Nurse-Specific Trauma: Let’s Give It a Name

Welcome to Karen J. Foli, PhD, RN, FAAN who is joining the
Nursology.net blogging team! Karen is the author of the
Middle Range Theory of Nurses’-Psychological Trauma, the
Middle Range Theory of Parental Postadoption Depression
and co-author of the recently published book
The Influence of Psychological Trauma in Nursing

Karen J. Foli

When I was earning my PhD, my cognitive world opened up. I learned about how discourse not only reflects reality, it creates reality. In my estimation, The Influence of Psychological Trauma in Nursing allows us to see a reality that eluded us before. Decades later, I find my work in nurse-specific trauma reflecting truth and creating a reality that nurses experience, but couldn’t name. Therefore, their reality of it didn’t exist.

We often hear about compassion fatigue. Its etiology is linked with secondary or vicarious trauma, created by seeing others suffer and experience traumatic events. Conversations abound about how nurses need to be resilient and use resiliency as a buffer to mitigate secondary trauma and secondary traumatic stress. The issue of individual versus organizational culpability in nurse-specific trauma is one that is needed, and for another time…

In addition to secondary trauma, there are six additional nurse-specific and nurse-patient-specific traumas that I have named, described, and provided context for (Foli & Thompson, 2019): historical or intergenerational trauma; workplace violence, system-induced or medically induced trauma, second-victim trauma related to medical errors, trauma from disaster work, and insufficient resource trauma. This final type of trauma is one that I have recently coined based on a current study, the findings of which I will present at the upcoming American Academy of Nursing conference as an e-poster (Foli, 2019).

Insufficient resource trauma. Now that’s a new reality. Every single nurse I have spoken to quickly nods their head in affirming its existence. It’s the trauma that occurs when nurses do not have the knowledge/expertise, personnel, accessibility to other professionals, supplies, and tangible and intangible resources to fulfill their ethical, professional, and organizational responsibilities.

As a nurse… think of being placed in an unfamiliar patient situation with no one to call for help. Think of the shift you are working with an overload patient assignment and two of your patients “go bad.” Think of the phone incessantly ringing on your day off to come in because of short staffing and the guilt experienced because there is no way you can work another shift and be safe. Think of the medication that will be late because pharmacy made an error and the physician on call hasn’t answered the page and you need an answer stat. Think of going into a supply room for the dressing kit and the shelf is empty. But most of all, think of the patients’ call lights that go unanswered because there aren’t enough nurses to render care.

It’s not just a shortage of resources that cause insufficient resource trauma. It’s the push to do more in the time we have, including tackling the electronic health record and as we’ve known for years, sicker patients. In a recently published letter to the editor, “Decline of the American Nursing Profession,” Vignato (2019) describes the decreasing time spent with patients: “.. changes in our health care system are transitioning nurses away from a therapeutic relationship…With these time constraints, nurses are left to complete scripted tasks” (p. 255).

As a result, patients don’t obtain the care they need and deserve. The tendency to see them as tasks to do increases. Nurses leave the units at the end of their shifts feeling guilty, anxious, and isolated. It’s the stuff that kills our spirits.

A common metaphor used in understanding trauma, the iceberg, symbolizes the large mass of “stuff” that’s underneath what is visible. The proportion is such that what is above the water is a fraction of the frozen ice beneath the water’s surface. In the hidden, murky depths lies our processing of trauma, our feelings, needs, desires. Above the surface, for all to see are our behaviors that are born from trauma.

While I believe this metaphor is useful, I also assert that nurse-specific trauma, as events and habitual occurrences, are readily visible to others (Foli & Thompson, 2019). We have an audience watching most of our traumas day in and day out. But are we, our peers, our leaders paying attention?  Let’s give these traumas a name, let’s build reality, and then, let’s get to work on preventing what we can prevent and fixing what we can fix.

References

Foli, K. J. (Accepted; 2019). Nurses’ trauma: “They leave me lying awake at night.” E-poster. American Academy of Nurses 2019: Transforming Health, Driving Policy Conference, Washington, DC, October 24-26, 2019.

Foli, K. J., & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, Indiana: Sigma.

Vignato, J. (2019). Letter to the editor: Decline of the American nursing profession. Journal of the American Psychiatric Nurses Association, 25(4), 255-256. doi: 10.1177/1078390319826702

Guest Post – The Big, Bad, Terrible Dissertation Defense

Guest Contributor: Ashley Rivera, PhD, RN
See “About the Author” below

“The best thesis defense is a good thesis defense.” Retrieved from https://xkcd.com/1403/.
Comic available under a Creative Commons Attribution-NonCommercial 2.5 License.

In my head, I built the entire day up to be a terror of being questioned for every decision I made throughout my study. All the prep-work from making draft revisions and polishing off the speech to accompany my slides did not prepare me for joy. My joy is not about the strength of my study or the loving support that my graduate school, Florida Atlantic University, bestowed upon me during my entire program. It’s about who showed up at my defense.

One of the first to arrive was an entry-level BSN student who had responded to the mass-dispersed open defense email sent out by the College of Nursing. When I was a student, I would probably have just dumped that email in the trash bin. The student who showed up truly felt that in nursing she could achieve anything, which was a refreshing sight to my battle-wounded soul from the years of micro-managing and counterintuitive policies that are experienced on the job. The memory of her being there is a reminder for me that there is a need to shine a light on the quiet strength that comes from being a nurse. This quiet strength is what guides nursing through the bad days, like when four call lights are going off and they all have to be answered in less than 3 minutes, or the code that just won’t end because nobody wants to tell mom her baby won’t be back. I didn’t see her leave, but I remember her clap and the light in her eyes at the end of the defense.

I didn’t think much of it when the crowd of fresh PhD students wandered in, after all, they were in school to do the very same thing. However, the feedback I received from them truly reinforced my passion for teaching. The best part was that the comments didn’t come from them directly, it came from the professor of Qualitative Research. As part of my defense, I explained my choice to use Charmaz’s constructive grounded theory by contrasting it with classic grounded theory and Straussian grounded theory. The professor was thrilled by the explanation I gave. She also stated that the PhD students indicated that my explanation was so clear that they now truly understood the differences between all three approaches to grounded theory. To me, that was the icing on the cake of such a momentous day. Their feedback is the start of my living my dream to inspire passion and clarity for research and theory in classes that so many students describe as the bane of their existence.

Defenses are an opportunity to inspire those who watch and fuel the passion of those who defend. This should be the goal at the end of a very long road in the PhD journey. I wouldn’t take a single step back, but the dissertation defense isn’t so big, bad, or terrible—in fact, it’s probably the most inspiring part of the whole PhD.

