Guest post: “Let’s talk theory”; Perspectives from the Associate Degree Nursing World

Contributors:
Emma Crocker, DNP, RN
Patrick McMurray, BSN, RN
Shelley Mitchell, BA, BSN, MS, RN
Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN,
CNE, FAEN, PhD Candidate
Timothy Joseph Sowicz, Ph.D., NP-C

Authors’ Disclosure:
The authors would like to note that all members
put in equal amounts of work in this project. 


Nursing theory is the foundation of our practice, the way we differentiate nursing from other professions and disciplines. As readers of the Nursology blog, we assume that we do not need to discuss why nursing theory is essential to our practice. We would instead like to call your attention to a concerning trend – the lack of nursing theory in associate degree nursing programs. Please note that we are making generalizations based on our experience of graduating from and/or working in associate degree programs. There is a paucity of current research surrounding theory in associate degree programs.

According to the National Council of State Boards of Nursing (NCSBN), in 2019 50% licensure applicants were graduates from ADN and diploma schools of nursing; this number has historically been even higher. In other words, half of our newly practicing nurses may not have foundational knowledge of nursing theory to apply to their practice, further widening the theory practice gap. If theory content is not being integrated into the initial nursing education for half of our profession, how can we convince them it is important, let alone essential to their praxis? 

 We suspect that several factors contribute to the lack of theory in some ADN programs. Many nursing education programs are externally accredited by agencies such as the Accreditation Commission on Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Previous accreditation standards required nursing education programs to explicitly name the nursing theorists that guide the curriculum. This emphasis has been removed from current standards, allowing nursing education programs to use general educational theorists such as Knowles Adult Learning Theory.

 Another critical point is that ADN programs do not usually require doctoral-level preparation for nurse faculty. According to the 2018-2019 National League of Nursing’s annual survey of nursing schools, 74% of schools replied that it was “somewhat difficult” or “challenging” to hire new faculty. The primary reasons cited were an inability to offer competitive salaries and a lack of qualified candidates. ADN programs usually have fewer financial resources and do not have research missions. Therefore, they have difficulty attracting and retaining faculty with research-focused doctorates and higher educational credentials. This may result in ADN faculty who do not have the knowledge and/or experience with integrating theory into pre-licensure education.

Without the requirements of accreditation and with faculty who are not supported and enabled to the inclusion of nursing theory, it is our anecdotal observation that many ADN programs have dropped the emphasis on nursing theory. We have personally worked in nursing education programs where theory is either given cursory attention or not included in the curriculum at all. This has resulted in removing or deemphasizing nursing theory from a large portion of the nursing professional population.

 Nursing theory is currently situated in a place where it feels like it only belongs to some nurses, those embedded in academia or research, never practice. This has created a culture where most nurses and students cringe at the thought of theory-based content, with some complaining it has very little to do with “real-world” nursing practice. Nursing theory has not been made relevant to the modern nurse.

 Many nurse scholars might use this conversation as yet another reason why the entry level of nursing practice should be raised. Students seeking nursing education in the U.S. encounter many barriers, such as socioeconomic status, geography, structural racism, and more. Many of these students choose to attend ADN programs rather than seek a BSN, especially as their entry to practice. If we want to continue to grow the practice of nursing in the US, we need to support and encourage ADN programs, especially in the integration of nursing theory in practice.

The authors of this blog post greatly value the contributions of ADN programs, ADN graduates, and ADN educators. We would like to challenge all educators, scholars, and researchers to consider how we might restore nursing theory to its rightful place in all levels of nursing education. Nursing theory belongs to all nurses – not just those in higher education. 

Nursologists, what do you think?

About the contributors:

Emma Crocker

Emma Crocker, DNP, RN – CHIPS Health and Wellness Center, St, Louis, Missouri. Emma is a equity driven, population health quality improvement doctorate and advocate, devoted to ensuring the implementation of constituent-centered health policies, enabling communities to thrive located in St. Louis, Missouri. Twitter: @EmmaCrockerDNP.

Patrick McMurray

Patrick McMurray, BSN, RN – Adjunct nursing faculty, Robeson Community College, Lumberton, North Carolina. Patrick is a Adjunct Nursing Faculty at Robeson Community College, in N.C. Patrick is patient about community college nursing education and championing social change via equitable access to nursing education. Twitter: @nursePatMacRN.

Shelley Mitchell

Shelley Mitchell, BA, BSN, MS, RN – Professor of Nursing, Austin Community College, Austin, Texas. Shelley contains multitudes. She teaches full-time in Austin Community College’s Professional Nursing Program, which has been voted as the best in the region for three years in a row, and she is deeply involved in the college’s equity and inclusion work. She has a BA in English from Oberlin College in addition to her nursing education, and she reads comics and writes queer romance in her spare time. Twitter: @ProfShelleyRN

Elizabeth Mizerek

Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN, CNE, FAEN, PhD Candidate – Director of Nursing Education, Mercer County Community College, West Windsor, New Jersey.  Elizabeth is the Director of Nursing Education at Mercer County Community College in New Jersey. She is currently a PhD candidate at Widener University in Chester, Pennsylvania pursuing a doctoral degree in Nursing Science. Her research interests include nursing education, patient safety, and emergency preparedness.

Tim Sowicz

Timothy Joseph Sowicz, Ph.D., NP-C – Assistant Professor, UNC Greensboro, Greensboro, NC. Tim is an assistant professor at UNC Greensboro. His research is concerned with aspects of living with heroin and opioid use disorders, especially following an overdose.

Guest post: The Role of Nurses and Women’s Health Advocates in Advancing a Social Justice Agenda in the Current Climate: The Case of Wisconsin

Contributors (see bios below)
Lucy Mkandawire-Valhmu, PhD, RN; Jeneile Luebke, PhD, RN;
Carolyn Eichner, PhD; Kaboni Gondwe, PhD, RN;
Diane Schadewald, DNP, RN; Peninnah Kako, PhD, RN;
Jacqueline Callari-Robinson, BSN, RN; Brittany Ochoa-Nordstrum;
Nicole Weiss; Jacqueline Campbell, PhD, RN, FAAN

As nursing professionals and women’s health advocates, we have watched in disbelief events unfolding in Barron County, Wisconsin. Embrace, a shelter serving survivors of sexual assault and domestic violence in Barron County, is facing backlash for displaying a Black Lives Matter (BLM) sign. Reacting to the sign, local officials stripped the organization of funding worth $25,000 and law enforcement are unwilling to continue collaborating with Embrace.

Source

Embrace, located in Northern Wisconsin, serves a predominantly White populace, but also has a significant population of migrant farmworkers and Somali refugees. Migrant farmworker women face difficulties in accessing help following an experience of violence due to transportation and language barriers. Many refugee women also often have a history of sexual violence and trauma. Black women make up less than 2% of the population in Baron County yet constitute 10% of the population accessing help at Embrace’s shelter. Part of the St. Croix Chippewa tribe is also located in Embrace’s service area. Black women and American Indian (AI) women are disproportionately impacted by violence, but do not ordinarily seek help despite the potential for severe negative impacts such as injury or even loss of life.

The National Intimate Partner and Sexual Violence Survey (NISVS) report shows that 84.3% of AI women have experienced lifetime violence (Rosay, 2016). The NISVS shows 41% of Black women have experienced physical IPV in their lifetime with homicide being one of the leading causes of death for women aged 44 and younger. It is in this context that Embrace seeks to serve the most vulnerable populations of women in a four-county area where they are the only available domestic violence shelter.

