Who Will be the First? More Random Thoughts of a Sleeper Awake

Once again, with apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake, these are my random thoughts of “Who Will be the First?” among nursology leaders while I was a sleeper awake one very early morning (see our first “sleepers awake” post: What if?). Here are my random “Who will be the first?” musings:

  • Who will be the first dean/director/chairperson to re-name the college/school/department/ program nursology?
  • Who will be the first Chief [Nursology] Officer to re-name the clinical agency department nursology?
  • Who will be the first journal editor to re-name the journal … Nursology or Journal of … Nursology?
  • Who will be the first “edge runner” or other nursologist recognized for innovative work to be referred to as a nursologist?
  • Who will be the first president or executive officer to re-name the association/academy/ council [Country or State] Nursology Association or [Country] Academy of Nursology or International Council of Nursology?

Again inspired by imagining these possibilities, I asked other Nursology.net management team members!

Adeline Falk-Rafael

  • Who will be the first newscaster/journalist to refer to nursologists or Nursology In the media?

Margaret Dexheimer Pharris

  • Who will be the first political leader to propose a Universal Access to Nursologists system for a country, state/department/region, city, and/or community?

Danny Willis

  • Who will be the first nursologist to lead peace, social justice, caring, and healing efforts throughout the world toward universal wellbeing/wellbecoming for all of humanity?

Rosemary William Eustace

  • Who will be the first nursologist to theorize “task shifting of nursing services and roles” in advancing nursing knowledge and the future of nursing as a profession within other “traditional” and “emerging” disciplines in health care?

Marian Turkel

  • Who will be the first academic dean to say we are advancing the discipline and profession of nursology by preparing nursologists? Nursologists practice nursology through the lens of nursological theory and the multiple patterns of knowing, with a focus on holistic practices such as mindfulness, centering, healing arts, aromatherapy, and coming to know the patient and family as person. The clinical practice sites for nursologists would expand beyond the hospital into healing centers, physician practices, and community centers.

Marlaine Smith

  • Who will be the first to graduate with a PhD in Nursology?

We invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “Who Will be the First?”

Nursology’s Philosophical and Practical Knowledge: Unified and Interdependent

Guest Contributor: Martha Raile Alligood, RN, PhD, ANEF

A few months ago, Martha Alligood sent me (Jacquelyn Fawcett) this intriguing article: Rovelli, C. (2018). Physics needs philosophy, philosophy needs physics, Foundations of Physics, 48, 481-491. We decided to write a paper, which has evolved into this blog, about the relationship between philosophy and science in nursology. The specific purpose of this blog is to underscore the importance of the relationship between practical knowing and foundational (philosophical) knowing for advancement of nursology.

Alligood writes:

Rovelli (2018) wrote about the interrelationship of philosophy and science (physics). His discussion of practical and foundational knowing led me to think about nursology and the contemporary disciplinary shift to a practical focus from one that was dominated by general foundational philosophical questions. For example, nursological literature has evolved from a strong foundational philosophical knowledge development focus on nursology’s discipline-specific concepts, models, and theories to an equally strong practical focus on quality of practice and nursing education expansion in relation to practice, specifically, the development of the Doctor of Nursing Practice (DNP) degree programs.

Time has shown the value of such shifts in focus for a discipline. Advancement of a discipline calls for recognition and valuing of the complementary relationship between practical knowing and foundational knowing, as both are essential to the development of a professional discipline, such as nursology.

Practical knowledge is–or should be–based on the results of scientific research. However, if science is essential to move the discipline ahead, then philosophy ensures that we move in the right direction. But, “a broader understanding of the interdependence of practical and philosophical matters in professional nursing is needed” (Bruce, Rietze, & Lim, 2014, p. 65). Drawing from Einstein’s discussions of the influence of philosophies and philosophers on his work, Rovelli (2018) noted, “Scientists do not do anything unless they first get permission from philosophy” (p. 484).

Rovelli’s (2018) claim of an interdependent relationship between physics and philosophy for his discipline also is relevant for nursology. That is, contemporary growth and development of nursology requires an explicit interdependent relationship between foundational knowing and practical knowing. Indeed, the re-emergence of nursology as the name for our discipline after its initial introduction in the 1970s (Fawcett, 2018) is evidence of a contemporary need for terminology at a level of abstraction to incorporate all of the discipline’s knowing–both philosophically foundational and scientifically practical.

Within nursing history there are examples of practical knowing leading to foundational knowing, such as research about the impact of patient positioning that has led to foundational knowledge, but it seems that foundational knowing has the capacity to affect practical knowing in a more powerful manner. An excellent example is the clarification of the disciplinary boundaries of nursological knowledge pertaining to human beings, environment, health, and nursing goals and processes (Fawcett, 1984; Fawcett & DeSanto-Madeya, 2013). This metaparadigmatic clarification led to expansion of nursological knowledge, practice, research, education, administration, and perhaps most importantly, a clearer understanding of the theoretical knowledge that existed at that time.  Explaining the relationship of the various models or theoretical works provided clarity and understanding to move nursological knowledge development to a new level.

