It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

At the time of the 2021 Virtual Nursing Theory Week, Christina Nyirati and Sharon Stour-Shaffer presented the baccalaureate curriculum they designed and now implement at Heritage University located on the Yakama Reservation in Washington State. This is the only session that was recorded during the conference; it represents the value of nursing knowledge in shaping the present and future of nursing as a discipline. The following is a brief description and a video of their presentation.

The first Heritage University BSN Program Outcome reads “The Graduate of the Heritage University BSN Program explains how nursing’s fundamental patterns of knowing –personal, aesthetic, ethical, empirical and emancipatory –contribute to understanding the complexity of nursing care in the treatment of human response”.

Carper’s (1978) Fundamental Patterns of Knowing in Nursing is the foundation of the BSN Program. Freshmen study discrete courses in each of Carper’s fundamental patterns: personal, aesthetic, ethical, and empirical knowing. The Personal Knowing course is founded on personal knowing as a precondition for nursing care. Students practice various methods of reflection to develop personal knowing in every moment of nursing care. The Aesthetics of Nursing course is grounded in assumptions from Nightingale’s theory of nursing arts and aesthetics as a fundamental pattern of knowing in nursing. An experiential course, based in the principles of performing arts, the focus is on the act of care; Students explore and apply dramatic arts foundational to holistic nursing care competencies. The Ethical Knowing course emphasizes the practice of ethical comportment in nursing care. The Empirical Knowing course students introduces students to fundamental theories, concepts, evidence, and competencies pertaining to generation of nursing knowledge.

Senior year features the community as the unit of nursing care, and is founded on Chinn and Kramer’s (2019) emancipatory knowing in nursing. The Policy, Power & Politics of Nursing course focuses on the professional nurse role in taking responsibility for shaping social policy. The two Community Oriented Nursing Inquiry and Practice and the Community Based Participatory Research courses center on principles of socially just reflective action to overcome health inequities.

Faculty developed rubrics to evaluate how students integrate the fundamental patterns of knowing nursing into clinical practice. Students complete reflective writing assignments during clinical practice each semester from sophomore through senior year.

About the contributors:

Christina Nyirati, RN, PhD

Christina Nyirati is Professor of Nursing at Heritage University on the Yakama Nation Reservation in Washington, where she serves as the founding Director of the BSN Program. Dr. Nyirati came to Heritage from Ohio University and The Ohio State University, where she directed the Family Nurse Practitioner (FNP) Programs. She practiced more than 30 years as an FNP in primary care of vulnerable young families in Appalachian Ohio, and worked to reduce dire neonatal and maternal outcomes. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice. Now at Heritage Dr. Nyirati prepares nurses in an innovative undergraduate curriculum faithful to the epistemic foundations of nursing. Two cohorts have graduated from the Heritage BSN Program. They openly proclaim and use their powerful nursing knowledge to correct inequities in their communities.

Sharon Stout-Shaffer, PhD, RN

Sharon Stout-Shaffer, PhD, RN, Professor Emerita, Capital University, Columbus, Ohio; Adjunct Faculty, Heritage University, Toppenish, Washington; Nursing Education Specialist, S4Netquest, Columbus, Ohio. Sharon has over 30 years of experience in educational administration and teaching in both hospital and academic settings. Her career has focused on developing education based on a nursing model that includes concepts of holism and healing.

Her Ph.D. in Nursing from The Ohio State University focused on the psychophysiology of stress and relaxation-based interventions to promote autonomic self-regulation and immune function in people living with HIV. She has attained certification in Psychosynthesis, Guided Imagery, and more recently, the Social Resilience Model; she has presented numerous papers on integrating holism into curricula as well as caregiver wellbeing and resilience including Adelaide, Australia, 2011; Reykjavik, Iceland, 2015; American Holistic Nurses Association Phoenix, 2016 & Niagara Falls, 2018.

During her tenure as Director, Post-Graduate Programs at Capital University, Sharon taught the graduate theory course and co-developed a theoretically grounded holistic healing course as the foundation for graduate study; the graduate program has been endorsed by the American Holistic Nurses Credentialing Center. Since her retirement, she has co-developed and implemented numerous educational interventions designed to develop the Therapeutic Capacity of working nurses and nursing students. This work includes concepts of centering, compassion, managing suffering, the psychophysiology of resilience and essential contemplative practices to develop stress resilience, deal with moral distress and promote long-term wellness. She is currently teaching courses in Personal Knowing and Nursing Ethics for undergraduate nursing students at Heritage University. Her most recent publication is dedicated to holistic self-care and self-development. (Shields, D. & Stout-Shaffer, S. 2020). Self-Development: The foundation of holistic self-care. In Helming, M., Shields, D., Avino, K., & Rosa, W. Holistic nursing: A handbook for Practice (8th). Jones and Bartlett Learning, Burlington MA.)

Theorizing as Emancipatory Action; Emancipatory Action as Theorizing

Over the past year those of us managing the Nursology.net website have experienced two unintended consequences – growing awareness of the importance of fundamental nursing/ public health knowledge and action, and the imperative to examine the structural and interpersonal dynamics of racism. As the web manager of this Nursology.net site as well as the NurseManifest.com website, the home of “Overdue Reckoning on Racism in Nursing,” I have had a front-row seat from which to witness and participate in these two complimentary processes.

From the NurseManifest sphere, we have addressed (explicitly and implicitly) questions such as: “How does our activism contribute to our discipline?” “What are the fault-lines in nursing created by our failure to address racism in nursing?” “How can we engage in authentic reckoning with racism in nursing?” “How can this reckoning shift nursing to more fully engage in facilitation of humanization for those who have historically been harmed by racism?” “How can nursing knowledge be decolonized to fully embrace the knowledge and wisdom of Black, Indigenous, Latina/x, and other nurses of color?”

