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

A dozen (and one) 2019 nursology events!

When we first started building Nursology.net, one of the “sections” that we set out in the plan was a “future events” section.  We all knew of a handful of conferences related to the development of nursing knowledge, but lo and behold – we have now discovered a grand total of twelve!  And there could be more!  If you have not yet browsed the impressive list of conferences, hover over “Future Events” on the main menu, and you can scroll down for an overview that includes locations and dates!

The first event of the year is the 50 Year Perspective conference at Case Western Reserve University in Cleveland, OH, March 21-22, 2019.  This conference will commemorate the very first nursing theory conferences held in 1968 and 1969 that resulted in a number of landmark articles published in Nursing Research – articles that remain a mainstay that launched a widespread effort to develop nursing’s disciplinary knowledge. The focus of the conference will be the disciplinary perspective of nursing, and the structure of nursing knowledge.  Articles in the current issue of Advances in Nursing Science, Volume 42:1 provide a focus that will be a foundation for discussion at the conference – so whether you can attend or not, check out those articles to learn more!

From March on, we have roughly one event every month until the end of the year – occasionally more than one!   Most of these are focused on one particular theoretic or philosophic focus, but are still of general interest for many nursologists!  Many are accepting abstracts, so watch our sidebar “Due Dates” feature to keep up with these opportunities.

The November KING conference is a collaborative conference for everyone, featuring participation from a number of groups focused on the development of nursing knowledge – including:

  • International Association of Human Caring
  • International Caritas Consortium
  • International Consortium of Parse Scholars
  • Neuman Systems Model Trustees Group, Inc.
  • Orem International Society
  • Roy Adaptation Association
  • Society for the Advancement of Modeling and Role Modeling
  • Society of Rogerian Scholars
  • Transcultural Nursing Society
  • Watson Caring Science Institute

Abstracts for this Collaborative conference are not due until May 1st — so consider this great opportunity now!

The (and one) conference is the annual Nursing Journal Editors (INANE) conference in July 30 – August 2 in Reno, Nevada – an event that welcomes all of those interested in and participating in the process of editing and producing nursing literature.  The conference this year features a day-long workshop for new editors and those who want to pursue a journal editing career!

The opportunities abound!  If you cannot participate in person, watch Nursology.net for reports and resources from each of these events!  If you know of an event that we have not yet listed, please let us know!  After each event concludes, we will move the conference “page” to our “history” section and add reports, papers, photos and videos that the conference planners provide for archiving. By keeping an eye on these important resources, you can benefit from being informed of the important outcomes and advances that will be sure to enrich our discipline!

 

Opportunities for Advancing Nursing Knowledge: A Personal Journey of Appreciation

24 years ago while completing the first baccalaureate nursing degree program offered in Tanzania, East Africa at Muhimbili University of Health and Allied Sciences (MUHAS); I sat in a nursing theory class trying to grasp concepts and principles that shape nursing as a professional discipline (i.e. the grand and middle range nursing theories and models). Surprisingly, most of the concepts I learned mirror concepts I have since encountered in my academic career as a graduate student and nurse scholar. For instance, self-care concepts in chronic disease management mirror concepts in Orem’s self-care theory; concepts in interprofessional models mirror concepts in nursing interpersonal and interactional theories (e.g. Imogene King’s theory and Peplau’s theory); Systems thinking concepts mirror concepts in Roy’s conceptual model  and Betty Neumann’s conceptual model; concepts in psychotherapeutic approaches mirror concepts in the nursing humanistic theories (e.g. relational and caring concepts) and concepts in the acculturation theories (e.g. Gordon’s theory, John Berry’s theory) mirror those in Leininger’s cultural care theory. These are just a few examples on how rich nursing theoretical underpinnings play a key role guiding health care actions and outcomes in addition to the medical disease-centered perspective.  In this case, I think we need to strategically revisit the existing models, refine and adapt them to our changing health care environments as well as develop new approaches and educational models that have an impact on health outcomes of interest.

