Struggling to Find Air: Emancipatory Nursing Response to COVID-19

Guest Contributor: Kathleen ‘Katie’ Clark, DNP
Edited by Kaija Freborg, DNP

“I can’t breathe.”  If these words were uttered in any healthcare setting in the country, an influx of healthcare providers would rapidly respond, attempting to save the person’s life by providing immediate care.  These words not only represent the recent murder of George Floyd, but mirror the racial inequities that exist for those who are struggling to breathe most in the worst pandemic in modern history. 

As a nurse bearing witness to these atrocities in the city of Minneapolis, I have observed nurses organizing themselves to respond as a collective to these unthinkable problems in real-time by taking immediate action to both maintain safety and fight for justice. These nurses are engaging in emancipatory nursing, a form of nursing that has the potential to dismantle power systems that privilege some over others due to economic means, social status, or hierarchies that create health inequity.1 Nurses must struggle to find the freedom to uncover the dominant health practices that foster Western ideals of health and minimizes nurse’s role to that of a ‘helper’ or a ‘do-gooder.’2 

The words, “I can’t breathe,” should call all nurses to action, first to look inward at our role in perpetuating systemic issues related to race and injustice, and then to respond as a collective to undo generations of harm that have traumatized communities and individuals for far too long.  Witnessing a man struggle to find oxygen to survive, at the knee of someone who has sworn to protect and serve — undoubtedly warrants a public health crisis be declared and calls for immediate nursing action.

Many nurses voiced, in their stories, frustrations of the constantly changing guidelines from the CDC or the Minnesota Department of Health (MDH) that have often created fear and conspiracy theories amongst some mostly well intended people.  Unfortunately, while engaging in self-reflection, many of the nurses reported they lacked the energy to continue to participate in social media platforms as the push back from others on these sites felt frustrating and belittling with little change observed.  Some nurses felt compelled to take a break from social media sites altogether because of the backlash experienced while trying to dismantle misinformation, such as information regarding wearing a mask in public spaces.  Others have taken on this opportunity to do more and respond to needs in innovative ways outside of traditional systems.

Katie Clark at the Health Commons

Kagan, Smith, and Chinn have provided a framework of action to inspire us to break these shackles in place — known as ‘emancipatory action’ — which require four vital characteristics to be deemed such work.  These elements include: “facilitating humanization, disrupting structural inequities, self-reflection, and engaging in communities.”1(p6) While strategically these four elements of emancipatory action have not been used together to tackle the racism that has existed in our care settings for the last 100 hundred years to my knowledge, I have witnessed them being practiced independently by nurses responding to the endless crises that have resulted from the COVID-19 virus and the recent racial justice unrest.  While collecting stories from nursing students and nurses in my role as the director of the Health Commons and an assistant professor of nursing at Augsburg University, it is clear that during this pandemic we have taken on the burden of not only caring for patients in practice settings, but also have felt a moral obligation to provide health education to people in social circles, families, and communities. 

Take for example Sarah Jane Keaveny, RN, public health nurse, activist, and Augsburg University nursing alum.  While buildings closed in response to guidelines set by government bodies due to COVID-19, those who were experiencing homelessness were left with limited options.  Typically those in the homeless community access the skyway system, light rail, public library, and other public spaces for shelter, toileting, and rest.  But, as the social quarantine measures continued to heighten, more buildings closed, leaving them with limited options to get their basic needs met.  One individual experiencing homelessness said to me while at the Health Commons , “It’s like no one cares that we are still out here.  I haven’t met anyone with this disease, but I will know people who will die from it because of all these rules.” 

MOODI Outreach

Sarah Jane connected with the existing resources of outreach workers and community members engaged in mutual aid to respond to those displaced by social structural inequities in the pandemic through establishing Mobile Outdoor Outreach Drop-in (MOODI) where meals are offered and connections to resources are made everyday of the week at a local park. In addition, while many of the shelters began moving individuals experiencing homelessness into nearby hotels, many of those left on the streets formed or joined existing encampments.  Because of the increased numbers in the unsheltered community, disproportionately representative of people of color or indigenous peoples, outreach workers were forced to secure food and water for this marginalized group rather than address long term housing or health issues. Sarah Jane has demonstrated emancipatory action through nursing practice and community engagement; while uplifting human dignity, she engages in communities to respond as a collective, outside of institutions or systems that have limited capacity to respond in the urgent manner required in this pandemic.1

 As the infection rates of the pandemic heightened, where black and indigenous populations are dying at alarming rates in comparison to their white counterparts, came the news of George Floyd’s murder by Minneapolis police officers when he was arrested for allegedly using a counterfeit 20 dollar bill at a local grocery store.3 Nurses in our state are coming to know all too well the appalling racial health inequities that exist due to systemic racism; systems of oppression including slavery, Jim Crow laws, redlining, and mass incarceration all tie directly to both wealth and health.While emancipatory knowing asks nurses to analyze root causes, such as inquiring why inequities of income related to race exist in the first place, it also requires us to take action in response to undoing these injustices. 

