Abstract Thoughts with Aphantasia: Learning Nursing Theory without the Ability to Imagine

Guest contributor: Elizabeth “Ellis” Meiser, MSN, RN-BC, CNE

            When I took a nursing theory course for the first time in my educational experience (at the doctorate level, mind you), I found myself grateful to finally be able to identify what may make learning theory difficult for me. A few years ago I was listening to a podcast in my car from the BBC. It began with a discussion on spatial navigation and transitioned into mental visualization. The topic was on how some people have a limited ability to imagine. The podcast asked listeners to close their eyes (I waited until I got to my destination to complete the exercise, don’t worry!) and picture a beach. Go ahead and do this if you can. Close your eyes and call to mind beautiful white sand, a palm tree, blue waves crashing under a clear blue sky. I settled into my seat and closed my eyes. But when I tried to see a beach, nothing happened. It was then I realized that I had a processing condition called aphantasia.

            Individuals with aphantasia have difficulty imagining visually. For me, it means when I close my eyes all that happens is I stop seeing. Most people are on a spectrum of capability when it comes to visualization. Some can recall only things they have seen before, for some it may appear like something from a cartoon, and for others it is as realistic as if it were before their eyes. Perhaps it seems shocking that I would not be aware of this until my mid-twenties, but how often does it come up in conversation? I suppose I always thought when someone said “mind’s eye” or that they could “picture it” these were expressions but that they couldn’t actually do it. Turns out, most people can actually picture things when my mind is woefully dark. With an impact on my ability to remember things, I just always assumed I had a poor memory.

My lifelong struggle with having to learn about and analyze abstract ideas suddenly made sense! The blog posts from Dr. Foli and Shannon Constantinides about the concerns with teaching theory in nursing education, along with the potential impact of generational differences, jumpstarted my questioning of my own journey through abstract learning. I cannot envision physical things, words, shapes, or even colors. Without those capabilities, I wonder: what could be the main factor impacting my ability to truly grasp abstract concepts? There could even be a combination of many contributing factors. Then I wondered, does it even matter? Why do I even need to understand theories?

As I mentioned, I’ve been through nearly ten years of formal education for nursing and cannot recall a course dedicated to nursing theory. I became faculty armed with a master’s in nursing leadership and management and a handful of education classes from my music education undergrad. I had been exposed to Piaget’s developmental theory and Maslow’s hierarchy of needs. I knew how to write objectives using Blooms, and in my master’s had been introduced to a variety of leadership theories. I had not, however, explored anything on Benner, Henderson, or even anything beyond the fact that Nightingale had something to do with a lamp. I didn’t even know nursing theories existed, and when presented with them in my doctorate program, I struggled understanding them and their purpose. However, in my practice of simulation, I have recognized the impact of Jefferies on how frameworks can guide development of scenarios. I have embraced Benner by recognizing how to consider the learners, where they are within the program, and within their own growth process. Much of this required me to evaluate how to learn abstract concepts.

Ultimately, a huge hurdle on abstract thought for me must involve aphantasia, which presents for me as the inability to daydream and the absence of visual recollection. It can be hard for me to remember what I’ve read or seen. As a learner, and now as a nursing educator, I feel as if it is taken for granted that all learners have the capacity to visualize mental images. Despite this having implications for learning, aphantasia is not currently considered a learning disability. Furthermore, there has been no progress on aiding those with aphantasia in developing the ability to produce mental imagery as it seems to be a neurological deficit. I am unsure of whether identifying students with aphantasia, or to what extent they are capable of visualizing, is important. Instead, what we need to do is create a holistic learning environment that is accessible to a variety of learners and learners need to be equipped with tools that suit their learning style. Using varied education techniques to address learning styles has long since been routine, but how often have we considered the student’s ability for mental imagery? How are we sharing abstract ideas? Is it in a tangible way? Do we encourage students to reflect on how they think, process, and picture things? Perhaps we need to consider adding this to the conversation to help students assess their learning needs before we begin introducing abstract concepts.

