Breaking the Silence-Exploring Perceptions of Power as Freedom in the World of Nursologists

by Julianne Mazzawi, Jacqueline Fawcett and Rosanna DeMarco

In 2015, the American Nurses Association released a purpose and position statement indicating that it is an individual and shared responsibility among all nursologists and employers to promote and sustain a culture of respect that is free of incivility, bullying, and workplace violence. Such a culture reflects the ethical, moral, and legal responsibility of everyone to create a healthy and safe work environment for all members of the healthcare team, participants in healthcare (sometimes called patients), families, and communities. So why is it that nursologists and their support staff continue to show manifestations of “silencing-the-self” when instances of incivility, bullying, and even violence occur? (DeMarco, Fawcett, & Mazzawi., 2017, p. 4)?

Too often, nursologists experience sleep problems, anxiety, distress, oppression, burnout, absence from or leaving work, organizational frustration, and job dissatisfaction, and commit more errors due primarily to incivility, bullying, and violence in the workplace (Lim & Berstein, 2014; The Joint Commission, 2008; Vagharseyyedin, 2015) Obviously, it is imperative to resolve these negative outcomes for all current and future nursologists.

We conceptualized civility and incivility within the context of Neuman’s Systems Model. (See model below). Accordingly, the client system was represented by the nursologists who are the perpetrators or recipients of covert incivility (CI), defined as the “appearance of civility with negative intent” (DeMarco et al., 2018, p. 254). Stressors were represented by CI, and the reaction to stressors was represented by such manifestations as sleep problems, anxiety, oppression, burnout, and organizational frustration. The reactions were regarded as the impact of CI on nursologists who are faculty, students, and staff nurses, as well as witnesses to CI. The workplace (academic or clinical) and society also may experience reactions to CI. We identified several prevention as interventions for CI, with an emphasis on secondary and tertiary interventions; we explained that these interventions “need to be directed to exiting levels of CI of all kinds that include measuring the level of ‘silencing-the-self'” (DeMarco et al., 2018, p. 256).

2018 © Jacqueline Fawcett

Of course, primary prevention as intervention also must be considered; we recommended educating all students and graduates nursologists about both overt incivility and signs of CI and creating contracts for nursologists focused on “creating a formal promise to not engage in overt of covert incivility and addressing the behavior direction at the individual, group, and systems levels” (DeMarco et al. 2018, p 257).

In this blog, we offer the specific recommendation that focus on resolution of CI through application of nursological theories of power. Resolution of CI, we are convinced, will occur when nursologists’ perceptions of power change from perceptions of others having power over them to perceptions of power as freedom to choose and peace as power.

The idea for this blog was Mazzawi’s and Fawcett’s attendance at the 2018 Society of Rogerian Scholars (, at which the four nursological theories of power discussed here were presented. We began to imagine a world where nursologists perceive power as freedom to choose and peace as power rather than perceiving power as others having power over them to control them and that in this world, civility would reign, bullying and workplace violence would not happen, and only positive outcomes would occur!

Four nursological theories of power provide explanations of having power that leads to civil discourse and the conversion of negative outcomes to positive outcomes.

  • Barrett’s (2010). theory of power as knowing participation in change provides a contrast between power as freedom and power as control and encompasses awareness, choices, freedom to act intentionally, and involvement in creating change. Participating knowingly in the ongoing mutual process with ourselves, with other people, and with our immediate world creates the opportunity for not only fulfillment in one’s life but also the opportunity to create positive change. (See
  • Chinn’s (2013; Chinn & Falk-Rafael, 2015) theory of peace and power provides a contrast between peace-power and power-over. The theory empathizes how “individuals and groups . . . shape their actions and interactions to promote cooperation, inclusion of all points of view in making decisions and in addressing conflicts. [Accordingly], … individuals and groups can make thoughtful choices about the ways they work together to promote healthy, growthful interactions and avoid harmful, damaging interactions.” (Retrieved from
  • Polifroni’s (2010) theory of clinical power provides a contrast between having power as the result of knowledge and hierarchical power or taking power from another person. The theory emphasizes “the belief that power is knowledge and all nurses possess that power. In this context power is a right and it is truth/knowledge. Intentionality, authenticity, ways of knowing, PEACE . . . and CARE . . . surround the awareness and relationship of the nurse who is exercising clinical power” (Retrieved from
  • Sieloff’s (1995, 2018) theory of work team/group empowerment in organizations provides an understanding of how nursologists have power in clinical and educational organizations. The theory encompasses competency in communication and in explicating goals and outcomes, as well as the work team/group’s leader’s competency; control of environmental forces; utilization of resources; empowerment perspective; empowerment potential and actual capacity to achieve outcomes; role, that is, the “degree to which the work of an [organization] is accomplished through the efforts of [a work team/group]” (Sieloff, 1995, p. 58); and position, that is, “the centrality of [the] nursing [work team/group] within the communication network of an [organization]” (Sieloff, 1995, p. 57).

