Who Will be the First? More Random Thoughts of a Sleeper Awake

Once again, with apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake, these are my random thoughts of “Who Will be the First?” among nursology leaders while I was a sleeper awake one very early morning (see our first “sleepers awake” post: What if?). Here are my random “Who will be the first?” musings:

  • Who will be the first dean/director/chairperson to re-name the college/school/department/ program nursology?
  • Who will be the first Chief [Nursology] Officer to re-name the clinical agency department nursology?
  • Who will be the first journal editor to re-name the journal … Nursology or Journal of … Nursology?
  • Who will be the first “edge runner” or other nursologist recognized for innovative work to be referred to as a nursologist?
  • Who will be the first president or executive officer to re-name the association/academy/ council [Country or State] Nursology Association or [Country] Academy of Nursology or International Council of Nursology?

Again inspired by imagining these possibilities, I asked other Nursology.net management team members!

Adeline Falk-Rafael

  • Who will be the first newscaster/journalist to refer to nursologists or Nursology In the media?

Margaret Dexheimer Pharris

  • Who will be the first political leader to propose a Universal Access to Nursologists system for a country, state/department/region, city, and/or community?

Danny Willis

  • Who will be the first nursologist to lead peace, social justice, caring, and healing efforts throughout the world toward universal wellbeing/wellbecoming for all of humanity?

Rosemary William Eustace

  • Who will be the first nursologist to theorize “task shifting of nursing services and roles” in advancing nursing knowledge and the future of nursing as a profession within other “traditional” and “emerging” disciplines in health care?

Marian Turkel

  • Who will be the first academic dean to say we are advancing the discipline and profession of nursology by preparing nursologists? Nursologists practice nursology through the lens of nursological theory and the multiple patterns of knowing, with a focus on holistic practices such as mindfulness, centering, healing arts, aromatherapy, and coming to know the patient and family as person. The clinical practice sites for nursologists would expand beyond the hospital into healing centers, physician practices, and community centers.

Marlaine Smith

  • Who will be the first to graduate with a PhD in Nursology?

We invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “Who Will be the First?”

Tribute to our Nurse Friends!

We welcome this guest post by Shannon Constantinides, MSN, NP-C, FNP, UCHealth Primary Care,  PhD Student, Florida Atlantic University.  Shannon also contributed the content on Jane Georges’ Theory of Emancipatory Compassion

Shannon Constantinides

In trying to explain to my husband (an osteopathic physician) why Nurses’ Week is an important week, I asked him, “Do you ever notice that I have my “friends” … but that I also have my “nurse friends?” He looked back at me, a bit quizzically, shrugged his shoulders and said, “yeah…? I guess so?” In a conversation a day or so later, he said, “Now that you’ve mentioned it, I guess I have heard you mention your Nurse Friends.” He then gave me a somewhat perplexed look and said, “I have friends who are physicians, but I don’t think I have Physician Friends. At least not in the way you talk about your Nurse Friends.” You’re right, my dear, you don’t.

From the inception of the profession, nurses have been working together, side by side in the figurative and literal “trenches.” Whereas our physician colleagues are trained to be the lone wolves, or as I’ve heard it described, “the captain of the ship,” nurses are from the onset of training, trained to work as part of a team.

This Nurses’ Week, I set an intention to celebrate and honor all my Nurse Friends. To me, Nurses’ Week is a reminder about the joy we find in work – not just the experiences that arise from patient care – but also joy we find from the relationships we’ve built with one another along the way.

In 2018, I had the honor and privilege to interview Dr. Jane Georges, Dean of the Hahn School of Nursing at the University of San Diego and the author of the Emancipatory Theory of Compassion. During the course of our conversation, we got onto the topic of finding joy in work and Nurse Friends. Until Dr. Georges pointed it out, I hadn’t given much thought to the concept of Nurse Friends. My mom, a 30-year NICU RN, had Nurse Friends. Dr. Georges’ mother was also a nurse who had Nurse Friends. “NurseFriends” was simply a word we’d always known, because we both grown up with the knowledge that there are two kinds of friends: your friends, and your NurseFriends.

In discussing ways in which we can recapture joy in work and joy in nursing, Dr. Georges circled back to the concept of NurseFriends and the deep connection nurses share with one another; the connection that allows us to find so much meaning in what we do. “I call it the nurse-nurse bond,” Dr. Georges said, “It’s knowing that we can’t do it alone, which is one of the most beautiful parts of nursing.” In recalling some of the most healing environments in which she’d worked, Dr. Georges commented on the presence of joy, respect, and connection with other nurses.

