatic bent and human caring prevailed. When my son was hospitalized and I was upset by the nurses treating a 26-year-old man like an infant, I called Dr. Brown and she sent two of her books to the nursing administrator to try to humanize the care. She was pragmatic but very compassionate.” Another friend described how Brown had seen in her the strain of visiting a resident in the Sequoias health center: “She sat with the woman to help save my energy. She made lots of tactful suggestions to the nursing administration here.” A hospital administrator said, “She was a formative influence on my approach to hospital administration.” Others said: “We enjoyed many cocktail hours, discussing art, architecture, civil rights and, of course, nursing.” “She greatly enjoyed arranging picnics in the park.” And “She was a woman of great mind and spirit. What she leaves behind is her compassion.” Dr. Brown was a champion of human and women’s rights. After World War 11, using her own resources, she helped many individual refugees from the Nazi regime to begin a new life in the United States. Barbara Nichols recalled meeting Brown in the 1970s, when Nichols was president of the Wisconsin Nurses’ Association: “I invited Dr. Brown to be the keynote speaker at our conference. I spent 72 hours with her. We had good rapport right away because we are both New Englanders, and we argued about Maine or New Hampshire being more beautiful. She mentored and prodded me, saying there are few Negroes in nursing leadership (in the early 1970s that’s what we were called) and I must continue to push myself and others to be leaders.”
A close friend said: “She saw strength and pushed it,” and then described a Thanksgiving dinner at her house, where before dinner it was customary for each person to state what he or she was thankful for. Dr. Brown said “for the progress women have made in the 20th Century” and then went on to give a perfectly phrased speech on the topic. 316
Elizabeth Lin, one of Dr. Brown’s “god-daughters,” described how Dr. Brown had met her father, a young psychiatrist from Taiwan, on a site visit to the Massachusetts Mental Hospital in
1950: “She learned that he had a family back in Taiwan, and his wife was interested in pursuing graduate studies in social work, in order that she could return to Taiwan and start the field. But she couldn’t come because of the expense. A few weeks later, Esther informed my Dad that there was a scholarship for my mother. When I came to the Bay Area for Medical School, Esther and Lucile Leone took me out to lunch. What began as lunch with one of my parents’ friends evolved into a godmother-goddaughterrelationship. There was such a loving and caring aspect of Esther that may not be readily apparent. Esther wanted so much to teach me about life! She used every opportunity to convey her values, opinions and observations gained from years of experience. Years ago, when I had difficulty writing my first journal article for publication, Esther made a trip to Seattle, and sat with me like a private tutor until the first draft was done. Of course, she made perfectly clear her distress that medical schools don’t teach doctors how to write well. She was such a confidant and so supportive.” Esther Lucile Brown’s friends paint a consistent picture of a warm, caring, pragmatic person behind the acutely perceptive researcher and commentator on the professions in general, on nursing, on patient care, and on the American health care system. She lived and enjoyed her life fully, with close friends, travel, theater and beauty, until the day she died. The memorial ended with the reading of a moving letter from Deborah Gordon, Dr. Brown’s other “god-daughter,” who currently lives in Italy. Anne Davis had introduced them in the late 1970s when Gordon was a doctoral student in medical anthropology and they maintained a very close relationship until Brown’s death. Dearest Esther, As I feel the bounty of your presence that I and so many others have received from you, may I at least thank you for your wonderful being these years: -for your enthusiasm, your endless, fundamental enthusiasm for every detail of life, every period of history, species of animal, human development, new piece of information; -for your unswerving purpose that put whatever you had or did to some good and that wasted nothing; -for your exacting dedication to this world, to live each and every moment you are here, and accept that things are finite as well; IMAGE: journal of Nursing Scholarship Volume 24, Number 4, Winter 1992