From the Nursology.net sphere, we have addressed (explicitly and implicitly) questions such as: “What does decolonization of nursing knowledge mean?” “What dynamics have persisted to bring us to this point in history where the scholarship and theorizing of Black, Indigenous, Latina/x and other nurses of color are strikingly absent from our historical record?” “How can we move away from performative action, to fully abandon white privilege in nursing, and to welcome nurse scholars of color to the center of our discourse?”

I do not have direct answers to any of these questions. In fact I believe there are no specific “action” prescriptions that can provide “answers.” The response to all of these questions is what I believe to be critical emancipatory process — a process that begins with a recognition of the fundamental realities of racism and dedication to the hard work of deepened awareness and action for change. In the first chapter of the text “Philosophies and Practices of Emancipatory Nursing,”(1) Kagan, Smith and Chinn identified the following characteristics of emancipatory knowledge and critical theory that informs emancipatory action, as revealed by the chapter authors who contributed to the text:

What is “critical’ –

  • Unpacking hegemonies
  • Upstream thinking
  • Interrogating historical/social context
  • Framing/anticipating transformative action

What is “emancipatory”

  • Facilitating humanization
  • Disrupting structural inequities
  • Self-reflection
  • Engaging communities

Taken together, these characteristics point to a deep understanding of what it might mean to bring knowledge and action together as one – the process and understanding that emerges from “knowing what we do, and doing what we know.” In my experience growing up and becoming an “elder” as a fully colonized white woman, I know all too well the experience of separation of mind and body, of understanding and experience. But there is a glimmer of recognition when I encounter instances – my own and those revealed to me in stories others recount – when experience and understanding come together as one – when we recognize the importance of personal knowing and doing. And, recognize when that unified experience reveals new knowledge, new understanding. This process of action/reflection is theorizing at its best. African American scholar Anthony James Williams described this process of theorizing that he observed in his mother and grandmother:

Everyday black women theorists are often forgotten, undervalued and rarely considered theorists due to their lack of formal training and scholarly publications. But for my maternal lineage, the social patterns they observed became lessons. Those lessons then became theories about the social world they incorporated into their daily lives. Keen observation on their part lead to mental maps of where it would be safe to walk as black women, raise their children and avoid white violence. As the wife of a man in the military, my grandmother inevitably had her own theory of residential redlining based on her lived experience well before any academics published on the topic. (2)

Now is the time to engage in the critical emancipatory act of centering the voices of nurses of color who have been undervalued and discounted, only rarely recognized as theorists. The privileged white gaze from which nursing scholarship views the world recognizes only that which appears consistent with white experience, white culture. To face the realities surrounding white complicity that perpetuates racism is a possibility that is either far too frightening, or simply not comprehensible. But comprehend we must if we are to ever move to a reality where all experience is celebrated as valid and valuable, where skin color is not a determinant of whether you live or die.

The time has now come for all in our discipline – nursologists, nurses, students, educators, administrators, policy-makers – to make a strong and unequivocal turn away from all words and actions that render advantage for those whose skin is “white” and that disadvantage all of those with dark skin. It is time to abandon performative words and actions that claim to care for all, and turn instead to dismantle dehumanizing forces of racism and restore full humanization for all. For those who have white skin, it is time to reckon with your own complicity, unveiling the fault-lines (rifts, splits) created by the persistence of racism, and engage in the healing that must be done. For those who have dark skin, it is time to gather the courage to speak your truth, calling on your keen capabilities to discern injustice. For all of us together, it is time to form strong bonds of connection and support for this difficult path. It is a difficult path, but it is the path that will lead us to mental maps – to theorizing the healing that must take place. As we have experienced in our “Overdue Reckoning on Racism in Nursing” journey, it is also a path that is lined with moments of pure joy!

Sources:

  1. Kagan, P. N., Smith, M. C., & Chinn, P. L. (2014). Introduction. In P. N. Kagan, M. C. Smith, & P. L. Chinn (Eds.), Philosophies And Practices Of Emancipatory Nursing: Social Justice As Praxis (pp. 1–20). Routledge Taylor & Francis Group.
  2. Williams, A. J. (2018, June 15). Who Teaches Academics to Theorize? Inside Higher Ed. https://www.insidehighered.com/advice/2018/06/15/theorizing-black-scholars-differs-white-western-academic-standards-no-less-valid

Guest Post: Decolonizing the Language of Nursology

Contributor: Daniel Suárez-Baquero
Scroll down for Spanish language version of this post

ENGLISH

Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.

The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.

It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).

I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.

I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.

Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science

SPANISH

La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.

Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.

Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).

Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.

Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.

REFERENCES/REFERENCIAS

References

Ayala, R. A. (2020). Towards a Sociology of Nursing. In Towards a Sociology of Nursing. Springer Singapore. https://doi.org/10.1007/978-981-13-8887-3

Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2).
Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175

Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903

About Daniel Suárez-Baquero

Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.

Nursing is a Discipline–Donaldson and Crowley Notable Work

Notable Works

The first time that I understood that nursing – what we now call nursology (Fawcett, 2018; Fawcett et al., 2015) – is a discipline was in 1978 when I read the just published Donaldson and Crowley’s now classic journal article, “The discipline of nursing.” My pride in what we are has always been great, so realizing that we are members of a discipline increased my pride from great to greater. I should note that at the time of publication of the Donaldson and Crowley (1978) paper, I did not know about Moore’s 1968 paper, “Nursing: A scientific discipline?” which certainly was due to my admittedly sloppy scholarship!

