This week marks 3 years since Nursolog.net became a reality! My thanks to the vision of Jacqueline Fawcett, Peggy Chinn and other members pf the AAN theory-guided practice panel who were part of that initial envisioning of bringing nursing knowledge into the digital age and making the theoretical and conceptual basis for nursing practice more visible and accessible.
In one of the first blogs, Dr. Jacqui Fawcett addressed the use of the word “Nursology” in the website’s name. She argued that it rightfully focuses attention on the discipline, or knowledge base, that informs nursing practice and provides some history as to the use of the term since the 1970s. She also provides the rationale for the “net” extension.
I was excited when I first heard of the initiative and still am. Perhaps it is because I learned nursing in a hospital-based nursing program in which nursing students’ primary responsibility seemed to be to provide the staffing needs of the hospital, wherever that might be. For instance, weeks of our “training” was, in general service areas such as the diet kitchen, central supply, infant formula, pre-op shaving and OR. Although some valuable principles might have been learned in these areas, they were not commensurate with the length of time spent there.
The educational component of that program, although it seemed dwarfed by the hospital’s staffing needs, was also completely medically focused, i.e., what nursing actions were required in the presence of specific medical diagnoses, treatments, or investigative procedures. Lectures by nursing faculty were often supplemented with physicians’ lectures.
I recall no mention of nursing knowledge. Although this was the early 1960s, the works of Henderson and Peplau, at least, had been in circulation for years. As students, we were aware of Nightingale but, as I recall, that awareness related more to her emphasis on character, e.g., the pledge to live one’s life in purity, rather than specific principles of nursing care.
I was recently reminded of those days when I received an alumni newsletter summarizing some key aspects of what it meant to be a “student nurse” in an even earlier period of the school’s history in the first half of the 20th century. It reinforced some of my memories, such as that “the curriculum also depended on the needs of the hospital” and emphasized the “ultimate authority of the [medical] doctor. Nurses were considered as doctors’ handmaidens.”
Collegiality between doctors and nurses seemed nonexistent; students were taught deference toward physicians, e.g., standing when they came into room, speaking only when spoken to by a doctor, etc. Much of this was still present in the 60s.
Nurses were taught obedience to authority, a principle that was reinforced in residence life (which was compulsory, even during the 60s). Punishments for staying out after curfew, not having tidy rooms, when an inspection took place, and being “improperly dressed in the bathroom” were met with significant restrictions, such as “being confined to barracks” for weeks at a time. One form of punishment was basically “shaming.” For example, an infraction in the residence could result in a student not being allowed to wear her nursing cap while nursing on the wards for a period of time. Even in the 60s, I remember similar instances.
These kinds of stories of the past are important in understanding nursing and health care today. While there is no doubt that both nursing education and society have changed, societal norms and workplace cultures are slower to change. We refer to “health care systems, although they are predominantly illness treatment orientated. People are admitted to, and discharged from hospitals for nursing care predominantly by physicians. Carrying out “Dr.’s orders is primarily a nursing responsibility that too often can take precedence over nursing care priorities.“1 Furthermore, the culture of nursing deference to physicians that was prevalent in the mid 20th century has not disappeared. I experienced it personally in the last hospital staff nurse position I had in the late 1980s, witnessed it the hospitalization of family members, and heard it from nursing students much more recently. That culture included, too often, messages to nursing students to “forget all that nursing theory stuff, you don’t need it here.”
To a significant extent, the culture of health/illness care systems are reflected in society at large: physicians are respected for what they know, whereas nurses are generally respected for what they do.
How do we change image of the nurse as “doer” to an emphasis on nurse as “informed doer.” The answer must come from nurses and nursing organizations. The nursing knowledge that informs nursing practice must be visible first to nurses themselves. Only then can nurses change public misperceptions about themselves, the profession, and the disciplinary knowledge that underpins it.
Naming a thing in any language is the first step in making it visible. In English, replacing the noun, ‘nursing’ with “Nursology” clearly differentiates if from the verb ‘nursing’. As Fawcett noted, Patterson and Zderad did that in the 1970s. Nursology.net has brought that idea into the 21st century for English language usage. Daniel Suárez-Baquero noted in his guest blog in April 2021, Spanish and other languages already ascribe different words to distinguish nursing knowledge from nursing practice.
Nursology, by definition, focuses on nursing knowledge, i.e., what nurses know, when for too long the emphasis has been primarily on what nurses do, without recognition that what nurses do is informed doing. We have used the terms “clinical nurse specialist” and “nurse practitioner” to designate nurses practicing at an advanced level, in which their advanced learning is assumed. Yet, most nursing care is given by nurses who are also knowledge workers. How do we better draw attention to the staff nurse as an informed practitioner?
It is time the names of nursing courses, educational programs and institutions reflect nursing knowledge, e.g, Schools and Departments of Nursology, course names, e.g., Nursology with School-Aged Children, etc. Nursology connotes the study of nursing knowledge, whether that is knowledge applied in practice, or advanced in scholarship.
Hopefully, and most importantly, Nursology students of the future will identify as knowledge workers, e.g., “Nursology majors” and, over time, shift personal, workplace, and societal perceptions from nurses as “doers” to nurses as informed practitioners.
- Bradley, P., Falk-Rafael, A. (2011). Instrumental care and human-centred caring: Rhetoric and lived reality. Advances in Nursing Science, (34)4, 297-314.