What If? Random Thoughts of Sleepers Awake

With apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake these are my random thoughts of “What If?” about our discipline while I was a sleeper awake one very early morning.

  • What if Florence Nightingale (circa 1859) founded modern nursology (rather than nursing), titled her book, Nursology: What it is and What it is not, and established the first college/school/department/program of nursology to prepare nursologists?
  • What if we referred to ourselves as nursologists, rather than nurses or advanced practice nurses or nurse practitioners or even “practitioners of nursing” (Orem & Taylor, 1986, p. 39)?
  • What if Dock and Stewart (1938) wrote A Short History of Nursology (instead of A Short History of Nursing)?
  • What if our conceptual models originally were called paradigms, as these abstract and general “horizon[s] of expectation” (Popper, 1965, p. 47) for disciplinary activities are called in other disciplines?
  • What if health was widely regarded as encompassing wellness, illness, and disease, so that wellness would be promoted, and illness and disease would be prevented, rather than health being promoted (who would want to promote illness and disease)?
  • What if NANDA-I was NATA, such that D = Diagnosis were replaced with T = Trophicognosis, which Levine (1966) used as the label for judgments stemming from assessments of each patient’s health (wellness, illness, disease) condition?

Inspired by these possibilities, I asked my Nursology.net management team colleagues to also share their “sleepers awake” inspirations!

Peggy L. Chinn

  • What if all healthcare providers (regardless of discipline) were to base their interactions with patients on nursology fundamental principles and values? If we did this, there would be no computer screens in the room where the interactions take place, or at least they would be way off in the corner and ignored until a basic relationship was established. Every person in the room would be acknowledged, there would be lots of eye contact, and a focus on hearing and listening. That would be for starters!
  • What if there were nursology think tanks happening regularly and often all over the world?
  • What if all undergraduate students had a “Nursology 101” course?
  • What if all current nurses were required to have a continuing education “Nursology 101” course to maintain licensure?
  • What if the accreditation criteria for all nursing programs at all levels addressed the nature of the focus of the discipline in the structure of the curriculum?

Margaret Dexheimer Pharris

  • What if the National Institute for Nursing Research (NINR) only funded proposals based on nursology and contributing to nursology?
    • Jacqueline Fawcett: Following from Dr. Pharris’ question, What if NINR was called the National Institute of Nursology (NIN) or the National Nursology Institute (NNI)?
  • What if there was a nursologist in every community who could know and attend to people across care settings (community, hospital, homeless shelter, long-term care. etc.)? The nursologist–rooted in nursology’s patterns of knowing–would truly know and care for each person and the people who are important to that person, and would collaborate with other nursologists and other healthcare providers within each setting to ensure that the person’s sense of health is honored and nurtured.

Danny Willis

  • What if nursologists always clearly communicated the value added by our knowledge and presence?

Rosemary William Eustace

  • What if all nursologists worldwide are made aware of the impact of nursology on our diverse roles, specialties, training and contributions in meeting overall health outcomes and challenges as part of the 21st century (so-called) nursing campaigns?
  • What if nursologists claim that meaningful healthcare transitions, mutual goal attainments and positive client outcomes would not be possible without the nursologist–client interactions as a vital step to quality health care, such as in keeping with King’s (1992) Theory of Goals Attainment? (See https://nursology.net/nurse-theorists-and-their-work/kings-conceptual-system/)

Marian Turkel

  • What if there was another curriculum revolution and nursologists would have a curriculum focused on nursing as a human science/caring science? For academics this would mean letting go of sacred cows to advance nursing knowledge focused on caring, ethics, health as expanding consciousness, meaning, patterning, presence, and relationships.
  • What if the curriculum for nursologists moved beyond the traditional patterns of knowing (aesthetic, empirical, ethical, and personal (Carper, 1978) to include intuitive, mystical, and spiritual patterns of knowing
    • Jacqueline Fawcett
      Following from Marian Turkel’s second question, readers of this blog may want to read a recently published paper about spirituality as another pattern of knowing (Willis & Leone-Sheehan, 2019). In addition, White (1995) identified sociopolitical knowing as another pattern of knowing. Since that time, Chinn and Kramer (2019) have identified and refined the meaning of emancipatory knowing as still another pattern of knowing. And lest we forget, Munhall (1973) wrote about unknowing as a pattern of knowing, “as a condition of openness” whereas knowing “leads to a form of confidence that has inherent in it a state of closure” (p. 125).

Marlaine Smith

  • What if Nursology 101 was offered for students, or better yet, required for all students enrolled in a university? The course would focus on an introduction to phenomena such as human wholeness, human-environment-health relationships, the nature of health, healing, well-being/becoming, and caring in the human health experience.

In closing, we invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “What Ifs?”

References

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23.

Chinn, P. L., & Kramer, M. K. (2019). Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO: Elsevier Mosby.

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

King, I. M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5, 19–26.

Levine, M. E. (1966)Trophicognosis: An alternative to nursing diagnosis. In American Nurses’ Association Regional Clinical Conference (Vol. 2, pp. 55–70). New York: American Nurses’ Association.

Munhall, P. L. (1973). ‘Unknowing’: Toward another pattern of knowing in nursing. Nursing Outlook, 41, 125-128.

Orem, D. E., & Taylor, S. G. (1986). Orem’s general theory of nursing. In P. Winstead-Fry (Ed.), Case studies in nursing theory (pp. 37–71). New York: National League for Nursing.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86.