Sue Donaldson

As I continued to think about nursology as a discipline, I realized I needed to determine the accepted definition of the word. I found that the term, discipline, comes from the Latin disciplina, meaning a branch of instruction or learning (Stein, 1966). Disciplines are distinguished by the subject matter of interest to its members (Schwab, 1962; Walton & Kuethe, 1963). Disciplines are a way of organizing knowledge; they have utility as administrative structures for education.

Donaldson and Crowley’s (1978) article is especially important for their telling us what we are all about. They pointed out, “At least since the time of Nightingale, there has been a remarkable consistency in the recurrent themes that [nursologist] scholars use to explain what they conceive to be the essence of the core of [nursology].” (p. 113). They identified the three general themes listed below. So influential were these themes to me that they became the first version of the relational propositions for my version of our disciplinary metaparadigm (Fawcett, 1984).

*Concern with principles and laws that govern the life processes, well –being, and optimum functions of human beings—sick or well

*Concern with the patterning of human behavior in interaction with the environment in critical life situations

*Concern with the processes by which positive changes in health status are affected. (Donaldson & Crowley, 1978, p 113)

Donaldson and Crowley (1978) identified two types of disciplines– academic and professional. They maintained that nurses (nursologists) are members of a professional discipline and, as such, nursologists have a social mandate to not only develop and disseminate knowledge, but also to use the knowledge in service to human beings. Members of academic disciplines, in contrast, develop and disseminate knowledge but do not have a social mandate to use the knowledge in service to anyone or anything.

Donaldson and Crowley’s (1978) claim that we are members of a professional discipline led me to search for a definition of a profession. I found that the term, profession, refers to a vocation requiring knowledge of some branch of learning (Stein, 1966). Obviously, the emphasis in the definitions of both discipline and profession is knowledge.

As can be seen in the diagram below, which was inspired by Donaldson and Crowley’s (1978) ideas about a professional discipline, I envision the components of the professional discipline of nursology to be science and the profession. For nursology, science encompasses eight types of knowledge—empirical, aesthetic, ethical, personal knowing, sociopolitical, emancipatory, spiritual, and unknowing, too (Carper, 1978; Chinn & Kramer, 2018; Munhall, 1993; White, 1995; Willis & Leone-Sheehan, 2019). Discovery and dissemination of knowledge is accomplished by means of the conduct and publication of the results of scholarly inquiry, including basic, applied, and clinical research (Donaldson & Crowley, 1978), as well as translational research (Wendler et al., 2013). Utilization of knowledge is accomplished by means of implementing the results of translational research into clinical practice activities as well as into educational programs and administration of nursology services.

The double-headed arrows in the diagram indicate that there is a reciprocal relation between science and the profession; between discovery and dissemination of knowledge and utilization of that knowledge; and between scholarly inquiry and practice. Ultimately, the results of utilization of disciplinary knowledge in practice are used to advance the scholarly inquiry that is required for further discovery and dissemination of knowledge.

Moore (1968) and Donaldson and Crowley (1978) indicated that scholarly inquiry guides practice. Thus, the starting point for the reciprocal relation between scholarly inquiry and practice always is scholarly inquiry. Some nursologists may disagree, maintaining that ideas for scholarly inquiry arise from problems encountered in practice. However, Donaldson and Crowley (1978) maintained that “the discipline of [nursology] should be governing clinical practice rather than being defined by it” (p. 118). They went on to explain,

Of necessity, clinical practice focuses on the individual in the here and now who has a problem requiring relevant and appropriate actions. The discipline, in contrast, embodies a knowledge base relevant to all realms of professional practice and which links the past, present and future. Its scope goes far beyond that required for current clinical practice. If the discipline were so narrowly defined, professional [nursology] could be limited to functioning in the realm of disaster relief rather than serving as a force in the promotion of world health. (p 118)

The major impact of Donaldson and Crowley’s (1978) artice is that understanding and recognizing that nursologists are members of a discipline provides the rationale for our place in the academy of higher education among other widely and long-recognized disciplines. Moreover and perhaps most important, are Donaldson and Crowley” (1978) closing words:

For the continued growth, significance, and utility of the discipline of [nursology], researchers must place their research within the context of the discipline. Theories must also be viewed in terms of the basic structural conceptualizations of the discipline [i.e., our nursology conceptual models]. The responsibility for revising and clarifying the structural conceptions, the very framework, of the discipline of [nursology] rests with [nursologist] researchers. This means lessening our preoccupation with the process of [nursology practice] and pedagogy and placing emphasis on content as substance. (p. 120).

Content as substance was, of course, the reason for creation of nursology.net.

References

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

Chinn, P. L., & Kramer, M. K. (2018). Knowledge development in nursing: Theory and process (10th ed.). Elsevier Mosby.

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26(2), 113-120

Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16(3), 84 87.Fawcett, J. (2018, September 24). Our Name: Why Nursology? Why .net? nursology.net.. https://nursology.net/2018/09/24/our-name-why-nursology-why-net/

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L, Mtengezo, J. T., Muchira, J. M., Nava, A., Thapa, S., & Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224

Moore, M. A. (1968) Nursing: a scientific discipline? Nursing Forum, 7(4), 340-348. (Reprinted Nursing Forum, 1993, 28(1), 28-31.)

Munhall PL. (1993). “Unknowing”: toward another pattern of knowing in nursing. Nursing Outlook, 41(3), 125–128.
Schwab, J. (1962). The concept of the structure of a discipline. Educational Record, 43(July), 197-204.

