It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

At the time of the 2021 Virtual Nursing Theory Week, Christina Nyirati and Sharon Stour-Shaffer presented the baccalaureate curriculum they designed and now implement at Heritage University located on the Yakama Reservation in Washington State. This is the only session that was recorded during the conference; it represents the value of nursing knowledge in shaping the present and future of nursing as a discipline. The following is a brief description and a video of their presentation.

The first Heritage University BSN Program Outcome reads “The Graduate of the Heritage University BSN Program explains how nursing’s fundamental patterns of knowing –personal, aesthetic, ethical, empirical and emancipatory –contribute to understanding the complexity of nursing care in the treatment of human response”.

Carper’s (1978) Fundamental Patterns of Knowing in Nursing is the foundation of the BSN Program. Freshmen study discrete courses in each of Carper’s fundamental patterns: personal, aesthetic, ethical, and empirical knowing. The Personal Knowing course is founded on personal knowing as a precondition for nursing care. Students practice various methods of reflection to develop personal knowing in every moment of nursing care. The Aesthetics of Nursing course is grounded in assumptions from Nightingale’s theory of nursing arts and aesthetics as a fundamental pattern of knowing in nursing. An experiential course, based in the principles of performing arts, the focus is on the act of care; Students explore and apply dramatic arts foundational to holistic nursing care competencies. The Ethical Knowing course emphasizes the practice of ethical comportment in nursing care. The Empirical Knowing course students introduces students to fundamental theories, concepts, evidence, and competencies pertaining to generation of nursing knowledge.

Senior year features the community as the unit of nursing care, and is founded on Chinn and Kramer’s (2019) emancipatory knowing in nursing. The Policy, Power & Politics of Nursing course focuses on the professional nurse role in taking responsibility for shaping social policy. The two Community Oriented Nursing Inquiry and Practice and the Community Based Participatory Research courses center on principles of socially just reflective action to overcome health inequities.

Faculty developed rubrics to evaluate how students integrate the fundamental patterns of knowing nursing into clinical practice. Students complete reflective writing assignments during clinical practice each semester from sophomore through senior year.

About the contributors:

Christina Nyirati, RN, PhD

Christina Nyirati is Professor of Nursing at Heritage University on the Yakama Nation Reservation in Washington, where she serves as the founding Director of the BSN Program. Dr. Nyirati came to Heritage from Ohio University and The Ohio State University, where she directed the Family Nurse Practitioner (FNP) Programs. She practiced more than 30 years as an FNP in primary care of vulnerable young families in Appalachian Ohio, and worked to reduce dire neonatal and maternal outcomes. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice. Now at Heritage Dr. Nyirati prepares nurses in an innovative undergraduate curriculum faithful to the epistemic foundations of nursing. Two cohorts have graduated from the Heritage BSN Program. They openly proclaim and use their powerful nursing knowledge to correct inequities in their communities.

Sharon Stout-Shaffer, PhD, RN

Sharon Stout-Shaffer, PhD, RN, Professor Emerita, Capital University, Columbus, Ohio; Adjunct Faculty, Heritage University, Toppenish, Washington; Nursing Education Specialist, S4Netquest, Columbus, Ohio. Sharon has over 30 years of experience in educational administration and teaching in both hospital and academic settings. Her career has focused on developing education based on a nursing model that includes concepts of holism and healing.

Her Ph.D. in Nursing from The Ohio State University focused on the psychophysiology of stress and relaxation-based interventions to promote autonomic self-regulation and immune function in people living with HIV. She has attained certification in Psychosynthesis, Guided Imagery, and more recently, the Social Resilience Model; she has presented numerous papers on integrating holism into curricula as well as caregiver wellbeing and resilience including Adelaide, Australia, 2011; Reykjavik, Iceland, 2015; American Holistic Nurses Association Phoenix, 2016 & Niagara Falls, 2018.

