Beyond the Boxes: Connecting Theory and Practice in a Pandemic

Guest contributor: Ellen E. Swanson
This is post is the final section of the new “Practice Exemplar”
describing the application of Mandalas in nursing

See also related Education Exemplar

In the process of writing the “Using Mandalas – An Holistic Approach to Practice” exemplars, Peggy Chinn shared with me that we need to “work toward a more complete and robust connection between theory and practice! The important thing for www.nursology.net is to give our viewers theory sources so that we can all deepen our appreciation of how important the theories of our discipline are!” Accordingly, I began to think about how the exemplars about mandalas reflect my theoretical thinking and how these exemplars can help all of us form a more complete and robust connection between nursing theory and practice, as well as deepen our appreciation for nursing theories.

The current COVID-19 pandemic is a very significant time to recognize the importance of connecting theory/science and practice.  As a nurse on the board of the 63 unit condo building in which I live, I have the opportunity to experience the value of connecting theory/science and practice during this pandemic.

I saw the immediate need for scientific education of the unit owners and proceeded to provide this with written information.  I then organized sanitizing teams with team leaders, by floors, with the focus on common areas where surfaces touched by all (i.e., laundry rooms, trash chute rooms) could be a source of spreading pathogens.  I practice by also being one of the team members. (During my career I always felt I could supervise better if I knew from experience what those I supervised were to be doing.)  I check two websites daily, looking for trends in the world and the nation, and use this and the information from CDC,  AHNA weekly updates, and HOA (Home Owners Association) legal requirements to keep owners informed and help make decisions about what is best for our vertical village.

The response has been very rewarding as everyone pulls together and the majority are gratefully caring about and serving one another.  In these times of national divisiveness, this is a gift.

A Healthier Linear Template

I ask that as you read the mandala exemplars, you become aware of your felt sense of the images in the exemplars. Look at the arched linear organizational chart model that lays the foundation for a more complete connection between theory and practice.

We can begin to understand the robust connection between nursing theory and practice by thinking creatively about the satellite and the mandala.

Merging two paradigms, Step one

The mandala is the sending and receiving dish of the satellite, representing nursing practice as we send and receive with patients/clients. The arched linear organizational chart model depicts the energy panels of the satellite and represents nursing theory, supporting and, therefore, energizing practice. Working together, we can successfully stay in orbit.

Satellites also have a few jets at the rear of the energy panels that keep them on course, making small directional corrections when needed. Much like a satellite’s course-correcting engines, theory can provide direction for needed changes that arise as our discipline adjusts to societal and informational shifts that come with human development over time. But theory does more than that. Theorists have committed years to conducting research about what practices work and why they work. The research yields a deep, rigorous science that informs the why, how, where, and when of what we do in practice. Furthermore, what occurs in practice provides the small and not so small directional corrections to the theory.

Just as all flowers are not the same color, all of us may resonate with a different theory to guide our practice. When we become aware of the various ways in which various theories can guide practice, we may select the theory or theories that best fit our own unique way of thinking and skill set. I came to this perspective toward the end of my career. I had always endeavored to hide how I practiced while maintaining all the requirements for licensure as a registered nurse. We hide when we feel fear. I also felt alone. About two years before I retired and after the first mandala application was made, I was sharing a few client stories with some colleagues, one of whom was Ellen Schultz  (See Education Exemplar)

Ellen quietly noted, “I think you might resonate with Modeling and Role-Modeling Theory.” I reviewed the theory and realized that she was absolutely right. I breathed a sigh of relief as I realized that a nursing theory actually had been my practice guide for all those years. I realized that I could have had a much less fearful and lonely career.

Then I started thinking deeply about how I might have learned to use Modeling and Role Modeling Theory without having known about it. Recall of an event in my life helped me understand this. The event involved a visit with my mother at the time of her 98th birthday; I journeyed 600 miles to be with her and to share with her some of my heart-centered stories from the 46 year nursing career from which I was retiring. I read some stories to her, and she was deeply touched, wondering how I learned to intervene with my clients in such a way. I told her that although she had taught me, I didn’t think she was aware of what she had given me. Indeed, she was surprised and wondered how she had taught me. I reminded my mother of the example of her friend Edith’s final months; Edith had died of brain cancer 35 years before. My mother had told me that she had spent time reading to Edith when Edith could no longer read. During one time of reading, Edith suddenly sat up in bed and anxiously interrupted my mother, saying, “Liz! There are worms crawling out of that book!” My mother replied, “Where?” Edith pointed, “Across the top!” My mother scooped her hand across the top of the book and asked,  “Did I get them all?” Edith visibly relaxed back into her pillow and told my mother that she had indeed gotten them all. My mother then continued reading to Edith. I explained to my mother that what she had role modeled with that example was how to step into another person’s reality and participate where that person is. She nodded slowly, saying it was just something she did intuitively without being aware of it. I then related this to how I had done that in the career stories I had read to her. I thanked her for that gift, letting her know I had only become aware of her gift because I had been asked by a few of my colleagues to write some of my orally shared stories.

This was a gift exchange. The first gift was given without explicit awareness. The return gift was to bring explicit awareness, express gratitude for the role modeling, and acknowledge the positive effect on those who benefitted from the teaching. The greatest gift was a strengthened, heartfelt relationship between mother and daughter.

I ask now, has there been a time when something implicitly led you, and then you became aware of it later? Did that change your perspective in any way? Was there a gift you received that you hadn’t been aware of before?

Nursing theories can help us become aware of who we are and what we have to offer. There is a history of practicing nurses feeling inferior or disinterested in theory, and

Merging two paradigms Step 2

theory nurses feeling dismissed by practicing nurses. Both need time to heal. Healing is a sacred process, and when deep healing occurs, it includes vulnerability and compassion. Perhaps this next image will help us heal by showing how much we need each other.

Here the arched linear organizational chart model, representing theory, has become a container. A container with no contents is empty. The mandala, the contents, represents practice. With no container the contents float away and disappear. Together we form a Holy Grail of practical, professional, and knowledgeable service to humankind. We simultaneously blossom and grow our profession.

Merging two paradigms Step 3

The next image represents this flowering.  There can be a sacred union within each of us and between theory and practice. Let us grow that union by nurturing and nourishing each other’s gifts. Holistic nursing theory concepts of expanded consciousness, oneness, transpersonal connections, healing, being, and process of becoming are illustrated throughout the mandala exemplars.

 

Ellen Swanson

Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired) had a 46 year career that included ortho-rehab, mental health, operating room, management, teaching, care managing, and consulting. For fifteen years she had a private practice in holistic nursing, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.

Never a Guardian: Remembering Breonna Taylor

Want to learn more about Nursing and Racism? Read the following Nursology blogs: Nursing and Racism and Decolonizing Nursing.