Stein, J. (Ed.). (1966). The Random House dictionary of the English language (Unabridged ed.). Random House.

Walton, J., & Kuethe, J. L. (Eds.). (1963). The discipline of education. University of Wisconsin Press.

Wendler, M. C., Kirkbride, G., Wade, K., & Ferrell, L. (2013). Translational research: A concept analysis. Research & Theory for Nursing Practice, 27(3), 214–232. DOI: 10.1891/1541-6577.27.3.214

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

Willis, D. G., & Leone-Sheehan, D. M. (2019). Spiritual knowing; Another pattern of knowing in the discipline. Advances in Nursing Science, 42(1), 58-68. doi: 10.1097/ANS.0000000000000236

Winning Essay – “Bringing Florence Nightingale to the Bedside of the Critically Ill Patient”

In celebration of the bicentenary of Florence Nightingale’s birth, the Nursing Archives Associates of the Boston University Libraries’ Howard Gotlieb Archival Research Center held an essay contest, open to nursing students enrolled at all levels of study— undergraduate, master’s and doctoral – and focused on Florence Nightingale’s influence on the evolution of nursing, both historical and contemporary. Although all Nightingale 2020 events were postponed due to the COVID-19 pandemic, we are proud to announce the winner of the Muriel A. Poulin Nursing Student Essay Contest.

The winning essay is titled “Bringing Florence Nightingale to the Bedside of the Critically Ill Patient,” written by Laura Beth Kalvas, MS, RN, PCCN, Graduate Fellow, The Ohio State University College of Nursing. Here is the essay:

In her Notes on Nursing (1969), Florence Nightingale argued that nature alone can cure the sick. Cautioning against an over-reliance on medical care, which could do nothing more than remove obstructions to the natural healing process, Nightingale encouraged nurses to put patients in the best possible conditions for nature to act upon them. Her environmental theory highlighted the importance of cleanliness, ventilation, limited noise, uninterrupted sleep, proper nutrition, and sunlight in promoting recovery of the sick (Hegge, 2013; Nightingale, 1969). Within this perspective, the role of the nurse was to provide an environment conducive to healing, support the patient in the healing process, and carefully observe the patient for signs of improvement or decline.

Certainly when Nightingale cautioned against an over-reliance on medical care, she could little have imagined the treatments and technology available today, especially in the care of the critically ill. Yet her careful distinction between the practice of medicine and the practice of nursing remains relevant. In the complex critical care environment, where medical treatments are frequently lifesaving, what unique contribution does the nurse bring to the care of the critically ill patient? I would argue that the role of the critical care nurse remains the same; to put the patient in the best possible condition for nature to act upon them (Nightingale, 1969). Yet “so deep-rooted and universal is the conviction that to give medicine is to be doing something, or rather everything; to give air, warmth, cleanliness . . . is to do nothing” (p. 9), that this important aspect of nursing practice is easily undervalued.

The phenomenon of pediatric delirium offers an interesting case study in the importance of high-quality nursing care in the modern intensive care unit. Delirium is a frequent, significant complication of critical illness consisting of acute changes in mental status that develop over a short period of time and fluctuate throughout the day (American Psychiatric Association, 2013). Up to 65.5% of children in the pediatric intensive care unit (PICU) experience delirium (Meyburg et al., 2017). Affected children exhibit signs of impaired attention, disorientation, agitation, hallucinations, and sleep/wake cycle disturbance (Holly et al., 2018). Children describe their delusional memories of the PICU as highly disturbing, including visual hallucinations of injured
parents, monsters trying to eat them, and insects crawling on the walls (Colville et al., 2008). Furthermore, pediatric delirium is associated with poor clinical outcomes, including increased length of stay (Smith et al., 2017), cost of care (Traube et al., 2016), and mortality (Traube et al., 2017).

Although delirium has only recently caught the attention of the pediatric critical care community (Kudchadkar, Yaster, et al., 2014), it is not a new phenomenon. Through her observations, Nightingale (1969) noted that lack of sunlight, excessive noise, and fragmented sleep were associated with delirium. Today’s pediatric critical care environment is characterized by excessive light and sound exposure and frequent nighttime caregiving (Al-Samsam & Cullen, 2005; Cureton-Lane & Fontaine, 1997). This environment likely contributes to the altered sleep patterns experienced by critically ill children (Kudchadkar, Aljohani, et al., 2014). Providing support for Nightingale’s (1969) early observations, we now know that these environmental exposures and resulting sleep disruption can impair cognitive function (e.g., attention, working memory, emotional regulation; Durmer & Dinges, 2005; Kahn et al., 2013) and disrupt the circadian rhythm of melatonin release, which has neuroprotective properties (Claustrat et al., 2005). Environmentally-induced circadian rhythm dysregulation is one hypothesized pathway to the cognitive changes observed in delirium (Maldonado, 2017), and sleep/wake cycle disturbances are often observed in children with delirium (Holly et al., 2018).

Nurses are uniquely positioned at the bedside to prevent delirium through environmental modification and regulation of the circadian rhythm; interventions which place the patient in the best possible conditions for recovery (Nightingale, 1969). Sleep promotion interventions in the adult ICU are associated with a decreased incidence and duration of delirium (Kamdar et al., 2013; Patel et al., 2014). However, few researchers have considered the role of sleep in the development of pediatric delirium (Calandriello et al., 2018), and few pediatric critical care clinicians implement sleep-promoting interventions to prevent or manage delirium (Kudchadkar, Yaster, et al., 2014; Staveski et al., 2018). Nurse scientists are needed in the medically-dominated field of pediatric delirium research to highlight the important role of the critical care nurse in preventing and managing delirium (Balas et al., 2012).

