Removing/Refusing the Invisibility Cloak

Invisibility cloaks are magical devices that render the wearers invisible

from Inaugural issue of “Revolution: The Journal of Nurse Empowerment,” 1991

and transparent – they simply become part of the background. Furthermore, the wearer of the cloak can see through it and actually be wearing it without being fully conscious of it. Although invisibility cloaks have existed in mythology for centuries, they have recently been brought to public consciousness through the work J.K. Rowlings in the Harry Potter series. But I think they provide a relevant metaphor for what many nurses often experience – instances in which they and/or their contributions to health and healing remain invisible. And, my question is, can a shift to focusing on the nursing knowledge that underpins our practice and making it visible by naming it Nursology, help nurses in general to remove or refuse the cloak of invisibility?

 In my years of nursing experience, whether in practice, education, or research,  I have experienced and witnessed many instances of nursing and nurses, myself included, being rendered invisible. Nurses may themselves put on the cloak of invisibility by using the phrase, “I’m just a nurse” or by undervaluing their work.  A participant in one of my studies recounted an amazing example of capacity building in a group of adolescent girls but described her role in the transformation that took place as not “ much of anything” 1.

From Revolution: The Journal of Nurse Empowerment

 We can also put on the cloak of invisibility by valuing the knowledge of related disciplines more highly than nursing knowledge, such as happens when nurses dismiss nursing conceptual frameworks as irrelevant while, at the same time, consciously or unconsciously using knowledge from other fields to inform or define their nursing practice, either in scope or content 2,3.

 Sometimes the cloak of invisibility is put on us by others. We may or may not be conscious of the cultural and societal cloaks put on those of us who are women. And those of us who “trained” to be nurses in the 1960s will also be able to relate to the cloaks we acquired as deference to physicians was instilled in us.  We can only remove these cloaks by becoming conscious of them.  Public health nurses in my studies provided evidence that such cloaking continues. For example, one nurse told me about being required by their employer not to refer to themselves as nurses or the work they did as care; instead they were to refer to themselves as public health professionals, in the name of interdisciplinarity. 

 These reflections came about because of a conversation I had with a friend and colleague in which I related the following incident.  I was attending, on behalf of a national nursing association and by invitation, a media release of interest to health and other workers involved in in promoting healthy populations. After the release we were invited to attend a luncheon to discuss implications of the report from each of our perspectives. One gentleman present clearly represented a biomedical approach to health and he and I exchanged perspectives that were rather diametrically opposed to one another. After the luncheon he made his way across the room to me and asked me what my PhD was in (we each had place card tents which included our credentials).  I told him “nursing”.  He thought I misunderstood him and repeated the  question and received the same answer.  He replied, “no, I can’t have a PhD in medicine and you can’t have one in nursing.”  I assured him I did.  Exasperated, he asked what my dissertation topic was.  I answered that it was an oral history of public health nursing in Ontario.  “Ahh”, he replied, “that’s the answer! Your PhD is in history!”  With that he left, satisfied that he had set me straight! 

 In relating that incident to my friend, we contemplated, would that have been the case if my PhD was in Nursology?  I think probably not. It might have raised the question, “What is Nursology” which I would have welcomed!  

 

1.    Falk-Rafael A, Betker C. The primacy of relationships: a study of public health nursing practice from a critical caring perspective. Adv Nurs Sci. 2012;35(4):315-332.

2.    Rafael A. From rhetoric to reality: The changing face of public health nursing in southern Ontario. Public Health Nurs. 1999;16(1):50-59.

3.    Rafael AR. Nurses who run with the wolves: the power and caring dialectic revisited. ANS Adv Nurs Sci. 1998;21(1):29-42.

 

Martha E. Rogers, RN, MSc , EdD (Canada)

Guardians of the Discipline
Downlaads (used by permission)
Transformative Learning article
Canadian Nursing in the Year 2020
Enchantment of the Soul
Syllabus: Conceptual Basis of Nursing Practice
Syllabus: The Nature of Nursing Knowledge

Note: we are delighted to introduce a new Nursology.net series – “Guardians of the Discipline” featuring notable nurse leaders who have made significant achievements to assure the integrity and protection of nursology values and ideals.  We begin this series with Canada’s outstanding leader and scholar, Martha E. Rogers.

