It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Christina Nyirati
Sharon Stout-Shaffer

At the time of the 2021 Virtual Nursing Theory Week, Christina Nyirati and Sharon Stour-Shaffer presented the baccalaureate curriculum they designed and now implement at Heritage University located on the Yakama Reservation in Washington State. This is the only session that was recorded during the conference; it represents the value of nursing knowledge in shaping the present and future of nursing as a discipline. The following is a brief description and a video of their presentation.

The first Heritage University BSN Program Outcome reads “The Graduate of the Heritage University BSN Program explains how nursing’s fundamental patterns of knowing –personal, aesthetic, ethical, empirical and emancipatory –contribute to understanding the complexity of nursing care in the treatment of human response”.

Carper’s (1978) Fundamental Patterns of Knowing in Nursing is the foundation of the BSN Program. Freshmen study discrete courses in each of Carper’s fundamental patterns: personal, aesthetic, ethical, and empirical knowing. The Personal Knowing course is founded on personal knowing as a precondition for nursing care. Students practice various methods of reflection to develop personal knowing in every moment of nursing care. The Aesthetics of Nursing course is grounded in assumptions from Nightingale’s theory of nursing arts and aesthetics as a fundamental pattern of knowing in nursing. An experiential course, based in the principles of performing arts, the focus is on the act of care; Students explore and apply dramatic arts foundational to holistic nursing care competencies. The Ethical Knowing course emphasizes the practice of ethical comportment in nursing care. The Empirical Knowing course students introduces students to fundamental theories, concepts, evidence, and competencies pertaining to generation of nursing knowledge.

Senior year features the community as the unit of nursing care, and is founded on Chinn and Kramer’s (2019) emancipatory knowing in nursing. The Policy, Power & Politics of Nursing course focuses on the professional nurse role in taking responsibility for shaping social policy. The two Community Oriented Nursing Inquiry and Practice and the Community Based Participatory Research courses center on principles of socially just reflective action to overcome health inequities.

Faculty developed rubrics to evaluate how students integrate the fundamental patterns of knowing nursing into clinical practice. Students complete reflective writing assignments during clinical practice each semester from sophomore through senior year.

About the contributors:

Christina Nyirati, RN, PhD

Christina Nyirati is Professor of Nursing at Heritage University on the Yakama Nation Reservation in Washington, where she serves as the founding Director of the BSN Program. Dr. Nyirati came to Heritage from Ohio University and The Ohio State University, where she directed the Family Nurse Practitioner (FNP) Programs. She practiced more than 30 years as an FNP in primary care of vulnerable young families in Appalachian Ohio, and worked to reduce dire neonatal and maternal outcomes. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice. Now at Heritage Dr. Nyirati prepares nurses in an innovative undergraduate curriculum faithful to the epistemic foundations of nursing. Two cohorts have graduated from the Heritage BSN Program. They openly proclaim and use their powerful nursing knowledge to correct inequities in their communities.

Sharon Stout-Shaffer, PhD, RN

Sharon Stout-Shaffer, PhD, RN, Professor Emerita, Capital University, Columbus, Ohio; Adjunct Faculty, Heritage University, Toppenish, Washington; Nursing Education Specialist, S4Netquest, Columbus, Ohio. Sharon has over 30 years of experience in educational administration and teaching in both hospital and academic settings. Her career has focused on developing education based on a nursing model that includes concepts of holism and healing.

Her Ph.D. in Nursing from The Ohio State University focused on the psychophysiology of stress and relaxation-based interventions to promote autonomic self-regulation and immune function in people living with HIV. She has attained certification in Psychosynthesis, Guided Imagery, and more recently, the Social Resilience Model; she has presented numerous papers on integrating holism into curricula as well as caregiver wellbeing and resilience including Adelaide, Australia, 2011; Reykjavik, Iceland, 2015; American Holistic Nurses Association Phoenix, 2016 & Niagara Falls, 2018.

