Guest Contributor: Jennifer M. Hackel
Adjunct Professor of Nursing, University of Southern Maine
Teaching Community Health Nursing to undergraduate students during the pandemic offered this professor a good opportunity to ground them in nursology.
The clinical placement for my section of eight students was immersing them in the community where I live — a rural unbridged island community in Maine. The overall course objective was to have students assess the health of a community and look for ways to strengthen it. As happens with all the courses I teach, I also learned a great deal, especially as I applied nursing theoretical models to the course and found two to be a perfect fit.
On the first day of the course, I had the students meet with the Town administrator as well as the curator of the Historical Society, where we learned about the current and former composition of the island community. The island is the largest in the bay at three by five miles in size with a year-round population of about 400, sitting about ten miles out to sea from a major city. Before the arrival of Europeans, the island was inhabited by the Algonquian-speaking Wabanaki peoples, including the Abenaki, Mi’kmaq, Maliseet, Passamaquoddy, and Penobscots (see https://en.wikipedia.org/wiki/History_of_Maine). In the late 1800s and at the turn of the 20th century, young European stone cutters came to the island in order to extract and ship granite from island ledges for use in city structures all down the East Coast. As their children grew up on the island, they became fisherman and farmers, living off the land and sea. The advent of electricity, cars, and air travel, and the historic effects of the world wars, had an impact on island life much as it did life on the mainland, but gradually led to people moving to the mainland, where it is easier to access jobs and resources. Thus, the year-round island population has shrunk, very few young families reside there, and the average age is older. All residents access their health care on the mainland.
During the semester, the students worked with preschool and elementary school children, designed a fitness fair for adults attending a recreation center, and interviewed community service providers, such as the island food pantry coordinator. Also, each student was assigned to two or three older adults (by definition over age 75) to conduct life review
interviews. In designing the practical assignments to meet the course objectives, I found that different nursology conceptual models and theories were critical for having the students build different skills.
Overall, Pender’s Health Promotion Model (Murdaugh, Parsons, & Pender, 2019) (HPM: https://nursology.net/nurse-theories/health-promotion-in-nursing-practice/), aligned with most of the course objectives. For example, regarding the
objective, “Apply nursing interventions and therapeutic communication techniques to promote, maintain or restore health”, Pender’s model has the nursologist focus on each person’s strengths when identifying their personal health goals and the situational and interpersonal factors that either serve as supports or barriers to achieving them. The model served well in working with the elementary school students to trace their outspread hands on a poster and identify ten health behaviors they wanted to do more of to promote their health and got them thinking about their unique strengths and agency.
The model was also very helpful to guide the focus of the “Fitness Fair” that the students organized at the island’s recreation center. There, students coached participants to identify health goals and how to realize them, screened them for hypertension and obesity, and engaged them in a variety of practical activities designed to promote higher level wellness in both physical and mental health. The activities were set up at stations including how to perform a sun salutation to promote flexibility and inner calm, safely build muscle with tailored strength training, and how to develop cardiovascular endurance on a treadmill. The students also researched and offered individualized educational information about coping skills, injury prevention, prevention of tick-borne illness and resources for mental health and chronic disease management.
One of the more transformational assignments of the course was each student’s life review of two different older adults isolated at home during the pandemic, and for this exercise, the students learned how to employ caritas nursing from Watson’s Human Caring Theory with (https://nursology.net/nurse-theories/watsons-theory-of-human-caring/). The theory aligns with current socio-psychological approaches to mental health promotion, such as trauma informed care, to develop trust, collaboration, and compassion, while also avoiding triggering traumatic experiences from a person’s past. In their book, “Caring Science, Mindful Practice: Implementing Watson’s Human Caring Theory,” Sitzman and Watson (2018) explained that caritas nursing is based on the humanistic values that underpin the nursologist’s healing approach to individuals.
The students and I found that caritas nursing was especially relevant when conducting and analyzing the life review interviews with the homebound older adults. This occurred due to the importance of the nursologist’s use of transpersonal caring in the form of conversation as a moment of undivided attention, allowing for the interviewees’ self discovery. In the process of reflection, the person’s self-discovery creates movement toward healing. As Sitzman and Watson (2018) explained:
“Transpersonal caring occurs when the one caring connects with and embraces the spirit of the other through authentic, full attention and intentionality to be present in the here and now, and conveys a concern for the inner life and personal meaning of another… the transpersonal caring relationships start with full attentive presence in the moment and then radiate spiritual limitless connection that tap the subtle healing possibilities” (p. 18).
Each student debriefed after conducting one life review and before engaging in a second one to reinforce learning about developing caring relationships. Watson’s Human Caring Theory emphasizes that literacy in caritas nursing is as critical, if not more so, than, for example, computer literacy for the modern day nursologist because technological competencies have overshadowed learning humanistic values and relationship development. The nursologist’s skills in Western medicine must be complemented by skills in caring and assisting others in tapping the strengths of their own deeper unique selves.
When I contacted the older adults to volunteer for life reviews, I was aware that many had past trauma they may not want to revisit–the loss of child, the suicide of a sibling, PTSD from combat, or struggles with addiction. Yet I found many were willing to volunteer upon learning that the nursologist students wanted only to have the interview serve them in gaining perspective on their lives and reinforce the strengths that they have. With unconditional regard in relating to the other person, the caritas model “highlights the joy of not only self-discovery, but also the discovery of our common humanity. As this consciousness evolves, the transpersonal caring moment helps an individual move toward their self-love and, therefore, toward their best, healthiest self” (Sitzman & Watson, 2018, p 20.)
In debriefing sessions, I used the pebble in the pond metaphor (see Sitzman & Watson, 2018, Figure 4.1) to discuss the outward effects of the caritas methodology, in which the life review process is not only good for the individual but also fosters the health of the community. When a pebble enters a pond, waves go out in concentric circles from the point of impact. Similarly, individuals gain perspective on their lives and become their better selves, which has outward moving positive effects on their families, neighborhoods and communities.
Just as Community Health Nursing upholds health much more than the absence of disease, these Pender’s model and Watson’s theory were synergistic in creating an expansive community health experience. Pender’s model through the inter- and intra-personal aspects that foster health promoting behaviors, and Watson’s theory embodied in the practice of
caritas nursing in which the nursologist’ s intentionality engenders wholeness, healing, and strength in the expanded, dynamic perspective of wellness.
References
Murdaugh, c., Parsons, M.A. & Pender, N. (2019). Health promotion in practice (8th ed.). Pearson Education.
Sitzman, K., & Watson, J. (2018). Caring science, mindful practice: Implementing Watson’s caring theory. Springer.
About Jennifer M. Hackel
Jennifer Hackel received her Nursing Baccalaureate (1980) and Masters (1984) degrees at the University of Michigan where she began practicing as an Adult-Gerontological Nurse Practitioner in 1984. In 2012, she received her Doctor of Nursing Practice from Columbia University in New York and began teaching at the University of Massachusetts in 2013. In 2020 she moved to Maine where she is an adjunct professor of nursing at the University of Southern Maine.