The newly minted,
Dr. Ashley Rivera

Left to right: Dr. Marlaine Smith, myself, Dr. Patricia Leihr, and Dr. Yash Bhagwanji

About Dr. Rivera

Ashley Rivera

Not known for being a wall-flower, I believe in the power of a positive attitude and a smile. I keep centered through my loving husband, my three rambunctious children and being outdoors in my organic garden. My practice experience includes Pediatric Hematology/Oncology, Liver Transplant, Medical Surgical, High Risk Pregnancy, Diabetic Education, Telemetry, and Epilepsy Monitoring. I started my health care journey as an EMT, but came to love nursing for the continuation of care aspects. I have worked in both inpatient and outpatient at different stages of my nursing journey. I also have experience as adjunct faculty and as a research assistant. I entered the PhD program at Florida Atlantic University in August of 2015 and received a Jonas Scholarship in 2016. In my immediate future, I plan to continue working on getting my dissertation, “The Social Process of Caregiving in Fathers” published, and growing the resulting mid-range theory, “Caregiving in Fathers”. I will be presenting my recruitment methodology at the upcoming K.I.N.G Collaborative Research Conference in D.C. and, eventually, I hope to teach  and accept a full-time position teaching.

Rhetaugh Etheldra Graves Dumas (1926 – 2007)*

Guardian of the Discipline

Rhetaugh Etheldra Graves Dumas was an esteemed nursing “leader with vision, insight, and wise counsel who had a major impact in the advancement of nursing, health care, and academic programs.“ She was inspired to become a nurse because of her mother, who wanted to be a nurse but could not because schools of nursing did not admit African American women at that time. Dr. Dumas earned her BSN degree from Dillard University in New Orleans in 1951, Her nursing career began as a school nurse in the segregated schools of Natchez, Mississippi. With a strong determination to improve the welfare of others, she went on to earn her master’s degree in psychiatric nursing from Yale University in 1961. In1975, when nursing doctorates were rare, she earned her doctoral degree in social psychology from the Union for Experimenting Colleges and Universities (now known as Union Institute & University).

Throughout her career, she was a strong advocate for Black  women and Black nurses, urging baccalaureate nursing education for all.  Dr. Dumas was the “first” in many dimensions related to the development of nursing as a discipline.  She was the first nurse to conduct clinical experiments that evaluated nursing practices. She was the first African-American to be named as a Dean of Nursing, University of Michigan (1981). She was subsequently appointed as Vice-Provost of the University, serving until her retirement.

Most notably,, she was the first woman and first nurse to serve as deputy director of the National Institute of Mental Health, from 1979-1981. As President of the American Academy of Nursing (1987-89), she led the establishment of Expert Panels to develop strong policy statements based on nursing expertise.  She began her presidency with the motto of “many voices, one vision,” calling on expansion of the Academy as a major force in shaping the future of healthcare.  Her vision for the Expert Panels was a way she saw to substantially engage nurse scholars in bringing nursing perspectives and expertise to the policy-making table.  Today over 20 Expert Panels of the Academy provide vital leadership driving research and policy that is  grounded in the values of the discipline of nursing.

I had the distinct privilege of working with Dr. Dumas as a member of the Board of Directors of the Academy when she was President.  Her clarity, strength of vision, and unrelenting commitment to nursing as a discipline remains as a major influence that inspired me, as a young scholar, to never waiver from a commitment to the very best that nursing offers in the service of others.

See more information about Dr. Dumas here and here

* Portions of this post originally appeared on the NurseManifest blog

Shaping the Future of Nursing Education and Practice: AACN Essentials Revision and the Next Generation NCLEX

In support of our mission “to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research and policy,” the Nursing Theory Collective (NTC) emailed the workgroup chairs of the American Association of Colleges of Nursing (AACN) Essentials Task Forces on September 16th, 2019. In this email, we as the NTC advanced our support for a strong nursing perspective and theoretical orientation in the planned revisions to the Essentials documents that form the basis for nursing education at all levels of study. To date, we have received positive responses from the chairs of the baccalaureate, master’s, and DNP essentials revision workgroups. We understand that AACN has invited nursing faculty to have discussions regarding the Essentials, both at their universities and future conferences. We have provided our letter below to foster open dialogue regarding the importance of nursing theory in the future of nursing education. Please join these conversations as you are able and feel free to use the points we have developed as a starting point for your thoughts as well.

In addition to the effort regarding the Essentials revision, we also reached out to the National Council of State Boards of Nursing (NCSBN) regarding the Next Generation NCLEX Project (NCSBN, 2019). As you are likely aware, the NCLEX is currently under revision with an eye toward ensuring novice nurses possess the necessary skills to detect the subtle changes in patient status, preventing deterioration, as well as avoiding errors. In pursuit of this project, the NCSBN has underscored the importance of clinical judgment and decision making in the safe practice of newly registered nurses. It is our concern that due to the absence of a framework founded in nursing knowledge and theory, the disciplinary perspective is lost such that clinical reasoning and clinical judgment devolve from a nursing skill to a generic biomedical task orientation (Bender, 2018). Moreover, the absence of nursing theory in the foundation of the Next Generation NCLEX project begs questions about our core values, how we value nursing knowledge, and to what regulation we agree to adhere (Perron & Rudge, 2015). Email communication with NCSBN about theory content and a guiding theoretical framework belied a lack of interest on their part in engaging in discussion of this issue, at least at this time. Given the role that the Essentials play in nursing education, the NTC has decided to focus on our efforts with the Essentials. We hope that, in time, with revision to the Essentials NCSBN will be motivated to consider the role of nursing theory in NCLEX and more readily engage. 

Appended below you will find our Essentials letter to the DNP workgroup, which is similar to the other two Essentials letters. Please share our letter among your colleagues to assist in the facilitation of discourse on this important topic.

Dear members of the DNP Essentials workgroup,

            We are writing to you today because of your role in the workgroup for the Revisions of American Association of Colleges of Nursing (AACN) DNP Essentials. We represent the Nursing Theory Collective. Our collective membership, made up of experienced nurse clinicians, researchers, educators and scholars, as well as graduate students, emerged from the landmark nursing conference that was held at Case Western Reserve University called Nursing Theory: A 50 Year Perspective, Past and Future in March, 2019. 

As future educators and scholars, we represent the next generation of nurses who will implement the DNP Essentials in the process of educating nurses in the decades to come. We recognize that the DNP Essentials will have a substantive influence on the future of nursing education.

We appreciate your efforts as in the DNP Essentials workgroup and the challenges inherent in taking on the task of creating this powerful and empowering nursing document. We understand that this document, when finalized, will significantly influence the curriculum and the education of thousands of nurses in our country for many years.

It is the recognition of the lasting power and influence of the DNP Essentials recommendations that brings us to write to you today. We join with the American Holistic Nurses Credentialing Center and nursing leaders from institutions of nursing education across the country to respectfully ask that you consider the following points of concern:

1. Theory and Competencies
Nursing theory, representing the wide variety of theories, frameworks, and models used in nursing and including those that provide the historical foundations of nursing, are missing from competencies within the DNP Essentials recommendations. We request that nursing theory and nursing history be included in the Essentials at every level because it is anchors us to our past, present, and future knowledge of nursing. Nursing theory, including knowing the connections to its philosophical roots, shapes who we are as nurses and highlights the critical and distinct human service of nursing that is not met by other disciplines. Education in nursing theory, along with other essential educational content, ensures a solid foundation in disciplinary knowledge and perspective for future nurses, nurse scientists, and scholars. The ongoing development of nursing theory can also lead to the creation of knowledge that can be shared across disciplines. 