 We are in unprecedented times with an ongoing COVID-19 pandemic that not only disproportionately affects the lives of Black and Brown women and their communities, but also increases their risk of violence and homicide. A recent US study showed a surge in the incidence of severe intimate partner violence (IPV) during the Covid-19 pandemic compared to the previous 3 years, and a decrease in the number of people seeking hospital care (Gosangi et al., 2020). It is important to be clear that this supports the idea that the stressors of Covid-19 including the economic fallout may exacerbate existing IPV but probably does not start IPV that has not existed before.  Consistent with what has been seen in some other countries, IPV and sexual assault advocates across the state began to report an increase in self and police referrals to their agencies after the pandemic began (Luthern, 2020).

Domestic violence related homicides have been on the increase in Wisconsin even before the pandemic.  According to End Abuse Wisconsin’s Domestic Violence Homicide Report (2020), there were 47 domestic violence related homicide deaths in 2018, and 72 in 2019.  And frighteningly, as of September 29, 2020, domestic violence homicide has taken 69 Wisconsin lives this year.   If that pattern continues, it is estimated that 93 lives will be lost this year. Also concerning is that 22% of the victims, so far in 2020, were age 18 or under. 

Black communities in urban metropolitan areas like Milwaukee are disproportionately impacted by violence in general while also experiencing tensions with law enforcement. Recent acts of police brutality captured on video and circulated widely on social media have implications for community relations with law enforcement. The fear that community members have about police officers potentially using excessive and unjustified force in the policing of Black bodies (Frazer, Mitchell, Nesbitt, et al., 2018) can impact women’s help-seeking following an experience of violence. Black women may want to call the police if they feel like they are in danger from their partner’s abuse but they do not want that partner to be harmed and they usually do not want him to go to jail.  They, like most abused women, just want the violence to stop.  At the same time, there needs to be a non-racist police response available to abused women who are in fear for their and their children’s lives.  There needs to be carefully informed triage (a concept well known to nursing) for 911 calls for IPV so that police are not brought in when not needed but can be brought to homes where there is a high risk for homicide.  

Our state has also been the site of civil unrest in the past few months. In Kenosha, the police shooting of Jacob Blake in August resulted in protests requiring the declaration of a state of emergency. Clashes have also ensued between law enforcement and community members in Wauwatosa in the last few weeks as a result of protests for the February, 2020 shooting and killing of Alvin Cole by a police officer. Apart from these incidents that have created not only unrest but also continued mistrust between Black and Brown communities and law enforcement, there have also been concerns about the prevalence of the trafficking and sexual violation of young Black and Brown women. In Kenosha, Chrystul Kizer, a 19-year-old African American woman, was released this year after being charged for killing a man who sexually abused her as a child in what her defense team argued was self-defense (Fortin, 2020).  Her defense team spoke of how the criminal justice system fails to protect Black and Brown women and girls and yet also holds them disproportionately ‘accountable’ for crimes that would not be charged in cases of White women and girls. This is eloquently detailed by Beth Richie in Arrested Justice

Within the past few months, Wisconsin has had a number of Indigenous women murdered and missing.  Kozee Medicinetop Decorah (Ho-Chunk Nation) was found deceased on May 16, 2020, a victim of domestic violence related homicide (Volpenheln, 2020).  Stephanie Greenspon was found deceased on August 19, 2020. It is suspected that she was also a victim of violence related homicide. Her case is still being investigated by the FBI (Menominee Nation, 2020).  Kaitlyn Kelly has been missing since June 17th (Conklin, 2020). There has been little mention of the missing and murdered Indigenous women in local or national media, particularly taking into account the extent of national and even global media attention drawn to the missing of Jamie Closs;  Closs went missing in the area where Embrace is located, but she was eventually located.

Given all this, dialogue from law enforcement and local officials indicating willingness and commitment to community safety and wellbeing would be helpful. Instead, the response of law enforcement to Embrace’s display of a Black Lives Matter sign intensifies tensions and mistrust between the police and the communities they serve. It also seriously undermines the vital work of the only shelter in a four-county area, further endangering the most vulnerable populations Embrace serves.

 Employing relevant theories to our practice as nurses and liaising with our colleagues across disciplines has now become urgent. Together with colleagues across disciplines, nurses need to support and advocate for survivors of violence. Screening and identification of resources for women is of utmost importance, and shelters like Embrace both ensure the provision of shelter and connect women with urgently needed health and social services. As nurse scholars, we wrote this blog post in collaboration with our colleagues at Women’s and Gender Studies at University of Wisconsin-Milwaukee as part of building coalitions. But we also did so for the purposes of deepening our understanding of the urgent healthcare challenges experienced by the most vulnerable across our state, in the context of the rising tensions and mistrust among various institutions and agencies that exist to enhance the health, wellbeing and safety of all Wisconsin communities.

Violence is central and even essential to the sustaining of social hierarchies that inform the oppression of some groups while enhancing the privilege of others (Collins, 2017). Patricia Hill Collins (2017) points out how without human agency and resistance, institutions can engage in bureaucracies that replicate power dynamics, and even perpetuate normalized violence that maintains dominance and inequities. Law enforcement is one institution, and healthcare, of which nurses are a part, is another.

Robin Walter’s theory of Emancipatory Nursing Praxis comes to mind as one that guides us towards allyship in advancing a social justice agenda in pursuit of health equity, which is central to ensuring the health and wellbeing of the most marginalized in our communities during this time. In order to advance a social justice agenda, there is need for nursing as a profession to partner closely with domestic violence advocates and shelters like Embrace as well as law enforcement officers, who play an important role in enhancing the safety and wellbeing of our communities. We must engage in research and dialogue that would help us reimagine a criminal justice response that acknowledges the context of racism in which Black and Brown women experience violence.

As professionals, we need to respond and to meet their urgent needs for health and safety. It has never been more urgent to engage in the learning processes that Walter outlines, critically reflecting on our social location in relation to those we serve, shifting our worldview and experiencing transformation by expanding our consciousness (Walter, 2017).

References

Campbell, J. C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, … & Laughon, K. (2003). Risk factors for femicide in abusive relationships: results from a multisite case control study. American journal of public health, 93(7), 1089–1097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447915/

Collins, P. H. (2017). On violence, intersectionality and transversal politics. Ethnic and Racial Studies, 40(9), 1460-1473. https://www.fbi.gov/news/stories/operation-cross-country/operation-cross-country

Conklin, M. (July 28, 2020). Searching for Katelyn Kelley: The 22-year-old Menominee woman is part of a crisis of missing Indigenous people that Wisconsin is just beginning to confront. Wisconsin Examiner.  https://wisconsinexaminer.com/2020/07/28/searching-for-katelyn-kelley/

Fortini, J.  (June 23, 2020). Chrystul Kizer, teen charged with killing abuser, is released on bond. The New York Times. https://www.nytimes.com/2020/06/23/us/chrystul-kizer-free-bond.html

Frazer, Eva et al. “The Violence Epidemic in the African American Community: A Call by the National Medical Association for Comprehensive Reform.” Journal of the National Medical Association vol. 110,1 (2018): 4-15. doi:10.1016/j.jnma.2017.08.009 https://pubmed.ncbi.nlm.nih.gov/29510842/