Martha E. Rogers (York University, Toronto, Ontario, Canada)

Martha E. Rogers is a Canadian nursing scholar and consultant who has made substantial contributions to advancing nursing knowledge. She is currently a Senior Scholar at York University, Toronto, Ontario and was the founder, and remains the director, of Canadian Nursing Consultants. Her contributions in advancing an appreciation of nursing knowledge cross both those roles and fall into 3 major categories that overlap and inform each other:  1). curricular design and pedagogy; 2) consulting work with nursing organizations to promote conscious application of conceptual models practice and in organizational design, and 3) her work on transformative learning in nursing, alternative nursing futures, and development of the concept of enchantment of the nursing soul. 

 Being In a unique position as a nurse who had focused  on future studies during her doctorate, Martha was commissioned by the Canadian Nurses Association in 1995 to develop future scenarios for nursing in Canada in the year 2020.  The book, Canadian Nursing in the Year 2020 was published by the Canadian Nurses Association for a number of years after it was written.  Download this document here (by permission of the author and copyright holder). That work was clearly informed by Martha’s extensive involvement in the previous decade in helping nurses to understand and embrace nursing conceptual frameworks, whether teaching post-RN baccalaureate students or practicing nurses in their workplace.

 In Canadian Nursing in the Year 2020, Martha created 4 scenarios of nursing in 2020 and invited readers to create a 5th.  On the eve of 2020, it is as relevant and sobering to read as it was when it was first published. Elements of each of the scenarios are recognizable in the present time, likely to significantly different degrees in different countries, cultures, and health care systems.  At the end of each scenario, readers  are invited to reflect on their reactions to the scenario and consider what action is necessary to increase or decrease the chances of them happening.

Canadian Nursing in the Year 2020 concludes with a section entitled, “Can one person make a difference.” Believing that to be possible, Martha asserted that maintaining hope and the personal power to take action requires engaging nurses’ minds , hearts, and souls. Critical minds (mind), caring about people (heart), and connecting with the meaning and purpose of nursing  (soul) are among the essentials she identifies as necessary for us to believe that each of us can make a difference. Martha explored in considerably more depth, the concept of the nursing soul in an unpublished article entitled Enchantment of the Soul

 These ideas were informed by Martha’s early nursing practice and education.  In meeting with her recently, I asked her what first sparked her interest in nursing conceptual frameworks and she replied it was the professors in her Post-RN baccalaureate degree. So, it is not surprising that she began to take action in her position as as a Clinical Nurse Specialist at Mount Sinai Hospital in Toronto, where she also served as Conceptual Framework Coordinator. Later, as an academic, Martha taught in a Post-RN BScN program at York.  One course she developed and taught focused on The Nature of Nursing Knowledge, and a second on the Conceptual Basis of Nursing Practice nursing. The transformative learning  approaches she developed in an unpublished manuscript as an approach to “facilitate “nurses’ learning and use of nursing conceptual frameworks” are evident in both course outlines.  As the School of Nursing evolved, Martha’s influence was evident again as the School adopted a caring-human science philosophy as a conceptual framework.1

 As a nursing consultant, Martha conducted many workshops and spoke at numerous conferences in Canada and the U.S. about transformative learning and facilitating nurses’ understanding and use of nursing conceptual frameworks. An example of this approach is seen in one of the videos she produced, “Conceptual Frameworks in Nursing Practice”, which is included below.

 Both through her academic and consulting roles, Martha was involved in research reporting the implementation and/or evaluation of use of nursing conceptual models in practice.  2,3, 4,5, 4 

Martha was passionate about the uniqueness of nursing knowledge and hoped to pass that passion on to others. Her goal was to facilitate nurses’ critical examination of dominant assumptions and values and the practice norms based upon them, and help them instead to value and give voice to their own nursing knowledge and imagine how nursing practice and health care institutions might be different if nursing values and knowledge were  a valued priority. I asked her recently what she thought her greatest contribution was as a “guardian of the discipline.”  This was her reply:  “If there is anything to be said about my work it would be that I held a belief about the beauty and potential power of unique nursing knowledge. It was my quest to explore nursing knowledge and to help others explore it through deep personal reflection and through critical appraisal of and emancipation from dominant paradigms.

