Barbara J. Hatcher Q&As on “Decolonizing Nursing”

From the September 23rd Panel Q&A

There were several questions in the chat for me.

Q. As part of my master’s degree (UVIC) I am currently going through a practicum at a Nursing School in BC, Canada. This course is a 12-week course that focuses on care of acutely ill clients experiencing surgical interventions. As such, it’s very med/surg/anatomy heavy. How can we implement anti-racist and indigenous content into such a course?
Barbara Hatcher

While it is extremely important to learn pathophysiology and to become a skilled and competent nurse, it is even more important to understand how the lived experiences of each person you touch is impacted by disease and disability. How do they see their circumstances, how will they adapt to any changes in health status? The five Cs I discussed related to vaccine hesitancy can also apply to other situations. The five Cs can be applied e to your nursing history to help you humanize and better understand each person as a unique being. In so doing, I believe you become pro-person and of course anti-racist as well. For example:

  • Confidence- Is the patient confident that medical care will safely address their condition? Are they confident about the skill and abilities of the hospital staff?

  • Complacency- Does the patient believe the treatments are necessary

  • Convenience- Does the person understand what is going on as it relates to language and health literacy. Are they accessible to follow-up care? Can they afford follow-up care? Can they afford the hospitalization?

  • Communication- Are patients informed about their disease or disability?

  • Context – How does race/ethnicity, occupation, socioeconomic and other structural factors impact the person.

Q. While teaching student nurses about structural inequities, how can faculty members create safe spaces where BIPOC students are not retraumatized by the content presented?

Those of us who are BIPOC have an inner strength others do not recognize. We have had to deal with “twoness” all our lives. We have had to create an authentic self we can live with. As I briefly shared in the chat, it is the concept of ” twoness.” So, we often live within and without the white vs BIPOC world. The twoness phenomenon is discussed in W.E.B. DuBois’s book the “Soul of Black Folk.” He states the following:

. . a black man “ever feels his two-ness– an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder”(1705).

You as a teacher can accept that twoness is necessary. You can make clear to students that they need not be ashamed of being in the space they are in, and they have the right to develop their authentic self and to honor their lived experience. It is not about the trauma, it is about projecting the changed mission and values of a of decolonized nursing community.

Finally, nursing education needs to expose students to broader sociological concepts and adopt or design more macro level theories. Many of our nursing theories deal with the individual and not the interplay of health to economics, governance and human rights or as we discuss now, the social determinants of health. During my ten-year career as a nursing educator, I most often used Bronfenbrenner’s Ecological Systems Theory because it broadened student’s perspectives.

Q: Another I remember was about the new Commissioner of Public Health in Florida. This is my response:

Unfortunately, I have taught graduate students whose beliefs did not represent any degree of cultural humility and whose politics were toxic. These students justified their stance through their belief that the US did so much for the world’s people; they did not need to tolerate charity at home.

As a global health expert, I met with physicians who looked at me in blank disdain as I discussed a public health approach versus a medical approach and talked about what we now in terms of the social determinants of health. It was hogwash to them, the medical approach was the only approach that made sense and public health, nursing, or another theoretical approach was just a “garbage pan” approach to health care. We now have physicians who want to discuss and take credit for public health being medicine.

I say all this to say the following: I disagree with the policies that the new Surgeon General of Florida has issued. I believe they are irresponsible and unscientific. However, I have learned that some people just do not embrace the notion that “ to whom much is given, much is required.” In respect to my African -American and American Indian ancestors and to the ancestral lands we all live on, I believe more is required of all in the healing professions.

The new Surgeon General does not exhibit the cultural humility required of such a position. in my estimation. Impeccable credentials and a Harvard School graduation does not make one prepared to run a public health department. What is more distressing to me are Black folk willing to go against the grain to support policies that seem to only advance them personally. To paraphrase other comments about the new Florida State Surgeon General , he is more with #DeSantis than with public health and health care aimed at building trust, equity, and decolonization.. Finally, it is a key example of what happens when our educational programs have not seemingly changed mission and values to advance the interplay of health and human rights.

Call for Abstracts – Nursing Theory Conference

Open for submissions – until 11:45 pm EST on November 15, 2021!

