How to Teach Nursology: A New Resource on Nursology.net

The nursology.net management team is very pleased to announce a new resource for educators of nursology – Teaching/Learning Strategies. This resource is devoted to explanations of diverse approaches to teaching nursology. The first approach focuses on one way to teach the APPLICATION of nursology conceptual models and theories for practice. This teaching strategy involves teams of students role playing nursologists working within the context of various nursology conceptual models and theories that are applied to a fictional multi-generational, multi-cultural family. (See https://nursology.net/resources/teaching-the-application-of-conceptual-models-and-theories-of-nursology/) Comments about this teaching strategy are welcome.

I am confident that the creativity of all nursologists who each in academic and/or clinical settings will be evident as other approaches to teaching nursology are added to this section of nursology.net. Therefore, the management team invites all educators to use the content guidelines and forms found on the “Teaching/Learning Strategies” page to submit explanations of effective teaching strategies.

I would like to thank Deborah Lindell, a new member of our management team, for her exceptionally fine work developing the content guidelines.

Searching the Literature of Nursology: Strategies for Success

Where is the nursing literature I need? (from https://www.iconsdb.com/green-icons/question-mark-8-icon.html)

Finding relevant literature is, of course, crucial for any scholarly work. I have been searching the literature about nursology discipline-specific conceptual models and theories for many, many years. When I first started these literature searches in the 1970s, I had to use printed indexes, which was exceedingly tedious and time-consuming, although I admit to enjoying the quiet time in university libraries. With the advent of computers and the internet–now many years ago—searching the literature took me out of libraries and into my home study or campus office and onto my computer and saved a great deal of time.

In this blog, I share the computer-based search strategies I have been using for many years. These search strategies have yielded the most targeted searches I have been able to locate for several years. Inasmuch as different vendors may use different keywords, readers are advised to seek help from a librarian if the strategies given here are not effective. Furthermore, readers are advised to read abstracts and articles carefully to determine if the indexing is accurate, as indexing errors do occur from time to tine.

The Cumulative Index to Nursing and Allied Health Literature (CINAHL), which has the most comprehensive indexing of nursing journals of any database, may be accessed via various on-line vendors (e.g., OVID, EBSCO). The headings listed below yield the most relevant citations for specific conceptual models of nursing and nursing theories when searching CINAHL. Note that EBSCO has an Alert option (EPAlerts) that automatically provides citations periodically (e.g., each week, each month) that are sent to the requester’s email address. A university librarian can provide information about how to set up the Alerts using these search terms:

  • Johnson Behavioral System Model
  • King Open Systems Model
  • King Conceptual System
  • Kings Theory of Goal Attainment
  • Levine Conservation Model
  • Neuman Systems Model
  • Orem Self-Care Model
  • Rogers Science of Unitary Human-Beings
  • Roy Adaptation Model
  • Synergy Model AND Nursing
  • Newman Health Model
  • Orlandos Nursing Theory
  • Parses Theory of Human Becoming
  • Peplau Interpersonal Relations Model
  • Watsons Theory of Caring
  • Transitions Theory AND Nursing

Citations for general literature about conceptual models and theories can be obtained using these headings in CINAHL:

  • Nursing Models Theoretical
  • Conceptual Framework
  • Nursing Theory

Before 1988, the most relevant citations for specific conceptual models of nursing and nursing theories in the CINAHL database can be located by using the following subject headings. The same subject headings can be used to locate citations for general materials about nursing models and theories.

  • Models Theoretical
  • Nursing Theory

Medline may be accessed via on line PubMed through various on line vendors (e.g., OVID, EBSCO). The following subject headings yield the most relevant citations for conceptual models of nursing and nursing theories when searching Medline:

  • Nursing Models
  • Nursing Theories

Dissertation Abstracts International (DAI), which also includes Master’s Abstracts, may be accessed via various on line vendors (e.g., EBSCO) and databases, including ProQuest (http://wwwlib.umi.com/dissertations/). The search strategies listed below yield the most relevant citations for conceptual models of nursing and nursing theories when searching DAI:

  • behavioral system (keyword) AND nursing (subject) [Johnson’s Behavioral System Model]
  • King (keyword) AND nursing (subject) [King’s Conceptual System]
  • King’s (keyword) AND nursing (subject) [King’s Conceptual System]
    goal attainment (keyword) AND nursing (subject) [King’s Theory of Goal Attainment]
  • Levine (keyword) AND nursing (subject) [Levine’s Conservation Model]
  • Levine’s (keyword) AND nursing (subject) [Levine’s Conservation Model]
    conservation (keyword) AND nursing (subject) [Levine’s Conservation Model]
  • Neuman (keyword) AND nursing (subject) [Neuman’s Systems Model]
  • Neuman’s (keyword) AND nursing (subject) [Neuman’s Systems Model]
  • Orem’s (keyword) AND nursing (subject) [Orem’s Self-Care Framework and theories]
  • science of unitary human beings (keyword) AND nursing (subject) [Rogers’ Science of Unitary Human Beings]
  • Roy’s (keyword) AND nursing (subject) [Roy’s Adaptation Model]
  • adaptation model (keyword) AND nursing (subject) [Roy’s Adaptation Model]
  • Newman’s (keyword) AND nursing (subject) [Margaret Newman’s Theory of Health as Expanded Consciousness]
  • expanded consciousness (keyword) AND nursing (subject) [Margaret Newman’s Theory of Health as Expanded Consciousness]
  • Orlando’s (keyword) AND nursing (subject) [Orlando’s Theory of the Deliberative Nursing Process]
  • Parse’s (keyword) AND nursing (subject) [Parse’s Theory of Human Becoming]
  • human becoming (keyword) AND nursing (subject) [Parse’s Theory of Human Becoming]
  • Peplau’s (keyword) AND nursing (subject) [Peplau’s Theory of Interpersonal Relations]
  • Watson’s (keyword) AND nursing (subject) [Watson’s Theory of Human Caring]

A discussion of computer and hand searches that remain relevant today is given in Johnson, E. D. (1989). In search of applications of nursing theories: The Nursing Citation Index. Bulletin of the Medical Library Association, 77, 176–184.

Peggy Chinn reminded me to add that any search of the literature must include consideration of the source of citations. For example, all searchers should be alert to the concerns of literature published in predatory journals. See McCann, T. V., & Polacsek, M. (2018). False gold: Safely navigating open access publishing to avoid predatory publishers and journals. Journal of Advanced Nursing, 74, 809– 817. https://doi.org/10.1111/jan.13483  for discussion of predatory journals and guidelines for recognizing these open access publications, which are inappropriate journals for and citations of nursing literature.

Peggy Chinn also reminded me to caution readers about the use of the internet (e.g., Google) as a resource for searches of the nursing literature. She noted, “one of the ways that people get trapped into citing literature from dubious sources is that they use google to search for what they are seeking!” One important way to avoid getting caught in this trap is to use the indexes that I have described in this blog].

Readers of this blog are invited to add comments about their experiences searching the nursology literature and contribute other successful search strategies and search terms.

Report of the 17th Biennial International Neuman Systems Model Symposium

Thank you to guest bloggers Karen Gehrling and Lora L .Wyss for this report!  Scroll down for guest blogger information.

Erin Maughan delivering Keynote Address on Population Health Friday, Malone University

On June 20-21, 2019, approximately 100 nurse scholars gathered in Canton, Ohio for the 17th Biennial International Neuman Systems Model (NSM) Symposium. Colleagues from around the world gathered to share knowledge and expertise in population health and the Neuman Systems Model (NSM).

The keynote speaker, Dr. Erin Maughan, shared significant population health issues and the importance of using models of care as context for interventions. Dr. Jacqueline Fawcett, an expert on conceptual models of nursing, built on the keynote to discuss a NSM perspective of the Conceptual Model of Nursing and Population Health. Podium and poster presentations focused on the application of the NSM for education, research, and practice within the context of various worldwide population health issues.

Dr. Fawcett delivering Plenary Address Malone University

On Thursday evening, at Walsh University, we were inspired by Dr. Betty Neuman, who sent videotaped greetings and encouragement to the participants for moving the use

Global Café discussion led by DeLyndia Green Walsh University

of the NSM forward. Global café discussions provided an opportunity to dialogue about population health issues directly affecting a variety of client systems. On Friday, at Malone University, attendees continued the dialogue and began forging new connections and collaborations between colleagues from across the nation and Europe. Many of the NSM Fellows and grant recipients discussed the application of the NSM as guides for their research, education, or practice work. We will be posting many of the presentations on the Nursology.net 2019 conference page as soon as they become available!