Willis, D. G., & Leone-Sheehan, D. M. (2019). Spiritual knowing: Another pattern of knowing in the discipline. Advances in Nursing Science, 42, 58–68. https://doi.org/10.1097/ANS.0000000000000236

 

Ann C. Wolbert Burgess, RN, APRN, FAAN

Guardians of the Discipline
Boston College web page

Dr. Burgess is perhaps best known for her scholarly work about and guiding practice of forensic nursing. She and Lynda Lytle Holmstrom, a sociologist at Boston College, described rape trauma syndrome and founded the first rape crisis counseling program at Boston City Hospital (now Boston University Medical Center). Dr. Burgess played a major role in developing the Federal Bureau of Investigation’s (FBI) Behavioral Science Unit, which focuses on profiling serial killers and other criminals. She also has provided exemplary testimony at trials for sexual assault, murder, and other criminal acts. She is the author or co-author or editor of many, many journal articles, book chapters, and books. In addition, she is the co-developer of the Comprehensive Sexual Assault Assessment Tool (CSAAT), which is based on Roy’s Adaptation Model. Collectively, this work has placed nursing in the forefront of assessment, treatment, and prosecution of many forensic matters.

Dr. Burgess received her baccalaureate and Doctor of Nursing Science degrees from Boston University, and her master’s degree from the University of Maryland. She holds an honorary Doctor of Humane Letters from the University of San Diego.

Dr. Burgess has held faculty appointments at Boston University, Boston College, and the University of Pennsylvania. She developed and taught a graduate program course in forensic nursing, first at the University of Pennsylvania and currently at Boston College.

Dr. Burgess’ major contributions as a Guardian of our Discipline have been widely recognized. She has received many awards, including American Academy of Nursing Living Legend, the inaugural Ann Burgess Forensic Nursing Award by the International Association of Forensic Nurses, the Sigma Theta Tau International Audrey Hepburn Award, the Sigma Theta Tau International Episteme Laureate Award, and the American Nurses Association Hildegard Peplau Award.

Dr. Burgess’ work with the FBI has been portrayed by a character in the television program, Mindhunters. Many years ago, during some of the time that Dr. Burgess was at the University of Pennsylvania School of Nursing, she shared a group faculty house with other nursing faculty colleagues. We often shared dinner and discussed cases about which Ann was providing consultation for the FBI. We would then refer to her as “Annie and the G-Men.” Imagine our surprise when a television program (many years before Mindhunters) soon appeared with a character named Annie, a psychiatric nurse just as Ann is, whose role was consultation with the FBI Behavioral Science Unit!

Portions of this blog were adapted from https://en.wikipedia.org/wiki/Ann_Burgess

The problem with the 5-10 year “rule” for citations

Recently I have encountered more and more students who tell me that their advisors are indicating that all of their citations be within the past 10 years – preferably the past 5.  This is one of many damaging myths about scholarship and writing that I encounter (the other most common is to never use personal pronouns – wrong – see “Finding Your Voice“).  I am not sure where the notion comes from that citations must be limited to only the most recent, but in nursing in particular, this is especially damaging to the development of our discipline.  Of course as scholars we all want to know that an author has thoroughly investigated the very latest writings related to their topic, and the fact is that by the time a work is published in a journal or book, any literature cited is already fading into the distant past.  So of course currency is vital, but today becomes yesterday very fast!

The problem is that only indicating the most recent background renders any work void of the context, the roots, the historical perspectives that bestow wisdom and understanding. The work becomes sterile and relatively meaningless, regardless of how valuable it might be for the present. In a particular journal article, with limited space, obviously an author has to make difficult choices about what to include, and it might not be possible to explain the rich background that informs their work.  Nevertheless, if that background has been developed, the work will reflect that understanding, and the content, even the list of references, will include hints about the context and the history that informs today’s ideas.  What better “place” for emerging scholars to explore the rich  connections between works from years gone by than in their student experiences!

Ignoring, or encouraging students to overlook the important works of the past is one factor that has led us to a point in time when past nursing scholarship has been more and more neglected.  Theories and philosophies in the discipline place current work within the disciplinary context.  If students are required to only consider works published in the past 5 to 10 years, they will miss the rich foundations that place their work within the the discipline.  Theoretical ideas, at the same time, are not static, nor are they meant to be.  There is an evolution over time, and current work that is situated within a theoretical and philosophic tradition contributes to that development.  The work becomes significant for the discipline as a whole, not simply significant to the topic of the specific inquiry.  To achieve participating in this “lineage” the early works must be acknowledged, and the lineage laid out, even if in very abbreviated form.

Overlooking the disciplinary context within which a work is developed leaves the author vulnerable to shifting into another disciplinary perspective, and struggling to find meaning with the context of nursing’s most important contributions to the discipline.  Take for example the recent popularity of using “self-efficacy” theory in nursing.  Taken alone, this theory is not unlike nursing’s own “self-care” theories, but bereft of acknowledging the evolution, criticisms and challenges to “self-care” in nursing, works based on this theory perpetuate the relatively limited perspectives inherent in “self-efficacy” (or “self-care.” (I might note that these theories are “older” than 5-10 years!)

To me, the missing “nursology” pieces here are the vital importance of relationship between those cared for and those providing the care, and the social context, the “social determinants.” Without a more complete nursology perspective, these fade into the background, even into oblivion.  I am reminded of the notable work by Joanne Hess in her dialectic critique of the notion of “compliance.”  (Hess, J. D. (1996). The Ethics of Compliance: A Dialectic. ANS. Advances in nursing science, 19, 18–27.).  Any work in nursing that deals with self-efficacy or self-care must, in my view, address these fundamental nursology perspectives.  Hess’s work addresses the nature of the relationship between the one who is expected to “comply” (often a self-efficacy or self-care “task”) and the one prescribing the desired compliance. Scholars bear a responsibility to dig deep into this kind of foundational literature – even looking in nooks and crannies that might, at first glance seem tangential.

I welcome your comments and responses to this!  I know I am taking a rather strident position on this – so maybe voices from other sides of the issue, or more moderate voices can contribute to our understanding!  Please share yours!