Gosangi B., Park H., Thomas R., Gujrathi R., Bay C. P., Raja A. S., …  Khurana, B. (2020). Exacerbation of Physical Intimate Partner Violence during COVID-19 Lockdown. Radiology, 202866, Epub ahead of print. https://pubs.rsna.org/doi/10.1148/radiol.2020202866

Luthern, A. (May 18, 2020). Milwaukee is seeing a spike in homicides, and nearly half of them are related to domestic or family violence. Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/crime/2020/05/18/milwaukee-homicides-nearly-half-linked-domestic-family-violence/3121220001/

Menominee Nation (October 22, 2020).  Press Release: Vehicle Arson and Discovery of Human Remains on Menominee Indian Reservation. Menominee Indian Tribal Newshttps://www.menominee-nsn.gov/NewsPages/NewsItem.aspx?NewsID=Vehicle%20Arson%20and%20Discovery%20of%20Human%20Remains%20on|10/22/2020

Richie, B. (2012).  Arrested Justice: Black women, violence and the America’s prison nation. NY: NYU Press.

Rosay, A. (2016). Violence Against American Indian and Alaska Native Women and Men. NIJ Journal, 277, 38-45.  Retrieved from:  http://nij.gov/journals/277/pages/violence-against-indians-alaska-natives.aspx

U.S. Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis (2017). Sex, Race, and Ethnic Diversity of U.S, Health Occupations (2011-2015), Rockville, Maryland.

Volpenheln, S. (June 29, 2020).  Wisconsin family calls for harsher charges in ‘heinous’ killing of Ho-Chunk woman.  Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/2020/06/29/wisconsin-family-calls-harsher-charges-homicide-ho-chunk-woman/3239543001/

Walter, R. (2017). Emancipatory nursing praxis. A theory of social justice in nursing. Advances in Nursing Science, 40(3), 225-243. Also see Walter’s Theory on Nursology.net

Acknowledgement:

We are grateful for the support and input of the following colleagues from Women’s and Gender Studies: Anna Mansson McGinty, PhD, Xin Huang, PhD, Kristin Pitt, PhD, Gwynne Kennedy, PhD, Melinda Brennan, PhD, & Jeremiah Favarah, PhD

About the contributors

Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.

Jeneile Luebke, PhD, RN is a post-doctoral nurse research associate at University of Wisconsin-Madison. She in an enrolled member of Bad River Band of Lake Superior Chippewa Indians. She received her early nursing degrees (LPN and ADN) in Bemidji, MN, and her BS and MS Nursing from the University of Wisconsin- Madison, and her PhD at UW-Milwaukee. Her area of research and expertise include intimate partner violence in the lives of American Indian women, community health nursing and utilization and application of postcolonial and indigenous feminist methodologies. She is a survivor of intimate partner violence and is passionate about sharing her knowledge and personal experiences to help to support and empower other women to transition to survivorhood.

Carolyn J. Eichner is Associate Professor of History and Women’s & Gender Studies at the University of Wisconsin, Milwaukee. She was a Member at the Institute for Advanced Study in Princeton, New Jersey, in 2015-2016. Eichner is the author of Surmounting the Barricades: Women in the Paris Commune (Indiana University Press); published in French as Franchir les barricades: les femmes dans la Commune de Paris (Editions de la Sorbonne). She has two forthcoming books: Feminism’s Empire, which traces the roots of nineteenth-century French anti-imperialism in the race, gender, and class politics of the era’s first French feminists to engage with empire; and A Brief History of the Paris Commune for the 2021 sesquicentennial of the 1871 revolution (Rutgers University Press). Eichner he is currently writing The Name: Legitimacy, Identity, and Gendered Citizenship. She has published in journals including Feminist Studies, Signs: Journal of Women in Culture & Society, French Historical Studies, and Journal of Women’s History

Kaboni Gondwe, PhD, RN is an assistant professor at University of Wisconsin-Milwaukee College of Nursing. Her research interests are on maternal and child health and she is focused on studying effects on how chronic life stressors moderates the effects of perinatal stress on preterm biomarkers in African American /Black mothers and Malawian Black mothers. She completed her PhD in Nursing from Duke University in 2018 where her research focused on relationship between preterm birth with postpartum stress and mother-infant relationship. She received her undergraduate degree and midwifery training from University of Malawi, Kamuzu College of Nursing and her Master in Nursing Education and Nursing Administration from Ohio University. 

Diane Schadewald, DNP, MSN, RNC, WHNP-BC, FNP-BC joined the faculty of the University of Wisconsin-Milwaukee, College of Nursing in 2013 and is currently a Clinical Professor. I have been certified as a Family Nurse Practitioner and a Women’s Health Nurse Practitioner since 1993. As a board-certified Women’s Health Nurse Practitioner, I have experience providing care for Black women as well as AI women who are at risk for or who have experienced IPV. Since working in academia, I have practiced in primary care and am currently working for an online nurse practitioner service. Prior to working in academia, I practiced in an OB/GYN clinic setting. I’m a co-author of Women’s Health: A Primary Care Clinical Guide which is in its 5th edition. I have also lectured on care of women who have experienced female genital cutting and IPV. I’m currently working on an educational research project about female genital cutting.

Peninnah Kako, PhD, RN, FNP-BC, APNP is an Associate Professor at the University of Wisconsin-Milwaukee (UWM) College of Nursing. Dr. Kako’s research focus includes improving health care access for underserved populations, issues affecting women living with HIV in sub-Saharan Africa. Her research also focuses on violence in the lives of women. Her research aims to contribute to efforts that meet primary and secondary HIV prevention needs in sub-Saharan Africa; and build sustainable, timely, and effective interventions to assist African women and their families in accessing treatment and managing chronic HIV illness. Clinically, Dr, Kako has served in underserved populations including corrections as a family nurse practitioner.

Jacqueline Callari-Robinson, BSN, RN is a Doctoral student at the University of Wisconsin, Milwaukee, School of Nursing, Research Assistant for Tracking our Truth, and an on-call SANE Nurse for United Concierge TELESAFE Program. Previously, Jacqueline was the Director of Sexual Assault Prevention and Statewide SANE Coordinator for the Wisconsin Coalition Against Sexual Assault and the Wisconsin Department of Justice. In that role, she developed the Wisconsin adult, adolescent, and pediatric SANE training courses. Jacqueline was also instrumental in the facilitation and creation of the Wisconsin Attorney General Sexual Assault Response Team (SART). Working collaboratively with SANE programs, law enforcement communities, and the Wisconsin Crime Lab, the AG SART addressed patient access to advocacy driven medical forensic care and the composition, handling, and processing of sexual assault kits. 

Brittany Ochoa-Nordstrum is set to graduate with a Bachelor’s degree in Sociology in the spring of 2021. As a recipient of a SURF (support for undergraduate research fellow) award, Brittany is working under the mentorship of Dr. Lucy Mkandawire-Valhmu on various projects pertaining to advocacy for marginalized communities of color. Brittany’s area of study is medical racism and its impacts on maternal mortality amongst African American women in Milwaukee. She is applying to Ph.D. programs across the country in Sociology and African Diaspora studies. As a third generation Mexican American, her life experiences often inform her passion for these areas of study. When Brittany is not researching, she is often involved in planning and organizing community grassroots demonstrations and fundraisers to benefit marginalized groups around the city of Milwaukee.