Ironically, recognizing the structure within which the various conceptual and theoretical frameworks fit may be seen as both practical and philosophical. Some of the very early National League for Nursing (NLN) faculty-curriculum development work that contributed to that understanding was very practical (O’Leary, 1975; Torres & Yura, 1975). Knowledge and understanding leads to future knowledge and understanding. Thus, foundational knowing and practical knowing collectively is nursological knowing that builds on all previous knowing. That is, there is no dichotomy between philosophical and practical knowing; instead, their complementary unified interrelationship may feature one or the other at periods of growth and change in nursology. Clearly, we want to ”counter those who would discard the discipline’s theoretical traditions as irrelevant or counterproductive, we need to [position] this new generation of critical scholarship to champion the intellectually exciting and complex philosophical challenge within which nursing has been engaged throughout its ideational history” (Thorne, 2014, p. 86).

Fawcett writes:

We know from Kuhn’s (1971) classic treatise on scientific revolutions that disciplinary perspectives change over time, typically as the result of scientists’ inability to continue to find support for a previous version of the disciplinary perspective. Sometimes, the revolution is in methodological shifts and sometimes it is in philosophical paradigm shifts. An example of a methodological shift is our contemporary acceptance of mixed methods research instead of the assertion—lasting into the early 2000s–that qualitative and quantitative methods are philosophically separate and, therefore, cannot ever be combined. An example of a philosophical paradigm shift is the growing recognition and acceptance of conceptual models and theories that reflect the simultaneity world view instead of those conceptual models and theories that reflect the totality world view (Parse, 1987).

The growing interest in nursology as the name for our discipline may be the beginning of major methodological and paradigm shifts from the contemporary emphasis on practical knowledge to a fuller understanding of the vital interrelationship of foundational and practical knowledge. These shifts are evident in that acceptance of nursology as the proper name for our discipline indicate that the foundational knowledge of our discipline guides the way we view our science and our practice—always within the context of an explicit nursological conceptual model and/or theory—rather than leaving the knowledge aspect of our science and our practice to the claim of being “atheoretical” (Fawcett, 2019). As Popper (1965) pointed out, everyone has a “horizon of expectations” (p. 47), such as a conceptual model or theory that guides research and practice, and as McCrae’s (2012) noted, “the legitimacy of any profession is built on its ability to generate and apply theory” (p. 222).

Finally, as Donaldson and Crowley (1978) so wisely told us,

A key point . . . is that the discipline should be governing clinical practice rather than being defined by it. Of necessity, clinical practice focuses on the individual in the here and now who has a problem requiring relevant and appropriate action. The discipline, in contrast, embodies a knowledge base relevant to all realms of professional practice and which links the past, present and future. Its scope goes far beyond that required for current clinical practice. If the discipline were so narrowly defined, professional nursing could be limited to functioning in the realm of disaster relief rather than serving as a force in the promotion of world health. (p. 118)

References

Bruce, A., Rietze, L., & Lim, A. (2014). Understanding philosophy in a nurse’s world: What, where, and why? Nursing and Health, 2(3), 65-71.

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113–120.

Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16, 84 87.

Fawcett, J. (2018, September 24). Our name: Why nursology? Why .net? Retrieved from https://nursology.net/2018/09/24/our-name-why-nursology-why-net/

Fawcett, J. (2019, January 22). The impossibility of thinking “atheoretically.” Retrieved from https://nursology.net/2019/01/22/the-impossibility-of-thinking-atheoretically/

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). Philadelphia, PA: F. A. Davis.

Kuhn, T. (1971). The structure of scientific revolutions. Chicago: University of Chicago Press.

McCrae, N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary healthcare. Journal of Advanced Nursing, 68, 222–229. doi: 10.1111/j.1365-2648.2011.05821.x

O’Leary, H. J. (1975). Changes in community nursing service that affect baccalaureate nursing programs. In Faculty-curriculum development, Part V. The changing role of the professional nurse: Implications for nursing education. New York, NY: National League for Nursing, Pub. No. 15-1574.

Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. Philadelphia, PA: Saunders.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

Rovelli, C. (2018). Physics needs philosophy, philosophy needs physics, Foundations of Physics, 48, 481-491.

Thorne, S. (2014). Nursing as social justice: A case for emancipatory disciplinary theorizing. In P. N, Kagan, M. C. Smith, & P. L. Chinn (Eds.), Philosophies and practices of emancipatory nursing (pp.79-90). New York, NY: Routledge.

Torres, G., & Yura, H. (1975). The conceptual framework as part of the curriculum process. In Faculty-curriculum development Part III: Conceptual framework-Its meaning and function. New York, NY: National League for Nursing, Pub. No. 15-1558.

What If? Random Thoughts of Sleepers Awake

With apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake these are my random thoughts of “What If?” about our discipline while I was a sleeper awake one very early morning.

