A Theory of Parental Post-Adoption Depression: What’s New is New Again

Welcome to guest blogger Karen J. Foli, PhD, RN, FAAN,
Associate Professor,
Director, PhD in Nursing Program
Purdue University School of Nursing
Here she discusses the challenges of interacting with public media
about her theory of parental post-adoption depression (PAD)

Recently, I was contacted by journalists from Denmark and the New York Times. In both cases, they wanted to interview me about my middle range theory of parental terpost-adoption depression (PAD). I was honored to be asked about my work, but what struck me was a feeling of déjà vu. When my book, The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption (2004 and co-authored by John Thompson) was published and then followed by several empirically driven papers published in peer-reviewed journals (see references below), the press was out en masse.

It’s tricky talking to the press. I’ve made my share of mistakes and learned with every interview I’ve given. But back to the content of these interviews – parental post-adoption depression. The first questions I can count on are: “How does this compare with postpartum depression? What about hormonal changes? How common is PAD?” First, I try to explain that we now see postpartum depression as encompassing the perinatal time period. I describe how we really don’t know about hormonal changes with adoptive parents, but there are differences in the experiences of these two parent groups. In terms of prevalence, we’re not sure – my best estimate is 10% to 20% of adoptive parents may experience depressive symptoms.

Adoptive parents reach into society for a license to parent a child born to others. They go through a rigorous, invasive process during which they are waiting, and ultimately matched with an infant or child. Often, parents “sell” themselves as “super parents,” beings that set themselves up with high, often unrealistic expectations. Herein lies the heart of my theory: unmet expectations of themselves as parent, of their child, of family and friends, and of society and others, are associated with depressive symptoms. Based on my research, expectations of themselves are the hardest to meet.

The question becomes: how do nurses and nursology fit into this? Based on my research and writing (see also Nursing Care of Adopted and Kinship Families: A Clinical Guide for Advanced Practice Nurses), the answer is more than you would suppose. Social work is the historical and current default profession that we defer to when children are relinquished and for home studies that evaluate the fitness of adoptive parents. Yet we understand that adoptive children visit healthcare providers more frequently than birth children. Herein lies our opportunity as care providers to support families.

Many adoptive parents experience significant shame when they struggle with PAD. Sometimes, when they share their feelings, they will be met with: “But isn’t this what you’ve wanted?” Nurses in myriad specialty areas can make a positive impact. Pediatric nurses can assess the dynamics between the child and parent and look for cues of impaired or delayed bonding. Nurses providing care to older adults can also assess for PAD – relative placements in foster care and in informal arrangements are surging (also known as kinship caregivers). Primary care providers have multiple opportunities to look for signs of parental depressive symptoms post-adoption and ask about expectations that were or were not met.

To end, when parents experience depression, we know the kids suffer too. Nurses can be savvy caregivers to this special and vulnerable group of parents and their children. While this blog is too brief to relay all that we know about PAD, it’s a welcomed beginning.

References

Foli, K. J., Lim, E., & South, S. C. (2017). Longitudinal analyses of adoptive parents’ expectations and depressive symptoms. Research in Nursing and Health, 40(6), 564-574. doi: 10.1002/nur.21838

Foli, K. J., Hebdon, M., Lim, E., & South, S. C. (2017). Transitions of adoptive parents: A longitudinal mixed methods analysis. Archives of Psychiatric Nursing31(5), 483-492. doi: https://doi.org/10.1016/j.apnu.2017.06.007

Foli, K. J., South, S. C., Lim, E., & Jarnecke, A. (2016). Post-adoption depression: Parental classes of depressive symptoms across time. Journal of Affective Disorders200, 293-302. doi: 10.1016/j.jad.2016.01.049

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2016). Longitudinal course of risk for parental post-adoption depression using the Postpartum Depression Predictors Inventory-Revised.  Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(2), 210-226doi:10.1016/j.jogn.2015.12.011

Foli, K. J., Lim, E., South, S. C., & Sands, L. P. (2014). “Great expectations” of adoptive parents: Theory extension through structural equation modeling. Nursing Research, 63(1), 14-25. doi: 10.1097/NNR.0000000000000006

Foli, K.J., South, S.C., & Lim, E. (2014). Maternal postadoption depression: Theory refinement through qualitative content analysis. Journal of Research in Nursing, 19(4), 303-327. doi: 10.1177/1744987112452183

South, S. C., Foli, K. J., & Lim, E. (2013). Predictors of relationship satisfaction in adoptive mothers. The Journal of Social and Personal Relationships30(5), 545-563. doi: 10.1177/0265407512462681

Foli, K. J., Schweitzer, R., & Wells, C. (2013).  The personal and professional: Nurses’ lived experiences of adoption. The American Journal of
Maternal/Child Nursing, 38
(2), 79-86. doi: 10.1097/NMC.0b013e3182763446

Foli, K. J. South, S. C., Lim, E., & Hebdon, M. (2013). Depression in adoptive fathers: An exploratory mixed methods study. Psychology of Men & Masculinity, 14(4), 411-422. doi: 10.1037/a0030482

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2012). Maternal postadoption depression, unmet expectations, and personality traits. Journal of the American
Psychiatric Nurses Association
18(5), 267-277. doi: 10.1177/1078390312457993

Foli, K. J. (2012). Nursing care of the adoption triad. Perspectives in Psychiatric Care, 48(4), 208-217. doi: 10.1111/j.1744-6163.2012.00327.x

Foli, K. J., South, S. C., & Lim, E. (2012). Rates and predictors of depression in adoptive mothers: Moving toward theory. Advances in Nursing Science35(1),
51-63. doi:10.1097/ANS.0b013e318244553e

Foli, K. J., & Gibson, G. C. (2011).  Training ‘adoption smart’ professionals.  Journal of Psychiatric and Mental Health Nursing, 18(5), 463-467. doi:  10.1111/j.1365-2850.2011.01715.x

Foli, K. J. & Gibson, G. C. (2011).  Sad adoptive dads:  Paternal depression in the post-adoption period,International Journal of Men’s Health10(2), 153-162. doi: 10.3149/jmh.1002.153

Foli, K.J. (2010). Depression in adoptive parents: A model of understanding through grounded theory. Western Journal of Nursing Research, 32, 379-400. doi: 10.1177/0193945909351299

Foli, K. J. (2009). Postadoption depression: What nurses should know. American Journal of Nursing, 109, 11. doi: 10.1097/01.NAJ.0000357144.17002.d3

What makes a theory or model “nursing”?

To our readers: the Nursology.net blog exists to prompt thoughtful discussion of critical issues related to the development of nursing knowledge.  We welcome your thoughts, challenges, alternative points of view, and critical questions!  Do not hesitate to comment on this or any other post at any time!  You are our “peer reviewers” and your perspectives contribute to all in our nursology.net community!

I am often asked (as are many of my colleagues):  What makes a theory or model a nursing theory or model?  This question is close to the challenge that I addressed in my keynote address in March at the Case Western Reserve Frances Payne Bolton School of Nursing Theory conference.  This question deserves serious reflection and discussion, because how each of us responds to this question is at the heart of what we envision for our discipline moving forward. In my keynote, I noted that various definitions of nursing as a discipline point to two essential matters: 1) knowledge of the human health experience, and 2) knowledge of nursing healing [well-becoming] actions.  Here I explore the issue of nursing theories and models, and propose that like the definitions, nursing theories and models are characterized by a focus on these same two essential characteristics.

