Guest Contributors*:
Andra Opalinski and Patricia Liehr
We are responding to Dr. Foli’s request in her blog titled “Say It Ain’t So: Graduate Students Shade Nursing Theory!” where she stated…”What about you? If you have suggestions for me on how to strengthen the theory-to-primary care advanced practice connection in a master’s level course, please forward them…”
WE BEGIN WITH DEFINITIONS
Throwing Shade: (verb) subtly disrespecting or ridiculing someone or something.
Shade: (noun) a comparative darkness caused by shelter from direct light.
We ARE the theory-practice connection.
As nurse educators who appreciate the theory-practice connection, we had been pondering Foli’s post and then Constantinide’s follow-up about graduate students throwing shade at nursing theory. Not knowing the meaning, we took the “throwing shade” descriptor quite literally and thought how we often prefer to find shade on sunny Florida days!!! In the midst of our extended pondering and thoughtful conversations came COVID-19; and a virtual class that we co-hosted with NP students to discuss the use of Story theory in practice; and THEN, we serendipitously came across a 2020 calendar page with a haiku by Tomihiro Hoshino entitled “In the Shade.” This haiku accompanies his calendar painting of a redbud tree with hanging red pods amidst green foliage:
In the shade of leaves,
They shyly sway,
Pods like strips of paper
With girlish wishes
Written on them
Moving along to a class with NP students.
In this class, we were talking about Story theory and the practicality of using it when working with patients. Story Path, a way to pursue story-sharing was the specific lesson (Liehr & Smith, 2020). Clare, an ER nurse, volunteered to share a recent practice story with the class.
“I was caring for an elderly patient in the Emergency Room who had just tested positive for COVID-19. However, this day, the provider I was working with was resistant to putting the patient on a ventilator.” As Clare reflected on the situation she shared, “I remember asking myself, is the provider just being lazy because the patient is elderly with a poor prognosis? However, I also knew, this doctor reads a lot of research. I still couldn’t help but question the decision. The patient did in fact improve without ventilator assistance,” giving Clare pause….thinking about the juxtaposition of knowledge with practice. As Clare’s recounting of the story concluded, Clare was asked to consider how her COVID-19 experiences may influence the future. The rawness of her sharing was palpable as she elaborated on the pause noted in her story: “I never knew nursing would get to this point. I am becoming suspicious of everyone, even co-workers. I stand away from everyone and wear masks all the time. I am challenged with what feels like lacking compassion. I don’t spend time in the rooms like I always did before, or place a hand on an arm to show comfort because we are thinking, is this the next COVID patient. I do make sure there is a phone in every room and I call often to check on the patients. It just feels less personal. It feels unnatural.”
Hmmm…lacking compassion feels unnatural. There is a theory and/or a philosophical perspective in this sentiment. We could go with Meyeroff’s ideas (1971) about caring as a way of ordering one’s values so that one feels “in place” rather than “out of place” in the world. We could go with Watson’s Transpersonal Caring Moment (Watson, 2018) where people come together in a human-to-human, spirit-to-spirit connection that is meaningful, authentic and intentional. These are just two examples providing context that allows for locating self in the theory-practice connection; many others could be the philosophical/theoretical lens providing context.
Then the class was asked, “What have you learned from Clare’s story that resonates with your own practice?” Anna was quick to answer, “Everything is fluid and flexible right now, we have protocols, but they change day by day, they are evolving and there is a lot of uncertainty. We have to be able to allow flexibility in new ways. I can’t get into my usual groove.” Then THE question was posed. “Is theory real for you in your everyday practice? If not, it’s ok to say so.” Perhaps the most insightful answer was Brad’s response. “We are taught many theories, but challenged to know how to apply them. I don’t have theory on my mind when I am in front of my patient. It may be subconscious, but I’m not thinking, I’m applying Leininger or Watson right at this moment.”
Brad is right…we don’t expect that nurses live real-time practice checking in with theoretical/philosophical perspectives. However…the perspectives are there and stepping back and reflecting on nursing circumstances may enable forward movement with theory-guided intention and with knowledge-building for the discipline.
