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      

New on Nursology.net – Aesthetic Knowing

We are delighted to announce an important new section on Nursology.net – Aesthetic Knowing in Nursing.

Aesthetic knowing in nursing is a way of knowing realities that are not empirically observable – the deep meanings in a situation. As nurses grasp these meanings, they can draw on their inner, creative resources to respond to the situation in ways move the situation from what is, to what is possible. Aesthetic knowing is called forth in the face of human experiences that are common for to all human experience such as grief, joy, anxiety, fear, love. Even though these experiences are common, they are expressed in ways that are unique to each and every individual experience. People recognize common expressions of such experiences as anxiety, or fear, or love. But each person’s experience is unique.

From Introduction to Aesthetic Knowing

This section features the works of nurse scholar/artists whose art expresses a dimension of caring in the human health experience. Our inaugural scholar/artists are:

View the Scholar/Artist Gallery

If you are a nurse/artist and have works you are willing to share, we welcome your submissions for this section of Nursology.net! Use our “Aesthetic Knowing in Nursing Submission Form“!

Guest Post: Allies and Advocates – Transforming Cultural Competence

Contributors: Jennifer Weitzel, Jeneile Luebke,
Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz,
Anne Dressel, & Lucy Mkandawire-Valhmu

The murder of George Floyd and Breonna Taylor has prompted a wake-up call to reflect on the pervasive issue of structural racism.  As a nation created through histories of colonization and slavery, these murders—among countless others—have acted as a catalyst for American society to recognize and act to disrupt continued legacies of racism embedded into the fabric of American society1.  As nurses, as a part of this society (and thus a reflection of society) it is incumbent upon the nursing profession to take a stark look at the ways in which the legacy of structural racism has continued to inform nursing practice, education, and research.  Doing so speaks towards the nursing professions commitment towards supporting best health outcomes for everyone.  As the most trusted profession, and largest healthcare profession, such allyship not only recognizes this issue, but acts to decolonize discourses, and provides explicit attention to the impact that racism holds on health outcomes.  Such measures call to realize the reality that racism is a health issue, that must no longer remain on the periphery of nursing education, research, and practice in the U.S. (see https://nursology.net/2020/01/14/decolonizing-nursing/ ) .

Source

Nursing as a science, has historically been constructed from a positivist and Eurocentric framework that serves to sustain the domination of “whiteness as a form of disciplinary power.”2(p.196)  Cultural competence is often the primary concept used to guide the nursing profession in addressing the needs of diverse populations locally and globally.3 The principles of cultural competence are heavily influenced by the social and political history of the U.S.4 Practicing with cultural competence is tainted with the effects of racial bias, as this concept fails to recognize how perceived “cultural differences” are code for modern-day racist ideologies dating back to colonialism.6 Therefore, what is often believed to be cultural knowledge is rooted in White, European worldviews and codified into healthcare practices based on faulty interpretations and observations of “Othering”. 

Calls have been put forth for nursing transform these harmful approaches to cultural competency using emancipatory knowledge development and critical theory. Although nursing has been heavily impacted by the hegemonic ideologies of the biomedical model, we have also pioneered ways of knowing that disrupt oppressive knowledge paradigms.   The very institutionalization of competence within the medical field was one way for healthcare providers to establish a standard of expertise. This was key to the professionalization of many disciplines informed by the biomedical model, which focuses primarily on biological factors of health and excludes psychological, environmental, and social influences.Because of the societal value placed on our education and our expertise (cultural competence), nurses enjoy a position of power in Western models of health care. Operating blindly within the hierarchies of power existent in the Western, biomedical model of health leads to running the risk of de-contextualizing the care we provide. For example, Ilowite, Cronin, Kang, and Mack found that parents of children with cancer, regardless of race and ethnicity, wanted detailed information regarding their child’s prognosis.7 However, the researchers also found that physicians provided less information to Black and Hispanic parents than to White parents. This is an example of how healthcare providers exert power by deciding what information to share with patients based on perceived cultural norms and implicit bias.