This critical reflective query originates from a quote I read in the 2010 Institute of Medicine Future of Nursing: Focus on Nursing Education Research Brief stating that, “New approaches and educational models must be developed to respond to burgeoning information in the field. For example, fundamental concepts that can be applied across all settings and in different situations need to be taught, rather than requiring rote memorization” (p2). This statement made me think further: Have we adequately synthesized the existing key concepts and principles? Is it time to re-visit the nursing metaparadigm concepts? What new concepts do we need to develop and how can we develop them? Which concepts and principles of the disciplines should we teach in undergraduate vs graduate nursing programs to avoid rote memorization? Are we at risk of re-inventing wheels of nursing knowledge? Have we been instrumental in advancing implementation science to promote “empirical and practical generalizability” of nursing theories and models? 

A memorable photo of the burn patient I cared for in the surgical ward.

Let me flashback on my personal educational and career journey to make the case: I was trained to understand and embrace the art and science of nursing within the realities of closing my own personal knowledge gap on nursing theory (didactic), research and practice.  My first taste of nursing knowledge application and development started when I was assigned to take care of a burn patient for my clinical case study assignment during my medical-surgical clinical rotation. As a BSN prepared student, the ‘why” of what we do as nurses was emphasized.  In this case, the nursing action of “turning and repositioning patients every two hours to prevent pressure sores” opened new insights on my nursing knowledge application beyond just doing a task. I was intrigued by the Braden scale for predicting pressure sores risk developed by Drs. Barbara Braden and Nancy Bergstrom from a conceptual schema that attributed key determinants of pressure ulcers from current evidence–intensity and duration, tissues tolerance of the skin, and supporting structure or pressure (Braden & Bergstrom, 1987). I continued my inquiry by completing my fourth year BSN capstone project on the topic of pressure sores in the medical and surgical population. Moreover, as part of my training, I was introduced to a course on principles of teaching and learning in our curriculum. Nursing students were expected to learn how to write up a philosophy in teaching, practice and research. Learning about philosophy helped me appreciate the importance of nursing values, beliefs, the different ways of knowing and different approaches to nursing education and practice that continue to shape our discipline to this day. I can truly attest to Bruce, Reitz and Lim’s (2014) statement that: “Philosophy is not only understood as relevant but vital to our discipline and professional practice (p. 70).

Completing my Carnegie African Diaspora Fellowship (CADFP) at MUHAS in 2017. Top: Group photo with nursing students and faculty at the MUHAS scientific conference

Later, as part of my graduate studies, I was exposed to concept analysis methods and how to evaluate and apply theories/models to a problem of interest. My graduate education provided me with a great foundation in nursing knowledge grounded within the health promotion and preventive care paradigms at the individual, family, population, community and systems levels of practice (i.e., MS Community/Public Health Clinical Nurse Specialist, MS and PhD in Family Science (focus on Family Life Education and Consultation).  Armed with this knowledge, I was successful in completing a concept analysis paper in my nursing theory class (Eustace & Ilagan, 2010), evaluated the family socio-ecological theory for my family theory class, and applied Berry’s acculturation theory in my doctoral dissertation to study acculturative stress (Eustace, 2007, 2010). Additionally, I learned how to appreciate the difference between conceptualization and operationalization of variables (concepts) across studies and disciplines.

Group photo with nursing students enrolled in the community/public health course. Invited guest lecture to teach concepts and principles of health promotion theories and models.

Overall, this knowledge has been instrumental in my nursing career as a nurse educator and scholar. I continue to learn and try to understand key concepts of interest to further my research agenda in the field of family nursing and how it impacts chronic disease prevention and risk reduction outcomes: “HIV/AIDS family interventions” (Eustace, 2013), “family health nursing intervention” (Eustace, Gray & Curry, 2015),  “male involvement” (Eustace, 2018) and “family nursing” (Eustace, in press). I am currently in the process of conceptualizing a “Family Health Strength-Based Socio-Ecological Model of Breast Cancer in Sub-Saharan Africa” (Eustace, Nyamhanga & Lee, 2018) to guide my international collaborative research agenda. This model is grounded in the theoretical foundations for nursing of families: the Bioecological systems theory (Bronfenbrenner & Lerner, 2004) and Strength based-nursing (SBN) approach (Gottlieb & Gottlieb, 2017).