Pondering We ARE the theory-practice connection
As the nurse theorist-practitioner team that we are, we have great appreciation for the comments of these practicing nurses who happen to be graduate students. We wondered …Could the shade granted by COVID-19 bring theory out of the shade for students when they don’t even know it? You see, we are educators in a setting where nursing theory is highly valued and caring theory is the organizing spine of our curriculum. Has caring theory become so naturally interwoven in their practice that these NP students know something is amiss but they have difficulty naming it beyond descriptors like “unnatural” or “I can’t get in my groove”? We can only hope….but we can also plan to honor the shade by:
- remembering that we are always working from a theoretical perspective – we have only to step back from any nursing situation and consider the principles/concepts that are guiding our actions;
- creating opportunities to share our practice stories with the knowledge that the implicit theory woven into the practice threads can come alive through scholarly engagement that is open to authentic expression and that gently supports exploration and maturing of an individual nurse’s own thinking;
- holding the theory-practice connection as a truth that just takes time and professional maturity for appreciation but it is a truth that can be readily described when nurses have a mentor who helps with connecting the practice-theory dots;
- pairing theorists and nurse practitioners to forge opportunities for growing nursing knowledge grounded in our practice.
Though there is little positive to say about COVID-19 these days, it may be that the pandemic granted some shade for us to reflect on the theory-practice connection in a way that can guide understanding. After all, We ARE the theory-practice connection. Let’s own it.
Now….what do you think – we would like to hear from you. How do you see our plan to honor the shade as an integral dimension of developing practice-scholars AND growing the discipline of nursing?
- Liehr, P. & Smith, M.J. (2020). Claiming the narrative wave with story theory. ANS, 43(1), 13-27.
- Meyeroff, M. (1971). On caring. Harper & Row: New York.
- Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. Louisville, CO: University Press of Colorado.
About the contributors
Andra Opalinski, PhD, CPNP-PC, NC-BC is a pediatric nurse practitioner and an Associate Professor at the Christine E. Lynn College of Nursing, Florida Atlantic University. She is an advocate for child and adolescent mental health promotion. Her current areas of interest include community-based participatory research with elementary through high school students using mindfulness interventions for self-regulation and stress management skill building. She also uses visual anthropology through photographs to explore perspectives of health of vulnerable populations. Right now, you’ll find her working remotely, doing the best she can to keep her household of 5 under strict physical distancing, and using the visual anthropology approach to document her family’s physical distancing experiences.
Patricia Liehr PhD RN is currently the Associate Dean for Nursing Research and Scholarship at the Christine E. Lynn College of Nursing, Florida Atlantic University (FAU). She is the co-author of story theory and the co-editor of Middle Range Theory for Nursing. Most of her scholarly work has focused on peace, from personal through mindfulness; to global through coming to know both sides (Pearl Harbor; Hiroshima) of surviving the bombings of WWII. Story-gathering has played a major role in her research endeavors and she highly values the place of nursing practice stories for disciplinary knowledge development. Right now, as she moves toward an August retirement from FAU, she is imagining all the things she will do with new-found time.
Such an interesting post! The shadow of COVID is indeed a meaningful way to contemplate, yet again, the presence of nursing theory in everyday practice – along with the question, yet again, about whether and how nurses are able to articulate their unique contributions. I have always wondered if nursing theory functions on two levels: 1) to shape and articulate unique nursing contributions and 2) to reflect nursing practice by finding ways to articulate what already exists. The last possibility may speak to the notion that WE ARE the theory/practice connection. The identification of what is currently missing from a nurses’ experience of providing care speaks to the way that theory is lived out, perhaps unconsciously, in nursing practice.
I undertook my initial nursing credential in the 1970’s…before nursing theory had been named. The nurses of those years, and the nurse that I became, reflected the very best of caring theory. How was that communicated? I always try to remember. I know that the ethics involved in becoming a “professional” were emphasized, along with honesty and compassion, all of which were superimposed on the scientific studies.. Excellent nursing was modeled by the nurses who supervised us as students. Nurses, as I remember them, WERE the theory/practice connection, although shaded in those years by the hierarchy and privileged approach to knowledge. Perhaps it is by identifying what it is that shades us, we will emerge, once and for all, into the light!
Thank you for this thoughtful comment and the idea about the two potential ways that theory may be functioning. I too, was educated in nursing more than a decade before nursing theory became part of my consciousness. Having graduated from a 3-year diploma program and then, completing a BSN, I had 10 years of practice before beginning my Masters education. However, when I was introduced to nursing theory in my Masters program by Parse, Coyne and Smith, I remember feeling like it made so much sense to finally be able to link what I valued in my practice to a structure of ideas. This was definitely an experience of finding a way to articulate what already existed for me. So, I think that since my Masters education, I have known that I embodied the theory-practice connection but with your post, you sharpened my focus on that dimension of my self-knowing. It’s a lovely gift!
Now…..I am thinking about other functions of nursing theory. I believe there must be more than two.