 

Reflections on the 6th National Nursing Ethics Conference

by Guest Blogger Darcy Copeland

See Conference details page

Ethics of Caring ®– the 6th National Nursing Ethics Conference was held at the University of California, Los Angeles March 21-22.  The theme of this year’s conference was Vulnerability and Presence:  An invitation to explore the intersection of vulnerability and the power of presence.  The two days were packed with keynote, plenary, breakout sessions and case discussions.

Joan Liaschenko

Joan Liaschenko delivered the opening keynote session: “The Moral Work of Nursing, Vulnerability, and Moral Community.”  The moral work of nursing involves acting for patients, helping patients have a life, and advocacy and relationship with others is the vehicle for nursing, our instrument.  Attendees were challenged to transform our work environments into moral communities. We are all vulnerable to the actions of others.  Nursing has a very important role in healthcare and we must hold others accountable to take our concerns seriously because our part is just as important as any other.

Denise Dudzinski then led a discussion, “Tackling Moral Distress with the Moral Distress Map”.  Nurses are susceptible to moral distress in part because of our strong commitment to the wellbeing of others.  We have a heightened sense of moral responsibility – and in general, we have more responsibility in our work than we do authority.  Our moral responsibility coming into contact with powerlessness can result in moral distress.  A challenging situation an audience member experienced was used to walk through the steps of a moral map:  identifying emotions, sources, constraints, conflicting responsibilities, possible actions, and final action.

Amy Haddad

Amy Haddad, a Hastings Center Fellow, described the poetry of witness and confessional writing in her closing, “Can You Describe This? Bearing Witness to Vulnerability”.  In sharing some of her own poetry she illustrated what is means to bear witness to the suffering of others.  Powerful examples of vulnerability from the perspectives of patients and providers were read, and felt, through the medium of poetry.

Kathy Brown-Saltzman led a discussion with Marsha Fowler who described her love affair with the ANA Code of Ethics.  She shared her personal journey to her ethics and spirituality work in nursing and inspired us all to envision the Code of Ethics as a document capable of guiding us in virtually any situation in which we find ourselves.

Jay Baruch, an assistant professor of medicine and author, described caring for others as caring for their stories during “Can We Write a Better Story for Ourselves”.  He embodied the conference’s vulnerability theme by sharing excerpts from some of his own, unpublished stories.

Daniel Goldberg

Daniel Goldberg, a historian and public health ethicist, connected the dots between stigma and vulnerability with “Vulnerability, Ethics, and Nursing:  Considering Health Stigma”.  Stigmatization results in certain groups of people experiencing worse morbidity and mortality outcomes when compared to groups who are not stigmatized. It is antithetical to our professional values.  Despite these both being the case, stigmatization of patient groups by providers is common.  The complexity of this structural/social phenomenon was discussed.

In between these phenomenal presentations were two case based small group discussions and a variety of break-out sessions focused on moral distress, vulnerability, stigma, healthcare ethics consultation, and the power and uses of stories and poetry.

Thank you to all members of the planning committee for putting together a truly remarkable conference.

Reflections on Case Western Reserve “Nursing Theory: A 50 Year Perspective Past and Future”

Download conference program
Download Chinn keynote
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On March 21-22, 2019, about 120 nurse scholars gathered in Cleveland, Ohio to celebrate 50 years since the earliest nursing theory conferences were held at Case Western Reserve and the University of Colorado.  (see 1967, 1968 and 1969 details). I believe this vibrant conference will be recognized as another landmark event in the history of nursing, a time when we renewed our appreciation of our core nursology ideas, ideals, mission and purposes, a time when we envisioned new possibilities, and a time when we launched significant initiatives to bring our values into action. The many doctoral students who attended, and who presented their work, speak to the significance of this event for the future.

We will be posting many of the presentations on the Nursology.net page for this conference as soon as they become available!

Here are reflections from a few of our nursology.net management team members who were there!

Leslie Nicoll –
It was a great conference overall–I am glad I went and had the opportunity to present. It was wonderful being with “like minded” folks and having the chance to spend two days thinking about nursing theory, science, and knowledge. I haven’t done that for awhile and it was a good exercise for my brain!
Looking around the room, certainly we skewed older, but I was encouraged by the younger people–doctoral students–and their enthusiasm. I think we definitely need to think about how we “pass the baton” from us oldsters to those who will be carrying on this work. This did get mentioned in the closing discussion but I think we need to be explicit and supportive. As many noted, nursing theory can get pushed aside or taken out of nursing curricula and that is not a good thing, since it underpins all of what we think and do.
One other thought–I was struck by how much Cleveland has changed, and in a good way! I am a CWRU alum from the mid-1980s. Although I didn’t spend a lot of time on campus/in Cleveland since I was a long-distance, summer student, my impression at the time was that Cleveland was definitely a city that was experiencing a very rough patch in its history. It’s nice to see the positive changes–the city looks much more vibrant, is cleaner, and feels safer. I would enjoy going back for another conference and have more time to look around!
Dorothy Jones –

Comments from students and others attending the Theory Conference.

This was a conference to enjoy…it resonated with what I believe nursing knowledge brings to patients, families and communities and reinforces in me that ‘ this is the work I want to do to move the discipline forward”,

This work is my passion, meetings like this reinforces the fact that others think so to.

“The work done to promote the Nursology site as well as the amazing discussions at this meeting reflect a wealth of nursing knowledge yet to be explored and expanded”.

as one student described the meeting…”you are my hero’s … what I read about… what I believe and value.”

Hearing the voices of nursologists … reinforces my dedication to nursing knowledge development. “You must keep these meetings going”.

“It was wonderful, exciting and inspiring meeting”.