When it comes to theory, abstract instruction, or other types of instruction, I have found myself having to use a range of resources. For example, graphs, images, and diagrams may help explain concepts, but they are difficult to recall as I cannot recreate them in my mind. Instead, I found myself using a mixture of media, videos, and having to use my trusty gel pens and notebook paper. As it is in any pool of learners, these will have different effects for different learners but include:

  • Make personal or emotional links to content
    • I find relating theories to stories extremely helpful. This means grounding abstract ideas to something that I can relate to, or experience.
  • Listen to podcasts or a recording of a lecture
    • This may be difficult for some with aphantasia as there is no visual imagery to which to connect the audio.
  • Write notes and draw concept maps on paper to physically forge connections
    • An age-old recommendation that should never have been replaced by typing and is even more effective when summarizing in my own words.
  • Use Flash cards, mnemonics or other rote memory tasks
    • While I can’t bring these to mind at a later date, I can force memorize the basic concepts before scaffolding the more abstract ones.
  • Involve music or rhythm
    • Again, this is helpful for the more basic concepts. However, there has been some evidence of links between those with aphantasia also having difficulty remembering sounds, tones, or music so this is very dependent on ability.
  • Teaching others or simply reading notes out loud
    • Yet another traditional method of evaluating learning and using kinesthetics and physicality to the party. When I get lost in reading about theory, I find that reading it out loud helps me stay on track.

It is crucial to remember that while linking learning to visual memory reportedly leads to better academic outcomes, it does not equate to higher intelligence. It certainly has an impact, but it is not the only variable to consider. Reflecting on how important the mind’s eye is to learning leads me to wonder how different schooling would have been had I known about aphantasia. For myself, I can apply it to what remains of my terminal degree and my continued lifelong learning. For others, I can write about its impact and attempt to add to the discussion on what influences how, when, and to whom we teach nursing theory and knowledge. Ultimately, we need to work with all learners to be advocates for what they need to succeed regardless of the topic at hand.

About Elizabeth “Ellis” Meiser

Ellis is a Clinical Educator of Nursing at Longwood University in Farmville, VA. They have their MSN with a focus on leadership and management, is a Certified Nurse Educator, and is certified in medical-surgical nursing. They are in their first year as a doctoral student in the online EdD Nursing Education program at Teachers College, Columbia University.

Being True to Yourself: A Career as a Nurse Educator Guided by Critical Caring Pedagogy

Guest Contributor: Erin Dolen, MS, RN, CNE*

My career in nursing education has spanned the better part of a decade. For the majority of that time, I taught in an associate’s degree nursing program. At first, I was not sure if nursing education was for me. I was always a preceptor on the nursing units during my time in the hospitals, but that does not necessarily equate to being a good educator. After a semester, I was hooked. I found so much joy in showing my students not just how to do nursing, but how to be nurses. Forget “teaching to the test”! I would teach through experience, stories, relationships, respect, and caring.

Over the years, I thought I was developing into an expert nurse educator. I obtained my MSN, I passed my Certified Nurse Educator (CNE) exam, and I achieved quite a following among the student body. Until one day, it all changed. I was accused of being too personal, too attached to my stories and experiences, too outward in my sharing. I couldn’t understand why this faculty member was attacking me for being who I am, for valuing my relationship with my students, for giving them a part of me so they know I am human too. The lateral violence (let’s face it, that is what it was) became too much and I decided to move on to where I currently am, a baccalaureate nursing program.

My world has changed. I am now valued for giving my students everything that I have. For sharing not just my experiences but who I am as a person, a nurse, a mom, a friend. I care about them, and they know this. I want them to succeed beyond all ways they could imagine. I want them to learn from me; not just how to be a nurse but how to be someone who cares, who is empathetic, moral, ethical, a life-long learner, and is committed to the profession of nursing. Through my own education at Teacher’s College, Columbia University in the Online Nursing Education EdD program, now I know why. My whole nursing education career I have been guided by the Critical Caring Pedagogy (CCP).

CCP provides a framework for nursing education that, all at once, encompasses ontology, epistemology, ethics, and praxis (Chinn & Falk-Rafael, 2018). This framework consists of seven critical caring health-promoting processes: preparing oneself to be in relation, developing and maintaining trusting-helping relationships, using a systematic reflective approach to caring, transpersonal teaching-learning, creating and supporting sustainable environments, meeting needs and building capacity of students, and being open and attending to spiritual-mysterious and existential dimensions (Chinn & Falk-Rafael, 2018).