Artwork used with permission of the artist Ariel Sinha

The Guardians of the Discipline is a series featured on Nursology.net as a way to commemorate the giants whose shoulders we stand on as we forge our nursing paths. Today, we – the Nursology Theory Collective – would like to memorialize someone who never had the chance to join the discipline, though we understand that she intended to be a nurse (Oppel & Taylor, 2020). Her name is Breonna Taylor. Murdered by the police executing a “no-knock” warrant, Breonna Taylor, a Black woman, was murdered as she slept in her home. Startled by the unannounced and forced entry of Louisville law enforcement, Breonna Taylor’s boyfriend – a licensed gun owner – began firing his gun, assuming their home was being invaded. The police returned fire, striking Breonna who died six excruciating minutes later, no aid ever rendered (Simko-Bednarski et al., 2020). Final analyses showed the police had invaded the wrong home and that she remained alive for minutes without critical aid being offered. Lack of further investigations suggests that  Breonna Taylor’s life has seemingly been brushed aside. To date, no one has been held accountable for her murder. The no-knock policy remains uninterrogated (Oppel & Taylor, 2020).

We wish to honor Breonna Taylor, recognizing the structural missingness her death signifies in our profession (Hopkins Walsh & Dillard-Wright, 2020). NTC members Jane Hopkins Walsh and Jessica Dillard-Wright (2020) “synthesized the concept of structural missingness to capture the state of exclusion from healthcare due to inequalities within a system, a country or globally” (p.1). The concept was imagined to capture the injustices and inadequacies of talking about healthcare as a structurally-sound starting place for any kind of analysis, recognizing the people and groups who are all too often missing in colonized and capitalism driven spaces. In this blog post, we wish to extend this concept, recognizing the implications that the murder of Breonna Taylor has for nursing, acknowledging that nursing will never have the opportunity to learn from her knowledge and experience. 

Breonna Taylor’s murder is a structural missingness double-jeopardy. Her murder points to violent systemic racism, inequities and injustice. As a discipline, nursing is part of the racist system, and carries this internalized and systematized racial prejudice (Barbee, 1993; Barbee & Gibson, 2001). Nursing bears the hallmarks of normative whiteness, part of the hidden curriculum of nursing enacted through practices rooted in the received values around respectability; what are accepted dress codes, hairstyles, body art, leading to gatekeeping, professionalism codes, and civility policing that narrowly define what a nurse looks like (Allen, 2006; Puzan, 2003).  Scholar Ibraham Kendi refers to this implicit racist system as the “White judge” (Kendi, 2017 p. 4). Nursing professor @UMassWalker recently spoke to this idea in their critique of the vague and subjectively worded term “good moral character” bound within their university’s prelicensure nursing syllabus (see Twitter post from July 22, 2020). Dr. Walker’s blog post the next day further expanded upon the issues of institutional racism in the system of nursing education. These enshrined messages and images of how nurses ought to look, speak and act connect back to our received historical narratives- the stories that tell stories (Haraway, 2016). 

The Nightingale chronicles are an example of how this image of normative whiteness in nursing continues to be the dominant legend for all who enter the profession. The reified Nightingale history embeds systemic values that intersect race narratives alongside received norms for behavior, gender, sexuality, and class. Mary Seacole who self identified in her writings as a Creole person, was a Jamaican nurse and peer of Nightingale’s who was awarded international medals for her service in the Crimean war. She was a published author, commented on political issues of slavery and racism, made scientific observations around cholera and diarrhea, but historical letters suggest she was deemed unsuitable for service by Nightingale and other British authorities. Her contributions to nursing are underreported, diminished and debated to this day (McDonald, 2014; Staring‐Derks et al., 2015).

Breonna Taylor will never graduate from nursing school. Murdered in her sleep, she has been rendered structurally missing by virtue of her death by brutal aggressive police actions, a victim of the very institution that purports to serve and protect. Breonna is forever erased from our discipline. We recognize this injustice and by honoring her memory, we refuse to ignore the political ideologies that fail to interrogate aggressive policing systems that neglect to bring her killers, who are still free, before the court. Her death speaks to the complex and structurally violent structures that silently continue to collude, reifying nursing’s hegemony through systematic exclusions and injustices surrounding Black people who are systematically oppressed and erased. We, the discipline of nursing, are not immune from the effects of police brutality, and as a result a future nurse and colleague is missing. Furthermore, nursing is not immune from perpetuating racist systems. We must actively work towards a more just, equitable, and inclusive discipline, recognizing that the minimum bar of humanness demands actively protesting and opposing police brutality and the unacceptable murders of Black people, including Breonna Taylor.

What can you do to support Breonna Taylor, who never got to be a guardian of our discipline?

  1. Learn more about Breonna Taylor and her murder.
  2. Sign a petition demanding justice for Breonna Taylor’s murder.
  3. Read the Nursology Theory Collective anti-racism statement and commit to be actively anti-racist. 
  4. Use the platforms you have to name, address, and dismantle racism and white supremacy in the systems in which you work and live.
  5. Contact your local, state and federal elected officials weekly to inquire about legislation they are enacting to combat violent police practices against Black people and other Non Black People of Color.
  6. Consider running for elected office to embody the change we want to see.
  7. Constructively critique existing nursing theories and philosophies to deconstruct the effects of colonization of our formal knowledge base and to understand the ways that racialized systems and structures influence the development of our discipline.
  8. Use these insights to develop anti-racist research, theory, education, practice and policy that is aimed to decolonize nursing.

References

Allen, D. G. (2006). Whiteness and difference in nursing. Nursing Philosophy, 7(2), 65–78. https://doi.org/10.1111/j.1466-769X.2006.00255.x

Barbee, E. L. (1993). Racism in US nursing. Medical Anthropology Quarterly, 7(4), 346-362. https://doi.org/10.1525/maq.1993.7.4.02a00040

Barbee, E. L., & Gibson, S. E. (2001). Our dismal progress: The recruitment of non-whites into nursing. Journal of Nursing Education, 40(6), 243-244. https://doi.org/10.3928/0148-4834-20010901-03

Haraway, D. J. (2016). Staying with the Trouble: Making Kin in the Chthulucene. Duke University Press.

Hopkins Walsh, J., & Dillard-Wright, J. (2020). The case for “structural missingness:” A critical discourse of missed care. Nursing Philosophy, 21(1), 1–12. https://doi.org/10.1111/nup.12279

Kendi, I. X. (2019). How to be an antiracist. One world.

McDonald, L. (2014). Florence Nightingale and Mary Seacole on nursing and health care. Journal of Advanced Nursing, 70(6), 1436–1444. https://doi.org/10.1111/jan.12291

Oppel, R. A., & Taylor, D. B. (2020, July 9). Here’s What You Need to Know About Breonna Taylor’s Death. The New York Times. https://www.nytimes.com/article/breonna-taylor-police.html

Puzan, E. (2003). The unbearable whiteness of being (in nursing). Nursing Inquiry, 10(3), 193–200. https://doi.org/10.1046/j.1440-1800.2003.00180.x

Simko-Bednarski, E., Snyder, A., & Ly, L. (2020, July 18). Lawsuit claims Breonna Taylor lived for “5 to 6 minutes” after being shot. CNN. https://www.cnn.com/2020/07/18/us/breonna-taylor-lawsuit/index.html

Staring‐Derks, C., Staring, J., & Anionwu, E. N. (2015). Mary Seacole: Global nurse extraordinaire. Journal of Advanced Nursing, 71(3), 514–525. https://doi.org/10.1111/jan.12559

Orem’s Self-Care Theory: A Critical Theory to Tanzania Nurses in the Wake of COVID-19

Guest author: Katunzi Mutalemwa
with Rosemary Eustace

see also Practice Exemplar
Self-Care Theory in Tanzania

Self-care is an integral part of nursing care delivery systems. Pioneered by Dr. Dorothea Orem, the self-care theory offers nurses with unique opportunities for health promotion, disease prevention and rehabilitation care worldwide. Self-care supportive-educative strategies through health promotion and prevention initiatives have been instrumental in health care service delivery in Tanzania, especially in primary care clinics. The emerging COVID-19 pandemic has delineated new care demands on self-care requisites that Tanzania populations need to meet in order to stay healthy and free of the illness.  With such a pandemic, nurses are being tasked to find new ways of assisting clients to effectively meet their self-care needs that best fit the cultural context.  So the following question remains to be answered: What kind of nursing system(s) are in demand in Tanzania in this COVID-19 era? 

