Contributor – Rudolf Cymorr Kirby Martinez, PhD, MA, RN, CGNC,
CNE, WWCC, HWNC-BC, AHN-BC, SGAHN, FFNMRCSI

I am a nurse educator who considers myself a holistic and transcultural nurse practicing primarily in community settings. Students often describe community health nursing as one of the most fulfilling fields of nursing, yet it remains an unpopular choice after graduation and licensure. The concerns of persons in the community are as varied as they are unpredictable, and it is precisely this volatility that makes prospective nurses uncomfortable.

One recurring pattern in nursing education is the equation of power with control. This operates as an unintentional hidden curriculum. Dictums such as nurses should know everything, nurses should always be on top of things, and that the nurse’s raison d’être is limited to healing, understood narrowly as fixing the person, subtly position the nurse as the authority figure and sole expert within the nursing situation. From early on, nurses are taught to believe that a sense of ease necessitates full command and certainty over everything, including the person whom we nurse. But power built on control is inherently fragile.

This fragility becomes most evident in community settings. The inherently uncertain nature of these environments, where nurses have no direct authority over another person’s decisions, can be deeply unsettling for those accustomed to structured, hierarchical spaces. In the community setting, medical and nursing “orders” become mere advice. Persons are free to choose what, when, and how much of these orders are to be followed. In this context, the perceived sources of nurses’ power no longer remain absolute, thereby exposing vulnerabilities that many nurses are uncomfortable confronting.
This prevailing mindset may be a consequence of how we educate nurses— often not grounded in nursing theory or the values inherent in nursing. For example, the majority of nursing schools offering BSN programs do not have an explicit theoretical grounding for their curriculum, and by extension, their clinical component.

Nursing education, much like nursing practice, is always theoretically grounded, and in the absence of deliberate grounding, another non-nursing theory, such as “Nursing as Medical Assisting,” which does not reflect the knowledge or values of nursing, might be unintentionally utilized. Added to that, a number of nurse educators themselves are unable to clearly articulate the nursing theory that grounds their practice, teaching, or personal philosophy of nursing, and instead solely hyperfocus on teaching skills, which are mistakenly equated with nursing knowledge.

Given this, it is not surprising that the default model for the clinical aspect of most nursing programs is Model A (see figure below), where people and communities are treated as a means to an end: student learning. Perspective matters. When students assume this model as normative for nursing, they begin to see persons as passive objects rather than the co-creators of nursing situations. In simpler terms, when control becomes the goal, caring becomes secondary.

A different orientation is both necessary and possible. The end goal of clinicals should be human betterment actualized through nursing. Clinicals must be understood not merely as sites of learning, but as opportunities to serve people and communities in fulfillment of nursing’s sacred covenant with society. In the process of serving, we learn, we transform, and we revitalize our being as caring persons.

Model A, therefore, is neither caring nor reflective of the values inherent in nursing; it is a model grounded in control and the kind of power that emerges from it. Model B places the person and the community at the center of nursing. It accepts unpredictability as intrinsic to life and recognizes that nursing situations unfold within liminal spaces where nurses do not, and should not, exercise dominion over others.

Caring-in-nursing theories, such as Boykin and Schoenhofer’s (2001) Theory of Nursing as Caring, Jean Watson’s (1997) Theory of Human Caring, and Rudolf Cymorr Kirby Martinez’s (2004) Nursing Situation as Caring Moment Theory, are more congruent with Model B as it is fundamentally caring in orientation. Unless nursing education is intentionally grounded in such theories and in the core values of the discipline, it will continue to default to Model A.

At the end of it all, we must decide: will we allow our educational system to continue producing nurses who seek control, or will we break the cycle and begin forming nurses who can truly care in the presence of uncertainty?

Resources

Boykin, A., & Schoenhofer, S. O. (2001). Nursing As Caring: A model for transforming practice. Sudbury, MA: Jones & Bartlett Publishers.

Martinez, R. C. K. P. (2024). Nursing-situation-as-caring-moment (NurCaM): A Filipino value-grounded theory of nursing. Philippine Nurses Association, Inc.; San Beda University, College of Nursing. https://osf.io/download/7yjxn/

Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10, 49–52.

About Rudolf Cymorr Kirby Martinez

Rudolf Cymorr Kirby P. Martinez, PhD, MA, RN, LMT, CAA, CSTP, CGNC, CNE, WWCC, HWNC BC, AHN BC, SGAHN, FFNMRCSI, is a Filipino nursologist, caring science scholar, and Kabaybay (Filipino Nurse Coach). He is the author of The Nursing Situation as Caring Moment Theory: A Filipino Value Based Theory of Nursing and The Filipino Caring Philosophy and Structure: A Life Nurturing System.

He is a Full Professor at the San Beda University College of Nursing and also teaches part time in the graduate programs of Arellano University–Florentino Cayco Memorial School, Graduate School of Nursing, and Holy Angel University–School of Nursing and Allied Medical Sciences. He serves as the Chairperson of the Philippine Nurses Association Department of Nursing Education and is the PNA representative to the Commission on Higher Education–Technical Panel for Nursing (2025–2028). Prior to transitioning to academia, he worked as a pediatric nurse in various capacities, including school nurse, clinic nurse, and staff nurse at the largest pediatric hospital in the Philippines.

Dr. Martinez is a scholar of the Global Academy of Holistic Nursing, a Wisdom of the Whole Certified Coach, and a Health and Wellness Nurse Coach–Board Certified. He is also an Advanced Holistic Nurse–Board Certified, a Certified Nurse Educator, a Certified Global Nurse Consultant, a Distinguished Fellow of the Faculty of Nursing and Midwifery of the Royal College of Surgeons in Ireland, and a regular member of the Department of Science and Technology–National Research Council of the Philippines.

His current advocacy focuses on the decolonization of Philippine nursing education and practice through the integration of caring science and indigenous, traditional, and folkloric health healing practices, as well as Filipino values and virtues, into nursing curricula and clinical practice.