Jacqueline Fawcett –

The conference was filled with exceedingly stimulating papers and discussions by “stars” and “rising stars” of nursology.  My “take away” from Peggy Chinn’s keynote address is that we DO have a focus for the discipline of nursology, although the specific focus varies. This message propels us into the future, where ALL nursologists will clearly articulate the disciplinary focus of their choice and progress to much more explicit theory development, with the understanding that the research findings = theory and theory = evidence for practice.

Danny Willis –

The 50th Anniversary for Nursing Theory at Case Western Reserve University was an excellent conference bringing together the past, present, and future!! Powerful and relevant messages were delivered by all the presenters throughout the two days. However, in this blog, I will focus only on the opening panel presentation and keynote. One of the most inspiring overarching messages coming out of the conference was delivered in the keynote address by Dr. Peggy Chinn when she indicated that we in the discipline and profession of nursing (Nursology) do have a clear focus and identity that we are communicating widely to the world. She gave more than one example of how this is occurring. This and other messages about the central themes clarifying the discipline were timely and significant. Dr. Marlaine Smith clarified central themes of the discipline from an historical view/analysis of the literature on the focus of the discipline to identify human wholeness, health/healing/wellbeing, human-environment-health relationship, and caring.  Dr. Callista Roy promoted the central unifying focus statement of Willis, Grace, & Roy (2008) namely, facilitating humanization, meaning, choice, quality of life and healing in living and dying as the overarching goals for knowledge/theory development.  Dr. Joyce Fitzpatrick and Dr. Mary Jane Smith clarified the unitary transformative perspective of person-environment-health process; and Dr. Pamela Reed advanced a philosophical perspective (Intermodernism) for the development of scientific theory. The convergence of ideas was clarifying and powerful and still provided space for future developments. I walked away from the conference inspired to continue writing and researching and with a healthy hope for the future of nursing. It was a pleasure to interact with students from various programs and to see their lights shine when discussing the future of theory in the discipline! We must continue this work and have biennial events in which we bring together all the best of our thinkers to advance theory with all of its worth to humankind.

Margaret Dexheimer-Pharris –

Underneath the umbrella of Danny Willis’s overview of the keynotes, I would like to bring in a few highlights from just a few of the 66 stellar breakout sessions. Marry Antonelli cautioned that the “mismeasure” of the significance of nursing knowledge blurs the unique contribution nursing brings to interdisciplinary collaboration. Pamela Grace called for nursing faculty to steep themselves in nursing theory lest they be coopted; Grace proposed a definition of nursing science that resolves the question of whether nursing science is a basic or applied science (to be published in a forthcoming issue of Nursing Philosophy). Helen Erickson, Elizabeth Cunniff and colleagues, and Debra Hanna addressed various aspects of designing and delivering nursing curricula steeped in nursing theory. Leslie Nicoll awoke the audience at the end of the day with research findings on how often nurse scholars cite the work of other nurse scholars. We all left that presentation with a new sensitivity to and passion for uplifting the knowledge of the discipline. Finally, Brandon Brown from the University of Vermont gave a riveting presentation on “The Convergence of Indigenous Knowledge, Ecology, and Nursing Theory,” calling us to use an Indigenous lens to more fully envision nursing’s responsibility to all living beings, nature, and our entire environment. I came away from this conference with a renewed spirit and a sense of resurgence, convergence, and urgency. It is obvious that nurses and nursing students around the world are eager to articulate and embrace nursing knowledge—there is a resurgence. We are finding ways to come together to advance the knowledge of the discipline—there is a convergence. Finally, we are realizing that the earth and all her inhabitants need an expanded commitment of nurse caring—there is an urgency.

Marian Turkel –

Peggy thank you for your profound commitment to Nursology and the Nursology website. Danny thank you for starting the Nursology discussion thread. Your thoughts are prolific and visionary and will advance the future of Nursology . For me the conference was intellectually stimulating and the presentations from the Nursologists  in attendance will continue to advance disciplinary specific Nursology knowledge. Being at the conference affirmed for me the importance of advancing nursing theory in education, practice and research and sharing the Nursology website more intentionally with students and colleagues. I am proud to call my self a Nursologist.

Jane Flanagan –
As Danny and Jacqui said, this was a wonderful conference during which many ideas were shared and great conversations were had. It was stimulating and I feel honored to have been a part of it. My takeaway in addition to what has already been said is that nursing theory is alive and well! As we individually and collectively move our work forward, grounded in nursing theory, this will become clear to all those who now wander not yet fully knowing of nursology!
See more photos here

Opening session speakers (L to R) Joyce Fitzpatrick, Peggy Chinn, Mary Jane Smith, Marlaine Smith, Callista Roy, Pamela Reed

Opening panel: Pamela Reed speaking. Seated: Joyce Fitzpatrick, Mary Jane Smith, Marlaine Smith, Callista Roy

Mary Antonelli breakout session.

Rosemary Eustace breakout session

PhD student Beth Cunniff with Peggy Chinn

Dorothy Jones presenting, Jane Flanagan seated.

Nursology cookies contributed by Christina Nyirati (prepared by Christina’s daughter)

Jane Flanagan, Pam Grace, Dorothy (Dotty) Jones, Danny Willis, Cathy Cuchetti, Sister Callista Roy, Mary Antonelli, Jane Hopkins Walsh ~~Boston College past and present

L-R Jane Hopkins-Walsh, Brandon Brown, Peggy Chinn, Jessica Dillard-Wright, Christina Nyirati

Rozella May Schlotfeldt, RN, PhD, FAAN (1914-2005)

Guardian of the Discipline
Nursology author Leslie Nicoll
Guest contributor: Elizabeth R. Berrey

Rozella M. Schlotfeldt (photo credit)

Rozella Schlotfeldt was among the great leaders in nursing in the years when nursing education was first shifting away from hospitals and becoming established in universities.  Students were educated for entry into the nursing profession and graduate programs were established to prepare them to take on roles as leaders in practice and as scientists equipped to advance nursing knowledge through research and theory development.

