Guest Post: I Thought all Nurses used Mirrors!

Contributor: Wyona M. Freysteinson, PhD, MN
Theory: Neurocognitive Model of Mirror-Viewing

Wyona Freysteinson

At the age of two, I decided I was going to be a nurse. My great grandmother, my first patient, taught me my colors while testing urine for ketones, how to give insulin, and that when I combed her hair, she looked in a mirror.

I thought all nurses used mirrors.

The quest to understand the mirror-viewing experience began in the 1970s-1980s when I practiced bedside nursing, with a small mirror my uniform pocket. I wondered why the mirror was soothing to so many of my patients (e.g., seeing how I had re-taped a nasogastric tube)? In some patients, I witnessed a look of terror (e.g., viewing a scalp incision)?

When I suggested a mirror-viewing study in my master’s program in 1990, the dean called me into her office. The dean said I could not study mirrors as sick people do not want to look in mirrors. Upon deep reflection, I realized that I had not caused severe psychological harm to thousands of patients with my pocket mirror. I turned to the philosophy department where a professor who had been a student of Paul Ricoeur joined me in my quest. The mirror research journey had begun.

This research trajectory continued with studies of the mirror-viewing experience after a terminal illness diagnosis, amputation, mastectomy, and military sexual trauma. This mirror knowledge base helped me understand the experience of mirroring.

This knowledge base, however, did not explain the mirror phenomenon. Why did some participants tell stories of severe mirror distress (e.g., I wanted to run out on the road screaming)? Why did other participants say they felt no emotions when seeing their bodies for the first time after disfigurement? Why did so many participants remember a terrifying mirror image that occurred several years earlier, and I struggled to remember my mirror image from this morning?

A deep dive into the literature unearthed MRI studies demonstrating self-recognition occurs in the pre-frontal cortex. Together with memory and the autonomic nervous system theories and my research, this information formed the foundation of the mid range nursing theory: Neurocognitive Model of Mirror-Viewing. Although mirrors have a tenuous historical and mythical past, and to some individuals are considered taboo, mirrors are simply tools. For example, mirrors are useful for self-assessment (e.g., diabetic foot care, skincare), self-incision and wound care, colostomy care, prosthetic alignment, and pushing during birth. Many individuals use a mirror to brush their teeth and other activities of daily living. Only in mirrors can we see our faces and whole bodies. However, Initial mirror-viewings in the aftermath of visible disfigurement, sexual trauma, or bullying may be distressing or traumatic. Ongoing mirror discomfort and mirror avoidance may occur.

Sensitive, supportive nursing mirror interventions are needed to mitigate mirror trauma. Since my visit to the dean, I cannot count the number of individuals who have considered my work absurd, frivolous, or inconsequential. Nor can I calculate the countless numbers of cheerleaders who have had traumatic mirror experiences and wished a nurse had been there for them. My hope is that my work expands nursing science to the extent that nurses do use mirrors.

Volume 2 of the Roy Academia Nursology Research Center (RANRC, Japan) now published!

The Roy Academia Nursology Research Center (RANRC) publishes a yearly Nursology Letter. Volume 2 has just been published! See information about volume 1 (2019) on our January 7, 2020 blog post celebrating the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan.

The RNARC is named for Callista Roy, the nursology theorist who developed the Roy Adaptation Model. Congratulations to our colleagues at St. Mary’s College for this notable achievement!

Robert V. Piemonte, EdD, RN, CAE, FAAN (1934- April 21, 2020)

Guardian of the discipline

Contributors: Diane Mancino and Dorothy Jones

Robert V. Piemonte

Robert V. Piemonte, EdD, RN, CAE, FAAN, a highly esteemed professional leader and former Executive Director of the National Student Nurses Association, succumbed to the coronavirus on April 21, 2020. Dr. Piemonte, born in 1934 was one of 12 siblings and is survived by one sister, Adele Grossi, of Medford, NY and numerous nieces and nephews. His sister passed away in December 2020.

Bob graduated from Pilgrim State Hospital School of Nursing and earned the Bachelor of Science Degree at Long Island University. He later received a Master of Arts, a Master of Education and a Doctorate of Nursing Education from Teachers College, Columbia University. It was at Teachers College that Bob formed a lifetime friendship with other emerging AAN leaders including Dr. Margaret McClure, Dr Louise Fitzpatrick and Dr. Muriel Poulin (A Nursology 2020 Guardian of the Discipline) as well as Dr Joyce Clifford, Dr Lucille Joel and others. Each of these individual contributed significantly to the growth of nursing leadership in education, clinical practice and international organizations. To simply observe this group in action was to witness innovation, creativity, tolerance only for the best of wat nursing was and could be, and their joy in being with others they respected and valued.