  • What if Florence Nightingale (circa 1859) founded modern nursology (rather than nursing), titled her book, Nursology: What it is and What it is not, and established the first college/school/department/program of nursology to prepare nursologists?
  • What if we referred to ourselves as nursologists, rather than nurses or advanced practice nurses or nurse practitioners or even “practitioners of nursing” (Orem & Taylor, 1986, p. 39)?
  • What if Dock and Stewart (1938) wrote A Short History of Nursology (instead of A Short History of Nursing)?
  • What if our conceptual models originally were called paradigms, as these abstract and general “horizon[s] of expectation” (Popper, 1965, p. 47) for disciplinary activities are called in other disciplines?
  • What if health was widely regarded as encompassing wellness, illness, and disease, so that wellness would be promoted, and illness and disease would be prevented, rather than health being promoted (who would want to promote illness and disease)?
  • What if NANDA-I was NATA, such that D = Diagnosis were replaced with T = Trophicognosis, which Levine (1966) used as the label for judgments stemming from assessments of each patient’s health (wellness, illness, disease) condition?

Inspired by these possibilities, I asked my Nursology.net management team colleagues to also share their “sleepers awake” inspirations!

Peggy L. Chinn

  • What if all healthcare providers (regardless of discipline) were to base their interactions with patients on nursology fundamental principles and values? If we did this, there would be no computer screens in the room where the interactions take place, or at least they would be way off in the corner and ignored until a basic relationship was established. Every person in the room would be acknowledged, there would be lots of eye contact, and a focus on hearing and listening. That would be for starters!
  • What if there were nursology think tanks happening regularly and often all over the world?
  • What if all undergraduate students had a “Nursology 101” course?
  • What if all current nurses were required to have a continuing education “Nursology 101” course to maintain licensure?
  • What if the accreditation criteria for all nursing programs at all levels addressed the nature of the focus of the discipline in the structure of the curriculum?

Margaret Dexheimer Pharris

  • What if the National Institute for Nursing Research (NINR) only funded proposals based on nursology and contributing to nursology?
    • Jacqueline Fawcett: Following from Dr. Pharris’ question, What if NINR was called the National Institute of Nursology (NIN) or the National Nursology Institute (NNI)?
  • What if there was a nursologist in every community who could know and attend to people across care settings (community, hospital, homeless shelter, long-term care. etc.)? The nursologist–rooted in nursology’s patterns of knowing–would truly know and care for each person and the people who are important to that person, and would collaborate with other nursologists and other healthcare providers within each setting to ensure that the person’s sense of health is honored and nurtured.

Danny Willis

  • What if nursologists always clearly communicated the value added by our knowledge and presence?

Rosemary William Eustace

  • What if all nursologists worldwide are made aware of the impact of nursology on our diverse roles, specialties, training and contributions in meeting overall health outcomes and challenges as part of the 21st century (so-called) nursing campaigns?
  • What if nursologists claim that meaningful healthcare transitions, mutual goal attainments and positive client outcomes would not be possible without the nursologist–client interactions as a vital step to quality health care, such as in keeping with King’s (1992) Theory of Goals Attainment? (See https://nursology.net/nurse-theorists-and-their-work/kings-conceptual-system/)

Marian Turkel

  • What if there was another curriculum revolution and nursologists would have a curriculum focused on nursing as a human science/caring science? For academics this would mean letting go of sacred cows to advance nursing knowledge focused on caring, ethics, health as expanding consciousness, meaning, patterning, presence, and relationships.
  • What if the curriculum for nursologists moved beyond the traditional patterns of knowing (aesthetic, empirical, ethical, and personal (Carper, 1978) to include intuitive, mystical, and spiritual patterns of knowing
    • Jacqueline Fawcett
      Following from Marian Turkel’s second question, readers of this blog may want to read a recently published paper about spirituality as another pattern of knowing (Willis & Leone-Sheehan, 2019). In addition, White (1995) identified sociopolitical knowing as another pattern of knowing. Since that time, Chinn and Kramer (2019) have identified and refined the meaning of emancipatory knowing as still another pattern of knowing. And lest we forget, Munhall (1973) wrote about unknowing as a pattern of knowing, “as a condition of openness” whereas knowing “leads to a form of confidence that has inherent in it a state of closure” (p. 125).

Marlaine Smith

  • What if Nursology 101 was offered for students, or better yet, required for all students enrolled in a university? The course would focus on an introduction to phenomena such as human wholeness, human-environment-health relationships, the nature of health, healing, well-being/becoming, and caring in the human health experience.

In closing, we invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “What Ifs?”

References

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23.

Chinn, P. L., & Kramer, M. K. (2019). Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO: Elsevier Mosby.

Dock, L. L., & Stewart, I. M. (1938). A short history of nursing: From the earliest times to the present day (4th ed.). New York: G. P. Putnam.

King, I. M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5, 19–26.

Levine, M. E. (1966)Trophicognosis: An alternative to nursing diagnosis. In American Nurses’ Association Regional Clinical Conference (Vol. 2, pp. 55–70). New York: American Nurses’ Association.

Munhall, P. L. (1973). ‘Unknowing’: Toward another pattern of knowing in nursing. Nursing Outlook, 41, 125-128.

Orem, D. E., & Taylor, S. G. (1986). Orem’s general theory of nursing. In P. Winstead-Fry (Ed.), Case studies in nursing theory (pp. 37–71). New York: National League for Nursing.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86.