The Orem’s Self-care theory guided the practice exemplar “Self Care Theory in Tanzania.” This exemplar highlights two common self-care strategies utilized in Tanzania in the wake of COVID-19, that we identify as Non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care nursing interventions.  The first example is focused on hand washing as a basic NP self-care strategy.  The second example relates to complimentary alterative medicines (CAM) as an Alternative pharmaceutical (AP) self-care strategy in particular herbal steam therapy (commonly known as kujifukiza in Kiswahili).

As the most trusted health care professionals in the world, we “nurses” have the duty and responsibility to help individuals, families and communities to be able to choose and select the right information for self-care.   In the wake of COVID-19, nursing self-care delivery systems should focus on prevention and health promotion in a safe and cost-effective manner. This approach supports Dr Jacqueline Fawcett assertion that “Nursology has an answer to how to emphasize primary prevention.” [Read her blog The Value of Primary Prevention]. This is the right time to do so.  We have to be part of the solution by being proactive and advocating for effective non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care policies through the lens of unique nursing perspectives, in this case, Orem’s Self-Care theory. 

The two exemplars clearly tell the story that upon planning of any successful health-related project, it is important to understand the extent of self-care practices in a community, collaboration, training needs in self-care and development of guidelines/protocols. The “Kujifukiza” (i.e. herbal steam therapy) phenomenon was eye opening. It is not surprising to see that Sub-Saharan nurses are receptive of alternative modalities but lack appropriate knowledge about complementary health therapies (Gyasi, 2018).   For example, I (Katunzi) am one of those nurses who lack appropriate knowledge about CAM. I was not fortunate to have this kind of education in my nursing program beside a one-day CAM observational opportunity during a palliative care rotation. I am now compelled to advocate for nursology-led initiatives to study and promote evidence-based protocols or guidelines. 

There is a lot to be done and a lot to learn from each other about Orem’s self-care theory guided practice related to NP and AP self-care strategies. To continue this dialogue on NP and AP self-care strategies, we would like to invite nurses and nursing students around the world to reflect on the COVID-19 pandemic as it relates to these important self-care issues:

  1. How has hand washing, a non-pharmaceutical (NP) self-care public health strategy been utilized within your cultural context (family, workplace or community)?
  2. How has alternative pharmaceutical (AP) self-care public health strategies been utilized in your cultural context (family, work place or community)?
  3. If Dorothea Orem lived to see the COVID-19 pandemic, what do you think she would say about nurses, nursing and self-care?

Please share your thoughts in the comment chat box. We look forward to hearing from you!

Suggested Readings

Mutalemwa, K. & Eustace, R. (2020). Self-Care Theory in Tanzania. Nursology.net Practice Exemplar https://nursology.net/practice-theory-exemplars/self-care-theory-in-tanzania/

Dorothea Orem: Self-Care Deficit Theory https://nurseslabs.com/dorothea-orems-self-care-theory/  web accessed on 29/05/2020

Gyasi, R. M. (2018). Unmasking the practices of nurses and intercultural health in sub-Saharan Africa: a useful way to improve health care?. Journal of evidence-based integrative medicine, 23 2515690X18791124.

Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange https://www.who.int/reproductivehealth/self-care-interventions/definitions/en/ web accessed on 08/06/2020

About Katunzi Mutalemwa

Katunzi Mutalemwa, BScN is an evolving young Tanzanian nurse leader who just completed his baccalaureate nursing education in the Fall 2019. He is currently working on a Non-Communicable Diseases (NCDs) project in Tanzania and waiting to start his one year nursing internship at Kilimanjaro Christian Medical Center in November 2020. Mr. Katunzi was honored to write his BScN thesis on ‘Nurses Experiences of Caring LGBTQ Patients with HIV Infections guided by Travelbee’s Human-to-Human Relationship Model’ at Swedish Red Cross University in Sweden. He recently published a book titled “Nurses the Cornerstone of Health Care System” to inspire his fellow nurses in Tanzania. He is the former Chairperson of the University Nursing Students Association of Tanzania (UNSATA). He would like to thank Dr Rosemary Eustace for her mentorship in preparing this information for Nursology.net.

Uncertainty in Life and in the Time of the Covid-19 Pandemic

Uncertainty is, in many ways, a human condition—each of us most likely feel uncertain about something at least some time in our life. However, the current covid-19 pandemic has brought forth a time of what is great uncertainty for many people worldwide. What, though, is the meaning of uncertainty and the outcome of feeling uncertain?

Merle Mishel’s Theory of Uncertainty in Illness tells us that uncertainty is “the inability to determine the meaning of illness-related events” (Mishel as cited in Clayton Dean, & MIshel, 2018, p. 49). More generally, uncertainty is defined as “The state of not being definitely known or perfectly clear; doubtfulness or vagueness. . . . the quality of being indeterminate as to magnitude or value” (Oxford English Dictionary, 1921/1989).

Mishel’s theory also tells us that uncertainty may be regarded as a danger or an opportunity. What are dangers associated with uncertainty during the covid-19 pandemic? Mental health problems, such as anxiety and depression, have been cited as a danger—Chinn wrote of the “Hidden Risks of Physical Distancing and Social Isolation” during the current pandemic. Foli wrote about the psychological trauma experienced by nurses caring for people with covid-19.

What are opportunities associated with uncertainty during the covid-19 pandemic? Media attention to the inequities of health care based on race is an opportunity to highlight what nursologists have known at least since the time of Florence Nightingale. The nursology.net management team has crafted a statement in support of the elimination of health care inequities that is visible in the sidebar of this website. The statement reads in part, “We are dedicated to building praxis in nursing that reflects the tradition of nursing’s dedication to social justice, that addresses injustice, and that welcomes dialogue and action focused on creating needed change within nursing and healthcare.” All nursologists have an opportunity, on which we must now capitalize, to be at the forefront of developing and applying knowledge to overcome finally widely recognized racial-based health care inequities. We must grasp the opportunity given to nursologists by the media and wider society to be recognized as competent and compassionate carers of people critically ill with covid-19. By doing so, we will actualize #neverforget, which Balakrishnan (2020) used to refer to climate change but is perfect for nursology especially at this time.