An inspirational reunion with my undergraduate dean and mentor –a pioneer of the BSN program in Tanzania, Professor Pauline P. Mella, (middle) with her sponsor Dr Eileen Stuart-Shor at the 2016 American Academy of Nursing Conference

Along the way, I must give credit to my professors early on in my nursing career as well as faculty mentors and external reviewers who have inspired me in the utilization of nursing theories and the process of theorizing nursing knowledge. I wish all nursing students today are exposed to these kind of learning and critical reflective discovery opportunities in their undergraduate or graduate studies.  Similarly, I wish junior and mid-level career nurses interested in nursing theories and the process of theorizing nursing knowledge have access to qualified educators and mentors.

Therefore, the following question remains to be answered: As a community of nurse scholars and practitioners, how are we strategic in building our capacity to meet the demands of developing a generation of nurses who will advance nursing knowledge as part of the future of nursing?  We need a well-trained and competent nurse educator and mentor workforce that is capable of offering the next generation of nurses (i.e., LPNs, RNs, DNPs, PhDs) and nursing paraprofessionals (e.g., nursing assistants, community health workers, and traditional attendants) the opportunity to learn and translate nursing knowledge that will impact health outcomes of interest.  For example, a nursing workforce with expertise in theory who will teach nursing theory and serve on dissertation and doctoral project committees, nursing research grant applications and nursing practice committees. If that were to happen, we will need proactive and revolutionary nurse scholars and leaders to lead the way in the areas of nursing education, nursing research, evidence based-practice, and policy-making as part of the future of nursing.

Food for thought: Why don’t we have clear standards to measure how nursing theoretical concepts and principles are integrated into nursing program curricula as part of our accreditation systems, as part of magnets status applications, and as part of nursing research agenda? Will taking this “backward step (to revisit our standards) as a way forward” be asking for too much from our leaders? Should we do this? How should we do this? If we should not do this, why not?  I welcome readers of nursology.net to reflect and share their thoughts on these epistemological issues and practical challenges in the comments section of this blog.

References

Braden, B., & Bergstrom, N. (1987). A conceptual schema for the study of the etiology of pressure sores. Rehabilitation Nursing, 12(1), 8-16.

Bronfenbrenner, U. & Lerner, R. M. (EdS.) (2004). Making human beings human: Biological perspective on human development. Thousand Oaks, CA: Sage Publications.

Bruce, A., Rietze, L., & Lim, A. (2014). Understanding Philosophy in a Nurse’s World: What, Where and Why? Nursing and Health, 2(3), 65-71. doi: 10.13189/nh.2014.020302

Eustace, R.W (in press). Family Nursing. Macmillan Encyclopedia of Families, Marriages, and Intimate Relationships,

Eustace, R.W. (2018) Male Involvement: An Evolving Global Cross-Cultural Concept inFamily-Centered Health Care. NCFR Report, Family Focus: Families and Cultural Intersections, p 4.

Eustace, R. W. (2010). Factors Influencing Acculturative Stress among International Students: From the International Students’ Perspectives. Germany: VDM Verlag Dr. Muller Aktiengesellschaft & Co. KG.

Eustace, R. W. (2007). Factors influencing acculturative stress among international students in the United States (Doctoral dissertation, Kansas State University).

Eustace, R. W. (2013). A discussion of HIV/AIDS family interventions: implications for family‐focused nursing practice. Journal of Advanced Nursing, 69(7), 1660-1672.

Eustace, R.W. (1994). The prevalence of pressure sores in the Medical surgical patients at Muhimbili Medical Center (Undergraduate Research Report). Muhimbili University of Health and Allied Sciences.

Eustace, R.W, Gray, B. & Curry. D. (2015). The meaning of family nursing intervention: what do acute care nurses think? Research and theory for nursing practice, 29(2), 125.

Eustace, R. W., & Ilagan, P. R. (2010). HIV disclosure among HIV positive individuals: a concept analysis. Journal of Advanced Nursing, 66(9), 2094-2103.

Eustace, R. W., Nyamhanga, T. Lee, E. (2018). A Discussion of Social Determinants of Breast Cancer among Women in Tanzania: Advantages, Gaps and Future Directions in Family Scholarship. The 2018 Annual NCFR Conference, San Diego, California, November 7-10, 2018

Gottlieb, L. N., & Gottlieb, B. (2017). Strengths-Based Nursing: A Process for Implementing a Philosophy into Practice. Journal of family nursing, 23(3), 319-340.

Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2010). The future of nursing: Focus on nursing education. Washington, DC: National Academies Press. http://www.nationalacademies.org/hmd/ ~/media/  Files/Report %20Files/2010/The-Future-of-Nursing/Nursing%20Education %202010%20Brief.pdf

Notable Works on “Medicalization” by Beverly Hall and Janet Allan

Note:  we are delighted to introduce a new Nursology.net series featuring notable works exploring concepts and issues that are related to the development of nursing knowledge. As this series evolves, you can see the posts in the series “Notable Works” under the main menu “Series/Collections”

In 1988, Janet Allan and Beverly Hall, both prominent nursology scholars and leaders

Janet Allan

in the discipline, published an article titled “Challenging the focus on technology: A critique of the medical model in a changing health care system.” Drawing on a rich body of literature from nursing and other disciplines, and their own insights as nursing scholars, they called on nurses to examine and challenge the dominant model that derives from a model that views the body as a machine, one that needs to be “fixed” if something goes awry, and the process of disease as an evil force to be obliterated.  They called for nurses to question the reification of

Beverly Hall

this model, and to engage in dialogue to explore alternatives that are derived more directly from the values and goals of nursing. In particular, they pointed to the lack of established efficacy of the model (despite claims to the contrary), the serious unaddressed ethical and iatrogenic questions the model engenders, the harmful effects on health and well-being that derive from the model, and the economic consequences (Allan & Hall, 1988).

In 1996, Hall specifically addressed the challenges of medicalization in undermining nursing approaches to chronic mental illness. In her critique, she discussed the ways in which the disease framework of chronic mental illness creates barriers to understanding the person as a person, and creates an unequal power structure that draws attention away from the personhood of the patient and their experience. Stated succinctly, Hall noted: “Nursing, in its attempt to be scientific, has embraced objective theories and diagnostic schemes that are devoid of practical reasoning that has as its inherent focus humanistic values, personal meanings, and subjective language” (Hall, 1996, p. 24).

In 2003, Hall published another remarkable work that represented a departure from the purely “scientific” approach to show what can emerge from an approach that uses practical reasoning, humanistic values, personal meanings and subjective language in exploring what is recognized as the focus of the discipline of nursing- the human response, the human experience.  In this moving essay Hall draws on her own experience of having a life threatening diagnosis of breast cancer, reflecting on the effects of medicalization on her experience.  As she summarized in the abstract, these effects were “(a) giving useless treatments to keep the patient under medical care; (b) demeaning and undermining efforts at self-determination and self-care; and (c) keeping the patient’s life suspended by continual reminders that death is just around the corner, and that all time and energy left must be devoted to ferreting out and killing the disease” (Hall, 2003, p, 53).

Hall’s essay prompted three nurse scholars/practitioners, each with different experiences related to diagnosis and treatment in the current health care system, to respond to Hall’s call for ongoing dialogue.  Richard Cowling, Mona Shattell, and Marti Todd (2006)  added their own personal narrative to the dialogue — Richard as a person who experienced a mitral valve prolapse; Marti living through the experience of ovarian cancer, and Mona who has had very little experience as a patient, but wrote as a nurse and stated:

“Upon reflection on my personal experience with medicalization, I separate myself from my colleagues, to use Hall’s term, “not-yet-diagnosed, against the sick.” (Hall, 2003, p62). I am not conscious of this; however, it is a part of me. Even as I write about my support of Hall’s personal experience of medicalization, I am simultaneously betrothed, naively, to medicalization.

Naivety is not an excuse. In fact, it is what angers me most about medicalization—this overreaching power that silences me.” (Cowling, Shattell & Todd, 2006, p. 299).

Responding to Cowling, Shattell and Todd’s reflections, Hall affirmed their work, and stated: “As a reader, I feel privileged to be on an inside track with personal narrations that are conceived within such a sensitive context” (Hall,2006, p. 305).  She also observed that her own 2003 article, and in the Cowling, Shattell and Todd article, there could be a misunderstanding as to the nature of “medicalization” – that this dynamic is not about helpful or not helpful medical care.  Rather,

“medicalization is a form of organized and systemic oppression that is so culturally entrenched, powerful, and invisible, that everyone’s choices, including those practicing in the biomedical field are manipulated, and options are precluded with scant awareness on the part of any of the actors (Hall, 2006, p. 305.)