Isn’t this what I have been doing all along? All seven?! I have just come to the realization that my own practice as a nurse educator for the last decade has consisted of being in a caring and guiding relationship with my students, the foundation of CCP. I have been guided by a theory I had no formal knowledge of until now. And yet, I was faulted for it. Told I was giving too much of myself to my students. Told that I was to teach the material, not cultivate relationships. Told I made the two students out of HUNDREDS uncomfortable (yes, you guessed it, these students were academically unsuccessful and reaching for reasons for their appeal to be upheld). I almost gave up teaching. I knew I could not work in an environment that did not support my own values and approach to the teaching-learning relationship. Until I moved into my current position, where my foundation in CCP is respected, appreciated, and celebrated. To where my colleagues also practice with the guidance of CCP, whether they know it or not.

Now I can put into words what I have felt all along. Thank you, Peggy Chinn and Adeline Falk-Rafael, for providing the framework and empirics to support what I felt was the right way to teach deep down in my core. Critical Caring Pedagogy has given my teaching practice meaning and validity. I will carry this knowledge with me wherever I go, and I will never give up teaching.

Source

Chinn, P.L. & Falk-Rafael, A. (2018). Embracing the focus of the discipline of nursing: Critical caring pedagogy. Journal of Nursing Scholarship, 50(6), 687-694. Doi: 10.1111/jnu.12426

*About Guest Contributor Erin Dolen
E Dolen Picture

Erin 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.

Letter to the ANA

On September 26, 2020, the Nursology.net management team sent the following letter to the American Nursses Association, urging the organization to take a stand on the U.S. Presidential election candidates. We believe that given the dual pandemic of COVID-19 and racism, nursing’s strong voice of advocacy for the health of the nation must be heard. Here is the letter in its entirety:

September 26, 2020
Dr. Loressa Cole, ANA Enterprise CEO
Dr. Ernest J. Grant, President, ANA President
Dr. Debbie Hatmaker, Chief Nursing Officer, ANA Enterprise
American Nurses Association

Dear Drs. Cole, Grant and Hatmaker:


The Management Team of Nursology.net is writing to urge the American Nurses Association (ANA) to reverse its position against endorsing any candidate for President/Vice President in the 2020 election. We understand that the ANA reversed its previous policy to endorse presidential candidates based on the desire to “engage nurses in the voting process through providing accurate information and data and promoting nursing’s political advocacy role without alienating an entire contingency…acknowledging the reality of political polarization in this country” (ANA 2019 Membership Assembly Consideration of ANA’s Presidential Endorsement Process).

The recent draft of the document, Nursing’s Scope and Standards (2020), specifies nursing’s social contract with the public. The document includes nursing’s commitment to reject racism and promote equity and social justice for all. In addition, the document points to nursing’s accountability and responsibility to promote the health of all populations and to advocate for social and environmental justice, and access to high quality and equitable health care.

The proposed ANA Scope and Standards contradicts the ANA position against endorsing a presidential candidate if a particular candidate is a threat to equity, social justice, equitable healthcare and health for the population. While we respect that the Board made their decision thoughtfully, the current situation calls for a reconsideration based on the positions of the current administration that threaten public health. Scientific American, a journal who has never endorsed a candidate for president, has broken with their policy because of the dangerous anti-science views of the President

Today, the country needs to hear nursing’s voice related to this election from the ANA. We find ourselves in the midst of a perfect storm fueled by the mismanagement of a global pandemic, a health and environmental crisis from rampant fires, storms and floods attributed by scientists to climate change, and the public health crisis of systemic racism.

Many have referred to this election as the most consequential in recent history, certainly in our lifetimes. This is not the time for the nursing profession to sit out and fail to exercise our unified voice and moral authority. As the discipline focused on caring for the health and well-being of the people with an understanding of how the physical, social, political and economic environment influences health and well-being, and as the most trusted profession, the ANA must speak out against the policies of the current administration and endorse Joe Biden and Kamala Harris for President and Vice President. Please reconsider your position based on the actions taken by President Trump after your vote in 2019.

Here are a few reasons why we urge the ANA to reconsider and endorse the presidential ticket that is aligned with nursing values and actions and protects the public health:

  • The current administration’s lack of leadership to enact policies to stem the rising incidence of COVID-19 infections, including the President’s lack of providing timely information to the public that could have prevented thousands of infections and death
  • The current administration’s policies that have threatened accessibility to healthcare for millions of Americans by working to overturn the advances made through the ACA
  • The current administration’s position that denies human contributions to climate change and fails to support policies to abate its dangers.
  • The current administration’s lack of acknowledgement of the racial injustices experienced by people of color, especially Black people, at the hands of law enforcement.
  • The current administration’s policies of family separation at the border resulting in hundreds of children being placed in inhumane and dangerous conditions to their health and well-being.
  • The current administration’s lack of meaningful responsiveness to address the public health crisis of gun violence.

