Celebration! 2nd Anniversary of Nursology.net

. . . . it is worth reiterating the point that compared with atheoretical actions, those that are conceptually grounded have a higher probability of achieving their intended consequences. Not just because they are contemplated more intentionally but because the vast majority of . . . . theories/frameworks pay heed to the important messiness of context and the use of power. (1) Patricia Butterfield (2017, p. 9)

Nurses are thirsting for a meaningful practice, one that is based on nursing values and knowledge, one that is relationship centered, enabling the expression of the depth of our mission, and one that brings a much needed, missing dimension to current healthcare. (2) Margaret A. Newman, Marlaine C. Smith, Margaret Dexheimer Pharris and Dorothy Jones (2008, p. E25)

With a strong conviction of the vital importance of nursing’s own theories and frameworks, the Nursology.net management team embarked on the development of a website to provide current and accurate information about discipline-specific knowledge. We started the development of the site in the summer of 2018, with the goal of publicly announcing the site once we had at least 20 theories/models on the site, and at least 1 Exemplar in each of the “Exemplar” sections! We met that goal and officially launched the site on September 18th, 2018! Today, we have

Plus, a new section dedicated to nursing philosophy, a host of resources related to nursology knowledge development, a record of past nursology-related conferences (including proceedings, photos and other materials related to the conferences), information about events that will be happening in the future (despite the pandemic), and an unbroken record of blog posts every Tuesday!

I, Peggy Chinn, have served as the architect of the site and am responsible for the nitty-gritty work of putting it all together, but all of this is only possible because of the work of members of our team of nursology scholars who have identified and composed the content.

Here are reflections from members of our management and blogging teams in response to two questions:

  • How has nursology.net influenced your approach to teaching, research, or practice?
  • What do you anticipate for the future of the discipline, and the role of nursology.net in shaping that future?

How has nursology.net influenced your approach to teaching, research, or practice?

Jacqui Fawcett
The website is exceptionally useful as a resource for the PhD students I have the honor to teach, as well as all other students in our program., and as resource for colleagues who are “thirsting” for information about nursology discipline-specific knowledge. In addition, I cite the blogs in many of my publications—journal articles, book chapters—and presentations at conferences and as a guest lecturer for other nursology programs.

Marlaine Smith
When I’m with any student or faculty group I call attention to the nursology.net site and describe the many resources available.  I’m teaching a course now for PhD students, Evolution of Nursing as a Professional Discipline.  In the first module I introduced students to Nursology and they were invited in the discussion board to respond to a question related to the Nursology site.  I have received so many comments from students and faculty who are amazed at and grateful for the many resources on the site. The Nursology blogs offer short position/perspective pieces that can spark meaningful discussion.

Dr. Eustace

Rosemary Eustice
Nursology.net is a vehicle that highlights the contribution of nursology wisdom to health and health care issues. The website continues to influence my teaching by enabling me to find new teaching and learning strategies that foster students’ acquisition of nursing knowledge to understand nursing phenomena of interest.  One thing that inspires me everyday when I share this website with my students, is to see how much the students appreciate the value of nursing theories and how much they wish for ‘good’ mentors and educators to support the next generation of competent nursologists. On the other note, as a nurse researcher, nursology.net has increased my curiosities on nursing knowledge development and how nursologists can utilize research in clarifying and developing new concepts/ideas using nursing lenses. 

Dorothy Jones
I am impressed with the global response to the nursology.net website. When I have shared this information with faculty and students at a University in Spain where I consult, the reaction has been inspirational. Doctoral students love having “free” access to the nursing theorists and their work in one central space. Faculty describe the site as “a way to connect with the nursing community “globally.” Dr. Emiko Endo from Japan recently translated a nursology blog “Covid 19- What would Margaret Newman Say” into Japanese for her students. She also presented the information to participants attending a virtual Nursing Theory Conference. Dr. Endo reported how moved the audience was by the message. When I shared the web site with a group of International Gordon International Scholars at Boston College, from Italy, Brazil and Africa they were excited to learn about the site and immediately shared it with the other faculty and students.  They noted that they now had immediate access to information about nursing theory never available to them before. The responsiveness of the site to contemporary issues makes nursology.net a living document that promotes nursing knowledge and its potential impact on the health and wellbecoming of all.

Jane Flanagan
I am teaching a new course this year – Philosophical Inquiry for Knowledge Development in Nursing.  I introduced my students to nursology.netas well as the faculty of a companion course – Strategies for Knowledge Development in Nursing. For my course, we will be using the site for the many resources it offers. I have encouraged them to read and respond to the blogs.  I think if I was to have a re-do on my syllabus, I would actually have an assignment include a meaningful contribution to the site. These students are our future nurse leaders and I know like many on this site, we want to hear from them. We have only had one class thus far, but based on the great dialogue, I think they will be joining in on the conversations on nursology.net

Jane Dickinson
I am pointing students to nursology.net in the Nursing Knowledge in Nursing Education course I teach for doctoral students in our Nursing Education program. I also have them write a blog post and an exemplar (if applicable) for submission to nursology.net as course assignments. Nursology.net is an amazing resource where students can learn about nursing theorists and their work. It also provides a wonderful opportunity for them to think and write about their own experiences with nursing knowledge.

