Contributor: Mike Taylor
The four metaparadigm concepts of nursing knowledge have been human beings, environment, health and nursing process; with the state of the person at the center of the definition and achievement of health goals. The idea that an individual has the wherewithal, not only in name but also but also in action, to determine what health means for them as an individual and is able to work to accomplish those same goals is the concept of agency. Among nursing’s most referenced conceptual models and theories — Orem, Parse, Newman and Roy — keep the focus of nursing’s work on the individual before us, and much less of a consideration is on the environment the person inhabits. Newman (1979) for example states that the goal of nursing “is to assist people to utilize the power that is within them as they evolve toward higher levels of consciousness” (p. 67) The concept of individual agency is central even in theories about the praxis of nursing such as Watson’s theory of human caring where the nurse/patient dyad “is influenced by the caring consciousness and intentionality of the nurse as she or he enters into the life space … of another person. It implies a focus on the uniqueness of self and other…” (https://www.watsoncaringscience.org/jean-bio/caring-science-theory/)
Agency is not something that is naturally given to a person but emerges from the process of human development. That process is frequently affected by poor schools, environmental pollution, and the other mediators of institutional racism and poverty. The chances of an individual reaching full agency, meaning the ability to identify and actualize individual health goals, in adulthood are much more likely when those limiting factors are not present due to privilege. Even when an individual is able to overcome early life challenges, the social environment where agency can be exercised, there are limits on who can participate based on class, race, and gender. These limitations on the exercise of agency extend to persons who either want to or are actively practicing the profession of nursing. Even when a person can overcome the intersecting influence of race, poverty and gender to become a nurse; the same barriers remain in the practice environment often limiting choice of practice arena and opportunities for advancement to leadership roles.
Nursing theory is right to place individual agency at the center of the health improvement process, but it does not address the uneven distribution of that agency and the effect that has on health. Agency is only possible where it is allowed and when individuals in disadvantaged communities do not have the inability to develop or exercise agency, the disparities in health outcomes we see today are the result. For nursing theory to meet these health challenges it must develop beyond a focus on individual agency to an emphasis on the social and environmental conditions that limit health improvement which means challenging institutional racism and poverty among others.
To develop the concept of agency in nursing and challenge existing social barriers, I believe that it would be instructive to align the development and exercise of agency with concepts of intersectionality. An important question might be can any correlation be found between the intersectionality and the degree of effective agency as reflected in an individual’s agency and the available social environments where that agency can be exercised. My anticipation is that it would be an inverse correlation with effective agency decreasing as the number of overlapping disadvantages increase.
Sources
Newman, M., (1979). Theory development in nursing. F.A. Davis. https://openlibrary.org/books/OL4409082M/Theory_development_in_nursing
Caring Science & Human Caring Theory, Transpersonal Caring and the Caring Moment Defined https://www.watsoncaringscience.org/jean-bio/caring-science-theory/
About William (Mike) Taylor
Mike Taylor is an independent nursing theorist specializing in the application of complexity science to health and compassion. His Unified Theory of Meaning Emergence takes a major stride in connecting the mathematics of complexity with self-transcendence and compassion. He has spoken at international, national and regional conferences on complexity in nursing, health, and business. He is a member of the board of the Plexus Institute where he is the lead designer of the Commons Project, a web based platform for rapid social evolution in climate change.
Thank you, Mike – that is an important observation!
I agree. Thank you Mike for continuing this important critique and discussion building on the Virtual Nurse Theory Week dialogs and presentations with your post here. My colleagues and I have similar observations and critiques around the theoretical framing of environment, person, and caring which often seem to assume equity in privilege, structural power, access to systems, access to safety, equity in systems of policing and governance, equity in mobility contexts like migration and travel. These assumptions deny the lived experience of people and communities who do not benefit from white supremacy and privileges that come from identities holding membership in dominant groups. “Percepticide” was a phrase I heard today
from talk on The Effects of Current Immigration Policies in the United States and in Santa Cruz: Understanding violence With Regina Langhout, Professor of Psychology, UC-Santa Cruz and Visiting Scholar at the BC Center for Human Rights & International Justice, 2020-2021 academic year Langhout, R. D., & Vaccarino‐Ruiz, S. S. (2020). “Did I see what I really saw?” Violence, percepticide, and dangerous seeing after an Immigration and Customs Enforcement raid. Journal of community psychology.
The idea of organized unseeing, as a form of structural violence, like organized forgetting (Giroux) and Politics of Ignorance by nurses Perron and Ridge 2015. Now is the time to see, time for “Overdue Reckoning in Nursing ” as framed by organizers of antiracism workshop here at Nursology.net . Let’s go.
“These assumptions deny the lived experience of people and communities who do not benefit from white supremacy and privileges that come from identities holding membership in dominant groups.”
Where did you get, in anything Mr. Taylor wrote that parlayed into this trite over used statement of WHITE SUPREMACY, MS Walsh?
Why is everything funneled into a “WHITE SUPREMACY” statement these days?
Cannot wait to hear the day when Oreo cookies are considered racist…
That being said, “social environments” can be a construct of a community of over zealot religious beliefs, rural areas where going to the doctor/hospital is considered a weakness, or urban cities where hospitals that are dumping grounds for the mentally ill, drug addled, and violent offenders fresh from a shooting. If you were raised in any of the following ( I can assure you, having come from an alternative “social environment” myself) your own beliefs/coping mechs, values and ethics come into question as to how to guide your practice when you first bust out on your own.
One needs a lodestar to be guided by, and it’s not always found in alternative social environments, but rather the exposure of another type societal norm and expectance that often will not be found where you came from. Intersection needs to have a universal goal way past “agency”. American health care has national standards from the East Coast to the West Coast all must practice the very same. Thus no matter how hard you want to scream “diversity” and all the other popular lingo of the current politically correct verbiage, you still have to be able to perform code by ACLS standards, even if your religion says you cannot be handled by a man if you are a women, nor if you think your pride can’t take receiving help from a hospital, or if you are dealing with a undiagnosed schizophrenic.
None of this “noise” matters if you can’t do the job to standard: it’s far from being “white supremacy”, its knowing your stuff and getting it done as per the “prudent nurse” way, as per the Nurse Practice Act in any state of this country. There are social environments that will never allow this to happen, no matter how much word salad you write, speak or scream.
Where one works as a Nurse and /or seeks care can prevent “full agency” IE profit or non-profit hospitals, private or institutionalized organizations like home health, or nursing homes can present as the real limits to health care. These are the “Agencies” that can prevent forward thinking and acceptance I believe this article is trying to advocate for. Healthcare is still dictated by insurance reimbursement. That is the reality we in health care live in.
We have to look at the Inuit ways of the Alaskan Health Care system to recognize that the values of alternative societies can actually enhance health care. Yet try telling this to the AMA.
Those “same barriers remain in the practice environment often limiting choice of practice arena and opportunities for advancement to leadership roles”.
Like this isn’t true for Nurses of ANY DEMOGRAPHIC, not just Minority/Immigrant/Disabled.
Come on…
Agency is not even a word I would have used. The use of the word “AGENCY” leads to connotations of institutionalized constructs that all must dealt with as a human being vs rules, regulations, policies and procedures that often do not lend itself to individualized needs of physical care.
The better words would have been “Self Advocacy” as this is truly what is needed for staff as well as patients, while dealing with the “Agency” of Medical Insurances, Hospitals and facilities and foolish law makers that think they can dictate what care should be when they don’t do the job.
Anyone thinking Cuomo from my home state of New York?
We don’t need incendiary viewpoints in Nursing, we need unifying,
I found this article incendiary.