This week, nurse scholars are gathered at the Frances Payne Bolton (FPB) School of Nursing at Case Western Reserve in Cleveland, OH, to recognize the earliest conferences dedicated to the development of nursing theory. Held one-half century ago, in 1967, 1968 and 1969, these landmark conferences were recognized with the publication of the proceedings in Nursing Research (see volume 17, issue 3; volume 17, issue 6; and volume 18, issue 5). The first symposium, held October 7, 1967, was the third in the series of conferences held at FPB but the first on theory development. Rozella Schlotfeldt was the Dean of the School at the time; regarding the conference, she noted, “Publication of the proceedings was sought with a view toward assisting in promoting discussion and debate among nursing’s intellectuals,” (Schlotfeldt, 1986, p. 98). Lucille Notter, then Editor of Nursing Research, commented in 1986, “I had the pleasure of being invited to attend this symposium…I was most enthusiastic about the papers given. Now, in retrospect, the symposium has proved to be a landmark in nursing…The decision to publish the symposium proceedings was a good one. Students…often use these papers in their quest for understanding the meaning of nursing theory and how nursing theory evolves,” (Notter, 1986, p. 97).

Rozella Schlotfeldt served as Dean at FBP from 1960-1972 and continued as a Professor until her retirement in 1982. Even after that, she continued to be active on the international, national, and local levels. I (Leslie) was fortunate to have Rozella serve as a member of my dissertation committee in the mid-1980s. She provided the leadership and vision to establish the PhD program at FPB in 1972, the third PhD program in nursing at that time.

Like any doctoral student, I was a little intimidated to have her as a committee member–she was invited at the request of my chair–but once I got to know Rozella, I appreciated her kindness, insight, intelligence, and warmth. Every doctoral student has “pearls” that they pick up through their studies; one pearl from Rozella was that “time has no points.” Never write, “At this point in time,” she said, “Just say, ‘At this time.’” I think of her practically every time I sit down to write something and remember the pointless time in which we exist! She also taught me how to always remember the difference between affect and effect: “Affect is to influence; effect is to bring about.” See the quote further on which uses “effect”–pure Rozella, and perfectly used.

Elizabeth R. Berrey’s doctoral dissertation was a feminist critical hermeneutic study to identify the themes and patterns in Rozella’s life that informed her thinking about nursing. Using oral history as a tool, Rozella’s remarkable life was documented, along with the unprecedented vision that Rozella brought to the development of the discipline of nursing.  Elizabeth and I were in the same PhD cohort at FPB; she provided the following summary of her work, focusing on those dimensions that exemplify Rozella as a “guardian of our discipline.”

In 1918, when Rozella Schlotfeldt was 4 years old, the Great Flu Epidemic claimed her father’s life. Her mother, along with Rozella and her younger sister, were spared. Her mother immediately went to work as a nurse to support her family. She impressed Rozella with her creativity and innovation in caring for her patients, greatly influencing Rozella’s choice of profession. “From an early age, no doubt about it, I determined to be a nurse!” The household in which she grew up was characterized by practicality, hard work, and doing that which needed to be done, as well as busyness, energy, and vigor. These generative themes and patterns of her life are reflected in, and affected, her thinking about nursing.

Rozella received her BSN in 1935 (in a time when that was uncommon) from the University of Iowa. She served in the Army in the European Theater during WWII, then earned her MS in Nursing Education/Administration in 1947 from the University of Chicago. In her words, “I already had a notion of being influential and not let anything encroach upon that.” She said, “I suppose that translates itself into mapping out what you do with your personal life, as well. She speculated that getting married to a man “would have stood in the way” and “I would have been bored to death …. maybe I was 30 years ahead of my time so far as independence of women.”

Rozella took a leave of absence from Wayne State University, where she was Professor and Associate Dean for Research, to earn her doctorate in 1956 from the University of Chicago in Education and Curriculum Development. While at Wayne State, she “was bitten with the research bug and did all kinds of research… we really got the [nursing] faculty going for research while I was there.” While at the University of Chicago, Rozella met Rosemary Ellis. Hallmarks of their friendship were their “mutual respect for and admiration for one another, their love of and commitment to nursing, and their readiness to share their best critical thinking for advancing nursing knowledge.” When Dr. Schlotfeldt, came to Case Western Reserve University (CWRU) as the Dean at FPB, she recruited Dr. Ellis to the faculty.

It was at CWRU that Dr. Schlotfeldt made what she considered her most significant contributions to nursing: the “collaboration model” between the faculty of the school of nursing and University Hospitals; her paradigm of nursing–to attain, retain, and regain health; and the Nursing Doctorate (ND) in which she was “shifting the emphasis from learning how to do, to learning how to know.” As she liked to say, “Nothing like knowledge!” With these aforementioned innovations, and her leadership locally, nationally, and internationally, Rozella Schlotfeldt changed forever the face of nursing, first in Cleveland and, as her ideas reverberated more widely, throughout the world. During her tenure as Dean, amongst several boards and commissions on which she served, she was a co-founder of the Midwest Nursing Research Society, held leadership roles in both Sigma Theta Tau and the International Council of Nurses, and was the first nurse member of the Council & Executive Committee of the Institute of Medicine.

In Safier’s 1977 publication, Rozella was named as “one of nursing’s most original thinkers” and as “an educator with innovative, progressive and sometimes startling concepts of education for nurse[s]” (p. 338). Rozella loved this! After her retirement from the deanship, she remained highly sought after for her intelligence, wit, creativity, and sheer clarity about, as she often said, “nursing qua nursing.” (Once she said to me with a chuckle, “I know exactly what nursing is! And if they’d just ask me, I’d tell them!”). And while Rozella wanted to be influential, she worried that she should not be seen as an exemplar of nursing excellence, some so-called ideal, whom all nurses should emulate. Rozella was simply and uniquely herself, a woman who was passionate about our discipline and, as she said, “I just think there is nobody more passionately involved in having nursing move toward what it could become. I always say, ‘what it could become,’ because it’s not there yet.” Rozella’s sights were set on nursing as a combination of her mother’s example, her liberalizing, research-oriented undergraduate education, and her own competitive ambition that helped her to emerge with a vision of herself in nursing. “Vision of herself in nursing” is a purposeful statement, for there exists little separation of her vision of nursing from her vision of herself in nursing.