 Michsel’s Revised Theory of Uncertainty in Illness  tells us that the outcome of feeling uncertain is a new life perspective. What is a preferred new live perspective? Are nursologists and all citizens of our planet willing to a new value system to guide the way we live and interact with others?

Although Mishel’s theories are about uncertainty in illness, many other facets of life involve uncertainty. For example: Will my car start today? Will public transportation be on time? Will the meal I ordered or cooked myself be delicious? Will my family member or friend like the gift I purchased for her or him? Will my partner always love me? Extended to knowledge development, we know that  inferential statistics used to test theoretical hypotheses do not produce results that are “facts” or “laws,” but instead are numbers that represent a certain level of probability – we are, for example,  95% (p = 0.05) or 99% (p = 0.01) certain about some result but %5 or 1% uncertain about the result. Thus, much of what we know empirically is under conditions of uncertainly.

Clearly, if we are to live comfortably with uncertainty, we need to be comfortable with learning that which is not yet certain (if it can ever be certain!). Within the context of theory development, we can learn from rejection of our hypotheses. Indeed, Popper (1963) maintained that rejection of hypotheses is desirable as the next hypothesis will be better–we will have a better theory.  Glanz (2002) added, “There is as much to learn from failure as there is to learn from success” (p. 546).  Knowing “what is not” advances theory development by eliminating a false line of reasoning before much time and effort are invested. Thus, wanting to be certain may be a trap that leads to arrogance or a barrier to accepting at least a certain extent of uncertainty. Paraphrasing Barry (1997), who wrote about truth in science, we can indicate that one can reach certainty “no more than one can reach infinity” (p. 90).   

References

Barry, J. M. (1997). Rising tide: The great Mississippi flood of 1927 and how it changed America. New York, NY: Touchstone/Simon and Schuster.

Balakrishnan, K. (2020, May 28). Aggressive containment, extensive contact tracing. Panel presentation as part of the Coronovirus Seminar: Global perspectives. Boston University School of Public Health webinar/ Retrieved from https://www.bu.edu/sph/news-events/signature-programs/deans-seminars/coronavirus-seminar-series/covid-19-global-perspectives/?utm_medium=email&utm_campaign=DLE%20-%20DSS%20-%20COVID%20-%20Global%20-%2023&utm_content=DLE%20-%20DSS%20-%20COVID%20-%20Global%20-%2023+CID_d2cf1e251bb8e6c937a202dfa97b651b&utm_source=Email%20marketing%20software&utm_term=Join%20us%20online

Clayton, M. F., Dean, M,, & MIshel, M (2018), Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.). Middle range theory for nursing (4th ed., pp. 49-81). New York, NY: Springer.

Glanz, K. (2002). Perspectives on using theory. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education: Theory, research, and practice (3rd ed., pp. 545-558). San Francisco: Jossey-Bass.

Oxford English Dictionary. (1921/1989). Definition of uncertainty. Retrieved from https://www-oed-com.ezproxy.lib.umb.edu/view/Entry/210212?redirectedFrom=uncertainty#eid

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

Struggling to Find Air: Emancipatory Nursing Response to COVID-19

Guest Contributor: Kathleen ‘Katie’ Clark, DNP
Edited by Kaija Freborg, DNP

“I can’t breathe.”  If these words were uttered in any healthcare setting in the country, an influx of healthcare providers would rapidly respond, attempting to save the person’s life by providing immediate care.  These words not only represent the recent murder of George Floyd, but mirror the racial inequities that exist for those who are struggling to breathe most in the worst pandemic in modern history. 

As a nurse bearing witness to these atrocities in the city of Minneapolis, I have observed nurses organizing themselves to respond as a collective to these unthinkable problems in real-time by taking immediate action to both maintain safety and fight for justice. These nurses are engaging in emancipatory nursing, a form of nursing that has the potential to dismantle power systems that privilege some over others due to economic means, social status, or hierarchies that create health inequity.1 Nurses must struggle to find the freedom to uncover the dominant health practices that foster Western ideals of health and minimizes nurse’s role to that of a ‘helper’ or a ‘do-gooder.’2 

The words, “I can’t breathe,” should call all nurses to action, first to look inward at our role in perpetuating systemic issues related to race and injustice, and then to respond as a collective to undo generations of harm that have traumatized communities and individuals for far too long.  Witnessing a man struggle to find oxygen to survive, at the knee of someone who has sworn to protect and serve — undoubtedly warrants a public health crisis be declared and calls for immediate nursing action.

Many nurses voiced, in their stories, frustrations of the constantly changing guidelines from the CDC or the Minnesota Department of Health (MDH) that have often created fear and conspiracy theories amongst some mostly well intended people.  Unfortunately, while engaging in self-reflection, many of the nurses reported they lacked the energy to continue to participate in social media platforms as the push back from others on these sites felt frustrating and belittling with little change observed.  Some nurses felt compelled to take a break from social media sites altogether because of the backlash experienced while trying to dismantle misinformation, such as information regarding wearing a mask in public spaces.  Others have taken on this opportunity to do more and respond to needs in innovative ways outside of traditional systems.

Katie Clark at the Health Commons

Kagan, Smith, and Chinn have provided a framework of action to inspire us to break these shackles in place — known as ‘emancipatory action’ — which require four vital characteristics to be deemed such work.  These elements include: “facilitating humanization, disrupting structural inequities, self-reflection, and engaging in communities.”1(p6) While strategically these four elements of emancipatory action have not been used together to tackle the racism that has existed in our care settings for the last 100 hundred years to my knowledge, I have witnessed them being practiced independently by nurses responding to the endless crises that have resulted from the COVID-19 virus and the recent racial justice unrest.  While collecting stories from nursing students and nurses in my role as the director of the Health Commons and an assistant professor of nursing at Augsburg University, it is clear that during this pandemic we have taken on the burden of not only caring for patients in practice settings, but also have felt a moral obligation to provide health education to people in social circles, families, and communities. 

Take for example Sarah Jane Keaveny, RN, public health nurse, activist, and Augsburg University nursing alum.  While buildings closed in response to guidelines set by government bodies due to COVID-19, those who were experiencing homelessness were left with limited options.  Typically those in the homeless community access the skyway system, light rail, public library, and other public spaces for shelter, toileting, and rest.  But, as the social quarantine measures continued to heighten, more buildings closed, leaving them with limited options to get their basic needs met.  One individual experiencing homelessness said to me while at the Health Commons , “It’s like no one cares that we are still out here.  I haven’t met anyone with this disease, but I will know people who will die from it because of all these rules.” 