The abstracts can be for either a 30-minute “Knowledge Session” or for a virtual poster presentation!

Visit the Nursing Theory Conference website for more details about submitting your abstract! Access to the abstract submission page is also posted in “Due Dates” to the right of each Nursology.net page!

Decolonizing Nursing Education

From the September 23rd Panel Q&A

Q. Do you have recommendations for decolonizing nursing education given the fact that nursing faculty are predominantly white? I find that our arguments about being “gatekeepers” for the profession are inherently racist but I also find that challenging those arguments is met with a lot of resistance.
Bukola Salami
Bukola Salami

This is why it is important to continue to be anti-racist in nursing, rather than not being racist.  For each advancement that is made toward equity and anti-racism, there are always opposing forces (often in creative ways). We need to continue to advocate for diversity in the nursing profession and at all levels.  As someone once told me, nursing is like a cappuccino; it is white on top and black underneath.  We need to mix it up.  This means we need to take into consideration the underlying inequities that prevent the upward career mobility of BIPOC nurses. 

For example, many BIPOC researchers are often engaged in invisible work that is unrecognized and also deters their career progression.  These include providing advice and informal mentorship of BIPOC students, more service and community engagement, and being called upon to do unrecognized work.  We need to bring to light some of these work and challenge issues related to knowledge production in nursing.  We also need to challenge embedded inequities in the mentorship process.  People often mentor those who look like them, have similar interest and similar background.  The decolonization process must involve a critical reflection on our mentorship process, succession planning process and its embedded exclusionary practices. We also need to ensure we decolonize our promotion process. Anti-racism needs to be included as a standard of practice and part of our ethical framework in the nursing profession.  At the current time, we tend to overly emphasize culture as a determinant of health rather than racism as a determinant.  Many standards of practice, entry into practice frameworks, and ethical frameworks do not have the word race in it but rather emphasize culture rather than race.  An emphasis on racism shifts the blame from victims of the colonial process.  We also tend to emphasize inequities experienced by patients rather than embedded inequities in our profession which also has implications for population outcomes.  The current COVID 19 pandemic has highlighted these inequities in the nursing profession and implications for population health.  Blacks are more likely to be diagnosed with COVID 19 infection.  There are structural issues that contribute to these — one of which is the structural inequities in the nursing profession where BIPOC individuals are concentrated in the lower level of the profession.  Indeed racism has become a public health emergency and central issue during the COVID 19 pandemic as we have seen the effects of racism on population health outcomes.

To directly answer your question, a central way to decolonize nursing education with nursing faculty being predominantly white is to ensure anti-racism is embedded into entry to practice frameworks, Faculty promotion policies, and nursing standards of practice.

Daniel Suárez-Baquero
Daniel Suárez-Baquero

The academy and faculty are predominantly white, the schools of nursing must open their doors to POC faculty. However, representation is not enough, we must develop programs aimed to make POC faculty feel welcomed and heard. The first step is to recognizes the disparities in tenure track between white and POC professors, even including immigrant scholars who can’t apply to NIH grants. For example, when I was looking for a postdoc position and I brought up the disparities I found when trying to find opportunities as an international scholar, in contrast to all the available options for residents and citizens, a professor said to me “this is how it is”… I refuse to that idea, it can be better for all of us

Nursing requires an identity turn that allows the historically minoritized population to be recognized as equals within the discipline.

Decolonization and Globalization

During the “Decolonizing Nursing: What? Why? How? webinar on September 23rd, there were questions posed for the panelists that could not be addressed due to time constraints. We promised to post responses to these questions on the Nursology.net blog – and here is the first of those responses!

Dr. Martinez

The first question we are addressing is from nursologist Rudolf Cymorr Kirby Martinez in the Philippines, and a blog contributor to Nursology.net! The Philippines has provided well educated and competent nurses to fill nursing shortages in the United States for decades. Dr. Martinez posed the following question:

From the perspective of a developing country who supplied nurses for developed countries, colonization of nursing, especially education, is often masked as globalization. In the process of conforming to the requirements for working abroad and in the guise of being “globally competitive”, the local and distinct practice of nursing is set aside. The nursing curriculum of some developing countries are more American than local.