During her tenure as Director, Post-Graduate Programs at Capital University, Sharon taught the graduate theory course and co-developed a theoretically grounded holistic healing course as the foundation for graduate study; the graduate program has been endorsed by the American Holistic Nurses Credentialing Center. Since her retirement, she has co-developed and implemented numerous educational interventions designed to develop the Therapeutic Capacity of working nurses and nursing students. This work includes concepts of centering, compassion, managing suffering, the psychophysiology of resilience and essential contemplative practices to develop stress resilience, deal with moral distress and promote long-term wellness. She is currently teaching courses in Personal Knowing and Nursing Ethics for undergraduate nursing students at Heritage University. Her most recent publication is dedicated to holistic self-care and self-development. (Shields, D. & Stout-Shaffer, S. 2020). Self-Development: The foundation of holistic self-care. In Helming, M., Shields, D., Avino, K., & Rosa, W. Holistic nursing: A handbook for Practice (8th). Jones and Bartlett Learning, Burlington MA.)

Guest Post: Decolonizing the Language of Nursology

Contributor: Daniel Suárez-Baquero
Scroll down for Spanish language version of this post

ENGLISH

Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.

The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.

It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).

I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.

I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.

Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science

SPANISH

La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.

Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.

Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).

Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.

Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.

REFERENCES/REFERENCIAS

References

Ayala, R. A. (2020). Towards a Sociology of Nursing. In Towards a Sociology of Nursing. Springer Singapore. https://doi.org/10.1007/978-981-13-8887-3

Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2).
Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175

Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903

About Daniel Suárez-Baquero

Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.

Guest Post: Restriction of Visits to Hospitalized Child? An Emerging Need for Theory-Informed Nursing Intervention during Pandemic

Contributor: Ana Filipa Paramos

In Portugal during the pandemic crisis, we have made it impossible for the family to be present during the child’s hospitalization, resulting in increased levels of separation anxiety and stress, with potential negative consequences for the child’s recovery process. Let’s talk about a specific case of a child with a prolonged hospital stay in the middle of a pandemic and unable to have his father visit during the hospitalization. The little boy was accompanied by his mother, but the family nucleus of this child includes his mother and father. Did they speak by cell phone? Yes, they did, but the physical presence and eye contact are not replaceable by a phone call. One afternoon of that long hospitalization, I found the child angry, crying and looking away from our approach, as if he almost blames us for the impossibility of the father being present during the hospitalization. I wondered how we could make this situation less stressful and anxious for the child.

The adoption of a humanistic approach through the use of the Humanistic Theory of Nursing proposed by Josephine Paterson and Loretta Zderad was needed. According to Paterson and Zderad (2007), nursing is seen as an experience lived among human beings that responds to a human need. This theory requires the recognition of the human being as a unique being, endowed with his singularity and, simultaneously, that there is an understanding of the individual characteristics, experiences and needs of each patient (Paterson & Zderad, 2007). Through the dialogue established between me and the child, I understood that his father’s visit was extremely important for the child, since he had a very strong connection with the father.

During our dialogue, there were tears, uncontrollable tears in the child’s eyes. Unable to allow the father’s entry, I asked myself, “How will I be able to respond to this child’s needs?” It was at that precise moment that we decided to place the child’s bed next to the window, allowing the child to establish eye contact with his father, that long awaited and desired eye contact. Immediately after the father’s visualization, a smile and happiness emerged in the child. This contact allowed the immediate decrease in the levels of separation anxiety experienced by the child.

© 2021 Ana Filipa Paramos
Child’s bed next to the window, allowing the child to establish eye contact with his father

in Humanistic Nursing Theory, the concept of nursing does not only address patients’ wellbeing but also patients’ better being, helping them to make the health/disease situation experience as human as possible (Paterson & Zderad, 2007). We must remember that each patient is a person with needs, anxieties, fears and desires that have to be met, regardless of whether we are in the middle of a pandemic or not. We have to try to make the hospitalization experience as less stressful and as comfortable as possible for the patient and, in this case, the father’s visit was an emerging need of this child. Not being a normal visit, the establishment of eye contact through the window was the closest it could be, and it brought immediate happiness to the child. I heard the word “thank you” associated with a look of tenderness and tranquility. Unable to show my smile behind the mask, my eyes shone, and a tear appeared in the corner of my eye, such was the happiness I also experienced at the moment. My experience with the child was an enriching moment for both of us and allowed us both to develop, becoming more and better, of that I have no doubt. We cannot forget that times are difficult and challenging for everyone, but the experiences lived with the patients cannot be put aside in our daily nursing practice.

References

Kleiman, S. (2010). Josephine Paterson and Loretta Zderad’s Humanistic Nursing Theory. In M.E. Parker & M. C. Smith (Eds.), Nursing Theories and Nursing Practice (3rd ed, pp. 337–350). Philadelphia: F.A. Davis Company.