MOODI Outreach

Sarah Jane connected with the existing resources of outreach workers and community members engaged in mutual aid to respond to those displaced by social structural inequities in the pandemic through establishing Mobile Outdoor Outreach Drop-in (MOODI) where meals are offered and connections to resources are made everyday of the week at a local park. In addition, while many of the shelters began moving individuals experiencing homelessness into nearby hotels, many of those left on the streets formed or joined existing encampments.  Because of the increased numbers in the unsheltered community, disproportionately representative of people of color or indigenous peoples, outreach workers were forced to secure food and water for this marginalized group rather than address long term housing or health issues. Sarah Jane has demonstrated emancipatory action through nursing practice and community engagement; while uplifting human dignity, she engages in communities to respond as a collective, outside of institutions or systems that have limited capacity to respond in the urgent manner required in this pandemic.1

 As the infection rates of the pandemic heightened, where black and indigenous populations are dying at alarming rates in comparison to their white counterparts, came the news of George Floyd’s murder by Minneapolis police officers when he was arrested for allegedly using a counterfeit 20 dollar bill at a local grocery store.3 Nurses in our state are coming to know all too well the appalling racial health inequities that exist due to systemic racism; systems of oppression including slavery, Jim Crow laws, redlining, and mass incarceration all tie directly to both wealth and health.While emancipatory knowing asks nurses to analyze root causes, such as inquiring why inequities of income related to race exist in the first place, it also requires us to take action in response to undoing these injustices. 

The unrest, riots, and violence in response to George Floyd’s death resulted in further displacement of those who were living on the streets of Minneapolis; homeless encampments were destroyed due to false accusations of riot participation, curfews were enforced, and members of the National Guard were deployed.  One nurse practitioner, Rosemary Fister, demonstrated disruption of racial policies in this moment when she fought for change in real-time.  As people living on the streets sought to find protection from the rubber bullets and tear gas released, she organized herself and others to respond to those left without protection due to structural inequities, or “a host of offenses against human dignity including…poverty, social inequalities….war, genocide, and terrorism.” 5(p8)  She was able to negotiate shelter at a local hotel for the unhoused to seek temporary protection. 

MOODI Outreach

As those who sought refuge in this space continued their stay past the days of the unrest, later named The Sanctuary Hotel, Rosemary envisioned a way to mobilize and change the policies and procedures relied upon in current systems.  She helped organize volunteers to operate the hotel in solidarity founded on the principles of mutual aid, where everyone had membership and human connections were made.  Knowing that the complexities of previous traumas and suffering wouldn’t simply end by having shelter, and as more barriers presented themselves, she knew the hotel stay for those unsheltered had to come to an end. 

However, this story has inspired a movement in Minneapolis to care for those displaced, to tackle issues of poverty through various means, to approach change using all forms of knowledge while forging a plan ahead with the very people experiencing the targeted oppression as means of disrupting structural inequities. Rosemary has engaged in social justice work in ways that will shape the discipline for the future to come.

These stories of nurses engaging in elements of emancipatory action while caring for marginalized communities in innovative ways during a pandemic and during social unrest, has shed light on what nursing practice can embody.  Many nurses fail to recognize, and most have yet to understand, the root source and impact of racial health disparities, which offers an opportunity to challenge our beliefs in what nursing practice should or shouldn’t entail as we are called to respond to unjust situations through collaborative action.1

Whether providing care in our acute care settings or shaping our communities, nurses can no longer ignore the words, “I can’t breathe” as we collectively gasp for air.

References

1Kagan PN, Smith MC, Chinn PL. Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis.  New York, NY: Routledge; 2014. 

2Chinn PL, Kramer MK. Integrated Theory and Knowledge Development in Nursing. 8th ed. St. Louis, MO: Mosby, Inc; 2011.

3Rosalsky G. National Public Radio. How The Crisis Is Making Racial Inequality Worse. May 26, 2020.

4Alexander,M. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: The New Press; 2010.

5Farmer, P. Pathologies of power: Human rights, and the new war on the poor. Berkeley, CA: University of California Press; 2004.

About Kathleen (Katie) Clark (pronouns she/her):

Katie is an Assistant Professor of Nursing at Augsburg University and is the Director of the Health Commons. She has taught at Augsburg University since 2009 where her primary responsibilities are in the graduate program in courses focused on transcultural nursing, social justice, and civic agency. She also practiced for over eight years in an in-patient hospital in both oncology-hematology and medical intensive care. She has a Masters of Arts in Nursing degree focused on transcultural care and a Doctor of Nursing Practice in transcultural leadership, both from Augsburg University.   Katie has been involved in the homeless community of Minneapolis for over 15 years and has traveled to over twenty countries.  She lives with her husband and three children in Stillwater, Minnesota.

About Kaija Freborg

Kaija Freborg is the Director of the BSN program at Augsburg University and has been teaching as an assistant professor in the undergraduate and the graduate nursing programs since 2011. Her focus in teaching includes transcultural nursing practice as well as addressing social and racial justice issues in healthcare. She obtained a Doctor of Nursing Practice degree in Transcultural Nursing Leadership in 2011 at Augsburg before teaching at her alma mater. Currently her scholarly interest in whiteness studies has her engaging in anti-racist activism work both in nursing education and locally; her aspirations include disrupting and dismantling white supremacy within white nursing education spaces. Previously Kaija had worked at Children’s Hospitals and Clinics in Minneapolis, in both pediatrics and neonatal care, for over 15 years

COVID-19 – What would Margaret Newman say?

Dorothy Jones and Jane Flanagan
See also Newman’s Theory of Health
as Expanded Consciousness

Although not the only global challenge we face, COVID-19 has the world’s attention while disrupting so many familiar routines. For those so fortunate, there is the new normal of working from home and countless conference calls that seem to blur one day into the next, almost erasing the confines of time while confining us to a physical space.  When things get back to “normal” what will that look like?

For those in service industries, there is the chaos of being the person in the midst of unsafe places whether the grocery store, a bus or as an employee in a hospital.  Making connections while fearing, am I safe? Do I have what I need to protect myself/ my family? And, sometimes knowing you do not have what you need, and in that moment, your awareness of the disparity of those who have and those who do not is heightened.  What will it be like when things get back to “normal?

 Then there are those who in a whirlwind, may have lost their job.  Now they are struggling to pay bills, perhaps visiting food banks for the first time mixed in with home schooling young children or a full house of grown children now back to the safety of their childhood home.  When and what will be that return to “normal”?  For every scenario, there is opportunity, freedom and new ways of being. There is also potential binding or unraveling.  But no matter the reality, there are the chants to “get back to normal”

Dr. Margaret Newman

This idea of “getting back to normal” raises the question; “What would Margaret say?” We think the answer is …actually, not very much.  She would smile gently and acknowledge each person who spoke and told his or her personal story. She would be present and authentically listen.  Her silence would spur more stories until in the sheer dizziness of it all, the cacophony would stop and everyone would look to her and wonder what she is thinking. Again, silence and this time the room would go quiet.  Finally, she would speak: “I’m just curious about people wanting to go back to normal, what do people think of that?”  Then she would sit and wait for us to react…and we would.  We would discuss how we cannot “go back” and about the opportunity in the chaos. What went well in nursing practice during COVID – 19 that was reflective of nursing and what did not?  She would smile, as we would envision a new future that informed by COVID-19, and the inequities of an illness, linked to an environmental crisis and manifested in our most vulnerable. An illness that has stuck down older adults, minorities and is on a path to literally destroying second and third world countries.  Go back?  No, we would not be going back we would be envisioning a new future, one with boundaryless opportunities.