Willis, D. G., & Leone-Sheehan, D. M. (2019). Spiritual knowing: Another pattern of knowing in the discipline. Advances in Nursing Science, 42, 58–68. https://doi.org/10.1097/ANS.0000000000000236

 

Ann C. Wolbert Burgess, RN, APRN, FAAN

Guardians of the Discipline
Boston College web page

Dr. Burgess is perhaps best known for her scholarly work about and guiding practice of forensic nursing. She and Lynda Lytle Holmstrom, a sociologist at Boston College, described rape trauma syndrome and founded the first rape crisis counseling program at Boston City Hospital (now Boston University Medical Center). Dr. Burgess played a major role in developing the Federal Bureau of Investigation’s (FBI) Behavioral Science Unit, which focuses on profiling serial killers and other criminals. She also has provided exemplary testimony at trials for sexual assault, murder, and other criminal acts. She is the author or co-author or editor of many, many journal articles, book chapters, and books. In addition, she is the co-developer of the Comprehensive Sexual Assault Assessment Tool (CSAAT), which is based on Roy’s Adaptation Model. Collectively, this work has placed nursing in the forefront of assessment, treatment, and prosecution of many forensic matters.

Dr. Burgess received her baccalaureate and Doctor of Nursing Science degrees from Boston University, and her master’s degree from the University of Maryland. She holds an honorary Doctor of Humane Letters from the University of San Diego.

Dr. Burgess has held faculty appointments at Boston University, Boston College, and the University of Pennsylvania. She developed and taught a graduate program course in forensic nursing, first at the University of Pennsylvania and currently at Boston College.

Dr. Burgess’ major contributions as a Guardian of our Discipline have been widely recognized. She has received many awards, including American Academy of Nursing Living Legend, the inaugural Ann Burgess Forensic Nursing Award by the International Association of Forensic Nurses, the Sigma Theta Tau International Audrey Hepburn Award, the Sigma Theta Tau International Episteme Laureate Award, and the American Nurses Association Hildegard Peplau Award.

Dr. Burgess’ work with the FBI has been portrayed by a character in the television program, Mindhunters. Many years ago, during some of the time that Dr. Burgess was at the University of Pennsylvania School of Nursing, she shared a group faculty house with other nursing faculty colleagues. We often shared dinner and discussed cases about which Ann was providing consultation for the FBI. We would then refer to her as “Annie and the G-Men.” Imagine our surprise when a television program (many years before Mindhunters) soon appeared with a character named Annie, a psychiatric nurse just as Ann is, whose role was consultation with the FBI Behavioral Science Unit!

Portions of this blog were adapted from https://en.wikipedia.org/wiki/Ann_Burgess

Nursologists and Their Comic Character Avatars


Once upon a time, I had a faculty colleague who had a wonderful sense of humor. She

could even inject humor into the statistics and research methods courses she taught. Unfortunately, I did not have anything close to her sense of humor. However, she assured me that it was very difficult to find humor in meta-theory, which is what I taught (and still teach), alas without any humor included.

Imagine my surprise when Peggy Chinn sent me an internet posting  by Jan Friesen and Skander Elleuche, who “developed a method that provides a simple, flexible framework to translate a complex scientific publication into a broadly accessible comic format” (italics in the original).

In an attempt to finally inject some humor into nursology, I started thinking of how comic characters could be transformed into nursologist avatars. I selected comic characters I knew from my childhood and, more recently, from the exhibits in Fawcett’s Art, Antiques, and Toy Museum, a small art gallery, shop, and toy museum that I co-own with my artist husband, John Fawcett. He is the creative one; I keep track of the finances.

My ideas for avatars for nursologists are:

  • Wonder nursologist (aka Wonder woman), whose special wrist cuffs

    deflect all negative concerns about theory

  • Super nursologist (aka Superman), who leaps over complex philosophical, conceptual,  theoretical, and methodological ideas with a single keystroke
  • Star nursologist (aka Star Trek), who goes where other nursologists are not yet ready to go
  • Fantastic nursologist (aka from

    Disney’s Fantasia movie) who converts theoretical knowledge to practice protocols.

  • Mighty nursologist (aka Mighty Mouse), who establishes nurse corporations that contract with clinical agencies to provide nursological qua nursological services to participants in practice (nurse corporations are Grayce Sills’ idea, nursing qua nursing is Jean Watson’s idea)
  • Terminator nursology (aka The Terminator), who eliminates all negative thoughts about conceptual models and theories
  • Spider nursologist (aka Spiderman), who climbs to the heights of nursology

    glory.

  • Yoda nursologist (aka Yoda from Star Wars), whose light saber illuminates all that is nursology.

I invite readers of this blog to contribute their ideas for comic character avatars for nursologists!

The Impossibility of Thinking “Atheoretically”

Some nursologists have claimed that they are “atheoretical.” When asked what they mean, they tend to say that they do not subscribe to or use a particular conceptual model or theory when conducting research or practicing. However, it is, according the physicist turned philosopher of science, Sir Karl R. Popper (1965), it is “absurd” to think that each of us does not have a “horizon of expectations” for whatever we are observing or doing (p. 47). Continuing, Popper (1965) claimed that everyone always has expectations, even if not in conscious awareness.