One reason that questions concerning the nature of nursing theory keep surfacing is the fact that so many nurses who embarked on activities related to the development of nursology (nursing science) were educated to be scholars (researchers, theory developers) in fields outside of, but related to nursing.  There are contemporary nurses who opt to pursue their preparation for scholarship in other disciplines, influenced by the appeal of certain lines of inquiry that are already well developed in another discipline, and recognizing the significant connection between nursing’s interests and the interests of other lines of thought.  When I say “related” what I mean is that the gaze of these other disciplines is certainly pertinent to what concerns nursing, but the central concern of nursology is not actually “at the center.”  When a nurse scholar’s central focus is on the periphery, it is likely to be better placed within the scope of another discipline.

Sally Thorne (2014) has addressed this tension often in her work, most specifically in her chapter that appears in the text “Philosophies and Practices of Emancipatory Nursing.” In this chapter titled “A Case for Emancipatory Disciplinary Theorizing” (pages 79-90), Dr. Thorne pointed to the habits of “false dichotomizing” and the allure of borrowing theories from other disciplines, both of which lead to valorizing constructions from other disciplines, while neglecting the distinct focus of nursing. False dichotomizing, in the the case of social justice concerns, is the tendency to pigeon-hole a theory as either being focused on “the individual” or on “the community” (social justice), failing to recognize that from the earliest days of theorizing in nursing, scholars have explicitly embraced both the individual and the community and the  social injustices that require nursing action.  Likewise, immersion in and borrowing from the theoretical traditions of other disciplines can lead to neglect of the complex social mandate that is central to the discipline of nursing.  Unlike other disciplines, many of which focus on building knowledge as an end in itself, nursing’s mandate to act shifts the disciplinary focus so that knowledge related to a phenomena must include a focus, or point the way to “right” or “good” nursing action.  I have addressed the challenge in nursing of developing theory with this extremely complex perspective as one of the reasons for turning to theory in other disciplines, where the focus is more limited, and this complexity is typically unacknowledged and undeveloped or underdeveloped.  (see “Thoughts About Advancement of the Discipline: Dark Clouds and Bright Lights”)

From my perspective, regardless of the theorist’s background, or the origin of methodological approaches, what defines a theoretical construction as nursing arises from a clear orientation to the values and priorities of the discipline – the direction in which nursologists focus their “gaze.”  The focus of nursing must include the two elements that centrally define our discipline: knowledge of the human health experience, and knowledge of nursing actions leading to health and well-becoming.

Every discipline has the right and the responsibility to define and to conceptualize its own knowledge, domain, practice – the field which it covers. Of course people from other disciplines, and the public, have a responsibility to challenge the discipline in any way that is needed – a process that contributes to the ongoing development of the discipline. This process was prominent during the early phases of feminist thought in which feminist scholars from all disciplines developed a “gaze” focused on the rights and well-being of women, challenged the parameters, assumptions and practices of their own, and other disciplines as well. This led to vast changes for the better in all of the sciences and the humanities.

Where nursing is concerned, or more specifically nursology, disciplinary knowledge must derive from those who have been immersed in the history, philosophy, theory, and the practices of the discipline – something that is required for any discipline. Even though, for example, I do know a lot about the field of educational psychology where I earned my PhD degree and where I completed many courses in psychology and educational psychology, I do not have the background and experience to even begin to claim that I could contribute to the knowledge base of that discipline. I have used theories and insights from other disciplines in my own work contributing to the discipline of nursing, but that is quite a different kind of scholarship than would be required to contribute to the discipline of psychology (or sociology, or anthropology, etc.). My own theorizing in nursing reflects my educational psychology background, particularly the work of Brazilian educator Paulo Friere.  While the very relevant focus of Friere’s work is on human liberation from oppressive conditions, in my work the focus shifts to the health experience involved in group interactions,  conditions which influence, perhaps even threaten human health and well-being.  Health-promoting group interactions in my work draw on the methods of Friere’s  liberation theory,  but are specifically directed toward creating group actions and interactions that are life-affirming, nurturing, and support human well-becoming.

I do not think it is helpful to dwell on the simple fact of whether or not a person contributing to the knowledge of the discipline is a nurse — not all nurses are prepared to contribute to the knowledge base of the discipline, nor should they be expected to. And there are certainly nurses whose “gaze” is directed primarily on phenomena that are rooted in other disciplines.  The key to me is where a theory or model focuses the gaze – what phenomena are central, and are those central ideas consistent with the defining focus of the discipline.  I find it difficult to imagine how someone could contribute to nursing knowledge without a nursing background, or without experience in nursing healing/ well-becoming actions, as well as a background in the history and foundational knowledge of the discipline.  Beyond this essential background from which the theoretical ideas emerge, nursing theories and models are defined by the substantive focus on the phenomena of the experience of human health and well-being, and the dynamics that contribute to nursing healing and well-becoming practices.   As we have demonstrated in gathering together for this website information about the theories and models we do have, there are many more than many nurses have as yet imagined!  But the task of clearing our mental images to more fully appreciate the possibilities in the development of the knowledge of our discipline is a huge challenge, and further focusing our gaze on these possibilities and priorities is at the heart of what matters for our own discipline.

A Critical Review of 5 Nursing Journal Editorials on the Topic of Nursology

A recent CINAHL search with the keyword “Nursology” revealed 5 editorials in leading nursing journals that focus on acquainting the journal’s readers with the website and the initiative.  Not surprisingly, 3 of those editors were founding members of the Nursology.net website. Each shared a different aspect of the project.

Jacqueline Fawcett is the facilitator of the Nursology website management team.  In her guest editorial in the Journal of Advanced Nursing,1 she briefly reviewed the history of the term and argued for its revival, citing a previous published work.2 “Use of the term, nursology for the discipline,” she and colleagues had noted in 2015,  “avoids the tautology of using the word, nursing, as the label for the discipline and as a concept of our metaparadigm.” In other words, it identifies and distinguishes what nurses know(nursology) from what nurses do(nursing) by using different words.  Fawcett also identified possible disadvantages of a change in terminology, such as causing confusion, or interfering with progress made towards the goal of increasing the number of baccalaureate prepared nurses, although she did not elaborate on how. Fawcett went on to describe the formation of the website and outlined some of its contents: nursological philosophies, theories, and conceptual models with exemplars of the use of nursing theories in practice, education, and research; a history of disciplinary knowledge development; identification of past landmark events and future nursology-focused events, and resources. She concluded by giving examples of the positive feedback about the website that has been received and inviting readers to champion nursology as a disciplinary name or to offer alternative ideas.