There is for some, an increased awareness, that the inequities of COVID-19 along with the murder of George Floyd and other racial incidences has heightened the issue of structural racism that has always been simmering under the surface. Go back?  Oh no, we will not go back. Not to complacency, not to a world where nurses today are lauded for their actions during a crisis, but who will return to being a hidden entity, part of the bed charge.  No, we are now in a world that recognizes, yes there were many deaths, but because of nursing care, because of nursing’s commitment to meeting the person where they were at, commitment to delving into knowing other, upward of 85% of those who had COVID and were hospitalized were successfully discharged.  Yes, nursing care! It was the authentic presence of nurses who connected with patients in new ways and journeyed with them on a path of discovery, nurses learning to recognize the pattern of the critically ill when the normal mode of communication was no longer possible, and nurses who transformed the care environment. It was not a cure or a vaccine that made the difference; it was “the difference nursing makes” that made the difference.

The COVID-19 virus made visible a pattern of turbulence and disruption within the global whole.  Lack of awareness to growing social challenges, loss of freedom creation of boundaries and isolation confounded the environment within which the virus emerged. Within this context, the virus took on new meaning and yielded variety of responses. Using the theoretical lens of Health as Expanding Consciousness, Margaret would reflectively and carefully suggest that being exposed to the global and dramatic changes of the day has already begun to reshape/repattern us. She would envision the voice of nurses advocating on behalf of patients, on behalf of the myth of curing rather than healing, on behalf of older adults, racial and ethnic minorities.  Margaret would not support “going back”; instead, she would reflect on the meaning of the unfolding pattern emerging before us …within the context of an illness.

The event COVID-19 has served to make visible the invisible for society as a whole.  Recognition that we are all connected and interrelated. The actions and behaviors of one individual directly affecting the very life of another. Response to the virus has revealed a complex, dynamic human pattern of the whole within a dynamic and changing environment. As the illness experience is unfolding, individual responses shaped by factors including  vulnerability,  gender, age and the older adults, race, ethnicity, compromised health status, poverty, lack of insurance, homelessness, exposure to environmental stressors and population density, and personal responses to life challenges have been made visible. Compromised relationships, sustained loneliness and disconnection challenged human becoming and threatened choices about health and wellness. Rather than creating new problems, COVID-19 has manifested not only a serious disease but made visible longstanding global societal challenges that have gone unnoticed or suppressed.

Margaret would caution that “fixing” the illness (i.e. treating to cure) without addressing the whole person/environment interaction that include people and events surrounding the individual experience, could lead to a reoccurring manifestation of the underlying pattern in new ways (e.g. inequities and disparities in care). She would stress the importance of collaborating with individuals and groups in dialogue, she would identify what is meaningful, to acknowledge the collective increased awareness, and seek to uncover an underlying pattern of the whole. COVID-19 then becomes a stimulus for active discussion, identifying barriers that compromise moving forward as individuals and as a society. The insights gained through information and connecting with another create opportunities for new insights, actions and freedom to participate knowingly in actions that promote transformative change.

The importance of relationship is core to advancing the process of discovery. Partnerships that are open and evolving allow pattern to emerge and potentially increase the realization that we are all interdependent and connected within and across environments. Recognizing that what affects one-person or community can have a reciprocal impact on another. Within the discovery process there is freedom to hold on to what gives new meaning to one’s being and what binds and threatens our freedom  to become and engage in sustainable holistic healing. No, Margaret we are not going back. And she would smile, knowing we are with new heightened awareness and renewed energy, accelerating toward new potentials and  transformation.

Additional References

Newman, M. A. (2008). Transforming presence: The difference that Nursing makes. Philadelphia: F. A. Davis.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. (2008). The focus of the discipline of nursing revisited. Advances in Nursing Science, 31(1), E16-E27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Smith, M. C. (2011). Integrative Review of Research Related to Margaret Newman’s Theory of Health as Expanding Consciousness. In Nursing Science Quarterly (Vol. 24, Issue 3, pp. 256–272). https://doi.org/10.1177/0894318411409421

Diversity, Equity, Inclusion, Justice, and the Future of Nursing Theory: A Webinar of Disciplinary Reflection

To learn more about the Nursology Theory Collective,
or join us in future work, please click here.
See video and full report here

On Friday, June 12th, the Nursology Theory Collective hosted a live webinar titled, “Diversity, Equity, Inclusion, Justice, and the Future of Nursing Theory.” In this webinar, Dr. Lucinda Canty and Patrick McMurray addressed the interrelated concepts of diversity, equity, inclusion, and justice in nursing. They discussed nursing’s homogeneity and how the absence of diversity in our discipline contributes to and reinforces inequity, injustice, and exclusion, even as our professional organizations purportedly value social justice and strive to reduce health inequities.

It is long past time for nurses and nursologists alike to take a stand and actively work towards an antiracist future for nursing. This is nonnegotiable and the time for action is now. We challenge you as readers of Nursology to watch this insightful webinar, reflect on your role in advancing equity and justice, and comment how YOU are going to contribute to transforming nursing into a more diverse, equitable, inclusive, and just discipline.

We understand that this topic may be uncomfortable – and if so, we encourage you to reflect and unpack that discomfort. Maybe you feel defensive as if you have done nothing personally to warrant interrogating your own positionality. Maybe this resonates with you because you see and know this truth as congruent with your own experience.In the words of Monica McLemore, “this can all be different,” if we choose to make it so. The starting place for this is critical self-reflection which paves the way for antiracist growth which creates the possibility for community-building and envisioning new futures for nursing. Embracing the discomfort we can become a more diverse, equitable, inclusive, and just discipline. As Patrick McMurray stated, “nursing is an act of justice,” and it can be if we do the work.

In Solidarity,
The Nursology Theory Collective

For more background on this webinar as well as the presenters, please click here.

We ARE the theory-practice connection; COVID-19 tells us so!

Guest Contributors*:
Andra Opalinski and Patricia Liehr

We are responding to Dr. Foli’s request in her blog titled “Say It Ain’t So:  Graduate Students Shade Nursing Theory!” where she stated…What about you?  If you have suggestions for me on how to strengthen the theory-to-primary care advanced practice connection in a master’s level course, please forward them…”

WE BEGIN WITH DEFINITIONS

Throwing Shade: (verb) subtly disrespecting or ridiculing someone or something.

Shade: (noun) a comparative darkness caused by shelter from direct light.

We ARE the theory-practice connection.

As nurse educators who appreciate the theory-practice connection, we had been pondering Foli’s post and then Constantinide’s follow-up about graduate students throwing shade at nursing theory. Not knowing the meaning, we took the “throwing shade” descriptor quite literally and thought how we often prefer to find shade on sunny Florida days!!!  In the midst of our extended pondering and thoughtful conversations came COVID-19; and a virtual class that we co-hosted with NP students to discuss the use of Story theory in practice; and THEN, we serendipitously came across a 2020 calendar page with a haiku by Tomihiro Hoshino entitled “In the Shade.” This haiku accompanies his calendar painting of a redbud tree with hanging red pods amidst green foliage:

In the shade of leaves,
They shyly sway,
Pods like strips of paper
With girlish wishes
Written on them

Moving along to a class with NP students.  