Application of the power theories as ways to enhance understanding and resolution of CI provides a nursology discipline-specific approach to practice. Readers are invited to share their experiences with application of the power theories as comments for this blog.


American Nurses’ Association. (2015). Incivility, bullying, and workplace violence. Retrieved from

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23, 47-54.

Chinn, P. L. (2013). Peace & power: New directions for building community (8th ed.). Burlington, MA: Jones and Bartlett Learning.

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: A theory of emancipatory group process. Journal of Nursing Scholarship. 47, 62–69.

DeMarco, R., F., Fawcett, J., & Mazzawi, J. (2017). Covert incivility: Challenges as a challenge in the nursing academic workplace. Journal of Professional Nursing, 1-6.

Lim, F. A., & Berstein, I. (2014). Civility and workplace bullying: Resonance of
persona and current best practices. Nursing Forum, 49, 124-129.

Polifroni, E. C. (2010). Power right and truth: Foucault’s triangle as a model for clinical power. Nursing Science Quarterly, 238-412

Sieloff, C. L. (1995). Development of a theory of departmental power. In M. A. Frey & C. L. Sieloff (Eds.), Advancing King’s systems framework and theory of nursing (pp. 46-65). Thousand Oaks, CA: Sage.

Sieloff, C. L. (2018, October 6). Thoughts about nursing and power: Theory of work team/group empowerment. Paper presented as part of a symposium on nursological theories of power at the Society of Rogerian Scholars 30th Anniversary Conference, New York University Rory Myers College of Nursing, New York, NY.

The Joint Commission (2008). Behaviors that undermine a culture of safety. Retrieved from

Vagharseyyedin, S.A. (2015). Workplace incivility: A concept analysis. Contemporary Nurse, 50, 115-125.

About the authors

Julianne Mazzawi

Julianne Mazzawi, RN; MS
PhD candidate, Department of Nursing
University of Massachusetts Boston

Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN; ANEF
Professor, Department of Nursing
University of Massachusetts Boston

Rosanna F. DeMarco, RN; PhD;  PHNA-BC; FAAN
Professor and Chair, Department of Nursing
University of Massachusetts Boston

Jacqueline Fawcett

Rosanna DeMarco

What are Legitimate Nursology Specialties?

 Bittencourt, Marques, and Mendes Diniz de Andrade Barroso’s (2018) paper, published in Revista de Enfermagem Referência, catalyzed my thoughts about labels for legitimate specialties in the discipline of nursology. (Scroll down for information about the authors and access to the article website.) Clearly, concern for nursology-discipline specific knowledge is of interest to our scholar colleagues from Brazil (Dr. Bittencourt) and Portugual (Dr. Dias Marques and Dr. Mendes Diniz de Andrade Barroso). They presented an innovative approach to further development of nursology by placing a traditional specialty (mental health) within the context of various nursological conceptual models and theories. (Download the PDF of the English open-access article here).

Bittencourt and colleagues (2018) pointed out that although nursologists “have been conducting studies with the purpose of promoting mental health in schools and other settings . . . based on evidence that clearly points to the effectiveness of promotion strategies, [nursological] theories are rarely put forward as a basis for these nurse-led mental health promotion strategies” (Bittencourt et al., 2018, p. 126). They recommended that nursological conceptual models and theories should be used to expand thinking about the practice of mental health promotion and described the contributions of Meleis’ Transitions Theory, Pender’s Health Promotion Model, Peplau’s Theory of Interpersonal Relations, and Roy’s Adaptation Model  to research and practice for promotion of mental health.

The starting point for Bittencourt and colleagues’ (2018) proposal is a traditional specialty area that imitates a medical specialty, that is, mental health. Nursologists typically identify with this and other specialties drawn from medicine, including but not limited to medical, surgical, obstetrical, and pediatric specialties. These specialties comprise many undergraduate and graduate educational curricula, the broad areas of nursologists’ research, and the naming of departments in clinical agencies. Thus, just as Bittencourt et al. (2018) did for the specialty of mental health, nursological conceptual models and theories could be used as guides for the content of the courses, research, and practice in other specialty areas.