Peggy Chinn is the webmaster of Nursology.net.  Her editorial introduces an issue of Advances in Nursing Science3 for which a call had been issued for articles addressing the focus of the discipline.  She noted this was in part to acknowledge that approximately 50 years had passed since a series of conferences had been initiated to explore the nature, focus, and future of disciplinary knowledge. The issue also appeared a few weeks before a similar conference, held at Case Western Reserve to commemorate those 50 years, and within months of the founding of Nursology.net. Chinn emphasized the nurse-led, nurse-developed nature of the site and  described it as providing “the most current and accurate information about nursing discipline-specific knowledge that advances human betterment globally.” She listed the assumptions and principles that guide the project: that nursology is a distinct discipline, vital to human health; is multidimensional bringing together diverse philosophical and theoretic perspectives; is autonomous and makes a unique contribution to health care; and that although nursology interacts with other disciplines cooperatively and collaboratively, it remains distinct and autonomous because it reflects the distinct perspective arising from caring in the human health experience. Chinn concluded by noting that these assumptions both shape the focus of the discipline and suggest issues that deserve serious consideration and discussion “not to achieve consensus but to appreciate the range of possibilities and diversities that inform and shape our discipline.” Whereas Chinn’s editorial highlights the philosophical underpinnings and beliefs that support the neurology.net initiative, it does not elaborate in detail on what ANS readers might expect to find on the site. 

 Jane Flanagan is a member of the Nursology.net management team and editor of the International Journal of Nursing Knowledge. She noted in her editorial4 that  the Nursology.net website is in keeping with the vision of the American Academy of Nursing Theory Guided Practice Expert Panel and described the purpose of the website is “to further the goals of what all of us as nurses are hoping to achieve…to explore the boundaries of nursing science and move that conversation in to a sphere where it reaches many.”  Flanagan noted the initial intent of the website- to be attractive, easy to read, and “overflowing with substance.” She indicated her hope that it will be a significant source of information for all nurses and those interested in nursing and invited feedback and participation of readers in contributing materials, blogs, and comments. She briefly described various sections of the site to provide examples of the resources that might be helpful to readers. Flanagan concluded by highlighting some of the similar reasons that Fawcett gave in her editorial for identifying the name of the discipline as nursology and those who practice, teach, or research disciplinary knowledge as nursologists. She noted, “ the name itself separates us from the stereotype and the reality in some quarters that we are handmaidens to physicians.” Flanagan’s editorial was the first to be published of all 5 editorials, just a month after the launch of the nursology.net website.  While she could have, perhaps, given more details about site contents, she does direct readers to the website for further information.  Her  palpable excitement at being “on the ground floor” of this project will probably encourage them to do so! 

The 3 editorials from members of the nursology.net management team were, as might be expected, exceedingly positive about the site and the initiative.  Two editorials were written by nursing editors who were not part of the Nursology.net management team. While their perspectives vary considerably, they may offer the most substantive perspectives and may prompt further serious and extensive discussion of these issues.

Rosemary Rizzo Parse’s editorial in Nursing Science Quarterly5 did not share the excitement and optimism evident in the above editorials.  Her understanding of the goal of the website is “to change the name of the discipline of nursing”. She commented favorably on the site’s “décor” but misleadingly reduced its content to a blog, “where contributors continue to add any material they wish without support evidence for the change.”  It is unfortunate that the readers of NSQ are not informed of the stated mission and purpose  of the website, which include developing a repository of nursing knowledge, disseminating that knowledge, and encouraging collaboration among nursing scholars. Currently the website profiles 45 nursing theories, ranging from conceptual frameworks to situation-specific theories, with the Theory of Human Becoming among them. Parse posited that efforts would be better directed at “making nursing science the hallmark of the discipline” and then asked a number of important questions about what such a change would mean, including how nursing educational programs could base courses on nursing knowledge when there is pressure by accrediting agencies to include more medical-bio-behavioral content. It is not clear how she sees that conundrum being addressed by either term,  nursology or nursing science. Despite having acknowledged that the “proposed change is consistent with O’Toole’s statement  in Mosby’s Medical Dictionary,” the editorial concluded that the change in name ”lacks semantic consistency with disciplinary knowledge and upends logical coherence.”

Sally Thorne’s editorial in Nursing Inquiry,6 begins with her admission of having a long-standing discomfort with the term “Nursing Science”, first because it sounds like a qualifier to science, “as if nurses take part in a skewed, partial, or watered-down version of the scientific enterprise,” and secondly, because the term nursing science has largely been used to describe nursing theorizing, rather than “formal scientific investigation.” Thorne contextualized the introduction of the Nursology.net website as a response from nursing thought leaders arising from their shared awareness and concerns of external pressures that are increasingly shaping nursing and threatening the further advancement of the discipline, and provided readers of Nursing Inquiry with citations of articles exploring the implications of those pressures for the preservation of “core disciplinary knowledge.” Thorne noted the term, Nursology, has been used in nursing literature at least as early as 1971 and, although she confessed to some discomfort with using the term, preferring to use “the study of nursing”, she enthusiastically endorsed the direction  the conversations that have led to the Nursology.net initiative have taken. She concluded that she will be watching the Nursology.net conversation with great excitement, “hoping that it attracts the attention, engagement, and dialogue it deserves, and that it helps bring a new generation of nurses back into an appreciative understanding of why the study of nursing really matters.”

I think I can speak on behalf of the Nursology.net management team in saying, we share that hope! And, I would ask if “ology” refers to “the study of” and is widely used by many other disciplines, e.g, pharmacology, biology, why is there such a hesitancy (I’ve experienced it in talking to other nurses about neurology as well) to use nursology to refer to the unique body of knowledge that is nursing knowledge?  Is it simply prudent caution to make the change for the reasons a number of the editors raised? To what extent does it feel pretentious, i.e., have we internalized a broader societal message that our body of knowledge is not as substantial or valuable as those of other fields? Is this another manifestation of “I’m just a nurse?” And/or, is it simply that it’s new and unfamiliar?

  1. Fawcett J. Nursology revisted and revived. J Adv Nurs. 2019; 1(2):1-2.
  2. Fawcett J, Aronowitz T, AbuFannouneh A, et al. Thoughts about the Name of Our Discipline. Nurs Sci Q.2015;28(4):330-333.
  3. Chinn PL. Introducing Nursology.net. ANS Adv Nurs Sci.2019;42(Jan-Mar):1.
  4. Flanagan J. Nursology – a Site by nurses, for nurses. Int J Nurs Knowl.2018;29(4).
  5. Parse RR. Nursology: What’s in a Name? Nurs Sci Q.2019;32(2):93-94.
  6. Thorne S. The study of nursing. Nurs Inq.2019;26(1):1-2.

 

 

 

 

 

Grayce M. Sills (1926-2016)

Guardian of the Discipline

Thank you to Sharon Tucker, PhD, RN, FAAN
and Christina Nyirati, RN, PhD
for their contributions to this post (see bios below).

Grayce M. Sills, circa 1986 while serving as Acting Dean of the Ohio State University School of Nursing. Photo by Charlene Eldridge Wheeler, featured for month of April, 1987 “Everyday Sheroes” Calendar

Grayce Sills, RN. PhD, FAAN, is widely recognized as a “pioneer . . . and supporter . . . of psychiatric mental health nursing . . . a champion for improving care for the chronically mentally ill . . .  [and] a pioneer in interdisciplinary collaboration among health care professionals” (Parrish, 2016, pp. 155-156).

