Decolonizing Nursing

Series: Notable Works

As the year 2020 starts to unfold, along with escalating tensions world-wide related to power imbalances, inequities, and injustices, I am drawn to consider how our own endeavors related to the development of nursing knowledge intersect with these very large tensions that so directly shape the health of people worldwide.  I will not even attempt to present you with a “laundry list” of ways in which we could begin to tackle these issues as nursologists – the list alone would greatly exceed the boundaries of a reasonable blog post. Instead, I have decided to focus on one critical topic that repeatedly rises to the surface in many nursing discourses – the topic of racism.  Despite the fact that race and racism so repeatedly rise to the surface with a clear intent to address this issue, there is typically little or no substantive discussion that begins to reach deep down into explanations or understanding of what is really going on. Our efforts to  address the issues are sincere and well-intended but more often than not, end up being superficial “remedies” – often remedies that themselves have clear and undeniable racist dimensions. Seldom, if ever, is there a recognition or discussion of the ways in which nursing perspectives sustain the structures of racism. 

The nursing literature, over the past decade, has provided our discipline with a number of notable sources addressing race and racism, most prominently from an emancipatory, critical theory perspective (see Kagan et al., 2014).  But one notable work in particular is well worth our focus – titled “Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative” authored by Canadian and South African  authors Elizabeth McGibbon, Fhumulani M Mulaudzi, Paula Didham, Sylvia Bartond and Ann Sochane (McGibbon et al., 2014)

 The authors draw on Canadian experience, where culturally, there is very active, visible and dedicated progress toward truth and reconciliation addressing the injustices imposed by European settlers on native Indigenous peoples (see for example the excellent webinar on “Racism and Privilege in the Everyday”).  The United States in general is far behind Canada, South Africa and other colonized nations in openly and systematically embedding awareness of these injustices in public discourse. Unlike other colonized countries, the US has not yet established practices and programs that attempt to address the significant injustices that have seriously harmed those who have been historically disadvantaged, as well as the effects of these colonizing systems and practices on those who have inherited white settler privilege.  The truth is that each situation in which there is disadvantage for some and advantage for others has specific and unique characteristics, but the common threads that run through all such situations, particularly where race and skin color are concerned are significant. McGibbon and her colleagues have provided a cogent explanation that specifically addresses the realm of nursing theory, and ways in which colonization inhabits much of our nursing theorizing. This is not to say that certain nursing theories should be banned from our lexicon because of their colonized and colonizing characteristics.  Rather, examining nursing perspectives from this standpoint is a key that can begin to shift nursing into spaces, actions and ways of theorizing that hold potential to resist the harmful dynamics of colonization, specifically the dynamics of racism.

As Dr. McGibbon reiterated to me in a recent personal communication:

Colonization is a term that refers to the Eurocentric project of empire building that was motivated by the intent to “civilize” the rest of the world.

“Decolonization” is the process of exposing, resisting and transforming the continuing presence and influence of colonial practices and thought.

The project of colonization historically involved indiscriminate destruction of the ways of life, the cultural values, ways of being, spiritual traditions – the whole experience of people who were not European (read not white skinned) – in other words, people of dark skin.  In their article, McGibbon and colleagues provided a detailed and clear explanation of the nature of colonization, as well as the contributions of postcolonial scholars, particularly those of indigenous backgrounds, who have taken bold steps to reveal the devastation and painful struggle, as well as the courage and skills of survival for those who have been, and still are harmed by colonial practices and thought. 

Most significantly, McGibbon and colleagues provided several still-relevant clues where we can focus our attention in the quest to decolonize nursing.  The first challenge is raising awareness of ways in which colonization, and its racist underpinnings persist in nursing thought. They stated: 

Nursing has developed within all of the . . .  contexts of colonization, including the intersections of racism and sexism that inform the colonial project. Embedded beliefs and assumptions provide a foundation for the colonizing of intellectual development in nursing. Similarly, racism and white privilege play a central role in the continued colonization of the profession.” (p. 183)

First, they addressed the persistent belief that we have now moved beyond the “old” days when the white settlers arrived to inhabit, uninvited, the lands of indigenous people.  The same belief persists in the United States where we sustain the notion that we are beyond the slavery of African people that ended decades ago. Since those “days” are in the long-ago past, we tend to sustain the notion that we are now all equal – that we all inhabit the “same” world and that the cultural [read dominant white culture] norms are true for all.  We recognize that there are disparities, and acknowledge some of the disadvantages experienced by people of color, but fail to recognize, or acknowledge that white privilege remains as powerful a dynamic as it ever was. The languages of “diversity” and “multiculturalism” actually sustain this dynamic; when examined closely these perspectives in nursing treat cultures of color as “other” – as interesting curiosities.  Culture is seen as characteristics of any practices that are not white.  Notice that there are rare, if any discussions of white dietary practices, rituals, family relationships, religious practices. “White” experience is typically seen as diverse and individualized, as the “norm” against which other practices are judged or compared, whereas the experience of the “other,” of “people of color” are seen as essentialized markers of difference, with the “white” norms as the point of reference.