But what if the content of each nursological conceptual model and theory was used to designate specialties? For example, many years ago, Rogers (1973) proposed that the subsystems of Johnson’s Behavioral System Model could be nursology-specific specialties. Accordingly, specialties for curriculum content, research, and practice could be the aggressive subsystem, the attachment subsystem, the achievement subsystem, the ingestive subsystem, the eliminative subsystem, the dependency subsystem, and the sexual subsystem. Similarly, specialties within the context of Neuman’s Systems Model could be physiological variables, psychological variables, sociocultural variables, developmental variables, and spiritual variables.
Although the proposal that specialties should be within the context of each nursological conceptual model and theory may be regarded as preposterous, at least some nursologists have understood the value and importance of labels for specialties that differentiate the discipline and profession of nursology from other sciences and especially from the trade of medicine. For example, Batey and Eyres (1979) explained that “Language is fundamental to the evolution of all disciplines [and] [w]ithin any discipline, selected terminology evolves to become the concepts that denote the specific knowledge domains and methodologies of that discipline” (p. 139). Moreover, “Every science has its own peculiar terms, concepts and principles which are essential for the development of its knowledge base. In [nursology] , as in other sciences, an understanding of these is a prerequisite to a critical examination of their contribution to the development of knowledge and its application to practice” (Akinsanya, 1989, p. ii). Barrett (2003) added, “How would one understand anatomy and physiology, microbiology, pharmacology, . . . without the precise use of language reflecting those domains of knowledge? . . . How else is substantive knowledge to be communicated without saying it is what it is that it is!” (p. 280).

As we think about the admittedly potential choas of having such diverse nursology-specific specialties, we may move to an innovative and integrative way of identifying the specialities that accurately delineate what nursologists actually teach, study, and practice. Clearly, we need to move to (paraphrasing) what Allison and Renpenning (1999) called thinking nursology, what Watson (1996) called nursology qua nursology, and certainly what Meleis (1993) pointed out is the need to progress from thinking like and pretending to be junior doctors to being senior nursologists.

Noteworthy is that many of the ideas included in this blog come from publications of decades ago. Yet, no progress has been made in all that time. So, what do you think nursology-specific specialties should be? Should we continue with the status quo of using the same terms as does medicine with the added value of the context of nursological conceptual models and theories? Or, should we be finally be bold and use the languge of our nursological conceptual models and theories to name and structure our specialties?


Akinsanya, J.A. (1989). Introduction. Recent Advances in Nursing, 24, i–ii.

Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.

Barrett. E. A. M. (2003). Response to Letter to the Editor. Nursing Science Quarterly, 16, 27-28.

Batey, M. V., & Eyres, S. J. (1979). Interdisciplinary semantics: Implications for research. Western Journal of Nursing Research, 1, 139-141.

Bittencourt, M. N., Dias Marques, M. I., & Mendes Diniz de Andrade Barroso, T. M. (2018). Contributions of nursing theories in the practice of the mental health promotion. Revista de Enfermagem Referência, 4(18), 125–132.

Meleis, A. I. (1993, April). Nursing research and the Neuman model: Directions for the future. Panel discussion at the Fourth Biennial International Neuman Systems Model Symposium (B. Neuman, A. I. Meleis, J. Fawcett, L. Lowry, M. C. Smith, and A. Edgil, participants), Rochester, NY.

Rogers, C. G. (1973). Conceptual models as guides to clinical nursing specialization. Journal of Nursing Education, 12(4), 2–6.

Watson, M. J. (1996). Watson’s theory of transpersonal caring. In P. Hinton Walker & B. Neuman (Eds.), Blueprint for use of nursing models (pp. 141–184). New York, NY: NLN Press.

About the authors

  • Marina Nolli Bittencourt, RN; Ph.D. is an Adjunct Professor, at the Federal University of Amapá, in Macapá, Brazil
  • Maria Isabel Dias Marques, Ph.D., is a Coordinating Professor, in the Nursing School of Coimbra,in Coimbra, Portugal
  • Tereza Maria Mendes Diniz de Andrade Barroso, Ph.D., is an Adjunct Professor in the Nursing School of Coimbra, in Coimbra, Portugal

Access the article

The file for their journal article, Contributions of nursing theories in the practice of the mental health promotion, is available in English and Portuguese at The abstract is available in English, Portuguese, and Spanish.

The journal, Revista de Enfermagem Referência, is the property of the Escola Superior de Enfermagem de Coimbra.

Update on early nursing theory think tanks facilitated by Margaret Newman

On November 13th, I posted information about early nursing theory think tanks organized by Margaret Newman!  A few days ago, I happened to be looking for something entirely unrelated in the early issues of Advances in Nursing Science and discovered a little notice announcing the second nursing theory think tank!   I have added the link to the announcement as an addendum to the November post, but also believe it is important to add here the information in this notice for its historic significance.