Grayce Sills was born in Bremen, a small town in southeast Ohio. She was raised by her grandparents and extended family from the age of 2 years, after her mother died. Grayce began her undergraduate education with a liberal arts concentration at Ohio University in Athens, close to her family home. Following her sophomore year, Dr. Sills took a federally funded training job in New York to prepare as a psychiatric aide, hoping to raise enough money to complete her college degree. The psychiatric nurses impressed Grayce with their specialized skill. She was particularly impressed by the head nurse, Betty Oliver, who seemed more able than the physicians to soothe and comfort patients by just being present. Inspired, she began her nursing education at Rockland State Hospital School of Nursing in Orangeburg, New York, where she received her diploma in 1950. Grayce then attended the baccalaureate completion program at Teachers College Columbia University in New York from 1950 to 1951 but did not complete the program.

While at Teachers College, Grayce met Hildegard Peplau, just as Dr. Peplau was completing what many consider the first middle range nursing theory, Interpersonal relations in nursing (Peplau, 1952). Many year later Dr. Sills shared stories about the Peplau seminars with The Ohio State University Ph.D. nursing students who were grappling with theory; Dr. Sills admitted to also being initially confounded by Dr. Peplau’s theoretical inquiries. Timidly curious, yet somewhat intimidated, Grayce left New York to return to her Ohio home. She finally received a baccalaureate nursing degree from the University of Dayton in 1956. Fortunately for our discipline in general and psychiatric nursing in particular, Dr. Peplau was invited to present a nursing workshop at Dayton State Hospital in 1957, where Grayce was working. Explaining how her perspective then shifted profoundly, she stated:

“I owe [a large debt to] Hildegard E. Peplau for bringing me a new perspective, a new approach, a theoretically based foundation for nursing practice, for therapeutic work with patients in those problematic settings. Imagine the excitement of making sense out of a patient’s hallucinatory experience through collaborative work! Imagine the joy that came from discovering that a delusion could be dealt with and satisfactorily eliminated through effective verbal work with patients, a new day had dawned! Theory was used to guide nursing practice. Theory was tested in the real world of practice.” (Sills, 1978, p. 122)

Dr. Sills earned a master’s degree in sociology from The Ohio State University (OSU) in 1964, and began teaching in the OSU School of Nursing that same year. She completed a PhD in sociology, also from OSU, in 1968.  At that time, the PhD in Nursing was not yet offered. Dr. Sills described herself as a “tourist” in the discipline of sociology, grateful for a conceptual perspective complementary to nursing, but convinced that nursing knowledge was necessary for nursing practice. With this conviction, Dr. Sills made major contributions to the nursing programs at OSU, including a graduate clinical nurse specialist program in psychiatric mental health nursing. She also chaired the Department of Family and Community Nursing and served as Director of Graduate Studies.

As the first OSU Nursing Acting Dean, by 1985 Dr. Sills had managed to re-position Nursing in the academic structure of OSU by establishing the College of Nursing with its own budget and self-governance. This, she believed, was the necessary foundation for creating a community of nurse scholars who would advance nursing education and nursing scholarship. Self-governance, she reasoned, would contribute significantly to the power of nursing to develop the scholarly discipline, as well as the practice profession of nursing. Her conviction that borrowed knowledge from established disciplines was useful to nursing – although that knowledge was not  nursing knowledge – influenced her vision for the Ph.D. Program in Nursing at OSU, established in 1985.

Dr. Sills retired from OSU College of Nursing in 1993 as Emeritus Professor. She holds the rare distinction of receiving three awards from OSU: a Distinguished Teaching Award, a Distinguished Service Award, and an honorary doctorate in public service. She also was awarded honorary doctoral degrees from Indiana University and from Fairfield University.

Dr. Sills’ contributions expanded beyond OSU. She chaired the Study Committee on Mental Health Services for Ohio and, in 1986, was chosen as a Woman of Achievement by the Columbus YWCA. As a past chair of the OSU Hospitals Board of Trustees, she was instrumental in gaining board support for magnet hospital status, achieved in 2005. Beyond Ohio, she held visiting professorships at several universities throughout her career and provided international consultation for community based mental health nursing in Italy, Japan, and South Korea. Dr. Sills was a founder of American Psychiatric Nursing Association and the American Nurses’ Association (ANA) Commission on Human Rights. She was elected to the American Academy of Nursing (AAN), and in 1999, was designated as an AAN Living Legend.  She received several other awards, including the ANA Hildegard Peplau Award.

Dr. Sills record of scholarly work includes more than 60 journal articles and book chapters. One of many innovations put forth by Dr. Sills in the idea of nurse corporations. She explained,

“The conceptual key to the corporation proposal is that it changes the fundamental nature of the social contract. The professional nurse would no longer be an employee of the hospital or agency, but rather a member of a professional corporation which provides nursing services to patients and clients on a fee‑for-service basis. . . . Such a change in the nature of the social contract is, it seems to me, fundamentally necessary for the survival of nursing as a profession rather than an occupational group of workers employed by other organizations.” (Sills, 1983, p. 573)

Inasmuch as nurse corporations would operate on a fee-for-service basis, the corporation would determine the costs of nurses’ work, which changes the economics of practice in a profound way. Furthermore, nurse corporations are a solution to the problem of collective bargaining by nurses, such that contracts are between the nurse corporation, which is a professional entity rather than a union, and individuals or organizations (Sills, 1983).

Christina Nyirati recalls that when she was a student at OSU several years ago, Dr. Sills had championed nursology as the name for our discipline.  Peggy Chinn recalls that at an American Nurses’ Conferene of many years ago, Dr. Sills was among the first nurse leaders to propose that the “doctor’s orders” be changed to the “physician’s prescriptions,” to serve as a parallel to the nurse’s prescriptions. ”One wonders what Dr. Sills now would think about the“nursologist’s prescriptions” or the “patient’s self-directed prescriptions”?

Given Dr. Sills’ substantial contributions to our discipline, it is not surprising that she was “affectionately referred to as ‘Amazing Grace’ by everyone who knew her” (Parrish, 2016, p. 166). See this video of an interview of Dr. Sills by Jeanne Clement:

References

Parrish, E., (2016). Remembering a pioneer of psychiatric mental health nursing. Perspectives in Psychiatric Care, 52, 155-156.

Peplau, H.E. (1952). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York, NY: G.P. Putnam’s Sons. [Reprinted 1989. London, UK: Macmillan Education Ltd. Reprinted 1991. New York, NY: Springer.] (Translated into nine languages) .

Sills G. (1978). Hildegard E. Peplau: Leader, practitioner, academician, scholar and theorist. Perspectives in Psychiatric Care, 16, 122–128.

Sills, G. M. (1983). The role and function of the clinical nurse specialist. In N.L. Chaska (Ed.), The nursing profession: A time to speak (pp. 563–579). New York: McGraw‑Hill.

About our guest Contributors

Christina Nyirati, RN; PhD
Photo retrieved from http://www.heritage.edu/faculty-staff/directory/staff-bio/

Christina Nyirati, PhD, RN – 

Professor, Department of Nursing, Chair and BSN Program Director, College of Arts & Sciences, Heritage University, Toppenish, WA.