References

 1.   Lewis S, Rogers M, Naef R. Caring-Human Science Philosophy in Nursing Education: Beyond the Curriculum Revolution. Int J Hum Caring. 2006;10(4):31-38.

2.   Rogers ME. Creating a Climate for the Implementation of a Nursing Conceptual Framework. JCEN. 1989;20(3):112-116.

3.   Shea H, Rogers M, Ross E, Tucker D, Fitch M, Smith I. Implementation of nursing conceptual models: observations of a multi-site research team. Can J Nurs Adm. 1989;2(1):15-20.

4.   Rogers, M., Jones Paul, L., Clarke, J., MacKay, C. Potter, M. Ward, W. The use of the Roy Adaptation Model in Nursing Administration. Can J Nurs Adm. 1991, June:21-26.

5.       Fitch, M., Rogers, M., Ross, E., Shea, H., Smith I., Tucker, D. Developing a plan to evaluate the use of nursing conceptual frameworks. Can J Nurs Adm. 1991, March/April:22-27.

 

 

An Introduction to the Canadian Nursing Theories Perspective

In a previous blog, I admitted my ignorance of nursing science during both my early diploma nursing education, and at least the first 18 years of my nursing practice.  But in the mid 1980s, I became aware of an increasing trend in Toronto area hospitals to adopt nursing theoretical frameworks.  Long after the fact, I also learned there had been nursing theory conferences held in Toronto around that time and set out to learn about those conferences, the experiences of the nursologists who attended, and with those in other provinces to discover other such events or activities.  What I found far exceeded what could be captured in 1 blog and yet I know I have barely scratched the surface!  My purpose here is first to thank everyone who has been so generous in sharing their time and archival documents (which will eventually be included in the Landmark Events section of the History tab of this website), and second, to invite nursologists from across Canada to add to my limited findings with what I’m sure is a wealth of information.

In pursuing information on the nursing theory conferences, I was reminded also of the other contributions to nursing knowledge made by Canadian nursologists, such as the:

  • Nursing Philosophy conferences organized by the Unit for Philosophical Research in the Faculty of Nursing, University of Alberta, proceedings of which were published;
  • Conceptual nursing frameworks used to guide curriculum development and pedagogy in Canadian University Schools of Nursing. At least one such model-the McGill model, also known as the Allen model or Developmental Health Model-has been explicated by research and used in nursing practice;1,2,3(3 articles of Ford-Gilboe and Margy Warner)
  • The development and or use of nursing conceptual frameworks to guide nursing practice in some hospitals and public health agencies;
  • The critique, comparison, and explication of nursing theories by Canadian nursing scholars.

Each of these areas will be explored in more detail in the weeks and months to come, hopefully by some of the key scholars who have been involved in these efforts. For the remainder of this blog, I will return to the Canadian nursing theory conferences

I have been able to identify 5 Canadian nursing theory conferences. One was held at the University of British Columbia, in 1988, and four in Ontario – two in Toronto in 1986 and 1988, one in Ottawa in 1989, and one at the Hamilton Psychiatric Hospital in 1993, in celebration of 20 years of theory-based nursing practice.4  Indeed HPH may well have been the first hospital in Canada to have adopted a nursing conceptual framework  (first Orlando, and later Peplau) to guide nursing practice.4

Many of the prominent nursing theorists of the time participated in the 1986 conference, including Dickoff and James, Imogene King, Myra Levine, Betty Neuman, Rosemary Parse, Martha Rogers, and Sister Callista Roy.  Some returned for the 1988 Toronto conference and notable additions for this conference included Virginia Henderson and Jean Watson.

Dorothea M. Fox Jakob, a retired public health nurse and nursing activist was a keen

Dorothea Fox-Jakob

participant in both nursing theory and NANDA conferences and, has generously provided proceedings from the 2 Toronto conferences as well as from many of the NANDA conferences.  Those proceedings are in the process of digitization and will be added to this website in the near future. Information about the other 3 conferences would be a great addition, as would information about any other Canadian nursing theory conferences.