Diane Mancino and Bob Piemonte

Bob Piemonte held many elected leadership positions in professional organizations including the presidency of: American Nurses Foundation, New York Society of Association Executives, Nurses Association of the Counties of Long Island (District 14), New York State Nurses Association; and Nurses House. He served as Assistant Director of Nursing at NYU Medical Center, Director of Nursing at NYC Health and Hospitals/Gouverneur Hospital and Chief Nurse, US Army 8th Medical Unit.

The major focus of Bob’s professional career was nursing organizations. In this capacity he served as the Executive Director of the New Jersey State Nurses Association; American Nurses Association as Director, Nursing Services Department; and as Director of House, Board and Cabinet Affairs.

Maggie McClure with Bob Piemonte

 In 1985 Dr. Piemonte was appointed as Executive Director of the National Student Nurses Association (NSNA), a position from which he retired in 1996. As the Executive Director of the NSNA Student Bob once said, “I saw the need for the pre-professional organization to prepare its members for leadership roles in the professional nursing organizations.”1 His dedication and commitment to student nurses across the United States promoted student leadership within SNA’s (Student Nurses Associations) at the local, state, and national level, fostered  professional commitment to addressing contemporary and national issues affecting the discipline and health care and enhanced socialization, mentoring and future collaborations for students as they advanced their professional career.  

Dr. Piemonte’s commitment to excellence in the profession, and tireless, pervasive professional leadership were recognized in such awards as: the Teachers College Nursing Education R. Louise McManus Medal; the National Student Nurses Association Honorary Member; the New York State Nurses Association Honorary Recognition Award; the Foundation of New York Nurses Driscoll Award; and the Nurses House Dolphin Award.  In 2008, Dr. Piemonte received the designation of Living Legend by the American Academy of Nursing and, in 2014, he was inducted into the American Nurses Association Hall of Fame, considered to be the highest honor in the nursing profession.  

Bob with Louise Fitzpatrick and Muriel Poulin (standing)

Dr. Piemonte was devoted to mentoring and encouraging nursing colleagues and students. His cousin, Phyllis Yezzo, DNP, RN, in thanking colleagues for their condolences, said, “He was the anchor of the family and a champion for the Nursing family.”2 Countless colleagues credit him with advancing their careers and professional development. He will be sorely missed but his legacy of extraordinary leadership will continue to advance his beloved profession.

A funeral mass and memorial service is planned in NYC at a later date.  Condolences may be made at the following website: http://www.folsomfuneral.com/?p=9085

The Foundation of the National Student Nurses Association has established the Dr. Robert V. Piemonte Memorial Scholarship for donations to honor him. Donations may be mailed to Foundation of NSNA, 45 Main St., Brooklyn, NY 11201 or made via the FNSNA website

1”Spotlight on Robert V. Piemonte,” NEAA Courier, spring, 2009, #97, pg.2.

2 “Email Re: Sad News: Robert Piemonte,” April 22. 2020

Source:  Cathryne A. Welch, EdD, RN, Foundation of New York State Nurses, Retired.

  • Photos provided by Diane Mancino

Recruiting participants for Nursing Research Guided by Barrett’s Theory

The Influence of Nurse Coaching on Power as Knowing Participation in Change in the Process of Health Patterning

Researcher:
Shirley Conrad, MSN, RN, CCRN, AHN-BC, HWNC-BC
PhD Candidate
Christine E. Lynn College of Nursing
Florida Atlantic University

Are you a NURSE who has experienced stress related to providing nursing care during the Covid-19 Pandemic?

We are currently enrolling nurses in CT, MA, NH, MN, MD, TN, NJ, PA, KS, and CA to study the effects of nurse coaching on individuals’ power to participate in life changes like COVID-19.

If you decide to participate what is involved?