Chloe Olivia Rose Littzen
As a PhD candidate, Nursology.net has influenced both my nursing education and the ways in which I know the world. Specifically, Nursology.net was one of the few references I was able to use for specific theory related nursing knowledge content in studying for my comprehensive exams.The organization of theory-related content made it easy for me to find what type of information I needed, and I knew that the information included was substantive in nature. As a nurse, Nursology.net has also informed the ways I know the world by keeping me up-to-date on current issues and events, while simultaneously giving me access to new nursing knowledge content I may have never come across during my own reading. 

Danny Willis
In the PhD course “Nursing Knowledge Development” I have been teaching at the University of Wisconsin-Madison we used the resources on nursology.net to guide our thinking. PhD students  were thirsty to explore the philosophical, conceptual, theoretical, and empirical aspects of the discipline in research, education, practice, and policy. Great examples are showcased on the website, which they enjoyed! As these PhD students prepare for their research and future programs of disciplinary knowledge development as leaders in the discipline, through the website they were better able to understand the value of grounding their work in the discipline, which feels like a Wonderful move in the right direction. Nursology.net is recognized as a go-to resource with the potential for nursologists to contribute to ongoing conversation, like none other! 

Patrick Palmieri
The emerging role of nursology.net in low- and middle-income countries is impactful due to our limited access to nursing knowledge. Unfortunately, knowledge is too expensive for many nurses throughout the world. The limited financial resources in many countries negatively impacts access to nursing literature, including published papers and nursing textbooks. Through nursology.net, student nurses and professors throughout the world have immediate access to contemporary nursing knowledge, including timely theoretical discourse related to current trends and events. Most importantly, nurse scholars such as I, are able to translate the resources, without copyright issues, for immediate application in our courses. This year, we continued to advance a project to translate resources from Nursology.net into Spanish for the history of nursing and theory of nursing courses. Through the efforts of the leaders and many donors at Nursology.net, the barriers to accessing knowledge have been removed. Nursology is linking scholars to students throughout the world!

What do you anticipate for the future of the discipline, and the role of nursology.net in shaping that future?

Jacqui Fawcett
I am both pessimistic and optimistic about the future of nursology—I am very concerned that our disciplinary knowledge will not survive as a continuing way to guide disciplinary advancement—there always is a tension to focus on pragmatic aspects of issues rather than the philosophical, conceptual, and theoretical aspects, and there is much too much emphasis on empirical methods—the primacy of methods for so many people is of great concern to me. In contrast, I am encouraged by the number of people who have been accessing nursology.net and by the continued publication of multiple editions of several books about nursology conceptual models and theories. Nursology.net serves as an ongoing resource for all nursologists, with blogs and other content already shaping what nursologists think about our discipline. We definitely are living our mission to be a repository for all things theory in nursology!

Marlaine Smith
While I can despair at the lack of valuing of nursing theories/models in our research, the lack of content related to nursing theories within the curricula, and the frequent absence of a clear nursing perspective in advanced practice and interprofessional practice, I’m encouraged by signs that there is a renewed appreciation of the importance of generating nursing qua nursing knowledge and practicing from nursing’s disciplinary perspective. Some of those signs… the committed group of scholars who have been attending and contributing to the annual Nursing Theory Conferences…the growing number of AAN members joining the Nursing Theory-Guided Practice Expert Panel…the recognition by CNOs about the value of practicing from a nursing theory-guided model…the lights in the eyes of students who “get it”. Nursology.net will continue to support this emergence. The site has global outreach and can bring the nursing community together around the critical issues of expanding disciplinary knowledge development and application. 

Dr. Eustace

Rosemary Eustace
I am optimistic that the future of the discipline and the role of nursology.net will continue to find a voice in health care, especially in the area of policy making. However, this process will be timely if we continue to value and acknowledge the uniqueness of nursing knowledge in influencing health care outcomes. When I think back at what we have learned so far and are learning each day with the wake of the Covid-19 pandemic, I see a window of opportunity for nursologists to advocate for this unique STEM discipline and use nursing knowledge to make positive changes in health care systems and population outcomes.   

Dorothy Jones
As a discipline we continue to experience many issues, even resistance to articulating nursing science within nursing curricula, research and care delivery.  Emphasis on preparing nurses with essential content that focus on  role development with little grounding in philosophical and theoretical underpinnings of the discipline challenges knowledge development and compromises the visibility of nursing’s impact on care delivery. While the interdisciplinary / intra professional focus on contemporary issues is critical, the unique voice of nursing is essential to informing and reshaping responses to global health concerns. While the threats to advancing nursing science are apparent, there is also indications of a renewed interest in nursing’s identity and expansion of nursing knowledge. Increasing membership in nursing theory groups, attendance at nursing theory conferences and active progress by groups such as the AAN Expert Panel of Nursing Theory Guided Practice to link nursing’s knowledge and policy, offer signs of hope for the future. Nursology.net has been an important catalyst that has supported this renewed dedication to nursing knowledge. The site provides an essential platform for all nurses to share in our history, explore our future, and increase our awareness of new opportunities for nursing’s voice to influence issues of global concern. Thank you nursology.net!