2.  Disciplinary Perspective
Competency-based education in nursing must reflect our unique disciplinary perspective with a focus on protecting, promoting and restoring health and well-being, the prevention of illness and injury, the alleviation of suffering (ANA, 2015, p.1) and perspectives on humanizing the health experience (Reed, 1997; Willis, Grace & Roy, 2008). The provision of nursing theory as a foundation for nursing education reinforces our discipline-specific perspective. Nurses need to be competent in articulating the history, voice, and vision of nursing. 

3. Nursing-Centered Frameworks 
Competencies derived from the biomedical models like the Interprofessional Domains of Practice (Englander, Cameron, Ballard, Dodge, Bull, & Aschenbrener, 2013) minimize 100 years of knowledge building that evolved within nursing to define the discipline specific contributions nursing brings to the patient care experience as a science and a discipline. This undermines the existence of the historical work that has been done in nursing theory development, and impedes the future progress of our discipline.

4. Nursing Identity
Interprofessional collaboration must be built upon a strong identity as nurses, so that each nurse can articulate what they bring to the healthcare team, highlighting the priorities that are different from but complementary to the interprofessional team. Without this perspective it will be all too easy for nurses to lose sight of their unique contributions to the interdisciplinary team.

5.  Healthcare Trends 
Healthcare trends and expectations will influence nursing’s roles and practice within healthcare delivery for the next decade, as AACN has articulated, making our strong nursing identity and unique perspective on patient care more important than ever. We are concerned that some current trends in healthcare may emphasize profit, technology and disease over the importance of nursing care, including an alarming shift away from the caring, holistic, scientific, and relationship-based nature of nursing and towards an often profit-driven, technical and biomedical model of interdisciplinary focus where nurses becoming identity-less “health care professionals.”

We envision harnessing the power of nursing through carefully constructed educational essentials to actively shape a just and equitable healthcare service model in the United States of America, and provide future nurses with a clear identity as nurses. However, our future nurses must be educated in the fundamental theoretical and philosophical foundations of nursing in order to preserve the character and ethos of our profession. 

In summary, nursing has always embraced interdisciplinary teamwork. However, we believe that our essential educational competencies must remain firmly grounded in nursing values, nursing theory, and nursing history. Educational essentials and nursing competencies must first reflect our nursing perspective, not those of other disciplines. 

We are nurses and our educational competencies should reflect nursing knowledge and nursing theory. We urge you to consider our recommendations, and how framing of the DNP Essentials within a biomedical, interdisciplinary model would minimize over 100 years of scholarly work by nurses to advance a unique disciplinary perspective and identity. We further recognize the impact that DNP-prepared nurses will have in the future of nursing and the future of healthcare, underscoring the urgency of our concerns.

We acknowledge and appreciate all of the hard work your committee has put forth on this important topic. We hope that you will consider our position in your future revisions of the DNP Essentials. If you wish to have further dialogue on this issue, we as future and present nurse leaders would appreciate the opportunity to engage further.

With gratitude,
The Nursing Theory Collective   

Cosigned by:
Brandon Brown, EdD Student, MSN, RN-BC, CNL 
Ellen Buckner PhD, RN, CNE, AE-C, FNAP
Clare Butt, RN, PhD 
Jill Byrne, MSN, RN, CNOR, PhD Student
Gayle L Casterline, PhD, RN, AHN-BC
Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN
Da’Lynn Clayton, PhD, RN 
Catherine Cuchetti, RN, MSN
Jessica Dillard-Wright, PhD Candidate, MA, CNM, RN
Margaret Erickson, PhD, RN, CNS, APRN, APHN-BC
Rosemary W. Eustace, PhD, RN, PHNA-BC
Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN, ANEF
Pamela Grace, RN, PhD, FAAN
Consuelo Grant, PhD Student, BSN, RN
Debra R. Hanna, PhD, RN, ACNS-BC
Jane Hopkins Walsh, PhD Candidate, PNP-BC, RN
Yuanyuan Jin, PhD Student, MSN, RN
Amy Kenefick Moore, PhD, RN, APRN, CNM, FNP-BC, APHN-BC, HWNC-BC
Kan Koffi, RN, AD, B.Sc., M.Sc.
Carrie Langley, PhD Student, MSN, MPH, RN 
Patricia Liehr, PhD, RN
Chloe Littzen, PhD Student, MSN, RN, AE-C
Colleen Maykut, RN, BScN, MN, DNP
Melissa McCoy, MSN, RN
Angela Norton, PhD Student, MSN/Ed, RN
Christina Nyirati, PhD, RN
Judith Pare, PhD, RN
Marilyn Ray, RN, PhD, CTN-A, FSfAA, FAAN, FESPCH (hon.), FNAP
Pamela Reed, PhD, RN, FAAN
M. Kay Sandor, PhD, RN, LPC, AHN-BC
Phyllis Shanley Hansell, DdD
Mike Taylor RN, MHA, CDE
Billie S. Vance, MSN, FNP-BC
Sylvia K. Wood, DNP, ANP-BC, AOCNP
Rorry Zahourek, PhD, RN, PMHCNS-BC (ret), AHN-BC, FAAN

References

American Nurses Association. (2015). Nursing scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Association.

Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), 1-9. doi: 10.1111/nin.12243

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088-1094. doi: 10.1097/ACM.0b013e31829a3b2b

NCSBN. (2019). Next generation NCLEX project. Retrieved from https://www.ncsbn.org/next-generation-nclex.htm 

Perron, A., & Rudge, T. (2015). On the Politics of Ignorance in Nursing and Health Care: Knowing Ignorance. New York, NY: Routledge.

Reed, P. G. (1997). Nursing: The ontology of the discipline. Nursing Science Quarterly, 10(2), 76-79. doi: 10.1177/089431849701000207

Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for the discipline: facilitating humanization, meaning, choice, quality of life, and healing in living and dying. Advances in Nursing Science, 31(1), E28-E40. doi: 10.1097/01.ANS.0000311534.04059.d9.

What is Real Nursing and Who are Real Nurses? Perspectives from Japan

Thank you to the graduate students and faculty
from St. Mary’s College, Kurume, Japan, who

contributed to this blog!

Hayes (2018) published a thought-provoking article, “Is OR Nursing Real Nursing,” in the September 2018 issue of the Massachusetts Report on Nursing. Her article was the catalyst for my invitation to students enrolled in the Fall 2018 University of Massachusetts Boston PhD Nursing Program course, NURS 750, Contemporary Nursing Knowledge, to join me in sharing our perspectives about “real nursing.” The result was published in the October 2019 issue of Nursing Science Quarterly (Fawcett et al., 2019).

Photo of the Misericordia Bell, The bell, which hangs In the tower of the St. Mary’s College Library, is a symbol of Misericordia et Caritus, which is the founding philosophy of St Mary’s College. Retrieved from http://st-mary-ac.sblo.jp/

This blog has provided an opportunity for six graduate students and three faculty members at St. Mary’s College Graduate School of Nursing, in Kurume, Japan to share their perspectives about “real nursing.” My invitation to them was given as part of a January 2019 video conference lecture I gave in my position as a visiting professor at St. Mary’s College. I am grateful to Eric Fortin, a St. Mary’s College School of Nursing faculty member, for his translation of the students’ and faculty’s contributions from Japanese to English.  Noteworthy is that St. Mary’s College School of Nursing is the first to include nursology as part of the name for their research center–the Roy Academia Nursology Research Center

Graduate Students’ Perspectives

Junko Fukuya: Throughout my nursing career, I have always used a nursing conceptual model to guide care of hospitalized patients from admission to discharge. I would like to become a better nursologist, a “real nurse,” who allows nursing knowledge to permeate my mind and impresses its importance on other nurses.