  • Four coaching sessions conducted remotely with an AHNCC certified nurse coach. Each will last about one hour. Scheduling is between you and the nurse coach.
  • Completion of short surveys and a phone interview after completion of the coaching. It should take no more than 5 minutes to complete the demographic survey, 10 minutes for pre assessment, 10 minutes for post assessment and 30 minutes for interview.
FOR MORE INFORMATION – please contact Shirley Conrad @ 407-314-3587 or Sconrad2009@health.fau.edu. Primary Investigator is Dr. Marlaine Smith @ 303-506-3450 or msmit230@health.fau.edu   IRB Number 1252160-1 Approved on: March 28, 2019 Expires on: Not Applicable      

New on Nursology.net – Aesthetic Knowing

We are delighted to announce an important new section on Nursology.net – Aesthetic Knowing in Nursing.

Aesthetic knowing in nursing is a way of knowing realities that are not empirically observable – the deep meanings in a situation. As nurses grasp these meanings, they can draw on their inner, creative resources to respond to the situation in ways move the situation from what is, to what is possible. Aesthetic knowing is called forth in the face of human experiences that are common for to all human experience such as grief, joy, anxiety, fear, love. Even though these experiences are common, they are expressed in ways that are unique to each and every individual experience. People recognize common expressions of such experiences as anxiety, or fear, or love. But each person’s experience is unique.

From Introduction to Aesthetic Knowing

This section features the works of nurse scholar/artists whose art expresses a dimension of caring in the human health experience. Our inaugural scholar/artists are:

View the Scholar/Artist Gallery

If you are a nurse/artist and have works you are willing to share, we welcome your submissions for this section of Nursology.net! Use our “Aesthetic Knowing in Nursing Submission Form“!

Guest Post: Allies and Advocates – Transforming Cultural Competence

Contributors: Jennifer Weitzel, Jeneile Luebke,
Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz,
Anne Dressel, & Lucy Mkandawire-Valhmu

The murder of George Floyd and Breonna Taylor has prompted a wake-up call to reflect on the pervasive issue of structural racism.  As a nation created through histories of colonization and slavery, these murders—among countless others—have acted as a catalyst for American society to recognize and act to disrupt continued legacies of racism embedded into the fabric of American society1.  As nurses, as a part of this society (and thus a reflection of society) it is incumbent upon the nursing profession to take a stark look at the ways in which the legacy of structural racism has continued to inform nursing practice, education, and research.  Doing so speaks towards the nursing professions commitment towards supporting best health outcomes for everyone.  As the most trusted profession, and largest healthcare profession, such allyship not only recognizes this issue, but acts to decolonize discourses, and provides explicit attention to the impact that racism holds on health outcomes.  Such measures call to realize the reality that racism is a health issue, that must no longer remain on the periphery of nursing education, research, and practice in the U.S. (see https://nursology.net/2020/01/14/decolonizing-nursing/ ) .

Source

Nursing as a science, has historically been constructed from a positivist and Eurocentric framework that serves to sustain the domination of “whiteness as a form of disciplinary power.”2(p.196)  Cultural competence is often the primary concept used to guide the nursing profession in addressing the needs of diverse populations locally and globally.3 The principles of cultural competence are heavily influenced by the social and political history of the U.S.4 Practicing with cultural competence is tainted with the effects of racial bias, as this concept fails to recognize how perceived “cultural differences” are code for modern-day racist ideologies dating back to colonialism.6 Therefore, what is often believed to be cultural knowledge is rooted in White, European worldviews and codified into healthcare practices based on faulty interpretations and observations of “Othering”. 

Calls have been put forth for nursing transform these harmful approaches to cultural competency using emancipatory knowledge development and critical theory. Although nursing has been heavily impacted by the hegemonic ideologies of the biomedical model, we have also pioneered ways of knowing that disrupt oppressive knowledge paradigms.   The very institutionalization of competence within the medical field was one way for healthcare providers to establish a standard of expertise. This was key to the professionalization of many disciplines informed by the biomedical model, which focuses primarily on biological factors of health and excludes psychological, environmental, and social influences.Because of the societal value placed on our education and our expertise (cultural competence), nurses enjoy a position of power in Western models of health care. Operating blindly within the hierarchies of power existent in the Western, biomedical model of health leads to running the risk of de-contextualizing the care we provide. For example, Ilowite, Cronin, Kang, and Mack found that parents of children with cancer, regardless of race and ethnicity, wanted detailed information regarding their child’s prognosis.7 However, the researchers also found that physicians provided less information to Black and Hispanic parents than to White parents. This is an example of how healthcare providers exert power by deciding what information to share with patients based on perceived cultural norms and implicit bias.