Another characteristic that reflects the effects of Euro-centric thought, and that persists as a pervasive characteristic in nursing thought, is the emphasis on empirics, and the presumption of “objectivity” in part because it is removed from the vicissitudes, the contamination, of everyday experience.  The gold standard of “evidence” presumes a certain “objectivity” that is apolitical and assumed to be universal to all human experience. The result is discourse that is largely grounded in white privilege, and its concurrent erasure of the experience of those with dark skin. When “race” is taken as a demographic variable, it tends to be treated, as in real life, as “different” and something other than what is presumed to be the “norm.” As McGibbon and colleagues pointed out, even when race and racism are brought into a conversation, the dominant impulse in relation to the nursing theoretical frameworks is to hide such dynamics in the larger metaparadigm concept of “environment.” 

Nursing’s search to become a credible science reflects this same dynamic of white privilege and unquestioned valuing of positivist values.  The focus of much of nursing’s theorizing is on the individual as a person with uninhibited free will, one who can care for oneself (with ample resources assumed to be available), with only a passing nod in the direction of the family and community (critical and central concerns for those who are not privileged).  The positivist assumption of the whole as the sum of the parts is reflected in just about all undergraduate nursing curricula, in the focus of our textbooks, and organization of hospitals, medical (and nursing) specialties – divided into children (under the medicalized label of pediatrics), various adult conditions (many of which have been transposed into major profit centers), mental health (again medicalized as “psychiatric”) etc.  To the extent that “family and community” is addressed, these vital, central dimensions of human experience are treated as separate and different from the individualized organizing concepts.

These dimensions of awareness are critical, but importantly, McGibbon and her colleagues devoted a significant focus on what this means for our current situation, and the future development of nursing knowledge.  They outline examples of everyday racism and the ways in which nurses of white privilege sustain racist practices, even when we wish not to do so and believe we do not. But as they correctly noted:

These experiences of ongoing racism form the fabric of everyday life for racialized nurses and are largely invisible for the perpetrators, be they in the individual, face-to-face realm, or at the level of governance and policy-making. (page 185)

They pointed to three significant steps that all nurses, and particularly white nurses and white nurse scholars, can take to begin to participate in the effort to decolonize nursing. These are  

  • Understanding racism and white privilege, and creating counternarratives that dismantle colonized thinking, in particular biomedical hegemony and other colonizing ideologies;
  • Committing to action based on social justice and human rights; and 
  • Sustaining attention to the structural determinants of health.

I would add one additional “goal” that deserves our particular attention as nursologist – the potential to completely re-vamp the organizing concepts and constructs of our discipline based on the insights from the three decolonizing projects that McGibbon and her colleagues outline.

The persistent question that always surfaces in these kinds of discussions is “What can I, as only one individual, do?” In my view, the most important and fundamental step is to learn about and take to heart the ways in which our own actions and perspectives sustain racism in our everyday practices. For those of us who inherited white privilege, we have a particular responsibility to dedicate ourselves to our own self-awareness and commitment to change.  I have provided below a list of various resources that I have found invaluable in my own journey. Once we begin to explore our own experience, and understand the dynamics of colonization, we will begin to see a huge shift that will have great power in the direction of decolonizing nursing. 

Sources cited:

Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge.

McGibbon, E., Mulaudzi, F. M., Didham, P., Barton, S., & Sochan, A. (2014). Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21(3), 179–191. https://doi.org/10.1111/nin.12042

Resources for self-awareness

Recommended reading, especially for white people, but also for people of color to gain understanding of the ways in which white privilege is sustained.

DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press.

Two part blog posted on The Scholarly Kitchen relating the everyday experiences of people of color in the white-dominated publishing industry, 

On Being Excluded: Testimonies by People of Color in Scholarly Publishing (Part 1).

On Being Excluded: Testimonies by People of Color in Scholarly Publishing, Part II

 “Everyday Feminism” webinars (available for a modest fee)

Beyond Diversity: How to Build a Truly Anti-Racist Organization

So… You Have White Guilt. What Now?

Please also see the webinar series recommended to me by Dr. McGibbon – produced by the Indigenous Cultural Safety Collaborative Learning Series (ICS)

Another First for Nursology!

The Roy Academia Nursology Research Center (RANRC, see http://www.ranrc.com/) recently published the first issue of the Nursology Letter (see http://www.ranrc.com/nursology-letter/). This is the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan –see http://www.st-mary.ac.jp/

The Nursology Letter is another first for our discipline. Specifically, the Nursology Letter is another answer to our Who Will be the First? blog on May 21, 2019. The first “answer” to the question was publicized on our June 11, 2019 blog post announcing the establishment of the Roy Academic Nursology Research Center. The founding of the Nursology Letter is a wonderful and very significant means of communication from the St. Mary’s College RANRC. Indeed, the Nursology Letter is the perfect way to share the very important research done by the faculty and students at St. Mary’s College.