Akemi Kumashiro: Nursing is practiced in many settings, including clinical agencies and local communities, with people who are well and those who are ill. Real nursing occurs when the nurse continually gains the knowledge and experience required to help people to adapt to a new life style when changes in environment occur.

Takako Shoji: Patients are persons who are important to and loved by someone. By recognizing patients as people with life experiences and families, I do not merely provide knowledge and technology, instead, as a real nurse, I work to establish a relationship with each patient that respects the values he or she has formed through life experiences.

Chizuko Takeishi: The real nurse endeavors to meet the universal needs of individuals, families, groups, and communities of all ages. Real nursing is directed to helping people to make decisions directed toward maintenance and promotion of wellness, prevention of illness, recovery from illness, relief from pain, maintenance of dignity, and promotion of happiness.

Tomomi Yamashita: As a real nurse, I know that patients are waiting for me and support me in establishing mutual and warm relationships. Real nursing involves actions, thoughts, and words that affect patients’ lives. It is a process of talking with patients about their perceived needs and anticipating those needs they have not yet identified.

Yuko Yonezawa: Real nursing involves seeing human beings as holistic beings consisting of body, mind, and spirit, who are deserving of respect and compassion from the very first moment of their existence to the end. Real nursing also involves knowledgeably helping people to help themselves to live their lives how they want.

Faculty Members’ Perspectives

Tsuyako Hidaka, Ikuko Miyabayashi, and Satsuki Obama: As a real nurse, the nursologist interacts with patients while providing daily care and obtains a lot of quantitative and qualitative data as he or she builds therapeutic relationships with patients. These data are the basis for what may be considered “invisible mixed methods nursing research” (Fawcett, 2015). Real nursing is a very noble profession in which real nurses learn “Life and Love” from patients as human beings and can thus grow as human beings themselves.

Jacqueline Fawcett: My position is that all nursologists (that is, all nurses) are real nurses who are engaged in real nursing. However, various perspective of what real nursing is (or is not) exist, as Hayes (2018) had indicated.

I am grateful to the graduate students and faculty at St. Mary’s College Graduate School of Nursing for sharing their perspectives about “real nursing” with the readers of this blog. I now invite students and faculty worldwide to send their perspectives about “real nursing” to me (jacqueline.fawcett@umb.edu) for inclusion in future nursology.net blogs. As we gather worldwide perspectives, we will be able to identify and describe what Leininger (2006) called universalities and diversities in who we are, what we do, and why and how we do what we do.

References

Fawcett, J. (2015). Invisible nursing research: Thoughts about mixed methods research and nursing practice. Nursing Science Quarterly, 28, 167-168.

Fawcett, J., Derboghossian, G., Flike, K., Gómez, E., Han, H.P., Kalandjian, N., Pletcher, J. E., & Tapayan, S. (2019). Thoughts about real nursing. Nursing Science Quarterly, 32, 331-332.

Hayes, C. (2018). Is OR nursing real nursing? Massachusetts Report on Nursing, September, 11.

Leininger, M. M. (2006). Culture care diversity and universality theory and evolution of the ethnonursing method. In M. M. Leininger & M. R. McFarland, Culture care diversity and universality: A worldwide nursing theory (2nd ed., pp. 1-41). Boston: Jones and Bartlett.

Are We Ready to Utilize Concept Analyses To Advance Nursology? Could This Be a Way Forward?

Rosemary, we found a recent citation of your research”, is a message I receive from ResearchGate whenever there is a new citation to my work! One message was another citation to one of my early papers (Eustace & Ilagan, 2010), which was the report of a concept analysis of HIV disclosure, published in the Journal of Advanced Nursing. Noteworthy is that this message was a report of the 50th citation to that paper. In the world of knowledge generation, this was particularly exciting news because I realized the impact the paper had for other scholars.  What I didn’t realize was the magnitude of influence the paper had in advancing nursing knowledge. This led me to some random thoughts on who exactly are these authors who cited my work and what was the context of their citations of my paper? A brief review of the citations and literature about the topic indicated that majority were from papers published in non-nursing journals and authored by non-nursing scholars. In addition, I found that some publications from nursing that examined closely related concepts did not cite my work. This surprised me but increased my curiosity about what all of this meant to me as a nursology scholar.

During a recent search of literature, I found an inspiring article by Rodgers et al. (2018) about the limitations of concept analysis. They underscored the importance of “moving knowledge development beyond the level of ‘concept analysis’ to developing a clear linkage to the resolution of problems in the discipline” (p. 451).  I asked myself, how can we do that? Do we have the theoretical and methodological knowledge to do that?  If we do, why are we still “stuck” on concept analysis per se?

These questions prompted me to reflect on my concept analysis of HIV disclosure (Eustace & Ilagan, 2010). I asked myself, what has been done to move beyond the concept analysis of HIV disclosure during the intervening years? A search for the citations using the Semantic Scholar impact search engine (https://www.semanticscholar.org) revealed that one replication of my concept analysis has been published (Kanyamura, Ncube, Mhlanga, & Zvinavashe 2016). Surprisingly, although the impact of the publication indicated was highly influential to others work, especially for background data, the impact of the analysis findings was very limited (see Figure 1). What this meant to me was that there was no indication of linkage of the concept analysis results with knowledge development. Inasmuch as this finding is consistent with Rodgers et al.’s (2018) concern that concept analyses are not being extended to resolve disciplinary problems, how, can we help nurse scholars advance science in this area? Is there a way?

Figure 1: Semantic Scholar Impact Output for the concept of HIV Disclosure by Eustace and Ilagan (2010)

One way forward is to develop clear guiding structures for nursing knowledge development as an essential step in closing the gaps between theory, research, and practice (Marrs & Lowry (2006). To help find a solution, I turned to the well-known approach of Conceptual-Theoretical-Empirical (CTE) structures in nursing that have been advocated for many years by Dr Jacqueline Fawcett (e.g. Fawcett, 1988; Fawcett, 2012). So, where do we start? I propose that nurse scholars consider the following 3 critical steps:

Step 1: Nurse Scholars need to examine where a nursing concept of interest is derived from within our nursing models/theories. For example, the case of the concept of HIV disclosure can be situated within the nursing model of HIV Disclosure developed by Bairan et al. (2007) (i.e. relationship model). It is important for the nurse scholar to indicate the purpose of the concept analysis: is there a need for clarification, development, or refinement or is there little or no literature about the concept? These queries will guide the scholar to the appropriate concept analyses methods. The selection of HIV disclosure, in my case was the lack of a clear definition and a broader perspective of the HIV disclosure process in both the Bairan et al. (2007) model and in other HIV disclosure models (e.g. disease progression (Kalichman, 1995 ); consequences model (Serovich, 2001).