In this class, we were talking about Story theory and the practicality of using it when working with patients. Story Path, a way to pursue story-sharing was the specific lesson (Liehr & Smith, 2020). Clare, an ER nurse, volunteered to share a recent practice story with the class.

“I was caring for an elderly patient in the Emergency Room who had just tested positive for COVID-19. However, this day, the provider I was working with was resistant to putting the patient on a ventilator.” As Clare reflected  on the situation she shared, “I remember asking myself, is the provider just being lazy because the patient is elderly with a poor prognosis? However, I also knew, this doctor reads a lot of research. I still couldn’t help but question the decision. The patient did in fact improve without ventilator assistance,” giving Clare pause….thinking about the juxtaposition of knowledge with practice. As Clare’s recounting of the story concluded, Clare was asked to consider how her COVID-19 experiences may influence the future. The rawness of her sharing was palpable as she elaborated on the pause noted in her story: “I never knew nursing would get to this point. I am becoming suspicious of everyone, even co-workers. I stand away from everyone and wear masks all the time. I am challenged with what feels like lacking compassion. I don’t spend time in the rooms like I always did before, or place a hand on an arm to show comfort because we are thinking, is this the next COVID patient. I do make sure there is a phone in every room and I call often to check on the patients. It just feels less personal. It feels unnatural.”

Hmmm…lacking compassion feels unnatural. There is a theory and/or a philosophical perspective in this sentiment. We could go with Meyeroff’s ideas (1971) about caring as a way of ordering one’s values so that one feels “in place” rather than “out of place” in the world. We could go with Watson’s Transpersonal Caring Moment (Watson, 2018) where people come together in a human-to-human, spirit-to-spirit connection that is meaningful, authentic and intentional. These are just two examples providing context that allows for locating self in the theory-practice connection; many others could be the philosophical/theoretical lens providing context.   

Then the class was asked, “What have you learned from Clare’s story that resonates with your own practice?” Anna was quick to answer, “Everything is fluid and flexible right now, we have protocols, but they change day by day, they are evolving and there is a lot of uncertainty. We have to be able to allow flexibility in new ways. I can’t get into my usual groove.” Then THE question was posed. “Is theory real for you in your everyday practice? If not, it’s ok to say so.” Perhaps the most insightful answer was Brad’s response. “We are taught many theories, but challenged to know how to apply them. I don’t have theory on my mind when I am in front of my patient. It may be subconscious, but I’m not thinking, I’m applying Leininger or Watson right at this moment.”

Brad is right…we don’t expect that nurses live real-time practice checking in with theoretical/philosophical perspectives. However…the perspectives are there and stepping back and reflecting on nursing circumstances may enable forward movement with theory-guided intention and with knowledge-building for the discipline.

Pondering We ARE the theory-practice connection

As the nurse theorist-practitioner team that we are, we have great appreciation for the comments of these practicing nurses who happen to be graduate students. We wondered …Could the shade granted by COVID-19 bring theory out of the shade for students when they don’t even know it? You see, we are educators in a setting where nursing theory is highly valued and caring theory is the organizing spine of our curriculum. Has caring theory become so naturally interwoven in their practice that these NP students know something is amiss but they have difficulty naming it beyond descriptors like “unnatural” or “I can’t get in my groove”? We can only hope….but we can also plan to honor the shade by:  

  • remembering that we are always working from a theoretical perspective – we have only to step back from any nursing situation and consider the principles/concepts that are guiding our actions;
  • creating opportunities to share our practice stories with the knowledge that the implicit theory woven into the practice threads can come alive through scholarly engagement that is open to authentic expression and that gently supports exploration and maturing of an individual nurse’s own thinking;
  • holding the theory-practice connection as a truth that just takes time and professional maturity for appreciation but it is a truth that can be readily described when nurses have a mentor who helps with connecting the practice-theory dots;
  • pairing theorists and nurse practitioners to forge opportunities for growing nursing knowledge grounded in our practice.

Though there is little positive to say about COVID-19 these days, it may be that the pandemic granted some shade for us to reflect on the theory-practice connection in a way that can guide  understanding. After all, We ARE the theory-practice connection. Let’s own it.

Now….what do you think – we would like to hear from you.  How do you see our plan to honor the shade as an integral dimension of developing practice-scholars AND growing the discipline of nursing?  

  1. Liehr, P. & Smith, M.J. (2020). Claiming the narrative wave with story theory. ANS, 43(1), 13-27.
  2. Meyeroff, M. (1971). On caring. Harper & Row: New York.
  3. Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. Louisville, CO: University Press of Colorado.

About the contributors

Andra S. Opalinski

Andra Opalinski, PhD, CPNP-PC, NC-BC is a pediatric nurse practitioner and an Associate Professor at the Christine E. Lynn College of Nursing, Florida Atlantic University. She is an advocate for child and adolescent mental health promotion. Her current areas of interest include community-based participatory research with elementary through high school students using mindfulness interventions for self-regulation and stress management skill building. She also uses visual anthropology through photographs to explore perspectives of health of vulnerable populations. Right now, you’ll find her working remotely, doing the best she can to keep her household of 5 under strict physical distancing, and using the visual anthropology approach to document her family’s physical distancing experiences.

Patricia Liehr

Patricia Liehr PhD RN is currently the Associate Dean for Nursing Research and Scholarship at the Christine E. Lynn College of Nursing, Florida Atlantic University (FAU). She is the co-author of story theory and the co-editor of Middle Range Theory for Nursing. Most of her scholarly work has focused on peace, from personal through mindfulness; to global through coming to know both sides (Pearl Harbor; Hiroshima) of surviving the bombings of WWII. Story-gathering has played a major role in her research endeavors and she highly values the place of nursing practice stories for disciplinary knowledge development. Right now, as she moves toward an August retirement from FAU, she is imagining all the things she will do with new-found time.

In case you missed it – Nursing and Racism

There seems to have been a glitch in our June 16th post titled “Nursing and Racism: Are We Part of the Problem, Part of the Solution, or Perhaps Both?” So just in case you missed it, follow this link to view, and please add your thoughts and comments to this important challenge! https://nursology.net/2020/06/16/nursing-and-racism-are-we-part-of-the-problem-or-part-of-the-solution-perhaps-both/

Nursing and Racism: Are We Part of the Problem, Part of the Solution, or Perhaps Both?

One of the first “lessons” in my now-long-ago nursing education was “the nursing process.” This was in the early 1960s, almost a decade before anyone spoke of nursing theory, but the University of Hawaii (my alma mater) had modeled the curriculum on that of the University of California at Los Angeles (UCLA) which was designed around the ideas of Dorothy Johnson. These ideas would ultimately become known as Dorothy Johnson’s Behavioral Systems Model (See also the history of the UCLA School of Nursing, pgs 43-48).