The Nursology Letter, Volume 1, 2019, includes a statement of the concept guiding the RANRC; an introduction to the inaugural issue of the Nursology Letter by Tsuyako Hidaka, RANRC Director, who also noted that the Roy Adaptation Model has been used to guide education and practice at St. Mary’s College for 30 years. The first issue of the Nursology Letter also includes greetings and message of congratulations from Nobu Ide, Chancellor of St. Mary’s Education Foundation; Callista Roy, for whom the RANRC is named; Jacqueline Fawcett, a visiting professor at St. Mary’s College School of Nursing; Debra Hanna, President of the Roy Adaptation Association-International; and Leah Fitzgerald, Dean of Mount St. Mary’s University School of Nursing in Los Angeles, CA.

In addition, the Nursology Letter includes messages about the research interests of the RANRC members, including Eric Fortin, Masako Momoi, Mayumi Sakita, Akemi Tsuruta, Michiru Asano, Satsuki Obama, Sachiko Ishimoto, Akina Ide, Chidori Hashiguchi, Ikuko Miyabayashi, and Miyuki Ichinose.

Congratulations to everyone who has made this notable publication possible!  We of the nursology.net leadership team,  are delighted to also let the entire nursology.net universe know about this remarkable achievement!

Visions for 2020 – the Year of the Nurse

To all Nursology.net visitors – welcome to the Year 2020!  As we enter this year, we members of the site management and blogging teams join in celebrating the “Year of the Nurse and Midwife” and offer our visions for the coming year and beyond!

The year 2020 was designated In January 2019 by the World Health Organization (WHO) as the “Year of the Nurse and Midwife”  in honor of the 200th birth anniversary of Florence Nightingale.  Far from being a mere sentimental expression recognizing the importance of nursing and midwifery worldwide, this designation is part of a worldwide effort to improve health globally by raising the status of nursing and midwifery.  Here is the statement issued in establishing this designation:

The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.

Nurses and midwives are essential to the achievement for universal heath coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals. (from https://www.who.int/hrh/news/2019/2020year-of-nurses/en/)

As members of the Nursology.net management team, we are welcoming the 2020 “Year of the Nurse and Midwife” with our visions for this coming year and beyond.  We hope our ideas will inspire you to join in making these values and visions a reality!

Maggie Dexheimer Pharris –

2020 vision. During an eye exam, there is a moment when just the right corrective lens falls into place and suddenly we appreciate 20/20 clarity of vision. Remarkable!  So too it is with theory. In this new decade may nurses around the world find just the right nursology theory to clearly see the path to creating a meaningful practice and equitable, accessible, and healing systems of care!

Karen Foli – 

Unity among nurses based on the care we offer and the universal experiences we share. kindness directed toward patients and fellow nurses, even when they may be unable to reciprocate in that moment. Wisdom to understand how nursing power can be harnessed to forward a sustainable, balanced work life and advocate for improvements in patient and family care. And for nurses’ truth to be spoken freely, a reality to be heard and honored.

Peggy Chinn – 

A renewal of deep respect and tireless dedication for the core values of our discipline – protection of the dignity of each individual, advocacy for the needs of those we serve, and belief in the healing potential of our caring relationships.

Marlaine Smith – 

An accelerating appreciation for the distinctive knowledge of the discipline and the unique contribution that this knowledge can make to the health, well-becoming and quality of life of those we serve. With this appreciation will come the growth of research that is focused on the theories of nursology and practice models that are theory-guided.  Our focus on human wholeness, health as well-being/becoming, the human-environment-health interrelationship and caring is what is missing and most needed in healthcare.

Jane K. Dickinson  –

My vision is that all nurses will know, value, and be guided by nursing knowledge and take caring to the next level in education, practice, and research.

Jessica Dillard-Wright – 

Because 2020 has been declared the Year of the Nurse by the World Health Organisation, my vision for the year is that nursing will embrace the emancipatory potential of our discipline, recognizing the interface between nursing knowledge, nursing praxis, and wellbeing on a global scale. In so doing, we can dismantle injustice and mobilize our profession to nurse the world.

Jacqueline Fawcett

 Now is the perfect time to accept NURSOLOGY as the proper name for our discipline and profession. Now is the perfect time to realize that all individuals licensed as Registered Nurses or equivalent designation worldwide are NURSOLOGISTS. Now is the perfect time for all nursologists to realize they are “knowledge workers” who engage in development, application, and dissemination of nursology discipline-specific knowledge so that we know and everyone else knows the what, why, how, where, and when of our work with those individuals and groups who  seek our services.

Chloe Littzen – 

My vision for nursing in 2020 is that we find unity among our diversity, despite settings, education levels, or beliefs, and work collaboratively to advance the discipline, enabling all nurses epistemic authority and well-being.