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-and for your balance, like the architectureyou so loved, between work and travel and other interests in life, allowing one to nurture the other; -for your discipline, your steady, mature acceptance that one cannot have or do everything, and so carefully selecting the most important and working to realize that and doing it excellently; -for the microscopic vision you shared with us, your keen, keen eye that took in the subtlest movement that gave you a clue to one of the many puzzles you were trying to decipher; -for your sweeping panoramic vision, you astute alertness to identifying trends and your commitment and belief in human ability to really make an impact, to guide our history intelligently - your living proof that this is possible; -for the stories, the hundreds of stories you followed over time, places and people, meticulously updating them with whatever tidbit of information you could get your hands on, and ever circulating them as treasured pearls among friends; -for your “serious”, “good”, inspirational conversation, and your uncluttered, nurturing, intelligent listening; -for your writing, for the classics you have left us, wrought with a wisdom, clarity and deft sophistication that make them ever fresh and accessible; -and for the many simple pleasures we shared with you, the picnics, simple, but, as you would say, “simply delicious”, with big blue plastic cups preserved after use, local bread hard crust! - cheese, and red wine, and a nice little spot... -for these and many many other things you leave with us. “Places and works of art are friends to me,” you once said.And so, together with all your dearly loved friends: -Together with your beloved statues of Donatello, pictures of Pier0 della Francesca, Leonardo, Simone Martini, Botticelli, Brunelleschi’s ambitious dome, the subtle, disciplined perfect proportions of Florentine architecture, the understated statues of Santa Trinita bridge in Florence; -Together with the canals, the shifting lights, Torcello’s ancient church, and unabashedly elaborate San Marco of Venice; -Together with your dearest Chartres cathedral, luminous St. Chappelle, the unicorn tapestries of Cluny, and the romanesque churches of France whom you visited so devotedly, returning all times of the day to track their varied aspects through different lights; -Together with the cherry blossoms around Willard Street, the rhododendrums in Golden Gate Park, your oleanders, roses, sweet little wild flowers, quotidian chrysanthemums, and the many many flowers you would spot with bursting delight; -Together with your beloved Bay area, steady companion for 30 years, the Golden Gate bridge and the fickle curtains of SanFranciscoBayfog, steadyfriendMt. Tamalpais, lovely Camel, and fascinating pantheon of fish and animals at the Monterey Aquarium; -Together with your many other treasured pilgrimages; -Together with all the many, many, many people you IMAGE:)ournal of Nursing Scholarship Volume 24, Number 4, Winter 1992
Esther Lucile Brown - A Memorial
helped so deftly, anonymously, and unremittingly, always sharing whatever extra bit you had to spare, be it food, money, resources, time, ideas, strength, or company; -Together with all the patients, family members, nurses, and physicians who benefitted from your unswerving vision, painstaking work, and support of what you considered to be a positive trend; -Together with all your friends, your family, your family of friends you wove together, even though some have never actually met; We thank you for all these wonderful years of your passionate and boundless interest, your adoring, studious, intelligent, disciplined attention. We all blossomed with your love i d grew inthe light of your enthusiasms and we will all miss you dearly. Such a devoted and impeccable lover of life -with all its angles -the world rarely enjoys. Like a good musical performer, you left us, even after 92 years, still wanting more! PublicationS by Esther Lucile Brown Brown, E.L. (1935). Social work as a profession. New York Russell Sage. Brown, EL. (1936). The professionalengineer. New York: Russell Sage. Brown, E.L. (1936). Nursing as a profession. New York Russell Sage. Brown, E.L. (1937). Physicians and medical care.New York Russell Sage. Brown,E.L.(1938).La~ersamlthepro~tionofjustice.New York RussellSage. Brown, E.L. (1945). Preface.. In E.R. Schweinberg Law training in continental Europe: Its principles and public function. New York Russell Sage.