Step 2: Nurse Scholars need to develop a conceptual theoretical empirical (CTE) structure for linking concept analyses to the next step in theory generation. As described by Fawcett and Gigliotti (2001), theory generation studies usually proceed from the “conceptual model directly to the empirical research methods and the data obtained is analyzed creating a new middle range theory” (p. 342). Thus, the CTE structure should direct the nurse scholar to the relevant literature for the concept analysis, which will be summarized and synthesized to identify the antecendents, attributes and consequences of the new descriptive middle-range theory of the concept of interest (see Figure 2 for an example of the CTE structure for the concept analysis of HIV Disclosure). The “C” in the CTE structure represents the HIV Disclosure Conceptual Model by Bairan et al. (2007). The “T” represents the specific concept to be analyzed, which is “HIV disclosure.” The E of the CTE structure indicates the empirical research methods used to generate the antecendents, attributes and consequences of the studied concept, as explained in Walker and Avant’s (2019) approach to concept analysis.

Figure2: Conceptual-Theoretical-Empirical Structure for Linking Concept Analyses to Theory Generation

Figure2

Step 3.  Nurse Scholars need to utilize the findings from the concept analyses to advance nursing knowledge by using the results of the concept analysis to develop/refine theory constructs, develop instruments and then progress to explanatory and predictive theories by linking other concepts of the conceptual model to theory concepts.  So how can scholars use the descriptive middle range theory from the concept analyses to advance existing theory/model development?  Figure 3 provides a CTE structure for a hypothetical study of linking the concept analysis of HIV disclosure to advance the HIV disclosure model by Bairan et al. (2007). The vital step within the CTE structure is the re-evaluation process of the theory of which I have named the “theory refinement” process. In the HIV disclosure example, the original guiding conceptual model by Bairan et al. (2007) needs to be refined utilizing the antecedents, attributes and consequences derived from the concept analysis of the HIV disclosure concept. Scholars should utilize the results of the analysis to assess the adequacy of the constructs of the HIV disclosure model and propose directions for further empirical inquiry to determine the theory’s credibility in clinical practice and advancing the discipline.

Figure 3 – A hypothetical Conceptual-Theoretical-Empirical Structure for the HIV Disclosure Concept Analysis by Eustace et al. (2010)

Here are some epistemological considerations if we choose to move forward with this approach:

  1. How can we best approach T in the CTE structure? In this case, how should nursology theorists guide scholars on how to systematically develop constructs from the descriptive middle range theory to be utilized in refining the concept for the existing theory/model?
  2. What strategic and systematic approaches should we employ to retrieve, summarize, and synthesize the evidence for concept analyses, report findings and, lastly evaluate empirical studies on the concept analyses -theory generation linkage? How can we standardize the documentation process during knowledge dissemination? For example, documenting the specific date ranges when evidence was retrieved, dates when the publication was received, revised, accepted, published online and in the journal.
  3. How should we move forward in designing shared CTE structures that are empirically adequate in nursing situations (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001). For instance, how can we generate a global nursing HIV theory model and also contribute to knowledge development of a global interprofessional HIV Disclosure model?

 

A Call to Action:

ARE YOU READY to end what Draper (2014) calls the “intellectual dead end” (p. 1208) of concept analyses in nursing? If so, join me in articulating and advocating for approaches that facilitate the use of concept analyses as the starting point for advancing nursing knowledge. Developing nursology focused CTE structures that link concept analyses to other relevant practice phenomena are timely and very much needed to meet the demands of the complex 21st health care delivery systems. I welcome any comments or suggestions from nursologist around the world on how we can better address this ongoing concern as we think about advancing nursing science for the Future of Nursing 2030.

References

Bairan, A., Taylor, G. A. J., Blake, B. J., Akers, T., Sowell, R., & Mendiola Jr, R. (2007). A model of HIV disclosure: Disclosure and types of social relationships. Journal of the American Academy of Nurse Practitioners, 19, 242-250.

Draper, P. (2014). A critique of concept analysis. Journal of Advanced Nursing70, 1207-1208.

Eustace, R. W., & Ilagan, P. R. (2010). HIV disclosure among HIV positive individuals: A concept analysis. Journal of Advanced Nursing66, 2094-2103.

Fawcett, J. (1988). Conceptual models and theory development. Journal of Obstetric, Gynecologic, & Neonatal Nursing17, 400-403.

Fawcett, J. (2013a). Thoughts about conceptual models and measurement validity. Nursing Science Quarterly26, 189-191.

Fawcett, J. (2013b). Thoughts about multidisciplinary, interdisciplinary, and transdisciplinary research. Nursing Science Quarterly26, 376-379.

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

Kalichman, S. C. (1995). Understanding AIDS: A guide for mental health professionals.  Washington, DC: American Psychological Association.

Kanyamura, D., Ncube, B., Mhlanga, M., & Zvinavashe, M. (2016). HIV Disclosure: Concept AnalysisJournal of Research in Pharmaceutical Science, 3(4), 1-4.

Marrs, J. A., & Lowry, L. W. (2006). Nursing theory and practice: Connecting the dots. Nursing Science Quarterly19, 44-50.

Rodgers, B. L., Jacelon, C. S., & Knafl, K. A. (2018). Concept analysis and the advance of nursing knowledge: State of the science. Journal of Nursing Scholarship50, 451-459.

Serovich J.M. (2001). A test of two HIV disclosure theories. AIDS Education Prevention, 13(4), 355–364

Villarruel, A. M., Bishop, T. L., Simpson, E. M., Jemmott, L. S., & Fawcett, J. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly14, 158-163.

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing. New York, NY: Pearson Education Inc.

Dolores (Dee) Krieger (1921-2019)

Guardian of the Discipline

Dolores (Dee) Krieger, RN, PhD, was a professor emeritus in what was the Division of Nursing at New York University (NYU) in New York City, when she retired.

Dee was born in Paterson, New Jersey, not far from New York City. She earned a diploma in nursing at the Westchester School of Nursing at Grasslands Hospital in Westchester, NY, and baccalaureate, master’s and PhD degrees in nursing at NYU. She was residing near Columbia Falls, Montana, at the time of her death.

Dee taught at NYU for many years, where “she developed innovative curricula. Her graduate course, Frontiers in Nursing, became a model for many other groundbreaking classes in the field of healing” (Therapeutic Touch International Association [TTIA], 2019).

Dee clearly lived the life of a Guardian of the Discipline, especially with her commitment to advancing the innovative non-invasive modality of Therapeutic Touch (TT). Indeed, Dee is best known for her co-founding, with Dora Van Gelder Kunz, of TT, which she taught and gave workshops in at NYU for many years. “In 2010, [Dee] extended the concept of Therapeutic Touch to include the idea of Therapeutic Touch Dialogues which [were designed to explore] in depth the future consciousness of the TT process, research and theory. . . . In 1979, [Dee] established Nurse Healers Professional Associates (NHPA) which eventually became known as Therapeutic Touch International Association” (TTIA, 2019).