“We just had this crew,” I mentioned as I reminisced about a group night-shift NurseFriends I worked with during my tenure working in an emergency department. Dr. Georges agreed, “I think the idea of the nurse-nurse bond, or NurseFriends, is worth exploring… how do we build back that community where we’re not adversarial to each other?” I think that the answer lies within ourselves and within the community of our discipline: building up our NurseFriends to strengthen one another, to strengthen the profession, to strengthen ourselves, and ultimately, to strengthen the care we give our patients.

Two years ago, I had to tell a NurseFriend who’d become my primary care patient that I’d found lymphoma on her MRI. That was one of the worst days of my professional career. I remember sitting in my office, sick to my stomach. Delivering bad news to a patient is never easy; delivering bad news to a NurseFriend will break your heart.

This NurseFriend is doing great. Her cancer is in remission. She’s healthy. She’s now the clinical manager of my primary care office. I’m lucky: we caught her cancer early, got her great treatment, and I get to see her smiling face every day.

To all of my NurseFriends, thank you for sharing your light with me. You are my heros not just during Nurses’ Week, but every week!

Inspired by Virginia Henderson

Henderson when she was a research associate at Yale (from https://nurseslabs.com/virginia-henderson/)

I first met Virginia Henderson when I was a student at Yale School of Nursing. She was a guest in one of our courses, and she started the class by saying, “I’m a million years old and deaf as a doornail, so speak up!” She was a force, and I loved her from the start. I had the opportunity to meet with Virginia at her home in New Haven, CT, where she showed a group of us her porcelain box collection. She even gave me one! Virginia was at our graduation from YSN in 1993 – in full academic regalia. The last time I saw Virginia was at her home in a retirement community in Connecticut. I consider myself fortunate to have spent time with such an influential nurse. Although I had no idea at the time, her work and thoughts on nursing shaped my own. Her definition of nursing

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

resonates with me because in my work with people who have diabetes I see the need to help people toward independence. Diabetes and other chronic diseases require knowledge, skills, and understanding so that people can make daily decisions and perform daily tasks to manage their disease and live well. There are times when people need more – education, direct care, or support – and times when they can function independently. The goal is always to help people toward independence and away from a mentality of “compliance” or “adherence.” I think Virginia would support the language movement in diabetes, where we are working hard to get away from judgmental, provider-centric language and move toward person-centered and strengths-based messages.

I also identify with Virginia’s beliefs on nursing as a discipline with a distinct body of knowledge and her emphasis on nursing education and nursing research. Ironically, I was a student at Yale School of Nursing and now teach at Teachers College Columbia University. Both schools had an impact on and were influenced by Virginia Henderson. It’s amazing to me that I have felt her presence throughout my career, despite not being directly connected to her work.

I sometimes wonder what Virginia would think if she were alive today. Is her definition of nursing being upheld? What would she think of nursing practice, nursing education, and nursing research? Are we honoring her legacy in our work today? It’s important for nurses to be aware of those who’ve gone before us, their work, and their influence on our discipline. Some of those nurses are still with us, and my hope is that we will learn from them and be shaped by them as we move nursing forward. When we practice, teach, and study, how often do we think about our own definition of nursing? Are we being true to that definition?

Honoring our Heritage, Building our Future

Today we are adopting a new nursology.net tag line “Honoring our Heritage, Building our Future” in concert with the annual focus in May of each year on nursing and nurses, anchored around  Florence Nightingale’s birth date – May 12, 1820. Almost 100 years later, nursology theorist Martha E. Rogers was born on the same date in 1914.  These two giants of nursology history, and many others, have built the foundation from which we move forward in the quest to understand human health experiences.  We have asked members of our nursology.net management team to share particular “heritages” that stand out for them as significant. Here are our responses:  

Leslie H. Nicoll – The Nursing Editors History Project

Leslie Nicoll

A few years ago, Peggy Chinn and I had an “Aha!” moment when we realized there was no archive or complete listing of the women and men who have served as editors of scholarly nursing journals. We believe this is a serious omission and sought to create such a resource and thus, the Nursing Editors History Project (NEHP) was born. The NEHP is a venture between the Dolan Collection at the School of Nursing at the University of Connecticut; along with Peggy and me, Carol Polfroni is providing leadership to the project. You can visit the site at nehp.uconn.edu.