The ANS notice confirms that the purpose of the  first nursing theory think tank in October 1978 was to “bring together persons involved in theory development in nursing to explore areas of needed theory development and to devise a means whereby continuing dialogue between theorists can occur” (page 105).

The October 1978 think tank participants were:

Margaret Newman, facilitator (The Pennsylvania State University)
June Brody (Herbert Lehman College),
Carol Deets (Indian University),
Ellen Egan (University of Minnesota),
Rosemary Ellis (Case Western Reserve University),
Jacqueline Fawcett (University of Pennsylvania),
Joyce Fitzpatrick (Wayne State University),
Beverly Hall (University of Washington),
Margaret Hardy (Boston University),
Joan Rinehart (The Pennsylvania State University),
Elizabeth See (Wayne State University)
Marilyn Sime (University of Minnesota),
Ardis Swanson (New York University),
Gertrude Torres (Wright State University), and
Lorraine Walker (The University of Texas).

Values and Ethics: Foundations of

There are sections of many websites that are seldom visited – the mission, goals, or “About” pages that set forth the purposes that shape the content, focus and direction of the site. is no exception, other than the fact that many first-time visitors may be intrigued by the name of this site and might explore the “About” menu item to learn more!

We have recently added to our “About” page a section we believe to be central to this project – our “Values and Ethics.”  These statements of value are not just words – they are the principles that guide every decision and that shape the content of this site.  Notice that central to what we value is your involvement! belongs to every member of our discipline, and we welcome you to respond to any part of this site, including our statement of values and ethics!  Here is what we have posted – let us know your thoughts and ideas!

Values and Ethics

The development and maintenance of this site are guided by the following values:

  • We take every step possible to assure accuracy of content on this site by
    • Assuring review of content by members of the management team prior to activation of pages and posts.
    • Securing review and approval from any nurses who are central to the content presented (e.g. authors, key nurses involved), if those individuals are available.
    • Inviting corrections and updates from viewers who have the best information available.
    • Welcoming feedback, discussion and critique from viewers where there are issues of controversy or different points of view.
  • We assure accountability and transparency of the content on this site by:
    • Showing the name or names of the contributors who have provided the information displayed on specific pages
    • Providing the dates when content was initially posted and revised.
    • Providing links or references to sources from which content is derived, or is quoted.
  • We welcome submissions of content for each section of the website and have provided submission forms tailored to each section.  These forms are found on main pages of each section.  In addition, we welcome:
  • We will respond promptly to all communications, including requests to correct, change or remove any content that violates our commitment to  be accountable and transparent in using content from other sources.

An Introduction to the Canadian Nursing Theories Perspective

In a previous blog, I admitted my ignorance of nursing science during both my early diploma nursing education, and at least the first 18 years of my nursing practice.  But in the mid 1980s, I became aware of an increasing trend in Toronto area hospitals to adopt nursing theoretical frameworks.  Long after the fact, I also learned there had been nursing theory conferences held in Toronto around that time and set out to learn about those conferences, the experiences of the nursologists who attended, and with those in other provinces to discover other such events or activities.  What I found far exceeded what could be captured in 1 blog and yet I know I have barely scratched the surface!  My purpose here is first to thank everyone who has been so generous in sharing their time and archival documents (which will eventually be included in the Landmark Events section of the History tab of this website), and second, to invite nursologists from across Canada to add to my limited findings with what I’m sure is a wealth of information.

In pursuing information on the nursing theory conferences, I was reminded also of the other contributions to nursing knowledge made by Canadian nursologists, such as the:

  • Nursing Philosophy conferences organized by the Unit for Philosophical Research in the Faculty of Nursing, University of Alberta, proceedings of which were published;
  • Conceptual nursing frameworks used to guide curriculum development and pedagogy in Canadian University Schools of Nursing. At least one such model-the McGill model, also known as the Allen model or Developmental Health Model-has been explicated by research and used in nursing practice;1,2,3(3 articles of Ford-Gilboe and Margy Warner)
  • The development and or use of nursing conceptual frameworks to guide nursing practice in some hospitals and public health agencies;
  • The critique, comparison, and explication of nursing theories by Canadian nursing scholars.