The unrest, riots, and violence in response to George Floyd’s death resulted in further displacement of those who were living on the streets of Minneapolis; homeless encampments were destroyed due to false accusations of riot participation, curfews were enforced, and members of the National Guard were deployed.  One nurse practitioner, Rosemary Fister, demonstrated disruption of racial policies in this moment when she fought for change in real-time.  As people living on the streets sought to find protection from the rubber bullets and tear gas released, she organized herself and others to respond to those left without protection due to structural inequities, or “a host of offenses against human dignity including…poverty, social inequalities….war, genocide, and terrorism.” 5(p8)  She was able to negotiate shelter at a local hotel for the unhoused to seek temporary protection. 

MOODI Outreach

As those who sought refuge in this space continued their stay past the days of the unrest, later named The Sanctuary Hotel, Rosemary envisioned a way to mobilize and change the policies and procedures relied upon in current systems.  She helped organize volunteers to operate the hotel in solidarity founded on the principles of mutual aid, where everyone had membership and human connections were made.  Knowing that the complexities of previous traumas and suffering wouldn’t simply end by having shelter, and as more barriers presented themselves, she knew the hotel stay for those unsheltered had to come to an end. 

However, this story has inspired a movement in Minneapolis to care for those displaced, to tackle issues of poverty through various means, to approach change using all forms of knowledge while forging a plan ahead with the very people experiencing the targeted oppression as means of disrupting structural inequities. Rosemary has engaged in social justice work in ways that will shape the discipline for the future to come.

These stories of nurses engaging in elements of emancipatory action while caring for marginalized communities in innovative ways during a pandemic and during social unrest, has shed light on what nursing practice can embody.  Many nurses fail to recognize, and most have yet to understand, the root source and impact of racial health disparities, which offers an opportunity to challenge our beliefs in what nursing practice should or shouldn’t entail as we are called to respond to unjust situations through collaborative action.1

Whether providing care in our acute care settings or shaping our communities, nurses can no longer ignore the words, “I can’t breathe” as we collectively gasp for air.

References

1Kagan PN, Smith MC, Chinn PL. Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis.  New York, NY: Routledge; 2014. 

2Chinn PL, Kramer MK. Integrated Theory and Knowledge Development in Nursing. 8th ed. St. Louis, MO: Mosby, Inc; 2011.

3Rosalsky G. National Public Radio. How The Crisis Is Making Racial Inequality Worse. May 26, 2020.

4Alexander,M. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: The New Press; 2010.

5Farmer, P. Pathologies of power: Human rights, and the new war on the poor. Berkeley, CA: University of California Press; 2004.

About Kathleen (Katie) Clark (pronouns she/her):

Katie is an Assistant Professor of Nursing at Augsburg University and is the Director of the Health Commons. She has taught at Augsburg University since 2009 where her primary responsibilities are in the graduate program in courses focused on transcultural nursing, social justice, and civic agency. She also practiced for over eight years in an in-patient hospital in both oncology-hematology and medical intensive care. She has a Masters of Arts in Nursing degree focused on transcultural care and a Doctor of Nursing Practice in transcultural leadership, both from Augsburg University.   Katie has been involved in the homeless community of Minneapolis for over 15 years and has traveled to over twenty countries.  She lives with her husband and three children in Stillwater, Minnesota.

About Kaija Freborg

Kaija Freborg is the Director of the BSN program at Augsburg University and has been teaching as an assistant professor in the undergraduate and the graduate nursing programs since 2011. Her focus in teaching includes transcultural nursing practice as well as addressing social and racial justice issues in healthcare. She obtained a Doctor of Nursing Practice degree in Transcultural Nursing Leadership in 2011 at Augsburg before teaching at her alma mater. Currently her scholarly interest in whiteness studies has her engaging in anti-racist activism work both in nursing education and locally; her aspirations include disrupting and dismantling white supremacy within white nursing education spaces. Previously Kaija had worked at Children’s Hospitals and Clinics in Minneapolis, in both pediatrics and neonatal care, for over 15 years

We ARE the theory-practice connection; COVID-19 tells us so!

Guest Contributors*:
Andra Opalinski and Patricia Liehr

We are responding to Dr. Foli’s request in her blog titled “Say It Ain’t So:  Graduate Students Shade Nursing Theory!” where she stated…What about you?  If you have suggestions for me on how to strengthen the theory-to-primary care advanced practice connection in a master’s level course, please forward them…”

WE BEGIN WITH DEFINITIONS

Throwing Shade: (verb) subtly disrespecting or ridiculing someone or something.

Shade: (noun) a comparative darkness caused by shelter from direct light.

We ARE the theory-practice connection.

As nurse educators who appreciate the theory-practice connection, we had been pondering Foli’s post and then Constantinide’s follow-up about graduate students throwing shade at nursing theory. Not knowing the meaning, we took the “throwing shade” descriptor quite literally and thought how we often prefer to find shade on sunny Florida days!!!  In the midst of our extended pondering and thoughtful conversations came COVID-19; and a virtual class that we co-hosted with NP students to discuss the use of Story theory in practice; and THEN, we serendipitously came across a 2020 calendar page with a haiku by Tomihiro Hoshino entitled “In the Shade.” This haiku accompanies his calendar painting of a redbud tree with hanging red pods amidst green foliage:

In the shade of leaves,
They shyly sway,
Pods like strips of paper
With girlish wishes
Written on them

Moving along to a class with NP students.  

In this class, we were talking about Story theory and the practicality of using it when working with patients. Story Path, a way to pursue story-sharing was the specific lesson (Liehr & Smith, 2020). Clare, an ER nurse, volunteered to share a recent practice story with the class.