Panelist Responses

Daniel Suárez-Baquero

I would like to begin by stating that the idea of developed and developing countries is one of the most colonial ideas. It centers the vision of superiority made by the “developed” nations over the others. These “developed” nations have been characterized for invading and exploiting the resources of other countries. Also, this notion underlies that the “developing” want to be like the “developed,” rather than considering their greatness and contributing to their self and authentic growing.

I agree in that, in many instances, globalization is a masked form of colonization. The “international cooperation” must be a “reparation” made by the colonizer for more than 500 years of historic colonization of other nations, which remains even today. This critical state of oppression, exclusion, and discrimination is a product of an historical political and economical relationship between the invaders and the invaded, in which the dominant nations must be accountable of their acts dating back to before the invasion of Abya Yala (word used by the native tribes of Latin America to refer to their territory as an indivisible macrocontinent from south to north (from Argentina to Canada) and that I will use here instead of “America” as a form of vindication..)

Having this global perspective, the idea that we have been sold (to us, the developing ones, the others) grounded in otherness is that we want to be like them (the dominant and developed). Such an idea has led, in many instances, to lose our own identities and, even nowadays in the north, the very identity of nursing is blurred. Then, the invitation is to reclaim what is ours, what has been denied to us and, in the other hand, to the dominant white elite of the discipline to recognize the epistemologies outside of what they consider the core of the discipline. This will be the first step in a co-construction of a new epistemology of Nursing and in the rescuing of the local identities and practices of Nursing.


Barbara Hatcher

I do not believe nursing education in some countries is masked as globalization. I note you are from the Philippines and nursing education is part of the economic development blueprint of your country. As a past member of the National Council of State Boards of Nursing, I can remember vividly and somewhat in shock, a presentation by government officials telling us emphatically that nursing was part of their blueprint for globalization. Even today, physicians who would have a hard time getting credentialed in this country are retrained in your country as nurses who then immigrant to the US. Economists suggest that countries taking part in the global economy are experiencing more economic growth and poverty reduction than those countries which remain in isolation. So, globalization is both good and bad.  However, the nursing community can turn this around by also seeing it as an opportunity for increased communication, and cultural exchange.  How might beliefs and practices of other countries humanize and change nursing worldwide.  How might nurses from other countries help nursing in your country design a more authentic part of your curriculum as well.  You can certainly honor and embrace your cultural heritage as is done in the US, Canada, and other parts of the world.  As an African American woman, I honor and embrace my ancestry and believe that it makes me unique and powerfully different.   Others can do the same.

Abstracts for the 2022 Virtual Nursing Theory Week due November 15th

Now open for submissions – until 11:45 pm EST on November 15, 2021!

The abstracts can be for either a 30-minute “Knowledge Session” or for a virtual poster presentation!

Visit the Nursing Theory Conference website for more details about submitting your abstract! Access to the abstract submission page is also posted in “Due Dates” to the right of each Nursology.net page!

Nursing Theory Forum with Mary Jane Smith

Presented by the Theory-Guided Practice Expert Panel of the American Academy of Nursing

This is another wonderful opportunity to meet and interact with a nurse pioneer in the development of nursing theory!

When: Oct 12, 2021 02:00 PM Eastern Time (US and Canada

Register in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZIuc-GvrT8tGNyB4Wcj1NJddLdRfiop2XEe

After registering, you will receive a confirmation email containing information about joining the meeting.

Dr. Smith is co-author of the book MIddle Range Theory for Nursing, now in its 4th Edition. She was also one of the podium presenters at the 2019 Case Western Reserve Nursing theory conference, shown with other presenters, shown below! We hope you can join us!

Opening session speakers (L to R) Joyce Fitzpatrick, Peggy Chinn, Mary Jane Smith, Marlaine Smith, Callista Roy, Pamela Reed

VISCERAL NURSOLOGY

Contributor: Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired)

Recently I had a professional practice story published in the American Holistic Nurses Association journal, “Beginnings”. Several responses to the story motivated me to think about the potential use of professional practice stories in nursing education. I shared with a local nursing professor and the magazine editor the possibility of using professional practice stories to have students identify what nursing theories and ways of knowing they saw in a given story.