Each of these areas will be explored in more detail in the weeks and months to come, hopefully by some of the key scholars who have been involved in these efforts. For the remainder of this blog, I will return to the Canadian nursing theory conferences

I have been able to identify 5 Canadian nursing theory conferences. One was held at the University of British Columbia, in 1988, and four in Ontario – two in Toronto in 1986 and 1988, one in Ottawa in 1989, and one at the Hamilton Psychiatric Hospital in 1993, in celebration of 20 years of theory-based nursing practice.4  Indeed HPH may well have been the first hospital in Canada to have adopted a nursing conceptual framework  (first Orlando, and later Peplau) to guide nursing practice.4

Many of the prominent nursing theorists of the time participated in the 1986 conference, including Dickoff and James, Imogene King, Myra Levine, Betty Neuman, Rosemary Parse, Martha Rogers, and Sister Callista Roy.  Some returned for the 1988 Toronto conference and notable additions for this conference included Virginia Henderson and Jean Watson.

Dorothea M. Fox Jakob, a retired public health nurse and nursing activist was a keen

Dorothea Fox-Jakob

participant in both nursing theory and NANDA conferences and, has generously provided proceedings from the 2 Toronto conferences as well as from many of the NANDA conferences.  Those proceedings are in the process of digitization and will be added to this website in the near future. Information about the other 3 conferences would be a great addition, as would information about any other Canadian nursing theory conferences.

Dorothea tells the story of meeting Virginia Henderson at a reception at the 1988 conference and telling her about her work in advocating for poverty reduction. Dorothea had prepared a resolution for the Registered Nurses Association of Ontario (RNAO), arguing that poverty was a health issue and urged RNAO to lobby for poverty reduction at the provincial and federal levels. The resolution was passed and promptly acted upon by RNAO. Dr. Henderson enthusiastically supported Dorothea’s actions and asked her to send her a copy of the resolution, which she did.  In return she received she received a letter in which she says she is encouraged by Dorothea’s efforts in “trying to do something about basic problems in society like poverty. We too often in the States leave this to others thinking that if we do our particular work well that we have fulfilled our role in society.” The handwritten letter, its transcribed content, and a brief statement of context have been framed and hang in the York University School of Nursing.

V Henderson letter-1.jpgReferences

  1. Ford-Gilboe, M. (2002). Developing knowledge about family health promotion by testing the developmental model of health and nursing. Journal of Family Nursing (8)2, 140-156.
  2. Warner, M. (2002). Postscript to “A Developmental Model of Health and Nursing” by F. Moyra Allen. Journal of Family Nursing, (8)2, 136-139.
  3. Ford-Gilboe, M. (1994). A comparison of two nursing models: Allen’s developmental Health Model and Newman’s Theory of Health as Expanding Consciousness. Nursing Science Quarterly (7)2, 113-118.
  4. Forchuk, C. & Tweedell, D. (2001). Celebrating our past: The history of Hamilton Psychiatric Hospital. Journal of Psychosocial Nursing and Mental Health Services (39)10, 16-24.






Nursology think tanks, anyone?

Notice in ANS 1:3 (April 1979) of 2nd NTTT gathering

What if we had a host of small nursology think tanks happening all over the world?  Sound impossible?  No, it is not impossible, and we have an historial model from which to build!  As Jacqueline Fawcett observes in her reflections below, this Nursology blog can be viewed as a think tank of sorts.  And, we can also envision ways for face-to-face nursology think tanks to happen! If you are inspired by this idea, don’t wait for someone else to do it – invite a few friends and colleagues, and do it!   Here is the model as Jacqui and I experienced it:

Dr. Margaret Newman

In 1978, Margaret Newman initiated a very simple idea with great influence – she called for a few of her colleagues around the country to gather at a designated airport hotel and spend a couple of days in deep discussion about the development of nursing theory.  She called the gathering a “Nursing Theory Think Tank (NTTT)”   There was no agenda, no note-taking, and no expectation for outcomes.  Everyone who was invited to participate each year made their own hotel reservation at a designated hotel near an airport hub, and Margaret arranged with the hotel to provide a small conference room for two days free of charge.  There were about a dozen people invited each year – often a handful of people who had attended in the past, and typically 2 or 3 who had not attended before and were doing significant work in the realm of nursing theory or philosophy (now of course known as nursology!). Margaret’s own book Health as Expanding Consciousness was in production at the time of the first gathering, and published early in 1979.

I attended about 2 or 3 of the gatherings – and the photo shown below is my only record of anything that happened one of the years I attended!  I know Margaret was there (she always was!), and since she is not in the photograph I am guessing that she might have taken the photo!  As you can see from the photo, this event happened in an era when nurses generally “dressed up” for such an occasion, but the fact is that the gatherings were very informal, and often peppered with humor, story-telling and sharing of life experiences.  There was always someone quick to remind the group that we were under no obligation to be “productive” – but of course, significant “productive” things happened as a result of these gatherings. Since we were all as busy as we could be with our very productive careers, we more than welcomed the opportunity to have this kind of discussion with no pressure – not even the pressure of taking notes!