“I was caring for an elderly patient in the Emergency Room who had just tested positive for COVID-19. However, this day, the provider I was working with was resistant to putting the patient on a ventilator.” As Clare reflected  on the situation she shared, “I remember asking myself, is the provider just being lazy because the patient is elderly with a poor prognosis? However, I also knew, this doctor reads a lot of research. I still couldn’t help but question the decision. The patient did in fact improve without ventilator assistance,” giving Clare pause….thinking about the juxtaposition of knowledge with practice. As Clare’s recounting of the story concluded, Clare was asked to consider how her COVID-19 experiences may influence the future. The rawness of her sharing was palpable as she elaborated on the pause noted in her story: “I never knew nursing would get to this point. I am becoming suspicious of everyone, even co-workers. I stand away from everyone and wear masks all the time. I am challenged with what feels like lacking compassion. I don’t spend time in the rooms like I always did before, or place a hand on an arm to show comfort because we are thinking, is this the next COVID patient. I do make sure there is a phone in every room and I call often to check on the patients. It just feels less personal. It feels unnatural.”

Hmmm…lacking compassion feels unnatural. There is a theory and/or a philosophical perspective in this sentiment. We could go with Meyeroff’s ideas (1971) about caring as a way of ordering one’s values so that one feels “in place” rather than “out of place” in the world. We could go with Watson’s Transpersonal Caring Moment (Watson, 2018) where people come together in a human-to-human, spirit-to-spirit connection that is meaningful, authentic and intentional. These are just two examples providing context that allows for locating self in the theory-practice connection; many others could be the philosophical/theoretical lens providing context.   

Then the class was asked, “What have you learned from Clare’s story that resonates with your own practice?” Anna was quick to answer, “Everything is fluid and flexible right now, we have protocols, but they change day by day, they are evolving and there is a lot of uncertainty. We have to be able to allow flexibility in new ways. I can’t get into my usual groove.” Then THE question was posed. “Is theory real for you in your everyday practice? If not, it’s ok to say so.” Perhaps the most insightful answer was Brad’s response. “We are taught many theories, but challenged to know how to apply them. I don’t have theory on my mind when I am in front of my patient. It may be subconscious, but I’m not thinking, I’m applying Leininger or Watson right at this moment.”

Brad is right…we don’t expect that nurses live real-time practice checking in with theoretical/philosophical perspectives. However…the perspectives are there and stepping back and reflecting on nursing circumstances may enable forward movement with theory-guided intention and with knowledge-building for the discipline.

Pondering We ARE the theory-practice connection

As the nurse theorist-practitioner team that we are, we have great appreciation for the comments of these practicing nurses who happen to be graduate students. We wondered …Could the shade granted by COVID-19 bring theory out of the shade for students when they don’t even know it? You see, we are educators in a setting where nursing theory is highly valued and caring theory is the organizing spine of our curriculum. Has caring theory become so naturally interwoven in their practice that these NP students know something is amiss but they have difficulty naming it beyond descriptors like “unnatural” or “I can’t get in my groove”? We can only hope….but we can also plan to honor the shade by:  

  • remembering that we are always working from a theoretical perspective – we have only to step back from any nursing situation and consider the principles/concepts that are guiding our actions;
  • creating opportunities to share our practice stories with the knowledge that the implicit theory woven into the practice threads can come alive through scholarly engagement that is open to authentic expression and that gently supports exploration and maturing of an individual nurse’s own thinking;
  • holding the theory-practice connection as a truth that just takes time and professional maturity for appreciation but it is a truth that can be readily described when nurses have a mentor who helps with connecting the practice-theory dots;
  • pairing theorists and nurse practitioners to forge opportunities for growing nursing knowledge grounded in our practice.

Though there is little positive to say about COVID-19 these days, it may be that the pandemic granted some shade for us to reflect on the theory-practice connection in a way that can guide  understanding. After all, We ARE the theory-practice connection. Let’s own it.

Now….what do you think – we would like to hear from you.  How do you see our plan to honor the shade as an integral dimension of developing practice-scholars AND growing the discipline of nursing?  

  1. Liehr, P. & Smith, M.J. (2020). Claiming the narrative wave with story theory. ANS, 43(1), 13-27.
  2. Meyeroff, M. (1971). On caring. Harper & Row: New York.
  3. Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. Louisville, CO: University Press of Colorado.

About the contributors

Andra S. Opalinski

Andra Opalinski, PhD, CPNP-PC, NC-BC is a pediatric nurse practitioner and an Associate Professor at the Christine E. Lynn College of Nursing, Florida Atlantic University. She is an advocate for child and adolescent mental health promotion. Her current areas of interest include community-based participatory research with elementary through high school students using mindfulness interventions for self-regulation and stress management skill building. She also uses visual anthropology through photographs to explore perspectives of health of vulnerable populations. Right now, you’ll find her working remotely, doing the best she can to keep her household of 5 under strict physical distancing, and using the visual anthropology approach to document her family’s physical distancing experiences.