Brown,EL.(1946).Theuseofresearehbyprofessionalorganizationsindeterminh g program and policy. New York Russell Sage. Brown, E.L. (1948). Law Schoolsand the pubtie service.New York Russell Sage. Brown, EL. (1948). Nursing for the future.New York Russell Sage. Brown,E.L.(1954-55)Reportofthesubeommitteeonnursingofthemedi~affalrs committee. (pamphlet).New Haven: Yale UniversityCouncil. Greenblntt,M, York, R. & Brown, E.L. (1955).From custodialto therapeuticcare in mental hospitals New York Russell Sage.
Brown,E.L.(1956).Nursingresearchforthefuture.InM.Cowan(Ed.)Theyearbook of madern nursing 1956. A source book of nursing.New York G.P. Pu!nam’s sons. Bro~EL.(1958).Theuniversity’sresponsibilityfornursing.InM.Cowan(Ed.)The yearbook of modem nursing 1957-1958A source book of nursing. New York G.P. Putnam’s Sons, 59-60. Brown, E.L. (1958).The role of university schools of nursing in the improvement of patient care and health guidance: A statement presented by deans of seventeen university schoolsof nursing. New York Russell Sage. Brown EL. (1961). Newer dimensions of patient care: Part 1: The use of the physical and social environment of the general hospital for therapeutic purposes. New York: Russell Sage. Brown, EL. (1962). Newer dimensions of patient care: Part 2: Improving staff motivationand competencein the general hospital.New York Russell Sage. EL. Brown (1964). Newer dimensions of patient care: Part 3: Patients as people. New York: Russell Sage. Brown,E.L.( 1%5).Meetingpatients’psychosocialneedsinthegeneral h0spital.hJ.K. Skipper&R.C.Leonard.SoeialinteradiwPndpatient~.Philadelphia: Lippencott. Brown,EL.(1966).Nursingandpatientcare. In F. Davis, V. OlesentE. Whitaker,The nursing profedon. New York John Wiley and Sons. Brown, E.L. (1970). Nusing reconsidered. A study of change: Part 1: The professional role in institutional nursing.New York Russell Sage. Brown, E.L. (1971). Numing reconsidered: a study of change: Part 2: The professional role in mmmunity nursing.New York Russell Sage. Brown,E L (1975).Meeting patients’psychosocialneeds in the general hospital.In T. Million, (Ed.),Medicalbehavioralscience.Philadelphia: Saunders. Brown, EL. (1978). Psychosocial needs of the aged: What nurses can do. In E. Seymour, (Ed.), Psychosocial needs of the aged: a health care perspective, Los Angeles: Univ. of So. CaliforniaPress. Brown,E.L. (1978). External social pressures and the culture of denial. In One step beyond Shock or reality?New York National League for Nursing.
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Assistant Director of Nursing Research The Medical College of Virginia Hospitals and Virginia Commonwealth UniversityhledicalCollege of Virginia School of Nursing, Richmond, invites applications for the position of Assistant Director of Nursing Research. This is a split-fundedposition between the Hospital and the School of Nursing. Responsibilities include, but are not limited to, the provision of leadership in developing and coordinating Nursing Research activities for Nursing Services at the Medical College of Virginia Hospitals and serving as a facilitator for the school faculty and student research in tertiary care. The successful candidate will possess an earned doctorate (Nursing major preferred), Master's degree in Nursing, successful experience in grant writing, two years formal teaching experience, two years clinical experience, one to two years administrative experience prefened, and evidence of scholarly research. Current experience working in a culturally diverse setting is preferred. Candidate should submit letter of application and curriculum vitae by mail or FAX to Lauren Goodloe, Chairperson, Search Committee, Medical College of Virginia Hospitals, Nursing Research and Development, Box 73,Richmond, Virginia 23298,FAX (804) 371-6479,or call the Department of Nursing Research and Development at (804)786-0418. Application deadline is January 4,1993.
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EEO/AA. Women, minorities, and persons with disabilitiesare encouraged to apply. A member of the University Hospital Consortium.
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1MAGE:journal of Nursing Scholarship- Volume 24, Number 4, Winter 1992
