Bittencourt, Marques, and Mendes Diniz de Andrade Barroso’s (2018) paper, published in Revista de Enfermagem Referência, catalyzed my thoughts about labels for 
legitimate specialties in the discipline of nursology. (Scroll down for information about the authors and access to the article website.) Clearly, concern for nursology-discipline specific knowledge is of interest to our scholar colleagues from Brazil (Dr. Bittencourt) and Portugual (Dr. Dias Marques and Dr. Mendes Diniz de Andrade Barroso). They presented an innovative approach to further development of nursology by placing a traditional specialty (mental health) within the context of various nursological conceptual models and theories. (Download the PDF of the English open-access article here).
Bittencourt and colleagues (2018) pointed out that although nursologists “have been conducting studies with the purpose of promoting mental health in schools and other settings . . . based on evidence that clearly points to the effectiveness of promotion strategies, [nursological] theories are rarely put forward as a basis for these nurse-led mental health promotion strategies” (Bittencourt et al., 2018, p. 126). They recommended that nursological conceptual models and theories should be used to expand thinking about the practice of mental health promotion and described the contributions of Meleis’ Transitions Theory, Pender’s Health Promotion Model, Peplau’s Theory of Interpersonal Relations, and Roy’s Adaptation Model to research and practice for promotion of mental health.
The starting point for Bittencourt and colleagues’ (2018) proposal is a traditional specialty area that imitates a medical specialty, that is, mental health. Nursologists typically identify with this and other specialties drawn from medicine, including but not limited to medical, surgical, obstetrical, and pediatric specialties. These specialties comprise many undergraduate and graduate educational curricula, the broad areas of nursologists’ research, and the naming of departments in clinical agencies. Thus, just as Bittencourt et al. (2018) did for the specialty of mental health, nursological conceptual models and theories could be used as guides for the content of the courses, research, and practice in other specialty areas.
But what if the content of each nursological conceptual model and theory was used to designate specialties? For example, many years ago, Rogers (1973) proposed that the subsystems of Johnson’s Behavioral System Model could be nursology-specific specialties. Accordingly, specialties for curriculum content, research, and practice could be the aggressive subsystem, the attachment subsystem, the achievement subsystem, the ingestive subsystem, the eliminative subsystem, the dependency subsystem, and the sexual subsystem. Similarly, specialties within the context of Neuman’s Systems Model could be physiological variables, psychological variables, sociocultural variables, developmental variables, and spiritual variables.
Although the proposal that specialties should be within the context of each nursological conceptual model and theory may be regarded as preposterous, at least some nursologists have understood the value and importance of labels for specialties that differentiate the discipline and profession of nursology from other sciences and especially from the trade of medicine. For example, Batey and Eyres (1979) explained that “Language is fundamental to the evolution of all disciplines [and] [w]ithin any discipline, selected terminology evolves to become the concepts that denote the specific knowledge domains and methodologies of that discipline” (p. 139). Moreover, “Every science has its own peculiar terms, concepts and principles which are essential for the development of its knowledge base. In [nursology] , as in other sciences, an understanding of these is a prerequisite to a critical examination of their contribution to the development of knowledge and its application to practice” (Akinsanya, 1989, p. ii). Barrett (2003) added, “How would one understand anatomy and physiology, microbiology, pharmacology, . . . without the precise use of language reflecting those domains of knowledge? . . . How else is substantive knowledge to be communicated without saying it is what it is that it is!” (p. 280).
As we think about the admittedly potential choas of having such diverse nursology-specific specialties, we may move to an innovative and integrative way of identifying the specialities that accurately delineate what nursologists actually teach, study, and practice. Clearly, we need to move to (paraphrasing) what Allison and Renpenning (1999) called thinking nursology, what Watson (1996) called nursology qua nursology, and certainly what Meleis (1993) pointed out is the need to progress from thinking like and pretending to be junior doctors to being senior nursologists.
Noteworthy is that many of the ideas included in this blog come from publications of decades ago. Yet, no progress has been made in all that time. So, what do you think nursology-specific specialties should be? Should we continue with the status quo of using the same terms as does medicine with the added value of the context of nursological conceptual models and theories? Or, should we be finally be bold and use the languge of our nursological conceptual models and theories to name and structure our specialties?