While the recommendations of the ANA’s Presidential Endorsement Process (2019) advocate for individual nurses to participate in election activities at the local, state and national levels and take advantage of educational opportunities to learn about the candidates that will inform their voting, nurses will look to the ANA for leadership, especially now. The ANA is the voice of the profession, and this is not the time for that voice to be silent. Without a unified position, the nursing profession is invisible, and the public trust in nursing’s commitment to protecting public health is compromised. Individual nurses can always vote their choice, but the unified voice of our profession is critical at this time in our history.

Please reverse your position and endorse the candidates that will advance policies that protect the health of the public. We cannot be silent. To be silent is to be complicit.

Thank you for your serious consideration of this request.

Respectfully,

Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN peggychinn@gmail.com

Jessica Dillard-Wright, MA, MSN, CNM, RN jdillardwright@gmail.com

Rosemary William Eustace, PhD, RN, PHNA-BC

Jacqueline Fawcett, RN, PhD, ScD(hon), FAAN, ANEF

Jane Flanagan, PhD, RN, ANP-BC, AHN-BC, FNAP, FNI, FAAN

Dorothy Jones, RN, PhD, FAAN

Deborah Lindell, DNP, MSN, RN, CNE, ANEF, FAAN, Deborah.Lindell@gmail.com

Chloe Olivia Rose Littzen, MSN, RN, AE-C

Leslie H. Nicoll, PhD, RN, FAAN leslie@medesk.com

Adeline Falk-Rafael, PhD, RN, FAAN afalk-rafael@rogers.com

Marlaine C. Smith, RN, PhD, AHN-BC, HWNC-BC, FAAN

Marian Turkel, RN, PhD, NEA-BC, FAAN

Danny Willis, DNS, RN, PMHCNS-BC, FAAN

A Nurse Practitioner’s Perspectives on Theory in Practice

Guest Post
Welcome  to Guest Contributor Christine Platt, NP-C*,

PhD Student at the University of Arizona College of Nursing

This week I asked, why does nursing theory matter to me? Can I see it directly affect my practice? As a nurse practitioner I see, on average, 26 patients each clinic day. Nursing theory helps define who I am as a nurse and what my goals are as a professional. It also can be evident in the way I give care at the bedside or even the way I influence health policies and practices of my community.

To begin, let’s look at what nursing is not. When discussing primary care, it is easy to think about making a diagnosis and then prescribing medication or a procedure to fix the disease. While these aspects may play a role in nurse practitioner practice, they don’t encompass the professional advanced practice of nursing. Without theory, the focus of our practice could easily become too narrow or lack the direction to influence and promote well-being. For example, let’s take the act of treating acne in a clinic. Without a disciplinary perspective, a nurse practitioner (NP) could easily look at the papules and pustules and determine an antibiotic, retinoid, hormonal control (such as spironolactone or oral birth control) will decrease the papules. If the acne is recalcitrant or scarring, the NP may decide isotretinoin is the best course of action. Without theory, we treat diseases instead of the patient and our communities.

Now, let’s contrast the same situation using our unique disciplinary perspective in our practice. Looking holistically, the NP notes that the patient won’t look them in the eyes very often, they seem withdrawn, which could be due to the embarrassment that the acne is causing. As the NP listens and learns more about the patient, they realize that the patient is depressed, has recently had suicidal ideation, and the patient’s current living conditions are stressful with a poor diet. Moreover, the acne flares significantly during weather inversions that increase pollution and aggregate the patient’s asthma. Nursing is not simply writing a prescription for isotretinoin.