Neuman Systems Model Fellows and Grant recipients: (L-R: Fatma Mataoui, Mickie Schuerger, Dawn Pla, Dwaine Thomas, Obiageli Obah, Marcia Jones-George)

Here are reflections from a few of the Symposium attendees:

Reception Walsh University

Mary Cook, from North Canton, OH, wrote: What a great opportunity to network with nursologists who not only know the Neuman Systems Model (NSM), but truly live (practice) the model. I was amazed at how “easily” some of the conference attendees and presenters on the first day during the Global Café discussions were able to extemporaneously frame shared comments within the NSMl. I was again awed by the presentations, both poster and podium, on the second day in relation to application of the NSM to diverse phenomena. It was overwhelming yet inspiring to witness the respect not only for the model but for the work of Dr. Neuman, Dr. Fawcett, Neuman Systems Trustees, and Fellows. I have had exposure to many of the nursing theories but have not had an opportunity to truly apply one model in my practice. What a great example of how theory can be and is used to guide daily nursing practice.
Mary Cook added: I had the privilege of organizing and overseeing the Silent Auction that is the fundraising portion of each Neuman Systems Model Symposium. There were numerous items donated but the two that commanded the most attention and competitive bidding were framed photos of Dr. Betty Neuman and Dr. Jacqueline Fawcett. Wow! What excitement over the possibility of owning a photo that represented so much to so many! The mentorship provided by these outstanding nursologists is astounding! We must continue mentoring and exploring effective strategies for engaging nursing students (undergraduate and graduate) as well as nurses at all levels of practice in theory application.

DeLyndia Green-Laughlin, from Baton Rouge, LA, wrote: The Neuman Systems Model Symposium was amazing as always, with forward thinking scholars working in collaboration to envision a brighter tomorrow. In this time of globalization, assessing population health through the lens of the NSM could not have been more appropriate. Having been a former school nurse myself, I cared for students and families in a time immediately after Hurricane Katrina. As our keynote speaker, Dr. Erin Maughan compared the Public Health Model with the Neuman Systems Model, I was reminded of the reconstitution the community experienced during the aftermath of the storm. As we had to work through the intra, inter, and extrapersonal stressors toward healing, addressing all five interacting variables was the keys to becoming whole again. In sharing the lived experience with families whose community was destroyed as a result of this environmental stressor, the NSM holds true for its use in the community. I was so excited to hear the many presentations during the symposium. Use of the NSM as a framework to address the opioid crisis that has devastated our nation, the impact caregiving will have on the community in the upcoming years, and our educators structuring their assignments within the model were a part of the breakout sessions. Dr. Neuman, thank you for your contribution to the Profession of Nursing.

Colleagues from The Netherlands attending the Symposium

Wichert Trip, an attendee from Zwolle, The Netherlands: Looking back at the NSM congress a couple of things popped out. Since 3 years I know of the existences of the NSM. I consider myself a freshman. I was overwhelmed by the magnitude of the concept. Not only is it applicable on a single patient, it’s very suitable for communities as well. As a community nurse I saw the NSM from a new perspective. That made my excited and I’m going to integrate the NSM into the minor Connecting Community Professional at Viaa University. I’m looking forward to the next congress!

Foekje Pol-Roorda, an attendee from The Netherlands: “A child with asthma must use his inhaler. But what if the mold grows on the walls at home? Or if the medication is not collected from the pharmacy during the holidays?” This example appealed to me in particular. I often draw students’ attention to the client system, but I also often refrain from making them aware of using inter, intra and extra personal factors to get a good picture of the situation. I myself give a lot of lessons in the minor Palliative care. The congress and the example above made me aware that we can look much more through the NSM and implement it even more in the Minor. And I think that this is an important purpose of a conference: improving education, improving professional practice. Personally, this congress has certainly given me an impulse to make the NSM an integrated part of my daily practice.