Rosemary Eustace – 

The year 2020 is a great reminder of the “200” unique contributions nurses and midwives make each day to improve health, health care, health policy and nursing across diverse settings.  As we celebrate this milestone, let us light our lamps in unity to advance nursing knowledge that is congruent with contemporary health care demands. Let us keep the Power of Nursology alive!

Marian Turkel – 

Vision for 2020: Nursing theory will guide nursing education, nursing practice and nursing research. RN-BSN, BSN and MSN programs will have at least one nursing theory course in the curriculum.  DNP and PhD curriculum will have 2 nursing theory courses.  Nursing faculty and Registered Nurses in the practice setting doing research will use a nursing theory to guide their practice and research.  The Nursology leaders will collaborate with the American Academy of Nursing to organize a conference similar to the Wingspread Conference. The American Nurses Credentialing Center will collaborate with the Magnet Recognition Program©® to require hospitals to have a nursing theory as the foundation for achieving Magnet©® Status Recognition.

 

Satori – Japanese Nurses Visualize a Path to Meaningful Practice: Report from the Newman Theory/Research/Practice Society in Japan

What is meaningful practice? How might we create a meaningful care environment? The Newman Theory/Research/Practice Society in Japan sent the Nursology.net team an update on their efforts to provide transformative nursing theory-guided care for patients in Japan, and a mutual action research process they created for nursing teams to reflect on meaningful practice and shape meaningful care environments.

This work began in the 1990s when Emiko Endo was a PhD student studying with nurse theorist, Margaret Newman, PhD, RN, FAAN.  Endo tested Newman’s theory of health as expanding consciousness in women with ovarian cancer in Japan. As a result of the caring partnership with Endo, who followed Newman’s theory and research method, the women reported finding greater meaning in their lives and experiencing personal growth and insight into the future.

Eager to share what she had learned, Endo returned to Japan and worked with a hospital-based nursing praxis team to incorporate Newman’s theory and research method into their nursing practice with women with cancer. Realizing the power of the process and the strain family members were experiencing, the nurses extended their attention to use Newman’s method with families of women with cancer. The praxis teams were expanded to include nurse educators, nursing graduate students, and clinical nurse specialists as co-researchers. On one unit, a head nurse assisted her staff to recognize their own patterns as they moved through the chaos of care with clients. The process of recognizing patterns of meaning expanded from the patients, to patients and families, and eventually to nursing care teams. It did not stop there.

Endo developed a process of Mutual Action Research and initiated monthly project meetings for the nurses to capture the meaning of their work as it unfolded. In these meetings, nurses recognized transformation in their caring partnerships with patients and families and visualized ways to improve the care environment. Nurses reflected on their pattern of relating to clients and others and how much more meaningful their practice was when rooted in nursing theory rather than simply in the medical model. The personal reflection and subsequent collective dialogue revealed the ways in which not only had they and their patients been transformed, but also the influence of their transformation on the entire interprofessional team and the care environment. Endo and colleagues realized a need to share what they had learned with nursing teams throughout Japan.

In 2016, the Newman Theory/ Research/ Practice Society was established as a Japanese Nonprofit Organization (NPO) to host national study meetings, dialogues, and seminars in Japan. The intent of the Society is to expend every effort for the development of nursing guided by Newman’s theory of health in Japanese society. Members of the society have been major contributors to international Newman Scholars Dialogues.

As you read the following entry that the Newman Theory/ Research/ Practice Society board members Emiko Endo, Mari Mitsugi, Tomoko Miyahara and Satoko Imaizumi submitted to Nursology.net, you will see that they ended with words from Margaret Newman’s foreword to the Japanese edition of her book, “Transforming Presence: The Difference that Nursing Makes.” The last word is “Satori!”

Satori embodies understanding, enlightenment, awakening to see into one’s true nature, comprehension.  In 2020, which the World Health Organization has declared the Year of the Nurse, and in light of Nursing being considered the most trusted profession for improving the U.S. healthcare system (The Commonwealth Fund, The New York Times, and Harvard T.H. Chan School of Public Health, October 2019, p. 17), the international nursing community looks to the wisdom of our colleagues in Japan for Satori.

Report from the Newman Theory/Research/Practice Society in Japan

Contributed by:*
Emiko Endo, Mari Mitsugi,
Tomoko Miyahara and Satoko Imaizumi

We are pleased to post the 2019 work of the Newman Theory/ Research/ Practice Society in Japan.

In memory of Dr. Margaret Newman, we are devoted to understanding the theory of health as expanding consciousness (HEC) and her life as a nursing theorist, researcher, and educator.

Emiko and Mari, today’s leader and sub-leader, are talking about HEC in the study meeting on June 2, 2019

At the first 2019 study meeting held on June 2, 54 participants gathered together. We read Dr. Newman’s 1994 theory book together chapter by chapter with a facilitator until Chapter Six, and had a dialogue within each small group. The second study meeting was the afternoon of October 19 followed by the annual HEC Dialogue Meeting on the next day. In the first half, we read some articles on Dr. Newman’s life and missed her. In the latter half, we read Chapter Seven (Practice: Order out of Chaos), connecting it with our own nursing practice within 7 small groups.

