Selling Theory

He lounged in the chair, laptop nestled in his lap. “Here, look at this,” he waived toward his screen.

I bent over, squinting, and saw a colorful graph of lines that reminded me of a holiday decoration. “It’s a stochastic model of cellular growth….” He went on to mention the conditions that were being modeled, and I marveled at how these predictions were created.

He turned to face me. “You know, the problem with social sciences (and nursing) is it’s too imprecise. You can’t replicate the studies and find the same results. The conclusions tend to way over-estimate the sample from which the data are drawn. Your theories don’t really reflect science.”

I studied his face and tried to determine whether he was serious. He knew my work and was aware of my approach to theory as a conduit to build science and expand knowledge. I am steeped in the Continental philosophy of human science; I believe in the Truth, but also with humans living different realities and how our personal narratives intersect to create the political. I believe that language not only reflects reality, it creates it. I subscribe to the notion that discourse is important to deconstruct as power relations (hegemonies) embedded in them are often unnoticed without such analysis.

Perhaps I was taking the conversation too seriously, but such science as this young man described and the data science paradigm are oozing – flooding really – into crevices of thought and science at a pace that makes me queasy. The battle of the empirical way of knowing overshadowing other ways of knowing (Chinn & Kramer, 2018) is amplified in the call to harness the seemingly infinite data collected daily that is supposed to tell us something of the human condition. What are these data trying to tell us? Patterns may be revealed without hypotheses. Theories were unnecessary for machine learning as one statistician told me, “You use machine learning when you don’t know what you’re going to find.”

This seems heretical for a theorist. I wanted to sell theory even harder.

In automatic cognitive reactions, I convey to those around me how important theory is — that the use of theory can inform, organize, and enlighten. I thought of Sarah Szanton and Jessica Gill’s (2010) work, Society-to-Cells Resilience Theory – could it be applied to stochastic methods? I thought of other times when I “sold” theory:

  • One of my colleagues asked for input on a community engagement proposal in the context of substance use and stigma within rural communities. I steered her to the Rural Nursing Theory of Winters and Lee (2018) and their remarkable understanding of concepts unique to rural dwellers, such as insider/outsider, the meaning of work, and so forth.
  • A doctoral student examining physical activity in couples – absolutely, I told her, see Pender’s (2011) health promotion model as this will help organize the co-variates.
  • Teaching advanced theory with enrollment from other healthcare professions, including pharmacy. I boasted about nursing’s rich theoretical foundations and how nursing can inform other disciplines in myriad ways. I applaud the student when she finds a singular concept analysis within her discipline.

But then, I give pause. With recent discussions surrounding racial and ethnic disparities, and decolonizing nursing theory, I question whether I am “selling theory” with a bit too much enthusiasm. I think of all the other Truths out there based on personal experience, which is a microcosm of the political. I think of the mix of what is current politically in juxtaposition with theory, and how the tight weave of beliefs leaves me looking for solid answers and coming up empty at times.

Without reflectivity and critical appraisals of what we believe – and try to sell – we are guilty of stagnation. We are guilty of ignorant exclusion. Now, with calls to examine our fundamental assumptions framed within privilege, do we “sell theory” with the same enthusiasm? I’m uncertain, but certain of caveats. We need to acknowledge the knowledge of other theoretical possibilities we haven’t addressed. We can accept “not knowing what we don’t know,” and with just as much enthusiasm explore our ignorance. We can honor those whose work has moved us forward, and move out of the way, or ask for a place alongside, of those who are informed in new ways or in ways that we didn’t listen to before. We must be committed to inclusion and diversity of thought, of the personal as political. As theorists, we are motivated to refine, refresh, extend, edit, delete, and discount. Only when we stop these activities, only when we think “we’re done,” will we be guilty of over-selling theory.

With a sigh, I look over again at the young man with his stochastic graphs and models. He’s been pushing buttons on his laptop, growing his models, as I have been reflecting on theory’s role in nursing. I kiss him, my son, on the cheek, and say with certainty, “We both have a lot to learn.”

References

Chinn, P. & Kramer, M. (2018). Knowledge development in nursing: Theory and process (10th ed.). Mosby, Inc.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6th Edition). Pearson.

Szanton, S. L., & Gill, J. M. (2010). Facilitating resilience using a society-to-cells framework: a theory of nursing essentials applied to research and practice. Advances in Nursing Science, 33(4), 329-343.

Winters, C. & Lee, H. J. (Eds.). (2018). Rural nursing: Concepts, theory and practice. (5th ed.). Springer Publishing Company.

The Definition of Health: Thoughts from Japan

Health is a central concept in most if not all versions of the metaparadigm of nursology (Fawcett, 2019). I have defined health as “human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6) and conceptualize health as inclusive of wellness, illness, and disease within that process. I deliberately separated wellness from illness and disease when I realized many years ago that the term, promotion of health, could mean that nursologists’ activities were directed toward promotion of illness and disease as well as wellness, rather than indicating that nursologists’ activities are directed toward promoting wellness and preventing illness and disease.

The St. Mary’s College School of Nursing Library. –A Repository of Nursology Knowledge

However, I recently realized that my conceptualization of health is Euro-centric and reflects my privilege as a white, Anglo-Saxon nursologist (Chinn, 2020). Accordingly, when I had the honor of speaking virtually with faculty and graduate program learners at St. Mary’s College Graduate School of Nursing in Kurume, Japan, in February 2021, I invited the learners to share their thoughts about health by responding to three questions. The questions and their responses constitute most of the remainder of this blog.

• The first question is: What is your definition of health?

• Inasmuch as the nursology curriculum at St. Mary’s College School of Nursing is based on the Roy Adaptation Model (RAM), I then asked this question: To what extent is your definition of health consistent with the Roy Adaptation Model definition of health, which is: “A state and process of being and becoming an integrated and whole human being” (Roy, 2009, p. 48).

• Finally, I asked: How does your definition of health affect what you think and do as a nursologist?

GRADUATE PROGRAM LEARNER TAKAKO TANAKA’S THOUGHTS ARE:

I define health as a feeling of harmony between body, mind, and living in society. Even if people have a disease or disability, they can be considered healthy if they feel that they are able to do what they want to do, while coping with their environment. My definition of health is similar to that of the RAM, in that human health in the RAM is not just a high or low level of health. Instead, it is about growth and development as we interact with our environment. Output behavior, when healthy, is positive adaptive behavior. According to the RAM, if energy is not spent on maladaptive coping, this energy can promote healing and enhance health, even in states of illness. I also believe that if people have a lifestyle disease, for example, and can controls the disease by going to the hospital and taking appropriate medication to stabilize the disease, and are able to live as members of society, then they are healthy. My definition of health has been informed by my work in public health nursing, as I learned to always value the concept of health promotion. Individually and collectively, I want to help people understand their health problems and support them to achieve independence and self-determination on their own, which will likely lead to illness prevention. Furthermore, I believe that it is essential to create an environment that supports health.