Nicole Weiss is a current graduate student at the University of Wisconsin-Milwaukee pursing a Masters of Sustainable Peacebuilding. Nicole is the project coordinator for the Department of Justice funded project: Tracking our Truth, Providing Access to Advocacy Driven Medical Forensic Care. She received her BA in International Studies at the University of Wisconsin-Milwaukee. Her areas of focus include undertaking a holistic, systems approach to complex issues within our community through facilitation and conflict resolution strategies.

Jacqueline Campbell, PhD, RN, FAAN is a national leader in research and advocacy in the field of domestic and intimate partner violence (IPV). She has authored or co-authored more than 230 publications and seven books on violence and health outcomes. Her studies paved the way for a growing body of interdisciplinary investigations by researchers in the disciplines of nursing, medicine, and public health. Her expertise is frequently sought by national and international policy makers in exploring IPV and its health effects on families and communities.

So You Want To Be More Equitable, Just, and Inclusive?: A Live Webinar

See Details here!

Watch the first event here!
Read the blog post summarizing the first event here!

Nursing is an act of Justice.” – Canty and McMurray (2020)

Earlier this year, in light of the events surrounding the murders of George Floyd, Breonna Taylor, and many others, the Nursology Theory Collective hosted a live event titled, “Equity, Justice, Inclusion, and the Future of Nursing.” At this event, Dr. Lucinda Canty and Patrick McMurray addressed the critical interrelated concepts of diversity, equity, inclusion, and justice for our discipline. The enduring homogeneity of nursing, Canty and McMurray noted, contributes to persistent inequity, injustice, and exclusion that exists today, both within the discipline and as it is practiced. Lamentably, many of our professional organizations address this in superficial ways, ways that may look good but fail to address the root causes of racism, sexism, homophobia, and more. This has the paradoxical effect of reinforcing hegemony even as these organizations purport to be about justice.

At the end of the event, many attendees raised questions about what we, as nurses, and we, as a discipline, could do to create a future for our discipline that is more equitable, just, and inclusive. In answer to these questions, we are happy to announce that we are going to host a part 2 to event on December 18th, 2020 at 1:00 Pacific Standard Time/4:00 Eastern Standard Time. To join this event, please register here in advance to save your seat. After registering, you will receive a confirmation email containing information about joining the event.

For our next event, we will continue the dialogue, recognizing that inequality, injustice, and exclusion remain systemic issues that we all play a part in. We will recommend tools that all nurses can do and share, no matter the setting, as individuals and within systems, in order to achieve our goal in making nursing and the world more equitable, just, and inclusive. 

If you have any questions you would like addressed at this event, please feel free to ask us on twitter @nursingtheoryco or email us at nursingtheorycollective@gmail.com.

We look forward to seeing you and continuing this important conversation on December 18th!

In solidarity,
The Nursology Theory Collective

The Marathon of Crisis: “We Want to Live Also”

None of us expected the pandemic to last this long. In March, we rallied against the growing and terrible virus, the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). At that time, we hunkered down, businesses temporarily closed to stem off the rising numbers of infection, and we all kind of figured it would end in about six months. It has not. Crises aren’t supposed to last this long. The nature of this beast is that its danger is unseen; its end is unseen; and its messaging couldn’t be more confusing.

So I didn’t think last April, when my research team and I received a small seed grant from our university called a “COVID Rapid Response Grant,” that the pandemic would be surging in the way it is now, seven months later. In my naivety, I quickly put together an online survey with the major inclusion criterion of having respondents be frontline, critical care nurses. Data collection lasted from mid-June through beginning of September.

My research assistant and I are swimming in the data, tackling a subset of the items, the open-ended responses. This is the qualitative stuff that as Cheryl Beck states (I paraphrase here), puts muscle on the skeleton bones of understanding. It’s rough going. The nurses had a lot to say.

On one hand, it validates so many nurse-specific and nurse-patient specific traumas that I articulate in my theory. Insufficient resource trauma (i.e., not enough personal protective equipment, not enough trained critical care nurses), vicarious trauma (i.e., patients passing alone; families in distress at not being with loved ones); workplace violence (i.e., families frustrated and taking it out on nurses); disaster trauma (i.e., fearful of endangering self and others); and system/medically-induced trauma (i.e., patients being coded and ventilated). These all seem so sterile when I list them but come alive in the narratives that reflect fear for self and fear for their family’s safety if exposed to the virus from them, agony, anxiety, intrusive thoughts, nightmares, isolation, abandonment, suffering, exhaustion. One nurse added: We… will be forever changed.”

They report feeling intense guilt over the limited care they can offer to the patients. I read the texts and re-read them. Then, my eyes see unassuming words buried in the single spaced narratives; a seemingly quiet voice stood out: “We want to live also.”

As I consumed this sentence, I was reminded of the period in my life when I was a full-time writer. I believe in the power of words and of the writer, the truths they can convey. At a visceral level, the writer decides the order of placement, the punctuation for emphasis, the parsimony over emotive phrases, even the phonemic sounds, soft versus hard, such as “puppy” and “paw” versus “dog” and “god.” In this moment, I saw this quote and envisioned an exhausted individual who just wanted to be done with it all and alive to move forward with life. But I think there is more.

This tiny, five-word, soft-sentence encompassed a primary reality: a nurse wanting to exist after this pandemic. The nurse used peripheral words surrounding the statement: the “hospital” viewed nurses as “bodies” to take care of patients, an objectification of the nurse. Beyond the words, the owner of this voice asks, “What about us?” As if to inquire gently, “Have you forgotten about us? Are we an afterthought?” A sentence sends a reminder when there should be none needed, but sends it nonetheless to those who see nurses as “bodies” to care of the sick patients: “We want to live also.”

And perhaps a second message is conveyed by the voice wanting to live – right now – without the trauma, without the fear. The existential plea to the “hospital” to affirm nurses’ right to exist and recognize their right to particular, individual, lived experiences amid a global pandemic. And the system responsibilities to acknowledge that they have provided services and supplies for some individuals to live, but perhaps not all. The “also” after this humble statement is noteworthy: “We want to live also.”

Based on my middle-range theory of nurses’ psychological trauma, one antidote is to use trauma-informed care of self and peers. Demonstrating trauma-informed care principles for self and fellow nurses is a critical piece, especially offering a sense of safety. This is a space occupied only when safety can be authentically assured. Unless organizations step up, safety is scarce. My theory is clear: the solutions to such psychological trauma must be shared between the individual and organization. Resiliency can grow when the environment allows. Fertile soil includes sufficient resources, supportive management, a safe work environment, and mental health services. Importantly, management has to de-objectify nurses and view us as sovereign professionals, individuals who have choices. Second, there will be a time when the pandemic is under control, perhaps when a healing space opens for posttraumatic growth. A few nurses also shared narratives where resiliency and posttraumatic growth existed now. One nurse, who had lived through the “HIV, Toxic Shock, Legionaires, H1N1 and so many other diseases,” seemed able to cope with the current pandemic: “I’ve learned that I can rise above it.” One of the few narratives that contrasted sharply from the majority.