Nursing has helped define our profession as a wholistic one that considers the person, environment, and nursing care to improve health (Fawcett, 1984). Nursing is further assessing the patient’s safety, linking them to the right mental health provider, improving diet, while simultaneously developing a relationship of trust. It does involve treating the acne, but it is so much more than the ability to write a prescription or plan of care. It involves understanding the patient’s culture, their beliefs, and the barriers to improved care. As more and more nurses are prepared at the PhD and DNP levels, they have a great opportunity to conduct research and implement change in practice. They continue to evolve the discipline from the original metaparadigm concepts toward the development and use of middle range theories, which are more specific to the problems they are investigating to guide their work. With their specialized knowledge, they influence change at community, state, national, and even global levels. The broad influence of theory translating into practice is evident when browsing over any national nursing conference program. With the case of the acne patient, NPs may take their experiences and develop studies with PhD and DNP nurses who focus on research and quality improvement projects. They can present their findings to legislators on asthma, acne, pollution, and poor nutrition, as a means of decreasing all of these in the community. They develop algorithms for treating acne combined with depression or other diseases.

Next time you come into contact with a patient, reflect on your nursing perspective in addition to all the specialized knowledge you have. Then think about how more specific theories could facilitate your practice, or maybe they are already embedded in your practice, ready to be articulated more explicitly, tested, and further refined. One of my favorite nursing theorist noted, “Nursing is not only a professional practice, it is a scientific practice as well (Reed, 2019).” Theory-based practice is essential and should be included in how we provide and deliver care on a daily basis. However, it is also time to consider how our professional practice can influence and improve our theories. If you have had an experience similar to mine, please share in the comments. I am excited to take part in this process and look forward to hearing how other nurse practitioners translate theory into practice and their practice into theory.

References

Fawcett, J. (1984). The Metaparadigm of Nursing: Present Status and Future Refinements. Image: the Journal of Nursing Scholarship, 16(3), 84-87. https://doi.org/10.1111/j.1547-5069.1984.tb01393.x

Reed, G. P. (2019). Intermodernism: A Philosophical Perspective for Development of Scientific Nursing Theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ANS.0000000000000249

About Christine Platt

Christine Platt, MSN, PHN, FNP-C began her career in nursing as a registered public health nurse and hospital staff nurse in St. Paul, MN. She became a critical care RN working in both cardiac and neuro intensive care units and received her CCRN certification after moving to Utah in 2006. She took on the role of house supervisor before returning to graduate school at Brigham Young University, where she received her MSN degree to become a family nurse practitioner. Currently, she sees patients in dermatology and also volunteers in the evenings to serve the community’s under- or un-insured population. Her family is a licensed foster family, caring for medically fragile children over the last decade. As a second-year PhD student at the University of Arizona, she has two areas of research, which span her clinical practice of dermatology and her passion for helping children with disabilities in the U.S. foster care system.

Beyond the Boxes: Connecting Theory and Practice in a Pandemic

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

See also related Education Exemplar

In the process of writing the “Using Mandalas – An Holistic Approach to Practice” exemplars, Peggy Chinn shared with me that we need to “work toward a more complete and robust connection between theory and practice! The important thing for www.nursology.net is to give our viewers theory sources so that we can all deepen our appreciation of how important the theories of our discipline are!” Accordingly, I began to think about how the exemplars about mandalas reflect my theoretical thinking and how these exemplars can help all of us form a more complete and robust connection between nursing theory and practice, as well as deepen our appreciation for nursing theories.

The current COVID-19 pandemic is a very significant time to recognize the importance of connecting theory/science and practice.  As a nurse on the board of the 63 unit condo building in which I live, I have the opportunity to experience the value of connecting theory/science and practice during this pandemic.

I saw the immediate need for scientific education of the unit owners and proceeded to provide this with written information.  I then organized sanitizing teams with team leaders, by floors, with the focus on common areas where surfaces touched by all (i.e., laundry rooms, trash chute rooms) could be a source of spreading pathogens.  I practice by also being one of the team members. (During my career I always felt I could supervise better if I knew from experience what those I supervised were to be doing.)  I check two websites daily, looking for trends in the world and the nation, and use this and the information from CDC,  AHNA weekly updates, and HOA (Home Owners Association) legal requirements to keep owners informed and help make decisions about what is best for our vertical village.

The response has been very rewarding as everyone pulls together and the majority are gratefully caring about and serving one another.  In these times of national divisiveness, this is a gift.

A Healthier Linear Template

I ask that as you read the mandala exemplars, you become aware of your felt sense of the images in the exemplars. Look at the arched linear organizational chart model that lays the foundation for a more complete connection between theory and practice.

We can begin to understand the robust connection between nursing theory and practice by thinking creatively about the satellite and the mandala.