Patricia Liehr

Patricia Liehr PhD RN is currently the Associate Dean for Nursing Research and Scholarship at the Christine E. Lynn College of Nursing, Florida Atlantic University (FAU). She is the co-author of story theory and the co-editor of Middle Range Theory for Nursing. Most of her scholarly work has focused on peace, from personal through mindfulness; to global through coming to know both sides (Pearl Harbor; Hiroshima) of surviving the bombings of WWII. Story-gathering has played a major role in her research endeavors and she highly values the place of nursing practice stories for disciplinary knowledge development. Right now, as she moves toward an August retirement from FAU, she is imagining all the things she will do with new-found time.

Nurse Trauma in the Face of COVID-19

Guest Contributor
Catherine Quay*

On a rainy night in October 2019, I watched and celebrated as nursing students walked across the stage to receive their hard earned nursing pins. Little did we know that they would be entering the nursing workforce just prior to a global pandemic unlike one that has been seen in over 100 years. Some of these students have reached out to me recently to express their frustration. Just four months into their careers and they are stressed, anxious, exhausted, and scared, and as their recent instructor and mentor I feel helpless. Understanding the mental health impact this pandemic and the shortage of resources is having on nurses is essential. We also must understand the impact on new graduate nurses so we can prevent them from joining the ranks of nurses who leave within their first year of practice.

Anyone with access to an electronic device has heard the stories of the shortage of supplies as the result of COVID-19. Not enough masks, gowns, gloves, and ventilators to care for the growing number of individuals infected with this virus. Nurses and healthcare providers are being required to act in ways that only weeks ago would have been unthinkable. They are being required to make decisions that are often in conflict with the nursing knowledge and values that we, as educators, worked so hard to develop and nurture within them. Such ethical dilemmas are creating psychological discord that over time will result in lasting harm (Foli and Thompson, 2019).
Foli and Thompson’s (2019) middle range theory, Nurses’ Psychological Trauma, addresses this situation. The authors identify insufficient resource trauma as a nurse-specific trauma that with repeated exposure, can result in diminished physical and mental health, unsafe patient care, and can potentially lead to the nurse abandoning the profession (Foli & Thompson, 2019).

The trauma of not being able to carry out one’s ethical, professional, and organizational obligations due to a shortage of resources is what practicing nurses and health care professionals are experiencing every day during the COVID-19 pandemic (Foli, 2019). As educators, have we prepared students for this current reality? Where does this fit in with the patterns of knowing? According to this theory, personal knowing addresses the self-awareness and resilience needed to overcome trauma as each individual’s perception of an event is influenced by multiple personal factors and experiences. However, this kind of self-awareness as a nurse takes time to develop. Where does this leave our new nurses in the face of this pandemic? Are they receiving the support they need from their organizations and experienced nurses to develop the resiliency and ability to grow in the face of trauma?

The search for an understanding of how to help my former students has left me with more questions than answers. If the nursing profession and the organizations that depend on them do not address these questions, we will potentially lose large numbers of nurses. The psychological traumas nurses face on a regular basis must be acknowledged. “If we don’t strategize to sustain and restore our psyches and souls, we are just as vulnerable as our patients”(Foli & Thompson, 2019, p.34). A multipronged approach is necessary to address the reality of nurse-specific trauma. The profession needs to openly discuss the mental health impact that practicing with insufficient resources has on a health care professional.

We are currently seeing this in the media as nurses across the country speak out against the conditions they are being subjected to. Nurses must bring their authentic voice to the current crisis. Additionally, from a nursing educator perspective, there needs to be a focus throughout curriculum on developing personal and ethical knowing. Through self-reflection activities that focus on personal, historical, and patient trauma, a nursing student can begin to develop self-awareness, resiliency, and coping skills (Foli & Thompson, 2019). Lastly, health care organizations need to take a vested interest in the psychological well-being of their health care professionals by providing the necessary physical and emotional support resources and by creating a culture that supports emotional and professional growth. The return on investment is worth it.

The current COVID-19 pandemic has brought the reality of practicing with insufficient resources in health care to the forefront of society. Nurses must take the opportunity to speak out about the conditions they are facing and the choices they are being forced to make. For the nurses who have recently entered the workforce, we know this is not what you imagined. Reach out for help if you need it. Experienced nurses, let them know that you are there for them. Provide them emotional support, be present, and actively listen to the trauma they are experiencing. Nurses will get through this but only if we support each other. Together we are resilient.

Sources

Foli, K. (2019, November 12). Nurse-specific trauma: Let’s give it a name. Nursology. https://nursology.net/2019/11/12/nurse-specific-trauma-lets-give-it-a-name/

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, Indiana: Sigma.

About Catherine Quay


Catherine Quay

I am a doctoral student at Teacher’s College, Columbia and am currently taking a course with Jane Dickinson. We have been spending time exploring this site as part our class. Thank you for your insight and for providing us with many discussion topics. I hope you and your family are staying safe.

Keeping the Spark: How to Maintain your Humanism During the COVID-19 Pandemic

Guest Contributor: Erin Dolen, MS, RN, CNE

The country, and the world, is at war. War against the virus SARS-CoV-2 that causes Coronavirus Disease 2019 or “COVID-19” (FDA, 2020). As nurses, we must be on the front lines. Our dedication to the community to provide high-quality care should not end despite the complications associated with this pandemic. But how? How can we stay dedicated, humanistic, and compassionate when we are stretched beyond the limits of what we can accomplish? Josephine Paterson and Loretta Zderad have the answer.