This prompted a literature review on the topic of storytelling in nursing. I also recalled that I had a section about storytelling in my graduate position paper of 1998. One of the references for that paper was “To a Dancing God” by Sam Keen (1970; 1990). I reviewed his quote: “A visceral theology majors in the sense of touch rather than the sense of hearing.” (p. 159). I immediately said to myself that if there can be visceral theology, there can be visceral Nursology!

And what would visceral Nursology look like? Definitions of visceral include “proceeding from the instinctive, bodily, or deep abdominal place rather than intellectual motivation.” This brought to mind two concepts: the felt sense and aesthetic knowing.

I first explored the concept of the felt sense in 2007, and continued to read more about it over time. One way I came to understand the felt sense is as an immediate precursor to intuitive insights.

The following statements about ‘felt sense’ are taken from two books which I found quite helpful. The first book is Focusing (1979) by Eugene T. Gendlin. The second book is Waking the Tiger: Healing Trauma (1997) by Peter A. Levine. A more recent book, Your Body Knows the Answer: Using Your Felt Sense to Solve Problems, Effect Change & Liberate Creativity (2014) by David I. Rome teaches how to access the felt sense.

  1. The felt sense is a difficult concept to define with words, as language is a linear process and the felt sense is a non-linear experience. Consequently, dimensions of meaning are lost in the attempt to articulate this experience. (Levine p. 67)
  2. A felt sense is not a mental experience but a physical one. Physical. A bodily awareness of a situation or person or event. An internal aura that encompasses everything you feel and know about the given subject at a given time – encompasses it and communicates it to you all at once rather than detail by detail. (Gendlin p. 32)
  3. Perhaps the best way to describe the felt sense is to say that it is the experience of being in a living body that understands the nuances of its environment by way of its responses to that environment. (Levine p. 69)
  4. In many ways, the felt sense is like a stream moving through an ever-changing landscape…..once the setting has been interpreted and defined by the felt sense, we will blend into whatever conditions we find ourselves. This amazing sense encompasses both the content and climate of our internal and external environments. Like the stream, it shapes itself to fit those environments. (Levine p. 69-70)
  5. The felt sense can be influenced – even changed by our thoughts – yet it’s not a thought, it’s something we feel. (Levine p. 70)
  6. The felt sense is a medium through which we experience the fullness of sensation and knowledge about ourselves. (Levine p. 8)
  7. Nowadays the phrase, “trust your gut” is used commonly. The felt sense is the means through which you can learn to hear this instinctual voice. (Levine p. 72)
  8. The felt sense heightens our enjoyment of sensual experiences and can be a doorway to spiritual states. (Levine p. 72)
  9. One must go to that place where there are not words but only feeling. At first there may be nothing there until a felt sense forms. Then when it forms, it feels pregnant. The felt sense has in it a meaning you can feel, but usually it is not immediately open. Usually you will have to stay with a felt sense for some seconds until it opens. The forming, and then the opening of a felt sense, usually takes about thirty seconds, and it may take you three or four minutes, counting distractions, to give it the thirty seconds of attention it needs. When you look for a felt sense, you look in the place you know without words, in body-sensing. (Gendlin p. 86)

I was so relieved to see how I had practiced nursing for decades put into words. I couldn’t always explain how I knew the effective interventions that seemed to just ‘happen’. I didn’t feel free to explore this in the non-holistic based career roles the first 30 years of my career. My graduate work in the late 1990’s gave me freedom to explore more holistic ways of thinking and practicing, but still doing it all rather privately. Membership in the Minnesota Holistic Nurses Association also gave me colleagues with whom to share more holistically.

The next movement toward being more open about my practice came when I learned about Modeling and Role Modeling Theory in 2012, two years before my retirement! Perhaps if I had been more open to nursing theories earlier, I wouldn’t have felt like I needed to hide how I practiced all those years. Listening, presence, and putting myself in the shoes of the other were always three of my stronger interventions. To see a theory include this latter one was such a relief. And it was in studying Modeling and Role Modeling that I learned there were a variety of ways of knowing, and aesthetic knowing was one of them.