My experience of these discussions had a lasting influence, affirming some of the ideas I was working on, challenging me to think at a deeper level about specific aspects of my work, and prompting me to take my ideas to a deeper level of understanding, But equally important, I had the opportunity to hear from other nursologists, learn about their perspectives, and come to appreciate not only who they were as individuals, but the importance of their ideas. So I have always carried with me the importance of this kind of free-flowing opportunity to just talk, challenge one another and deepen our understandings of our ideas and of one another as individuals.

It was at the NTTT that Jacqueline Fawcett and I first met in person – probably in about 1981 or 2.  When I founded Advances in Nursing Science  in  1978, someone suggested that Jacqui was a young scholar who would be a wonderful addition to the review panel – and she has served faithfully in this capacity ever since! While we have known one another all these years, serving together on the management team for is our first opportunity to work closely together.  Here are Jacqui’s reflections of the NTTT:

My notes indicate that that the Nursing Theory Think Tank (NTTT) began in
1978 and ended in 1988. My recall of the decade of existence of the NTTT
are as follows.

The NTTT was begun by Dr. Margaret A. Newman. The first meeting, in 1978,
was at State College, PA, when Margaret was on the faculty at Pennsylvania
State University. I was exceptionally honored to be invited to join the NTTT in 1978. The members, including those who were invited and those who joined later,
included Margaret, of course, as well as Ellen Egan (Margaret’s former NYU
classmate), Ardis Swanson (Margaret’s former NYU faculty colleague), June
Brodie and me (former students in Margaret’s NYU theory development course),
Beverly Hall, Lorraine Walker, Kay Avant, Elizabeth See, Peggy Chinn, Afaf
Meleis, and Barbara Carper. We met approximately once each year, typically
for a weekend in the fall season, at a hotel near an airport.

The NTTT discussions focused on the current and desired future state of
nursing knowledge. Most discussions were informal and wide-ranging; others
were more formal discussions, based on papers presented by NTTT members. I
presented a paper for discussion at the NTTT meeting in Dallas, TX, in
September 1982, which was published along with a critique by June Brody in
1984: Fawcett, J. (1984). The metaparadigm of nursing: Present status and
future refinements. *Image: The Journal of Nursing Scholarship, 16*,
84‑87; Brodie, J. N. (1984). A response to Dr. J. Fawcett’s paper: “The
metaparadigm of nursing: Present status and future refinements. Image: *The
Journal of Nursing Scholarship, 16,* 87-89.

I presented another paper for discussion at the NTTT meeting in Austin, TX,
in October 1986, which was published in 1989: Fawcett, J. (1989). Spouses’
experiences during pregnancy and the postpartum: A program of research and
theory develop­ment. *Image. The Journal of Nursing Scholarship, 21,*

Although the NTTT ended in 1988, many of the members have continued to
contribute to the development of nursology. To the extent that the blog
posts on might be considered a contemporary NTTT, all
nursologists are invited to submit blogs and publish their ideas about all
matters nursology in journal articles, book chapters, and books.

Addendum – added to this post on December 2, 2018 – I discovered a notice published in ANS 1:3 (April, 1979) describing the first NTTT in October, 1978, announcing the second think tank planned for March 1979, and inviting interested nursologists to contact Margaret Newman.

“Seated, L to R, Peggy Chinn, Beverly Hall, Jacqueline Fawcett, Elizabeth See
Standing, L to R, Afaf Meleis, Kay Avant, Lorraine Walker, Ellen Egan, Ardis Swanson”

Confronting Cultural Noise Pollution

Much earlier in my career a group of colleagues and I conducted a survey published in the American Journal of Nursing that addressed friendship in nursing*.  We were motivated to confront the message that nurses are their own worst enemies, and not friends. The results of the survey affirmed that although the message persists, and sometimes accurately describes relationships and interactions, there is ample evidence that nurses are more often than not our own best supporters and friends. I call these kinds of repeated negative messages cultural noise pollution that obscure the realities of the more accurate and complete situation – messages that obscure what is real and what is possible.

We created with a  similar motivation to confront the often repeated message that nursing theory is irrelevant, not necessary, or too abstract to be useful in practice.  These messages obscure the realities of the vital importance of nursing knowledge in the context of systems that serve to address the healthcare needs of our time.  They interrupt serious consideration, discussion and thought concerning who we are as nurses, what we are really all about, and why we persist in our quest to improve our practice. Failing to recognize the value of our own discipline’s knowledge, we fall prey to serving the interests of others, and neglect our own interests.