Josephine Paterson (left), Loretta Zderad (right)

Paterson and Zderad (2007) first published their Humanistic Nursing Theory in 1975. Their hope was to help nurses understand that nursing is “an experience lived between human beings” (p.14). Through this experience, nurses can bring meaning and understanding to each patient’s life, the patient’s family’s life, and their own life. Paterson and Zderad maintained that this experience is important and effects the existence of all human beings.

So, what would they think about this global pandemic we currently find ourselves in? What does their theory propose that can help us now? These theorists also maintained that through having this shared experience with patients, nurses may hopefully remember why they chose to answer the calling of the nursing profession and stay dedicated to nursing despite the challenges that most certainly lie ahead. They could not be more right. We need this dedication to our profession now more than ever. We need to all remember why we chose to become nurses. What life experiences led us to this profession? What patients have we had during our careers that only further solidified that meaning in our lives? We have all had them. That older gentleman who was living his last moments on earth and grabbed our hands, and simply said “thank you”. That teenager who made a choice and found themselves in a life-changing situation who actually listened to us. I mean, really listened. That mother who lost a child who found solace in our embrace during the most difficult time in her life.

We need to remember these experiences but we also need to make new ones. Remember that each patient is a human being with needs, fears, and desires. Live this experience with them, not around them. Help them see meaning and understanding in their current situation. Help them see that they are not alone, nurses are with them. When you feel the need to rush out of the room, take the extra moment to lay a therapeutic hand on the patient’s shoulder, and simply smile. The smile may be behind your mask, but let it light up your eyes. The humanistic approach to nursing isn’t just for verbal interactions, but non-verbal as well (McCamant, 2006). For the pediatric patient who needed to have an x-ray and was taken from their mother, hold them PPE and all.

The humanistic nursing theory also has a subset of five phenomenological phases of nursing: preparation for coming to know, intuitive knowledge of others, scientific knowledge of others, synthesis of current knowledge to supplement practice and the inner transition from “many to the paradoxical one” (Lelis, Pagliuca, & Cardoso, 2014, p. 1117). As structured as this sounds, when you think about it, all nurses need to prepare to accept new knowledge, utilize their own intuitive knowledge, recall and retain scientific knowledge, apply that knowledge to guide their practice, and become one with their patients and their profession. Regardless of whether they know it or not, every nurse has been practicing the humanistic nursing theory their entire careers. Keep going. Keep accepting new knowledge and new experiences. Keep trusting your intuition and your scientific knowledge. Keep guiding your actions with evidence-informed practice. Keep becoming one with your patients and their families.

During this pandemic, when nurses feel exhausted, powerless, and ill-prepared, these experiences will help get us through. They will bring meaning and understanding to our lives. This meaning and understanding will help us remember that spark that lights our way to humanism. Most importantly, this lived experience with our patients will help us stay dedicated to our vital profession during this pandemic, and during any challenging times that lie ahead, just as Paterson and Zderad had hoped.

References

Lelis, A.L.P.A., Pagliuca, L.M.F., & Cardoso, M.V.L.M.L. (2014). Phases of humanistic theory: Analysis of applicability in research. Text Context Nursing, Florianopolus, 23(4), 1113-1122. https://doi.org/10.1590/0104-07072014002140013

McCamant, K.L. (2006). Humanistic nursing, interpersonal relations theory, and the empathy-altruism hypothesis. Nursing Science Quarterly, 19(4), 334-338. doi: 10.1177/0894318406292823

Paterson, J.G. & Zderad, L.T. (2007). Humanistic nursing [ebook]. Wiley. (Original work published 1975).

U.S. Food and Drug Administration (FDA). (2020). Coronavirus disease 2019 (COVID-19). https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus- disease-2019-covid-19

About Guest Contributor Erin Dolen

E Dolen PictureErin is an Assistant Professor of Practice at Russell Sage College in Troy, NY. She is a doctoral student in the EdD Nursing Education Program at Teachers College, Columbia University. She has her MSN with a focus in Nursing Education from Excelsior College. Erin has her national certification as a Certified Nurse Educator. Her nursing background is in emergency medicine. She lives in Delmar, NY with her husband and two children.

 

Beyond the Boxes: Mandala Introduction and Nursing Organizational Application

Guest contributor: Ellen E. Swanson
This post introduces the new “Practice Exemplar”
describing the application of Mandalas in nursing

See related Education Exemplar

We have constructed so much of our society based on the traditional hierarchical or linear organizational model. This model has dominated and influenced our thinking and behaviors. The linear model has also affected how we organize various types of information in the educational, health care, social, religious, economic, and political arenas. This hierarchical organizational chart looks familiar to all of us.

The energy is linear and we are all in boxes. I want out, don’t you? So, let’s play with this. In place of the hierarchical chart, a new circular model in the form of a mandala template is now available for organizing information. One translation of a Sanskrit root word for mandala means “that which is the essence” (Huyser, 2002 p. 2). In the recent Nursology Education Exemplar highlighting a class at Metropolitan State University in St. Paul, MN, “Nursing Theory Mandala Based on Modeling and Role-Modeling Theory”, we showed the mandala template application to holistic nursing and also to the specific theory of Modeling and Role-Modeling.

© 2011 Ellen E. Swanson, all rights reserved

The template features four rings and a center. Each ring has a suggested definition for application.

