The concept of “nursing” is very abstract and can take many forms. It may be living entities’ activities to promote or regain their own health (self-care), professional nurses’ direct care of patients’ who need assistance in self-care, or indirect patient care through teaching, research, administration, and/or policy development. I believe this broad view of nursing is reflected well in the Nursing Theory Think Tank’s description of nursing’s disciplinary perspective: “Unitary humanenvironmenthealth processes: The dynamic and transformative changes manifested and experienced through living and dying. Healing Relationships: Humanenvironment intentions, expressions, behaviors, actions, and experiences that enhance well-being” (Fitzpatrick, et al, 2019).
From September 2021-May 2022, I was a Fulbright Faculty Scholar in Turkana County (TC), Kenya. My host, Turkana University College (TUC), was founded in 2017 and is the first public college in northwest Kenya. My award was for teaching/research. The primary aim of teaching was to partner with TUC to develop a plan to provide nursing education, specifically, an upgrading BScN program (aka RN-BSN). Secondary teaching aims were to assist TUC to offer a program of nursing continuing professional development and co-teach in community health courses. The research was a needs assessment of TC nurses to inform the program planning.
By context, TC is a remote, rugged area about two hours by plane from Nairobi, capital of Kenya. It is 215 miles north of the Equator, the climate is semi-arid, and the daily high temps average 95 degrees F. year-round. Of TC’s 1,000,000 residents, about 80,000 live in the rapidly growing, central town of Lodwar. Others reside in distant small towns and villages. TC and its’ people are undergoing transition on many levels due to climate change (more arid with more frequent and prolonged droughts leading to famine) and efforts to recover recently identified reserves of underground oil and gas and groundwater.
Since returning home, I’ve spent much time processing my Fulbright “experience”. Seems like I have changed. How? Why? Did I make a difference? How? Why? What is next for me? Nursing’s disciplinary perspective has helped shape my reflections and make sense of my time in Kenya.
Unitary humanenvironmenthealth processes is a lens through which to view life anywhere. However, in TC, I was struck by the unity and mutual dependency of living things, the environment, and health. The people of Turkana are pastoralists, raising goats, sheep, and camels. To pastoralists, their livestock, rather than money, are “wealth” and goats are the primary source of food (slaughtered after prayers of thanks). Health is so fragile. By example…for humans, rates of infant and child mortality are very high and the people of TC are heavily dependent on numerous non-governmental organizations (NGOs) for food, wells for water, education, and healthcare. For the livestock, on two mornings, we passed groups of 8-10 sheep that had died overnight. I was told that the sheep’s health is so unstable due to limited food and water, they couldn’t tolerate a “chilly” night (temps in the 60’s F). One of my drivers, who has a family farm in southern Kenya, had lost precious cattle due to the droughts and famine.
TC is known as the “Cradle of Humankind” and Turkana Basin Institute (TBI) is a research organization that focuses on human origins in the Great Rift Valley. TBI was my secondary partner and I lived at one of their two base camps for scientists’ field work. At TBI, we were one with the environment. Windows and doors are open 24/7 except during the rare rain (a few hours twice in 7 months) and there are no screens. Founded by Richard Leakey, renowned anthropologist, and conservationist, TBI has a culture of avoiding harm to animals unless there is risk to life. So, I purchased a broom to escort large spiders out of my cottage and sat in the dark when, a few days after rain, tiny, flying insects swarmed around the yellow light and covered my phone screen. Fun fact: did you know that scorpion spiders glow blue green when flashed with a UV light or bright moonlight? Malaria is endemic, and, despite bed netting, cases at the camp were so frequent, the manager had meds to dispense as needed.