Jane Flanagan
I think we are in a time that has raised our social consciousness and many nurses are questioning our role in power dynamics, sociopolitical movements, structural racism. They are asking are we going to be part of the problem or mobilize and act?  Foundational to our discipline is our ethics aimed at striving for the greater good, health and healing for all people. We can no longer tolerate an inequitable society or health care system that does not meet the needs of those we say we are committed to serve. Nursology.net  is a forum that created the space for us to have the dialogue, work through the sometimes awkward, sometimes obvious and at other times not so obvious issues. It is a safe place that allows all nurses to think, write share and activate. Our future is in not only finding our voice, but in leading the way. Nursology.net is the format and catalyst to accelerating our movement toward a universally experienced wellbecoming.

Jane Dickinson
I see nursing knowledge (and all five ways of knowing!) becoming more prominent in nursing education, research, and practice as we move further into the 21st century. Nursology.net is the preeminent source for nurse educators and leaders in research and practice to share their work, and to inspire newer nurses to take the next step in further developing and refining what we know and what we do.

Chloe Olivia Rose Littzen
I anticipate that nursing theory and philosophy, including our unique disciplinary perspective, will come to the forefront of importance in our nursing practice, research, education, and policy. Additionally, I believe that nursing theory and philosophy will be revealed to play a significant role in the well-being of our nurses and the healthcare environment. I believe Nursology.net will support nurses to be confident and grounded in their own unique disciplinary perspective, promote the use of nursing theory and philosophy in all settings, and provide a forum in which nurses can gather from across the globe to stay up-to-date on relevant issues and events in nursing.

Danny Willis
The future is in our hands and the website will continue to play a major role in orienting nurses and our PhD, DNP, Masters, and Baccalaureate students. Nurse leaders and educators in practice settings would benefit from having this website as a part of their orientation. Therefore, I see it as my responsibility to let every Chief Nursing Officer I meet with know about this resource and offer to speak to anyone in educational leadership roles in practice settings about the website. Faculty leaders must also be aware and able to speak to the substance of the discipline, which the website acts as a vehicle for. Nurse leaders will be called upon to champion ready access to the fundamentals of nursing depicted on the website and to further the ongoing evolution of disciplinary thought and communication. The future of the discipline can be bright as we nurses promote humanization, caring, healing, relationship, love for one another, diversity, belongingness, transitioning through living and dying, meaning in living and dying, and well-becoming. The future can be bright if we nurses promote openness, dialogue, healing transformative power with each other, critique, intellectual curiosity, community, and nursing ethics of our shared humanity and a deep commitment to the greater good for all of humankind and planet Earth in all its complexity and beauty. Onward nursologists! 

Sources for the opening quotes:

  1. Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. ANS. Advances in Nursing Science, 40(1), 2–11. https://doi.org/10.1097/ANS.0000000000000161
  2. Newman, M. A., Smith, M. C., Dexheimer-Pharris, M., & Jones, D. A. (2008). The focus of the discipline revisited. ANS. Advances in Nursing Science, 31(1), E16–E27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Muriel A. Poulin, EdD, RN, FAAN (1925 – 2019)

Guardian of the Discipline
In Memoriam

Contributors: Sarah B. Pasternack, MA, RN
Dorothy A. Jones EdD, APRN, FAAN, FNI

Magnet Study Author and Nursing Advocate, Educator, Leader 

Muriel Poulin was above all – a fierce advocate for nursing. Her disciplinary contributions have transcended her impact on education, practice, administration and policy. Muriel’s work embraced nursing excellence, promoting nursing’s potential in all she did. Above all, Dr. Muriel Poulin modeled what it meant to be a leader in nursing. When she stood up to speak she was articulate, clear and resounding in delivering her sustaining message that nursing made a difference in health care and nursing leaders needed to create the environment for nursing to flourish.

Muriel died on September 6th in 2019 in Sanford Maine. She began her nursing career as a Cadet Nurse, graduating from Massachusetts General Hospital School of Nursing in 1946.  She earned a bachelor’s degree in nursing at Catholic University, a master’s degree in nursing at University of Colorado and a doctorate at Teacher’s College, Columbia University.

Muriel held several nursing positions including the nursing director at the opening of a hospital in Damascus, Syria, during the early 1950s.  She served on the faculty of the University of Kentucky, American University in Lebanon and University of Barcelona. She served as Professor and Chairperson of the Nursing Administration Graduate Program at Boston University School of Nursing from 1972 to the time of her retirement  in 1988. 

As a dedicated leader in promoting the visibility of nursing internationally, Muriel was also unwavering in her promotion of nursing through organizational action. She was a voice for nursing in the American Nurses Association (ANA) throughout her career, holding membership in the organization throughout her career and in her retirement. She was elected Second Vice President of the American Nurses’ Association in 1976 as a Massachusetts member.  

Muriel was a leading force in the early development of the American Academy of Nursing (AAN). She viewed the Academy as the “knowledge arm” of the American Nurses Association, influential, informing and reforming nursing at all levels. She advocated for the early goals of AAN especially the goal that addressed nursing knowledge, development, use and translation to inform education, practice and policy.