Dee “traveled internationally as a teacher and speaker and her many books have been translated into at least nine languages. Thousands of people spread around the world have learned to practice and teach Therapeutic Touch . . . to bring this compassionate work to those in need. Her work is carried on by a cadre of professionals who will extend Therapeutic Touch into the future both theoretically and in everyday healing interactions” (TTIA, 2019). Barrett (2003) pointed out that Dee had taught TT to “48,000 professionals and numerous laypersons.” Barrett (2003) added, “Aside from Florence Nightingale, probably more people recognize the name Dolores Krieger than that of any other nurse throughout history. Her first book on TT is in its 37th printing, and she has written 4 more books on TT.

Dee received many awards for her teaching and TT work, including a Distinguished Alumni Award from NYU (1982) “and the Alice and Elmer Green Award for Excellence from the International Society for the Study of Subtle Energies and Energy Medicine in 1997” (TTIA, 2019). Another award, for holistic healing, was bestowed in 2003 by the Open Center. On that occasion, Barrett (2003) commented  that Dee’s “pioneering work in [TT] has had a profound impact on the practice of healthcare worldwide. Through her lectures, workshops, and writing over the past [2.5] decades, she has helped to bring holistic healing into the mainstream.” The Open Center award is especially noteworthy, as it was “the first award [given] to a nurse and [the Open Center’s] first award in holistic healing” (Barrett, 2003).

However, being an innovator rarely is without challenges from the mainstream. Indeed, as Barrett (2003) indicated, Dee had “withstood political slings and arrows with courageous perseverance. She recently reminded me that she simply responds to misinformation, misinterpretation, and misunderstanding about [TT] with that powerful ally the truth.”

Despite the challenges, Dee’s work has had a substantial impact on healthcare in general and nursology in particular. That impact is evident in the results of a recent search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), which revealed the vast reach of Dee’s work (see Table).


References

Barrett, E. A. M. (2003, April 6). Introduction of Dolores Krieger on the occasion of receipt of an award for holistic healing from the Open Center. (Personal communication to J. Fawcett, August 3, 2019.)

Therapeutic Touch International Association. (2019). Dr. Dolores “Dee” Krieger: Obituary. Retrieved from http://therapeutictouch.org/

The Environment, Climate Change, and the #Climate Strike: A Nursology Perspective

with contributions by Peggy Chinn
Also see Adeline Falk-Rafael’s “addendum” to this post below

The nursology.net management team agreed to participate in the September 20, 2019 #Climate Strike – Nursology.net went to a  green screen acknowledging the importance of this public action for the entire day on September 20th. By doing so, we joined people “[i]n over 150 countries . . , to support young climate strikers and demand an end to the age of fossil fuels. The climate crisis won’t wait, so neither will we.” (from Global Climate Strike)

Climate can be defined as “characteristic weather conditions of a country or region; the prevalent pattern of weather in a region throughout the year, in respect of variation of temperature, humidity, precipitation, wind, etc., esp. as these affect human, animal, or plant life” (Oxford English Dictionary, 1889/2008)

The lack of sufficient attention to widely documented climate change by so many people, is, of course, the impetus for #Climate Strike. Climate change is defined as “an alteration in the regional or global climate; esp. the change in global climate patterns increasingly apparent from the mid to late 20th cent. onwards and attributed largely to the increased levels of atmospheric carbon dioxide produced by the use of fossil fuels .”(Oxford English Dictionary, 1889/2008).

The nursology.net management team’s concern with climate reflects our heritage of Florence Nightingale’s emphasis on environment and the effects of environment on human beings’ health status. Climate is, of course, a major aspect of environment, although climate is rarely mentioned in nurse theorists’ discussions of environment. An exception is found in the content of Orem’s self-care framework. Orem (2001) referred to two dimensions of what she labeled environmental features–physical, chemical, and biological features; and socioeconomic cultural features. Physical and chemical features include what typically is thought of as at least part of the climate—the atmosphere of the earth, gaseous composition of air, solid and gaseous pollutants, smoke, [and] weather conditions (Orem, 2001). Another exception is found in the content of a new conceptual model—the Conceptual Model of Nursology for Enhancing Equity and Quality—Population Health and Health Policy (Fawcett, in press). Following a suggestion from a PhD nursology student at the University of Massachusetts 2018 Five Campus PhD Forum, climate was explicitly included in this conceptual model in the definition of the physical environment.

Two recent nursing scholars have given primary focus on the environment in their work; their work provides important foundations for nursing action. Patricia Butterfield’s Upstream Model for Population Health (BUMP Health) provides a framework for addressing general issues related to health and the environment at a population level (Butterfield, 2017).  Dorothy Kleffel has been a thought-leader in nursing for more than 2 decades pointing the way toward a nursing focus on the environment and its effect on health (Kleffel, 1996).

A recent search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete), using the search terms, climate AND nursing, yielded 1,875 publications. However, a search using the terms, climate change AND nursing, yielded only 186 publications Two particularly informative publications are scoping reviews of the literature (Hosking & Campbell-Lendrum, 2012; Lilienfeld, Nicholas, Breakey, & Corless, 2018). Another informative publication is a call for action (Travers, Schenk, Rosa, & Nicholas, 2019).

Contemporary interest in environment and climate change has been prompted by two global initiatives–the 2008 World Health Organization (WHO) Member States World Health Assembly resolution (Hosking & Campbell-Lendrum, 2012) and the United Nations (UN) Sustainable Development Goals (Lilienfeld et al., 2018). The WHO resolution supports progress on studies of the effects of climate change on human health, including health vulnerability, health protection and its costs, the impact of migration and adaptation policies, and decision-support and other tools. Other health effects of climate change include an increase in communicable and noncommunicable diseases, weather-related injuries, mental health disorders, and effects of nutritional deficiencies on growth and development (Lilienfeld et al., 2018).

Hosking and Campbell-Lendrum’s (2012) scoping review of literature published between 2008 and June 2010 yielded 40 relevant papers. Of concern is that none of the papers were reports of studies of effective interventions, which clearly was a major gap in our literature of that time. Lilienfeld et al.’s (2018) scoping review placed climate change with the context of nursology. They identified and categorized 48 papers in their search of literature from 1996 to 2018, only a few of which were research reports. The categories are;

  • Background of climate change
  • Health consequences
  • Nursing knowledge and attitudes
  • Reference to UN Millennium Development Goals and/or the UN Sustainable Development Goals
  • Migration and/or adaptation strategies
  • Urgency
  • Plan
  • Climate justice

Once again, a major gap is research, especially the design and testing of interventions.

Travers, Schenk, Rosa, and Nicholas’ (2019) call for action by nurses may be the catalyst needed to advance nursology’s contribution to filling the gap in the literature. They underscored the findings of previous literature reviews revealing the effects of climate change on the environment and, consequently, on human health. Their call for action, which encompasses research, education, advocacy, and practice, exhorts nurse “to step up and see themselves as part of the solution to climate change” (Travers et al., 2019, p. 11).

There is, however, little evidence that nurses have begun to step up, to move beyond “talk about what needs to be done” (Travers et al., 2019, p. 11). As reported in The Washington Post (Tan, 2019), nurses are continuing to talk about climate change. An encouraging development is nurses’ willingness to join climate-oriented organizations as they increase their awareness of and even experiences of recent natural disasters, including hurricanes, wild fires, floods, and tornados (Tan, 2019).