GRADUATE PROGRAM LEARNER MIHO YOSHIOKA’S THOUGHTS ARE:

I define health as a state in which subjective well-being and objective health indicators are in marvelous harmony. Subjective well-being differs depending on the culture, customs, and environmental values of each individual; and even if they have a disease or handicap, I think that they are in health if they feel well-being within themselves. However, I ask if there is a possibility of being a detriment to themselves, such as leaving the illness to their own discretion, are they truly healthy? Therefore, I dare to consider that a state in which these conflicting things are in marvelous harmony can be called health. The RAM emphasis on an interaction between the person and the environment is consistent with my idea of subjective well-being. The RAM emphasizes that health behaviors based on individual values are adaptive and can never be measured by the values of others, which helps me to understand that whether people consider themselves healthy is a complete affirmation of their diverse values. However, the RAM contention that health behaviors cannot be measured is not consistent with the inclusion of objective aspects of health in my definition. In recent years, people’s lifestyles and values have changed, and subjective well-being, an aspect of my definition of health, has also diversified. The practice of providing sensitive care for the different needs of each individual requires a holistic understanding of that individual. A nursologist is the professional who is closest to the client. By paying attention to and engaging with the client, I think that we can become aware of the needs of that person and provide individualized nursology that protects human consideration and dignity. I also think that nursology, which requires being close to the client, is important in terms of developing trust and respect for their subjective well-being. Moreover, I think that nursology practice is caring for others, which is essential for curing and healing. Therefore, the attitude of facing each individual, the full use of professional knowledge and experience with dignity to maintain and improve well-being, and cooperation with clients while caring for them, are all affected by my definition of health and by our thinking and acting as a nursologist.

GRADUATE PROGRAM LEARNER MASUMI OKA’S THOUGHTS ARE:

I define health as a state of understanding and accepting of one’s condition, and also a quest for health itself. Although the World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” I regard health as the way of understanding the state of experiencing a disease or disability, accepting one’s response to the disease or disability, and trying to become satisfied and fulfilled despite the disease or disability. My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. There are subjective and objective aspects to health, but factors such as ideals, goals, and prejudices toward health are the driving force behind the quest for health. I believe that human beings are creatures that constantly seek “health” and have the power to control their way of life. In other words, the act of pursuing “health” itself becomes human empowerment, and I think that it also affects one’s quality of life. My definition of health has been greatly influenced by the RAM definition of health. Being and becoming a whole and integrated human being can be interpreted as a quest for health, so that process is health itself. The RAM considers health from the perspective of human goals and the significance of existence, and lack of integration is said to denote inadequate health. The facilitation of the process of integration is seen as care for my idea of a “quest for health” and is consistent with all human care required of nursologists. My definition of health has a great influence on my thinking and behavior as a nursologist. I believe that supporting the acceptance of people with a disease or disability and considering together with them is caring for their “quest for health.” Quality of life changes significantly depending on how disease or disorder is perceived and understood. As a nursologist, I think that by being involved in the process of accepting illness and disability and supporting people’s ability to satisfy themselves, they can accept and love their existence. As a nursologist, I would like to continue to study and learn the potential “investigative power of health” of human beings and contribute to the development of the science of nursology in the future.

GRADUATE PROGRAM LEARNER TATSUNARI HARA’S THOUGHTS ARE:

My definition of health has two aspects: it is the situation in which people think of their condition as being “good” despite any physical malady they might have, and it is also the process they are going through in changing or adapting to their condition to become “better” in terms of their own understanding of the word. My definition of health has been greatly influenced by the RAM, as I learned nursology through the RAM. My definition of health is, however, more abstract than that of the RAM, as my definition emphasizes the largely subjective nature of health. My definition of health has influenced by thoughts and actions. Thus, I understand that nursologists strive to establish a caring connection to patients by ascertaining what kind of state they think is good, their goals and abilities required to attain that state, how they perceive their current situation, and what their values are. Furthermore, as I work in rehabilitation nursology, I see many of the patients leave the hospital with remaining disabilities to go on with their lives. Therefore, we nursologists may be required to change our ideas about health so that we can work together with the patients while thinking about how to establish health in their lives, and encourage any necessary changes they may need to make.

GRADUATE PROGRAM LEARNER MIHO ISHIBASHI’S THOUGHTS ARE:

I think that health is not a concept that opposes illness, but a process in which a person interacts with the environment as a human being and tries to become a person looking positively toward their hopes and wishes. Health in the RAM is an integrated overall condition or process. Nursologists say that by promoting adaptation, they contribute to human health, quality of life, and dignified death. I think that for people to be the people they are, nursologists have to understand the hopes and wishes of what the people want to be and do, as well as understand and support them physically, mentally, and socially. I believe it is necessary to understand the environment surrounding a person, think about the influences that affect their health, and consider how to manage these aspects to make people healthy. I think it is necessary to act as a nursologist to understand people’s hopes and wishes people and to help them attain these hopes and wishes.

GRADUATE PROGRAM LEARNER YUKIE NAKANISHI’S THOUGHTS ARE:

I think of health as being familiar with one’s self, having the ability to deal with problems, and having the ability to make decisions. The notion of health in the RAM as a state of integration is consistent with my thoughts about health. Until I entered graduate school, I was convinced that “health” was not having any illnesses or disability. However, even if one has an illness or a disability, I have now come to think that true health is the ability to face oneself, accept what one has become, and move forward toward the future. While studying the RAM and bioethics, I have learned it is important to learn that “person” equals “life”, and that it is equally important to think about a person’s “purpose of life” and “meaning of life” while practicing nursology. Nursologists are practitioners of caring, so I have realized that it may be inadequate to not understand what health is. In the future, I would like to continue learning so I can augment my humanity and human power, learn more about the attitudes necessary for caring, and put them to practical use.

CONCLUDING NOTE:

As I began to write this blog, I realized that I did not know the Japanese word for health; Google translate provided an answer: Kenkō, which is written in Japanese characters as 健康 (https://translate.google.com/?sl=en&tl=ja&text=health%20&op=translate)

I was remiss in not having invited the St. Mary’s College Graduate School of Nursing faculty and learners to share the word each uses for health. Therefore, I do not know whether their responses reflect a Euro-centric or Japanese meaning for the word.

When I sent a draft of this blog to Eric Fortin, of the St. Mary’s College School of Nursing faculty, he replied with his interpretation of the Japanese characters for health. I am, therefore, indebted to Mr. Fortin (personal communication, April 26, 2021), who wrote “健 means ‘humans build,’ and ‘康’ means “breathing space, . , , probably implying the lack of obstruction or disease. So, ‘humans building breathing space’ implies being healthy.”

REFERENCES

Chinn, P. (2020, January 14). Decolonizing nursing. nursology.net. https://nursology.net/2020/01/14/decolonizing-nursing/

Fawcett, J. (2019, March 21) Questions and Answers about our Discipline: Name and Metaparadigm. Paper presented at the Nursing Theory: A 50 Year Perspective Past and Future Conference. Sponsored by Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. nursology.net. . https://nursologycom.files.wordpress.com/2019/03/cwru-paper-fawcett-3-28-19.pdf

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.

Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.

World Health Organization. (1948). Preamble to the constitution. World Health Organization. https://www.who.int/about/who-we-are/constitution

Guest Post – Emancipatory Nursing in Chile

Contributor: Luz Galdames, PhD (Nursing)

Today, more than twenty years after nursing was incorporated into the Chilean Health Code in 1997 as an autonomous profession, one begins to see how nurses empower themselves defending their rights at the institutional, social and political level. This is seen through events such as the establishment of the National Nursing Directorate at the Ministry of Health and the role that nursing has had in the Covid-19 pandemic. Nurses are raising their voices. In the political sphere, nurses are campaigning as representativeness to draft the new Chilean Constitution, defending/advocating care as a constitutional right and guarding professional autonomy. Another important example of nursing empowerment is the growing generation/development of nursing scientific associations. These organizations seek to socialize what nurses do, the ongoing research in different areas of care and the development of profession itself. Currently, there are more 40 scientific nursing societies in the country.