Most individuals entering the healthcare field espouse a belief that they need to deliver care with impartiality.  However, without a sufficient understanding of the machinations of racism in everyday society, the ways in which racism are perpetuated in the healthcare system will remain a blind spot.6 In attempting to provide care regardless of race or ethnic background, we might overcompensate (“I don’t see color”) and subsequently fail to see how social determinants of health, including racism, affect our patient’s opportunities to achieve and maintain optimal health. 6

Practicing with cultural competence is predicated on the nurse’s ability to learn and understand cultures other than their own  to predict health behaviors and ultimately health outcomes.7 When these predictions drive how care is delivered, the complexities of how individuals, families, and communities make decisions about life, illness, and death become reduced to single narratives and stereotypes.9 By many of our textbooks and NCLEX review materials still provide content based on assumptions and broad categorizations. These assumptions often boil down to ideas such as the belief that because of their race or ethnicity, people share static traits, values, and beliefs, racial categories are legitimized as objective truths, when in reality, these categories are social constructions shaped by history and politics.

It is fundamentally impossible for nurses to provide culturally competent care under the premise that knowledge is based on these singular narratives, beliefs, and stereotypes. We must be open to the use of new frameworks that underpin the delivery of nursing care to meet the needs of diverse populations.  These frameworks derive from epistemologies that challenge Western hegemonic knowledge, how it is produced and who produces it.  For example, cultural safety is a concept originating from indigenous Maori New Zealanders that calls on nurses to engage in ongoing self-reflection about issues of power and privilege. Intersectionality theory, rooted in Black feminist thought, requires an understanding that people identify in a myriad of ways that are fluid and interactive.  These identities, some of which are self-ascribed, and others are socially ascribed, form matrices that confer or deny power. Legal scholars introduced Critical Race Theory (CRT) drawing from critical legal and civil rights scholarship.  CRT is underpinned by the following assumptions:

1.  Race is a social construct with no basis in science.

2. White supremacy does not exist on the fringes of society but is embedded in the everyday order of U.S. life.

3.  The voices of those experiencing racism are essential to knowledge development.

4.  The notion of ‘colorblindness’ is a detour that allows White people to absolve themselves of racial biases and deny the oppressive realities of structural racism.

These are a few of the concepts and frameworks that could inform nursing science and ultimately our practice. Why are we interested in theories from other disciplines? How might we develop nursology discipline specific knowledge that addresses the issues?  In the midst of the world witnessing the murder of George Floyd by police officers, the COVID-19 pandemic continues unabated with its current epicenter in the U.S.  In urban metropolitan areas, we have watched how centuries of disinvestment in Black and Brown communities and systematic oppression has led to health disparities that are also manifesting clearly in this pandemic in disproportionate morbidity and mortality of Black and Brown peoples.  Ethnic minority populations are at greater risk for contracting Covid-19, or experiencing severe COVID related illnesses.10  According to the CDC’s report on COVID-19 in the Racial and Ethnic Minority Groups, cases of COVID-19 are highest among American Indian persons, and hospitalization rates for COVID-19 related illness are highest among Latinos, American Indians, followed by Black persons.10  Since Covid-19 was first reported on the Navajo Nation in mid-March, infection rates per capita have soared to the highest in the country compared with any individual state.11   The COVID-19 pandemic thus only exacerbates the challenges that ethnic minority communities already face, particularly American Indians who already experience disproportionate disparities in health outcomes.

The time for nurses to act is now, not just in the care of people and communities that are most marginalized, but to address the very root of marginalization and oppression through a practice of critical reflection on our own profession: which of our theories need to be contested because they are rooted in colonist and white supremacist ideologies?  How can we embrace of innovative ways of theorizing, through meaningful and intentional care that results from a critical and reflective analysis of the realities going on around us and our role as a profession in fostering lasting change? We leave you with these questions and call upon you as fellow allies and advocates on the path towards health equity and social justice.  When we discuss racism, should we not include all races and ethnicities?