Ferdy Pluck, Poster Presenter, from Utrecht, The Netherlands, Malone University

Guest bloggers

Karen Gehrling, RN, PhD

Dr. Gehrling, a Neuman Systems Model Trustee since 1999, is a faculty member at  Walsh University Byers School of Nursing. She has been using the NSM to guide her scholarly work and educational endeavors for many years. In 2016, Dr. Gehrling received the Neuman Award, “established in honor of Dr. Betty Neuman for her distinguished contributions to the nursing profession and given annually to a member of the nursing profession who has made significant contributions to the profession as a nursing educator, leader or clinician. ‘Karen is an outstanding leader in nursing theory development and nursing education,’ said 2015 Neuman Award Recipient Dr. Jacqueline Fawcett, who presented the award to Dr. Gehrling. ‘She is a superb scholar with a record of numerous important papers published in top-ranked peer-review journals and important books, as well as many presentations on timely topics at regional, national and international conferences. Most of all, Karen is an outstanding scholar of the Neuman Systems Model.’ Her areas of interests with the Neuman Systems Model include developing a theory of reconstitution, helping nursing programs and curriculum development utilize the Neuman Model, helping students focus on family communication techniques and health promotion while using Neuman as a framework and the family as client, and most recently while consulting in Colombia South America, learning about the need to translate Neuman’s work into Spanish.” Retrieved from https://www.walsh.edu/nursing-research-day-2016-recap

Lora L .Wyss, PhD,  APRN-CNS

Lora Wyss earned Bachelor’s and Master’s degrees from George Mason University in Fairfax VA, a school nurse certification from Ashland University, and a PhD from the University of Akron. Currently, she teaches nursing full time at Malone University. Beyond her teaching responsibilities, Lora is the President of the Hartville Migrant Ministry Board as well as the nursing director of the medical clinic. Latino migrant farm workers who sought treatment at the center were the subject of her doctoral dissertation and of her outgoing research. Lora has studied the impacts of culture, economic hardship, gender, isolation, and status as barriers to medical treatment.

 

Lillian Wald (March 10, 1867 – September 1, 1940)

Guardian of the Discipline

Co-authored by
Deborah Lindell, Adeline Falk-Rafael, Jacqueline Fawcett

Lillian Wald (retrieved from https://www.vnsny.org/timeline/#prettyPhoto)

A recent article in the American Journal of Nursing (Pittman, 2019) reignited our interest in Lillian Wald’s landmark accomplishments, most notably co-founding, with Mary Brewster, of the Henry Street Settlement in New York City in 1893 (Dock & Stewart, 1938).  “Their work” according to Dock and Stewart (1938), “led to the next development of visiting nursing by their relating it to all the social, economic and industrial conditions that affected their patients’ lives” (p. 162).

Pittman (2019) in her recent American Journal of Nursing article highlighting the importance of Wald’s practice as a model for the future, explained, “Wald’s model of care [involved] nurses working side by side with social workers at the intersection of medicine and society” (p. 46). Another perspective would be to think of Wald’s work as an approach to health care delivery that encompasses complementary services provided by nursologists and social workers.

A hallmark of Wald’s approach was prevention of illness and disease and promotion of wellness. Her approach was such that everyone had a nursologist for primary care, and that the nursologist referred those needing treatment for disease to a physician. We can only wonder how differently the health care system would have evolved if Wald’s model had indeed been become THE approach to health care.

Similarly, we can only wonder what would have happened had Wald’s model been incorporated and implemented as part of Grayce Sill’s (1983) proposal for the establishment of nursologist owned and operated corporations that contracted with all clinical agencies for provision of nursologists’ services (see our tribute to Grayce Sills here). Alternatively, we can only wonder would could happen if Wald’s model were to be incorporated into Parse’s (2019) proposal for establishment of “community centers owned and managed by [nursologists] that are regionally situated to offer services to a group of families in a region” (p. 169).

Wald’s delivery model, the focus of Pittman’s recent article. was extremely important because it allowed the nursologists to be, in Wald’s words, in an “organic relationship with the neighbourhood” and, therefore, allowed for the “development of community coalitions for influencing health and social policy” (Falk-Rafael (1999, p. 27).  The delivery model followed Nightingale’s model of district “health nursing,” which Wald re-created as public health nursing. It was a model, however, that facilitated the enactment of Wald’s conceptual model of nursing, which Falk-Rafael has argued followed the Nightingale model (Falk-Rafael, 1999, 2005). Like Nightingale, Wald considered the patient to be the central focus of practice and viewed the “patient” as the individual, family, or community within the context of society; valued caring and compassion; and emphasized a holistic, person-centered, multi-determinant view of health. It is Wald’s conceptual model that informed nursing practice and without which, the delivery model would not have achieved the success alluded to in Pittman’s AJN article.