References
Akinsanya, J.A. (1989). Introduction. Recent Advances in Nursing, 24, i–ii.
Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.
Barrett. E. A. M. (2003). Response to Letter to the Editor. Nursing Science Quarterly, 16, 27-28.
Batey, M. V., & Eyres, S. J. (1979). Interdisciplinary semantics: Implications for research. Western Journal of Nursing Research, 1, 139-141.
Bittencourt, M. N., Dias Marques, M. I., & Mendes Diniz de Andrade Barroso, T. M. (2018). Contributions of nursing theories in the practice of the mental health promotion. Revista de Enfermagem Referência, 4(18), 125–132.
Meleis, A. I. (1993, April). Nursing research and the Neuman model: Directions for the future. Panel discussion at the Fourth Biennial International Neuman Systems Model Symposium (B. Neuman, A. I. Meleis, J. Fawcett, L. Lowry, M. C. Smith, and A. Edgil, participants), Rochester, NY.
Rogers, C. G. (1973). Conceptual models as guides to clinical nursing specialization. Journal of Nursing Education, 12(4), 2–6.
Watson, M. J. (1996). Watson’s theory of transpersonal caring. In P. Hinton Walker & B. Neuman (Eds.), Blueprint for use of nursing models (pp. 141–184). New York, NY: NLN Press.
About the authors
- Marina Nolli Bittencourt, RN; Ph.D. is an Adjunct Professor, at the Federal University of Amapá, in Macapá, Brazil
- Maria Isabel Dias Marques, Ph.D., is a Coordinating Professor, in the Nursing School of Coimbra,in Coimbra, Portugal
- Tereza Maria Mendes Diniz de Andrade Barroso, Ph.D., is an Adjunct Professor in the Nursing School of Coimbra, in Coimbra, Portugal
Access the article
The file for their journal article, Contributions of nursing theories in the practice of the mental health promotion, is available in English and Portuguese at https://doi.org/10.12707/RIV18015. The abstract is available in English, Portuguese, and Spanish.
The journal, Revista de Enfermagem Referência, is the property of the Escola Superior de Enfermagem de Coimbra.
I find this discussion fascinating. I currently hold a certification in Medical-Surgical Nursing, which, to be honest, I’ve always questioned the terminology. While the substance of such certification and knowledge certainly goes beyond “medicine” or “surgery” and denotes a clinical population for care, I can’t help but wonder if a new term should be considered that is closer to nursology.
As a nursologist, I currently consider myself to be a “generalist” in the specialties you have discussed. As a generalist, I often find it necessary to inform my thinking from all 3 (reaction, reciprocal interaction, and simultaneous action) paradigms. In this way, the 7 classical conceptual models, grand theories, and middle range theories become the “umbrella” that I carry with me everyday in practice. The content of these theoretical foundations thus become part of my clinical reasoning, and I have to chose an approach that best meets the patients needs.
For example, I always aim to espouse unitary thinking in my clinical practice. However, this requires, as a nursologist, the ability collaborate with the patient in understanding their needs and priorities of human becoming. However, if I were to assume care of a patient who is comatose, with no family, and no prior history, then I don’t think that a unitary paradigm is completely applicable. While unitary pattern recognition is possible in certain ways, my duty to care for patients in this condition would, ethically, need to be informed by more reciprocal interaction (or even reaction) paradigms which bring with it certain epistemological orientations and axiologies.
My understanding is that some scholars would consider a pluralistic orientation unfavourable. This has not been my experience in clinical practice.
In comparison, pharmacology, patho physiology, technical skills etc., all bring different ontologies and epistemologies to the table. These are often brought together to inform the clinical reasoning of the nursologist. Is it, then, possible (and even desirable) for clinical reasoning to be informed by our multiple conceptual models and theories that best meet the needs of patients in specific contexts?
I would love to hear your thoughts.
Cameron
What an excellent and thought-inspiring comment, Cameron!! Thank you!