However, I did not understand aesthetic knowing as fully until the more recent Nursology posts. I experience sheer delight with this learning. I can finally acknowledge my way of practicing to my nursing community. Chinn & Kramer (2018 p. 142) define aesthetic knowing as “An intuitive sense that detects all that is going on and calls forth a response, and you act spontaneously to care for the person or family in the moment.” It involves sensations as opposed to intellectuality. Chinn & Kramer (2018) also say “Aesthetic knowing is what makes possible knowing what to do and how to be in the moment, instantly, without conscious deliberation.” In other words, I have to not only let my head get out of the way, but also not let my head talk me out of aesthetic knowing, in both my professional life and personal life.

And so it is for me, that aesthetic knowing is Visceral Nursology. I now have a theory, an organization, and a way of knowing that supports how I practice.

REFERENCES

Chinn, P.L. & Kramer, M.K. (2018). Knowledge Development in Nursing: Theory and Process. (10th Ed.). Elsevier. St. Louis, MO.

Erickson, H.L. (Ed). (2006). Modeling and Role-Modeling: A View from the Client’s World. Unicorns Unlimited. Cedar Park, TX.

Gendlin, E. T. (1979). Focusing. (2nd ed.) Bantam Books. NY.

Keen, S. (1970, 1990). To a Dancing God: Notes of a Spiritual Traveler. Harper Collins. San Francisco.

Levine, P.A. with Frederick, A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books. Berkeley, CA.

Rome, D.I. (2014). Your Body Knows the Answer: Using Your Felt Sense to Solve Problems, Effect Change & Liberate Creativity. Shambhala. Boston & London.

About Ellen Swanson

Ellen Swanson

Ellen E. Swanson is retired from a 46 year nursing career that included ortho-rehab, mental health, OR, care management, consulting, and supervision. She also had a private practice in holistic nursing for 15 years, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.
She enjoys writing that incorporates holistic concepts, whether through storytelling or her booklet about Alzheimer’s or her book about healing the hierarchy.

Our Voices: Addressing Racism in Nursing

September 27, 2021. 1-4:30pm Eastern – Virtual Zoom Meeting

Register Here

Join us to learn more about our voices reckoning with racism in nursing. Share your voice in a dialogue, discussion, and future direction inspired by first person interviews and shown through the compelling stories of Black, Indigenous, Latinx, and other nurses of color.

Featuring Nurses from the “Overdue Reckoning on Racism in Nursing” project: Lucinda Canty, Sue Hagedorn, Raeann LeBlanc, Frankie Manning, Melissa Mokel, Gayle Robinson and StoryCenter guides and media production team: Jonny Chang, Joe Lambert, Sharon Mosley, and Daniel Weinshenker.

A Seedworks Foundation Supported Event in Collaboration with StoryCenter

Call for Abstracts for the 2022 Virtual Nursing Theory Week

Now open for submissions – until 11:45 pm EST on November 15, 2021!

The abstracts can be for either a 30-minute “Knowledge Session” or for a virtual poster presentation!

Visit the Nursing Theory Conference website for more details about submitting your abstract! Access to the abstract submission page is also posted in “Due Dates” to the right of each Nursology.net page!

Fostering dialogue about practice knowledge development in a DNP Curriculum; Opportunity for theory innovation?

Guest Contributor: Lydia D. Rotondo, DNP, RN, CNS, FNAP

The practice doctorate in nursing developed in response to an increasingly complex healthcare landscape that requires additional competencies for 21st century advanced nursing practice. Complementing traditional graduate (MS) specialty curricula, the Doctor of Nursing Practice (DNP) program of study incorporates additional curricular content in the areas originally detailed in the 2006 DNP Essential domains (now integrated into AACN’s 2021 Essentials). DNP students complete a summative scholarly practice inquiry project that is theoretically-guided and evidence-based, demonstrating synthesis and application of the tools of clinical scholarship learned throughout the DNP program.

Particularly relevant to the design of DNP projects is the critical importance of context and the application (or adaptation) of best evidence (when available) to specific practice settings or specific populations. As context experts DNPs utilize systems thinking to design, implement, and evaluate interventions within complex adaptive systems revealing new understandings about health care delivery, the healthcare experience, and the role of DNPs as change agents and clinical scholars.