Following from Popper, I submit that it is impossible to think “atheoretically.” Instead, I submit that every nursologist has a “horizon of expectations” in the form of a conceptual frame of reference that guides what she or he is observing or doing as research is conducted, curricula are constructed, interactions are occurring with people who seek nursologist services, and nursologist services are administered. That conceptual frame of reference is what I refer to as a conceptual model or a grand theory.

I suspect that every nursologist agrees that she or he “talk[s] nursing” (Chalmers, as cited in Chalmers, Kershaw, Melia, & Kendrich,, 1990, p. 34), thinks nursing (Nightingale, 1993; Perry, 1985), and engages in thinking nursing (Allison & Renpenning, 1999) rather than mindlessly doing tasks and carrying out physicians’ orders (Le Storti et al., 1999). But what do those nursologists regard as nursing? What is meant by talking or thinking nursing? I also suspect that every nursologist agrees that she or he engages in critical thinking and clinical reasoning. If so, what is the frame of reference for the thinking or reasoning? Something has to capture one’s attention (Myra Levine (1991),  developer of the Conservation Model, called what captures one’s attention provocative facts, which are noticed within the context of conservation of energy, structural integrity, personal integrity, and social integrity.

Thus, the challenge for each nursologist who regards self as thinking “atheoretically” is to identify what her or his frame of reference (horizon of expectations) is. What is that person’s view of who are the human beings or documents that are appropriate for whatever activity is being done (i.e., research, practice, education, administration)? What is the person’s view of the relevant environment? What is the person’s view of what constitutes wellness, illness, and disease? What is the person’s view of what nursologists’ do in practice – what is worthy of assessment, how are priorities set when planning, what interventions are appropriate, and most of all, what outcomes are expected?

It is possible that my claim that being “atheoretical” is impossible. Therefore, in closing, I urge those of you who claim you are “atheoretical” to respond to this blog and let everyone know what you mean by being “atheoretical” in all of your nursologist activities.

References

Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.

Chalmers, H., Kershaw, B., Melia, K., & Kendrich, M. (1990). Nursing models: Enhancing or inhibiting practice? Nursing Standard, 5(11), 34–40.

Le Storti, L. J., Cullen, P. A., Hanzlik, E. M., Michiels, J. M., Piano, L. A., Ryan, P. L., & Johnson, W. (1999). Creative thinking in nursing education: Preparing for tomorrow’s challenges. Nursing Outlook, 47, 62–66.

Levine, M. E. (1991). The conservation principles: A model for health. In K. M. Schaefer & J. B. Pond (Eds.), Levine’s conservation model: A framework for nursing practice (pp. 1–11). Philadelphia, PA: F.A. Davis.

Nightingale, K. (1993). Editorial. British Journal of Theatre Nursing, 3(5), 2.

Perry, J. (1985). Has the discipline of nursing developed to the stage where nurses do “think nursing?” Journal of Advanced Nursing, 10, 31–37.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

Breaking the Silence-Exploring Perceptions of Power as Freedom in the World of Nursologists

by Julianne Mazzawi, Jacqueline Fawcett and Rosanna DeMarco

In 2015, the American Nurses Association released a purpose and position statement indicating that it is an individual and shared responsibility among all nursologists and employers to promote and sustain a culture of respect that is free of incivility, bullying, and workplace violence. Such a culture reflects the ethical, moral, and legal responsibility of everyone to create a healthy and safe work environment for all members of the healthcare team, participants in healthcare (sometimes called patients), families, and communities. So why is it that nursologists and their support staff continue to show manifestations of “silencing-the-self” when instances of incivility, bullying, and even violence occur? (DeMarco, Fawcett, & Mazzawi., 2017, p. 4)?

Too often, nursologists experience sleep problems, anxiety, distress, oppression, burnout, absence from or leaving work, organizational frustration, and job dissatisfaction, and commit more errors due primarily to incivility, bullying, and violence in the workplace (Lim & Berstein, 2014; The Joint Commission, 2008; Vagharseyyedin, 2015) Obviously, it is imperative to resolve these negative outcomes for all current and future nursologists.

We conceptualized civility and incivility within the context of Neuman’s Systems Model. (See model below). Accordingly, the client system was represented by the nursologists who are the perpetrators or recipients of covert incivility (CI), defined as the “appearance of civility with negative intent” (DeMarco et al., 2018, p. 254). Stressors were represented by CI, and the reaction to stressors was represented by such manifestations as sleep problems, anxiety, oppression, burnout, and organizational frustration. The reactions were regarded as the impact of CI on nursologists who are faculty, students, and staff nurses, as well as witnesses to CI. The workplace (academic or clinical) and society also may experience reactions to CI. We identified several prevention as interventions for CI, with an emphasis on secondary and tertiary interventions; we explained that these interventions “need to be directed to existing levels of CI of all kinds that include measuring the level of ‘silencing-the-self'” (DeMarco et al., 2018, p. 256).

2018 © Jacqueline Fawcett

Of course, primary prevention as intervention also must be considered; we recommended educating all students and graduate nursologists about both overt incivility and signs of CI and creating contracts for nursologists focused on “creating a formal promise to not engage in overt of covert incivility and addressing the behavior direction at the individual, group, and systems levels” (DeMarco et al. 2018, p 257).