Merging two paradigms, Step one

The mandala is the sending and receiving dish of the satellite, representing nursing practice as we send and receive with patients/clients. The arched linear organizational chart model depicts the energy panels of the satellite and represents nursing theory, supporting and, therefore, energizing practice. Working together, we can successfully stay in orbit.

Satellites also have a few jets at the rear of the energy panels that keep them on course, making small directional corrections when needed. Much like a satellite’s course-correcting engines, theory can provide direction for needed changes that arise as our discipline adjusts to societal and informational shifts that come with human development over time. But theory does more than that. Theorists have committed years to conducting research about what practices work and why they work. The research yields a deep, rigorous science that informs the why, how, where, and when of what we do in practice. Furthermore, what occurs in practice provides the small and not so small directional corrections to the theory.

Just as all flowers are not the same color, all of us may resonate with a different theory to guide our practice. When we become aware of the various ways in which various theories can guide practice, we may select the theory or theories that best fit our own unique way of thinking and skill set. I came to this perspective toward the end of my career. I had always endeavored to hide how I practiced while maintaining all the requirements for licensure as a registered nurse. We hide when we feel fear. I also felt alone. About two years before I retired and after the first mandala application was made, I was sharing a few client stories with some colleagues, one of whom was Ellen Schultz  (See Education Exemplar)

Ellen quietly noted, “I think you might resonate with Modeling and Role-Modeling Theory.” I reviewed the theory and realized that she was absolutely right. I breathed a sigh of relief as I realized that a nursing theory actually had been my practice guide for all those years. I realized that I could have had a much less fearful and lonely career.

Then I started thinking deeply about how I might have learned to use Modeling and Role Modeling Theory without having known about it. Recall of an event in my life helped me understand this. The event involved a visit with my mother at the time of her 98th birthday; I journeyed 600 miles to be with her and to share with her some of my heart-centered stories from the 46 year nursing career from which I was retiring. I read some stories to her, and she was deeply touched, wondering how I learned to intervene with my clients in such a way. I told her that although she had taught me, I didn’t think she was aware of what she had given me. Indeed, she was surprised and wondered how she had taught me. I reminded my mother of the example of her friend Edith’s final months; Edith had died of brain cancer 35 years before. My mother had told me that she had spent time reading to Edith when Edith could no longer read. During one time of reading, Edith suddenly sat up in bed and anxiously interrupted my mother, saying, “Liz! There are worms crawling out of that book!” My mother replied, “Where?” Edith pointed, “Across the top!” My mother scooped her hand across the top of the book and asked,  “Did I get them all?” Edith visibly relaxed back into her pillow and told my mother that she had indeed gotten them all. My mother then continued reading to Edith. I explained to my mother that what she had role modeled with that example was how to step into another person’s reality and participate where that person is. She nodded slowly, saying it was just something she did intuitively without being aware of it. I then related this to how I had done that in the career stories I had read to her. I thanked her for that gift, letting her know I had only become aware of her gift because I had been asked by a few of my colleagues to write some of my orally shared stories.

This was a gift exchange. The first gift was given without explicit awareness. The return gift was to bring explicit awareness, express gratitude for the role modeling, and acknowledge the positive effect on those who benefitted from the teaching. The greatest gift was a strengthened, heartfelt relationship between mother and daughter.

I ask now, has there been a time when something implicitly led you, and then you became aware of it later? Did that change your perspective in any way? Was there a gift you received that you hadn’t been aware of before?

Nursing theories can help us become aware of who we are and what we have to offer. There is a history of practicing nurses feeling inferior or disinterested in theory, and

Merging two paradigms Step 2

theory nurses feeling dismissed by practicing nurses. Both need time to heal. Healing is a sacred process, and when deep healing occurs, it includes vulnerability and compassion. Perhaps this next image will help us heal by showing how much we need each other.

Here the arched linear organizational chart model, representing theory, has become a container. A container with no contents is empty. The mandala, the contents, represents practice. With no container the contents float away and disappear. Together we form a Holy Grail of practical, professional, and knowledgeable service to humankind. We simultaneously blossom and grow our profession.

Merging two paradigms Step 3

The next image represents this flowering.  There can be a sacred union within each of us and between theory and practice. Let us grow that union by nurturing and nourishing each other’s gifts. Holistic nursing theory concepts of expanded consciousness, oneness, transpersonal connections, healing, being, and process of becoming are illustrated throughout the mandala exemplars.

 

Ellen Swanson

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.

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.