Dorothea tells the story of meeting Virginia Henderson at a reception at the 1988 conference and telling her about her work in advocating for poverty reduction. Dorothea had prepared a resolution for the Registered Nurses Association of Ontario (RNAO), arguing that poverty was a health issue and urged RNAO to lobby for poverty reduction at the provincial and federal levels. The resolution was passed and promptly acted upon by RNAO. Dr. Henderson enthusiastically supported Dorothea’s actions and asked her to send her a copy of the resolution, which she did.  In return she received she received a letter in which she says she is encouraged by Dorothea’s efforts in “trying to do something about basic problems in society like poverty. We too often in the States leave this to others thinking that if we do our particular work well that we have fulfilled our role in society.” The handwritten letter, its transcribed content, and a brief statement of context have been framed and hang in the York University School of Nursing.

V Henderson letter-1.jpgReferences

  1. Ford-Gilboe, M. (2002). Developing knowledge about family health promotion by testing the developmental model of health and nursing. Journal of Family Nursing (8)2, 140-156.
  2. Warner, M. (2002). Postscript to “A Developmental Model of Health and Nursing” by F. Moyra Allen. Journal of Family Nursing, (8)2, 136-139.
  3. Ford-Gilboe, M. (1994). A comparison of two nursing models: Allen’s developmental Health Model and Newman’s Theory of Health as Expanding Consciousness. Nursing Science Quarterly (7)2, 113-118.
  4. Forchuk, C. & Tweedell, D. (2001). Celebrating our past: The history of Hamilton Psychiatric Hospital. Journal of Psychosocial Nursing and Mental Health Services (39)10, 16-24.

 

 

 

 

 

Why Not Nursology?

Photo – Adeline Falk-Rafael © 2018

Dr. Jacqui Fawcett  eloquently argued the case for “Why Nursology “a few weeks back. Another question might be asked – why not nursology? The use of “logy” – the study of – is widely used as a convention for identifying the knowledge base of other disciplines, e.g, biology, sociology, psychology, etc. On the other hand, the word “nursing” can be confusing because it has both popular uses, such as sipping a drink slowly or breastfeeding, and professional uses such as nursing (practice) and nursing (knowledge). It is beyond time for distinguishing between those two professional meanings. I believe doing so will go a long way toward making nursing knowledge visible, not only to other health disciplines and the public, but also to nurses and nursing students themselves. Language is powerful – it is the reason, I have previously advocated for replacing the term “student nurse” with nursing student. I look forward to that becoming nursology students!

I am excited about this initiative! Perhaps that is because my first nursing program was a hospital-based diploma program in the Canadian mid-west during the early 1960s in which the only reference to nursing science that I recall was a textbook called “The Art and Science of Nursing.”  The science of nursing was, sadly,  never explicated. I learned nursing basically as an ancillary medical service, i.e., the care required in the context of specific medical diagnoses and/or treatments. Over the next 15 years, I worked in various units in different hospitals in different cities and provinces. I practiced as I had been taught and consistent with how other Registered Nurses practiced. I say with some shame that I wasn’t reading nursing journals during that time and looking back, I think that was the norm for my colleagues, as well. Hospital or unit procedure books provided the necessary instruction for how to perform essential tasks.

It wasn’t until I moved into a leadership position and took a nursing leadership course that I was introduced to and required to engage with nursing (and other) literature. I marveled at how nursing leaders so articulately argued the contributions nurses make to health and healing, contributions that were based on nurses’ assessments and judgments, independent of medical directives. Nursing  process, nursing diagnoses and nursing theories excited me because they named and provided systematic structure for the work that nurses did in promoting health and healing. In other words, they began to make the invisible, visible! I began to read books and papers on my own, but soon realized I needed more knowledge and returned to school.

I don’t think my journey was unusual for that time. What grieves me is seeing still, much too often, nurses who acknowledge the biological, physiological, psychological, sociological and/or medical knowledge that informs their practice but fail to recognize the critical contribution of nursing knowledge. Nursology is a term that by its very nature emphasizes the disciplinary field of study that informs nursing practice. I can’t wait for the first Nursology programs and for nursing researchers and advanced practioners being recognized as nursologists, in keeping with the conventions of so many other disciplines.