In this blog, we offer the specific recommendation that focus on resolution of CI through application of nursological theories of power. Resolution of CI, we are convinced, will occur when nursologists’ perceptions of power change from perceptions of others having power over them to perceptions of power as freedom to choose and peace as power.

The idea for this blog was Mazzawi’s and Fawcett’s attendance at the 2018 Society of Rogerian Scholars (https://nursology.net/2018/10/09/celebrating-30-years-the-society-of-rogerian-scholars/), at which the four nursological theories of power discussed here were presented. We began to imagine a world where nursologists perceive power as freedom to choose and peace as power rather than perceiving power as others having power over them to control them and that in this world, civility would reign, bullying and workplace violence would not happen, and only positive outcomes would occur!

Four nursological theories of power provide explanations of having power that leads to civil discourse and the conversion of negative outcomes to positive outcomes.

  • Barrett’s (2010). theory of power as knowing participation in change provides a contrast between power as freedom and power as control and encompasses awareness, choices, freedom to act intentionally, and involvement in creating change. Participating knowingly in the ongoing mutual process with ourselves, with other people, and with our immediate world creates the opportunity for not only fulfillment in one’s life but also the opportunity to create positive change. (See https://nursology.net/nurse-theorists-and-their-work/theory-of-power-as-knowing-participation-in-change/).
  • Chinn’s (2013; Chinn & Falk-Rafael, 2015) theory of peace and power provides a contrast between peace-power and power-over. The theory empathizes how “individuals and groups . . . shape their actions and interactions to promote cooperation, inclusion of all points of view in making decisions and in addressing conflicts. [Accordingly], … individuals and groups can make thoughtful choices about the ways they work together to promote healthy, growthful interactions and avoid harmful, damaging interactions.” (Retrieved from https://nursology.net/nurse-theorists-and-their-work/peace-power/)
  • Polifroni’s (2010) theory of clinical power provides a contrast between having power as the result of knowledge and hierarchical power or taking power from another person. The theory emphasizes “the belief that power is knowledge and all nurses possess that power. In this context power is a right and it is truth/knowledge. Intentionality, authenticity, ways of knowing, PEACE . . . and CARE . . . surround the awareness and relationship of the nurse who is exercising clinical power” (Retrieved from https://nursology.net/nurse-theorists-and-their-work/clinical-power/).
  • Sieloff’s (1995, 2018) theory of work team/group empowerment in organizations provides an understanding of how nursologists have power in clinical and educational organizations. The theory encompasses competency in communication and in explicating goals and outcomes, as well as the work team/group’s leader’s competency; control of environmental forces; utilization of resources; empowerment perspective; empowerment potential and actual capacity to achieve outcomes; role, that is, the “degree to which the work of an [organization] is accomplished through the efforts of [a work team/group]” (Sieloff, 1995, p. 58); and position, that is, “the centrality of [the] nursing [work team/group] within the communication network of an [organization]” (Sieloff, 1995, p. 57).

Application of the power theories as ways to enhance understanding and resolution of CI provides a nursology discipline-specific approach to practice. Readers are invited to share their experiences with application of the power theories as comments for this blog.

References

American Nurses’ Association. (2015). Incivility, bullying, and workplace violence. Retrieved from http://www.nursingworld.org/MainMenuCategories/WorkplaceSafetyHealthy-
Nurse/bullyingworkplaceviolence/Incivility-Bullying-and-Workplace-Violence.html.

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23, 47-54.

Chinn, P. L. (2013). Peace & power: New directions for building community (8th ed.). Burlington, MA: Jones and Bartlett Learning.

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: A theory of emancipatory group process. Journal of Nursing Scholarship. 47, 62–69.

DeMarco, R., F., Fawcett, J., & Mazzawi, J. (2017). Covert incivility: Challenges as a challenge in the nursing academic workplace. Journal of Professional Nursing, 1-6.
doi:10.1016/j.profnurs.2017.10.001

Lim, F. A., & Berstein, I. (2014). Civility and workplace bullying: Resonance of
persona and current best practices. Nursing Forum, 49, 124-129.

Polifroni, E. C. (2010). Power right and truth: Foucault’s triangle as a model for clinical power. Nursing Science Quarterly, 238-412

Sieloff, C. L. (1995). Development of a theory of departmental power. In M. A. Frey & C. L. Sieloff (Eds.), Advancing King’s systems framework and theory of nursing (pp. 46-65). Thousand Oaks, CA: Sage.

Sieloff, C. L. (2018, October 6). Thoughts about nursing and power: Theory of work team/group empowerment. Paper presented as part of a symposium on nursological theories of power at the Society of Rogerian Scholars 30th Anniversary Conference, New York University Rory Myers College of Nursing, New York, NY.

The Joint Commission (2008). Behaviors that undermine a culture of safety. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_40.PDF.

Vagharseyyedin, S.A. (2015). Workplace incivility: A concept analysis. Contemporary Nurse, 50, 115-125.