The participants are having dialogue in each small group about HEC and their nursing practice

The next day at the 13th HEC Dialogue Meeting, the topic was “A challenge to develop an HEC study group at your clinical nursing unit or hospital.” Two presenters talked about their experiences. They noted that these experiences were not easy, because nurses were working in their irregular working time and mostly under the medical model. But they added, in having continued these meetings patiently, they realized that the nurses were enjoying the meetings and were moving toward the HEC model gradually. The last presenter spoke about a trial to introduce HEC theory into a practicing Chemotherapy Nursing Course. The next study meeting will be held in February, 2020, with the topic of “More efforts to develop study meetings at one’s own working place.”

The praxis research course on HEC and the pre-praxis research course to understand HEC theory are moving forward. Each time in the process, nurses reached a new realization in terms of HEC.

In the foreword for the translation of her 2008 book into Japanese, Dr. Newman wrote to us:

“… The search leads
in different directions
and along new paths
To unanticipated horizons.

Stay with the search.
Wait…
Understanding will come
Satori!”

          ( Margaret Newman, June 2009)

The following are two videos from the October 2019 meetings.

*About the contributors

Emiko Endo, PhD, RN
Chair, Board of Directors and Professor Emerita, Musashino University

Mari Mitsugi, PhD, RN
Vice-chair of the Board of Directors and Associate Professor, Musashino University, Faculty of Nursing

Tomoko Miyahara, PhD, RN, OCNS
Vice-chair of the Board of Directors and Chief of Outpatient Clinic Kanagawa Prefectural Ashigarakami Hospital

Satoko Imaizumi, PhD, RN
Secretary-general and Professor, Tokai University, School of Medicine, Faculty of Nursing

Margaret Ruth McCorkle 1940-2019

Guardian of the Discipline

Published in The New Haven Register on Aug. 19, 2019 Retrieved from https://www.legacy.com/obituaries/nhregister/obituary.aspx?pid=193674212

Ruth McCorkle was born in Johnson City, TN. Peggy Chinn (personal communication, October 12, 2019) reminded me that Martha E. Rogers also was born in Johnson City, TN.  Ruth earned a baccalaureate degree in nursing from the University of Maryland, a master’s degree in medical-surgical nursing from the University of Iowa, and a PhD degree in mass communication, also from the University of Iowa. Ruth was a distinguished faculty member in the Schools of Nursing at the University of Washington, the University of Pennsylvania, and Yale University. Prior to her retirement, Ruth was Director of Psychosocial Oncology at the Yale Comprehensive Cancer Center. At the time of her death, she was the Florence Schorske Wald Professor Emerita of Nursing (this endowed chair, of which Ruth was the inaugural holder, was given by Rick Levin (R. Wittenmore, personal communication, October 15, 2019)) and Professor Emerita of Medicine and Public Health at Yale University. Ruth earned master’s and PhD degrees from the University of Iowa. Robin Wittemore (personal communication, October 15, 2019), a colleague of Ruth’s at Yale School of Nursing, added that Ruth was “recruited to Yale to be the director of the Doctor of Nursing Science (DNSc) program . . . [and] [s]he directed the Center for Excellence in Chronic Illness Care.

Ruth served in the United States Air Force Nurse Corps, caring for Vietnam War wounded and dying military personnel, which greatly influenced her commitment to caring for acutely ill persons, with a special focus on psychosocial experiences of persons living with and dying from cancer. Subsequently, she studied at St. Christopher’s Hospice in London and later cofounded the Hospice of Seattle and the Northwest Regional Oncology Society.

Ruth “was a pioneer and an international leader in cancer nursing, education, and cancer control research conducting landmark research on the psychosocial ramifications of cancer” (Villarruel, 2019). Her research included development and psychometric testing of the widely used Symptom Distress Scale (SDS) and the Enforced Social Dependency Scale. Mark Lazenby (personal communication, October 6, 2019), a faculty colleague of Ruth’s at Yale School of Nursing, added that the the SDS was the first scale that not only assessed whether a patient experienced a symptom but also measured the distress the patient associated with the symptom.

Ruth served as the Principal Investigator for seven clinical trials, four cancer research education projects (R25s) and, at the University of Pennsylvania School of Nursing, as the Program Director for a T32 Pre- and Post-Doctoral Training grant. I had the honor of serving as Co-Program Director of the T32 for several years, which enabled me to observe the intensity and effectiveness of Ruth’s superb mentorship of the next generation of nursologist scholars.

Ruth’s work was published in many healthcare journals, books, and book chapters. She was a generous author, providing many opportunities for co-authorship of journal articles and authorship of chapters in books she edited for her students and faculty colleagues.