Sources

  1. Paradies Y. Colonisation, racism and indigenous health. J.Popul. Res. 2016; 33(1):83-96.
  2. Puzan E. The unbearable whiteness of being (in nursing). Nurs Inq. 2003; 10(3):193-200.
  3. Rajaram SS. Bockrath S. Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. J Health Dispar Res Prac. 2014; 7(5):82-89.
  4. Kirmayer LJ. Rethinking cultural competence. Transcult Psychiatry. 2012; 49(2). 149-164. doi.org/10.1177/1363461512444673
  5. Wesp, L. M., Scheer, V., Ruiz, A., Walker, K., Weitzel, J., Shaw, L., . . . Mkandawire-Valhmu, L. An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories. Advances in Nursing Science, ePub Ahead of Print. 2018.  doi:10.1097/ans.0000000000000230
  6. Hester, RJ. The promise and paradox of cultural competence. HEC forum. 2012;24(4):279-291. doi.org/10.1007/s10730-012-9200-2.
  7. Ilowite MF. Cronin AM. Kang TI. & Mack JW. Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity. Cancer. 2017; 123(20): 3995-4003.
  8. Brascoupé S. Waters C. Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. Int J Indig Health; 2009; 5(2):6-41.
  9. Carter C. Lapum J. Lavallée L. Schindel ML & Restoule JP (2017). Urban First Nations Men: Narratives of Positive Identity and Implications for Culturally Safe Care. J Transcult Nurs. 2017; 28(5):445-454.
  10. Centers for Disease Control (CDC).  COVID-19 Racial and Ethnic Health Disparities. 10 December 20.  Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/increased-risk-illness.html
  11. Cheetham, J. Navajo Nation: The people battling America’s worst coronavirus outbreak.  BBC News.  15 June 2020.  Retrieved from: https://www.bbc.com/news/world-us-canada-52941984

Note: this post is based on the ANS article published in the spring of 2020 – Weitzel, J., Luebke, J., Wesp, L., Graf, M. D. C., Ruiz, A., Dressel, A., & Mkandawire-Valhmu, L. (2020). The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time. ANS. Advances in Nursing Science, 43(2), 102–113. https://doi.org/10.1097/ANS.0000000000000290

L-R: Jennifer Weitzel, Jeneile Luebke, Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz, Anne Dressel, Lucy Mkandawire-Valhmu

Jennifer Weitzel, MS, RN is a doctoral student and public health nurse with Public Health Madison & Dane County. Her research examines the use of cultural safety in the delivery of humanitarian nursing in Haiti

Jeneile Luebke, PhD, RN is a post-doctoral nurse research fellow at University of Wisconsin-Madison. Her area of research and expertise include violence in the lives of American Indian women and girls, and utilization and application of postcolonial and indigenous feminist methodologies.

Linda Wesp, PhD, FNP, APNP, RN is a Clinical Assistant Professor at University of Wisconsin-Milwaukee in the College of Nursing and Zilber School of Public Health, with a focus on health equity, participatory research, and critical theories. She also works as a family nurse practitioner and HIV Specialist at Health Connections, Inc. in Glendale, WI

Maria del Carmen Graf, MSN, RN, CTN-A, is a PhD candidate at UW-Milwaukee. Her research area includes studying the mental health needs within vulnerable populations with an emphasis on the Latina population and women of color in the US using a Postcolonial Feminist approach.

Ashley Ruiz RN, BSN, is a doctoral nursing student and clinical instructor at the University of Wisconsin-Milwaukee, as well as a Sexual Assault Nurse Examiner (SANE). Her current work focuses on advancing feminist theory in nursing science for the purposes of providing a theoretical foundation for addressing the problem of violence against women. Such advances inform Ashley’s research, which seeks to identify and develop nursing interventions that are tailored towards the unique needs of Black women that disclose sexual assault and seek healthcare services

Anne Dressel, PhD, CFPH, MLIS, MA, is an Assistant Professor in the College of Nursing at the University of Wisconsin-Milwaukee, where she also serves as Director of the Center for Global Health Equity

Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.

Scholarly Publishing Shaping Anti-Racist Futures

The recent spotlight on police brutality and killing of Black Americans prompted widespread reflection and change toward social justice and racial inequities in almost all sectors of society – including the realm of scholarly publishing. The “Scholarly Kitchen,” blog of the Society for Scholarly Publishing, posted a notice of an “Antiracist Framework for Scholarly Publishing” on August 6, 2020 that serves as a guide to re-shape policies and practices in the production of scholarly literature.

I am delighted to share the outcome our initiative to examine and revise guidelines and practices for Advances in Nursing Science. As Editor, I established a workgroup of scholars of color who serve on the ANS Panel of Reviewers to take a deep dive into the journal’s “Information for Authors”. Together we created major anti-racist changes that have now gone into effect.