In 2005, through the Health Authority Law 19,937, self-managed hospitals were established, which brought with them an important change in their administrative organization. It implied that hospitals in their structure should consider the Medical Directorate and the Subdirectorate of care management, both with direct dependence of the hospital management. Historically, nursing had depended on the medical directorates. In this context, the nursing professional association of the time and, the scientific societies (in that period there were no more than ten) defended before the authority of the Ministry of Health and the Comptroller General of the Republic, that by then nursing was the only profession that in its definition evidenced care management as a component of its role. As a result of these negotiations in 2007, by means of the General Administrative Norm No. 19 of the Ministry of Health, it recognized the nursing profession as the most suitable for implementing the care management model in self-managed hospitals.

In this context, “Nursing Care Management” was defined as the professional practice of the nurse based on the nursing discipline, the science of caring (based on Watson’s philosophy and theory), understanding the exercise of the profession as the application of professional judgment in planning, organization, motivation and control of the provision of timely, safe, comprehensive care that ensures continuity of care and is based on the institution’s strategic policies and guidelines. This achievement was constituted a demonstration of empowerment of the nurses of the decade.

However, even when the definition indicated that “care management” was based on the science of caring, the care provided to people was mainly focused on the biomedical model. The National Directorate of Nursing: it is specified through Exempt Resolution No. 1443, on August 20, 2019, during the mandate of the Minister of Health Jaime Mañalich who formalized the appointment of the National Director of Nursing. Being a milestone for the profession, providing from the central level, support to direct and guide the care of people, develop the nursing structure for the health sector, ensure that the nursing care management sub-directorates are not only considered in in-hospital care, but also in primary care.

In parallel, there have been other relevant events in the country, which show the awakening of nurses as a professional group. An example has been the number of nurses who present themselves to the process of electing representatives to the constituent assembly, in defense of care as a constitutional right, as well as the defense of the autonomy of the profession and the rights of nurses.

Another event that has led to the empowerment of nurses has been the Covid-19 Pandemic, which has resulted in the defense of the right of profession, the union of the group to be in the spaces where decisions are made. Likewise, the growth of scientific Societies that bring together nurses for a common purpose, whether it is around the care of people, such as the defense of the rights of the profession (see the list of Scientific Societies below).

The immunization of the population through the vaccine for Covid-19, means another instance in which the nurses raised their voices to defend the vaccination process as a historical nurse’ s responsibility. To respond to the vaccination demands, other healthcare professionals were called by the authorities as volunteer. This led, the nurses defended before the authorities, that although the voluntary participation of other professionals in vaccination is recognized, the vaccination programmeshould be under the supervision of the nursing staff only. Highlighting that, vaccination does not only imply the act of inoculating the vaccine, but an entire process of organization, administration, register and following up.

One of the last events that brings together nurses as an empowered group is the call that the National Director of Nursing makes to Scientific Societies to be part of a Technical Working Table, with the purpose of generating strategic collaboration links in for the development of protocols for the management of care and research in the discipline of Care.

Photo of group meeting from the Scientific Societies

Scientific Societies

  • Agrupación de enfermeras holísticas de Chile (AEHCh)
  • Agrupación de enfermeras y enfermeros ecologistas
  • Agrupación de enfermeros perioperatorios (AGEPCH)
  • Asociación chilena de enfermería en estomas heridas y/o continencias (ACCHIEHC)
  • Asociación chilena de enfermeros educadores en diabetes (ACHIENED)
  • Capítulo de enfermería de la Sociedad Médica de Cuidados paliativos
  • Capítulo de enfermería de SOCHIQUEM
  • División de enfermería intensiva de la sociedad chilena de medicina intensiva (SOCHIMI)
  • Federación Latinoamericana Esterilización FELACEH
  • Fundación de enfermería Gestión del Cuidado
  • Fundación latinoamericana de enfermería en cuidado humanizado (FLECH)
  • Sociedad de Enfermera Latinoamericana en Heridas (SELH)
  • Red Nacional EBE Chile
  • Red Chilena de Enfermería en Lactancia Materna (REDCHIELM)
  • Red Chilena de Enfermeros En Odontología (RECHIENFOD)
  • Red de Enfermería en Informática Chile
  • REDENFI Chile
  • Red Chilena de Gestión del Cuidado REDGECU
  • Red de Enfermería en Salud del Adulto Mayor- Chile (REDESAM)
  • Red Chilena de Historia de la Enfermería
  • Red en Salud Ocupacional (RedENSO Chile)
  • Red iberoamericana de investigación en educación en enfermería-RIIEE Chile
  • Red Internacional de Enfermería en Cuidados Paliativos – Chile (RienCupa)
  • Red internacional de enfermería quirúrgica -RedIEnQu Chile
  • Sociedad Chilena de Enfermería en Salud Ocupacional (SOCHENSO)
  • Sociedad chilena de enfermeras de salud escolar (SOCHIESE)
  • Sociedad Cientíca chilena de enfermeras del niño y adolescente (SOCHENA)
  • Sociedad Chilena de Enfermería en Cardiología y Cirugía Cardiovascular (SOCHICAR)
  • Sociedad Chilena de Enfermería en Donación, Procuramiento y Trasplante (SOCHIENFDPT)
  • Sociedad Chilena de Enfermería Oncológica (SEOC)
  • Sociedad científica de enfermería comunitaria y familiar (SOCHIENFA)
  • Sociedad chilena de enfermeras comunitarias (SOCHIENCO)
  • Sociedad Chilena de Enfermería Prehospitalaria, Agrupación Científico-Técnica. (SOCCHIENPRE)
  • Sociedad chilena de prevención y control de infecciones asociadas a la atención en salud, (SChIAAS)
  • Sociedad Chilena de Enfermeras de Pabellones Quirúrgicos y Esterilización
  • Sociedad Chilena de Terapia de Infusión (SOCHITEIN)
  • Sociedad científica de atención temprana, rehabilitación e inclusión
  • Sociedad Científica Docente Estudiantil de Enfermería UACh Pto Montt (SOCIDENF)
  • Sociedad de enfermeras de diálisis y trasplante renal (SENFERDIALT)
  • Sociedad Chilena de Enfermería Geronto-Geriátrica
  • Sociedad de Enfermeras Dermoestéticas (SOCHIEDE)
  • Sociedad de Profesionales en Esterilización de Chile
  • Sociedad Chilena de Simulación Clínica (SOCHISIM

About Luz Galdames

Luz Galdames Cabrera Ph.D. in Nursing, Mg. Instructional Design, Nurse-Midwife, Research Professor, School of Nursing, Faculty of Sciences, Universidad Mayor. Researcher in project “Development and validation of the prototype dressing with copper nanoformulation for the treatment of infected chronic wounds, Universidad Mayor, Project ID18I10085 Funded by the Fund for the Promotion of Scientific and Technological Development FONDEF 2018-2020. Director of the Nursing Specialization Program in Adult Oncology at the Universidad Mayor. Member of the International Center for Nursing Research CIIENF of the Chilean Association of Nursing Education. Coordinator of the international Care Management Network. Founder and President of the Chilean Network of Care Management Last publication Galdames l., Enders B., Pavez A. Self-regulation, Autonomy and Identity of Nursing as a profession. Science and Nursing Magazine. 2019 24 (4). Doctoral thesis Care Management: Understanding the Meanings of the Social Role and Professional Autonomy of the Nurse in Chile. Funded by the Vice-rectory for Research and Doctorate as a start-up project, Universidad Andrés Bello Chile 2014.