Medicalization is the exercise of a power dynamic that restricts the possibility to see any alternatives other than those prescribed by the “canon,” and that insists on excluding any other possibility.  From this frame of reference, western medicine is not the only source of “medicalization” – other forms that we sometimes call “alternatives” can be equally drawn in to the same type of power dynamic that uses the power of prescription to diminish human experience, and that destroys the possibility of an authentic human relationship that nurtures meaning and authenticity in the experience.

Parallel to the writing and deep thought that produced these notable articles, Hall was simultaneously engaged in her own nursing practice in the community, working with people who were experiencing life-threatening illness.  Drawing on her own experiences as a patient and as a nurse, she wrote and self-published a book that provides a glimpse into possibilities beyond the realms in which medicalization has taken hold.  The second edition of her book, published in 2008, explains three challenges of surviving and thriving after a life-threatening diagnosis – the challenge of preparing yourself mentally for surviving and thriving, the challenge of learning that help lies within you and all around you, and the challenge of focusing your attention on what your body needs to heal (Hall, 2008).  These challenges are relevant, as Bev shows, to anyone – whether they continue to live, or they move through dying.

I invite Nursology.net viewers to explore these notable works, and find ways to contribute to the ongoing dialogue that raises awareness of this dynamic, and in doing so explore pathways to shift our focus in the direction of nursing’s own perspectives.

Sources cited:

Allan, J. D., & Hall, B. A. (1988). Challenging the focus on technology: A critique of the medical model in a changing health care system. ANS. Advances in Nursing Science, 10, 22–34.

Cowling, W. R., 3rd, Shattell, M. M., & Todd, M. (2006). Hall’s authentic meaning of medicalization: An extended discourse. ANS. Advances in Nursing Science, 29(4), 291–304; discussion 305–7. https://www.ncbi.nlm.nih.gov/pubmed/17135798

Hall, B. A. (1996). The psychiatric model: A critical analysis of its undermining effects on nursing in chronic mental illness. ANS. Advances in Nursing Science, 18(3), 16–26.  https://www.ncbi.nlm.nih.gov/pubmed/8660009

Hall, B. A. (2003). An essay on an authentic meaning of medicalization: The patient’s perspective. ANS. Advances in Nursing Science, 26(1), 53–62. https://www.ncbi.nlm.nih.gov/pubmed/12611430

Hall, B. A. (2006). Author’s Response to “Hall’s Authentic Meaning of Medicalization: An Extended Discourse.” ANS. Advances in Nursing Science, 29(4), 305.

Hall, B. A.. (2008). Surviving and thriving after a life-threatening diagnosis. AuthorHouse.  https://market.android.com/details?id=book-giE2mx62bAwC . Also available here,

Nursologists and Their Comic Character Avatars


Once upon a time, I had a faculty colleague who had a wonderful sense of humor. She

could even inject humor into the statistics and research methods courses she taught. Unfortunately, I did not have anything close to her sense of humor. However, she assured me that it was very difficult to find humor in meta-theory, which is what I taught (and still teach), alas without any humor included.

Imagine my surprise when Peggy Chinn sent me an internet posting  by Jan Friesen and Skander Elleuche, who “developed a method that provides a simple, flexible framework to translate a complex scientific publication into a broadly accessible comic format” (italics in the original).

In an attempt to finally inject some humor into nursology, I started thinking of how comic characters could be transformed into nursologist avatars. I selected comic characters I knew from my childhood and, more recently, from the exhibits in Fawcett’s Art, Antiques, and Toy Museum, a small art gallery, shop, and toy museum that I co-own with my artist husband, John Fawcett. He is the creative one; I keep track of the finances.

My ideas for avatars for nursologists are:

  • Wonder nursologist (aka Wonder woman), whose special wrist cuffs

    deflect all negative concerns about theory

  • Super nursologist (aka Superman), who leaps over complex philosophical, conceptual,  theoretical, and methodological ideas with a single keystroke
  • Star nursologist (aka Star Trek), who goes where other nursologists are not yet ready to go
  • Fantastic nursologist (aka from

    Disney’s Fantasia movie) who converts theoretical knowledge to practice protocols.