My research assistant, Anna, and I meet virtually to discuss these voices (I can’t call them data right now as they seem so intimate). We discuss our reactions, our general thoughts because I want to authentically make sense of them. I feel responsible to the nurses who offered them to us. Anna is about 30 years younger than me. Yet she and I agree on what we see and feel from the voices, and perhaps within ourselves. There is truth: “We want to live also.”

References

Beck, C. T. (2015). Developing a program of research in nursing. Springer.

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Sigma Theta Tau International Publishing.

Foli, K. J., Reddick, B., Zhang, L., & Krcelich, K. (2020). Nurses’ Psychological Trauma: “They leave me lying awake at night.” Archives of Psychiatric Nursing, 34(3), 86-95. http://doi.org/10.1016/j.apnu.2020.04.011

The Intersections of Nursing Scholarship and Nursing Activism

In the early 1980s  when Maeona Kramer and I first began to put together ideas for a text on theory development in nursing, we were committed to addressing nursing knowledge development beyond the typical boundaries of empirical research and theory development.  We had both completed, in 1971,  doctoral degrees in Educational Psychology (Maeona at Wayne State University in Detroit, and me at the University of Utah) focusing on theory development in education (nursing doctoral degrees at the time were few and far between).  For that first edition we drew on the work of a psychologist named Zygmunt Piotrowsky (1971)  who had proposed that the development of knowledge required contributions from scholars with different personalities, some who were drawn to theoretical abstract thought, and some who were drawn to concrete empirical “laboratory” science. 

In 1987 when we embarked on the 2nd revision of our book now titled “Knowledge Development in Nursing” we introduced Carper’s fundamental patterns of knowing in nursing, which gave us a starting point for narrative clearly grounded in the discipline of nursing. In the 3rd edition (1991) we turned our attention to revising our language from the stilted tradition of what was once considered scholarly writing to language that was more accessible and gender neutral.  By 1999, we realized that simply listing and describing Carper’s patterns of knowing fell short; we needed to project ways in which knowledge is developed for each pattern of knowing.  This evolution made it possible to articulate our belief that nursing knowledge encompasses so much more than that which can be studied empirically.  However, we continued to have this sense that something was missing, and in 2008 we articulated the emancipatory pattern of knowing. 

It was the growing and compelling body of nursing literature focused on critical social theory, socio-political knowing, and social justice that gave us the impetus, in 2008, to develop the emancipatory pattern of knowing. We see this not as simply a fifth pattern of knowing, but rather as the fundamental human capability to see a situation, recognize that something is amiss, and create ways to change the situation – an ongoing process in creating nursing knowledge that is necessary for the development of knowledge related to any of the four fundamental patterns of knowing.   

We had finally arrived at the intersection of social activism and the development of nursing knowledge.  But what does this really mean?  It is now over a decade since we first conceptualized what emancipatory knowing means, and the possibilities that this pattern of knowing holds for the future development of nursing.  We have been puzzled by the fact that it took us so long to see the connections and have speculated why this might be so (the long-standing subservient positions of women and nurses, the socialization to avoid that which is political, the dominant concern with one-to-one “bedside” care, etc. etc.). 

The fact has been that nurses, dating from the earliest days of the profession, have engaged in social and political activism, but have remained reticent to fully embrace social activism as a core nursing concern. Maeona and I both had been actively involved in the 1980’s effort to advance feminism in nursing through the work of “Cassandra: Radical Feminist Nurses Network.”  In 2000, Richard Cowling, Sue Hagedorn and I  wrote “A Nursing Manifesto: A Call to Conscience and Action,” acknowledging that at its core, nursing itself is “political” in the sense that politics is the ability to advance one’s own values in a public context.  Every time a nurse acts to bring nursing values into action, bends over backwards, jumps through hoops, and does cartwheels to obtain what individuals and families and communities need to be healthy, we are acting politically.  We are activists.  

The values of our discipline, expressed eloquently in the theories and conceptual models that form our foundation, guide our thoughts, words and actions. At the same time, our intimate engagement with others as we practice nursing, also informs what we think and do, opening awareness of ways to challenge, question and re-design the nature of our discipline.  The social and political contexts we face in this moment call for a new awareness of distortions, prejudices, stereotypes, social injustices amplified by racism. What is happening in this moment of time has raised alarm bells and demands that we turn our gaze on ways in which we nurses, individually and collectively have been complicit. The situation we find ourselves in today calls for nurses, and particularly white nurses, to finally recognize the dynamics of racism that infect our own “house” and start the tedious, and yet ultimately rewarding, process of healing.

In facing this challenge, we will begin to understand the dynamics of the widespread public health crisis of racism in ways never before attempted.  The development of knowledge demands that we understand the problem, explore the dynamics that sustain the problem, seek new ways to prevent and change those circumstances that perpetrate the crisis, and heal those who are affected.  There are theories and philosophies of our discipline that can guide us as we move forward.  Here are a few to consider:

This website – Nursology.net – is accomplishing the very important purpose of bringing to the fore the rich traditions and values expressed in the theories, models and philosophies of our discipline.  And now the time has come to recognize the ways in which the practices, attitudes, philosophies and thought patterns that derived predominantly from white perspectives are lacking.  This reality now calls for activism of a type not often recognized – a sustained and determined challenge that can change our own disciplinary ways of thought and action.  This does not mean in any way that we discard or denigrate our foundation, or that we disrespect the ways in which our own scholarly work has real value.  What it does mean is that we examine our accomplishments through a new lens, and recognize ways in which we need to re-direct course.  

Take as an example my theory and practice of “Peace and Power.” This theory was inspired in part by the Brazilian scholar and activist Paulo Freire (1970), and is closely aligned with practices commonly used in native American cultures and in Quaker communities. Yet people of color have also challenged this process as reflecting colonized white privilege – despite the commitment embedded in the processes that seek to dismantle power inequities in group processes.  Part of this challenge came from the early descriptions of the process that clearly reflected the concerns of white women and defined by white feminists. The fact is that the lens through which I view these ideas bear “decolonization.” What this means exactly is still in process, requiring a deep deconstruction of the Euro-centric assumptions on which the theory and process is built.  How this will affect the theory itself remains to be seen, and may be actually accomplished by scholars of the future!  

The time has come to shift this process in to high gear – to recognize the ways we have silenced the voices of many of those we claim to serve, ways in which we have excluded nurses of color from participating in our efforts to develop the knowledge of the discipline, and ways in which white nurses have in fact dehumanized, disrespected and excluded nurses of color from full participation in the practices, leadership and development of the discipline.  This is not an activist project that can happen in one or two “training” sessions addressing “diversity, inclusion and equity.” Nor can it be accomplished by performative actions such as recruiting more people of color, or curriculum revisions.  Although of course these kinds of actions are warranted and need to happen they will not in themselves end the inequities and injustices of racism.  There are no formulas.  

I believe that the activist commitment of all nurses now and going forward is to learn all we can about the mechanisms of both systemic and everyday racism, question each choice we make in light of our growing awareness, challenge one another with loving kindness, and create spaces that challenge white privilege.  The “Overdue Reckoning on Racism in Nursing” discussion series has now ended but in those discussions we established a starting point, including important resources for becoming well informed about the challenges we face. Now we have new actions to continue this work, centering nurses of color and engaging white nurses in meaningful processes consistent with the ideals of “truth and reconciliation.”  