Wald, as Nightingale before her, understood from providing care to those members of society who were impoverished, disenfranchised, and otherwise vulnerable, that many of the health issues they faced could be prevented by upstream actions focused on changing/enacting public policies. Like Nightingale, Wald’s delivery model ensured nursing care to address immediate health concerns “downstream,” while simultaneously working “upstream” to shape policies affecting health.  She lobbied for health care for those who were impoverished and established rural and school nursing. Moreover, again like Nightingale, Wald recognized the value of measuring outcomes. For example, she published narratives and graphs describing and depicting the dramatically lower death rates, overall and by age group, of 3535 children with pneumonia cared for in the home during 1914 by Henry Street nursologists compared to those admitted to hospitals (Wald, 1915, pp 38-39). Nor was Wald alone in her political activism among nursologists of the Henry Street Settlement (see “The Family” photo below). Lavinia Dock, the noted suffragist, and Margaret Sanger, who defied the Comstock Laws to provide contraceptive information to women and who established the forerunner of Planned Parenthood, were also Henry Street nursologists (Falk-Rafael, 2005).

Lillian Wald’s accomplishments extended beyond, albeit were connected with, the Henry Street Settlement. For example, she was elected the first president of the National Organization for Public Health Nursing “twenty years after [she] had gone to Henry Street to live and her name was known in many countries” (Dock & Stewart, 1938, p. 166). Earlier, Wald had contributed to the initiative to control the spread of tuberculosis, when she and Mary Brewster “bought sputum cups as part of their first equipment” for the Henry Street Settlement (Dock & Stewart, 1938, p. 325). Later, Wald contributed to the life insurance movement when, in 1909, she “arranged with Dr. Lee K. Frankel of the Metropolitan Life Insurance Company to have the Henry Street Visiting Nurses give their service to the sick industrial policy holders of that company, as a certain rate per visit” (Dock & Stewart, 1938, p. 344). In doing so, she increased health care accessibility to people who otherwise could not afford it and hoped to expand such accessibility through more partnerships with both the private and government sectors. In addition, Wald proposed what became the United States Children’s Bureau, which was established by Congress in 1912 (Dock & Stewart, 1938).

Lillian Wald’s work is an exemplar of Critical Caring, a mid-range theory rooted in the conceptual frameworks of Nightingale, Watson, and critical feminist social theories. This theory also emphasizes both downstream and upstream nursing as essential for population health and shares with Nightingale and Wald the tenet that justice-making is a manifestation of caring and compassion (Falk-Rafael, 2005).

References

Dock, L. L., & Stewart, I. M. (1938). A short history of nursing: From the earliest times to the present day(4thed.). New York, NY: G. P. Putnam’s Sons.

Falk-Rafael, A. R, (1999). The politics of health promotion: Influences on public health promoting nursing practice in Ontario, Canada from Nightingale to the nineties. Advances in Nursing Science,22(1), 23.

Falk-Rafael, A. (2005). Speaking truth to power. Nursing’s legacy and moral imperative. Advances in Nursing Science, 28, 212-223.

Jewish Women’s Archive. “Lillian Wald.” (Viewed on July 26, 2019) <https://jwa.org/womenofvalor/wald>

Parse, R. R. (2019). Healthcare venues in transition: A paradigm shift? Nursing Science Quarterly, 32, 169-170.

Pittman, P. (2019). Rising to the challenge: Re-Embracing the Wald model of nursing. American Journal of Nursing, 119(7) 46-52.

Wald, L. (1915) The house on Henry Street.New York, NY: Henry Holt.