Guest post: The Overlooked Impact of Case Management during the COVID-19 Pandemic

Contributor:
Christy McDonald, BSN, RNC, Case Manager

I have witnessed an amazing workforce in our hospitals during this pandemic. While physicians and nurses are clearly lifesavers at the bedside, hospital rooms are scarce. These frontline workers need the partnership of nurse case managers to arrange safe discharges and free up beds for those waiting in the ER. But this partnership provides much more than just discharges.

Nurses have a unique perspective that is vital in every area. This idea was explained well in 1952 by Hildegard Peplau, “mother of psychiatric nursing,” who understood the strength of nurses that could create a personal connection with their patients. She created a Theory of Interpersonal Relations, where she named 6 main roles for nurses which could be applied individually according to the needs of the patient. This differentiation of roles including counselor, surrogate, teacher, stranger, resource person, and leader can help nurses today in many different areas of care beyond psychiatric nursing. I believe it has been very beneficial for RN case managers working alongside bedside nurses to fulfill these roles for patients during this pandemic.

These behind the scenes case managers efficiently arrange placement while taking the time to comfort patients and family members, filling the role of counselor, which allows the patient to express their feelings to the case manager. In a time of urgency, these nurses can be a listening ear for family members to process their worries and discuss medical conditions. Often information has been relayed, but family members don’t want to take time away from the bedside staff with clarifying questions. The loved ones value the time and sacrifice given so highly that they are willing to forgo understanding. I personally filled the role of surrogate, which allowed me to fill in for family, when I had a patient who never told his bedside nurse he was a vegetarian because he didn’t want to bother her. He was only eating the bread of his sandwiches. I was able to speak with his spouse who informed me of his diet, and quickly messaged the nurse who changed his meal that very day. The teacher role is something nurses are excellent at providing in normal circumstances, however this pandemic has created a unique need for patients to be educated on a novel virus.

As with all nurses, case managers connect with their patients and loved ones, and want the best outcome for all involved. This in it’s simplest form if fulfilling the stranger role by offering the decency that should be given to any human. However we know that we often connect deeper with the emotions of a patient. For example, a fellow case manager cried with a family member about no visitation policies, because we all mourn the necessary changes needed to slow this pandemic. While continuing these much needed conversations, case managers arrange for home health or skilled nursing admissions. If we can find placement for recovered patients, those who are sick and waiting in holding areas of the ER can receive care from our skilled floor nurses. I worked tirelessly to find an open bed in another state for a pt while discussing end of life decisions with another family, fulfilling both the resource role providing information and the leader role offering direction with the patient’s wishes. It takes so many people working together to provide care in these unprecedented circumstances we find ourselves fighting.

Nurse case managers truly maintain the flow of care so we can provide the maximum benefit to as many patients as possible. Without nurse case managers there would be nowhere for our loved ones to go. And with them we can fulfill the necessary roles as described by Peplau needed to care for our patients.

About Christy McDonald

Christy is a hospital case manager in a large metro healthcare system. She had the privilege of being a bedside NICU nurse for 17 years before moving into Case Management. She has cared for those in public schools, remote Haiti, and the hospital setting. She serves on the Board of Directors for a Haitian NICU and children’s home.

Guest post: Aesthetic Knowing: A Transformative Encounter

Contributor: Bibiane Dimanche Sykes

Knowing is an elusive concept. It is fluid, and it is internal to the knower (Chinn & Kramer, 2018). Carper (1978) identified four fundamental patterns of knowing for an understanding of the conceptual structure of nursing knowledge. The four patterns are classified logically to elucidate aspects of empirics, personal knowledge, ethics and aesthetic knowing in nursing. Here, the pattern of aesthetic knowing is demonstrated through the actions, comportment, thoughts, behaviors and exchanges of the nurse’s relationship with the patient. It is aesthetic knowing that allows us to navigate when faced with nuanced situations.

The Call

It was late on a Tuesday morning. I was pleased to finally have a few days of rest from work and was already planning how I was going to spend my second day off, when I heard the ring tone from my phone. I glimpsed at the phone screen and noticed that it was a number I was unfamiliar with, so I decided to skip the call and told myself that they can always leave me a voice message if it is important. Ten minutes later, I heard the same familiar ringtone of my phone. This time it was coming from work. “Oh my,” I thought, what could it be…. did I forget to enter a note on the computer, or have I failed to sign the medication sheet? When I picked up the phone, the Director of Nursing at the subacute nursing facility I worked for was on the line. She mentioned that Ms. Smith’s situation took a turn for the worse; her condition had weakened overnight. According to Nancy, the Director of Nursing, Ms. Smith had been asking to see me since yesterday, and it was her nephew whose desperate call I had moments earlier ignored.

Nurse-Patient Relationship

Ms. Smith was a 75-year-old widow who moved about 7 months ago to the hospice unit where I worked as a charge nurse. Her overall health and well-being had since deteriorated. Her cancer had metastasized to other adjacent organs of her body, and treatment was no longer a viable option. She had very little family support. Her only living relative was a nephew who visited occasionally. Although she had many other disciplines assigned to her care, she seemed to gravitate more towards me. I also enjoyed her company and spent many hours of my free time listening to her joys and regrets about life. I would play her favorite songs, encourage her to eat, to bathe, and to take her medications, before her pain became unbearable. She looked forward to the days I was at work, and I would always stop by her room for a chat whenever I had the chance. She confided in me and shared many of her life and death expectations, which included the minute details of her imminent death and funeral wishes. She and I developed a bond and maintained a caring nurse-patient relationship that encompassed understanding, trust and compassion.

The Encounter

It was already afternoon when I rushed into Ms. Smith’s room that Tuesday. She seemed agitated; however, she immediately became calm at the sound of my voice, telling her that it was going to be okay. As I was helping her take her prescribed medications, she appeared to be hallucinating. She kept on saying something about not being able to get on the bus. She was becoming restless and continued to repeat this for about an hour. I finally approached her and asked why she was not able to get on the bus. She opened her eyes for the first time since I entered her room and mumbled, “they wouldn’t let me, I don’t have money to pay for it.” I was devastated at the thought of that. I knew this day would come but still I was becoming emotional. I reminded myself that I needed to stay on course to help fulfill her wish of an undisturbed, smoothed transition. I thought for a second, what could I do to alleviate her suffering at this moment? I searched in my pocket and found a quarter. I slipped it into her hand and whispered in her ear, “use this for your bus fare, it’s going to be fine.” I felt her tight squeeze as she received the quarter, and less than five minutes later, Ms. Smith peacefully took her last breath with poise and dignity.

Aesthetic Knowing

Aesthetic knowing is what makes possible knowing what to do and how to be in the moment, instantly, without conscious deliberation (Chinn & Kramer, 2018). I am currently an adjunct professor, teaching nursing fundamental to first year students. Every semester, I share this experience with my students. It serves as the perfect introduction to the conceptual framework of the nursing discipline through the patterns of knowing (Carper, 1978). The patterns of knowing in nursing ultimately presents a tool for developing abstract and theoretical thinking in the classroom. It allows for broader, clearer perspectives and self-integration of the concepts of empirics, personal knowledge, ethics and finally aesthetic in nursing education (Carper, 1978). This transformative encounter that I had experienced with my patient embodies the true essence and elements of aesthetic knowing.

Sources

Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004

Chinn, P. L. & Kramer, M. K. (2018). Knowledge Development in Nursing: Theory and Process. 10th Ed. Elsevier. St. Louis, MO.