Fifteen years after the release of the DNP Essentials, appropriate focus is now on evaluating the impact of DNP practice on healthcare systems and health outcomes. As a practice discipline, however, there remains little attention by nursing academe regarding the potential impact of the practice doctorate on the discipline of nursing. In other words, how will the growing cadre of DNP-prepared nurses be leveraged to advance the discipline? In today’s interdependent, knowledge–based, digital world, how will advancing the discipline be defined and measured in the coming decades? What additional scholarly tools and curricular content will DNP students need to begin to answer these questions?

As doctoral-prepared nurses, DNPs share stewardship with other doctoral-prepared nursing colleagues to generate disciplinary knowledge. Yet, discussion about DNPs as knowledge producers and theory innovators remains largely unexplored. Scholarly treatment of knowledge generation in nursing practice is not a new phenomenon and has, in fact, been posited and published by several nursing theorists for decades. However, the introduction of the latest iteration of the practice doctorate in nursing, now in its second decade, with more than 36,000 enrolled in DNP programs and close to 8,000 graduates, has not sparked interest among leaders in DNP education to approach practice epistemology from the DNP lens.

Moreover, with a de-emphasis on philosophy of science and theory and stronger attention to evidence-base practice in DNP curricula, DNP programs as currently designed may lack sufficient educational grounding to engage in practice theory development. This further impedes the opportunity for scholarly discourse on practice knowledge production specifically and doctoral roles in nursing knowledge generation more broadly. While the promotion of evidence-based practice among all health professionals is useful to reduce clinical variation in care, there remains nascent opportunity for DNPs to consider how their scholarly work can produce practice-based evidence- knowledge that both improves care outcomes for individuals and populations and illuminates the contributions of nurses to healthcare.

In 2019, we developed a theory and conceptual foundations for clinical scholarship course at the University of Rochester School of Nursing in which students explore the historical and philosophical roots of the practice doctorate in nursing and nursing as a practice discipline. Our early efforts were inspired by Dr. Pamela Reed, Professor at the University of Arizona College of Nursing, whose considerable contributions in the area of practice epistemology provided a framework for course development. In an early course assignment, students are asked to create a concept map using the four nursing metaparadigm concepts to describe their philosophy of nursing. Students present their maps in class which encourages rich discussion about the nature of nursing knowledge related to their role in health care and health/wellness promotion. What is particularly striking is that for many students, this course is their first exposure to nursing’s theoretical grounding and opportunity to reflect on their professional practice from a disciplinary perspective. Several DNP student exemplars from the spring 2021 semester are included below with permission.

Exemplar 1 – Sarah Dunstan, University of Rochester School of Nursing DNP student

Circumnavigating and persevering through life’s most challenging roadblocks, the nurse dutifully guides the most weary and vulnerable of travelers towards safety and solace, both physically and emotionally. Committing to the vision of “Ever Better” and the pursuit of optimal patient wellness, nurse leaders are tasked with the responsibility of advancing the field and creating the new standards of care for the future.

As depicted above, my philosophy of nursing is best explained in the context of a journey. The person, or patient, is represented as a vehicle. Similar to vehicles, each patient is a unique make and model, some with more miles or more baggage than others. The nurse navigating the vehicle must carefully consider these differences and individual patient needs when mapping out the patients’ journey to health. The map, or environment, is laden with roadblocks or barriers to optimal wellness. The barriers may be geographical, financial, cultural, psychological, or physical. Whether few or many, these roadblocks may delay or completely inhibit the patient from reaching their health care goals. The metaparadigm concept of nursing describes the individual caregiver at the bedside that assists the patient around and through these various states of illness in order to reach the ultimate destination of optimal wellness. The destination “Health” is malleable and ever evolving, as depicted with multiple possible end points marked on the map. Health is defined by and dependent on the individual patient and their own informed healthcare goals, as optimal wellness is not always defined as the absence of disease.

The map is in the hands of the DNP-prepared nursing scholar. As a leader and nursing expert in the field, the DNP is the visionary change agent tasked with closing the practice-theory gap at the bedside in the clinical setting. DNPs are the cartographers for the future of nursing, responsible for defining clinical scholarship in nursing, creating, upholding, and disseminating the proposed standards of the discipline.