If we consider Florence Nightingale to be the founder of nursology, then our profession is relatively young, spanning less than 200 years. There has always been a focus on education and scholarship in nursology; the first disciplinary journals were published starting in the 1880s. In the US, the American Journal of Nursing published its inaugural issue in 1900. It has been published continuously ever since. Other journals with long and distinguished histories include Sygeplejersken (“The Nurse,” in Danish, since 1901); the Canadian Nurse (Canada, 1905); Nursing Times (United Kingdom, 1905); Kai Tiaki Nursing New Zealand (1908); and the Philippine Journal of Nursing (1926).

Editors of professional journals play an important role as gatekeepers of practice innovations, research findings, and other information that is disseminated through the published literature. The impact of the editor is profound and influential. Given that, you might think that an easy-to-use listing of editors would have been maintained over the years–but it has not. In the absence of such a list, you might think you could go to the online home of a journal and search through the digitized collection to find editor information. Go ahead and try to do that. You will find, as we did, that journal archives include that published articles but they do not include the “front matter,” that is, the pages that list the editor, associated editorial staff, editorial board members, and information about the publisher. Thus, the archive for a journal represents just one dimension of the publication. What is missing is the knowledge of the people who were in charge, in particular, the editor–whose voice was important, influential, and must be heard.

The NEHP has been growing slowly. At present, it includes 34 journals with publishing histories ranging from 100+ years to 9. We have learned that tracking down editor information–especially for some of the older journals–takes time and effort. Finding pictures is even harder! This realization has impressed upon us the importance of the NEHP and the need to capture this information before it disappears completely. Our goal is to be comprehensive, both at the individual journal level as well as in the breadth of nursology journals that are included in the NEHP. We welcome submissions to the NEHP from editors, publishers, and librarians. When submitted information is comprehensive and accurate we are able to quickly list the journal in the database. You can read more about the process here: https://nehp.uconn.edu/submissions/

Florence Nightingale was a meticulous data collector, prodigious correspondent, and author of books and articles. As far as I can determine, she was never a journal editor, but I am sure she held the editors those journals published in her life in high esteem–as we should. The NEHP truly “honors our heritage” by capturing essential information about the leaders of scholarly publication in nursology.

Adeline Falk-Rafael – Returning to our Roots

Adeline Falk-Rafael

It is only fitting that we honor nursing’s past each year around the time of Florence Nightingale’s birthday.   She was a remarkable woman and visionary. In many ways, she reflected the thinking of her day, i.e., that social, economic, and political factors greatly influenced (often adversely in vulnerable populations) the potential to be healthy. She believed that compassion, therefore, must include social and political activism focused on changing laws and the conditions that adversely affected health for many and  led by example (Falk Rafael 1999). Many examples have been documented and extend beyond policies in the UK to international efforts (Falk-Rafael 2005).  Nightingale’s focus on promoting the health of populations was evident in the first nursing program she established, in which one entire year was dedicated to health nursing of communities.

Her model of health nursing, including social and political advocacy influenced early nursing leaders elsewhere in the world, as well.  I know first hand of her influence in Canada, e.g, in the work of the Victorian Order of Nurses, and the U.S., in the work of Lillian Wald who added the word public to health nursing. She and other nurses of the Henry Street Settlement (more information here)  followed Nightingale’s example in advocating for social and political reform to create conditions that were more conducive to health (Falk-Rafael 2005) .  I hope nurses from other parts of the world will add  further examples of Nightingales influence on nursing elsewhere.

Finally, honoring our heritage  must, I believe include those women who provided nursing and health care before or during Nightingales time. Mary Seacole, was a Jamaican nurse who also cared for soldiers in the Crimean War. In Canada, centuries before Nightingale, women in religious orders and pioneer women, such as Jeanne Mance in the 17th and 18th century provided nursing care to communities. They also understood the necessity of advocating for laws and societal reforms to move toward social justice and health equity.  And, I think of the nurses who fought for womens rights and the abolition of slavery like Sojourner Truth  and Harriet Tubman. Many others are also profiled on the Nurse Manifest Gallery of Activism Inspirations.

Our heritage is nursing practiced from a nursing paradigm before the rise of a dominant biomedical model that can shape and limit our conceptualizations of health and its promotion. We can learn from the examples of those who have gone before. I believe that Nursology, by making visible the nursing science which informs nursing practice can help nurses reclaim their authentic nursing identity.