In her first published article in 1949, addressing the nursing care component of educating a patient with the medical diagnosis of TB, she opened with a strong statement that includes nurses as professional members of the healthcare team that are responsible for prevention of communicable disease, based upon “constant scientific study and research… [by these] competent professional workers,” (p. 375). (Note: this flew in the face of the extant practice of nurses employed by hospitals and physicians of the era.) In 1960 she made a point in an article with Safford, that nursing care was defined as care rendered by, or that took place under the direct supervision of, the registered nurse, a clear statement of the autonomy of nursing practice.

During the mid-60s and into the early 70s, Rozella repeatedly called upon nurses to recognize their profession’s rightful role in society and to support that role through increased research, education, and leadership. Examples of her actions include a symposium she held at CWRU, through the Legislative Committee of the Ohio Nurses Association, and through forthright challenges to nurses and legislators to “fulfill their public trust” to enact a mandatory nurse licensure act. She brought her extensive political and social savvy to bear to speak for the profession and the discipline and thereby be recognized for her effectiveness.

In 1969, along with Janetta MacPhail, she published a series of three articles describing the nationally-known and heralded “experiment in nursing,” aka, “the collaboration model.”  The three articles themselves are landmarks for the clarity, care, and specificity with which the new concept was presented to the nursing community. Briefly, the new concept of inter-institutional organization invested the school of nursing with the authority and responsibility for controlling the quality of nursing education, nursing care, and nursing research in the health center.  The heads in the clinical departments were the heads in both practice and education, with 50/50 appointments in each institution. Example: head nurse given the new title: Senior Clinical Nurse to help with the transition. Rather than waiting on physicians or spending all her time charting or ordering supplies, “she spent her time being the authority on nursing.” Here’s another example that Rozella remembered with relish: The medical director of OB/GYN came over to see her at FPB because some physicians’ noses were getting out of joint “due to the sophisticated care being provided by the master’s prepared nurse clinician.”  He demanded that this nurse be fired.  “I said to him, ‘I don’t think you can tell me that. What is your rank?’ He said he was an assistant professor…in the medical school. I said, ‘Well, I happen to be a full professor. I’ll be very happy to listen to what you have to say and then I suggest that you go to your Dean and I’ll talk to your Dean.’”

The following year (1970), tired of medicine’s intrusion into nursing, she wrote an article, an unequivocal assessment of the relationship of nursing and medicine, in response to an AMA Board action, devoid of any appeasing, deference, or gratuitous caveats.  She audaciously defined medicine, concluding that, “the physician’s contacts with patients of necessity are episodic, with each episode of relatively short duration. The primary focus of the physician‘s work is to effect cure.” She further wrote a statement intended to counterbalance, and serve as a contrast to, her definition of medicine, which was purposive in its intention to draw a marked distinction between the practice of medicine and the practice of nursing, concluding with, “Each discipline represents some but not all of the skills needed to keep people well.”

In 1972, determined to “set forth a straightforward and unambiguous conceptualization of nursing in terms of the profession’s goal and the phenomena with which nurses must be concerned,” she stated succinctly and unequivocally, “nursing…is healthcare.” She claimed that “nurses are independent, professional practitioners…the goal of nursing is to attain, retain, and regain health.”

When the American Nurses Association came out with a statement about the Baccalaureate degree being the degree for entry into practice she said, “I even wrote to the ANA President…and said, ‘We already have programs that recognize that nursing is a complex profession and that we should have first professional degrees that are based upon liberalizing education and a strong scientific, humanistic base.’”

Rozella readily gave her successor as Dean, Janetta MacPhail, credit for completion and implementation of the ND, while counting her early work in conceptualizing the ND as one of her own significant contributions to the profession. Due to her dissatisfaction with the amount of knowledge that nursing students had, she “began cooking in my head about the ND…. The result was an educational model designed to give students a solid foundation in nursing’s knowledge base prior to caring for patients: shifting the emphasis from learning how to do to learning how to know.” It was also designed to put nursing parallel with two other major professions, medicine (MD) and law (JD).

Dr. Schlotfeldt’s  papers are archived at the University of Pennsylvania Library.  The collection includes her addresses, articles, and files, reflecting her association with various academic institutions and professional nursing organizations; her personal correspondence, and photographs.

Sources:

Berrey, Elizabeth R. (1987). Researching the lives of eminent women in nursing: Rozella M. Schlotfeldt. Unpublished doctoral dissertation, Frances Payne Bolton School of Nursing, Case Western Reserve University.

Notter, L.E. (1986). The author comments.  In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 97.

Safford, B. J., & Schlotfeldt, R. M. (1960). Nursing service staffing and quality of nursing care. Nursing Research, 9, 149-154.

Safier, G. (1977). Contemporary American leaders in nursing: an oral history.  New York, NY: McGraw-Hill.

Schlotfeldt, R.M. (1949).  Safer ways in nursing to prevent spread of Tubercle Bacilli. National Tuberculosis Association Transactions, 45, 375-377.

Schlotfeldt, R.M. (1970). Nurses and physicians: Professional associates and assistants to patients, Ohio Nurses Review, 45(March), 6-12.

Schlotfeldt, R.M. (1972). This I believe: Nursing is health care, Nursing Outlook, 20(4) 246-246.

Schlotfeldt, R.M. (1986). A colleague comments. In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 98.