Ruth championed a curriculum for Oncology Clinical Nurse Specialist practice, with an emphasis on theory-guided evidence-based practice. While at the University of Pennsylvania School of Nursing, Ruth insisted on retaining a master’s degree program course focused on nursology conceptual models and theories at a time when almost all other advance practice nursing programs at the school and across the nation eliminated that course as a required part of their respective curricula.

Ruth was a Fellow of the American Academy of Nursing (AAN) and of the American Psychosocial Oncology Society (APOS). Among her many other honors are her 1990 election to the Institute of Medicine (now the National Academy of Medicine), being named in 1993 as Nurse Scientist of the Year by the Council of Nurse Researchers, receiving the 2017 Lifetime Achievement Award from the Yale Cancer Center, and being named a 2018 Living Legend by the AAN. Ruth also received “the Bernard Fox Award from the International Psycho-Oncology Society and the Jimmie C. Holland Award from the APOS, both societies’ highest awards for contributions to the field . . . [and] she was named to the [International Nurse Researcher Hall of Fame in 2014 by] Sigma Theta Tau International” (R. Wittemore, personal communication, October 15, 2019).

“In addition to her extraordinary scientific contributions to health care in the field of cancer care, [Ruth] was also well-known for humanizing the face of cancer care. For those of us who knew her here at [the University of Pennsylvania School of Nursing], we also remember well her fun-loving spirit as she was at the forefront of special events and activities – donning costumes at Halloween, decorating her office, and being first in line to sign up for the Penn Nursing softball team.” (Villarruel, 2019). In addition, “Ruth bought yellow daffodils [every March] for every member of the staff [and faculty at the University of Pennsylvania School of Nursing] and personally delivered them as part of [an American Cancer Society] fundraiser (Franco, 2019). Robin Wittemore (personal communication, October 15, 2019) added that Ruth “brought her fun-loving spirit to [Yale School of Nursing,] encouraging a yearly Halloween costume event.”

References

Portions of this blog were adapted from Ruth McCorkle’s obituary, published in The New Haven Register on Aug. 19, 2019. Retrieved from https://www.legacy.com/obituaries/nhregister/obituary.aspx?pid=193674212

Additional information was adapted from “Honoring Dr. Ruth McCorkle: Nurse pioneer in hospice, palliative care, and oncology.” Retrieved from https://nursing.yale.edu/news/honoring-dr-ruth-mccorkle-nurse-pioneer-hospice-palliative-care-and-oncology

Franco, A. M. (2019, August 19). Email message. University of Pennsylvania School of Nursing.

Villarruel, A. M. (2019, August 19). Email message from the Dean, University of Pennsylvania School of Nursing.

Unity in Our Diversity: the KING Collaborative Conference and Nursology

         Last month, on November 14th and 15th, nurses from all over the world gathered to discuss nursing theory and the future of nursing at a landmark conference at George Washington University in Washington D.C. Hosted by the King International Nursing Group, the theme of the conference was “Nursing theories: Moving forward through collaboration, application and innovation.” Present at the conference included members of various scholarly groups in nursing such as the International Consortium of Parse Scholars, Leininger Culture Care, the Neuman Systems Model Trustees Group, Orem International Society, Roy Adaptation Association, Society for the Advancement of Modeling and Role Modeling, Society of Rogerian Scholars, the Transcultural Nursing Society, the University of Connecticut School of Nursing, the Watson Caring Science Institute, and the Nursing Theory Collective.

The above collage depicts different moments during the panel presentation at the King Collaborative Conference. On the bottom from left to right is Jacqueline Fawcett, Callista Roy, and Marlaine Smith.

         On the first day of the conference, a representative member of each of these scholarly groups presented on the nursing theory central to their organization. Each oriented their discussion toward the future of nursing as a discipline. Awareness of our habitual silos slowly emerged as each of these scholars presented, revealing our tendencies as nurse theorists – nursologists – to work in isolation. These voices were put into dialogue in a panel, convened to discuss the future of nursing theory and the discipline as we know it. From this discussion, panelists and attendees alike unanimously agreed that the future of the discipline required that we identify common ground and work collaboratively from our shared values grounded in nursing while recognizing and honoring our differences. The panel discussion concluded with a call to find unity in our diversity and recognize the strengths inherent in divergent perspectives. 

The Nursology Theory Collective at their first in-person meeting on November 15th, 2019.

      The next day, the Nursing Theory Collective had their first in-person meeting. In light of the pivotal discussion that had occurred on the previous day, representatives from different scholarly groups were in attendance to participate. One of the main agenda items for the first in-person meeting was revisiting the adoption of the term “nursology” in the group’s name, mission, vision, and values, in place of the term nursing. Achieving consensus through lively discussion on the politics and peculiarities of the term, the Collective ultimately determined that “nursology” was best suited for navigating the future of the discipline. As such, the Nursing Theory Collective has now been renamed the Nursology Theory Collective. It is our hope with this adoption that we can become more inclusive for all scholars and practitioners alike, breaking down walls towards a unified future for the discipline.