The global action of the #Climate Strike, including worldwide demonstrations led by teenagers on Friday, September 20, 2019, and planned future Friday demonstrations certainly is encouraging. Perhaps these demonstrations will be a catalyst to actions by nursology students, faculty, and practitioners to conduct the research needed to identify effective interventions to mitigate the deleterious effects of climate change on human health. Perhaps, too, these demonstrations will move the UN and federal governments worldwide to fund that research.

Nursology is founded on a holistic conceptual orientation that points the way to recognizing the role of environment on human health, and toward nursing action to respond to this global crisis. It is time for nursologists and nursing as a discipline to step up to the challenge and provide a leading voice for healing the planet, for healing those who are harmed by the climate crisis, and join the many others who are demanding social and political action now to turn this crisis around.

Addendum by Adeline Falk-Rafael: Watson’s early publications of her philosophy and science of caring also explicitly identified the provision for “supportive protective and(or) corrective” environments, including specifically the physical environment as a carative factor. Although her language has changed, I believe the intent has not. That aspect of her theory was one key which led me to develop the mid-range theory of Critical Caring, based on her and Nightingale’s work (although my thinking has also been influenced by Butterfield’s and Kleffel’s work). Note: Adeline  (who is on our management team) was hiking in the Alps when we prepared this post!  Thank you Adeline for adding this important information to this post!)

References

Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. Advances in Nursing Science, 40, 2–11. http://dx.doi.org/10.1097/ANS.0000000000000161

Fawcett, J. (in press). The conceptual model of nursology for enhancing equity and quality: Population health and health policy. In M. Moss & J. Phillips (Eds.), Health equity and nursing: Achieving equity through population health & public policy. New York, NY: Springer.

Hosking, J. & Campbell-Lendrum, D. (2012). How well does climate change and human health research match the demands of policymakers? A scoping review. Environmental Health Perspectives, 8, 1076-1082.

Kleffel, D. (1996). Environmental Paradigms: Moving Toward an Ecocentric Perspective. Advances in Nursing Science, 18, 1–10. https://doi.org/10.1097/00012272-199606000-00004

Lilienfeld, E., Nicholas, P. K., Breakey, S., & Corless, I. B. (2018). Addressing climate change through a nursing lens within the framework of the United Nations sustainable development goals. Nursing Outlook, 66, 482-494.

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St. Louis, MO: Mosby.

Oxford English Dictionary (1889/2008). Definitions of climate and climate change.

Tan, R. (2019, September 20). Why nurses, America’s most trusted professionals, are demanding “climate justice.” The Washington Post. Retrieved from
https://www.washingtonpost.com/local/why-nurses-americas-most-trusted-profession-are-speaking-out-against-climate-change/2019/09/19/1c5314d8-dae2-11e9-a688-303693fb4b0b_story.html

Travers, J. L., Schenk, E. C., Rosa, W. E., & Nicholas, P. K. (2019). Climate change, climate justice, and a call for action. Nursing Economic$, 37, 9–12.

Happy Anniversary/Happy Birthday to Nursology.net!

We invite all of our visitors to join with us in developing this important resource!  Contact us with your interest and ideas!
This site is developed and managed solely by nursologist volunteers so our costs are minimal, but we welcome contributions to help assure the site’s future!!

Jacqueline Fawcett:

Jacqueline Fawcett

This is a very special blog, as we are celebrating the first anniversary/first birthday of the launch of nursology.net on September 18th. From a chronological developmental perspective, the website is transitioning from infancy to early childhood. However, given the amount of content already posted on this website, the weekly blogs, and the number of nursologists from many, many countries who have accessed the website, I dare to declare that we never were infants and now are mature adults! I am especially grateful to Peggy Chinn, our outstandingly superb webmaster, for her fabulous and steadfast work to create the website, the forms for submission of content and other items, many of the weekly blogs, and everything else that is needed to maintain the vibrancy of nursology.net. I also am very grateful to all members of our management team, whose interest in and enthusiasm for preserving our discipline has fostered so much success in one short year. In addition, I am very grateful to all other nursologists who have contributed content to the website, to those who have written blogs, and to those who have added comments to the blogs. I continue to welcome all nursologists to nursology.net—to view what is on the website, to contribute content, to submit blogs, and otherwise share your thoughts about nursology and all the wonderful work you are doing. The remainder of this blog is contributions from some of the members of our management team; I thank them for sharing their thoughts on the occasion of nursology.net’s first anniversary/birthday.

Peggy Chinn

Peggy Chinn:

When we first conceived of the website that we decided to call “nursology.net,” I certainly never imagined that the site would grow and develop as it has in just the first year! First, even though I have been immersed during my entire career in scholarship around the development of nursing knowledge, I honestly had no idea of the vastness, diversity, and widespread commitment that nurse scholars have demonstrated over the 50=plus years of nursing knowledge development. Those of us who have contributed to the development of the website knew one another professionally, and we all had deep respect for the scholarship that each of us brought to the table. But once we put all of our insights and expertise together in the tangible reality of the website, lo and behold, what we had was much larger than any of us imagined! During the past several months, I have had the opportunity to provide live “deep dives” into the website to demonstrate what is actually here – and with each occasion, everyone who participates leaves amazed at the true vastness of information that is here! As we look forward to the coming year, we will continue to add to the information in each section of the website, but our main focus will be to develop more thoroughly the “Exemplar” sections. After all, each of us involved in the site are nurses first – so our primary concern is using the theoretical ideas, our scholarship, to inform, shape, and re-shape our practices! We believe that nursing perspectives are necessary and valuable – that we offer dimensions that are respected by other disciplines. However, if we do not bring our perspectives as a central concern to each of our practices, something that is extremely valuable will be missing. Nursing perspectives do make a difference in practice, research, education, policy, and quality improvement – and each of the exemplar sections will continue to grow to demonstrate more clearly what that difference is!

Marlaine Smith:

Cheers to nursology.net on its one year anniversary! In only one year, nurses throughout the world have accessed nursology.net, offering us a valuable resource for learning more about the knowledge within the discipline. It is amazing to explore and discover the rich contributions, detailing the development and application of nursing theories of all levels in practice, education, and policy. Thank you to Drs. Peggy Chinn and Jacqueline Fawcett for their leadership in launching and advancing this website and thanks to all the contributors. Here’s to many more productive years of growing nursology!

Danny Willis:

When I pause to celebrate the one year anniversary/birthday of nursology.net, what comes up for me is a sense of hope for the future! Nursology is the substantive perspective that makes the difference in human and environment wellbecomng and alleviation of human suffering. Nursology addresses What Matters Most!” The philosophical, conceptual, theoretical, and empirical contributions that have shaped the discipline and profession are reflected at nursology.net. For nursologists everywhere, nursology.net provides a venue to be engaged in the knowledge endeavor, discerning clear direction should we get distracted. nursology.net is a wonderful resource for the world right here and right now, at our fingertips !! I look forward to continuing to participate in the evolution.