Schlotfeldt, R.M., & MacPhail, J. (1969a). Experiment in nursing: Characteristics and rationale, American Journal of Nursing, 69(5), 1018-1023.

Schlotfeldt, R.M., & MacPhail, J. (1969b). Experiment in nursing: Introducing planned change, American Journal of Nursing, 69(6), 1247-1251.

Schlotfeldt, R.M., & MacPhail, J. (1969c). An experiment in nursing: Implementing planned change, American Journal of Nursing, 69(7), 1475-1480.

 

About Guest Contributor Elizabeth R. Berrey, RN, PhD

Now retired, Elizabeth has been a featured speaker at nursing conferences and conventions, focusing on the importance of nurses as agents for change and advocates for better healthcare.  She was the first nurse appointed to the Cleveland MetroHealth Hospital Board of Trustees (1985-1990), the first private practice in nursing in Ohio (1980-1986), and appointed to the Ohio Board of Nursing (1987-1992) as the first clinical nurse specialist to serve on the Board, advocating for nursing autonomy and control of our own practice.  She now lives in New Mexico and remains a leader in the Albuquerque community, focusing on political advocacy on behalf of nurses and nursing.

In describing her relationship with Rozella, Elizabeth says: “. . .  not only did I write my dissertation on the themes & patterns of Rozella Schlotfeldt’s life, I was in her life right up until the end, as her power of attorney for healthcare. So in addition to knowing Rozella since the mid-1970s, as my dean, then Dean Emerita, I spent close to 2 decades with her at the end of her life, spending time at least weekly with her in the last 15 years.”

 

Moral ecology in nursing

by Darcy Copeland, RN, PhD*

Darcy Copeland

I have the good fortune to have two professional roles that compliment one another beautifully. As a hospital based nurse scientist I have focused my research on workforce issues including workplace violence, professional quality of life, moral distress, and the spiritual/emotional elements of providing care. I am a member of the ethics committee and participate in educational and consultation activities. I am also an associate professor of nursing and teach master’s, PhD and DNP level nursing theory courses. My days are literally sometimes spent filling the “theory-practice” gap on both sides of that gap.

One “gap”, maybe dissonance is more accurate, I notice is how messy ethical decision making is in practice compared to how clean it seems in academia. Nursing students spend time learning about the ANA Code of Ethics, written specifically to be both aspirational and normative. The nine provisions articulate values, duties, and ideals that are foundational to our discipline. Most students probably also learn principles of bioethics and research ethics and at least have a cursory understanding of these when entering clinical practice. Nursologists have debated whether or not we should develop our own ethical framework or adopt an existing framework. Personally, I oppose both of those ideas and would advocate for a pluralistic approach to addressing ethical issues in practice.

There is no debating that nurses are moral agents who must make decisions and be held accountable for their actions. Those decisions, however, occur in complex, dynamic (I’ll say messy) environments involving multiple stakeholders whose perspectives often conflict with one another. In the grand scheme of things nurses receive very little formal education related to ethics. In my experience, it is rare for a practicing nurse to justify an ethical decision by articulating anything from the code of ethics or principles of bioethics. The first thing I hear is most often something like, “it felt like the right thing to do.” This response alone would lead me to believe that the decision was based on the person’s individual moral awareness or personal value system. With more dialogue, however, it becomes clear that the nurse’s own moral compass is the starting point for ethical decision-making, not the end point. Nurses may justify their actions because it is what the patient wanted, because people have the right to make their own decisions, because it was the best way to use available resources, because it is wrong to with-hold information, because that is our policy, etc. Any and all of these are acceptable justifications to act in one way instead of another. Each of these justifications can be traced back to an ethical framework, but not the ethical framework of nursing.

It was from these experiences in teaching and applying ethics that I developed a model of moral ecology in nursing (see below). It is based on the social ecological model in which behavior is contextualized and understood as occurring within a web of complex social systems in which the individual is placed. It was developed from the perspective of American nursing, but could be modified to include the ICN code of ethics and eastern philosophy for example. I plan to use this model in my own teaching as a way to introduce students to the messiness of ethical decision making in practice.

An ecological model of ethics in nursing. © 2019 Darcy Copeland

 

Copeland, D. (in press). Moral ecology in nursing: A pluralistic approach. Sage Open Nursing DOI: 10.1177/2377960819833899

  • Darcy Copeland is an associate professor of nursing at the University of Northern Colorado and a nurse scientist at St Anthony Hospital in Lakewood, CO. She has undergraduate degrees in nursing and psychology from the University of Northern Colorado, a master’s degree in forensic nursing from Fitchburg State College in Massachusetts, a PhD in nursing from UCLA, and is pursuing a master’s degree in health humanities and ethics at the University of Colorado. Her clinical background is in mental health and forensic nursing; her research interests involve the psychosocial work environment including issues of workplace violence, moral distress, professional quality of life, and the spiritual effects of caregiving.

Removing/Refusing the Invisibility Cloak

Invisibility cloaks are magical devices that render the wearers invisible

from Inaugural issue of “Revolution: The Journal of Nurse Empowerment,” 1991

and transparent – they simply become part of the background. Furthermore, the wearer of the cloak can see through it and actually be wearing it without being fully conscious of it. Although invisibility cloaks have existed in mythology for centuries, they have recently been brought to public consciousness through the work J.K. Rowlings in the Harry Potter series. But I think they provide a relevant metaphor for what many nurses often experience – instances in which they and/or their contributions to health and healing remain invisible. And, my question is, can a shift to focusing on the nursing knowledge that underpins our practice and making it visible by naming it Nursology, help nurses in general to remove or refuse the cloak of invisibility?