Aesthetic Knowing. (2021, February 2). https://nursology.net/aesthetic-knowing/

About Bibiane Dimanche Sykes

Bibiane Dimanche Sykes is a student in the Doctorate of Nursing Education (EdD) Program at Teachers College, Columbia University. She earned a Master of Science degree in Nursing Education at Mercy College in Dobbs Ferry, New York. She’s an Adjunct Professor at Mercy College in Dobbs Ferry, New York and also works as a Clinical Nurse Quality Assurance in New York City. Bibiane is a wife and mother of 4 sons. She enjoys reading, traveling and prides herself in giving back to the community. She serves her community through various philanthropic and nursing organizations.

It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

At the time of the 2021 Virtual Nursing Theory Week, Christina Nyirati and Sharon Stour-Shaffer presented the baccalaureate curriculum they designed and now implement at Heritage University located on the Yakama Reservation in Washington State. This is the only session that was recorded during the conference; it represents the value of nursing knowledge in shaping the present and future of nursing as a discipline. The following is a brief description and a video of their presentation.

The first Heritage University BSN Program Outcome reads “The Graduate of the Heritage University BSN Program explains how nursing’s fundamental patterns of knowing –personal, aesthetic, ethical, empirical and emancipatory –contribute to understanding the complexity of nursing care in the treatment of human response”.

Carper’s (1978) Fundamental Patterns of Knowing in Nursing is the foundation of the BSN Program. Freshmen study discrete courses in each of Carper’s fundamental patterns: personal, aesthetic, ethical, and empirical knowing. The Personal Knowing course is founded on personal knowing as a precondition for nursing care. Students practice various methods of reflection to develop personal knowing in every moment of nursing care. The Aesthetics of Nursing course is grounded in assumptions from Nightingale’s theory of nursing arts and aesthetics as a fundamental pattern of knowing in nursing. An experiential course, based in the principles of performing arts, the focus is on the act of care; Students explore and apply dramatic arts foundational to holistic nursing care competencies. The Ethical Knowing course emphasizes the practice of ethical comportment in nursing care. The Empirical Knowing course students introduces students to fundamental theories, concepts, evidence, and competencies pertaining to generation of nursing knowledge.

Senior year features the community as the unit of nursing care, and is founded on Chinn and Kramer’s (2019) emancipatory knowing in nursing. The Policy, Power & Politics of Nursing course focuses on the professional nurse role in taking responsibility for shaping social policy. The two Community Oriented Nursing Inquiry and Practice and the Community Based Participatory Research courses center on principles of socially just reflective action to overcome health inequities.

Faculty developed rubrics to evaluate how students integrate the fundamental patterns of knowing nursing into clinical practice. Students complete reflective writing assignments during clinical practice each semester from sophomore through senior year.

About the contributors:

Christina Nyirati, RN, PhD

Christina Nyirati is Professor of Nursing at Heritage University on the Yakama Nation Reservation in Washington, where she serves as the founding Director of the BSN Program. Dr. Nyirati came to Heritage from Ohio University and The Ohio State University, where she directed the Family Nurse Practitioner (FNP) Programs. She practiced more than 30 years as an FNP in primary care of vulnerable young families in Appalachian Ohio, and worked to reduce dire neonatal and maternal outcomes. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice. Now at Heritage Dr. Nyirati prepares nurses in an innovative undergraduate curriculum faithful to the epistemic foundations of nursing. Two cohorts have graduated from the Heritage BSN Program. They openly proclaim and use their powerful nursing knowledge to correct inequities in their communities.

Sharon Stout-Shaffer, PhD, RN

Sharon Stout-Shaffer, PhD, RN, Professor Emerita, Capital University, Columbus, Ohio; Adjunct Faculty, Heritage University, Toppenish, Washington; Nursing Education Specialist, S4Netquest, Columbus, Ohio. Sharon has over 30 years of experience in educational administration and teaching in both hospital and academic settings. Her career has focused on developing education based on a nursing model that includes concepts of holism and healing.

Her Ph.D. in Nursing from The Ohio State University focused on the psychophysiology of stress and relaxation-based interventions to promote autonomic self-regulation and immune function in people living with HIV. She has attained certification in Psychosynthesis, Guided Imagery, and more recently, the Social Resilience Model; she has presented numerous papers on integrating holism into curricula as well as caregiver wellbeing and resilience including Adelaide, Australia, 2011; Reykjavik, Iceland, 2015; American Holistic Nurses Association Phoenix, 2016 & Niagara Falls, 2018.

During her tenure as Director, Post-Graduate Programs at Capital University, Sharon taught the graduate theory course and co-developed a theoretically grounded holistic healing course as the foundation for graduate study; the graduate program has been endorsed by the American Holistic Nurses Credentialing Center. Since her retirement, she has co-developed and implemented numerous educational interventions designed to develop the Therapeutic Capacity of working nurses and nursing students. This work includes concepts of centering, compassion, managing suffering, the psychophysiology of resilience and essential contemplative practices to develop stress resilience, deal with moral distress and promote long-term wellness. She is currently teaching courses in Personal Knowing and Nursing Ethics for undergraduate nursing students at Heritage University. Her most recent publication is dedicated to holistic self-care and self-development. (Shields, D. & Stout-Shaffer, S. 2020). Self-Development: The foundation of holistic self-care. In Helming, M., Shields, D., Avino, K., & Rosa, W. Holistic nursing: A handbook for Practice (8th). Jones and Bartlett Learning, Burlington MA.)

Theorizing as Emancipatory Action; Emancipatory Action as Theorizing

Over the past year those of us managing the Nursology.net website have experienced two unintended consequences – growing awareness of the importance of fundamental nursing/ public health knowledge and action, and the imperative to examine the structural and interpersonal dynamics of racism. As the web manager of this Nursology.net site as well as the NurseManifest.com website, the home of “Overdue Reckoning on Racism in Nursing,” I have had a front-row seat from which to witness and participate in these two complimentary processes.

From the NurseManifest sphere, we have addressed (explicitly and implicitly) questions such as: “How does our activism contribute to our discipline?” “What are the fault-lines in nursing created by our failure to address racism in nursing?” “How can we engage in authentic reckoning with racism in nursing?” “How can this reckoning shift nursing to more fully engage in facilitation of humanization for those who have historically been harmed by racism?” “How can nursing knowledge be decolonized to fully embrace the knowledge and wisdom of Black, Indigenous, Latina/x, and other nurses of color?”

From the Nursology.net sphere, we have addressed (explicitly and implicitly) questions such as: “What does decolonization of nursing knowledge mean?” “What dynamics have persisted to bring us to this point in history where the scholarship and theorizing of Black, Indigenous, Latina/x and other nurses of color are strikingly absent from our historical record?” “How can we move away from performative action, to fully abandon white privilege in nursing, and to welcome nurse scholars of color to the center of our discourse?”