The changes that we made begin with a fundamental acknowledgement of the power of the published word to shape thought and power structures, and the responsibility of authors in situating their work within existing power structures:

Published scholarly works play a major role in shaping thought and power structures. We encourage authors to include a standpoint statement that describes your position relative to power relations of race, gender, and class. This is particularly important if your work involves disadvantaged populations or issues of social determinants of health and health equity. Examples include: 

  • “The authors Identify as white middle-class nurses. We have drawn on literature authored by scholars of color to inform the design, interpretations and conclusions reported in this article.”
  • “Our work arises from our experiences as able-bodied nurses, as well as our identities as mixed-race descendants of immigrants from Central and South American countries.”

The following is a new section that specifically addresses guidelines related to racism:

The ANS leadership – Editor, advisory board members, peer reviewers and Publisher recognize that published scholarly works are vehicles that can challenge systemic racism and intersecting forms of power inequities.  ANS expects an explicit antiracist stance as a means to provide scholarly resources to support antiracism in research, practice, education, administration, and policymaking. To this end, we offer the following guidelines:

  • Remain mindful of the many ways in which white privilege is embedded in scholarly writing, and engage in careful rereading of your work to shift away from these explicit and implied messages.  As an example, general “norms” are typically taken to reflect white experience only; this is revealed when the experience of people of color are taken to be “other” or “unusual” or worse yet “unhealthy” 
  • When race is included as a research variable or a theoretical concept, racism  must be named and integrated with other intersecting forms of oppression such as gender, sexuality, income, and religion.
  • If your work does include race,
    • Provide a rationale that clearly supports an antiracist stance.
    • Be careful not to explicitly or implicitly suggest a genetic interpretation.
    • Explicitly state the benefit that your work contributes on behalf of people of color.
  • Refrain from any content that explicitly or implicitly blames the victim or that stereotypes groups of people; situate health inequities clearly in the context of systemic processes that disadvantage people of color. 
  • Focus on unveiling dynamics that sustain harmful and discriminatory systems and beliefs, and on actions that can interrupt these structural dynamics.

We also added a new criterion on which all submissions are evaluated during the peer review process:

  • Acknowledgement of and challenges to power relations involving race, gender, class, ableism or any other systematic disadvantage.

Please visit the complete ANS Information for Authors to review these changes. We welcome your feedback, comments and questions! Please respond below!

Deep appreciation to the following team of ANS peer reviewers who developed these guidelines:

Helene Berman, RN, Ph.D, University of Western Ontario

Mary K. Canales, Ph.D., RN, University of Wisconsin, Eau Claire

Lucy Mkandawire-Valhmu, PhD, RN (also member of Nursology.net management team)

Margaret Dexheimer Pharris, RN, PhD, FAAN, St. Catherine University (Emerita)

Bukola Oladunni Salami, RN, MN, PhD, University of Alberta

Holly Wei, PhD, RN, CPN, NEA-BC, East Caroline University

Jennifer Woo, Ph.D., CNM, WHNP, FACNM, Texas Woman’s University (also member of Nursology.net management team)

Foundations of Nursology Syllabus: Another New Resource on Nursology.net

Coauthor: Rosemary William Eustace, PhD, RN, PHNA-BC

We, along with all members of the nursology.net management team, are very pleased to offer another resource for nursology – the Foundations of Nursology syllabus. The syllabus is offered in conjunction with our teaching strategies resources (Fawcett, 2019) as well as other nursology website resources about nursing conceptual models, grand theories, middle-range theories, situation-specific theories, and philosophies.

The syllabus is offered to all interested nurse educators in academic and practice settings. Our intent in developing the syllabus was to provide a starting point for the teaching of nursology discipline-specific knowledge, with emphasis on nursology philosophies, conceptual models, and theories. We envision the syllabus as a key foundational tool for teaching and learning the essence of the philosophic, conceptual, theoretical, and application knowledge of our discipline as a foundation for transforming health care and health care delivery.

The syllabus has been designed to address the Future of Nursing documents and various nursology organizations initiatives as well as accreditation criteria for nursology programs (such as the National League for Nursing accreditation criteria for all programs and the American Association of Colleges of Nursing criteria for undergraduate and for graduate programs).