Grayce Sills became Christina’s mentor when she was admitted to the first OSU PhD nursing cohort in 1985 after several years of experience as a family nurse practitioner (FNP). At their initial meeting Dr. Sills questioned whether, as an FNP, Christina had disavowed her nursing knowledge. Dr. Sills ventured Christina would have to work a little harder than her classmates to question her assumptions about the Discipline of Nursing. Christina recalls Dr. Sills spoke be-musingly about Drs. Paterson and Zderad, Sills’ former OSU faculty colleagues, who had referred to themselves as Nursologists. At a recent American Association of Colleges of Nursing (AACN) Dean’s meeting, Christina reminisced with erstwhile PhD classmate, Dr. Janet Fulton, (now Professor and Associate Dean for Graduate Programs at Indiana University-Purdue University) about their seminars with Dr. Sills, who, with a twinkle in her eye, challenged the doctoral students to ponder nursing as a discipline rather than an applied discipline, and to consider Nursology the organizing concept for our discipline.

Throughout her career Dr. Nyirati has endeavored to fulfill her mentor’s admonition. When she became the founding director of the FNP program at OSU she integrated nursing theory with primary care concepts into the curriculum. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice [See article by Nyirati, C. M., Denham, S. H., Raffle, I., & Ware, J. (2012). Journal of Family Nursing, 18, 378-408).

Now as BSN program director at Heritage University on the Yakama Reservation in Washington State, Christina honors Grayce’s legacy as she prepares nurses in a curriculum faithful to the epistemic foundation of nursing. BSN students develop their reflective practices from The Fundamental Patterns of Knowing in Nursing  (See article by Carper, B. A. (1978). Advances in Nursing Science, 1(1), 13-24.) Before her death in 2016, Dr. Sills used to Skype with the first cohort of Heritage BSN students, reminding them to recognize and use their powerful nursing knowledge to correct the inequities in their communities.

Sharon Tucker, PhD, RN, FAAN
Photo retrieved from https://nursing.osu.edu/faculty-and-staff/sharon-tucker

Sharon Tucker, PhD, RN, APRN-CNS, F-NAP, FAAN – 

Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing, College of Nursing; Translational/Implementation Research Core Director, Helene Fuld Health Trust National Institute for EBP; Nurse Scientist, Wexner Medical Center, The Ohio State University

Faculty and staff at OSU are privileged to continue to advance the work of the amazing Dr. Sills through an endowed professorship established in her name by a generous gift from Dr. Sills and her family. Dr. Tucker was hired in 2017 as the Grayce Sills Endowed Professor of Psychiatric Mental Health Nursing. She has practiced, taught, and conducted research in behavioral and mental health interventions and outcomes for decades. She was recognized in 1997 with an Award for Excellence in Research by the American Psychiatric Nurses Association, at which time Dr. Sills was recognized with the Psychiatric Nurse of the Year Award.

Dr. Tucker seeks to advance Dr. Sills’ work in promoting independent nursing practice (she is a board certified Advanced Practice Psychiatric Clinical Nurse Specialist), teaching interpersonal and health coaching skills, studying mental health assessment strategies and behavior change interventions, and advocating for individuals living with mental illness who are underserved and undertreated.

 

 

 

 

 

 

 

Moving Towards the Next Fifty Years Together

We are delighted to welcome guest bloggers representing the  Nursing Theory Collective
formed March 2019 Case Western Reserve
Nursing Theory Conference:
Chloe Littzen, Jane Hopkins Walsh  and Jessica Dillard Wright

I. Introduction

Chloe Littzen

Jessica Dillard-Wright (L) and Jane Hopkins-Walsh (R)

In March 2019, 130 nurses from all over the world gathered at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio for Nursing Theory: A 50 Year Perspective, Past, and Future, a landmark conference to celebrate the history of nursing theory and elicit discussion for the future of nursing. The attendees were diverse, comprised of seasoned nursing theorists and doctoral students in equal measure, participating in lively and thoughtful conversation across many domains. The future of nursing theory quickly emerged as a critical issue as nurses working at all levels of expertise expressed their concern over the loss of nursing theory at the institutional level, both academic and clinical. What is at stake in this erosion is discipline-specific nursing knowledge, in particular at this 50-year juncture as the great theorists of nursing like Drs. Peggy Chinn, Joyce Fitzpatrick, Pamela Reed, Callista Roy, Marlaine Smith, and many others approach the end of their illustrious careers. The question resonated, “who will carry the nursing theory torch forward?”

To advance the discipline of nursing, the next wave of nursing theorists and thought leaders must actively engage to advance nursing theory, improve nursing praxis, and articulate nursing’s identity leading our profession into the future. This is the rallying cry that led to the blog post you are reading today. In follow-up to this conference, doctoral student Chloe Littzen engaged other students who attended to embark on a collaborative effort to articulate our vision for the future of nursing theory. What follows is a brief discussion of our course so far, the background, plan, and desired outcomes for convening a nursing theory working group as we envision the next fifty years of nursing theory and beyond.

lI. Background

After the landmark conference concluded, a collaborative effort ensued to form a theory working group focused on promoting nursing theory and advancing nursing’s identity. This group is comprised of both scholars and students and is open to all nurses practicing in all settings. Our first meeting was held online via video-conferencing on May 18th, with a total of six participants from Arizona, Massachusetts, and West Virginia. This first meeting was an experimental think-tank where we considered ideas about the future of nursing and our professional identity. Below, we outline our mission and vision for this nursing theory working group.

III. Plan

The primary mission, as established by our working group, is to promote nursing theory and advance the identity of nursing through knowledge development for all nurses in all settings, including practice, education, research, and policy. As a group, we believe that nursing and nursing theory are dynamic and evolving to meet the needs of an increasingly complex healthcare landscape and global environment. In order to keep nursing theory and nursing relevant and current, thinking about theory must be on-going and iterative, with a continuous cycle of critique, testing, and scholarship. Failure to seriously engage these questions has dire consequences for nursing theory and the profession as nursing as it slowly cedes its identity to the economic pressures of the healthcare environment and the supremacy of biomedicine.

The following bullets summarize our discussion and desired outcomes from the first nursing theory workgroup meeting:

  • Discussion Points:
    1. We need a plan to sustain and evolve nursing theory and nursing’s identity with discipline-specific knowledge.
    2. Nursing theory must be derived from and applicable to the practice environment, not just academia.
    3. The purpose of nursing theory must be clarified for nursing practice, education, research, and policy.
    4. Nurses in clinical practice must have an educational foundation grounded in nursing theory that empowers the application of theory in practice.
    5. Nursing students must be educated and mentored in nursing theory, beginning at the pre-licensure level.
    6. This discussion must include considerations of how nursing theory is taught in the academic environment and how that can be linked to and informed by nursing practice.
    7. The need for nursing theory is global, making this an international, even planetary problem.
  • Desired Outcomes:
    1. To write a manuscript demystifying nursing theory for the nurse in the practice environment.
    2. Write a second manuscript demystifying nursing theory for the nurse educator in academia.
    3. Explore the potential of a future study identifying and describing the barriers and facilitators for using nursing theory in practice, education, research, and policy settings.
    4. Share the discussions, experiences, and findings with the community at Nursology.net.