While these actions are labeled as “activism” they are also vital in shaping nursing knowledge going forward.  Becoming immersed in social and political activism to address the public health crisis of racism, guided by the values of our discipline, we provide the best of nursing care to heal ourselves, to heal the damaging effects of racism in our communities, and build a stronger future.  We create the ‘hermeneutic circle” of thought and action – where our actions inform how we think, and how we think shapes our action in a constant process that changes and shapes both thought and action going forward.

Sources

Freire, P. (1970). Pedagogy 0f the oppressed. Seabury Press.

Piotrowski, Z. A. (1971). Basic System of All Sciences. In H. J. Vetter & B. D. Smith (Eds.), Personality Theory: A Source Book (pp. 2–18). Appleton-Century-Crofts.

How Evidenced Based Practice Supports Inequality

Guest contributor: Mike Taylor,
Member, Nursology Theory Collective

About six years ago, the Maryland Department of Health sponsored a conference for all state stakeholders with an interest in chronic disease, including nursing and medical groups, hospitals, EMS and diabetes product companies. The latest evidenced based practice models were being presented but I was only half listening because I, like most of those in the room, already knew what we were going to hear. Which is what happened, in session after session we heard that non-white patients had the highest incidence in all chronic disease states, probably related to genes or culture, and the major solutions were primarily public awareness and ethnic specific education without any mention of the role of racism.

So, I decided to shake things up and during the break went to the Department of Health table in the exhibit hall and asked the two representatives there if we were ready to tackle institutional racism or if we were still playing around the edges. Looking unsure what to say, one of them responded “we are still playing around the edges” but offered that there was a new director who may be willing to talk with me and she would send her over to my table. She never came and the chance for a different conversation ended there.

While the department of health representatives didn’t deny the existence of institutional racism, unless evidence of institutional racism and other inequalities are allowed to be presented as part of the discussion nothing will change.

In addressing institutional racism, we tend to spend 80% of our time on awareness which is only 20% of the problem and not on changing institutions which is 80% of the problem. In this first of a series of blogs, I will argue that evidenced based practice (EBP) is a key component of the institutional structures that support racial and economic inequalities. The evidence about any clinical subject is often contradictory even in well-designed studies which is not a problem but simply a feature of the difficulty of doing science. The fact that the evidence found in scientific journals provides a range of possible answers, requires practioners, practice organizations and health systems to make choices about what evidence to include and not to include in their own practice and in practice guidelines. The science of EBP may appear to be objective but the process of choosing the subject and design of studies along with what evidence to use and how to use it is inherently subjective and open to bias that perpetuate economic and racial inequalities.

Institutional selection of what evidence to include in policy and practice is based on the degree of fit with an existing institutional theory. The institutional theories that support inequalities in race and poverty, are unspoken but widely accepted theories of health without theoreticians and based on unquestioned assumptions which can make them hard to challenge.

If we in the Nursing Theory Collective specifically and in nursing in general, are to undertake this fight to change the intertwined histories of these inequalities we must concentrate on changing the institutions and the false assumptions they are based on, and demand alternatives. Follow-up blogs will examine the use of EBP in supporting three areas of institutional inequalities including the maintenance of structural racism, control of nursing practice and control of patient autonomy. Please reach out to me and tell me what assumptions you have found in your work that you feel need to be questioned.

About William (Mike) Taylor

Mike Taylor is an independent nursing theorist specializing in the application of complexity science to health and compassion. His Unified Theory of Meaning Emergence takes a major stride in connecting the mathematics of complexity with self-transcendence and compassion. He has spoken at international, national and regional conferences on complexity in nursing, health, and business. He is a member of the board of the Plexus Institute where he is the lead designer of the Commons Project, a web based platform for rapid social evolution in climate change.

Abstract Thoughts with Aphantasia: Learning Nursing Theory without the Ability to Imagine

Guest contributor: Elizabeth “Ellis” Meiser, MSN, RN-BC, CNE

            When I took a nursing theory course for the first time in my educational experience (at the doctorate level, mind you), I found myself grateful to finally be able to identify what may make learning theory difficult for me. A few years ago I was listening to a podcast in my car from the BBC. It began with a discussion on spatial navigation and transitioned into mental visualization. The topic was on how some people have a limited ability to imagine. The podcast asked listeners to close their eyes (I waited until I got to my destination to complete the exercise, don’t worry!) and picture a beach. Go ahead and do this if you can. Close your eyes and call to mind beautiful white sand, a palm tree, blue waves crashing under a clear blue sky. I settled into my seat and closed my eyes. But when I tried to see a beach, nothing happened. It was then I realized that I had a processing condition called aphantasia.

            Individuals with aphantasia have difficulty imagining visually. For me, it means when I close my eyes all that happens is I stop seeing. Most people are on a spectrum of capability when it comes to visualization. Some can recall only things they have seen before, for some it may appear like something from a cartoon, and for others it is as realistic as if it were before their eyes. Perhaps it seems shocking that I would not be aware of this until my mid-twenties, but how often does it come up in conversation? I suppose I always thought when someone said “mind’s eye” or that they could “picture it” these were expressions but that they couldn’t actually do it. Turns out, most people can actually picture things when my mind is woefully dark. With an impact on my ability to remember things, I just always assumed I had a poor memory.

My lifelong struggle with having to learn about and analyze abstract ideas suddenly made sense! The blog posts from Dr. Foli and Shannon Constantinides about the concerns with teaching theory in nursing education, along with the potential impact of generational differences, jumpstarted my questioning of my own journey through abstract learning. I cannot envision physical things, words, shapes, or even colors. Without those capabilities, I wonder: what could be the main factor impacting my ability to truly grasp abstract concepts? There could even be a combination of many contributing factors. Then I wondered, does it even matter? Why do I even need to understand theories?

As I mentioned, I’ve been through nearly ten years of formal education for nursing and cannot recall a course dedicated to nursing theory. I became faculty armed with a master’s in nursing leadership and management and a handful of education classes from my music education undergrad. I had been exposed to Piaget’s developmental theory and Maslow’s hierarchy of needs. I knew how to write objectives using Blooms, and in my master’s had been introduced to a variety of leadership theories. I had not, however, explored anything on Benner, Henderson, or even anything beyond the fact that Nightingale had something to do with a lamp. I didn’t even know nursing theories existed, and when presented with them in my doctorate program, I struggled understanding them and their purpose. However, in my practice of simulation, I have recognized the impact of Jefferies on how frameworks can guide development of scenarios. I have embraced Benner by recognizing how to consider the learners, where they are within the program, and within their own growth process. Much of this required me to evaluate how to learn abstract concepts.

Ultimately, a huge hurdle on abstract thought for me must involve aphantasia, which presents for me as the inability to daydream and the absence of visual recollection. It can be hard for me to remember what I’ve read or seen. As a learner, and now as a nursing educator, I feel as if it is taken for granted that all learners have the capacity to visualize mental images. Despite this having implications for learning, aphantasia is not currently considered a learning disability. Furthermore, there has been no progress on aiding those with aphantasia in developing the ability to produce mental imagery as it seems to be a neurological deficit. I am unsure of whether identifying students with aphantasia, or to what extent they are capable of visualizing, is important. Instead, what we need to do is create a holistic learning environment that is accessible to a variety of learners and learners need to be equipped with tools that suit their learning style. Using varied education techniques to address learning styles has long since been routine, but how often have we considered the student’s ability for mental imagery? How are we sharing abstract ideas? Is it in a tangible way? Do we encourage students to reflect on how they think, process, and picture things? Perhaps we need to consider adding this to the conversation to help students assess their learning needs before we begin introducing abstract concepts.