Paterson, J., & Zderad, L. (2007). Humanistic Nursing. http://www.gutenberg.org/ebooks/25020

Wolf, Z. R., & Bailey, D. N. (2013). Paterson and Zderad’s Humanistic Nursing Theory: Concepts and Applications. International Journal of Human Caring, 17(4), 60–73. https://doi.org/10.20467/1091-5710.17.4.60

About Ana Filipa Paramos

I have finished my Nursing Degree in 2016, at Escola Superior de Enfermagem de Lisboa (ESEL). In 2016, I started working as a general nurse at Centro Hospitalar Lisboa Central, more specifically at Hospital Dona Estefânia. From 2016 to 2019 I worked at the pediatric surgery/ pediatric burn unit and in the beginning of the pandemic, I have integrated the pediatric respiratory unit/ COVID, where I currently am.

In 2020 I entered the Master Nursing Course of the Health Sciences Institute of Universidade Católica Portuguesa (Lisbon). This post was made in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).

Guest post: The privilege of agency: The political shortcomings of nursing theory

Contributor: Mike Taylor

The four metaparadigm concepts of nursing knowledge have been human beings, environment, health and nursing process; with the state of the person at the center of the definition and achievement of health goals. The idea that an individual has the wherewithal, not only in name but also but also in action, to determine what health means for them as an individual and is able to work to accomplish those same goals is the concept of agency. Among nursing’s most referenced conceptual models and theories — Orem, Parse, Newman and Roy — keep the focus of nursing’s work on the individual before us, and much less of a consideration is on the environment the person inhabits. Newman (1979) for example states that the goal of nursing “is to assist people to utilize the power that is within them as they evolve toward higher levels of consciousness” (p. 67)  The concept of individual agency is central even in theories about the praxis of nursing such as Watson’s theory of human caring where the nurse/patient dyad “is influenced by the caring consciousness and intentionality of the nurse as she or he enters into the life space … of another person. It implies a focus on the uniqueness of self and other…” (https://www.watsoncaringscience.org/jean-bio/caring-science-theory/)

Sourcehttps://www.coe.int/en/web/interculturalcities/systemic-discrimination

Agency is not something that is naturally given to a person but emerges from the process of human development. That process is frequently affected  by poor schools, environmental pollution, and the other mediators of institutional racism and poverty. The chances of an individual reaching full agency, meaning the ability to identify and actualize individual health goals,  in adulthood are much more likely when those limiting factors are not present due to privilege. Even when an individual is able to overcome early life challenges, the social environment where agency can be exercised, there are limits on who can participate based on class, race, and gender. These limitations on the exercise of agency extend to persons who either want to or are actively practicing the profession of nursing. Even when a person can overcome the intersecting influence of race, poverty and gender to become a nurse; the same barriers remain in the practice environment often limiting choice of practice arena and opportunities for advancement to leadership roles.

Nursing theory is right to place individual agency at the center of the health improvement process, but it does not address the uneven distribution of that agency and the effect that has on health. Agency is only possible where it is allowed and when individuals in disadvantaged communities  do not have the inability to develop or exercise agency, the disparities in health outcomes we see today are the result. For nursing theory to meet these health challenges it must develop beyond a focus on individual agency to an emphasis on the social and environmental conditions that limit health improvement which means challenging institutional racism and poverty among others.

To develop the concept of agency in nursing and challenge existing social barriers, I believe that it would be instructive to align the development and exercise of agency with concepts of intersectionality. An important question might be can any correlation be found between the intersectionality and the degree of effective agency as reflected in an individual’s agency and the available social environments where that agency can be exercised. My anticipation is that it would be an inverse correlation with effective agency decreasing as the number of overlapping disadvantages increase. 

Sources

Newman, M., (1979). Theory development in nursing. F.A. Davis. https://openlibrary.org/books/OL4409082M/Theory_development_in_nursing 

Caring Science & Human Caring Theory, Transpersonal Caring and the Caring Moment Defined https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

About William (Mike) Taylor

Mike Taylor is an independent nursing theorist specializing in the application of complexity science to health and compassion. His Unified Theory of Meaning Emergence takes a major stride in connecting the mathematics of complexity with self-transcendence and compassion. He has spoken at international, national and regional conferences on complexity in nursing, health, and business. He is a member of the board of the Plexus Institute where he is the lead designer of the Commons Project, a web based platform for rapid social evolution in climate change.