“The Family” about 1905. Standing, left to right: Jane Hitchcock, Sue Foote, Jene Travis. Second row, seated: Mary Magoun Brown, Lavinia Dock, Lillian D. Wald, Ysabella Waters, Henrietta Van Cleft. In Front: ‘Little Sammy’ Brofsky who ran everybody’s errands and ‘Florrie’ Long, the Coob’s little daughter and the “baby of the house.” (retrieved from https://www.vnsny.org/who-we-are/about-us/history/)

Roy Adaptation Association – International (RAA-I): 2019 Annual Conference Report

Debra Hanna, inducted as first President of RAA-I, June 8, 2019

We welcome this report contributed by Debra R. Hanna, President, RAA-I.  For additional information about the conference, and to download selected presentations, see the Nursology.net past conference page here.

Members of the Roy Adaptation Association—International gathered in Los Angeles, California on June 7 and 8, 2019 for their annual conference. This year’s conference theme was “Adaptation Towards Transformation for the Future.”
The conference opened with a lively, intriguing presentation by Dr. Scott Ziehm from University of San Francisco, California. His presentation “The State of Nursing Science through the DNP and PhD lens: Historical Perspectives and Future Directions” aptly set the stage for two workshops that followed. Dr. Ellen Buckner from Samford University, Alabama, conducted a dynamic workshop on Knowledge for DNP education. Dr. Debra Hanna from Molloy College in New York, and Drs. Alejandra Alvarado and Maria Elisa Moreno-Fergusson from Universidad de la Sabana in Chia, Colombia conducted a second workshop on Knowledge for PhD Education. The workshops were followed by the Awards ceremony for presenters of Award-winning papers. That afternoon, attendees enjoyed a relaxing reception during the poster session.

The second conference day opened with a networking breakfast, where Executive Board member Dr. Pamela Senasac guided attendees in an enjoyable ice-breaker exercise. A spirit of welcoming hospitality has always characterized our annual RAA-I conferences, so the ice-breaker exercise was in keeping with our long-established organizational persona. RAA-I Executive Board members hope to always preserve the spirit of genuine welcome to every colleague that wishes to join us.
Sr. Callista Roy gave an inspiring keynote speech: “Adaptation Towards Transformation for the Future.” After a short coffee break, the conference resumed with presentations of award-winning papers.

The Susan Pollack Award went to Melissa Lord, DNP, Jennifer Hunt, DNP and Ellen Buckner, PhD for their study: Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release through [project] HOPE. The Lizzie Whetsell Award went to Britton Buckner and Ellen Buckner, PhD, for their work using the Roy Adaptation Model to facilitate child adaptation in refugee-camps. The Carol Baer Award went to Luis Carlos Rodriguez Chanis and Yolanda Gonzalez, PhD of Panama, for their study of people living with chronic heart failure. The General and Mrs. Huberto Valesco Award went to Drs. Alejandra Alvarado Garcia and Blanca Venegas for their research to develop coping strategies within a group of chronically ill elderly adults. The last award was recently established as a memorial for one of our late RAA-I colleagues from Colombia. The Maria Elena Lopez award went to Beverly Kass, DNP, of New Jersey for her study that addressed caregiver coping with role strain.
During the annual Business Meeting the Leadership Mentoring program was described. Nine new mentees were matched with eight mentors in a short ceremony. Three newly elected officers of RAA-I were inducted: Dr. Debra Hanna, President, 2019-2012; Dr. Clare Butt, Treasurer, 2019-2021; Dr. Ellen Buckner, Secretary, 2019-2022. Sr. Callista Roy reported that Dr. Sumiko Tsuhako, our well-loved Executive Board member and First President of RAA-Japan has decided to step down from these roles after more than 13 years. Several colleagues from Japan were present at this year’s conference with very good news about the formation at St. Mary’s College in Fukuoka, Japan of a wonderful new nursing research center. From the photos they shared with attendees, we saw that the Roy Academia Nursology Research Center is located in Roy Academia Hall at St. Mary’s College. Transformation for the future of RAA-I was evident in several ways this year.

Our next annual conference for RAA-I will be held in Los Angeles, California on June 19, 20, 2020. The theme for the 2020 conference is: Roy Adaptation Model: Contributions to Authentic Nursing Knowledge. The Call for Abstracts will be released soon.

Mount St. Mary’s University Los Angeles, California.
Photo retrieved from https://www.msmu.edu/about-the-mount/nursing-theory/roy-adaptation-association/conference/

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.

Rosemarie 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 Humanbecoming 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!