When it comes to theory, abstract instruction, or other types of instruction, I have found myself having to use a range of resources. For example, graphs, images, and diagrams may help explain concepts, but they are difficult to recall as I cannot recreate them in my mind. Instead, I found myself using a mixture of media, videos, and having to use my trusty gel pens and notebook paper. As it is in any pool of learners, these will have different effects for different learners but include:

  • Make personal or emotional links to content
    • I find relating theories to stories extremely helpful. This means grounding abstract ideas to something that I can relate to, or experience.
  • Listen to podcasts or a recording of a lecture
    • This may be difficult for some with aphantasia as there is no visual imagery to which to connect the audio.
  • Write notes and draw concept maps on paper to physically forge connections
    • An age-old recommendation that should never have been replaced by typing and is even more effective when summarizing in my own words.
  • Use Flash cards, mnemonics or other rote memory tasks
    • While I can’t bring these to mind at a later date, I can force memorize the basic concepts before scaffolding the more abstract ones.
  • Involve music or rhythm
    • Again, this is helpful for the more basic concepts. However, there has been some evidence of links between those with aphantasia also having difficulty remembering sounds, tones, or music so this is very dependent on ability.
  • Teaching others or simply reading notes out loud
    • Yet another traditional method of evaluating learning and using kinesthetics and physicality to the party. When I get lost in reading about theory, I find that reading it out loud helps me stay on track.

It is crucial to remember that while linking learning to visual memory reportedly leads to better academic outcomes, it does not equate to higher intelligence. It certainly has an impact, but it is not the only variable to consider. Reflecting on how important the mind’s eye is to learning leads me to wonder how different schooling would have been had I known about aphantasia. For myself, I can apply it to what remains of my terminal degree and my continued lifelong learning. For others, I can write about its impact and attempt to add to the discussion on what influences how, when, and to whom we teach nursing theory and knowledge. Ultimately, we need to work with all learners to be advocates for what they need to succeed regardless of the topic at hand.

About Elizabeth “Ellis” Meiser

Ellis is a Clinical Educator of Nursing at Longwood University in Farmville, VA. They have their MSN with a focus on leadership and management, is a Certified Nurse Educator, and is certified in medical-surgical nursing. They are in their first year as a doctoral student in the online EdD Nursing Education program at Teachers College, Columbia University.

Virtual Nursology Theory Week March 17-24, 2021!

View Nursology Theory Conference Site!
Invitation to discuss terminology
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Details for a Virtual Nursology Week 2021 have just been announced on the Nursology Theory Conference website! This virtual conference will be a combination of the March 2020 program that was interrupted by the COVID-19 pandemic, and a transition to what we can anticipate when we are able to gather at the University of Tennessee in Memphis, which we hope will happen in the spring of 2022!

Since our 2021 conference will be a virtual event, we decided to deviate from the intense 2-day format that works well when we all travel to be together in one place, but creates an unbearable experience of staring at our screens for far too many hours at a time! There will be three general sessions from 10 am to noon (Eastern) on Wednesday March 17th, Monday March 22nd, and Wednesday March 24th. Every day of that week, there will be a schedule of stand-alone 30-minute sessions during which the breakout sessions will be available! Attendees will be able to attend as many of the sessions as you wish – even every single one of them if you so desire!

We are in the process of setting up the details of this plan, and have been in touch with everyone who had an abstract accepted for 2020 so that they can select the time for their breakout session. There will be times available for a few additional breakout sessions, so we will be announcing additional abstract submissions soon.

If you registered for the 2020 conference and asked to have your registration held for the 2021 conference – you are all set, and you will receive confirmation of your registration soon. Registration for those who have not yet registered will be open by November 1st – so watch for details coming soon! Links to all of the conference activities will be available to those who register on an “honor system” basis!

Follow the Nursology Theory Conference website for details on abstract submissions, registration, and breakout sessions! Here are the details for the general sessions to wet your appetite for attending this series of important events!

Wednesday March 17, 10 am to noon (Eastern)
  • Panel discussion honoring the contributions of Rosemary Ellis
  • Keynote address by Patricia Davidson, PHD, MED, RN, FAAN. Professor and Dean, School of Nursing, Johns Hopkins University – topic: Is STEM and Nursing Theory an Oxymoron?
  • Open Discussion
Monday, March 22 – 10 am to noon (Eastern)
  • Student/Early-career Scholars Panel: Emerging Possibilities for the Focus of the Discipline
Wednesday, March 24 – 10 am to noon (Eastern)

The planning team members for 2021 are:

  • Leslie H. Nicoll, PhD, MBA, RN, conference planner extraordinaire! and Nursology.net management team member
  • Deborah Lindell, DNP, MSN, RN, CNE, ANEF, FAAN, Case Western Reserve Frances Payne Bolton School of Nursing faculty and Nursology.net management team. member
  • J. Carolyn Graff, PhD, RN, FAAIDD, University of Tennessee Memphis faculty
  • Wendy Likes, PhD, DNSc, APRN-Bc, FAANP, Dean, College of Nursing University of Tennessee Health Sciences Center
  • Peggy Chinn, RN, PhD, DSc(Hon), FAAN, Web manager for Nursology.net and NursingTheoryConference.com

Being True to Yourself: A Career as a Nurse Educator Guided by Critical Caring Pedagogy

Guest Contributor: Erin Dolen, MS, RN, CNE*

My career in nursing education has spanned the better part of a decade. For the majority of that time, I taught in an associate’s degree nursing program. At first, I was not sure if nursing education was for me. I was always a preceptor on the nursing units during my time in the hospitals, but that does not necessarily equate to being a good educator. After a semester, I was hooked. I found so much joy in showing my students not just how to do nursing, but how to be nurses. Forget “teaching to the test”! I would teach through experience, stories, relationships, respect, and caring.

Over the years, I thought I was developing into an expert nurse educator. I obtained my MSN, I passed my Certified Nurse Educator (CNE) exam, and I achieved quite a following among the student body. Until one day, it all changed. I was accused of being too personal, too attached to my stories and experiences, too outward in my sharing. I couldn’t understand why this faculty member was attacking me for being who I am, for valuing my relationship with my students, for giving them a part of me so they know I am human too. The lateral violence (let’s face it, that is what it was) became too much and I decided to move on to where I currently am, a baccalaureate nursing program.

My world has changed. I am now valued for giving my students everything that I have. For sharing not just my experiences but who I am as a person, a nurse, a mom, a friend. I care about them, and they know this. I want them to succeed beyond all ways they could imagine. I want them to learn from me; not just how to be a nurse but how to be someone who cares, who is empathetic, moral, ethical, a life-long learner, and is committed to the profession of nursing. Through my own education at Teacher’s College, Columbia University in the Online Nursing Education EdD program, now I know why. My whole nursing education career I have been guided by the Critical Caring Pedagogy (CCP).