Launch of BILNOC Leaders Database

We are delighted to launch a database that provides information about Black, Indigenous, Latina/x and other Nurses of Color (BILNOCs) who are (or have been) leaders and scholars who have contributed to the development of the discipline. This will be a significant resource for scholars and students who seek to recognize and honor BILNOC leaders. This database will fill a huge gap that contributes to the underrecognition of the contributions of nurses of color to the discipline.

View the BILNOC Submission Form to review the information we are seeking. You can find a link to the this form from the website “Resources” menu anytime later.

Guest Post: Mid-Range Theory: In the Gap or In The Dark?

Contributor:
Teresa Tarnowski Goodell, PhD,RN,TCRN,CWCN

A recent post by Karen Foli presents a perennial nurse educators’ problem: students finding nursing theory irrelevant in practice. A commenter wrote, “If I have a patient crashing, I’m not going to stand there and theorize about how to treat the patient!.” The remark illustrates the theory-practice gap perfectly; the notion that there is little practical utility in nursing theory “at the bedside.”

Nursing theory describes and differentiates us from other professional disciplines, yet many practicing nurses struggle to integrate theory into their practice, perhaps because nursing theory is not recognized by most practice settings. (I certainly didn’t see much of it in my 30 years in intensive care.)

“the strange fish in water…” by Biscarotte is licensed with CC BY-SA 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-sa/2.0/

Practicing nurses swim in the water of the medical model. Just as the fish says, “Water? What water?” when asked “How’s the water?,” nurses don’t always realize that they are swimming in the water of the medical model in their practice setting. Nurses implement both nursing and medical models, yet only the latter holds sway in many practice settings.

The electronic health record serves as an indicator of the widening theory-practice gap. Filled with checkboxes for medications, procedures, and physical exams, the EHR leaves little room for documenting nursing theory-guided practice. Built on the medical model and optimized for billing and regulatory purposes, the EHR cannot capture self-efficacy, unmet needs, living with unpleasant symptoms or helping, all concepts informed by nursing mid-range theories.

The EHR is also poor at capturing individual characteristics, such as whether someone is a night shift worker who sleeps during the day. Even when mid-range theories are in the back of a nurse’s mind, quietly informing practice, they are not visible in documentation. Because they are not seen, they become less valued by nurses and other health professionals.

The theory-practice gap affects research as well. Evidence-based practice is inhibited by a lack of research guided by nursing theory. While our colleagues in medicine rarely cite a theoretical framework, one is expected, and useful, in nursing research. Nurses acknowledge that there are many ways of viewing health and illness. Still, the medical model predominates in practice settings, inhibiting broader research implementation. Individual nurses can’t implement research based on nursing theory; nursing practice must make sense to others and must be visible in the EHR. Thus, practicing nurses who decry the pointlessness of nursing theory can’t be blamed; they practice in an environment where, for example, documenting self-efficacy for breastfeeding is irrelevant to other users of the health record. There is no checkbox for it.

My cynical side says the medical model is linked to payment and regulatory oversight, and thus will continue to prevail in clinical settings. This calls upon us to ask: how then do we acknowledge, incorporate, and communicate nursing theory within our own profession, and also outside it? How do we implement evidence-based, theory-driven nursing practice when large parts of research and practice are driven by the medical model? Nurse educators have been doing this work, but we also need drivers of change in the clinical setting.

I envision a time when nurses study pharmacology, yes, but other health professionals also study Kolcaba’s Theory of Comfort (for example.) A time when the EHR captures more than medications, procedures and physical exams. When nurse informaticists play a key role in design of clinical information systems, incorporating nursing models, interventions and observations into the EHR. Improving the presence of nursing knowledge in the EHR will not only provide practicing nurses with more complete information about the person, but it will make nursing more visible to other professionals. Changing clinical settings entrenched in the medical model will be hard. How do we develop nurse change agents to get us there?

About Teresa Goodell

Gerontology, trauma, and skin/wound care clinical nurse specialist. Now retired from clinical setting, I serve on the board of a hospice and teach trauma continuing education. I’ve been an RN for 38 years and a clinical nurse specialist for 27 years. Nurse educator in academic and continuing education settings for 26 years.