  • Ring 1: Outer rainbow ring – seven resources or sources of energy for the chosen application topic.
  • Ring 2: Teaching and learning ring – what each resource or source teaches or contributes.
  • Ring 3: Inner resources ring – resources available from or applied to the body, mind, and spirit either literally or figuratively (ancient cultures included emotions in the mind arena).
  • Ring 4 and center: Manifestation ring — based on the Feng Shui Ba-Gua system and its life aspects.

Visuals are powerful, affecting us consciously and unconsciously. So how then might we use this template visual where energy is circular and therefore synergistically self-enhancing to show the essence of other topics? Let’s start with an organization and look at the application to the MN Holistic Nurses Association. The definitions of the four rings above apply. For an organization, in ring 3, the body segment could be values or purpose, the mind segment could be the mission statement, and the spirit segment could be the vision statement.

© 2011 Ellen E. Swanson, all rights reserved.
The Minnesota Holistic Nurses Association has included their mandala on their website at Minnesota Holistic Nurses Association. This mandala makes visible the holistic nursing theory concepts of trust and collaboration as experienced in the organization.

Download the PDF file of the MinnHNA Mandala here

This mandala makes visible the holistic nursing theory concepts of trust and collaboration as experienced in the organization.

Source:
Huyser, Anneke. (2002). Mandala Workbook for Inner Self-Discovery. Havelte/Holland: Binkey Kok Publications.

About the Author

Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired) had a 46 year career that included ortho-rehab, mental health, operating room, management, teaching, care managing, and consulting. For fifteen years she had a private practice in holistic nursing, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.

Visions for 2020 – the Year of the Nurse

To all Nursology.net visitors – welcome to the Year 2020!  As we enter this year, we members of the site management and blogging teams join in celebrating the “Year of the Nurse and Midwife” and offer our visions for the coming year and beyond!

The year 2020 was designated In January 2019 by the World Health Organization (WHO) as the “Year of the Nurse and Midwife”  in honor of the 200th birth anniversary of Florence Nightingale.  Far from being a mere sentimental expression recognizing the importance of nursing and midwifery worldwide, this designation is part of a worldwide effort to improve health globally by raising the status of nursing and midwifery.  Here is the statement issued in establishing this designation:

The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.

Nurses and midwives are essential to the achievement for universal heath coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals. (from https://www.who.int/hrh/news/2019/2020year-of-nurses/en/)

As members of the Nursology.net management team, we are welcoming the 2020 “Year of the Nurse and Midwife” with our visions for this coming year and beyond.  We hope our ideas will inspire you to join in making these values and visions a reality!

Maggie Dexheimer Pharris –

2020 vision. During an eye exam, there is a moment when just the right corrective lens falls into place and suddenly we appreciate 20/20 clarity of vision. Remarkable!  So too it is with theory. In this new decade may nurses around the world find just the right nursology theory to clearly see the path to creating a meaningful practice and equitable, accessible, and healing systems of care!

Karen Foli – 

Unity among nurses based on the care we offer and the universal experiences we share. kindness directed toward patients and fellow nurses, even when they may be unable to reciprocate in that moment. Wisdom to understand how nursing power can be harnessed to forward a sustainable, balanced work life and advocate for improvements in patient and family care. And for nurses’ truth to be spoken freely, a reality to be heard and honored.

Peggy Chinn – 

A renewal of deep respect and tireless dedication for the core values of our discipline – protection of the dignity of each individual, advocacy for the needs of those we serve, and belief in the healing potential of our caring relationships.

Marlaine Smith – 

An accelerating appreciation for the distinctive knowledge of the discipline and the unique contribution that this knowledge can make to the health, well-becoming and quality of life of those we serve. With this appreciation will come the growth of research that is focused on the theories of nursology and practice models that are theory-guided.  Our focus on human wholeness, health as well-being/becoming, the human-environment-health interrelationship and caring is what is missing and most needed in healthcare.

Jane K. Dickinson  –

My vision is that all nurses will know, value, and be guided by nursing knowledge and take caring to the next level in education, practice, and research.

Jessica Dillard-Wright – 

Because 2020 has been declared the Year of the Nurse by the World Health Organisation, my vision for the year is that nursing will embrace the emancipatory potential of our discipline, recognizing the interface between nursing knowledge, nursing praxis, and wellbeing on a global scale. In so doing, we can dismantle injustice and mobilize our profession to nurse the world.

Jacqueline Fawcett

 Now is the perfect time to accept NURSOLOGY as the proper name for our discipline and profession. Now is the perfect time to realize that all individuals licensed as Registered Nurses or equivalent designation worldwide are NURSOLOGISTS. Now is the perfect time for all nursologists to realize they are “knowledge workers” who engage in development, application, and dissemination of nursology discipline-specific knowledge so that we know and everyone else knows the what, why, how, where, and when of our work with those individuals and groups who  seek our services.

Chloe Littzen – 

My vision for nursing in 2020 is that we find unity among our diversity, despite settings, education levels, or beliefs, and work collaboratively to advance the discipline, enabling all nurses epistemic authority and well-being.

Rosemary Eustace – 

The year 2020 is a great reminder of the “200” unique contributions nurses and midwives make each day to improve health, health care, health policy and nursing across diverse settings.  As we celebrate this milestone, let us light our lamps in unity to advance nursing knowledge that is congruent with contemporary health care demands. Let us keep the Power of Nursology alive!