As a doctoral nursing student, my interest in pediatric delirium is driven both by Nightingale’s (1969) mandate to the nursing profession and the Human Response Model, a conceptual model for nursing that depicts the complex interplay between the patient, their environment, and their health (Heitkemper & Shaver, 1989; Shaver, 1985). My dissertation work focuses on the relationship between exposures in the pediatric critical care environment (i.e., light and sound exposure, caregiving patterns), sleep disruption, and delirium in young, critically ill children. I chose to focus on PICU environmental exposures and sleep patterns because they are inherently nurse-driven; as the primary bedside caregiver, the nurse determines the type of environment in which children receive treatment. This dissertation study will inform future large-scale stu dies of sleep disruption and pediatric delirium, as well as the design and implementation of sleep promotion interventions for the PICU. The validation of sleep promotion as an effective, nurse-driven, non-pharmacological delirium prevention method has the potential to improve the neurocognitive symptom management and clinical outcomes of survivors of pediatric critical illness.

In my future work as a nurse scientist, I will continue to root my research in the ideals espoused by Nightingale in her Notes on Nursing (1969). My long-term career goal is to become a leader in improving the neurocognitive symptom management, clinical outcomes, and long-term health of critically ill children by optimizing the pediatric critical care environment. In today’s complex critical care setting, full of advanced treatments and lifesaving technology, let us never forget the unique role of the nurse: To place critically ill patients in the best possible intensive care environment to receive life saving treatment, heal, and promote long-term health.

References

Al-Samsam, R. H., & Cullen, P. (2005). Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients. Pediatric Critical Care Medicine, 6(5), 562–7.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012). Critical care nurses’ role in implementing the “ABCDE bundle” into practice. Critical Care Nurse, 32(2), 35–8, 40–7; quiz 48. https://doi.org/10.4037/ccn2012229

Calandriello, A., Tylka, J., & Patwari, P. (2018). Sleep and delirium in pediatric critical illness: What is the relationship? Medical Sciences, 6(4), 90. https://doi.org/10.3390/medsci6040090

Claustrat, B., Brun, J., & Chazot, G. (2005). The basic physiology and pathophysiology of melatonin. Sleep Medicine Reviews, 9(1), 11–24. https://doi.org/10.1016/J.SMRV.2004.08.001

Colville, G., Kerry, S., & Pierce, C. (2008). Children’s factual and delusional memories of
intensive care. American Journal of Respiratory and Critical Care Medicine, 177(9), 976–982. https://doi.org/10.1164/rccm.200706-857OC

Cureton-Lane, R. A., & Fontaine, D. K. (1997). Sleep in the pediatric ICU: an empirical investigation. American Journal of Critical Care, 6(1), 56–63.

Durmer, J. S., & Dinges, D. F. (2005). Neurocognitive consequences of sleep deprivation. Seminars in Neurology, 25(1), 117–129. https://doi.org/10.1055/s2005-867080

Hegge, M. (2013). Nightingale’s Environmental Theory. Nursing Science Quarterly, 26(3), 211–219. https://doi.org/10.1177/0894318413489255

Heitkemper, M. M., & Shaver, J. F. (1989). Nursing research opportunities in enteral nutrition. The Nursing Clinics of North America, 24(2), 415–26.

Holly, C., Porter, S., Echevarria, M., Dreker, M., & Ruzehaji, S. (2018). Recognizing delirium in hospitalized children: A systematic review of the evidence on risk factors and characteristics. American Journal of Nursing, 118(4), 24–36. https://doi.org/10.1097/01.NAJ.0000532069.55339.f9

Kahn, M., Sheppes, G., & Sadeh, A. (2013). Sleep and emotions: Bidirectional links and
underlying mechanisms. International Journal of Psychophysiology, 89(2), 218–228. https://doi.org/10.1016/j.ijpsycho.2013.05.010

Kamdar, B. B., King, L. M., Collop, N. A., Sakamuri, S., Colantuoni, E., Neufeld, K. J., Bienvenu, O. J., Rowden, A. M., Touradji, P., Brower, R. G., & Needham, D. M. (2013). The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Critical Care Medicine, 41(3), 800–9. https://doi.org/10.1097/CCM.0b013e3182746442

Kudchadkar, S. R., Aljohani, O. A., & Punjabi, N. M. (2014). Sleep of critically ill children in the pediatric intensive care unit: A systematic review. Sleep Medicine Reviews, 18(2), 103–110. https://doi.org/10.1016/j.smrv.2013.02.002

Kudchadkar, S. R., Yaster, M., & Punjabi, N. M. (2014). Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: A wake-up call for the pediatric critical care community. Critical Care Medicine, 42(7), 1592–1600. https://doi.org/10.1097/CCM.0000000000000326

Maldonado, J. R. (2017). Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International Journal of Geriatric Psychiatry, 1-30 https://doi.org/10.1002/gps.4823

Meyburg, J., Dill, M. L., Traube, C., Silver, G., & von Haken, R. (2017). Patterns of postoperative delirium in children. Pediatric Critical Care Medicine, 18(2), 128–133. https://doi.org/10.1097/PCC.0000000000000993

Nightingale, F. (1969). Notes on nursing: What it is and what it is not. Dover Publications, Inc.

Patel, J., Baldwin, J., Bunting, P., & Laha, S. (2014). The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia, 69(6), 540–549. https://doi.org/10.1111/anae.12638

Shaver, J. F. (1985). A biopsychosocial view of human health. Nursing Outlook, 33(4), 186–91.