Exemplar 2 – Christine Boerman, University of Rochester School of Nursing DNP student

My nursing theory and paradigm is composed of many moving parts that work interchangeably and without each of these elements working together, the discipline of nursing would not be complete. My nursing theory is illustrated via the gears that work together in order to create the full working “maChinne” of nursing discipline.

Exemplar 3 – Christina D’Agostino, University of Rochester School of Nursing DNP Student

The figures included within the map are all intended to mirror constellations within that sky, represent the person, the environment and one’s health. Centered at the bottom of the map, shining its beacon of light on the sky is nursing, represented by two hands which provide the foundation. Nursing is a global role. As people around the globe all look up to the same night sky, all people share the benefits of the nursing domain.

My personal philosophy of nursing is a holistic approach of providing culturally-sensitive care for individuals, regardless of locality or ethnicity while being mindful of the interconnectedness that involves the person, environment, and one’s health as the recipient of that care.

Exemplar 4 – Victoria Mesko, University of Rochester School of Nursing DNP Student

My personal philosophy of nursing is: Caring for individuals with a holistic approach, striving for wellness within the community and the world. Along with all of the skills that nurses develop, what sets nurses apart is their caring nature. Nurses have an all-encompassing view of our patients’ mind, body, and spirit. Nurses see patients in the context of their environment and are able to propose treatments that will consider all of the influences on patient’s lives. Nurses take into account all of the meanings that “health” can have to a person, not just the absence of disease, but a sense of wellness even if they have disease. In my map, there is no one nursing domain that is more important than another, as they all have an influence on patient care. The interlocking circle of different hands represents nurses working to form relationships and connections between patients, the community and the environment across cultural lines.  

Exemplar 5 – Kalin Warshof, University of Rochester School of Nursing DNP Student

My philosophy of the nursing discipline is the utilization of the art and science of nursing care, compassion, and practice interventions to enhance the health and well-bring of the person, within their individual environmental context, including social determinants, culture, and beliefs. The metaparadigm map depicts the person at the center of the diagram, with nursing as a discipline, nursing interventions and compassionate care contributing to the improvement of health and well-being of the person. This is evident by the upward arrow, with health and well-being above the person, portraying the upmost importance to the person and nursing. The background in light blue, labeled the environment, indicates that the person, nursing discipline, health, and well-being interpretation and improvement occurs within the context of the personal environment. My philosophy of the nursing discipline is consistent with the Doctor of Nursing Practice Essentials I objective focusing on the whole person and their interaction with the environment to improve health and well-being (American Association of Colleges of Nursing [AACN], 2006).

Exemplar 6 – Kara Mestnik, University of Rochester School of Nursing DNP Student

Individual nursing philosophy is shaped overtime by individual practice, and life experience. My philosophy has shifted over the past twenty years, I have gained vast clinical experience and growth in intrapersonal interaction and relationships. The term balance is often sought for and emphasized as an indicator of health and wellness, comparable to the concept of homeostasis. My personal philosophy of Nursing is the ability to navigate all facets of human life despite the magnitude of directional force that may attempt to imbalance ones mental, physical, and spiritual well-being. Refer to (figure 1) for metaparadigm map. Consider the patient the pivot at the center of the compass, with a multidirectional view of their own life and well-being, while the nurse is the hand that holds the compass. The hand holding the compass helps both align and balance the direction the patient is aiming to travel. The nurse becomes both the navigational guide and the stable hand that allows for balance to be achieved at any given period or direction in time. The hands holding the compass indicate a personal connection with the patient as well as an oversight into the larger picture in which patients may travel. The acquired achievement of balance despite a directional force is guided by the hands that allow for health and wellness optimization.

About Lydia Rotondo

Lydia Rotondo

Lydia Rotondo, DNP, RN, CNS, FNAP is the associate dean for education and student affairs and director of the doctor of nursing practice program at the University of Rochester School of Nursing. She received her DNP from Vanderbilt University, MSN from the University of Pennsylvania, and BSN from Georgetown University. Lydia is a 2018 AACN Leadership in Academic Nursing Fellow and has actively contributed to the national dialogue on DNP scholarship and curriculum development through presentations at AACN’s doctoral education conference and publications.