Jacqueline Fawcett – Florence Nightingale’s Contributions to Martha E. Rogers’ Thinking and Development of the Science of Unitary Human Beings

Jacqueline Fawcett

Martha E. Rogers (1992) contributed a marvelous essay to the Commenorative edition of Florence Nightingale’s classic book, Notes on nursing: What it is and what it is not. She began her essay with these words:

Florence Nightingale’s Notes on Nursing is an exciting and far-reaching compendium of ideas and statements concerning the purposes and scope of nursing, the essentials of good nursing practice, and the variety of providers of nursing that existed in her purview. With consummate skill and cogent humor, she decries the fallacies of health practices and the superstitions that existed among the public and in particular health workers. (p. 58)   

Rogers went on to point out that much of what Nightingale wrote is as relevant today as it was in the middle 1800s. She noted that Nightingale’s vision of the need for “human compassion, a broad knowledge base, intelligent reasoning, and understanding” (p. 58) were particularly relevant in the 1990s, and I will add, are even more relevant—indeed crucial—in the 21st century.    

Furthermore, Rogers (1978, 1992) traced her own dual concern with human beings and their environments to Nightingale. She explained, “Rogerian science of irreducible human beings provides a framework rooted in a new reality and directed toward moving us from what might be called a pre-scientific era to a scientific era. Certainly Nightingale laid a firm foundation for this kind of an approach to nursing knowledge and its use” (Rogers, 1992, p. 61).

oward the end of her essay, Rogers (1992) further emphasized the importance of Nightingale’s work for all of us today. She wrote that Nightingale’s ideas not only are meaningful today but also provide a firm foundation as nurses move forward in the development of nursing as a science in its own right, and make way for knowledgable directions that enable nurses to practice based on their own phenomena of concern. It is the uniqueness of nursing that makes it important, not the ways in which it is like other fields.

Rogers (1992) concluded that section of her essay by exhorting us to carefully consider Nightingale’s comment “that medicine and nursing should never be mixed up, since it spoils both” (p. 61).

I am certain that both Florence Nightingale and Martha E. Rogers would agree that the proper name for our discipline is nursology and that the members of the discipline are appropriately referred to as nursologists. I also am certain that both would applaud the development of nursology.net as a repository for all things theoretical in nursology!

References

Rogers, M. E. (1978, December). Nursing science: A science of unitary man. Paper presented at Second Annual Nurse Educator Conference, New York. [Audiotape.]

Rogers, M. E. (1992). Nightingale’s notes on nursing: Prelude to the 21st century. In F.N. Nightingale, Notes on nursing: What it is, and what it is not (Commemorative edition, pp. 58–62). Philadelphia: Lippincott.

Marlaine Smith – Standing on the Shoulders of the Giants of Nursology

Marlaine Smith

As we approach the birthdays of Florence Nightingale and Martha Rogers on May 12th I’m reminded that we are standing on the shoulders of the giants of nursology.  What is my responsibility as I stand on these shoulders? First, is to acknowledge and cite the work of the giants who have come before us. At times I hear newer ones to our discipline speak of a great new idea or concept that I know was actually something that was advanced by previous scholars and is in the literature.  This certainly is not the fault of the newer members coming into our professional discipline. It is our responsibility of faculty and mentors to expose students of nursology to the wisdom of our heritage. As Peggy Chinn admonished us in her blog, let’s  get rid of the instructions to students that they should only review the past five years of the literature.  Our students need to be introduced in the most engaging way to the seminal writings of our foremothers and forefathers.  Would any undergraduate psychology student not be introduced to  Freud, Piaget, Erikson? Absolutely not! Our challenge is to create opportunities for the past work of our scholarly giants to come from the shadows into the light.  In my BSN program I was briefly introduced to Florence Nightingale…just by name…Do you know what I remember? …only that I heard that Florence Nightingale died of syphilis.  While this is not true, that myth was propagated widely and it diminished us. When I began my Masters program I had to read Notes on Nursing as part of my theory course.  I was filled with amazement and pride that this courageous, brilliant woman discovered the human-health-environment-caring connections that ground nursology today.  Let’s give this gift to our students by studying the giants of the past. By standing on the shoulders of the giants of nursology we can reach lofty heights. The most beautiful buildings need strong foundations.  They cannot exist without them. In order to build our professional discipline to new heights we must build on our disciplinary, theoretical foundations. In this way, we are truly building NURSOLOGY. This doesn’t mean staying within the limits of the past.  We are free to innovate, create, change, renovate, regenerate as we reach for the possibilities of what nursology can bring to the world.