Smith, H. A. B., Gangopadhyay, M., Goben, C. M., Jacobowski, N. L., Chestnut, M. H., Thompson, J. L., Chandrasekhar, R., Williams, S. R., Griffith, K., Ely, E. W., Fuchs, D. C., & Pandharipande, P. P. (2017). Delirium and benzodiazepines associated with prolonged ICU stay in critically ill infants and young children. Critical Care Medicine, 45(9), 1427–1435.
https://doi.org/10.1097/CCM.0000000000002515

Staveski, S. L., Pickler, R. H., Lin, L., Shaw, R. J., Meinzen-Derr, J., Redington, A., & Curley, M. A. Q. (2018). Management of pediatric delirium in pediatric cardiac intensive care patients: An international survey of current practices. Pediatric Critical Care Medicine, 19(6), 538–543.
https://doi.org/10.1097/PCC.0000000000001558

Traube, C., Mauer, E. A., Gerber, L. M., Kaur, S., Joyce, C., Kerson, A., Carlo, C., Notterman, D., Worgall, S., Silver, G., & Greenwald, B. M. (2016). Cost associated with pediatric delirium in the ICU. Critical Care Medicine, 44(12), e1175–e1179. https://doi.org/10.1097/CCM.0000000000002004

Traube, C., Silver, G., Gerber, L. M., Kaur, S., Mauer, E. A., Kerson, A., Joyce, C., & Greenwald, B. M. (2017). Delirium and mortality in critically ill children: Epidemiology and outcomes of pediatric delirium. Critical Care Medicine, 45(5), 891–898. https://doi.org/10.1097/CCM.0000000000002324

Guest Post: Restriction of Visits to Hospitalized Child? An Emerging Need for Theory-Informed Nursing Intervention during Pandemic

Contributor: Ana Filipa Paramos

In Portugal during the pandemic crisis, we have made it impossible for the family to be present during the child’s hospitalization, resulting in increased levels of separation anxiety and stress, with potential negative consequences for the child’s recovery process. Let’s talk about a specific case of a child with a prolonged hospital stay in the middle of a pandemic and unable to have his father visit during the hospitalization. The little boy was accompanied by his mother, but the family nucleus of this child includes his mother and father. Did they speak by cell phone? Yes, they did, but the physical presence and eye contact are not replaceable by a phone call. One afternoon of that long hospitalization, I found the child angry, crying and looking away from our approach, as if he almost blames us for the impossibility of the father being present during the hospitalization. I wondered how we could make this situation less stressful and anxious for the child.

The adoption of a humanistic approach through the use of the Humanistic Theory of Nursing proposed by Josephine Paterson and Loretta Zderad was needed. According to Paterson and Zderad (2007), nursing is seen as an experience lived among human beings that responds to a human need. This theory requires the recognition of the human being as a unique being, endowed with his singularity and, simultaneously, that there is an understanding of the individual characteristics, experiences and needs of each patient (Paterson & Zderad, 2007). Through the dialogue established between me and the child, I understood that his father’s visit was extremely important for the child, since he had a very strong connection with the father.

During our dialogue, there were tears, uncontrollable tears in the child’s eyes. Unable to allow the father’s entry, I asked myself, “How will I be able to respond to this child’s needs?” It was at that precise moment that we decided to place the child’s bed next to the window, allowing the child to establish eye contact with his father, that long awaited and desired eye contact. Immediately after the father’s visualization, a smile and happiness emerged in the child. This contact allowed the immediate decrease in the levels of separation anxiety experienced by the child.

© 2021 Ana Filipa Paramos
Child’s bed next to the window, allowing the child to establish eye contact with his father

in Humanistic Nursing Theory, the concept of nursing does not only address patients’ wellbeing but also patients’ better being, helping them to make the health/disease situation experience as human as possible (Paterson & Zderad, 2007). We must remember that each patient is a person with needs, anxieties, fears and desires that have to be met, regardless of whether we are in the middle of a pandemic or not. We have to try to make the hospitalization experience as less stressful and as comfortable as possible for the patient and, in this case, the father’s visit was an emerging need of this child. Not being a normal visit, the establishment of eye contact through the window was the closest it could be, and it brought immediate happiness to the child. I heard the word “thank you” associated with a look of tenderness and tranquility. Unable to show my smile behind the mask, my eyes shone, and a tear appeared in the corner of my eye, such was the happiness I also experienced at the moment. My experience with the child was an enriching moment for both of us and allowed us both to develop, becoming more and better, of that I have no doubt. We cannot forget that times are difficult and challenging for everyone, but the experiences lived with the patients cannot be put aside in our daily nursing practice.

References

Kleiman, S. (2010). Josephine Paterson and Loretta Zderad’s Humanistic Nursing Theory. In M.E. Parker & M. C. Smith (Eds.), Nursing Theories and Nursing Practice (3rd ed, pp. 337–350). Philadelphia: F.A. Davis Company.

Paterson, J., & Zderad, L. (2007). Humanistic Nursing. http://www.gutenberg.org/ebooks/25020

Wolf, Z. R., & Bailey, D. N. (2013). Paterson and Zderad’s Humanistic Nursing Theory: Concepts and Applications. International Journal of Human Caring, 17(4), 60–73. https://doi.org/10.20467/1091-5710.17.4.60

About Ana Filipa Paramos

I have finished my Nursing Degree in 2016, at Escola Superior de Enfermagem de Lisboa (ESEL). In 2016, I started working as a general nurse at Centro Hospitalar Lisboa Central, more specifically at Hospital Dona Estefânia. From 2016 to 2019 I worked at the pediatric surgery/ pediatric burn unit and in the beginning of the pandemic, I have integrated the pediatric respiratory unit/ COVID, where I currently am.