IV. Invitation – Join us!

While we are a new workgroup, we welcome and encourage all nurses, both advanced scholars and novice theorists alike, to consider joining us in this journey in promoting nursing and nursing theory into the future. We currently meet monthly over Zoom video-conferencing. If you are interested, please contact form below to be placed on the email list for future meetings and content.

If you are planning to go to the 2019 Collaborative K.I.N.G. conference in Washington D.C. from November 14th-15th, we are planning an in-person meeting to take place. We hope to see you there as we drive nursing and nursing theory into the future. Join us!

With optimism and gratitude for the future,
Nursing Theory Collective
(Final group name pending vote at next meeting)

Footnotes:

See more information on the King Conference here.

See more information on the landmark theory conference at Case Western Reserve University Frances Payne School of Nursing here.

Please use this form to contact us if you want to join us, or for more information!

Who IS the First!

This blog is a follow up to the Who Will Be First? blog posted on May 21st. We now have an answer to that question!

St. Mary’s College Campus (from http://www.st-mary.ac.jp/about/)

I recently learned from Sr. Callista Roy  that a research center in her name included the word, nursology, in the center title. The title is: Roy Academia Nursology Research Center. This research center was founded in 2018 at St. Mary’s College School of Nursing in Kurume, Japan (http://www.st-mary.ac.jp/english/).

Professor Tsuyako Hidaka, of St. Mary’s College School of Nursing in Kurume, Japan, provided this description of the research center:

“The Roy Academia Nursology Research Center aims to explore Mercy, Caring, and Love through the avenues of both practice and education, which are executed across three departments: educational program development, postgraduate education, and continuing education.

1. The educational program development department facilitates education, practice, and research based on the Roy Adaptation Model, conducts activities for the Japan Chapter of the Roy Adaptation Association of Japan (RAA-J), and develops programs that enhance nursing skills for undergraduate and graduate students.

2. The postgraduate education department works with a wide range of students, from those planning to continue their research post-graduation, to those conducting activities as certified nurse specialists (CNS). Faculty members also assist students with research as well as offer counseling to undergraduates interested in pursuing a graduate degree.

3. The continuing education department is responsible for developing the curriculum for use in the wards at St. Mary’s Hospital, and continues to reform the currently-used clinical ladder education program to include elements for which nurses can continue earning education credits. The department also offers a continuing education program for nurses who work in community-based settings.”

The nursology.net management team members congratulate Professor Hidaka, her colleagues, and the St. Mary’s College administrators on being the very first entity to include nursology in the title of their research center. We look forward to learning of many other entities that will follow their lead and include nursology in the title of schools and colleges, departments, programs, and centers.

Callita Roy and Jacquiline Fawcett visiting St. Mary’s College (photo from http://www.st-mary.ac.jp/education/)

Why Nursology?: The Perspective of an International PhD Student

Guest contributor: Toqa Alanby

Toqa Alanby

Hello, my name is Toqa Alanby MSN, BSN, RN, from Saudi Arabia, a full-time nursing PhD student in Christine E. Lynn College of Nursing at Florida Atlantic University. I have chosen to begin the pursuit of my academic career in Nursing with a sense of determination. Through my B.Sc. in Nursing from Umm Al-Qura University (Mecca, Saudi Arabia), my English program at INTO University of South Florida (Tampa, Florida, US), and my M.Sc. in Nursing from Trinity College Dublin, University of Dublin (Dublin, Ireland), I have dedicated my life to advance my nursing knowledge and skills.

I was introduced to the Nursology website by Dean Marlaine Smith, my advisor, as she said, “websites are vehicles to assist us in coming to know an organization.” The Nursology website is a quantum leap in nursing. Nurse scholars, nurses in clinical settings, and postgraduate students, all of them, can be involved by joining or just by browsing this site. It was designed and maintained by nurse scholars with sufficient experience who can enrich the nursing profession throughout the world. For me as an international PhD student who came from a different background, I found it as a repository for sources about nursing conceptual models, grand theories, middle-range theories, and situation-specific theories, philosophies and related methodologies. It is momentous to nursing practice, education and scientific research because it is a guide to what is already known and what further knowledge and skills are required. Also, I found it as a station that can connect to the pioneers of the nursing profession, a link to enable us to communicate with them easily.

Exploring the website, gave me a better understanding about the history of nursing in the United States. Furthermore, it reminded me of how nursing started in Saudi Arabia. In both cases war had an impact on the development of nursing. For instance, the first mention of nursing in Saudi Arabia was during the time of the Prophet Muhammad in the service of the Muslim armies during periods of war. Women accompanied veterans as companions and caretakers. According to Jan (1996) nursing activities carried over into peacetime when the women served as midwives and continued to nurse the sick and dying.  Subsequently nursing concepts emerged to inform this practice.

Nurses, nursing students and other health professionals understand and view nursing differently. Many definitions have been used to define the concept of nursing. Sapountzi-Krepia (2013) justifies this diversity due to different educational backgrounds, cultures and experiences. Now that nursing is based on the interaction with others, caring appears as one of its central concepts. The concept of care emerged during the decade of the 1950’s; however many factors hampered its progress. It was not until two decades later that not only the first National Caring Research Conference but also the publication of Leininger’s and Watson’s theories stimulated the interest of researchers in the concept (Brilowski & Wendler, 2005). Caring seems to be inherent to nursing practice and originates from respect and concern for the patients, which is a skill that evolves with experience. As for my culture, caring from the Islamic perspective refers to a critical, reflective analysis of what we think we know about our universe and ourselves. Saeed (2006) mentioned that the Islamic philosophy is rooted in the attempt to understand reality rationally. The Qur’an, the Holy book of Muslim faith, and the Sunnah, which documents the life and practices of the prophet, built the Islamic belief system.

Outside of the nursing community, when I talk about nursing science, I always have been asked what distinguishes nursing science from other disciplines? Cowling, Smith & Watson. (2008) answered this question by stating that there are 3 fundamental concepts which are wholeness, consciousness, and caring singled out and positioned in the disciplinary discourse of nursing to distinguish it from other disciplines. In my opinion, nursing implies an intentional activity, attitudes and feelings that shape the professional interaction established between nurses and patients.

Having an understanding of these perspectives will inform health professionals to achieve cultural competence and deliver care that is culturally sensitive (Rassool, 2014). Individualized, holistic care can be achieved by apprehending culture, beliefs and ethnicities, and a display of cultural competence. I saw Dr. Sadat Hoseini’s model on the Nursology website as a model that comes from a Muslim perspective. It is wonderful and informative. However, there is a great diversity of cultural, tribal and linguistic groups among Muslim societies, each of which has its own cultural characteristics and worldview of well-being and sickness. Delivering nursing care to Muslim patients means having an insight of Islamic faith and Islamic beliefs. Thus, what goes on in Saudi Arabia is totally different from what Dr. Hoseini’s model looks for. She is from a different culture, country, and doctrine.