CCP provides a framework for nursing education that, all at once, encompasses ontology, epistemology, ethics, and praxis (Chinn & Falk-Rafael, 2018). This framework consists of seven critical caring health-promoting processes: preparing oneself to be in relation, developing and maintaining trusting-helping relationships, using a systematic reflective approach to caring, transpersonal teaching-learning, creating and supporting sustainable environments, meeting needs and building capacity of students, and being open and attending to spiritual-mysterious and existential dimensions (Chinn & Falk-Rafael, 2018).

Isn’t this what I have been doing all along? All seven?! I have just come to the realization that my own practice as a nurse educator for the last decade has consisted of being in a caring and guiding relationship with my students, the foundation of CCP. I have been guided by a theory I had no formal knowledge of until now. And yet, I was faulted for it. Told I was giving too much of myself to my students. Told that I was to teach the material, not cultivate relationships. Told I made the two students out of HUNDREDS uncomfortable (yes, you guessed it, these students were academically unsuccessful and reaching for reasons for their appeal to be upheld). I almost gave up teaching. I knew I could not work in an environment that did not support my own values and approach to the teaching-learning relationship. Until I moved into my current position, where my foundation in CCP is respected, appreciated, and celebrated. To where my colleagues also practice with the guidance of CCP, whether they know it or not.

Now I can put into words what I have felt all along. Thank you, Peggy Chinn and Adeline Falk-Rafael, for providing the framework and empirics to support what I felt was the right way to teach deep down in my core. Critical Caring Pedagogy has given my teaching practice meaning and validity. I will carry this knowledge with me wherever I go, and I will never give up teaching.

Source

Chinn, P.L. & Falk-Rafael, A. (2018). Embracing the focus of the discipline of nursing: Critical caring pedagogy. Journal of Nursing Scholarship, 50(6), 687-694. Doi: 10.1111/jnu.12426

*About Guest Contributor Erin Dolen
E Dolen Picture

Erin is an Assistant Professor of Practice at Russell Sage College in Troy, NY. She is a doctoral student in the EdD Nursing Education Program at Teachers College, Columbia University. She has her MSN with a focus in Nursing Education from Excelsior College. Erin has her national certification as a Certified Nurse Educator. Her nursing background is in emergency medicine. She lives in Delmar, NY with her husband and two children.

Letter to the ANA

On September 26, 2020, the Nursology.net management team sent the following letter to the American Nursses Association, urging the organization to take a stand on the U.S. Presidential election candidates. We believe that given the dual pandemic of COVID-19 and racism, nursing’s strong voice of advocacy for the health of the nation must be heard. Here is the letter in its entirety:

September 26, 2020
Dr. Loressa Cole, ANA Enterprise CEO
Dr. Ernest J. Grant, President, ANA President
Dr. Debbie Hatmaker, Chief Nursing Officer, ANA Enterprise
American Nurses Association

Dear Drs. Cole, Grant and Hatmaker:


The Management Team of Nursology.net is writing to urge the American Nurses Association (ANA) to reverse its position against endorsing any candidate for President/Vice President in the 2020 election. We understand that the ANA reversed its previous policy to endorse presidential candidates based on the desire to “engage nurses in the voting process through providing accurate information and data and promoting nursing’s political advocacy role without alienating an entire contingency…acknowledging the reality of political polarization in this country” (ANA 2019 Membership Assembly Consideration of ANA’s Presidential Endorsement Process).

The recent draft of the document, Nursing’s Scope and Standards (2020), specifies nursing’s social contract with the public. The document includes nursing’s commitment to reject racism and promote equity and social justice for all. In addition, the document points to nursing’s accountability and responsibility to promote the health of all populations and to advocate for social and environmental justice, and access to high quality and equitable health care.

The proposed ANA Scope and Standards contradicts the ANA position against endorsing a presidential candidate if a particular candidate is a threat to equity, social justice, equitable healthcare and health for the population. While we respect that the Board made their decision thoughtfully, the current situation calls for a reconsideration based on the positions of the current administration that threaten public health. Scientific American, a journal who has never endorsed a candidate for president, has broken with their policy because of the dangerous anti-science views of the President

Today, the country needs to hear nursing’s voice related to this election from the ANA. We find ourselves in the midst of a perfect storm fueled by the mismanagement of a global pandemic, a health and environmental crisis from rampant fires, storms and floods attributed by scientists to climate change, and the public health crisis of systemic racism.

Many have referred to this election as the most consequential in recent history, certainly in our lifetimes. This is not the time for the nursing profession to sit out and fail to exercise our unified voice and moral authority. As the discipline focused on caring for the health and well-being of the people with an understanding of how the physical, social, political and economic environment influences health and well-being, and as the most trusted profession, the ANA must speak out against the policies of the current administration and endorse Joe Biden and Kamala Harris for President and Vice President. Please reconsider your position based on the actions taken by President Trump after your vote in 2019.

Here are a few reasons why we urge the ANA to reconsider and endorse the presidential ticket that is aligned with nursing values and actions and protects the public health:

  • The current administration’s lack of leadership to enact policies to stem the rising incidence of COVID-19 infections, including the President’s lack of providing timely information to the public that could have prevented thousands of infections and death
  • The current administration’s policies that have threatened accessibility to healthcare for millions of Americans by working to overturn the advances made through the ACA
  • The current administration’s position that denies human contributions to climate change and fails to support policies to abate its dangers.
  • The current administration’s lack of acknowledgement of the racial injustices experienced by people of color, especially Black people, at the hands of law enforcement.
  • The current administration’s policies of family separation at the border resulting in hundreds of children being placed in inhumane and dangerous conditions to their health and well-being.
  • The current administration’s lack of meaningful responsiveness to address the public health crisis of gun violence.

While the recommendations of the ANA’s Presidential Endorsement Process (2019) advocate for individual nurses to participate in election activities at the local, state and national levels and take advantage of educational opportunities to learn about the candidates that will inform their voting, nurses will look to the ANA for leadership, especially now. The ANA is the voice of the profession, and this is not the time for that voice to be silent. Without a unified position, the nursing profession is invisible, and the public trust in nursing’s commitment to protecting public health is compromised. Individual nurses can always vote their choice, but the unified voice of our profession is critical at this time in our history.

Please reverse your position and endorse the candidates that will advance policies that protect the health of the public. We cannot be silent. To be silent is to be complicit.

Thank you for your serious consideration of this request.

Respectfully,

Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN peggychinn@gmail.com

Jessica Dillard-Wright, MA, MSN, CNM, RN jdillardwright@gmail.com

Rosemary William Eustace, PhD, RN, PHNA-BC

Jacqueline Fawcett, RN, PhD, ScD(hon), FAAN, ANEF

Jane Flanagan, PhD, RN, ANP-BC, AHN-BC, FNAP, FNI, FAAN

Dorothy Jones, RN, PhD, FAAN

Deborah Lindell, DNP, MSN, RN, CNE, ANEF, FAAN, Deborah.Lindell@gmail.com

Chloe Olivia Rose Littzen, MSN, RN, AE-C

Leslie H. Nicoll, PhD, RN, FAAN leslie@medesk.com

Adeline Falk-Rafael, PhD, RN, FAAN afalk-rafael@rogers.com

Marlaine C. Smith, RN, PhD, AHN-BC, HWNC-BC, FAAN

Marian Turkel, RN, PhD, NEA-BC, FAAN

Danny Willis, DNS, RN, PMHCNS-BC, FAAN