Marian Turkel – 

Vision for 2020: Nursing theory will guide nursing education, nursing practice and nursing research. RN-BSN, BSN and MSN programs will have at least one nursing theory course in the curriculum.  DNP and PhD curriculum will have 2 nursing theory courses.  Nursing faculty and Registered Nurses in the practice setting doing research will use a nursing theory to guide their practice and research.  The Nursology leaders will collaborate with the American Academy of Nursing to organize a conference similar to the Wingspread Conference. The American Nurses Credentialing Center will collaborate with the Magnet Recognition Program©® to require hospitals to have a nursing theory as the foundation for achieving Magnet©® Status Recognition.

 

Guest Post – The Big, Bad, Terrible Dissertation Defense

Guest Contributor: Ashley Rivera, PhD, RN
See “About the Author” below

“The best thesis defense is a good thesis defense.” Retrieved from https://xkcd.com/1403/.
Comic available under a Creative Commons Attribution-NonCommercial 2.5 License.

In my head, I built the entire day up to be a terror of being questioned for every decision I made throughout my study. All the prep-work from making draft revisions and polishing off the speech to accompany my slides did not prepare me for joy. My joy is not about the strength of my study or the loving support that my graduate school, Florida Atlantic University, bestowed upon me during my entire program. It’s about who showed up at my defense.

One of the first to arrive was an entry-level BSN student who had responded to the mass-dispersed open defense email sent out by the College of Nursing. When I was a student, I would probably have just dumped that email in the trash bin. The student who showed up truly felt that in nursing she could achieve anything, which was a refreshing sight to my battle-wounded soul from the years of micro-managing and counterintuitive policies that are experienced on the job. The memory of her being there is a reminder for me that there is a need to shine a light on the quiet strength that comes from being a nurse. This quiet strength is what guides nursing through the bad days, like when four call lights are going off and they all have to be answered in less than 3 minutes, or the code that just won’t end because nobody wants to tell mom her baby won’t be back. I didn’t see her leave, but I remember her clap and the light in her eyes at the end of the defense.

I didn’t think much of it when the crowd of fresh PhD students wandered in, after all, they were in school to do the very same thing. However, the feedback I received from them truly reinforced my passion for teaching. The best part was that the comments didn’t come from them directly, it came from the professor of Qualitative Research. As part of my defense, I explained my choice to use Charmaz’s constructive grounded theory by contrasting it with classic grounded theory and Straussian grounded theory. The professor was thrilled by the explanation I gave. She also stated that the PhD students indicated that my explanation was so clear that they now truly understood the differences between all three approaches to grounded theory. To me, that was the icing on the cake of such a momentous day. Their feedback is the start of my living my dream to inspire passion and clarity for research and theory in classes that so many students describe as the bane of their existence.

Defenses are an opportunity to inspire those who watch and fuel the passion of those who defend. This should be the goal at the end of a very long road in the PhD journey. I wouldn’t take a single step back, but the dissertation defense isn’t so big, bad, or terrible—in fact, it’s probably the most inspiring part of the whole PhD.

The newly minted,
Dr. Ashley Rivera

Left to right: Dr. Marlaine Smith, myself, Dr. Patricia Leihr, and Dr. Yash Bhagwanji

About Dr. Rivera

Ashley Rivera

Not known for being a wall-flower, I believe in the power of a positive attitude and a smile. I keep centered through my loving husband, my three rambunctious children and being outdoors in my organic garden. My practice experience includes Pediatric Hematology/Oncology, Liver Transplant, Medical Surgical, High Risk Pregnancy, Diabetic Education, Telemetry, and Epilepsy Monitoring. I started my health care journey as an EMT, but came to love nursing for the continuation of care aspects. I have worked in both inpatient and outpatient at different stages of my nursing journey. I also have experience as adjunct faculty and as a research assistant. I entered the PhD program at Florida Atlantic University in August of 2015 and received a Jonas Scholarship in 2016. In my immediate future, I plan to continue working on getting my dissertation, “The Social Process of Caregiving in Fathers” published, and growing the resulting mid-range theory, “Caregiving in Fathers”. I will be presenting my recruitment methodology at the upcoming K.I.N.G Collaborative Research Conference in D.C. and, eventually, I hope to teach  and accept a full-time position teaching.

Happy Anniversary/Happy Birthday to Nursology.net!

We invite all of our visitors to join with us in developing this important resource!  Contact us with your interest and ideas!
This site is developed and managed solely by nursologist volunteers so our costs are minimal, but we welcome contributions to help assure the site’s future!!

Jacqueline Fawcett:

Jacqueline Fawcett

This is a very special blog, as we are celebrating the first anniversary/first birthday of the launch of nursology.net on September 18th. From a chronological developmental perspective, the website is transitioning from infancy to early childhood. However, given the amount of content already posted on this website, the weekly blogs, and the number of nursologists from many, many countries who have accessed the website, I dare to declare that we never were infants and now are mature adults! I am especially grateful to Peggy Chinn, our outstandingly superb webmaster, for her fabulous and steadfast work to create the website, the forms for submission of content and other items, many of the weekly blogs, and everything else that is needed to maintain the vibrancy of nursology.net. I also am very grateful to all members of our management team, whose interest in and enthusiasm for preserving our discipline has fostered so much success in one short year. In addition, I am very grateful to all other nursologists who have contributed content to the website, to those who have written blogs, and to those who have added comments to the blogs. I continue to welcome all nursologists to nursology.net—to view what is on the website, to contribute content, to submit blogs, and otherwise share your thoughts about nursology and all the wonderful work you are doing. The remainder of this blog is contributions from some of the members of our management team; I thank them for sharing their thoughts on the occasion of nursology.net’s first anniversary/birthday.