Based on my experience, non-Muslim nurses who work in my country are not able to utilize the existing knowledge and framework of health from Islam to enhance the nursing profession. The inability to shape nursing practice, education, and policy from an Islamic perspective can be attributed to multiple factors such as social status of nursing in the country, professional identity of nurses, and societal approval and recognition (Ismail et al., 2015). Therefore, the professional development of nursing among Muslim nurses is based on utilizing Western practice, education, and ethical models instead of integrating the holistic view of Islam (Gharaibeh & Al-Maaitah, 2012). The curricula of our colleges in Saudi Arabia still follow the theories that come from the United States (F. AlShaibany, personal communication, April 25, 2019). Though, in general, the development of nursing theories and models are almost neglected in Saudi Arabia, whether in education or practice. While nursing students know about nursing theories, they most likely don’t see them as a part of their practice. They also tend more to use theories from other disciplines such as change theories instead of nursing theories.

I was eager to explore nursing from another perspective and the Nursology website was a vehicle to achieve this purpose.  The Western concept is the most visible and distinctive in the site. I believe this site will be a real connection for other nurses around the world to the study of Western nursing. Thus, I hope one day to join the great scholars here to advance Nursology forward and perhaps contribute by sharing my theoretical work from a different cultural point of view. My goal is to embark on an academic career and to conduct research.  In other words, scholars absorb and integrate information coming from the world around them as they create their own work. The role they play calls for the development and maintenance of collective learning and comprehension. A scholar’s work, according to Boyer’s (1990) definition, calls for taking a step backwards from the investigation, searching for connection, and bridging the gap between theory and practice while having one’s knowledge communicated effectively (p.16).

Being able to comprehend and associate with nurses of different cultures is vital for nursing advancement. Understanding cultural differences among nursing perspectives is essential. By educating ourselves about different cultures through communication with diverse nurses in conferences, organized meetings, and engagement with a website like Nursology can prepare us well to broaden our perspectives on nursing knowledge from all over the world in multiple cultures.

References

Boyer, E. L. (1990). Scholarship reconsidered. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching.

Brilowski, A., & Wendler, C. (2005). An evolutionary concept analysis of caring. J Adv Nurs (50), 641-50.

Cowling, W.R., Smith, M.C. & Watson, J. (2008). The power of wholeness, consciousness, and caring: A dialogue on nursing science, art, and healing. Advances in Nursing Sciences, 31(1), 41-51.

Alshaibany, F. (2019, April 25). Personal Interview.

Gharaibeh, K. & Al-Maaitah, R. (2012). Islam and Nursing, in Religion, Religious Ethics, and Nursing. Spinger New York, NY. p. 229-249.

Ismail, S., Hatthakit, U., & Chinawong, T. (2015). Caring science within islamic contexts: a literature review. Nurse Media Journal of Nursing, 5(1), 34. doi:10.14710/nmjn.v5i1.10189

Jan, R. (1996). Rufaida Al-Asalmiya, the first Muslim nurse. Image: Journal of Nursing Scholarship, 28, 267-268.

Rassool, G. H. (2014). Cultural competence in caring for Muslim patients. Palgrave Macmillan.

Saeed, A. (2006). Islamic Thought: An Introduction. New York, USA: Routledge.

Sapountzi-Krepia, D. (2013). Some thoughts on nursing. Int J Caring Sci (6), 127-133.

Student response to a doctoral “Knowledge Development in Nursing” course

The University of Wisconsin-Madison School of Nursing PhD program offers a required course entitled Knowledge Development in Nursing. In the Fall 2018 semester, the course was co-taught by Dr. Anne Ersig and Dr. Danny Willis. The course examines the history of knowledge development in the discipline of nursing. PhD students are prepared to understand nursing philosophical perspectives; scientific thinking; conceptual models; conceptual analysis; grand, middle-range, and situation-specific theory; the nature, sources, syntax, and development of knowledge in the discipline.

One of the major strengths we witnessed in co-teaching the Knowledge Development in Nursing course together is the diversity of perspectives and ways of knowing that the students were exposed to given our complementary ways of approaching our phenomenon of interest (see more about our own approaches below). We were inspired every time the course met. The students enrolled in our course represented life experience and perspectives from around the world – China, Jordan, South Korea, Turkey, Uganda, and the United States. It was such a wonderful experience! We were particularly moved by Yuanyuan Jin’s reflection on her learning journey through the Knowledge Development in Nursing course and felt compelled to ask her to share her story with Nursology.net. When we asked YuanYuan, she commented to Dr. Willis that she hopes to be one of the future professors and leaders in nursing theory and knowledge development for the future. We could not have been prouder to hear this as it offers hope for the future of our discipline. Enjoy Yuanyuan’s reflection as much as we did!!

Question: Reflect on how your thinking about your identity as a nurse scholar and researcher has evolved over this semester. How do you think this might influence your future as a nurse scholar?

Yuanyuan Jin, MSN, RN, PhD student

For me, this was a very short but intensive semester. I guess I will never say that the 4-year nursing PhD program is too long again!

I greatly appreciated the learning experience in N815 (Knowledge Development in Nursing) during the 15 weeks. In short, it was like a journey. Dan and Anne took us to a place where we have heard of and never been there before. We were curious about everything we saw during this journey. Local people in that place communicated with each other by using a language we were not familiar with and sometimes we even had difficulty understanding their dialogue. But Dan and Anne were very good guides and interpreters, they gave us a lot of important resources and information to help us understand the history of this place, where the local people came from, what they are doing there, and where they are heading to.

The place we went to is called Nursing Knowledge Development, the local people were the theorists like Dr. Fawcett, Dr. Chinn, Dr. Roy, Dr. Rogers, Dr. Johnson and many other nursing scientists who have/had dedicated themselves to nursing knowledge development. The language we had difficulty understanding including metaparadigm, paradigm, philosophies, conceptual models, theories, empirical indicators, ontology and epistemology, etc. The resources and information Dan and Anne gave to us were readings before the class, explanations during the class and summaries after the class. The history of Nursing Knowledge Development was that nursing used to be a task-oriented occupation, subservient to medicine with little autonomy and had no place in the academic setting. During the mid-twentieth century and the years that followed, nursing leaders in the US saw theory development as a means of firmly establishing nursing as a profession. Therefore, they are developing a unique body of nursing knowledge and using nursing theory to guide professional practice and making contribution to the health and wellbeing of people.

I like the analogy of journey because firstly, not every nurse/nursing student has the chance to go on this kind of trip (i.e., he/she is not exposed to nursing theory development), and secondly, when we are back from our trip, we can always share our experience with those who have been or have never been to that place. One big new thing I learned from this course is that we do need theory to guide our research intervention, and also how to select an appropriate theory and how to integrate theories if we are using more than one theory — this is very important. In the future, I still need to dig into how to align the theory with research question and research design and how to correctly synthesize different concepts in different theories.

Therefore, the end of the course of N815 is the very beginning of my nursing scholarship. I will be more eager and open to discussions about nursing knowledge development; I will take the responsibility to reduce people’s stereotype that nurses are just assistants of doctors; I will de-mystify theory and sensitize people to the significance of theory in their research and practice; and I will carry on nursing theorists’ lifelong learning spirits and cultivate my own academic expertise so as to contribute to the nursing knowledge development.