My Fulbright experience led to a deeper appreciation of how relationships are integral to life when viewed through the lens of Unitary humanenvironmenthealth processes and that “healing relationship” and “well-being” can take many forms. At TBI, Dr. Elizabeth Hildebrand explained her team’s findings about relationships at the “pillar site”: a “massive, monumental site” built by early pastoralists about 4000 years ago. In a 2018 paper, Dr. Hildebrand, et al. noted: “The uncertainties of living on a “moving frontier” of early herding—exacerbated by dramatic environmental shifts—may have spurred people to strengthen social networks that could provide information and assistance. …Pillar Site would have served as both an arena for interaction and a tangible reminder of shared identity” (p.8942).
Fast forward to today. My proposal was framed in models that emphasized relationships with stakeholders: Iwasiw, et al’s model for nursing curriculum development (2020), Kotter’s 8-Step Change Model (2009) and the SOAR model for strategic planning (2019). I envisioned I would collaborate with TC nurses to develop a nursing curriculum with a guiding framework reflective of their values and beliefs about unitary humanenvironmenthealth processes, healing relationships, and well-being.
As it turned out, relationships, not curriculum, were the primary focus of my project. They began in 2018, when I met Isaiah Nengo, TBI’s Associate Director of Research, and two TUC senior leaders at my home institution, Case Western Reserve University (CWRU). That visit was arranged by, Patricia Princehouse, a CWRU faculty member and close friend of Isaiah. Patricia facilitated for me to visit Turkana County in 2019. Isaiah, a former Fulbrighter, and instant champion for nursing education at TUC, became my mentor and Fulbright sponsor and linked me to two other TBI staff with whom I had regular virtual meetings before arriving in Kenya. Once at TUC, I had to quickly establish relationships with new colleagues; and, with minimal orientation, function within their organization. Beatrice Ondago, TUC’s public relations/marketing aide and my liaison, was very helpful as were Isaiah and my TBI staff colleagues. At TUC, my co-teacher and his learners were gracious in welcoming me to their courses. Establishing relationships at the TC Ministry of Health and Sanitation was essential to implement the professional development and research. This took some time. However, once we connected, several nurse leaders were highly supportive and actively involved.
“Healing relationships” took on a deeper, special meaning after the sudden deaths of Isaiah (January) and Beatrice (March). Colleagues, family, and friends in Kenya and the U.S. stepped in and offered much needed support as I garnered the resilience and perseverance to complete my project and maintain my well-being.
These are just a few examples of how using the lens of nursing’s disciplinary perspective has helped me realize my Fulbright experience was truly transformative and that nursing of self and others through Unitary humanenvironmenthealth processes and healing relationships has helped me promote my well-being and that of my colleagues in Kenya. As I write this, I am mentoring a nurse colleague from TC to present the project at the National Nurses Association of Kenya’s Annual Conference on October 12-14. To no surprise, the title is: “Building Connections: Preparing for a BScN Program in Turkana County”.
Fitzpatrick, J. et al (2019) The nursing disciplinary perspective- 50 years ago and the view forward. Advances in Nursing Science, 42 (1) 2. DOI: 10.1097/ANS.0000000000000251
Fulbright Scholar Program. https://fulbrightscholars.org
Hildebrand, E., et al (2018) A monumental cemetery built by eastern Africa’s first herders near Lake Turkana, Kenya. Proceedings of the National Academy of Sciences (PNAS):115 (36) 8942-8947 https://doi.org/10.1073/pnas.1721975115
Iwasiw, C., Andrusyszyn, M-A., & Goldenberg, D. (2020) Curriculum Development in Nursing Education, 4th ed. Jones & Bartlett Learning.
Kotter, J. (2012) Leading Change. Harvard Business Review Press.
Stravos, J. & Hinrichs, G. (2019) The Thin Book of SOAR: Creating Strategy that Inspires Innovation and Engagement, 2nd ed. Thin Book Publishing Company.
Swanson, K. M. (1993). Nursing as informed caring for the well-being of others. Image–the Journal of Nursing Scholarship, 25(4), 352–357. https://doi.org/10.1111/j.1547-5069.1993.tb00271.x