Guardian of the Discipline – “Lucie S. Kelly: A nurse’s nurse who held us all accountable for being better, doing better”

Contributor:
Marion Broome, PhD, RN, FAAN,
Editor Nursing Outlook, 2003-present

When I entered nursing in 1973, Lucie Kelly, PhD, RN, FAAN was already a well-respected scholar and leader in the field. Lucie obtained all 3 degrees from the University of Pittsburg: her BSN in 1947, a masters in nursing education in 1957 and a PhD in Higher Education in 1965. When she died on November 19, 2020 Dr. Kelly had left her impression on so many of us- nurses in practice, academe and in professional associations.  She held many leadership positions, such as Vice-President of Nursing, Chair and Professor, President of Sigma Theta Tau International,  as well as an academic dean in schools of nursing and public health. She was selected as a Living Legend in the American Academy of Nursing…. Such an apt and befitting title! Finally, her 6 (yes 6!) honorary doctorates speak volumes about her accomplishments as a scholar and leader in nursing. 

Lucie S. Kelly (source)

But here is what I remember about Dr. Lucie Kelly: she was a woman with ‘her own mind’ (not an exceptionally common thing said of most women in the mid-1900s). And she didn’t hesitate to share her ideas with others. Lucie Kelly spoke and wrote about everyday beliefs and practices of nurses across the profession- practice and education. Lucie was editor of Nursing Outlook for several years in the late 1980s.  As an assistant and associate professor I loved reading her editorials then. Lucie Kelly was always questioning existing myths and urban legends in the field. She would often ask readers ‘why’ AND ‘why not’?  For instance, in her editorial in the May-June Nursing Outlook issue of 1988 of Dr. Kelly shared her belief that nurse administrators ought to reach out to those young nurses who hold promise………. “who dare to bang on their doors with confidence and talent” and to groom them for leadership. To not turn them away as ‘too inexperienced, too young’.  She believed it was their mentoring and belief in these young nurses that would lead to the “biggest payoff for all: a stronger future for nursing in the image of the pioneers who dared”.

Source

On that same theme in another issue (Kelly, 1991), Dr. Kelly talked about “The Conundrum of Leadership” and shared her observation about the ‘recycling of the same leaders in nursing’ who were often invited to and assumed positions of influence and powers across many of the professional associations. Of course, she shared, these individuals were the experienced ones, the ‘proven’ ones who people knew and elected. Lucie asked readers to think about that as a viable strategy for leadership longer term or a way to infuse new thinking into the field at a time when it was so sorely needed.  

So many of the issues Lucie wrote about in her editorials are still very real today and deserve ongoing reflection and commentary by contemporary leaders.. That is, just how do we not just encourage but embrace young leaders! How do we make sure we sponsor our emerging leaders in key areas so they can expand their skills and spread their wings. Lucie Kelly’s written words reflected someone who was a wise sage in the field and yet still so ‘young at heart’ and still so willing to embrace those starting out and who stood out as future leaders and scholars.

And she didn’t just write about such. Many of her mentees have shared with me over the years how much faith she had in them and how that made all the difference in their career success.

What stuck me and so many others about Lucie Kelly was her smile and her sense of style which reflected her energy and timeliness, her laughter when with good colleagues and friends. So many of us who did have any opportunity to interact with, listen to, read about, and observe (as young leaders always do) will not just remember what Lucie Kelly said but how she made us feel….like we could spread our wings, could make a difference in our chosen field and maybe, just maybe ‘look and sound like’ Lucie Kelly one day.

Kelly, L. (1988). Calculated risk” Big Payoff.  Nursing Outlook, 36(3), 25.

Kelly, L. (1991).The conundrum of recycled leadership. Nursing Outlook, 39 (1), 5.

Guest Post: I Thought all Nurses used Mirrors!

Contributor: Wyona M. Freysteinson, PhD, MN
Theory: Neurocognitive Model of Mirror-Viewing

Wyona Freysteinson

At the age of two, I decided I was going to be a nurse. My great grandmother, my first patient, taught me my colors while testing urine for ketones, how to give insulin, and that when I combed her hair, she looked in a mirror.

I thought all nurses used mirrors.