         Inspired by our shared space and time at the King Conference, looking towards the future, the Nursology Theory Collective intends to continue to advocate for the future of our discipline through practice, research, education, and policy. We hope to foster an inclusive home for nursologists from all perspectives. We ask you, as important voices in our discipline, what issues are most important to you? Though you may not attend our meetings, we value diversity, discourse, and dissensus. We want to hear from you about the future you envision for nursing. What are the theory, practice, education, policy issues you see as critical to our future? We want to hear from you, and we invite you to our next meeting on Monday, December 16th from 1:00 – 2:30 PM MST. If you wish to participate, please contact us via email at nursingtheorycollective@gmail.com

Please continue the conversation from the King Conference below in the comments, we look forward to hearing from you!

With gratitude,
The Nursology Theory Collective 

The Nursology Theory Collective at their first in-person meeting on November 15th, 2019.

Making Nursing Theory Real!

In March, 2019, Case Western Reserve University, Cleveland, OH hosted the conference: “Nursing Theory: A 50 Year Perspective, Past and Future”.  One theme that emerged from the lively dialogue at the conference was that nursing theory should be introduced and integrated in all pre-licensure programs. At the same time, participants noted that many pre-licensure educators lack knowledge and skills for teaching nursing theory.

Energized by the March theory conference, several nurse educators from Northeast Ohio joined together to offer a workshop on the basics of teaching nursing theory. The workshop, Making it Real: Connecting Nursing Theory to Nursing Education, was co-sponsored by Case Western Reserve University (CWRU), Ursuline College, and Lorain County Community College. There was no registration fee, parking was free, light refreshments were provided, and 2 contact hours of CE were awarded.

Patricia Sharpnack speaking at Nursing Theory: Making It Real

We scheduled the workshop to precede a Northeast Ohio League for Nursing (NEOLN) dinner meeting and program at the same location. The event was publicized through emails to directors of pre-licensure programs and, in the spirit of collaboration, the theory group and NEOLN each publicized the other’s event.

The program was coordinated by Dr. Mary Quinn-Griffin (CWRU). The planners kept the workshop to two hours so participants could see that they did not need extensive,highly theoretical content to begin incorporating theory in their class, lab, or clinical teaching. During the first hour, Drs. Joyce Fitzpatrick and Deborah Lindell (CWRU), and Dr. Patricia Sharpnack (Ursuline College) presented content on the disciplinary perspective, nuts and bolts of theories, core concepts of nursing, and strategies for integrating nursing theory in pre-licensure education. During the second hour, the participants worked in small groups to identify, and report out on, ways they could integrate nursing theory in their teaching.

Participants engaged in a group activity

We were delighted by the response to our workshop! In two days, we filled the 35 seats and had a waiting list! So, we repeated this program in November. Evaluations were highly positive and participants suggested topics for future programs, such as in-depth discussion and application of specific theories. We look forward to Making It Real, Phase II.

Please contact Debbie Lindell for more information about our theory workshop.

2nd Annual Nursing Theory Conference March 20-21, 2020!

The year of 2019 brought a surge of interest in the development of nursing knowledge – theories, models and philosophies that define our discipline and provide direction for the vital service nurses provide worldwide!  Two major 2019 conferences – Case Western Reserve in March, and the KING collaborative conference last week in DC – inspired the establishment of a structure for an annual nursing theory conference!  The 2020 conference will again be at Case Western Reserve University, March 20-21! And plans are already underway for spring conferences in 2021 and for 2022 – the locations and dates for these conferences will be announced very soon.

As noted on the conference website,

The purpose of the Annual Nursing Theory Conference is to provide a global forum where all nurses can gather to nurture and critique nursing theory thereby expanding nursing’s unique disciplinary knowledge for practice, research, education, and policy. Recognizing that the ultimate purpose of nursing is the improvement of the health and wellbeing of all people, situated in the wholeness of their system context, we commit to supporting a place for active and equitable theoretical discourse. We value, support, and encourage the diversity of theoretical perspectives in nursing to enhance our unique knowledge base. Grounding us firmly in these tenets, we acknowledge the powerful link between philosophy, theory, research, and social change.

The theme for the 2020 conference is “Evolution from the Scientist Nurse to Nursologist: Values and Vicissitudes.”  This theme was inspired by  the ideas published  in Nursing Research in 1970  by Rosemary Ellis titled “Values and Vicissitudes of the Scientist Nurse.”  The program will open by reflecting on how Ellis’s early ideas contributed to where we are today, and the choices we now face as we shape a vision for the future development of nursing knowledge.  The major portion of the program will feature breakout sessions based on participant abstracts, where nursology scholars can present their current work in a context of rich discussion that challenges and inspires our movement forward!  Toward the conclusion of the conference, there will be time for theory-specific groups to gather and discuss matters related to their particular work, giving conference participants an opportunity to connect with others who are working from a specific theoretical framework.