I do not have direct answers to any of these questions. In fact I believe there are no specific “action” prescriptions that can provide “answers.” The response to all of these questions is what I believe to be critical emancipatory process — a process that begins with a recognition of the fundamental realities of racism and dedication to the hard work of deepened awareness and action for change. In the first chapter of the text “Philosophies and Practices of Emancipatory Nursing,”(1) Kagan, Smith and Chinn identified the following characteristics of emancipatory knowledge and critical theory that informs emancipatory action, as revealed by the chapter authors who contributed to the text:

What is “critical’ –

  • Unpacking hegemonies
  • Upstream thinking
  • Interrogating historical/social context
  • Framing/anticipating transformative action

What is “emancipatory”

  • Facilitating humanization
  • Disrupting structural inequities
  • Self-reflection
  • Engaging communities

Taken together, these characteristics point to a deep understanding of what it might mean to bring knowledge and action together as one – the process and understanding that emerges from “knowing what we do, and doing what we know.” In my experience growing up and becoming an “elder” as a fully colonized white woman, I know all too well the experience of separation of mind and body, of understanding and experience. But there is a glimmer of recognition when I encounter instances – my own and those revealed to me in stories others recount – when experience and understanding come together as one – when we recognize the importance of personal knowing and doing. And, recognize when that unified experience reveals new knowledge, new understanding. This process of action/reflection is theorizing at its best. African American scholar Anthony James Williams described this process of theorizing that he observed in his mother and grandmother:

Everyday black women theorists are often forgotten, undervalued and rarely considered theorists due to their lack of formal training and scholarly publications. But for my maternal lineage, the social patterns they observed became lessons. Those lessons then became theories about the social world they incorporated into their daily lives. Keen observation on their part lead to mental maps of where it would be safe to walk as black women, raise their children and avoid white violence. As the wife of a man in the military, my grandmother inevitably had her own theory of residential redlining based on her lived experience well before any academics published on the topic. (2)

Now is the time to engage in the critical emancipatory act of centering the voices of nurses of color who have been undervalued and discounted, only rarely recognized as theorists. The privileged white gaze from which nursing scholarship views the world recognizes only that which appears consistent with white experience, white culture. To face the realities surrounding white complicity that perpetuates racism is a possibility that is either far too frightening, or simply not comprehensible. But comprehend we must if we are to ever move to a reality where all experience is celebrated as valid and valuable, where skin color is not a determinant of whether you live or die.

The time has now come for all in our discipline – nursologists, nurses, students, educators, administrators, policy-makers – to make a strong and unequivocal turn away from all words and actions that render advantage for those whose skin is “white” and that disadvantage all of those with dark skin. It is time to abandon performative words and actions that claim to care for all, and turn instead to dismantle dehumanizing forces of racism and restore full humanization for all. For those who have white skin, it is time to reckon with your own complicity, unveiling the fault-lines (rifts, splits) created by the persistence of racism, and engage in the healing that must be done. For those who have dark skin, it is time to gather the courage to speak your truth, calling on your keen capabilities to discern injustice. For all of us together, it is time to form strong bonds of connection and support for this difficult path. It is a difficult path, but it is the path that will lead us to mental maps – to theorizing the healing that must take place. As we have experienced in our “Overdue Reckoning on Racism in Nursing” journey, it is also a path that is lined with moments of pure joy!

Sources:

  1. Kagan, P. N., Smith, M. C., & Chinn, P. L. (2014). Introduction. In P. N. Kagan, M. C. Smith, & P. L. Chinn (Eds.), Philosophies And Practices Of Emancipatory Nursing: Social Justice As Praxis (pp. 1–20). Routledge Taylor & Francis Group.
  2. Williams, A. J. (2018, June 15). Who Teaches Academics to Theorize? Inside Higher Ed. https://www.insidehighered.com/advice/2018/06/15/theorizing-black-scholars-differs-white-western-academic-standards-no-less-valid

Guest Post: Decolonizing the Language of Nursology

Contributor: Daniel Suárez-Baquero
Scroll down for Spanish language version of this post

ENGLISH

Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.

The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.

It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).

I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.

I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.

Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science

SPANISH

La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.

Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.

Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).

Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.

Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.

REFERENCES/REFERENCIAS

References

Ayala, R. A. (2020). Towards a Sociology of Nursing. In Towards a Sociology of Nursing. Springer Singapore. https://doi.org/10.1007/978-981-13-8887-3

Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2).
Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175

Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903

About Daniel Suárez-Baquero

Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.

Nursing is a Discipline–Donaldson and Crowley Notable Work

Notable Works

The first time that I understood that nursing – what we now call nursology (Fawcett, 2018; Fawcett et al., 2015) – is a discipline was in 1978 when I read the just published Donaldson and Crowley’s now classic journal article, “The discipline of nursing.” My pride in what we are has always been great, so realizing that we are members of a discipline increased my pride from great to greater. I should note that at the time of publication of the Donaldson and Crowley (1978) paper, I did not know about Moore’s 1968 paper, “Nursing: A scientific discipline?” which certainly was due to my admittedly sloppy scholarship!

Sue Donaldson

As I continued to think about nursology as a discipline, I realized I needed to determine the accepted definition of the word. I found that the term, discipline, comes from the Latin disciplina, meaning a branch of instruction or learning (Stein, 1966). Disciplines are distinguished by the subject matter of interest to its members (Schwab, 1962; Walton & Kuethe, 1963). Disciplines are a way of organizing knowledge; they have utility as administrative structures for education.

Donaldson and Crowley’s (1978) article is especially important for their telling us what we are all about. They pointed out, “At least since the time of Nightingale, there has been a remarkable consistency in the recurrent themes that [nursologist] scholars use to explain what they conceive to be the essence of the core of [nursology].” (p. 113). They identified the three general themes listed below. So influential were these themes to me that they became the first version of the relational propositions for my version of our disciplinary metaparadigm (Fawcett, 1984).

*Concern with principles and laws that govern the life processes, well –being, and optimum functions of human beings—sick or well

*Concern with the patterning of human behavior in interaction with the environment in critical life situations

*Concern with the processes by which positive changes in health status are affected. (Donaldson & Crowley, 1978, p 113)

Donaldson and Crowley (1978) identified two types of disciplines– academic and professional. They maintained that nurses (nursologists) are members of a professional discipline and, as such, nursologists have a social mandate to not only develop and disseminate knowledge, but also to use the knowledge in service to human beings. Members of academic disciplines, in contrast, develop and disseminate knowledge but do not have a social mandate to use the knowledge in service to anyone or anything.

Donaldson and Crowley’s (1978) claim that we are members of a professional discipline led me to search for a definition of a profession. I found that the term, profession, refers to a vocation requiring knowledge of some branch of learning (Stein, 1966). Obviously, the emphasis in the definitions of both discipline and profession is knowledge.

As can be seen in the diagram below, which was inspired by Donaldson and Crowley’s (1978) ideas about a professional discipline, I envision the components of the professional discipline of nursology to be science and the profession. For nursology, science encompasses eight types of knowledge—empirical, aesthetic, ethical, personal knowing, sociopolitical, emancipatory, spiritual, and unknowing, too (Carper, 1978; Chinn & Kramer, 2018; Munhall, 1993; White, 1995; Willis & Leone-Sheehan, 2019). Discovery and dissemination of knowledge is accomplished by means of the conduct and publication of the results of scholarly inquiry, including basic, applied, and clinical research (Donaldson & Crowley, 1978), as well as translational research (Wendler et al., 2013). Utilization of knowledge is accomplished by means of implementing the results of translational research into clinical practice activities as well as into educational programs and administration of nursology services.

The double-headed arrows in the diagram indicate that there is a reciprocal relation between science and the profession; between discovery and dissemination of knowledge and utilization of that knowledge; and between scholarly inquiry and practice. Ultimately, the results of utilization of disciplinary knowledge in practice are used to advance the scholarly inquiry that is required for further discovery and dissemination of knowledge.