In 2020 I entered the Master Nursing Course of the Health Sciences Institute of Universidade Católica Portuguesa (Lisbon). This post was made in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).

Guest post: The privilege of agency: The political shortcomings of nursing theory

Contributor: Mike Taylor

The four metaparadigm concepts of nursing knowledge have been human beings, environment, health and nursing process; with the state of the person at the center of the definition and achievement of health goals. The idea that an individual has the wherewithal, not only in name but also but also in action, to determine what health means for them as an individual and is able to work to accomplish those same goals is the concept of agency. Among nursing’s most referenced conceptual models and theories — Orem, Parse, Newman and Roy — keep the focus of nursing’s work on the individual before us, and much less of a consideration is on the environment the person inhabits. Newman (1979) for example states that the goal of nursing “is to assist people to utilize the power that is within them as they evolve toward higher levels of consciousness” (p. 67)  The concept of individual agency is central even in theories about the praxis of nursing such as Watson’s theory of human caring where the nurse/patient dyad “is influenced by the caring consciousness and intentionality of the nurse as she or he enters into the life space … of another person. It implies a focus on the uniqueness of self and other…” (https://www.watsoncaringscience.org/jean-bio/caring-science-theory/)

Sourcehttps://www.coe.int/en/web/interculturalcities/systemic-discrimination

Agency is not something that is naturally given to a person but emerges from the process of human development. That process is frequently affected  by poor schools, environmental pollution, and the other mediators of institutional racism and poverty. The chances of an individual reaching full agency, meaning the ability to identify and actualize individual health goals,  in adulthood are much more likely when those limiting factors are not present due to privilege. Even when an individual is able to overcome early life challenges, the social environment where agency can be exercised, there are limits on who can participate based on class, race, and gender. These limitations on the exercise of agency extend to persons who either want to or are actively practicing the profession of nursing. Even when a person can overcome the intersecting influence of race, poverty and gender to become a nurse; the same barriers remain in the practice environment often limiting choice of practice arena and opportunities for advancement to leadership roles.

Nursing theory is right to place individual agency at the center of the health improvement process, but it does not address the uneven distribution of that agency and the effect that has on health. Agency is only possible where it is allowed and when individuals in disadvantaged communities  do not have the inability to develop or exercise agency, the disparities in health outcomes we see today are the result. For nursing theory to meet these health challenges it must develop beyond a focus on individual agency to an emphasis on the social and environmental conditions that limit health improvement which means challenging institutional racism and poverty among others.

To develop the concept of agency in nursing and challenge existing social barriers, I believe that it would be instructive to align the development and exercise of agency with concepts of intersectionality. An important question might be can any correlation be found between the intersectionality and the degree of effective agency as reflected in an individual’s agency and the available social environments where that agency can be exercised. My anticipation is that it would be an inverse correlation with effective agency decreasing as the number of overlapping disadvantages increase. 

Sources

Newman, M., (1979). Theory development in nursing. F.A. Davis. https://openlibrary.org/books/OL4409082M/Theory_development_in_nursing 

Caring Science & Human Caring Theory, Transpersonal Caring and the Caring Moment Defined https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

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.

Virtual Nursing Theory Week – A Landmark Success!

Q – How on earth can we have a dynamic theory conference with 70 breakout sessions – on Zoom?

A – We are nurses — we will find a way!

And find a way we did!

Thanks to the amazing leadership and expert organizing skills of Leslie Nicoll (Editor of CIN: Computers Informatics Nursing), we found a way! Every day from March 17th through March 23rd, 140 nurses tuned in to one or more of the sessions scheduled throughout the week. There were three general sessions – one on the first day of the conference, another on the 6th day, and the final on the last day to close the week. The remaining sessions were 30-minute long “breakout” sessions based on the abstracts that had been submitted for the 2020 conference that had to be canceled due to the COVID pandemic. The presenters and attendees ranged from students and early-career scholars – to well-established and well-known nurse theorists. You can browse the detail of all of the sessions here!

Even though we are over a year into “pandemic culture” when everything has gone virtual, the technical challenges of doing this were huge. After all, we are not instructional technology experts! But Leslie organized each and every detail of the conference, and discovered a wonderful technology expert to give support for all technology aspects of the conference – Ray Harwood of Goodclix. Ray was tuned in to every moment, always ready to step in and solve each technical challenge, but also engaged with us to help make each session run smoothly for each presenter and for all of us attending. Ray says on his website: “Frankly, it’s not what I do, it’s how I do it that counts” – and nothing could be more true!

To compensate for the disappointment of the canceled 2020 conference and taking advantage of the virtual capabilities, Leslie laid out a daily schedule with no overlap in the breakout sessions, so that speakers had a full 30 minutes for their breakout sessions, and attendees were able to attend every single one of the sessions! Of course, hardly anyone was able to do this – but for those of us who were present for every session (or almost all), every moment was interesting – and also inspiring!

Top left clockwise: Brandon Blaine Brown, Chloe Littzen-Brown, Jane Hopkins-Walsh, Claire Valderama-Wallace, Patrick McMurray – Panelists in the March 22nd general session addressing “The Focus of the Discipline Reimagined from an Emancipatory Lens.”

Here are a range of comments and responses from the evaluations:

This conference was the most enriching and enlightening conference that I had attended in a long time. This is a great contribution to the growth of the profession.