About the Professors’ Research

Dr. Willis has a program of research focused on explicating mental health, wellbeing, and healing for boys and men in the aftermath of experiencing traumatic and marginalizing situations of violence and abuse, primarily using qualitative approaches to knowledge development.  Dr. Willis positions his work in the central unifying focus of the discipline/values of humanization, meaning, choice, quality of life, and healing in living and dying (Willis, Grace, & Roy , 2008). In terms of nursing conceptual models and theories, his work is closely aligned with Watson’s Unitary Caring Science (Watson, 2018) and Rogers’ Science of Unitary Human Beings (Rogers, 1992). Within nursing paradigms, he locates his work within the unitary-transformative perspective (Newman, 1997) with its focus on pattern recognition and caring-healing for unitary human beings in mutual process with their environments.

Dr. Ersig’s program of research focuses on chronic stress among children, adolescents, and young adults with chronic health conditions, including biological stress and genetic influences on the human response to stress. Dr. Ersig aligns her work with Roy’s Adaptation Model. She identifies strongly with Roy’s delineation of the physiological, self-concept, role function, and interdependence modes. Roy’s model provides essential support for Dr. Ersig’s inclusion of physiological, biological, and genetic measures in her work. To obtain a more holistic view of individuals, families, and the broader social context, Dr. Ersig also incorporates measures of psychological and behavioral responses to stress.

 

Who Will be the First? More Random Thoughts of a Sleeper Awake

Once again, with apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake, these are my random thoughts of “Who Will be the First?” among nursology leaders while I was a sleeper awake one very early morning (see our first “sleepers awake” post: What if?). Here are my random “Who will be the first?” musings:

  • Who will be the first dean/director/chairperson to re-name the college/school/department/ program nursology?
  • Who will be the first Chief [Nursology] Officer to re-name the clinical agency department nursology?
  • Who will be the first journal editor to re-name the journal … Nursology or Journal of … Nursology?
  • Who will be the first “edge runner” or other nursologist recognized for innovative work to be referred to as a nursologist?
  • Who will be the first president or executive officer to re-name the association/academy/ council [Country or State] Nursology Association or [Country] Academy of Nursology or International Council of Nursology?

Again inspired by imagining these possibilities, I asked other Nursology.net management team members!

Adeline Falk-Rafael

  • Who will be the first newscaster/journalist to refer to nursologists or Nursology In the media?

Margaret Dexheimer Pharris

  • Who will be the first political leader to propose a Universal Access to Nursologists system for a country, state/department/region, city, and/or community?

Danny Willis

  • Who will be the first nursologist to lead peace, social justice, caring, and healing efforts throughout the world toward universal wellbeing/wellbecoming for all of humanity?

Rosemary William Eustace

  • Who will be the first nursologist to theorize “task shifting of nursing services and roles” in advancing nursing knowledge and the future of nursing as a profession within other “traditional” and “emerging” disciplines in health care?

Marian Turkel

  • Who will be the first academic dean to say we are advancing the discipline and profession of nursology by preparing nursologists? Nursologists practice nursology through the lens of nursological theory and the multiple patterns of knowing, with a focus on holistic practices such as mindfulness, centering, healing arts, aromatherapy, and coming to know the patient and family as person. The clinical practice sites for nursologists would expand beyond the hospital into healing centers, physician practices, and community centers.

Marlaine Smith

  • Who will be the first to graduate with a PhD in Nursology?

We invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “Who Will be the First?”

Tribute to our Nurse Friends!

We welcome this guest post by Shannon Constantinides, MSN, NP-C, FNP, UCHealth Primary Care,  PhD Student, Florida Atlantic University.  Shannon also contributed the content on Jane Georges’ Theory of Emancipatory Compassion

Shannon Constantinides

In trying to explain to my husband (an osteopathic physician) why Nurses’ Week is an important week, I asked him, “Do you ever notice that I have my “friends” … but that I also have my “nurse friends?” He looked back at me, a bit quizzically, shrugged his shoulders and said, “yeah…? I guess so?” In a conversation a day or so later, he said, “Now that you’ve mentioned it, I guess I have heard you mention your Nurse Friends.” He then gave me a somewhat perplexed look and said, “I have friends who are physicians, but I don’t think I have Physician Friends. At least not in the way you talk about your Nurse Friends.” You’re right, my dear, you don’t.

From the inception of the profession, nurses have been working together, side by side in the figurative and literal “trenches.” Whereas our physician colleagues are trained to be the lone wolves, or as I’ve heard it described, “the captain of the ship,” nurses are from the onset of training, trained to work as part of a team.

This Nurses’ Week, I set an intention to celebrate and honor all my Nurse Friends. To me, Nurses’ Week is a reminder about the joy we find in work – not just the experiences that arise from patient care – but also joy we find from the relationships we’ve built with one another along the way.

In 2018, I had the honor and privilege to interview Dr. Jane Georges, Dean of the Hahn School of Nursing at the University of San Diego and the author of the Emancipatory Theory of Compassion. During the course of our conversation, we got onto the topic of finding joy in work and Nurse Friends. Until Dr. Georges pointed it out, I hadn’t given much thought to the concept of Nurse Friends. My mom, a 30-year NICU RN, had Nurse Friends. Dr. Georges’ mother was also a nurse who had Nurse Friends. “NurseFriends” was simply a word we’d always known, because we both grown up with the knowledge that there are two kinds of friends: your friends, and your NurseFriends.

In discussing ways in which we can recapture joy in work and joy in nursing, Dr. Georges circled back to the concept of NurseFriends and the deep connection nurses share with one another; the connection that allows us to find so much meaning in what we do. “I call it the nurse-nurse bond,” Dr. Georges said, “It’s knowing that we can’t do it alone, which is one of the most beautiful parts of nursing.” In recalling some of the most healing environments in which she’d worked, Dr. Georges commented on the presence of joy, respect, and connection with other nurses.

“We just had this crew,” I mentioned as I reminisced about a group night-shift NurseFriends I worked with during my tenure working in an emergency department. Dr. Georges agreed, “I think the idea of the nurse-nurse bond, or NurseFriends, is worth exploring… how do we build back that community where we’re not adversarial to each other?” I think that the answer lies within ourselves and within the community of our discipline: building up our NurseFriends to strengthen one another, to strengthen the profession, to strengthen ourselves, and ultimately, to strengthen the care we give our patients.

Two years ago, I had to tell a NurseFriend who’d become my primary care patient that I’d found lymphoma on her MRI. That was one of the worst days of my professional career. I remember sitting in my office, sick to my stomach. Delivering bad news to a patient is never easy; delivering bad news to a NurseFriend will break your heart.

This NurseFriend is doing great. Her cancer is in remission. She’s healthy. She’s now the clinical manager of my primary care office. I’m lucky: we caught her cancer early, got her great treatment, and I get to see her smiling face every day.

To all of my NurseFriends, thank you for sharing your light with me. You are my heros not just during Nurses’ Week, but every week!