My favorite pithy definition of theory is this – theory is a vision.  Theory provides a view of concrete realities that makes it possible to mentally construct all sorts of dimensions that are not obvious to our limited perception of a situation in the moment.  It provides ways to understand how a particular “thing” comes about, what it means, what might happen next,  how the trajectory of a situation might unfold, and how human actions might change that trajectory.   In the practice of nursing, this is precisely what we are all about – we take a close look at a situation that presents a health challenge, we set about to understand what is going on beneath the surface, we examine evidence related to the situation, and we chart a course of action that might move the situation in a way that would not otherwise be possible.  People in other healthcare disciplines are doing much the same thing, but we have a nursing lens through which we as nurses view the situation.  Our  lens determines what we deem to be important in the evolution of the situation, and shapes the sensibilities we bring to the actions we take.  Our lens derives from nursology – the knowledge of the discipline.

If you take even a brief tour of, you will soon see that nursing theories, models and philosophies represent a coherent message focused on visions of health and well-being in the face of complex, sometimes tragic,  health challenges. You will also find a vast diversity of lenses that give a particular focus on this central message.  Some of the lenses give us a vision that is a lofty “30-thousand foot altitude” view. Some of the lenses focus in more closely on particular aspects of health challenges. There is no “right or wrong,” “better or worse.” Each lens simply brings about a different vision. Just as a camera can bring a different tone, hue or filter to see a single image in different ways, our nursing theories open possibilities and alternatives that would never be possible if we did not have the various lenses through which to view the situations we encounter. Taken together, these theories, models, philosophies form an ever-expanding nursology. Our theories, models and philosophies open possibilities for practice that can make a huge difference in the lives of real people.

We have an amazing, vast and rich heritage of nursing knowledge – and we are nowhere near done with the task!  Our vision for is to document and honor the serious knowledge-work that has been accomplished in the past, draw on this foundation, and inspire new directions that are yet unimagined!  We hope nurses everywhere, regardless of how or where you practice as a nurse, will join us in this journey, and add your voice to help shape what is possible! And importantly, we invite you to join us in confronting the negative, self-destructive effects of various forms of cultural noise pollution that cloud our vision!

*Friendship Study references

Chinn, P. L., Wheeler, C. E., Roy, A., Berrey, E. R., & Madsen, C. (1988). Friends on friendship. The American journal of nursing, 88, 1094–1096.

Chinn, P. L., Wheeler, C. E., Roy, A., & Mathier, E. (1987). Just between friends: AJN friendship survey. The American journal of nursing, 87, 1456–1458.

Scholarship for research or clinical practice project in process based in Rogers’ Science of Unitary Human Beings

The Society of Rogerian Scholars (SRS) offers funding for research or clinical practice project in process based in Rogers’ Science of Unitary Human Beings.  Up to three awards of $1000 each are given each year, and the application deadline is April 1!

Go to the Society of Rogerian Scholars website for more details – the award criteria, application  requirements, and the award process.  We are adding the application due date to the “Due Dates” list in the sidebar, with a link to  the SRS website details!

Theory-guided Practice Exemplar: United States Air Force Professional Caring Practice Using Ray’s Theory of Bureaucratic Caring

The first exemplar of theory-guided practice posted on was the United States Air Force Professional Caring Practice Using Ray’s Theory of Bureaucratic Caring.  In the process of preparing the information for posting, Dr. Marilyn “Dee” Ray shared how this came to be!  Here is her story:

It was a great honor to have the USAF, Nurse Corps accept my theory as their framework for

Photo credit: Lifetouch Church Directories – directories@lifetouch .com.

the new Interprofessional Person Centered Caring Model. The actual development came after Colonel Marcia Potter chose the Bureaucratic Caring Theory (BCT) for her doctoral (DNP) research on nurse and staff efficacy and economic outcomes regarding patients with diabetes. She completed her DNP in 2015. Her work improved USAF clinical practice and economic outcomes to the sum of over 2 million dollars.

At the same time, Lt General Dorothy Hogg, Surgeon General and Chief of the Air Force Nurse Corps wanted to develop a theory-guided person centered caring model for implementation in the Nurse Corps. She was the Deputy Surgeon General then but is now the first nurse and woman chosen to the rank of Lieutenant General (3 star) and Surgeon General of the US Air Force . She was recognized for her creativity, intellect, caring nature, and ability to motivate professionals toward health care collaboration and dynamic policy change. Colonel Potter recommended my theory to be the one that the executive should review to see if it would be the best to choose for development in the whole Nurse Corps for theory-guided practice because she had positive clinical and economic outcomes from her research in primary care. Colonel Potter called me on the phone after she found my information in the Society of Retired USAF nurses. So that call began our relationship and my reconnection to the executive of the USAF.