During the early 1980s, Muriel was one of four distinguished nurse leaders selected by the American Academy of Nursing to identify and describe clinical practice environment variables that attracted and retained well-qualified nurses.  In 1983 the groundbreaking study, Magnet Hospitals: Attraction and Retention of Professional Nurses was published.  The significant outcome from this study was the establishment of the Magnet Recognition Program by the American Nurses’ Credentialing Center (ANCC) in 1990.  As of August 2020, there are 523 Magnet-designated Hospitals in the US and 10 other countries, with 10 in Massachusetts.  Dr. Patricia Reid Ponte, President of the Board of the ANCC and Clinical Associate Professor of Nursing and Health Administration at Boston College and a former student of Muriel’s, stated “today’s interest in The Magnet Recognition Program internationally can be linked to the efforts of nursing leaders like Dr. Muriel Poulin. This program has had profound positive impact on health care delivery.  Muriel Poulin’s legacy is carried on across the globe through the nurses and advanced practice nurses working in these organizations.” 

Dr. Poulin was honored by ANA Massachusetts as a Massachusetts “Living Legend in Massachusetts Nursing” in 2011 and also as a “Living Legend in Nursing” by American Academy of Nursing in 2012.  In 2016 she was honored by induction into the Nursing Hall of Fame by the American Nurses Association.

Muriel educated and personally mentored many of the current and former nursing executives and leaders in the Boston area and beyond.  Dr. Ponte, stated: “Muriel Poulin was a force of nature – a truly extraordinary nurse, leader, researcher and educator. As a member of my dissertation committee at Boston University School of Nursing in the late 1980s, she pushed me to become a better nurse executive through her mentorship. I will be forever grateful to her. I was able to have lunch with her in the last couple of years when she attended the ANCC Magnet Conference (a real thrill for Muriel) and again at the American Academy of Nursing meeting.”

As a junior faculty (Dr. Dorothy Jones), teaching in the undergraduate nursing program at Boston University, I often wondered if I would ever be able to stand up and advocate for nursing the way Dr. Poulin did in the classroom and at a faculty meeting. One day I got my chance.  I was called to a meeting with Muriel. “I want you to teach my Masters students about health and nursing practice. They need to know this information.” I was pleased and overwhelmed by the opportunity to work with Muriel. We developed a new course that  incorporated holistic nursing concepts  into the Masters in Nursing Administration curriculum. A few years later, she was my AAN Fellowship cosponsor, an honor I will forever remember.

 Dr. Susan LaRocco, Dean and Professor of the School of Nursing, Mount St. Mary College, Newburgh, NY and a graduate of the BU graduate program in Nursing Administration, stated: “Dr. Poulin has been influential throughout my administrative career.  Whenever I had to handle a difficult situation, I could be fearless because she taught me that the patient is the center of all that we do.  When I had to deal with a patient abuse case, I thought that I was going to be fired for pursuing it.  But I knew that I was doing the right thing because a frail elderly patient had been harmed and I could not just look the other way.  After reconnecting with Muriel at a BU History of Nursing Archives event, I had the privilege of meeting her occasionally for lunch.  It was always a lively conversation with this wonderful mentor.”

Dr. Poulin  was an international nursing leader. She worked to prepare nursing organizational leaders, globally, Through her publications, teaching and presentations she influenced a generation of  nurses involved in  leading  hospital and organizational administration today.  Even in her “retirement,” Dr. Poulin exerted her leadership in the profession with service on the Board of Directors of her local Visiting Nurses Association in Maine and with the establishment and management of a very successful second-hand bookstore to benefit a local hospice.  She was a fierce advocate for Nursing and her voice will be missed by many.

Power in Nursing

Power has been a concern to all living beings – humans and animals – since the beginning of time. Nursologists have been sensitive to power issues at least since Florence Nightingale’s time. It is likely, however, that power has different meanings for different people, including those who hold positions associated with power and those who regard themselves as subjected to power and may think they are powerless.

Very specific meanings of power are evident in a nursology theory developed by Elizabeth Barrett and a nursology theory developed by Peggy Chinn. Elizabeth Barrett developed the theory of power as knowing participation in change. This theory focuses on power-as-freedom, which contrasts with power-as-control. Barrett (2010) explained that power-as-freedom comes from and is associated with participating knowingly in life changes.

Peggy Chinn developed the theory of peace and power. This theory focuses on peace-power, which contrasts with power-over. Chinn (2018) explained, “This theory provides a framework for individuals and groups to shape their actions and interactions to promote health and well being for the group and for each individual, using processes based on values of cooperation and inclusion of all points of view in making decisions and in addressing conflicts.

My interpretation of these theories is that both emphasize power as a beneficial attribute that enables the individual or group to thrive and evolve, as opposed to power as a detrimental attribute that often prevents others from thriving and evolving. But what, I wondered, are meanings of power held by other nursologists?

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

Therefore, I invited graduate students at St. Mary’s College School of Nursing in Kurume, Japan, where I am a visiting professor, to share their meanings of power. I asked the students to respond to two questions:

  • How do you define power?
  • How does power affect what you think and do as a nursologist

The students’ responses are given here. I am indebted to Eric Fortin, who is a faculty member at St. Mary’s College School of Nursing, for translating the students’ responses from Japanese to English. (See notes below for more information about St. Mary’s College School of Nursing)

How do you define power?

