Guest contributor: Ellen E. Swanson
This is post is the final section of the new “Practice Exemplar”
describing the application of Mandalas in nursing
See also related Education Exemplar

In the process of writing the “Using Mandalas – An Holistic Approach to Practice” exemplars, Peggy Chinn shared with me that we need to “work toward a more complete and robust connection between theory and practice! The important thing for www.nursology.net is to give our viewers theory sources so that we can all deepen our appreciation of how important the theories of our discipline are!” Accordingly, I began to think about how the exemplars about mandalas reflect my theoretical thinking and how these exemplars can help all of us form a more complete and robust connection between nursing theory and practice, as well as deepen our appreciation for nursing theories.

The current COVID-19 pandemic is a very significant time to recognize the importance of connecting theory/science and practice.  As a nurse on the board of the 63 unit condo building in which I live, I have the opportunity to experience the value of connecting theory/science and practice during this pandemic.

I saw the immediate need for scientific education of the unit owners and proceeded to provide this with written information.  I then organized sanitizing teams with team leaders, by floors, with the focus on common areas where surfaces touched by all (i.e., laundry rooms, trash chute rooms) could be a source of spreading pathogens.  I practice by also being one of the team members. (During my career I always felt I could supervise better if I knew from experience what those I supervised were to be doing.)  I check two websites daily, looking for trends in the world and the nation, and use this and the information from CDC,  AHNA weekly updates, and HOA (Home Owners Association) legal requirements to keep owners informed and help make decisions about what is best for our vertical village.

The response has been very rewarding as everyone pulls together and the majority are gratefully caring about and serving one another.  In these times of national divisiveness, this is a gift.

A Healthier Linear Template

I ask that as you read the mandala exemplars, you become aware of your felt sense of the images in the exemplars. Look at the arched linear organizational chart model that lays the foundation for a more complete connection between theory and practice.

We can begin to understand the robust connection between nursing theory and practice by thinking creatively about the satellite and the mandala.

Merging two paradigms, Step one

The mandala is the sending and receiving dish of the satellite, representing nursing practice as we send and receive with patients/clients. The arched linear organizational chart model depicts the energy panels of the satellite and represents nursing theory, supporting and, therefore, energizing practice. Working together, we can successfully stay in orbit.

Satellites also have a few jets at the rear of the energy panels that keep them on course, making small directional corrections when needed. Much like a satellite’s course-correcting engines, theory can provide direction for needed changes that arise as our discipline adjusts to societal and informational shifts that come with human development over time. But theory does more than that. Theorists have committed years to conducting research about what practices work and why they work. The research yields a deep, rigorous science that informs the why, how, where, and when of what we do in practice. Furthermore, what occurs in practice provides the small and not so small directional corrections to the theory.

Just as all flowers are not the same color, all of us may resonate with a different theory to guide our practice. When we become aware of the various ways in which various theories can guide practice, we may select the theory or theories that best fit our own unique way of thinking and skill set. I came to this perspective toward the end of my career. I had always endeavored to hide how I practiced while maintaining all the requirements for licensure as a registered nurse. We hide when we feel fear. I also felt alone. About two years before I retired and after the first mandala application was made, I was sharing a few client stories with some colleagues, one of whom was Ellen Schultz  (See Education Exemplar)

Ellen quietly noted, “I think you might resonate with Modeling and Role-Modeling Theory.” I reviewed the theory and realized that she was absolutely right. I breathed a sigh of relief as I realized that a nursing theory actually had been my practice guide for all those years. I realized that I could have had a much less fearful and lonely career.

Then I started thinking deeply about how I might have learned to use Modeling and Role Modeling Theory without having known about it. Recall of an event in my life helped me understand this. The event involved a visit with my mother at the time of her 98th birthday; I journeyed 600 miles to be with her and to share with her some of my heart-centered stories from the 46 year nursing career from which I was retiring. I read some stories to her, and she was deeply touched, wondering how I learned to intervene with my clients in such a way. I told her that although she had taught me, I didn’t think she was aware of what she had given me. Indeed, she was surprised and wondered how she had taught me. I reminded my mother of the example of her friend Edith’s final months; Edith had died of brain cancer 35 years before. My mother had told me that she had spent time reading to Edith when Edith could no longer read. During one time of reading, Edith suddenly sat up in bed and anxiously interrupted my mother, saying, “Liz! There are worms crawling out of that book!” My mother replied, “Where?” Edith pointed, “Across the top!” My mother scooped her hand across the top of the book and asked,  “Did I get them all?” Edith visibly relaxed back into her pillow and told my mother that she had indeed gotten them all. My mother then continued reading to Edith. I explained to my mother that what she had role modeled with that example was how to step into another person’s reality and participate where that person is. She nodded slowly, saying it was just something she did intuitively without being aware of it. I then related this to how I had done that in the career stories I had read to her. I thanked her for that gift, letting her know I had only become aware of her gift because I had been asked by a few of my colleagues to write some of my orally shared stories.

This was a gift exchange. The first gift was given without explicit awareness. The return gift was to bring explicit awareness, express gratitude for the role modeling, and acknowledge the positive effect on those who benefitted from the teaching. The greatest gift was a strengthened, heartfelt relationship between mother and daughter.

I ask now, has there been a time when something implicitly led you, and then you became aware of it later? Did that change your perspective in any way? Was there a gift you received that you hadn’t been aware of before?

Nursing theories can help us become aware of who we are and what we have to offer. There is a history of practicing nurses feeling inferior or disinterested in theory, and

Merging two paradigms Step 2

theory nurses feeling dismissed by practicing nurses. Both need time to heal. Healing is a sacred process, and when deep healing occurs, it includes vulnerability and compassion. Perhaps this next image will help us heal by showing how much we need each other.

Here the arched linear organizational chart model, representing theory, has become a container. A container with no contents is empty. The mandala, the contents, represents practice. With no container the contents float away and disappear. Together we form a Holy Grail of practical, professional, and knowledgeable service to humankind. We simultaneously blossom and grow our profession.

Merging two paradigms Step 3

The next image represents this flowering.  There can be a sacred union within each of us and between theory and practice. Let us grow that union by nurturing and nourishing each other’s gifts. Holistic nursing theory concepts of expanded consciousness, oneness, transpersonal connections, healing, being, and process of becoming are illustrated throughout the mandala exemplars.

Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired) had a 46 year career that included ortho-rehab, mental health, operating room, management, teaching, care managing, and consulting. For fifteen years she had a private practice in holistic nursing, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.