A sample 15 week outline is provided to introduce nursology students to the history and contemporary status of the discipline of nursology and the value and approaches to nursology theory-guided practice, quality improvement projects, and research. Depending on program level, students will use, translate, and/or develop new knowledge in coming to know and engage individuals, families, and communities in the praxis of nursology and wellbecoming, as well as coming to know healthcare systems. The syllabus provides course objectives, suggested methods of instruction, course delivery methods, examples of recommended readings and resources, examples of learning activities, and a sample topical/content outline and course schedule.

We invite readers to post any questions or comments they may have about the syllabus and to recommend development of resources for any other nursology theory-related teaching needs that need to be addressed.

Reference

Fawcett, J. (2019, August 20). How to teach nursology: A new resource on nursology.net. Blog. https://nursology.net/2019/08/20/how-to-teach-nursology-a-new-resource-on-nursology-net/

Lessons from the COVID-19 pandemic: Changes to the meaning of our experiences based on Newman’s theory of health as expanding consciousness (HEC)

Report from the Newman Theory/Research/Practice Society (a Japanese Nonprofit Organization)

Contributors: Emiko Endo,
Satoko Imaizumi, Minako Kakimoto,
Yayoi Kajiwara, Yoshie Kamiya

We are pleased to write our blog about the 2020 work of the Newman Theory/Research/Practice Society in Japan. We submitted a brief about our Society on January 10, 2019 (scroll down here to see this brief) followed by more detail from Dr. Margaret Pharris, who introduced our society and work on December 17, 2019.

We had the last pre-praxis research course of HEC for 2019 virtually on August 2, 2020, because the COVID-19 pandemic. We read the last chapter, “A transforming arc”, and Appendix A, “HEC Praxis: The process of pattern recognition” in Newman’s “Transforming presence: The difference that nursing makes.” After that, Emiko Endo, as a leader of this course, introduced the blog by Drs. Jones and Flanagan, “COVID-19 – What would Margaret Newman say?”(June 30, 2020) In listening to it, our comprehension expanded, and we feel enlightened, and awakened in new ways.

There is an increased awareness within selves, our nursing care, and our society. No, we will never get back to normal. We will certainly move on in “Satori.” On an annual event of the Study meeting held by zooming on November 22, 2020, three practicing nurses presented their experiences of turbulence and disruption, and then recognition of the changes to the meaning of their experiences in the COVID-19 pandemic. The following are the summaries of each presentation.

Minako Kakimoto

In February, the spread of COVID-19 started in Asian areas, but I was looking at that situation as no concern of ours, and I thought it would disappear sooner or later like SARS and MARS. However, soon after being informed of the cases with COVID-19 in Japan, daily necessities, masks, alcohol, etc. disappeared from every store and the situations in hospital settings dramatically changed. The nurses, including me in a cancer hospital, had very hard time making temporal rules without any exact knowledge.

Soon after, we were informed that some positive cases were found at my hospital. I was on the list of medical staff exposed deeply to the COVID-19. “It finally came to us. We cannot overlook their distress as no concern of ours.” I felt strong fear. I had a test, and was afraid of the result. “If I am positive, what will happen to my family? If I and my husband are positive, how my child should be?” I imagined a dead body in a special bag and a crying child there. But, fortunately my test was negative.

After that, I was in charge of an outpatient clinic for the clients with fever. There were many difficulties because of a pickup setting. There were many inquiries and complaints from clients. The relationship among the staff became so bad because of a sense of unfairness, stress, overwork, etc. “How long does this chaotic situation last?

One day I spoke to my colleague about how to organize this disorder. Astonishingly, she said, “You told me some time ago that a transformation would occur after a chaos!” Her words made me come to my senses. “It is true. After the chaos, there is our growth.” I felt as if I had the scales fall from my eyes. I certainly grasped the meaning of “We will never get to back to normal” as Dr. Newman said.

I looked at the chaotic staff relationship from a different angle. “We do not need to get back to the normal. The confusion is not really bad, but it will bring forth. We do not need to endure the current difficult situation with many complaints until the typhoon has passed. Let’s find a new way to move on.” I approached my colleagues to exchange ideas about how to stand up. Of course, my change of actions prevailed into my family.

Yayoi Kajiwara

In the midst of the pandemic of COVID-19, my father, who had had a so-called incurable disease for a long time, died. As I learned a lot from my sad but meaningful experience, I would talk about it.