About the authors

Julianne Mazzawi

Julianne Mazzawi, RN; MS
PhD candidate, Department of Nursing
University of Massachusetts Boston

Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN; ANEF
Professor, Department of Nursing
University of Massachusetts Boston

Rosanna F. DeMarco, RN; PhD;  PHNA-BC; FAAN
Professor and Chair, Department of Nursing
University of Massachusetts Boston

Jacqueline Fawcett

Rosanna DeMarco

What are Legitimate Nursology Specialties?

 Bittencourt, Marques, and Mendes Diniz de Andrade Barroso’s (2018) paper, published in Revista de Enfermagem Referência, catalyzed my thoughts about labels for legitimate specialties in the discipline of nursology. (Scroll down for information about the authors and access to the article website.) Clearly, concern for nursology-discipline specific knowledge is of interest to our scholar colleagues from Brazil (Dr. Bittencourt) and Portugual (Dr. Dias Marques and Dr. Mendes Diniz de Andrade Barroso). They presented an innovative approach to further development of nursology by placing a traditional specialty (mental health) within the context of various nursological conceptual models and theories. (Download the PDF of the English open-access article here).

Bittencourt and colleagues (2018) pointed out that although nursologists “have been conducting studies with the purpose of promoting mental health in schools and other settings . . . based on evidence that clearly points to the effectiveness of promotion strategies, [nursological] theories are rarely put forward as a basis for these nurse-led mental health promotion strategies” (Bittencourt et al., 2018, p. 126). They recommended that nursological conceptual models and theories should be used to expand thinking about the practice of mental health promotion and described the contributions of Meleis’ Transitions Theory, Pender’s Health Promotion Model, Peplau’s Theory of Interpersonal Relations, and Roy’s Adaptation Model  to research and practice for promotion of mental health.

The starting point for Bittencourt and colleagues’ (2018) proposal is a traditional specialty area that imitates a medical specialty, that is, mental health. Nursologists typically identify with this and other specialties drawn from medicine, including but not limited to medical, surgical, obstetrical, and pediatric specialties. These specialties comprise many undergraduate and graduate educational curricula, the broad areas of nursologists’ research, and the naming of departments in clinical agencies. Thus, just as Bittencourt et al. (2018) did for the specialty of mental health, nursological conceptual models and theories could be used as guides for the content of the courses, research, and practice in other specialty areas.

But what if the content of each nursological conceptual model and theory was used to designate specialties? For example, many years ago, Rogers (1973) proposed that the subsystems of Johnson’s Behavioral System Model could be nursology-specific specialties. Accordingly, specialties for curriculum content, research, and practice could be the aggressive subsystem, the attachment subsystem, the achievement subsystem, the ingestive subsystem, the eliminative subsystem, the dependency subsystem, and the sexual subsystem. Similarly, specialties within the context of Neuman’s Systems Model could be physiological variables, psychological variables, sociocultural variables, developmental variables, and spiritual variables.
Although the proposal that specialties should be within the context of each nursological conceptual model and theory may be regarded as preposterous, at least some nursologists have understood the value and importance of labels for specialties that differentiate the discipline and profession of nursology from other sciences and especially from the trade of medicine. For example, Batey and Eyres (1979) explained that “Language is fundamental to the evolution of all disciplines [and] [w]ithin any discipline, selected terminology evolves to become the concepts that denote the specific knowledge domains and methodologies of that discipline” (p. 139). Moreover, “Every science has its own peculiar terms, concepts and principles which are essential for the development of its knowledge base. In [nursology] , as in other sciences, an understanding of these is a prerequisite to a critical examination of their contribution to the development of knowledge and its application to practice” (Akinsanya, 1989, p. ii). Barrett (2003) added, “How would one understand anatomy and physiology, microbiology, pharmacology, . . . without the precise use of language reflecting those domains of knowledge? . . . How else is substantive knowledge to be communicated without saying it is what it is that it is!” (p. 280).

As we think about the admittedly potential choas of having such diverse nursology-specific specialties, we may move to an innovative and integrative way of identifying the specialities that accurately delineate what nursologists actually teach, study, and practice. Clearly, we need to move to (paraphrasing) what Allison and Renpenning (1999) called thinking nursology, what Watson (1996) called nursology qua nursology, and certainly what Meleis (1993) pointed out is the need to progress from thinking like and pretending to be junior doctors to being senior nursologists.

Noteworthy is that many of the ideas included in this blog come from publications of decades ago. Yet, no progress has been made in all that time. So, what do you think nursology-specific specialties should be? Should we continue with the status quo of using the same terms as does medicine with the added value of the context of nursological conceptual models and theories? Or, should we be finally be bold and use the languge of our nursological conceptual models and theories to name and structure our specialties?

References

Akinsanya, J.A. (1989). Introduction. Recent Advances in Nursing, 24, i–ii.

Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.

Barrett. E. A. M. (2003). Response to Letter to the Editor. Nursing Science Quarterly, 16, 27-28.

Batey, M. V., & Eyres, S. J. (1979). Interdisciplinary semantics: Implications for research. Western Journal of Nursing Research, 1, 139-141.