Yukari Shitaki wrote: Power is generally defined as authority, motive power, energy, and so on. In nursing, I think that there are many things that are demonstrated through relationships among people, such as manpower, empowerment, and power augmentation, which improve technical skills and abilities. In addition, I think that the way people, whether individuals, groups, or society at large, perceive that power changes according to the situation at any particular time. Therefore, for me, power is defined as the force in the fellowship among people that produces synergistic effects and is further demonstrated through the interactions among them.

Kiyoko Tanaka wrote: We as nursologists work to maintain and promote human health, prevent health problems, create an environment that promotes health, and share and resolve issues related to the destruction of the natural environment and the deterioration of the social environment. In contrast, nursology is caring and has the power to realize and maintain a peaceful human society by fulfilling its role

Yoko Hashimoto wrote: In Japan, some nurses work in the government as licensed nurses and are involved in devising national policies. Many other nurses are involved with patients and local residents in hospitals and communities. Nurses see problems and other issues in their daily practice. Therefore, as nurses, we are working to improve the quality of nursing to solve these issues. I believe that nurses consider motivation and the ability to improve the quality of nursing to be power

Risa Fujimoto wrote: I think that nursologists’ power can be defined as action. As nursologists, everything should be done for the patient. It is very important to possess the ability to do something useful for people and to act on and realize what we want to do, including even little things. I also think that studying at graduate school may be the first step that will lead to having the power of a nursologist.

Saki Higashi wrote: The power of a nursologist for me is defined as the ability to constantly grow from the soul and to spread that around to others. I categorize power into three aspects. The first is the core, the second is influences absorbed from one’s surroundings, and the third is action. The core is latent and spiritual and includes one’s thoughts on nursing. The aspect of power that is absorbed from one’s surroundings is the power that can exert influence and that can be taken in from all external stimuli such as patients and other staff through one’s experiences of being a nursologist. Action is the aspect of power that derives from what has been cultivated up to now, including from the first and second aspects, and it works by giving back what has been absorbed from others through one’s practice and by diffusing one’s own power to those around us. Power is not always constant, but fluctuates; and power, although being influenced by others, also gives of itself and continues to grow.

How does power affect what you think and do as a nursologist?

Yukari Shitaki wrote: The reason I wanted to raise the level of my expertise was that I strongly believe in the importance of education. In my work environment as a perinatal nursologist, I encounter situations in which induced abortions are easily requested due to undesired, unexpected, or young pregnancies. One of the reasons for this involves the issue of sex education. I have thought about what I could do to change the consciousness of the women in these cases by inculcating in them the value of life and the desire to protect its dignity. It is difficult to face such a problem through one individual’s power alone, so it is necessary to first acquire the ability to judge the essence of one’s role as a professional and to think about what kind of method is possible to implement an action from an educational perspective. I also think it is possible to augment an individual’s power by utilizing the power of a larger group through fellowship with its members, and thereby be better able to put necessary actions into practice.

Kiyoko Tanaka wrote: As a pediatric nurse, I realize that the family is very important in child development. If families cannot fully understand children with developmental disabilities and cannot understand the characteristics of their own children, it will not be possible to support those children, and it will be difficult to expand their possibilities with adequate developmental support. It will also be difficult to improve their future health in connection with possible secondary disabilities. The risk of ruining a healthy life can also develop. Conversely, with regard to the mental health of parents, especially mothers, of children with developmental disabilities, feelings of difficulty in raising these c)hildren have led to depression and reduced self-esteem. Based on this situation, we, as nursologists have the power of specialized knowledge to offer counseling, guidance, and a positive nursing environment for children with developmental disabilities and their families in cooperation with related organizations such as prefectures, municipalities, hospitals, and schools. We can also provide information about services available for children with developmental disabilities and their families so that they can maintain, promote, recover from, and prevent illness. In addition, we believe that such support will promote the health of caregivers, promote a better understanding of children with developmental disabilities, and lead to their healthy development.

Yoko Hashimoto wrote: Japan has had a background of advanced medical care catering to the needs of an aging society having an increasingly long lifespan, and medical care is moving from the hospital to the home. However, there are few nurses who are practicing in the field of home nursing, so evidence in this field is weak and, therefore, has failed to lead to policies. In the future, it will be necessary to conduct research and establish evidence for issues arising from daily practice to provide high-quality nursing in response to social changes. It is difficult to act alone, so it is necessary to become involved with others and to work together. Through the power of nurses, nursing practice will be better visualized, which will hopefully allow it to occupy a more important position among government circles, thus leading to improved nursing and medical care.

Risa Fujimoto wrote: For nursologists, power is the ability to help people by being useful to them. In my clinical experience, I often wondered whether I could really help others or if there was something more I could do for them. Therefore, I decided to undertake graduate study with the goal of improving my knowledge level and nursologists’ practice skills. As a rehabilitation nurse, I want to become a nursologist with a wide range of knowledge and be involved in primary through tertiary stroke prevention. We can only become useful to people by taking action and practicing what we know. However, to take action, we cannot act entirely alone; we need the knowledge and skills of other nursologists. Personally, if I obtain enough knowledge in graduate school, I am confident that I will have to play a role in creating an opportunity for many nursologists to understand the value of nursology. So, I think that that would be one of my responsibilities as a nursologist. As a practitioner, I will keep in my heart and mind what I believe to be useful for people and will work to obtain knowledge and skills so that I can better perform the actions of a nursologist.