You did an excellent job and I was surprised and pleased by the breadth of the presenters and the depth of some of the discussions. I loved hearing what the other nursologists were doing and it gave me hope to see nursology being supported and growing!

Holding it on zoom and for an entire week was just too much. We are already zoom fatigued and while you had no option, I think the conference would have been manageable if shorter duration. Our lives at our home offices don’t stop for virtual conferences; if we were on site, we could focus better and not worry about home duties. All conferences are experiencing this, I realize. Thank you for all your good work. 

In person conference would be better. If it is virtual, should be condensed, not so spread out, I appreciate your efforts. I know this zoom presentations are all new for everyone

It would be nice to have a remote option for next year

Ray was very supportive. The richness of this conference was incredible!

Structured well, solid content, great dialogue

This is just a busy time for me. The planning and program for this were excellent. I’ve heard from many how much they enjoyed this. I’m glad I have guidebook to look up what I missed. Really excellent work on this. I do like that it was on zoom. I am finding organizational memberships and conferences to be costly so I like this zoom as an option.

Let us think about a virtual nursing theory week every other year and an in person conference the other alternate year. I would not want to lose what we had with this VNTW by always having in person conferences. Or perhaps we can have a virtual component to in person conferences, so that colleagues who cannot travel can still participate.

I did not expect to enjoy the conference as much as I did. I learned so much. Not only about theory, also about who I am and ways that I could use nursing theory to informed nursing education and clinical practice. I liked not having to choose between two or more workshops.

I have loved the zoom format. I am surprised at the depth of connections with my colleagues through this format.

Awesomeness! Inspiring! Hope for the Future of Nursology!

If the next conference is offered in a hybrid format, I will definitely attend. I hope that it is and I highly encourage this conference to remain in some form of virtual format. This material is critical to the future of nursing as a discipline. 

So now — we trust the we will be able to gather in person at the University of Tennessee Health Science Center College of Nursing! We will post information here on Nursology.net, and on the Nursology Nursing Theory website – so stay tuned and join us in Memphis!

Practice and Research Speak: The Words We Use to Describe Ourselves and Others

In March 2020, I posted a blog about the meaning of words used to describe the extent to wish a person’s (patient or client) behavior does not comply with, adhere to, or is concordant with what has been prescribed by nursologists or physicians. In December 2020, I posted a blog about the meaning of words researchers use in their research reports, such as allow, respondents, and informants. In these blogs, I pointed to the power differential that is implied in the use of these words. In the first blog, I asked why do we use compliance, adherence, and even concordance instead of a term that more accurately reflects relationship-based care; and in the second blog, why do we use allow rather than invite, and why do we use respondent or informant rather than people.

The purpose of this blog is to discuss the words we use to describe ourselves and others in the context of healthcare. Collectively, we tend to refer to ourselves (nursologists) as healthcare providers, using the same term for physicians, physical therapists, occupational therapists, social workers, and others who “provide” healthcare “services.” We refer to others (patients, clients, people) as recipients of these services.

Copyright 2021 Jacqueline Fawcett

I have used these terms in my publications for many years. Now, as I become more sensitive to the connotative meaning of words, I must question how my use of these words – provider, recipient – conveys a huge power differential, a clear instance of power-over (Chinn & Falk-Rafael, 2015; https://nursology.net/nurse-theorists-and-their-work/peace-power/), and power-as-control (Barrett, 2010; https://nursology.net/nurse-theorists-and-their-work/theory-of-power-as-knowing-participation-in-change/

In the compliance etc. blog, I referred to co-created narrative, and a comment from a reader of that blog replied that a co-created narrative is one “in which the healthcare consultant and the person consulting with him/her engage in dialogue around the recommendations offered, within an environment of mutual respect and honesty, arriving at a mutually agreed upon plan led by the person seeking input” (https://nursology.net/2020/03/17/what-is-reflected-in-a-label-about-health-non-nursology-and-nursology-perspectives/).

I thank that reader very much for her comment. Healthcare consultant instead of healthcare provider is a better term, as it at least implies peace as power (Chinn & Falk-Rafael, 2015) and power-as-freedom (Barrett 2010) perspectives, as does person who is consulting instead of recipient. I shall do my best to use these words in all future publications until the potential awkwardness or unfamiliarity with these words evolves to the familiar, conveying the dignity and mutual respect of the encounter. (Note that I wrote “do my best” rather than “try,” as I am committed to removing “try” from my vocabulary, for as Yoda tells us: DO OR DO NOT; THERE IS NO TRY.) .

Yoda Says: Do or do not. There is no try.
Yoda in Fawcett’s Art, Antiques, and Toy Museum in Waldoboro. Maine
Photo by Jacqueline Fawcett

I very much look forward to comments from readers of this blog–what are your thoughts about words that convey different types of power? Do you have suggestions for other words to convey who we are and who others are?

References

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23(1), 47-54.doi: 10.1177/089431840935379

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: a theory of emancipatory group process. Journal of Nursing Scholarship, 47(1), 62–69. https://doi.org/10.1111/jnu.12101

Launch of BILNOC Leaders Database

We are delighted to launch a database that provides information about Black, Indigenous, Latina/x and other Nurses of Color (BILNOCs) who are (or have been) leaders and scholars who have contributed to the development of the discipline. This will be a significant resource for scholars and students who seek to recognize and honor BILNOC leaders. This database will fill a huge gap that contributes to the underrecognition of the contributions of nurses of color to the discipline.

View the BILNOC Submission Form to review the information we are seeking. You can find a link to the this form from the website “Resources” menu anytime later.