Bittencourt, M. N., Dias Marques, M. I., & Mendes Diniz de Andrade Barroso, T. M. (2018). Contributions of nursing theories in the practice of the mental health promotion. Revista de Enfermagem Referência, 4(18), 125–132.

Meleis, A. I. (1993, April). Nursing research and the Neuman model: Directions for the future. Panel discussion at the Fourth Biennial International Neuman Systems Model Symposium (B. Neuman, A. I. Meleis, J. Fawcett, L. Lowry, M. C. Smith, and A. Edgil, participants), Rochester, NY.

Rogers, C. G. (1973). Conceptual models as guides to clinical nursing specialization. Journal of Nursing Education, 12(4), 2–6.

Watson, M. J. (1996). Watson’s theory of transpersonal caring. In P. Hinton Walker & B. Neuman (Eds.), Blueprint for use of nursing models (pp. 141–184). New York, NY: NLN Press.

About the authors

  • Marina Nolli Bittencourt, RN; Ph.D. is an Adjunct Professor, at the Federal University of Amapá, in Macapá, Brazil
  • Maria Isabel Dias Marques, Ph.D., is a Coordinating Professor, in the Nursing School of Coimbra,in Coimbra, Portugal
  • Tereza Maria Mendes Diniz de Andrade Barroso, Ph.D., is an Adjunct Professor in the Nursing School of Coimbra, in Coimbra, Portugal

Access the article

The file for their journal article, Contributions of nursing theories in the practice of the mental health promotion, is available in English and Portuguese at https://doi.org/10.12707/RIV18015. The abstract is available in English, Portuguese, and Spanish.

The journal, Revista de Enfermagem Referência, is the property of the Escola Superior de Enfermagem de Coimbra.

Our Name: Why Nursology? Why .net?

Why Nursology?

At least since the publication of Donaldson and Crowley’s (1978) seminal paper titled The Discipline of Nursing, nurses have been considered members of a discipline. A discipline (the term comes from the Latin disciplina) is a branch of instruction or  learning and is a way of organizing knowledge. Different disciplines are distinguished one from another by the subject matter of interest to their members. In what way does calling our discipline nursing convey a focus on knowledge development and testing, rather than, for example, breast feeding? Those of us involved in founding this web site agreed to use of the term, nursology, as the best way to convey this focus.

The term, nursology, comes from the Latin, Nutrix, [meaning] nurse; and from the Greek, Logos, [meaning] science (O’Toole, 2013, p. 1303). The first mention of nursology apparently is by Paterson, an American nurse, in her 1971 journal article. She coined the term, nursology, “to designate the study of nursing aimed towards the development of nursing theory” (p. 143). Roper (1976), a Scottish nurse, also referred to our discipline as nursology. She explained,

“It could be that nursing might develop as a discipline without using a word to describe its characteristic mode of thinking, but it will have to make the mode explicit and it will have to have the same meaning for nurses anywhere. Should the nursing profession require to use a word, I propose the word nursology for the study of nursing, so that the logical pattern of derivation of an adverb could be followed. (p. 227)

Fitzpatrick (2014) pointed out that use of the term, nursology, as the name for the discipline has not been supported by nurses, although “remnants of this minor movement appear today. Students in current doctoral-level nursing theory classes often express interest in the term as a way to legitimize the scientific enterprise and distinguish nursing science from other disciplines, particularly [other] health disciplines” (p. 5).

Nursology is not only a name for our discipline. It also is regarded and has been used as a research method and a practice method (Fawcett et al., 2015). The name for our schools and department and programs most properly, also is nursology. The members of our discipline—students, practicing nurses, researchers, educators, and administrators—are scholars of nursology, that is, nursologists. Noteworthy is that Josephine Paterson (1978) and Loretta Zderad (1978) held the formal title of nursologists while at the Veterans Administration Hospital in Northport, New York. As nursologists, we clearly no longer regard ourselves or can be regarded by others as handmaidens to physicians, who are members of the trade of medicine (medicine cannot be regarded as a discipline due to no evidence of distinctive knowledge).

Why .net?
.net was selected as the extension for the web site name to,  as Peggy Chinn pointed out, convey a network of nurses who are interested in learning about all things theoretical in nursology, including advances in the knowledge needed and used by nurses to guide their practice.

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28, 330-333.

Fitzpatrick, J. J. (2014). The discipline of nursing. In J. J. Fitzpatrick & G. McCarthy (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit (pp. 3-13). New York: Springer.

O’Toole, M. (Ed.) (2013). Mosby’s medical dictionary (9th ed.). St.Louis: Mosby.
Paterson, J. G. (1971). From a philosophy of clinical nursing to amethod of nursology. Nursing Research, 20, 143-146.

Paterson, J. G. (1978). The tortuous way toward nursing theory. In Theory development: What, why, how? (pp. 49-65). New York, NY: National League for Nursing. (Pub. No. 15-1708)

Roper, N. (1976). A model for nursing and nursology. Journal ofAdvanced Nursing, 1, 219-227.

Zderad, L. T. (1978). From here -and-now to theory: Reflections on“how.” In Theory development: What, why, how? (pp. 35-48).New York< NY: National League for Nursing. (Pub. No. 15-1708)