I, as a hospital nurse, had asked patients’ families to put restrictions on visiting their loved ones to prevent bringing COVID-19 virus into the hospital. However, the situation has reversed. I was not allowed to visit my father. I was so afraid of not being able to meet his death. When I had been a nurse at the palliative care unit, I valued a patient’s death surrounded with his or her family members before everything else. But, I thought it might be impossible for me to be present with my father.

I wondered why my father was on the brink of death in the midst of the pandemic of COVID-19 ? “If I cannot be present at my father’s death, what does it mean? My father may be telling me something important to get a new meaning in my experience. He may be telling me that the length of the time is not so important. The importance is to be present with the patient.”

When my father ran into a critical condition, I was finally allowed to see him. I could be present with him for a while with all my heart. My father did die after several days from good-bye with my aching heart. However, in spite of his death, the relationship between him and me has changed through the process of our hard experience in the pandemic. Our relationship came closer than ever, and we became deeply united in spirit.

From this experience, I realized that I had been captured by the “good dying moments” which nurses think. I surely comprehended the meaning of “Transforming presence” in terms of HEC. That is, being present together brings the transformation to both. I realized the true meaning of “Vulnerability, suffering, disease, death do not diminish us” which Dr. Newman emphasized.

I am very thankful to my father, and the lesson on the COVID-19 pandemic will help me better care for clients in our community.

Yoshie Kamiya

I am a nurse in charge of an outpatient clinic at a university hospital. The COVID-19 pandemic brought me so many difficulties and at the same time many lessons.

We, nurses, were distributed one mask for several days and one raincoat bought at a $1.00 shop. At an information desk, I received a lot of phone calls, claims, and complaints from clients because of the lack of information and fear. The staff’s fear and offensive attitudes were also increasing, and some co-workers could not show up because of their children’s care at home. I was full of fear and exhaustion as I could not know how things would turn out.

In those days, I participated in the last class of the pre-praxis study course and we read the blog by Drs. Jones and Flanagan. I vividly remember the shock I felt after reading the blog. “I feel very relieved.” I thought, “What we need to do is not to go back, but to move on even in the process of confusion.” I thought, “Now is a pinch point, but it is not, really. Now is a chance.” Then, I looked back the past experiences and tried to get a new meaning from them. I will tell you about my change.

As the charge nurse at an out-patient clinic, I was always thinking, “I should take a determined attitude,” “I should not make mistakes,” “I should not be afraid of COVID-19,” “I should meet patients with fever by myself.” One day, when I was working the information desk, I spoke with a patient who turned out to be COVID-19 positive. When I was informed of this fact, I was afraid. Moreover, I felt so sorry for my family. However, I did not tell anyone, not even my family, though I was so worried about my contagion.

Finally, COVID-19 had invaded into our hospital. Some nurses were on a watch list for the virus. One day, one nurse came to me and told me, “I feel very afraid, and I feel very sorry for my family.” She told her feeling openly. At this time, I was startled and recognized my pattern. I realized that I was not honest. I piled up “should do” every day.

The pattern recognition, which is the most important concept in HEC, helped me realize my situation. Since then, I tried to be open and to tell what I am thinking and feeling to people. Especially, I tried to be honest and open with the staff. I realize now that our relationship is changing and expanding. This is one of the great lessons to me during the COVID-19 pandemic. There is another one. At the out-patient clinic, we started to receive clients’ words of appreciation. I can accept their thanks honestly and my relationship with clients became more genuine. This is the other lesson from the pandemic. Thank you for listening to me.

All participants were deeply touched by their presentations. “Yes, we will move on!!!” We will continue to search for ‘caring in the human health experience’ during the COVID-19 pandemic.

Call for Blog Submissions: Antiracism, Politics, and Nursing Knowledge

Nursology.net is issuing a call for blog submissions for an upcoming special issues series on the topics of antiracism and politics. At this critical time in history, we are committed to providing sentinel, contemporary, comprehensive, humanistic and authentic information to facilitate advancement of nursing science. We are calling for blog posts acknowledge antiracism and politics. We welcome you (students, scholars, practitioners, everyone!) to submit blogs on relevant topics of nursing knowledge, including nursing theory and philosophy, and the intersections of antiracism and politics. You are welcome to speak to one topic, or both as they are interconnected.

This call is open for Spring 2021, and notification will be made when our call is closed.

Read previous blogs on racism/antiracism on Nursology.net here.
Read previous blogs on politics on Nursology.net here.

For more information on how to submit a blog to Nursology.net please click here.
For information on how to write a blog, please click here.