Moore (1968) and Donaldson and Crowley (1978) indicated that scholarly inquiry guides practice. Thus, the starting point for the reciprocal relation between scholarly inquiry and practice always is scholarly inquiry. Some nursologists may disagree, maintaining that ideas for scholarly inquiry arise from problems encountered in practice. However, Donaldson and Crowley (1978) maintained that “the discipline of [nursology] should be governing clinical practice rather than being defined by it” (p. 118). They went on to explain,

Of necessity, clinical practice focuses on the individual in the here and now who has a problem requiring relevant and appropriate actions. The discipline, in contrast, embodies a knowledge base relevant to all realms of professional practice and which links the past, present and future. Its scope goes far beyond that required for current clinical practice. If the discipline were so narrowly defined, professional [nursology] could be limited to functioning in the realm of disaster relief rather than serving as a force in the promotion of world health. (p 118)

The major impact of Donaldson and Crowley’s (1978) artice is that understanding and recognizing that nursologists are members of a discipline provides the rationale for our place in the academy of higher education among other widely and long-recognized disciplines. Moreover and perhaps most important, are Donaldson and Crowley” (1978) closing words:

For the continued growth, significance, and utility of the discipline of [nursology], researchers must place their research within the context of the discipline. Theories must also be viewed in terms of the basic structural conceptualizations of the discipline [i.e., our nursology conceptual models]. The responsibility for revising and clarifying the structural conceptions, the very framework, of the discipline of [nursology] rests with [nursologist] researchers. This means lessening our preoccupation with the process of [nursology practice] and pedagogy and placing emphasis on content as substance. (p. 120).

Content as substance was, of course, the reason for creation of nursology.net.

References

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23.

Chinn, P. L., & Kramer, M. K. (2018). Knowledge development in nursing: Theory and process (10th ed.). Elsevier Mosby.

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26(2), 113-120

Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16(3), 84 87.Fawcett, J. (2018, September 24). Our Name: Why Nursology? Why .net? nursology.net.. https://nursology.net/2018/09/24/our-name-why-nursology-why-net/

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L, Mtengezo, J. T., Muchira, J. M., Nava, A., Thapa, S., & Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224

Moore, M. A. (1968) Nursing: a scientific discipline? Nursing Forum, 7(4), 340-348. (Reprinted Nursing Forum, 1993, 28(1), 28-31.)

Munhall PL. (1993). “Unknowing”: toward another pattern of knowing in nursing. Nursing Outlook, 41(3), 125–128.
Schwab, J. (1962). The concept of the structure of a discipline. Educational Record, 43(July), 197-204.

Stein, J. (Ed.). (1966). The Random House dictionary of the English language (Unabridged ed.). Random House.

Walton, J., & Kuethe, J. L. (Eds.). (1963). The discipline of education. University of Wisconsin Press.

Wendler, M. C., Kirkbride, G., Wade, K., & Ferrell, L. (2013). Translational research: A concept analysis. Research & Theory for Nursing Practice, 27(3), 214–232. DOI: 10.1891/1541-6577.27.3.214

White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86.

Willis, D. G., & Leone-Sheehan, D. M. (2019). Spiritual knowing; Another pattern of knowing in the discipline. Advances in Nursing Science, 42(1), 58-68. doi: 10.1097/ANS.0000000000000236

Winning Essay – “Bringing Florence Nightingale to the Bedside of the Critically Ill Patient”

In celebration of the bicentenary of Florence Nightingale’s birth, the Nursing Archives Associates of the Boston University Libraries’ Howard Gotlieb Archival Research Center held an essay contest, open to nursing students enrolled at all levels of study— undergraduate, master’s and doctoral – and focused on Florence Nightingale’s influence on the evolution of nursing, both historical and contemporary. Although all Nightingale 2020 events were postponed due to the COVID-19 pandemic, we are proud to announce the winner of the Muriel A. Poulin Nursing Student Essay Contest.

The winning essay is titled “Bringing Florence Nightingale to the Bedside of the Critically Ill Patient,” written by Laura Beth Kalvas, MS, RN, PCCN, Graduate Fellow, The Ohio State University College of Nursing. Here is the essay:

In her Notes on Nursing (1969), Florence Nightingale argued that nature alone can cure the sick. Cautioning against an over-reliance on medical care, which could do nothing more than remove obstructions to the natural healing process, Nightingale encouraged nurses to put patients in the best possible conditions for nature to act upon them. Her environmental theory highlighted the importance of cleanliness, ventilation, limited noise, uninterrupted sleep, proper nutrition, and sunlight in promoting recovery of the sick (Hegge, 2013; Nightingale, 1969). Within this perspective, the role of the nurse was to provide an environment conducive to healing, support the patient in the healing process, and carefully observe the patient for signs of improvement or decline.

Certainly when Nightingale cautioned against an over-reliance on medical care, she could little have imagined the treatments and technology available today, especially in the care of the critically ill. Yet her careful distinction between the practice of medicine and the practice of nursing remains relevant. In the complex critical care environment, where medical treatments are frequently lifesaving, what unique contribution does the nurse bring to the care of the critically ill patient? I would argue that the role of the critical care nurse remains the same; to put the patient in the best possible condition for nature to act upon them (Nightingale, 1969). Yet “so deep-rooted and universal is the conviction that to give medicine is to be doing something, or rather everything; to give air, warmth, cleanliness . . . is to do nothing” (p. 9), that this important aspect of nursing practice is easily undervalued.

The phenomenon of pediatric delirium offers an interesting case study in the importance of high-quality nursing care in the modern intensive care unit. Delirium is a frequent, significant complication of critical illness consisting of acute changes in mental status that develop over a short period of time and fluctuate throughout the day (American Psychiatric Association, 2013). Up to 65.5% of children in the pediatric intensive care unit (PICU) experience delirium (Meyburg et al., 2017). Affected children exhibit signs of impaired attention, disorientation, agitation, hallucinations, and sleep/wake cycle disturbance (Holly et al., 2018). Children describe their delusional memories of the PICU as highly disturbing, including visual hallucinations of injured
parents, monsters trying to eat them, and insects crawling on the walls (Colville et al., 2008). Furthermore, pediatric delirium is associated with poor clinical outcomes, including increased length of stay (Smith et al., 2017), cost of care (Traube et al., 2016), and mortality (Traube et al., 2017).

Although delirium has only recently caught the attention of the pediatric critical care community (Kudchadkar, Yaster, et al., 2014), it is not a new phenomenon. Through her observations, Nightingale (1969) noted that lack of sunlight, excessive noise, and fragmented sleep were associated with delirium. Today’s pediatric critical care environment is characterized by excessive light and sound exposure and frequent nighttime caregiving (Al-Samsam & Cullen, 2005; Cureton-Lane & Fontaine, 1997). This environment likely contributes to the altered sleep patterns experienced by critically ill children (Kudchadkar, Aljohani, et al., 2014). Providing support for Nightingale’s (1969) early observations, we now know that these environmental exposures and resulting sleep disruption can impair cognitive function (e.g., attention, working memory, emotional regulation; Durmer & Dinges, 2005; Kahn et al., 2013) and disrupt the circadian rhythm of melatonin release, which has neuroprotective properties (Claustrat et al., 2005). Environmentally-induced circadian rhythm dysregulation is one hypothesized pathway to the cognitive changes observed in delirium (Maldonado, 2017), and sleep/wake cycle disturbances are often observed in children with delirium (Holly et al., 2018).