The quest to understand the mirror-viewing experience began in the 1970s-1980s when I practiced bedside nursing, with a small mirror my uniform pocket. I wondered why the mirror was soothing to so many of my patients (e.g., seeing how I had re-taped a nasogastric tube)? In some patients, I witnessed a look of terror (e.g., viewing a scalp incision)?

When I suggested a mirror-viewing study in my master’s program in 1990, the dean called me into her office. The dean said I could not study mirrors as sick people do not want to look in mirrors. Upon deep reflection, I realized that I had not caused severe psychological harm to thousands of patients with my pocket mirror. I turned to the philosophy department where a professor who had been a student of Paul Ricoeur joined me in my quest. The mirror research journey had begun.

This research trajectory continued with studies of the mirror-viewing experience after a terminal illness diagnosis, amputation, mastectomy, and military sexual trauma. This mirror knowledge base helped me understand the experience of mirroring.

This knowledge base, however, did not explain the mirror phenomenon. Why did some participants tell stories of severe mirror distress (e.g., I wanted to run out on the road screaming)? Why did other participants say they felt no emotions when seeing their bodies for the first time after disfigurement? Why did so many participants remember a terrifying mirror image that occurred several years earlier, and I struggled to remember my mirror image from this morning?

A deep dive into the literature unearthed MRI studies demonstrating self-recognition occurs in the pre-frontal cortex. Together with memory and the autonomic nervous system theories and my research, this information formed the foundation of the mid range nursing theory: Neurocognitive Model of Mirror-Viewing. Although mirrors have a tenuous historical and mythical past, and to some individuals are considered taboo, mirrors are simply tools. For example, mirrors are useful for self-assessment (e.g., diabetic foot care, skincare), self-incision and wound care, colostomy care, prosthetic alignment, and pushing during birth. Many individuals use a mirror to brush their teeth and other activities of daily living. Only in mirrors can we see our faces and whole bodies. However, Initial mirror-viewings in the aftermath of visible disfigurement, sexual trauma, or bullying may be distressing or traumatic. Ongoing mirror discomfort and mirror avoidance may occur.

Sensitive, supportive nursing mirror interventions are needed to mitigate mirror trauma. Since my visit to the dean, I cannot count the number of individuals who have considered my work absurd, frivolous, or inconsequential. Nor can I calculate the countless numbers of cheerleaders who have had traumatic mirror experiences and wished a nurse had been there for them. My hope is that my work expands nursing science to the extent that nurses do use mirrors.

Volume 2 of the Roy Academia Nursology Research Center (RANRC, Japan) now published!

The Roy Academia Nursology Research Center (RANRC) publishes a yearly Nursology Letter. Volume 2 has just been published! See information about volume 1 (2019) on our January 7, 2020 blog post celebrating the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan.

The RNARC is named for Callista Roy, the nursology theorist who developed the Roy Adaptation Model. Congratulations to our colleagues at St. Mary’s College for this notable achievement!

Recruiting participants for Nursing Research Guided by Barrett’s Theory

The Influence of Nurse Coaching on Power as Knowing Participation in Change in the Process of Health Patterning

Researcher:
Shirley Conrad, MSN, RN, CCRN, AHN-BC, HWNC-BC
PhD Candidate
Christine E. Lynn College of Nursing
Florida Atlantic University

Are you a NURSE who has experienced stress related to providing nursing care during the Covid-19 Pandemic?

We are currently enrolling nurses in CT, MA, NH, MN, MD, TN, NJ, PA, KS, and CA to study the effects of nurse coaching on individuals’ power to participate in life changes like COVID-19.

If you decide to participate what is involved?

  • Four coaching sessions conducted remotely with an AHNCC certified nurse coach. Each will last about one hour. Scheduling is between you and the nurse coach.
  • Completion of short surveys and a phone interview after completion of the coaching. It should take no more than 5 minutes to complete the demographic survey, 10 minutes for pre assessment, 10 minutes for post assessment and 30 minutes for interview.
FOR MORE INFORMATION – please contact Shirley Conrad @ 407-314-3587 or Sconrad2009@health.fau.edu. Primary Investigator is Dr. Marlaine Smith @ 303-506-3450 or msmit230@health.fau.edu   IRB Number 1252160-1 Approved on: March 28, 2019 Expires on: Not Applicable