Dorothy Jones:

Nursology.net has become a global phenomenon, offering nurses from around the world immediate access to nursing knowledge and historical developments in nursing theory, education, research, and practice. When I presented the site to doctoral students in Spain, one student noted, “Having access to this site (for free) not only exposes us to information we do not have in our libraries but helps to connect us to our science in a new way. Thank you”. The continued development of nursology, with attention to presentations [in] other languages, will continue to grow the site and expand nurses’ ability to access knowledge and increase disciplinary dialogue around the world.

Dr. Eustace

Rosemary Eustace:

As we celebrate the one year anniversary of nursology.net,, we acknowledge the contributions of many of our founders and nursing scholars to evidence-based nursing (EBN). We call upon our fellow nurses around the world to advocate for the future of nursing that advances nursing science by developing, utilizing, and evaluating EBN to create a culture of health, promote social and financial justice, and increase access and responsiveness to evidence-based health care services.

Margaret Dexheimer Pharris:

Nursology.net has gotten off to a running start! In the past year, nursology.net leaders helped shape and participated in the 50th anniversary nursing theory conference at Case Western Reserve University (see Peggy Chinn’s conference keynote); several nursing journal editors have written about nursology.net in their journals; the American Academy of Nursing’s (AAN) Nursing Theory-Guided Practice Expert Panel has grown to be one of AAN’s largest expert panels; and, there have been over a dozen major nursology related conferences throughout the world. This resurgence of commitment to nursology practice and research rooted in the knowledge of the discipline provides a springboard propelling nursologists to ensure that nursing theory is woven through national nursing education guidelines for all professional levels, that every nurse can clearly articulate the difference that nursology makes because of its theories and philosophical perspectives, and that in the U.S., the National Institute for Nursing Research (NINR) be directed by a nursologist who understands the importance of grounding all NINR funded research in nursing theories and philosophies. These and many other efforts in which nursologists are engaging serve to holistically and equitably enhance the human experience of health. The year 2020 holds great promise for nursology to reach new heights!

Deborah Lindell:

Happy first anniversary to Nursology.net! This site serves a valuable service to all nurses by raising awareness of the essential role nursing knowledge plays in the discipline of nursing. It provides in-depth, understandable information about nursing knowledge in a variety of formats. I especially like the Guardians of the Discipline and the blog which promotes dialogue about current topics in nursing knowledge. I’ve integrated Nursology.net as a required resource in my DNP and MSN theory courses.

Thinking about Ideas in Nursing: 13th Philosophy in the Nurse’s World/23rd International Philosophy of Nursing Society Conference

Welcome to Jessica Dillard-Wright, who has now joined our
Nursology.net blogging team!
Jessica is a founding member of the
Nursing Theory Collective and
currently a PhD Student at Augusta University (Georgia)

I knew I was going to love Moby-Dick when I read the line, “Whenever I find myself growing grim about the mouth; whenever it is a damp, drizzly November in my soul; […] especially whenever my hypos get such an upper hand of me, that it requires a strong moral principle to prevent me from deliberately stepping into the street, and methodically knocking people’s hats off – then, I account it high time to get to sea as soon as I can” (Melville, 1851/1953, p. 17). And I did love it, still do. Sometimes the hypos get the upper hand of me, too, in particular when I am mired in the politics of nursing and education (not to mention the state of affairs we find ourselves in more broadly in the United States). This is especially the case when my ideas feel a couple of standard deviations outside the nursing norm. And then I find my way toward the niches and corners where other nurse dissidents reside and it’s like being at sea. 

The 13th Philosophy in the Nurse’s World/23rd International Philosophy of Nursing Society Conference was held August 18-20, 2019 in Victoria, B.C., a glorious coastal town IPONSlogothat satisfies the seaward impulse and welcomes a conference full of nursing philosophers. Dr. Thomas Foth’s opening plenary on the evening of the 18th softened my perioral grimness, asking us to contemplate the disciplinary apparatuses imposed through humanitarian efforts, focusing specifically on Canadian harm reduction and safe injection efforts for intravenous drug users. Here, Foth made the case that such humanitarian efforts paradoxically perpetuate individualist downstream interventions while failing to address structural inequalities. To this end, humanitarian efforts then shore up the neoliberal state, which in turn reproduces individual inequality and suffering. Foth concluded that the way forward for nursing was political action, oriented toward structural solutions to eliminate the foundations of human suffering. 

The question of politics was picked up in the second plenary session on the morning of the 19th, delivered by Dr. Sally Thorne. Thorne advanced a discussion of Carper’s ways of knowing in which she critiqued the dimension of personal ways of knowing. Thorne cited anti-science views held and advanced by some individual nurses, using anti-vaccination beliefs. Thorne urged nurses to develop a collective set of priorities and to use these priorities as a way to advance nursing writ large in an effort to avoid getting mired in individual nurses’ politics and beliefs. Following Thorne’s plenary, the concurrent sessions began.

In Dr. Kylie Smith’s collaboration with Foth on nursing history as philosophy, my soul found further refuge as Smith unpacked the complex legacy of nursing, the notion of care, and the work required for nurses to contribute to health equity and social justice. This marked another commonality in the concurrent sessions, which explored the hidden and suppressed stories of nursing, including the history of nursing, the colonialist and racist narratives housed within nursing’s assumptions, and the connection of nursing to greater social, cultural, and global challenges like climate injustice, enforced ignorance, and the impact of capitalism.

The critical thread that kicked off the conference was again picked up in a remarkable series of papers in the final concurrent session Dr. Marilou Gagnon first gave a concept analysis of the notion of “whistleblowing” in nursing, unpacking the complexity and muddiness of the concept. This was followed by Dr. Amelie Perron’s talk on the effects of ignorance and knowledge in nursing, advancing the idea of whistleblowing as an act of “epistemic disobedience,” challenging hegemonic order in nursing and healthcare systems. Together, Gagnon and Perron are directing the Nursing Observatory, a project focused on analyzing, acting, amplifying critical perspectives in Canadian nursing. The closing plenary was delivered by Dr. Janet Rankin, an empirical analysis of the “ruling forces” that shape nursing practice as nursing becomes increasingly technologically-dependent.

Of note, in contextualizing ideas in the nurses’ world, most of the papers (including those not commented on specifically here!) connected nursing to “outside” ideas like posthumanism, New Materialism, radical feminism, intersectionality, poststructuralism, neoliberalism, and social justice, situating nurses as political agents, encouraging nurses to engage critically with the ideas and influences that impact their practice, the communities they serve, their profession, and the world around them. A balm for the November drizzle, “the great flood-gates of the wonder world swung open” (p. 21) revealing possibility for nursing praxis, education, philosophy, and policy (Melville, 1851/1953). A call to political action for nursing. If you are interested in reading more, you can find the concurrent session abstracts here.

Currently, the International Philosophy of Nursing Society website is under construction but IPONS would love to have you. Please contact Mark Risjord at mrisjor@emory.edu to join. Look for more information soon on the IPONS conference for 2020, which will be held in Gothenburg, Sweden. 

References

Melville, H. (1953). Moby-dick or the white whale. London, UK: Collins Clear-Type Press.

(Original work published 1851).

 

This was written in conjunction with Jane Hopkins Walsh, who also attended IPONS 2019.