During her tenure as Director, Post-Graduate Programs at Capital University, Sharon taught the graduate theory course and co-developed a theoretically grounded holistic healing course as the foundation for graduate study; the graduate program has been endorsed by the American Holistic Nurses Credentialing Center. Since her retirement, she has co-developed and implemented numerous educational interventions designed to develop the Therapeutic Capacity of working nurses and nursing students. This work includes concepts of centering, compassion, managing suffering, the psychophysiology of resilience and essential contemplative practices to develop stress resilience, deal with moral distress and promote long-term wellness. She is currently teaching courses in Personal Knowing and Nursing Ethics for undergraduate nursing students at Heritage University. Her most recent publication is dedicated to holistic self-care and self-development. (Shields, D. & Stout-Shaffer, S. 2020). Self-Development: The foundation of holistic self-care. In Helming, M., Shields, D., Avino, K., & Rosa, W. Holistic nursing: A handbook for Practice (8th). Jones and Bartlett Learning, Burlington MA.)

4 thoughts on “It’s Time We Raise Nursologists!

  1. My comment has nothing much to do with today’s essay. Rather, I have been stewing about the invisibility of Lillian Wald, given her accomplishments. In part this is due to the damnable “five year rule” which contributes to disciplinary amnesia – not my term, but rather that of a Carnegie Foundation commission on the purpose of PhD education. Given that she established the Henry Street Settlement House, the precursor to the NY Visiting Nurse Service, and the first nursing curriculum at Teachers College, was a co-founder of NAACP, responded through labor organizing among girls and women to the Triangle Shirtwaist fire, was extremely well connected to donors and the Roosevelts, and more, it concerns me that a person who so clearly responded to social determinants of health before we had words for them is so ignored in our discipline. I have come to wonder if the intellectual descendants of Nightingale wanted to sweep her under the rug because she was Jewish and a lesbian. Thoughts?


    • How wonderful to see your comment here, Nancy! You are so very right about the amazing contributions of Lillian Wald! Would you be willing to write a bit more about what you have shared here for a blog post? Let me know and I will do all I can to facilitate this happening! Peggy


  2. “in the treatment of human response”…I know the authors didn’t coin this phrase…it strikes me as just about the coldest description of the warm intimate personal relationship that is nursing I can imagine! I suggest we all drop this phrase as descriptive of nursing! This phrase in no way distills the meaning of the caring that is nursing…and nursology! Any one of the “extant general theories of nursing” makes a more accurate statement of the essence and focus of nursing. If we are truly to ground our nursing thought and action, whatever the realm, in nursing theory, I urge that each of us joins a cadre of nurses aligned with one or the other grand nursing theories…or create a new one for the 21 century. I don’t recall now who was involved in the group that came out with the phrase “treatment of human response” as having anything to do with nursing, let alone epitomizing it – I’ll accept it was the best that group could come up with at the moment – but that doesn’t mean we have to continue promoting this as a genuine representation of nursing.

    The patterns of knowing were a wonderful advancement in understanding and organizing nursing as a discipline of knowledge and field of professional practice. However, the idea of patterns of knowing fundamental to nursing constitutes an epistemological framework for coming to know in nursing – it says nothing about the content of nursing. That’s where the grand theories and their related mid-range and practice theories come into play. It’s my view that frameworks for nursing education must provide explicit theoretical guidance regarding content, not just process. General or grand theories of nursing not only provide explicit guidance about content, they offer explicit guidance on the coherent, justifiable integration of content-and-process, and the practice of that coherent, justifiable integration.


  3. Thank you for your insightful comments regarding how frameworks for nursing education must provide explicit theoretical guidance regarding content, not just process. You are right in saying that the presentation on the Heritage Nursing curriculum highlighted the theoretical assumptions, rooted in the fundamental patterns of knowing in nursing, without providing more explicit guidance to nurse educators. We look forward to presenting in a journal article the process of how our students learn and the specific content. I also believe, as you suggest, that we all are ready to enter a fresh debate about how “the treatment of human response” might be replaced by a phrase that more aptly describes the deeply caring relationship between nurses and those who entrust themselves to the care of nurses.


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