Nurses are uniquely positioned at the bedside to prevent delirium through environmental modification and regulation of the circadian rhythm; interventions which place the patient in the best possible conditions for recovery (Nightingale, 1969). Sleep promotion interventions in the adult ICU are associated with a decreased incidence and duration of delirium (Kamdar et al., 2013; Patel et al., 2014). However, few researchers have considered the role of sleep in the development of pediatric delirium (Calandriello et al., 2018), and few pediatric critical care clinicians implement sleep-promoting interventions to prevent or manage delirium (Kudchadkar, Yaster, et al., 2014; Staveski et al., 2018). Nurse scientists are needed in the medically-dominated field of pediatric delirium research to highlight the important role of the critical care nurse in preventing and managing delirium (Balas et al., 2012).

As a doctoral nursing student, my interest in pediatric delirium is driven both by Nightingale’s (1969) mandate to the nursing profession and the Human Response Model, a conceptual model for nursing that depicts the complex interplay between the patient, their environment, and their health (Heitkemper & Shaver, 1989; Shaver, 1985). My dissertation work focuses on the relationship between exposures in the pediatric critical care environment (i.e., light and sound exposure, caregiving patterns), sleep disruption, and delirium in young, critically ill children. I chose to focus on PICU environmental exposures and sleep patterns because they are inherently nurse-driven; as the primary bedside caregiver, the nurse determines the type of environment in which children receive treatment. This dissertation study will inform future large-scale stu dies of sleep disruption and pediatric delirium, as well as the design and implementation of sleep promotion interventions for the PICU. The validation of sleep promotion as an effective, nurse-driven, non-pharmacological delirium prevention method has the potential to improve the neurocognitive symptom management and clinical outcomes of survivors of pediatric critical illness.

In my future work as a nurse scientist, I will continue to root my research in the ideals espoused by Nightingale in her Notes on Nursing (1969). My long-term career goal is to become a leader in improving the neurocognitive symptom management, clinical outcomes, and long-term health of critically ill children by optimizing the pediatric critical care environment. In today’s complex critical care setting, full of advanced treatments and lifesaving technology, let us never forget the unique role of the nurse: To place critically ill patients in the best possible intensive care environment to receive life saving treatment, heal, and promote long-term health.

References

Al-Samsam, R. H., & Cullen, P. (2005). Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients. Pediatric Critical Care Medicine, 6(5), 562–7.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012). Critical care nurses’ role in implementing the “ABCDE bundle” into practice. Critical Care Nurse, 32(2), 35–8, 40–7; quiz 48. https://doi.org/10.4037/ccn2012229

Calandriello, A., Tylka, J., & Patwari, P. (2018). Sleep and delirium in pediatric critical illness: What is the relationship? Medical Sciences, 6(4), 90. https://doi.org/10.3390/medsci6040090

Claustrat, B., Brun, J., & Chazot, G. (2005). The basic physiology and pathophysiology of melatonin. Sleep Medicine Reviews, 9(1), 11–24. https://doi.org/10.1016/J.SMRV.2004.08.001

Colville, G., Kerry, S., & Pierce, C. (2008). Children’s factual and delusional memories of
intensive care. American Journal of Respiratory and Critical Care Medicine, 177(9), 976–982. https://doi.org/10.1164/rccm.200706-857OC

Cureton-Lane, R. A., & Fontaine, D. K. (1997). Sleep in the pediatric ICU: an empirical investigation. American Journal of Critical Care, 6(1), 56–63.

Durmer, J. S., & Dinges, D. F. (2005). Neurocognitive consequences of sleep deprivation. Seminars in Neurology, 25(1), 117–129. https://doi.org/10.1055/s2005-867080

Hegge, M. (2013). Nightingale’s Environmental Theory. Nursing Science Quarterly, 26(3), 211–219. https://doi.org/10.1177/0894318413489255

Heitkemper, M. M., & Shaver, J. F. (1989). Nursing research opportunities in enteral nutrition. The Nursing Clinics of North America, 24(2), 415–26.

Holly, C., Porter, S., Echevarria, M., Dreker, M., & Ruzehaji, S. (2018). Recognizing delirium in hospitalized children: A systematic review of the evidence on risk factors and characteristics. American Journal of Nursing, 118(4), 24–36. https://doi.org/10.1097/01.NAJ.0000532069.55339.f9

Kahn, M., Sheppes, G., & Sadeh, A. (2013). Sleep and emotions: Bidirectional links and
underlying mechanisms. International Journal of Psychophysiology, 89(2), 218–228. https://doi.org/10.1016/j.ijpsycho.2013.05.010

Kamdar, B. B., King, L. M., Collop, N. A., Sakamuri, S., Colantuoni, E., Neufeld, K. J., Bienvenu, O. J., Rowden, A. M., Touradji, P., Brower, R. G., & Needham, D. M. (2013). The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Critical Care Medicine, 41(3), 800–9. https://doi.org/10.1097/CCM.0b013e3182746442

Kudchadkar, S. R., Aljohani, O. A., & Punjabi, N. M. (2014). Sleep of critically ill children in the pediatric intensive care unit: A systematic review. Sleep Medicine Reviews, 18(2), 103–110. https://doi.org/10.1016/j.smrv.2013.02.002

Kudchadkar, S. R., Yaster, M., & Punjabi, N. M. (2014). Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: A wake-up call for the pediatric critical care community. Critical Care Medicine, 42(7), 1592–1600. https://doi.org/10.1097/CCM.0000000000000326

Maldonado, J. R. (2017). Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International Journal of Geriatric Psychiatry, 1-30 https://doi.org/10.1002/gps.4823

Meyburg, J., Dill, M. L., Traube, C., Silver, G., & von Haken, R. (2017). Patterns of postoperative delirium in children. Pediatric Critical Care Medicine, 18(2), 128–133. https://doi.org/10.1097/PCC.0000000000000993

Nightingale, F. (1969). Notes on nursing: What it is and what it is not. Dover Publications, Inc.

Patel, J., Baldwin, J., Bunting, P., & Laha, S. (2014). The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia, 69(6), 540–549. https://doi.org/10.1111/anae.12638

Shaver, J. F. (1985). A biopsychosocial view of human health. Nursing Outlook, 33(4), 186–91.

Smith, H. A. B., Gangopadhyay, M., Goben, C. M., Jacobowski, N. L., Chestnut, M. H., Thompson, J. L., Chandrasekhar, R., Williams, S. R., Griffith, K., Ely, E. W., Fuchs, D. C., & Pandharipande, P. P. (2017). Delirium and benzodiazepines associated with prolonged ICU stay in critically ill infants and young children. Critical Care Medicine, 45(9), 1427–1435.
https://doi.org/10.1097/CCM.0000000000002515

Staveski, S. L., Pickler, R. H., Lin, L., Shaw, R. J., Meinzen-Derr, J., Redington, A., & Curley, M. A. Q. (2018). Management of pediatric delirium in pediatric cardiac intensive care patients: An international survey of current practices. Pediatric Critical Care Medicine, 19(6), 538–543.
https://doi.org/10.1097/PCC.0000000000001558

Traube, C., Mauer, E. A., Gerber, L. M., Kaur, S., Joyce, C., Kerson, A., Carlo, C., Notterman, D., Worgall, S., Silver, G., & Greenwald, B. M. (2016). Cost associated with pediatric delirium in the ICU. Critical Care Medicine, 44(12), e1175–e1179. https://doi.org/10.1097/CCM.0000000000002004

Traube, C., Silver, G., Gerber, L. M., Kaur, S., Mauer, E. A., Kerson, A., Joyce, C., & Greenwald, B. M. (2017). Delirium and mortality in critically ill children: Epidemiology and outcomes of pediatric delirium. Critical Care Medicine, 45(5), 891–898. https://doi.org/10.1097/CCM.0000000000002324