  • Mighty nursologist (aka Mighty Mouse), who establishes nurse corporations that contract with clinical agencies to provide nursological qua nursological services to participants in practice (nurse corporations are Grayce Sills’ idea, nursing qua nursing is Jean Watson’s idea)
  • Terminator nursology (aka The Terminator), who eliminates all negative thoughts about conceptual models and theories
  • Spider nursologist (aka Spiderman), who climbs to the heights of nursology

    glory.

  • Yoda nursologist (aka Yoda from Star Wars), whose light saber illuminates all that is nursology.

I invite readers of this blog to contribute their ideas for comic character avatars for nursologists!

The Impossibility of Thinking “Atheoretically”

Some nursologists have claimed that they are “atheoretical.” When asked what they mean, they tend to say that they do not subscribe to or use a particular conceptual model or theory when conducting research or practicing. However, it is, according the physicist turned philosopher of science, Sir Karl R. Popper (1965), it is “absurd” to think that each of us does not have a “horizon of expectations” for whatever we are observing or doing (p. 47). Continuing, Popper (1965) claimed that everyone always has expectations, even if not in conscious awareness.

Following from Popper, I submit that it is impossible to think “atheoretically.” Instead, I submit that every nursologist has a “horizon of expectations” in the form of a conceptual frame of reference that guides what she or he is observing or doing as research is conducted, curricula are constructed, interactions are occurring with people who seek nursologist services, and nursologist services are administered. That conceptual frame of reference is what I refer to as a conceptual model or a grand theory.

I suspect that every nursologist agrees that she or he “talk[s] nursing” (Chalmers, as cited in Chalmers, Kershaw, Melia, & Kendrich,, 1990, p. 34), thinks nursing (Nightingale, 1993; Perry, 1985), and engages in thinking nursing (Allison & Renpenning, 1999) rather than mindlessly doing tasks and carrying out physicians’ orders (Le Storti et al., 1999). But what do those nursologists regard as nursing? What is meant by talking or thinking nursing? I also suspect that every nursologist agrees that she or he engages in critical thinking and clinical reasoning. If so, what is the frame of reference for the thinking or reasoning? Something has to capture one’s attention (Myra Levine (1991),  developer of the Conservation Model, called what captures one’s attention provocative facts, which are noticed within the context of conservation of energy, structural integrity, personal integrity, and social integrity.

Thus, the challenge for each nursologist who regards self as thinking “atheoretically” is to identify what her or his frame of reference (horizon of expectations) is. What is that person’s view of who are the human beings or documents that are appropriate for whatever activity is being done (i.e., research, practice, education, administration)? What is the person’s view of the relevant environment? What is the person’s view of what constitutes wellness, illness, and disease? What is the person’s view of what nursologists’ do in practice – what is worthy of assessment, how are priorities set when planning, what interventions are appropriate, and most of all, what outcomes are expected?

It is possible that my claim that being “atheoretical” is impossible. Therefore, in closing, I urge those of you who claim you are “atheoretical” to respond to this blog and let everyone know what you mean by being “atheoretical” in all of your nursologist activities.

References

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

Chalmers, H., Kershaw, B., Melia, K., & Kendrich, M. (1990). Nursing models: Enhancing or inhibiting practice? Nursing Standard, 5(11), 34–40.

Le Storti, L. J., Cullen, P. A., Hanzlik, E. M., Michiels, J. M., Piano, L. A., Ryan, P. L., & Johnson, W. (1999). Creative thinking in nursing education: Preparing for tomorrow’s challenges. Nursing Outlook, 47, 62–66.

Levine, M. E. (1991). The conservation principles: A model for health. In K. M. Schaefer & J. B. Pond (Eds.), Levine’s conservation model: A framework for nursing practice (pp. 1–11). Philadelphia, PA: F.A. Davis.

Nightingale, K. (1993). Editorial. British Journal of Theatre Nursing, 3(5), 2.

Perry, J. (1985). Has the discipline of nursing developed to the stage where nurses do “think nursing?” Journal of Advanced Nursing, 10, 31–37.

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