 

Nursology’s Philosophical and Practical Knowledge: Unified and Interdependent

Guest Contributor: Martha Raile Alligood, RN, PhD, ANEF

A few months ago, Martha Alligood sent me (Jacquelyn Fawcett) this intriguing article: Rovelli, C. (2018). Physics needs philosophy, philosophy needs physics, Foundations of Physics, 48, 481-491. We decided to write a paper, which has evolved into this blog, about the relationship between philosophy and science in nursology. The specific purpose of this blog is to underscore the importance of the relationship between practical knowing and foundational (philosophical) knowing for advancement of nursology.

Alligood writes:

Rovelli (2018) wrote about the interrelationship of philosophy and science (physics). His discussion of practical and foundational knowing led me to think about nursology and the contemporary disciplinary shift to a practical focus from one that was dominated by general foundational philosophical questions. For example, nursological literature has evolved from a strong foundational philosophical knowledge development focus on nursology’s discipline-specific concepts, models, and theories to an equally strong practical focus on quality of practice and nursing education expansion in relation to practice, specifically, the development of the Doctor of Nursing Practice (DNP) degree programs.

Time has shown the value of such shifts in focus for a discipline. Advancement of a discipline calls for recognition and valuing of the complementary relationship between practical knowing and foundational knowing, as both are essential to the development of a professional discipline, such as nursology.

Practical knowledge is–or should be–based on the results of scientific research. However, if science is essential to move the discipline ahead, then philosophy ensures that we move in the right direction. But, “a broader understanding of the interdependence of practical and philosophical matters in professional nursing is needed” (Bruce, Rietze, & Lim, 2014, p. 65). Drawing from Einstein’s discussions of the influence of philosophies and philosophers on his work, Rovelli (2018) noted, “Scientists do not do anything unless they first get permission from philosophy” (p. 484).

Rovelli’s (2018) claim of an interdependent relationship between physics and philosophy for his discipline also is relevant for nursology. That is, contemporary growth and development of nursology requires an explicit interdependent relationship between foundational knowing and practical knowing. Indeed, the re-emergence of nursology as the name for our discipline after its initial introduction in the 1970s (Fawcett, 2018) is evidence of a contemporary need for terminology at a level of abstraction to incorporate all of the discipline’s knowing–both philosophically foundational and scientifically practical.

Within nursing history there are examples of practical knowing leading to foundational knowing, such as research about the impact of patient positioning that has led to foundational knowledge, but it seems that foundational knowing has the capacity to affect practical knowing in a more powerful manner. An excellent example is the clarification of the disciplinary boundaries of nursological knowledge pertaining to human beings, environment, health, and nursing goals and processes (Fawcett, 1984; Fawcett & DeSanto-Madeya, 2013). This metaparadigmatic clarification led to expansion of nursological knowledge, practice, research, education, administration, and perhaps most importantly, a clearer understanding of the theoretical knowledge that existed at that time.  Explaining the relationship of the various models or theoretical works provided clarity and understanding to move nursological knowledge development to a new level.

Ironically, recognizing the structure within which the various conceptual and theoretical frameworks fit may be seen as both practical and philosophical. Some of the very early National League for Nursing (NLN) faculty-curriculum development work that contributed to that understanding was very practical (O’Leary, 1975; Torres & Yura, 1975). Knowledge and understanding leads to future knowledge and understanding. Thus, foundational knowing and practical knowing collectively is nursological knowing that builds on all previous knowing. That is, there is no dichotomy between philosophical and practical knowing; instead, their complementary unified interrelationship may feature one or the other at periods of growth and change in nursology. Clearly, we want to ”counter those who would discard the discipline’s theoretical traditions as irrelevant or counterproductive, we need to [position] this new generation of critical scholarship to champion the intellectually exciting and complex philosophical challenge within which nursing has been engaged throughout its ideational history” (Thorne, 2014, p. 86).