The 2020 conference will firmly establish an ongoing context for nurturing the ideas and frameworks that shape our discipline – building on the values of the past and shaping the vicissitudes of the future! Explore the conference website today, and plan to be there!

Registration now open!
  • Early Bird registration ends February 15, 2020
  • Regular registration ends March 15, 2020
  • There is no on-site registration!
Abstract Submissions now being accepted!
  • Abstract due date: December 15, 2019
  • Notification date: January 15, 2020

Nurse-Specific Trauma: Let’s Give It a Name

Welcome to Karen J. Foli, PhD, RN, FAAN who is joining the
Nursology.net blogging team! Karen is the author of the
Middle Range Theory of Nurses’-Psychological Trauma, the
Middle Range Theory of Parental Postadoption Depression
and co-author of the recently published book
The Influence of Psychological Trauma in Nursing

Karen J. Foli

When I was earning my PhD, my cognitive world opened up. I learned about how discourse not only reflects reality, it creates reality. In my estimation, The Influence of Psychological Trauma in Nursing allows us to see a reality that eluded us before. Decades later, I find my work in nurse-specific trauma reflecting truth and creating a reality that nurses experience, but couldn’t name. Therefore, their reality of it didn’t exist.

We often hear about compassion fatigue. Its etiology is linked with secondary or vicarious trauma, created by seeing others suffer and experience traumatic events. Conversations abound about how nurses need to be resilient and use resiliency as a buffer to mitigate secondary trauma and secondary traumatic stress. The issue of individual versus organizational culpability in nurse-specific trauma is one that is needed, and for another time…

In addition to secondary trauma, there are six additional nurse-specific and nurse-patient-specific traumas that I have named, described, and provided context for (Foli & Thompson, 2019): historical or intergenerational trauma; workplace violence, system-induced or medically induced trauma, second-victim trauma related to medical errors, trauma from disaster work, and insufficient resource trauma. This final type of trauma is one that I have recently coined based on a current study, the findings of which I will present at the upcoming American Academy of Nursing conference as an e-poster (Foli, 2019).

Insufficient resource trauma. Now that’s a new reality. Every single nurse I have spoken to quickly nods their head in affirming its existence. It’s the trauma that occurs when nurses do not have the knowledge/expertise, personnel, accessibility to other professionals, supplies, and tangible and intangible resources to fulfill their ethical, professional, and organizational responsibilities.

As a nurse… think of being placed in an unfamiliar patient situation with no one to call for help. Think of the shift you are working with an overload patient assignment and two of your patients “go bad.” Think of the phone incessantly ringing on your day off to come in because of short staffing and the guilt experienced because there is no way you can work another shift and be safe. Think of the medication that will be late because pharmacy made an error and the physician on call hasn’t answered the page and you need an answer stat. Think of going into a supply room for the dressing kit and the shelf is empty. But most of all, think of the patients’ call lights that go unanswered because there aren’t enough nurses to render care.

It’s not just a shortage of resources that cause insufficient resource trauma. It’s the push to do more in the time we have, including tackling the electronic health record and as we’ve known for years, sicker patients. In a recently published letter to the editor, “Decline of the American Nursing Profession,” Vignato (2019) describes the decreasing time spent with patients: “.. changes in our health care system are transitioning nurses away from a therapeutic relationship…With these time constraints, nurses are left to complete scripted tasks” (p. 255).

As a result, patients don’t obtain the care they need and deserve. The tendency to see them as tasks to do increases. Nurses leave the units at the end of their shifts feeling guilty, anxious, and isolated. It’s the stuff that kills our spirits.

A common metaphor used in understanding trauma, the iceberg, symbolizes the large mass of “stuff” that’s underneath what is visible. The proportion is such that what is above the water is a fraction of the frozen ice beneath the water’s surface. In the hidden, murky depths lies our processing of trauma, our feelings, needs, desires. Above the surface, for all to see are our behaviors that are born from trauma.

While I believe this metaphor is useful, I also assert that nurse-specific trauma, as events and habitual occurrences, are readily visible to others (Foli & Thompson, 2019). We have an audience watching most of our traumas day in and day out. But are we, our peers, our leaders paying attention?  Let’s give these traumas a name, let’s build reality, and then, let’s get to work on preventing what we can prevent and fixing what we can fix.

References

Foli, K. J. (Accepted; 2019). Nurses’ trauma: “They leave me lying awake at night.” E-poster. American Academy of Nurses 2019: Transforming Health, Driving Policy Conference, Washington, DC, October 24-26, 2019.

Foli, K. J., & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, Indiana: Sigma.

Vignato, J. (2019). Letter to the editor: Decline of the American nursing profession. Journal of the American Psychiatric Nurses Association, 25(4), 255-256. doi: 10.1177/1078390319826702