Peggy Chinn

Peggy Chinn:

When we first conceived of the website that we decided to call “nursology.net,” I certainly never imagined that the site would grow and develop as it has in just the first year! First, even though I have been immersed during my entire career in scholarship around the development of nursing knowledge, I honestly had no idea of the vastness, diversity, and widespread commitment that nurse scholars have demonstrated over the 50=plus years of nursing knowledge development. Those of us who have contributed to the development of the website knew one another professionally, and we all had deep respect for the scholarship that each of us brought to the table. But once we put all of our insights and expertise together in the tangible reality of the website, lo and behold, what we had was much larger than any of us imagined! During the past several months, I have had the opportunity to provide live “deep dives” into the website to demonstrate what is actually here – and with each occasion, everyone who participates leaves amazed at the true vastness of information that is here! As we look forward to the coming year, we will continue to add to the information in each section of the website, but our main focus will be to develop more thoroughly the “Exemplar” sections. After all, each of us involved in the site are nurses first – so our primary concern is using the theoretical ideas, our scholarship, to inform, shape, and re-shape our practices! We believe that nursing perspectives are necessary and valuable – that we offer dimensions that are respected by other disciplines. However, if we do not bring our perspectives as a central concern to each of our practices, something that is extremely valuable will be missing. Nursing perspectives do make a difference in practice, research, education, policy, and quality improvement – and each of the exemplar sections will continue to grow to demonstrate more clearly what that difference is!

Marlaine Smith:

Cheers to nursology.net on its one year anniversary! In only one year, nurses throughout the world have accessed nursology.net, offering us a valuable resource for learning more about the knowledge within the discipline. It is amazing to explore and discover the rich contributions, detailing the development and application of nursing theories of all levels in practice, education, and policy. Thank you to Drs. Peggy Chinn and Jacqueline Fawcett for their leadership in launching and advancing this website and thanks to all the contributors. Here’s to many more productive years of growing nursology!

Danny Willis:

When I pause to celebrate the one year anniversary/birthday of nursology.net, what comes up for me is a sense of hope for the future! Nursology is the substantive perspective that makes the difference in human and environment wellbecomng and alleviation of human suffering. Nursology addresses What Matters Most!” The philosophical, conceptual, theoretical, and empirical contributions that have shaped the discipline and profession are reflected at nursology.net. For nursologists everywhere, nursology.net provides a venue to be engaged in the knowledge endeavor, discerning clear direction should we get distracted. nursology.net is a wonderful resource for the world right here and right now, at our fingertips !! I look forward to continuing to participate in the evolution.

Dorothy Jones:

Nursology.net has become a global phenomenon, offering nurses from around the world immediate access to nursing knowledge and historical developments in nursing theory, education, research, and practice. When I presented the site to doctoral students in Spain, one student noted, “Having access to this site (for free) not only exposes us to information we do not have in our libraries but helps to connect us to our science in a new way. Thank you”. The continued development of nursology, with attention to presentations [in] other languages, will continue to grow the site and expand nurses’ ability to access knowledge and increase disciplinary dialogue around the world.

Dr. Eustace

Rosemary Eustace:

As we celebrate the one year anniversary of nursology.net,, we acknowledge the contributions of many of our founders and nursing scholars to evidence-based nursing (EBN). We call upon our fellow nurses around the world to advocate for the future of nursing that advances nursing science by developing, utilizing, and evaluating EBN to create a culture of health, promote social and financial justice, and increase access and responsiveness to evidence-based health care services.

Margaret Dexheimer Pharris:

Nursology.net has gotten off to a running start! In the past year, nursology.net leaders helped shape and participated in the 50th anniversary nursing theory conference at Case Western Reserve University (see Peggy Chinn’s conference keynote); several nursing journal editors have written about nursology.net in their journals; the American Academy of Nursing’s (AAN) Nursing Theory-Guided Practice Expert Panel has grown to be one of AAN’s largest expert panels; and, there have been over a dozen major nursology related conferences throughout the world. This resurgence of commitment to nursology practice and research rooted in the knowledge of the discipline provides a springboard propelling nursologists to ensure that nursing theory is woven through national nursing education guidelines for all professional levels, that every nurse can clearly articulate the difference that nursology makes because of its theories and philosophical perspectives, and that in the U.S., the National Institute for Nursing Research (NINR) be directed by a nursologist who understands the importance of grounding all NINR funded research in nursing theories and philosophies. These and many other efforts in which nursologists are engaging serve to holistically and equitably enhance the human experience of health. The year 2020 holds great promise for nursology to reach new heights!

Deborah Lindell:

Happy first anniversary to Nursology.net! This site serves a valuable service to all nurses by raising awareness of the essential role nursing knowledge plays in the discipline of nursing. It provides in-depth, understandable information about nursing knowledge in a variety of formats. I especially like the Guardians of the Discipline and the blog which promotes dialogue about current topics in nursing knowledge. I’ve integrated Nursology.net as a required resource in my DNP and MSN theory courses.