Saki Higashi wrote: Power influences my activities as a nursologist. In the future, by incorporating my experiences and various influences from the external environment and applying them to my nursology activities, I am confident that I will not only grow as a nursologist, but also expand my influence to people, regions, countries, and the world at large.

References

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23(1), 47-54. doi:10.1177/0894318409353797 

Chinn, P. L. (2018, August 23). Peace & Power. Retrieved from https://nursology.net/nurse-theorists-and-their-work/peace-power/

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

More about St. Mary”s College School of Nursing on Nursology.net

Who IS the First?

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

How the Nursing Philosophy of Intermodernism Changed the Way I See the World as a Novice Nurse Scientist

When I started my PhD program, I had no idea how important philosophy would become in my life. Fast forward to now, as a PhD candidate, my nursing philosophy is the cornerstone for how I look at the world and how I perform research as novice nurse scientist. But, this is not to say that prior to my PhD program I didn’t value philosophy! I always had a strong affection for philosophy. When I was in 6th grade, I remember sitting in my government and politics course and being absolutely enthralled with discussions about John Locke (I mean, how cool is the idea of tabula rasa?). In my late teens and early twenties, I began my fascination with eastern philosophies related to yoga and Buddhism. But, even though I had been a nurse since I was 22, I never learned about the philosophy of nursing. It wasn’t until I started my PhD program at age 27 where nursing philosophy even became a part of my nursing knowledge base. Once I wrapped my head around complex areas of philosophical inquiry such as epistemology and ontology, it was like a light bulb went off in a dark room that I had previously been stumbling around in — I finally had a way to make sense of the world as a nurse!

Pamela Reed

            The philosophy that changed it all for me was the philosophy of nursing science and practice called Intermodernism (Reed, 2019). Intermodernism, which was originally titled as neomodernism (1995, 2006a, 2006b), is unique in that it is an expanded view of epistemology where practice and science partner to create new knowledge originally developed by Dr. Pamela Reed (Reed, 2018). Nursing practice, and the nurses within, thus become a source of knowledge, and not just a repository of the knowledge (Reed, 2018) developed in the ivory tower. This is not to say the academe is not important, instead, intermodernism acknowledges the necessity of partnership in knowledge development; the theory-practice gap becomes the theory-practice connection, and ALL nurses are recognized as the theorists they are. Being a theorist is often put on a pedestal, where theory is an intimidating and unrelatable aspect of the academic world. Intermodernism cleverly acknowledges that nurses theorize every day in their practice. And, if you don’t believe that, just ask a nurse to explain how they solved a problem on their last shift, this is theorizing at its finest.

            This is just the tip of the iceberg with intermodernism, and as much as I could ramble on about the ins-and-outs about intermodernism, I invite you to explore some of the literature related to intermodernism on your own. My rationale for this invitation is that it is important in philosophical inquiry to take time for “arm chair work” (as Dr. Reed has very wisely taught me), which is sitting, thinking, reading, and repeating that process – and for me I would add, when you run into a philosophical conundrum or question talk to someone about it!

Comic Art by XKCD

That is why I invite you to explore the new philosophy section on Nursology.net. If you are new to philosophy, don’t get intimidated as we have provided some beginning definitions of at first kind of scary but actually really interesting words such as epistemology and ontology. You will also find lists of substantive literature in both nursing ontology and epistemology. Intermodernism also has it’s very own page here, where I have listed the most relevant articles for your enjoyment. These pages will be continued to be added to, so be sure to check back, and if you think something is missing we would love to hear your suggestions!

References

Reed, P. G. (1995). A treatise on nursing knowledge development for the 21st century: beyond postmodernism. Advances in Nursing Science, 17(3), 70-84. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7778892

Reed, P. G. (2006a). The practice turn in nursing epistemology. Nursing Science Quarterly, 19(1), 36-38. https://doi.org/10.1177/0894318405283545

Reed, P. G. (2006b). Commentary on neomodernism and evidence-based nursing: implications for the production of nursing knowledge. Nurs Outlook, 54(1), 36-38. https://doi.org/10.1016/j.outlook.2005.01.001

Reed, P. G. (2018). A philosophy of nursing science and practice: Intermodernism. In P. G. Reed & N. B. C. Shearer (Eds.), Nursing knowledge and theory innovation: Advancing the science of practice (2nd ed., pp. 21-46). Springer Publishing Company.

Reed, P. G. (2019). Intermodernism: A philosophical perspective for development of scientific nursing theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ans.0000000000000249

By and For Numbers: Meaningless Without Theory

We have always lived in interesting and challenging times, filled with reports of numbers indicating what is happening – life expectancy, births, deaths, and most likely millions of other numbers representing important and probably not so important events. Currently, we are living in what many people regard as an especially interesting and challenging time, with numbers about the coronavirus pandemic dominating news reported in the print, radio, television, and internet media. Most recently, numbers about climate change have taken almost center stage as the “hurricane season” occurs. .

I confess to checking the coronavirus pandemic numbers every day, especially for the state of Maine, where I live and now also work during this time of remote teaching and scholarly work. I also keep track of what is happening with hurricanes, which occasionally do make landfall along the coast of Maine and can create many tree downings and power outages, beach erosion, and flooding.

