Contributor – Justin McFail, MSN, RN

Last year I wrote a piece about Spoon Theory as a way of understanding self-care. My spoons have been limited this week. My wife very nicely shared her COVID virus with me. While our cases have been mild in comparison to many, my spoons – our spoons – have been limited. It reminded me that I was going to write about forks. Because…who doesn’t need more esoteric semi-poetic loquacious ramblings on the eruditical nursing theorists and their obscure epitomes as a metaphorical form of cutlery?

Wait…maybe I have the wrong audience… You may be exactly the people who need or want such magniloquence. You’re all here of your own volition reading about nursing theory that you, theoretically, enjoy enough to click the link without being aggressively cajoled. Very different than when I try to explain any of this to students who look me like listless lobotomized ungulates. I’ve come to think you and I are the tails of the bell curve on this one.

Anyway…I digress…cutlery!

Way back when I wrote part 1 all about spoons as a metaphor for self-care and what we can accomplish in any given day, I knew forks would come up eventually. Much like Spoon Theory, I didn’t invent Fork Theory. Some random stranger on the internet (I’ll refer to them as Jenrose) wrote a lovely blog post where they explain it much better than I. To be brief, forks are all the things that poke us throughout the day. I think of them as shirt tags, itchy socks, or the pile of dishes in the sink that have cultivated their own ecosystem bordering on civilization that I’m afraid are going to soon rise against me overthrowing my domain much like Sid’s toys from Toy Story. Those sometimes little sometimes large things that aggravate you throughout the day.

Turns out we’ve been using Fork Theory for a really long time in nursing. Or, at least, longer than I’ve been alive, which feels like a really long time in modern nursing (I’m actually only in my 30s while writing this). We’ve just never called it Fork Theory. Roy and Mishel both referred to forks as stimuli. Neuman referred to them stressors. Either way they’re all referring to roughly the same thing – metaphorical and sometimes physical manifestations that poke us over and over again until we (borrowing from Jenrose) say “stick a fork in me I’m done.” The difference is for the nursing theorists I need several flow charts, a small nation’s GDP worth in paper, and a thesaurus in order to understand. It’s a lot easier to conceptualize poking myself with forks.

If you can’t tell by my other writings, I really enjoy pontificating haphazardly about the inaccessibility of nursing theory. However, I’m not saying there isn’t wisdom here. After all, what we’re aiming for is…adaptation. We (the individual) must learn to adapt to the stressors, the stimuli, the forks that keep digging into us. Sometimes that means ripping them out. I mean this quite literally. Until the widespread use of “tagless” shirts I cut every tag out of every one of my shirts. I, personally, would refer to this as primary prevention because I’m not wearing the shirt until the tag is cut out – thus, eliminating the stressor before it reaches me. Although, you could make the argument it’s secondary or tertiary prevention. But that’s not really the point. I’m using prevention to avoid a stressor/stimulus in my life. I’m adapting.

Sometimes, on days where the fates are especially generous, you may pull out a fork only to realize…it was…a spoon! Or, at the very least, a spork. I think about this a lot with hunger. That thing that falls into the base of Maslow’s hierarchy of needs. Food is, after all, a very physiological need. I tend to forget to eat. It’s a common problem for those of us with ADHD and/or general neurospicydiversity. It tends to make me hungry and grumpy, or rather, HAAANGRY (the capitals are for emphasis). My wife has learned the adaptation and tertiary prevention that when I get snippy, she should throw some version of pasta and cheese at me while maintaining a semi-physical barrier as I ferally growl at her from the other side of the room. I might be hyperbolizing a bit (my wife would consider this an accurate depiction though). This is a rather long and circuitous way of saying, removing the fork that is hunger both decreases the poking and provides an assortment of spoons. Now, I have a stable blood sugar and that lets me accomplish something that isn’t petulant grumbling in the corner.

I’m sure on a different day I could probably more thoroughly link forks and hunger to adaptation with Roy or Neuman or some other grand nursing theorist. But, in case it wasn’t clear, I have a pandemic related virus attacking my cells and releasing various cytokines. I pretty sure my brain is only getting a fraction of the oxygen it’s supposed to…and I have other things I’d rather ramble on about.

Lately, since about November 2024, there’s been one very large very obnoxious orange fork that keeps poking me…AND I CAN’T DO ANYTHING ABOUT IT. The fork doesn’t even know or care that I exist. Every time I try to ignore the fork it just gets louder, because that’s all it knows how to do. It just keeps poking over and over again. If I had to take a guess, there are a number of Nursology readers who feel similar about the current state we’re living in. Political Activism has been a hot topic for a while now. The most frustrating part is it appears a lot of people with a lot of money really like this fork, or at least the ideals this fork keeps spouting from its gullet (who knew forks had gullets?).

There was a point here…

Let’s turn to Mishel’s Theory of Uncertainty, because uncertainty describes a lot of what I’ve been feeling. Mishel frame’s stimuli with patterns, familiarity, and congruency. Recognizing symptom patterns allows more control and differentiation of symptoms. Am I anxious because I’ve been doom scrolling for an hour? Because I haven’t eaten today? Sometimes these symptoms are easy to remove, and I can pluck the fork out. I can walk away from the doom scroll. Other times I have to use a spoon to gouge it out. Making an entire meal takes a lot of mental acuity. As I practice pattern recognition the symptoms become easier to recognize. I need a snack. I need to block social media for awhile. I need to go outside and touch grass as the kids say. Mishel might refer to this as Event Familiarity. Things become easier as we recognize patterns and know what to expect.