 In my years of nursing experience, whether in practice, education, or research,  I have experienced and witnessed many instances of nursing and nurses, myself included, being rendered invisible. Nurses may themselves put on the cloak of invisibility by using the phrase, “I’m just a nurse” or by undervaluing their work.  A participant in one of my studies recounted an amazing example of capacity building in a group of adolescent girls but described her role in the transformation that took place as not “ much of anything” 1.

From Revolution: The Journal of Nurse Empowerment

 We can also put on the cloak of invisibility by valuing the knowledge of related disciplines more highly than nursing knowledge, such as happens when nurses dismiss nursing conceptual frameworks as irrelevant while, at the same time, consciously or unconsciously using knowledge from other fields to inform or define their nursing practice, either in scope or content 2,3.

 Sometimes the cloak of invisibility is put on us by others. We may or may not be conscious of the cultural and societal cloaks put on those of us who are women. And those of us who “trained” to be nurses in the 1960s will also be able to relate to the cloaks we acquired as deference to physicians was instilled in us.  We can only remove these cloaks by becoming conscious of them.  Public health nurses in my studies provided evidence that such cloaking continues. For example, one nurse told me about being required by their employer not to refer to themselves as nurses or the work they did as care; instead they were to refer to themselves as public health professionals, in the name of interdisciplinarity. 

 These reflections came about because of a conversation I had with a friend and colleague in which I related the following incident.  I was attending, on behalf of a national nursing association and by invitation, a media release of interest to health and other workers involved in in promoting healthy populations. After the release we were invited to attend a luncheon to discuss implications of the report from each of our perspectives. One gentleman present clearly represented a biomedical approach to health and he and I exchanged perspectives that were rather diametrically opposed to one another. After the luncheon he made his way across the room to me and asked me what my PhD was in (we each had place card tents which included our credentials).  I told him “nursing”.  He thought I misunderstood him and repeated the  question and received the same answer.  He replied, “no, I can’t have a PhD in medicine and you can’t have one in nursing.”  I assured him I did.  Exasperated, he asked what my dissertation topic was.  I answered that it was an oral history of public health nursing in Ontario.  “Ahh”, he replied, “that’s the answer! Your PhD is in history!”  With that he left, satisfied that he had set me straight! 

 In relating that incident to my friend, we contemplated, would that have been the case if my PhD was in Nursology?  I think probably not. It might have raised the question, “What is Nursology” which I would have welcomed!  

 

1.    Falk-Rafael A, Betker C. The primacy of relationships: a study of public health nursing practice from a critical caring perspective. Adv Nurs Sci. 2012;35(4):315-332.

2.    Rafael A. From rhetoric to reality: The changing face of public health nursing in southern Ontario. Public Health Nurs. 1999;16(1):50-59.

3.    Rafael AR. Nurses who run with the wolves: the power and caring dialectic revisited. ANS Adv Nurs Sci. 1998;21(1):29-42.

 

Donna Diers, PhD, RN, FAAN (1938 – 2013)*

Guardians of the Discipline

To remember Donna Diers is to bring into clear focus what it means to be a guardian of

Donna Diers

our discipline.  Donna died on February 24, 2013, but her influence on the discipline of nursing remains palpable, even for many who never knew her.  Donna was born on May 11, 1938 – just one day before the May 12th birth date shared by  Florence Nightingale and Martha Rogers.   These three figures – Donna Diers, Martha Rogers and Florence Nightingale shared many traits of creative vision and great leadership – not the least of which was sparking lively controversy that led to great leaps forward in our profession.

Donna Diers aspired to be a journalist before she decided on nursing as a career, then came to realize both as Editor of Image: The Journal of Nursing Scholarship from 1985 to 1993. She assumed her editorship the year after her tenure as Dean of the Yale School of nursing ended (1972-1984). During her deanship, she developed the first Graduate Entry Program for people without an undergraduate degree in nursing, a program that continues to this day leading to entry into speciality practice as an advanced practice nurse.

Donna was a prolific writer – she wrote one of the first nursing research methods texts, and her writing appears in almost all major nursing journals and in many texts. Her talent as a journalist came through vividly in her editorials published in Image – editorials that I anticipated and read eagerly as each issue arrived in my mail.

There is no better tribute to Donna Diers than the 2010 “Living Legend” ceremony when the American Academy of Nursing bestowed this honor on her. Her own remarks at this ceremony bring to life the amazing spark that she brought to the world and reveal the ways in which nursing and journalism came together in her career. She also shares a moving tribute to many others whom she names as significant in her own life. I urge you to take a few moments to dwell with the memory of this remarkable guardian of our discipline – Donna Diers.

* Portions of this post appeared previously on the INANE blog 

Public session of the Committee on the Future of Nursing 2020-2030

The Committee on the Future of Nursing 2020-2030 will be holding a public session onWednesday, March 20, 2019, from 1:30 PM to 4:00 PM ET, online and at the National Academy of Sciences building in Washington, DC.

This committee has been tasked by the Robert Wood Johnson Foundation to extend the vision for the nursing profession into 2030 and to chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.

Through the course of the study, the committee will meet several times. This public session is one of the many processes that the committee will use to gather information and assemble evidence that members will examine and discuss in the course of making the committee’s findings, conclusions, and recommendations. The focus of this public session is for the committee to clarify the scope of the charge with the study sponsor and initiate the process of gathering relevant information related to the study. Future public sessions will focus on specific topic areas and be conducted in other locations.

This public session will be accessible via webinar and in-person attendance (seating is limited).

Please register online by 12pm ET on March 20, 2019, to receive an email with the instructions on how to join this public session.

More information about the study can be found here.

What: Public session of the Committee on the Future of Nursing 2020-2030
When: March 20, 2019, from 1:30pm to 4:00 pm ET
Where: Online and in person at National Academy of Sciences building, 2101 Constitution Avenue, NW, Washington, DC 20418
How: Click here to register online by 12 pm ET on March 20, 2019