Fawcett writes:

We know from Kuhn’s (1971) classic treatise on scientific revolutions that disciplinary perspectives change over time, typically as the result of scientists’ inability to continue to find support for a previous version of the disciplinary perspective. Sometimes, the revolution is in methodological shifts and sometimes it is in philosophical paradigm shifts. An example of a methodological shift is our contemporary acceptance of mixed methods research instead of the assertion—lasting into the early 2000s–that qualitative and quantitative methods are philosophically separate and, therefore, cannot ever be combined. An example of a philosophical paradigm shift is the growing recognition and acceptance of conceptual models and theories that reflect the simultaneity world view instead of those conceptual models and theories that reflect the totality world view (Parse, 1987).

The growing interest in nursology as the name for our discipline may be the beginning of major methodological and paradigm shifts from the contemporary emphasis on practical knowledge to a fuller understanding of the vital interrelationship of foundational and practical knowledge. These shifts are evident in that acceptance of nursology as the proper name for our discipline indicate that the foundational knowledge of our discipline guides the way we view our science and our practice—always within the context of an explicit nursological conceptual model and/or theory—rather than leaving the knowledge aspect of our science and our practice to the claim of being “atheoretical” (Fawcett, 2019). As Popper (1965) pointed out, everyone has a “horizon of expectations” (p. 47), such as a conceptual model or theory that guides research and practice, and as McCrae’s (2012) noted, “the legitimacy of any profession is built on its ability to generate and apply theory” (p. 222).

Finally, as Donaldson and Crowley (1978) so wisely told us,

A key point . . . is that the discipline should be governing clinical practice rather than being defined by it. Of necessity, clinical practice focuses on the individual in the here and now who has a problem requiring relevant and appropriate action. 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 nursing 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)

References

Bruce, A., Rietze, L., & Lim, A. (2014). Understanding philosophy in a nurse’s world: What, where, and why? Nursing and Health, 2(3), 65-71.

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

Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16, 84 87.

Fawcett, J. (2018, September 24). Our name: Why nursology? Why .net? Retrieved from https://nursology.net/2018/09/24/our-name-why-nursology-why-net/

Fawcett, J. (2019, January 22). The impossibility of thinking “atheoretically.” Retrieved from https://nursology.net/2019/01/22/the-impossibility-of-thinking-atheoretically/

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). Philadelphia, PA: F. A. Davis.

Kuhn, T. (1971). The structure of scientific revolutions. Chicago: University of Chicago Press.

McCrae, N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary healthcare. Journal of Advanced Nursing, 68, 222–229. doi: 10.1111/j.1365-2648.2011.05821.x

O’Leary, H. J. (1975). Changes in community nursing service that affect baccalaureate nursing programs. In Faculty-curriculum development, Part V. The changing role of the professional nurse: Implications for nursing education. New York, NY: National League for Nursing, Pub. No. 15-1574.

Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. Philadelphia, PA: Saunders.

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

Rovelli, C. (2018). Physics needs philosophy, philosophy needs physics, Foundations of Physics, 48, 481-491.

Thorne, S. (2014). Nursing as social justice: A case for emancipatory disciplinary theorizing. In P. N, Kagan, M. C. Smith, & P. L. Chinn (Eds.), Philosophies and practices of emancipatory nursing (pp.79-90). New York, NY: Routledge.

Torres, G., & Yura, H. (1975). The conceptual framework as part of the curriculum process. In Faculty-curriculum development Part III: Conceptual framework-Its meaning and function. New York, NY: National League for Nursing, Pub. No. 15-1558.

What If? Random Thoughts of Sleepers Awake

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

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

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

Peggy L. Chinn

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

Margaret Dexheimer Pharris

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

Danny Willis

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

Rosemary William Eustace

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

Marian Turkel

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

Marlaine Smith

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

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

References

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

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

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

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

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

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

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

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

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

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

 

Ann C. Wolbert Burgess, RN, APRN, FAAN

Guardians of the Discipline
Boston College web page

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Reflections on the 6th National Nursing Ethics Conference

by Guest Blogger Darcy Copeland

See Conference details page

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

Joan Liaschenko

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

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

Amy Haddad

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

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

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

Daniel Goldberg

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

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

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

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

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

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

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

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

Comments from students and others attending the Theory Conference.

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

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

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

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

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

“It was wonderful, exciting and inspiring meeting”.

Jacqueline Fawcett –

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

Danny Willis –

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

Margaret Dexheimer-Pharris –

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

Marian Turkel –

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

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

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

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

Mary Antonelli breakout session.

Rosemary Eustace breakout session

PhD student Beth Cunniff with Peggy Chinn

Dorothy Jones presenting, Jane Flanagan seated.

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

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

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