Numbers are perhaps especially important to researchers who conduct quantitative research to test hypotheses. Thinking of numbers within the context of hypothesis testing requires theoretical thinking. Thus, even if implicit, theory is paramount to the interpretation of numbers. Of course, it would be more significant if the numbers were interpreted using explicit theory.

It is, unfortunately, not unusual to read reports of hypothesis testing research conducted by nurses with no mention of any theory that might have guided the research and articulation of the hypothesis. Should we then assume that the researchers are not thinking theoretically? Or, are they unable or unwilling to tell readers what theory was used? As I wrote in a 2019 blog, it is impossible to think atheoretically. Why, then, are so many reports of numbers devoid of any theoretical perspective?

How are we to understand the meaning of numbers about the coronavirus pandemic or climate change without some theoretical perspective? I maintain that it is all nursologists’ responsibility to place all numbers in some theoretical context. For example, nursological conceptual models and theories about primary prevention provide understanding of the extent to which numbers for the coronavirus pandemic are or are not responding to primary prevention interventions (see https://nursology.net/2020/04/21/the-value-of-primary-prevention/). In addition, all nursological conceptual models include attention to the environment, which could easily be extended to encompass the issues surrounding climate change (see my September 24, 2019 post). Furthermore, Nightingale’s theory provides an important nursological perspective for interpreting both pandemic and climate change numbers (see https://nursology.net/2020/05/12/wwfd-what-would-florence-do-in-the-covid-19-pandemic/).

Nightingales’ theoretical perspective of the importance of numbers and the environment is evident in that she “recognized the need to provide an environment conducive to recovery, [and] that data [i.e., numbers] can prompt innovation” (Hundt, 2020, p. 26), and that the effectiveness of theoretically-based innovations is supported by numbers. In particular, for all nursologists “advocating for public policy and conducting research, [theoretically-based numbers] help frame two questions: “How can we improve the health of our communities? Are our interventions making a difference?” (Hundt, 2020, p. 28).

Aula’s (2020) caution about “misplaced trust in numbers” underscores the importance of not only using theory to interpret numbers but also to be wiling to allow the numbers to support rejection of the current version of the theory. Willingness to reject the theory – or at least a hypothesis derived from the theory – is consistent with Popper’s (1965) philosophy of science, which indicates that rejection of the theory leads to a better theory.

“May you live in interesting times” (Wikipedia, 2020) is a widely used saying that may or may not be a positive wish—perhaps it is better to wish to live in uninteresting times that are characterized by tranquility and harmony. I would like to paraphrase a positive interpretation of the saying and offer the wish that all of us may always live in nursological theoretical times and always interpret numbers within the context of nursological theory.

References

Aula, V. (2020, May 15). The public debate around COVID-19 demonstrates our ongoing and misplaced trust in numbers. https://blogs.lse.ac.uk/impactofsocialsciences/2020/05/15/the-public-debate-around-covid-19-demonstrates-our-ongoing-and-misplaced-trust-in-numbers/

Hundt, B, (2020), Reflections on Nightingale in the year of the nurse. American Nurse Journal, 15(5), 26-29.

May you live in interesting times (2020, June 3), In Wikipedia. https://en.wikipedia.org/wiki/May_you_live_in_interesting_times

Popper, K. R. (1965). Conjectures and refutation: The growth of scientific knowledge. Harper Torchbooks.

Overdue Reckoning on Racism in Nursing

Our Nursology.net community is committed to addressing the burning issue of racism, how this systemic condition has influenced the development of nursing knowledge, and how this situation can be changed (see our statement on racism in the sidebar for more information). The NurseManifest project has just announced a series of web discussions “Overdue Reckoning on Racism in Nursing” that will interest many nursologists! Starting on September 12th, and every week through October 10th! This initiative is in part an outgrowth of the 2018 Nursing Activism Think Tank and inspired by recent spotlights on the killing of Black Americans by police, and the inequitable devastation for people of color caused by the COVID-19 pandemic.

Racism in nursing has persisted far too long, sustained in large part by our collective failure to acknowledge the contributions and experiences of nurses of color. The intention of each session is to bring the voices of BILNOC (Black, Indigenous, Latinx and other Nurses Of Color) to the center, to explore from that center the persistence of racism in nursing, and to inspire/form actions to finally reckon with racism in nursing.

Lucinda Canty, Christina Nyirati and Peggy Chinn have teamed up to create the plan – you can see the details here; it is also easily accessed from the NurseManifest main menu!

Hope in Nursing

Contributors: Barbara MacDonald
and Jane K. Dickinson

Barbara and Jane worked together as student/faculty in the online MS in Diabetes Education and Management program at Teachers College, Columbia University. Hope was a common thread throughout Barbara’s work in the program, and the conversation continues:

JKD: How did you get interested in hope?

BJM: My introduction to the concept of hope in health care was through a book recommendation: The Anatomy of Hope: How People Prevail in the Face of Illness by Jerome Groopman. In the context of nursing, I have always believed in health equity and striving for the best possible care for all people. To achieve this, hope is the underlying and fundamental driver. To keep keeping on, to advocate, to fight for the best possibilities, one must believe in and have hope for a better future. As nurses, and fellow humans on a journey together, we have the ability and responsibility to identify and foster hope in ourselves and others in need, in our care and as we are able.

JKD: Where do you see hope in nursing? Where is it lacking?