Of course this same problem-solving process is widely used in many walks of life, and many see it as a mere pragmatic outline for making good decisions and forming appropriate action – a necessary process but several degrees removed from developing foundational knowledge of the discipline. In reflecting on the situation in which we find ourselves today I fear that as a discipline we have not adequately faced the realities before us as a discipline and as a society – both as a problem, and as a health experience. As I wrote in my January 20th post titled “Decolonizing Nursing”

Despite the fact that race and racism so repeatedly rise to the surface with a clear intent to address this issue, there is typically little or no substantive discussion that begins to reach deep down into explanations or understanding of what is really going on (see https://nursology.net/2020/01/14/decolonizing-nursing/)

I know that I am not alone in recognizing this challenge, but I continue to wonder — when and how will this begin to change? This is not merely a “political” matter — it is a matter of life and death, of health and sickness. It is a pandemic of proportions far beyond the COVID-19 pandemic, and it has been infecting our lives for decades. In recent weeks we have witnessed the public killing of George Floyd by a Minneapolis police officer, of Ahmaud Arbery shot down while jogging in February, and Breonna Tayler, an EMT with plans of becoming a nurse, killed by police in her own home in March. Then just a few days before this post published, the killing in Atlanta of 27-year-old Rayshard Brookes, shot in the back several times by police after indicating that he was able and willing to walk home to his sister’s house.

These tragic murders in plain sight, coupled with widespread recognition of the over-proportioned number of Black and Brown people suffering from COVID-19 – give us a glimmer of opportunity to finally act. The calls for change are so pervasive and so sustained, that those of us ready and willing to make change have a real opportunity to do so. And so I return to my earliest nursing education and the foundational ideas that have been baked into my very fabric – the processes of active listening and observation that are vital to assessing and “diagnosing” a problem(1).

One of the notable signs that appears in all of the protests says “I see you, I hear you.” For me, this is a key to meeting the challenge before us. It starts with our interactions among our own colleagues. Throughout my nursing career I have seen many Black nurse colleagues come and go, and every single one of the nursing faculty I have served with have repeatedly decried how “difficult” it is to recruit and retain Black nurse faculty. Yet all too rarely have I witnessed concerted, deliberate efforts by the predominantly White(2) faculty to stop, step away from our privilege, seek the authentic stories of our Black colleagues, and actively hear (understand) their experience. Equally egregious is the fact that there are myriads of situations that, viewed through a lens of anti-racist awareness, could be instantly recognized as potentially harmful to a Black person, even dangerous. But over and over again we turn a blind eye, and fail to act. I have all too often been just as complicit in all of this as anyone else – we have all been caught up, and participate in a systemic web of injustice. And I suspect that this pattern is not unique to academics – that it runs deep in every setting where nursing is practiced.

Further, there is the all-too often deflection of the problem by the insistence that the “problem” is not unique to Black people – that all lives matter. Of course all lives matter and Black people are not the only ones who suffer injustice and discrimination. But this sentiment turns the lens away from the specific voices, experiences, and challenges faced Black people. We can listen to all people – but until we listen to, and sincerely seek to understand, Black people and recognize the experiences of trauma and harm that Black people uniquely suffer, and how we participate, we will not be able to truly understand the problem.

It is undeniable that the prejudice and hate toward Black Americans, and people of African descent in many other countries is profound and amplified by the historical trauma of slavery and in the United States, the fall-out of the civil war fought to end slavery in the United States. I hear many White nurses in my circle expressing true outrage about this situation and we are all sincere in our desire to see it change, yet the problem persists. Until we White nurses face the reality of our privilege and the injustices that flow from this, until we learn ways to step away from our privilege and engage in serious anti-racism work, until we create spaces in which we can authentically engage with our Black colleagues to understand the problem, the injustices in our own house will remain.

We can all shift in the direction of being part of the solution. There are signals that point us in the direction of actions we can all take – particularly those of us who are White – to seize this moment, start to address the scourge of racism in our own house, and make real change. The circumstance of the COVID-19 shift to virtual reality offers ample opportunities for all of us to engage in antiracism work! Here are a few examples that I can personally recommend – if you start searching, you will find many many others!

  • Nurse Caroline Ortiz organized a “platica” (Spanish for discussion) held on March 9th over Zoom. Caroline recorded the session, which you can access here: https://vimeo.com/397047962. You can organize similar discussions – we are all now expert Zoom organizers!
  • African-American activist Nanette Massey holds a weekly discussion with White people from all walks of life to discuss the ideas in Robin DiAngelo’s book “White Fragility: Why It Is So Hard for White People to Talk About Race.” I have participated in many of these informative, interesting and affirming Sunday discussions. Learn more here.
  • The “Everyday Feminism” website has pages and pages of content on ethnicity and racism – https://everydayfeminism.com/tag/race-ethnicity/. Just browsing titles is a rich experience! Their 2014 post of 10 Simple Ways White People Can Step Up to Fight Everyday Racism is precisely relevant today!
  • Invest 1.5 hours into Everyday Feminism’s founder, Sandra Kim’s excellent session on “Why Healing from Internalized Whiteness is a Missing Link in White People’s Anti-Racism Work.” White nurses can benefit especially, but knowing that White people are facing this challenge, and how this can happen, can be helpful for everyone.
  • Practice generosity of spirit toward your nursing colleagues – each of us are being challenged in this moment to examine our own attitudes, actions and words. Many of us are just starting on this journey. This demands kindness and understanding toward one another as we work together, often in uncomfortable situations, to make meaningful change. Let us call forth the best we can be, and support one another with compassion and understanding when we mis-step.
  • Consider how application of many tenets of our own nursing theories can be activated in the quest to address racism. Consider Peplau’s approach to meaningful interpersonal relationships, the very important insights from Margaret Newman “Health as Expanded Consciousness,” and any one of several theories of caring such as Watson’s Theory of Human Caring, or Boykin and Schoenhofer’s Theory of Nursing as Caring, While these and other nursing theories were not created specifically to address racism and social injustice, we certainly can draw on their wisdom to bring nursing perspectives to the center in our anti-racism work.
  • Follow the opportunities provided by the Nursology Theory Collective to join discussions focused on creating equity in nursing
  • Find, read and cite nursing literature authored by nurses of color. Learn the names of these authors, and seek out their work. If you teach, make sure you include this literature in your syllabi(3).
  • Explore the work of scholars in other disciplines who are also committed to anti-racism work. The “Scholarly Kitchen” blog posts regularly on matters of racism and discrimination – see their June 15, 2020 post titled Educating Ourselves: Ten Quotes from Researchers Exploring Issues Around Race
  • Make your own video, as a nurse, speaking to these issues and how your values, ideas, nursing perspectives inform your actions to fight racism! Post it on YouTube or Vimeo .. and then share it with us – we can consider posting on Nursology.net or another nursing website. See this wonderful video (below) by de-cluttering expert Mel Robertson for inspiration!
Notes
  1. Ultimately the concept of active listening formed a basis for the essential processes of “critical reflection” and “conflict transformation” in my heuristic theory of Peace and Power.
  2. See this excellent article from the Center for the Study of Social Policy on the capitalization of the terms “Black” and “White,” which I consulted in refining this post: Nguyễn, A. T., & Pendleton, M. (2020, March 23). Recognizing Race in Language: Why We Capitalize “Black” and “White” | Center for the Study of Social Policy. Center for the Study of Social Policy. https://cssp.org/2020/03/recognizing-race-in-language-why-we-capitalize-black-and-white/
  3. See Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge. This collection includes many of the leading authors, including many nurse scholars of color, whose work focuses on social justice.