We had many discussions and a number of iterations of the model until the one posted on was selected. Colonel Potter has implemented Bureaucratic Caring Theory-Guided practice and research in all those areas you see on the website. It astounds me in terms of all she accomplishes.  All this has taken place since 2015.

There is now a new initiative that facilitates the development of person-centered caring in the USAF, NC called the C21 or Centers for Clinical Inquiry under the leadership of Brigadier General Robert Marks and Colonel Deedra Zabokrtsky. This initiative is planned in key locations around the Air Force where there are nurse researchers and librarians to support inquiries from the field looking for the best, most relevant research in the literature as it relates to nursing practice (evidence-based/informed practice), as well as engaging nurse researchers in different USAF sites directly in response to queries about improving nursing practice.

At the installation to Surgeon General and Lt. General in Washington, DC last June, Dorothy Hogg gave me this amazing recognition highlighting my theory as the theory that was selected to respond to the new health care initiative to focus on person centered and improve care in the USAF. As you can imagine, I was so deeply humbled and honored. I served in the USAF Nurse Corps for 32 years and served our country in many roles as flight nurse, clinician, educator, administrator, command nurse, consultant, and researcher in aerospace and organizational nursing and health care, veteran, and Colonel Retired, and now in this new role as a nursing theorist. What can I say, but a sincere thank you to so many people, including colleagues like [the Nursology.Net developers] who are role models and have encouraged and guided me throughout the years.

Kindest regards and caring thoughts,

Follow-up note –
I forgot to mention that I was invited to present the BCT guided interprofessional Person-Centered Caring Model and work in the USAF to the European Society for Person Centered Healthcare in London in September, 2016 where I was awarded an Honorary Distinguished Fellowship of the ESPCH. That is another great honor.

“Florence” as metaphor and reality was officially launched on September 18,  2018, just as hurricane-turned-tropical storm “Florence” raged through the U.S. southeast!  The name of this storm, and the timing of our launch, seemed more than a simple coincidence, considering the significance of this name in nursing history, and for the new beginnings that each “Florence” catalyzed for the global community.


Florence Nightingale – 1820-1910 

  • Vision of nurses as agents of societal and individual reform
  • Coupled care with political activism directed at laws and social conditions contributing to ill health – used the results of statistical analyses to convince politicians and military leaders and others about what people needed for high-quality wellness.
  • Laid foundation for professional nursing by establishing world’s first secular school for nurses at St. Thomas’ Hospital in London


Florence Wald – 1917-2008 

  • Dean of Yale University School of Nursing 1958-1968
  • Opened the first hospice in the United States in 1971.
  • Initiated training for inmates in Connecticut to become hospice volunteers for dying inmates, an approach that became a model for prisons worldwide.



Florence Downs – 1925-2005 

  • Director of Post Graduate and Research Programs, New York University 1972-1977
  • Associate Dean and Director of Graduate Studies, University of Pennsylvania 1977-1993
  • Served as Chairperson for more than 100 doctoral dissertation committees
  • Editor, Nursing Research 1979-1997. As the first academic editor of Nursing Research, Dr. Downs changed the editorial policies of the journal from publication of “one shot studies” and infrequent publication of the same researcher’s work to the new policies that enhanced the publication of programs of research by the same researcher or team of researchers
  • “Florence Downs, a well-recognized nursing leader, educator, editor, and Scholar helped shape nursing as an intellectual discipline and wrote extensively about the importance of links between research and practice” In Memoriam: Florence Downs. Nursing Research, 54, 373. .
  • The Florence S. Downs PhD Program in Nursing Research and Theory Development at New York University Rory Myers College of Nursing is named for Florence Downs

Each of these pre-eminent nurses who bore the name “Florence” emerged from circumstances in which they recognized that something significant needed to change – the status-quo was not sufficient. Their actions and the direction they set for the future were based on the premise that Nightingale put forward – it is the things that people do that cause illness and disease.  Like a hurricane, human actions can chart a new course, can change the lives and life-ways of so many people., is based on the belief that nursing itself holds the power to change the direction of healthcare, and to set a course toward health – for thriving in the face of hardship, and for peace in the midst of turbulent times.

Peggy L. Chinn, RN, PhD, FAAN and Jacqueline Fawcett, RN; PhD; ScD(hon); FAAN; ANEF

References for Information on Florence Downs:

Fairman J, & Mahon MM. (2001). Oral history of Florence Downs: the early years. Nursing Research, 50, 322–328.
In Memoriam: Florence Downs. Nursing Research, 54, 373.
Vessey J, & Gennaro S. (2005). The gardener: Florence Downs, August 20, 1925-September 8, 2005. Nursing Research, 54, 374–375.