However, symptoms aren’t always consistent. Thus, when symptoms become inconsistent and patterns become less discernable more uncertainty is generated. There is a lack of Event Congruence, or a rapid shift inconsistent with our expectations. If I wanted to sound scholarly, I’d add a diatribe about disruption of homeostasis. But, I don’t want to sound scholarly here. I want Fork Theory to be accessible. Thus, what Mishel is describing is too many forks poking in unexpected ways makes us feel uncertain.

The giant orange fork has been poking me in unpredictable ways recently.

It’s at this point Mishel discusses Cognitive Capacity. Which, as I reflect, was probably a bit ahead of its time. It would be almost a decade until the CDC-Kaiser ACE study and several decades until we understood some of the neurobiology associated with chronic stress. But, even back in 1988, Mishel recognized that overutilization of our cognitive capacity – whether it be by using all of our spoons or having many fork poking us – leaves us with weaker cognitive processing skills and increased uncertainty.

I’ve heard a lot of people say they’re just not as sharp right now. That something seems…off? Aging? Microplastics? Climate change? Yes, these are all possibilities. But we also need to pause for a moment and recognize the work we’re doing to survive. We need to take a moment to realize how much energy is going into just existing right now. Or as Jenrose put it “This shit is objectively hard.”

Mishel identifies structures that can support us during uncertainty.

Education seems to help with anxiety, or at least that’s what Mishel suggests. She might be right. Although, I’m fairly well educated and I don’t think it’s helping me in this case. Actually, I think it’s making me worse. Ignorance is bliss as Thomas Gray might say. In this case, I’m fairly certain, being well educated hasn’t decreased my anxiety. It’s only made me more anxious because I can see everything that is going wrong and the long lasting damage that will remain for years to come. I might be focusing too much on the negatives and not enough on the positives….are there positives right now?

So, then, social support should help. Mishel says social support can help cope with uncertainty. Jenrose mentions online communities, the sharing of resources, and support networks. And…yes…support groups have efficacy. But…I don’t know about anyone else…I’m having trouble with this one. My social support structures are also having mental breakdowns watching the uncertainty that continues to unfold. I don’t know anyone who’s thriving right now.

At least that’s a little solidarity?

So…creditable authority?…yeah…no…The credible authorities have been removed from a majority of their stations. I don’t have many credible authorities I can look to for support anymore. At least not for the moment.

Mishel says that uncertainty can be a bit of protective factor. The illusion of uncertainty can give us hope. Can being the key word. Not to say – I don’t have hope. It’s just this big orange fork is making really hard right now! It’s also creating a lot of uncertainty, but not the positive kind. In fact, it’s entirely negative at the moment.

So where is the hope?

Emily Dickinson said “it perches in the soul.” Neil Gaiman argues at the end days, when the universe withers and the darkness swallows the remainder of the light – hope will remain. The words of award winning author John Green have helped remind me to listen. “The song of hope is still singing, and I know you can’t hear it, but one day soon you will.” What hope I have remaining, the positive uncertainty, tells me “this too shall pass” – “the storm always passes.”

The forks will come out one day.

Mishel goes on to say when opportunity does not present itself – when you can no longer hear the song of hope – buffering helps support. To me, buffering is what my Netflix video does when Comcast decided to throttle my internet (again). I don’t use the term buffering in my schema. What I do use is Polyvagal Theory and the idea of a “freeze” state, or numbness, or hypo-arousal – whatever term most clicks with your brand of neurospicy (chances are good a majority of people reading this are neurospicy). We think of the sympathetic nervous system as fight-or-flight. What we often don’t recognize is that we actually have a freeze state. The ability to shut down, shut out, and to go numb.

Both Mishel and I find numbness a reasonable coping mechanism despite what the link above may say. At least…in the short term. Avoid, ignore, and then reprioritizing. I don’t listen to the news anymore. I can’t. There are times I will completely walk away from a conversation about current events. I recognize I NEED to use these skills in order to cope. I have to avoid the forks hanging above my head like a sword of Damocles. If that means there are times I’m ostrich with my head in the sand, so be it. Just to be clear, it doesn’t mean I can’t engage with these idea, advocate for change, and support those who need it. I can and do do all of those things. But it’s on my terms. It’s entirely based on how many forks I have poking at that time. Some days I just have to pull out whatever fork I can.

There’s no easy answer here. I talked about this a lot with my therapist (because if it wasn’t obvious I’m the type of person who needs to see a therapist regularly in order to function). She really tried to find the positive, point out areas for hope, focus on the good…none of it really stuck. Finally, she said to me, “you don’t have to be ok.” And that was it. That’s what I needed to hear.

I’m not “ok” right now, but I’m coping. I’m recognizing what spoons I have each day. I’m finding patterns. I’m noticing forks more. I’m trying to remove them. control and the small ones, the ones I can control, and then moving on to some of the larger ones. I can’t quiet all the forks in my life (especially the big orange one). And, sometimes, that means I have to ignore them. Because if I don’t, the forks will dig too deep and overwhelm me.

I’ll be back at some point to discuss knives – the trauma that leaves wounds deeper than the tines of a fork.

My parting thoughts – What’s poking you today? What smaller forks can you remove so that the big ones don’t overwhelm you?

About Justin McFail

Justin is an adjunct instructor for Millersville University in Pennsylvania. A registered nurse since 2015, Justin has worked in various specialties including medical-surgical and intensive care areas. Currently, he still maintains part-time hours in the SICU. He is also a wearer of many hats for Millersville University. As an educator, Justin strives to bring creative models of education to the classroom and on occasion shouting about cutlery to his colleagues.