BJM: Hope is everywhere in nursing. Nurses work with the fundamental belief that we will and can make things better. We continue to get up and go to make things better everywhere at all times. We use a process of critical thinking and decision-making to create that better future for people. Hope is the foundation of this process. We are continually thinking about and creating ways to make things better for the people we are fortunate enough to encounter and for whom we provide care. Hope is woven into the fabric of nursing, and yet, ironically, it is not necessarily identifiable, quantifiable, or systematically measured or fostered as an essential component of care. Hope is fostered through strengths-based, rather than deficit-based, models and systems in health care, and we have work to do to achieve that. What if we began with identifying what is going well and what is working, particularly in non-acute care? What if we had an assessment where we asked how hopeful someone is about their health, and what gives them the greatest hope?

JKD: How does hope have an impact on health outcomes?

BJM: I believe that hope is a pilot light in each of us that is always there, even in the darkest times. If hope is identified and fostered, there is the potential for people to rise up and have the will and energy to move toward a desired future. This is true for both the person receiving care and the nurse. Hope is sustained through incremental progression toward the goal and desired future. When people experience success associated with their efforts, they are inspired, empowered and more hopeful about their future. Success and movement toward results, such as blood glucose levels in the goal range, create energy for continuing the momentum toward the desired future. When hope is fostered, health outcomes are positively influenced and people tend to feel more empowered in their self-management and self-advocacy.

JKD: What connections exist between hope and nursing knowledge?

BJM: It is likely that there is an element of hope in all nursing theories, whether named as such or otherwise. Gottlieb’s philosophy of strengths-based nursing is an approach that embodies hope along with empowerment and self-efficacy and their relationships with achieving desired outcomes (Gottlieb, 2014). As inherent as hope is in all aspects of nursing, it is both surprising and disappointing that there is not a formalized mechanism for identifying and fostering hope to systematically advance health outcomes. While hope is specifically mentioned in the works of Weidenbach, Travelbee, and Kolcaba, almost every nursing theory and theoretical/conceptual model appears to be addressing hope in some way.

JKD: What else would you like to tell us about hope and nursing?

BJM: When I asked a leading mental health specialist about scales to measure hope in diabetes self-management, much like the tools used for assessment of depression and diabetes distress, he replied that to his knowledge there are none. Pausing to think about why that is, I wonder if the effort has been placed on what hope is rather than assuming that it is, and strategizing to identify and foster hope. What if we assume that hope exists within everyone, and find ways to foster it in conjunction with evidence-informed best practice to ensure movement toward the desired future? One thing that stuck in my head in the conversation with the mental health specialist was what he said about assessments in general, such as a depression instrument: “whatever you are looking for, you will find.” If we are looking for depression through use of a depression scale, we will find it. So let’s create a measure to find hope and then foster it.

Even in our current reality, I believe that hope is abundant. We pin our hopes on our everyday approaches, and in the potential of the future. There is hope in science for understanding the coronavirus and immunity to it. There is hope in understanding more about how we need to become informed and examine our thoughts and actions about addressing inadequacies and achieving health equity for all. There is hope for humanity to come together to make a better future, and in this nurses and nursing leadership play a fundamental role. By being hopeful we can find a way to optimize nursing practice in the interest of the public. There is hope as we strive for this optimization in this International Year of the Nurse and Midwife. Could there be a more significant challenge and call to action for nurses than what we are currently facing in 2020? I am hopeful that nurses can come together, rise to the challenge, and be the change we are looking for. Let’s be hopeful and lead a path which inspires hope in others as we create a great movement toward health equity.

Reference

Gottlieb, L.N. (2014). Strengths-Based Nursing. American Journal of Nursing,  114(8), 24-32. doi: 10.1097/01.NAJ.0000453039.70629.e2

About the contributors

Barbara J. MacDonald, RN, BSN, MS-DEDM CDE is a diabetes consultant and co-founder of IDEA | Inspiring Diabetes Empowerment Associates, as well as practice advisor for Saskatchewan’s nursing regulatory body. She is a 2017 graduate of the Master of Science, Diabetes Education and Management, Teachers College Columbia University and is completely hopeful about our collective power to shift the health care experience and outcomes for all, particularly those who are most overlooked.

 

Jane K. Dickinson, RN, PhD, CDCES is a Nursology.net blogger and is the Program Director and Faculty for the solely online and asynchronous Master of Science in Diabetes Education and Management at Teachers College Columbia University. Jane’s research, publications, and speaking focus on the language in diabetes and the need to impart hope through our messages to and about people living with diabetes.

Beyond the Boxes: Connecting Theory and Practice in a Pandemic

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

See also related Education Exemplar

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

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

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

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

A Healthier Linear Template

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

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

Merging two paradigms, Step one

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

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

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

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

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

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

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

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

Merging two paradigms Step 2

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

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

Merging two paradigms Step 3

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

 

Ellen Swanson

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

Never a Guardian: Remembering Breonna Taylor

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

Artwork used with permission of the artist Ariel Sinha

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

Guest author: Katunzi Mutalemwa
with Rosemary Eustace

see also Practice Exemplar
Self-Care Theory in Tanzania

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

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

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

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

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

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

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

Suggested Readings

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

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

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

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

About Katunzi Mutalemwa

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