Most individuals entering the healthcare field espouse a belief that they need to deliver care with impartiality.  However, without a sufficient understanding of the machinations of racism in everyday society, the ways in which racism are perpetuated in the healthcare system will remain a blind spot.6 In attempting to provide care regardless of race or ethnic background, we might overcompensate (“I don’t see color”) and subsequently fail to see how social determinants of health, including racism, affect our patient’s opportunities to achieve and maintain optimal health. 6

Practicing with cultural competence is predicated on the nurse’s ability to learn and understand cultures other than their own  to predict health behaviors and ultimately health outcomes.7 When these predictions drive how care is delivered, the complexities of how individuals, families, and communities make decisions about life, illness, and death become reduced to single narratives and stereotypes.9 By many of our textbooks and NCLEX review materials still provide content based on assumptions and broad categorizations. These assumptions often boil down to ideas such as the belief that because of their race or ethnicity, people share static traits, values, and beliefs, racial categories are legitimized as objective truths, when in reality, these categories are social constructions shaped by history and politics.

It is fundamentally impossible for nurses to provide culturally competent care under the premise that knowledge is based on these singular narratives, beliefs, and stereotypes. We must be open to the use of new frameworks that underpin the delivery of nursing care to meet the needs of diverse populations.  These frameworks derive from epistemologies that challenge Western hegemonic knowledge, how it is produced and who produces it.  For example, cultural safety is a concept originating from indigenous Maori New Zealanders that calls on nurses to engage in ongoing self-reflection about issues of power and privilege. Intersectionality theory, rooted in Black feminist thought, requires an understanding that people identify in a myriad of ways that are fluid and interactive.  These identities, some of which are self-ascribed, and others are socially ascribed, form matrices that confer or deny power. Legal scholars introduced Critical Race Theory (CRT) drawing from critical legal and civil rights scholarship.  CRT is underpinned by the following assumptions:

1.  Race is a social construct with no basis in science.

2. White supremacy does not exist on the fringes of society but is embedded in the everyday order of U.S. life.

3.  The voices of those experiencing racism are essential to knowledge development.

4.  The notion of ‘colorblindness’ is a detour that allows White people to absolve themselves of racial biases and deny the oppressive realities of structural racism.

These are a few of the concepts and frameworks that could inform nursing science and ultimately our practice. Why are we interested in theories from other disciplines? How might we develop nursology discipline specific knowledge that addresses the issues?  In the midst of the world witnessing the murder of George Floyd by police officers, the COVID-19 pandemic continues unabated with its current epicenter in the U.S.  In urban metropolitan areas, we have watched how centuries of disinvestment in Black and Brown communities and systematic oppression has led to health disparities that are also manifesting clearly in this pandemic in disproportionate morbidity and mortality of Black and Brown peoples.  Ethnic minority populations are at greater risk for contracting Covid-19, or experiencing severe COVID related illnesses.10  According to the CDC’s report on COVID-19 in the Racial and Ethnic Minority Groups, cases of COVID-19 are highest among American Indian persons, and hospitalization rates for COVID-19 related illness are highest among Latinos, American Indians, followed by Black persons.10  Since Covid-19 was first reported on the Navajo Nation in mid-March, infection rates per capita have soared to the highest in the country compared with any individual state.11   The COVID-19 pandemic thus only exacerbates the challenges that ethnic minority communities already face, particularly American Indians who already experience disproportionate disparities in health outcomes.

The time for nurses to act is now, not just in the care of people and communities that are most marginalized, but to address the very root of marginalization and oppression through a practice of critical reflection on our own profession: which of our theories need to be contested because they are rooted in colonist and white supremacist ideologies?  How can we embrace of innovative ways of theorizing, through meaningful and intentional care that results from a critical and reflective analysis of the realities going on around us and our role as a profession in fostering lasting change? We leave you with these questions and call upon you as fellow allies and advocates on the path towards health equity and social justice.  When we discuss racism, should we not include all races and ethnicities?

Sources

  1. Paradies Y. Colonisation, racism and indigenous health. J.Popul. Res. 2016; 33(1):83-96.
  2. Puzan E. The unbearable whiteness of being (in nursing). Nurs Inq. 2003; 10(3):193-200.
  3. Rajaram SS. Bockrath S. Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. J Health Dispar Res Prac. 2014; 7(5):82-89.
  4. Kirmayer LJ. Rethinking cultural competence. Transcult Psychiatry. 2012; 49(2). 149-164. doi.org/10.1177/1363461512444673
  5. Wesp, L. M., Scheer, V., Ruiz, A., Walker, K., Weitzel, J., Shaw, L., . . . Mkandawire-Valhmu, L. An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories. Advances in Nursing Science, ePub Ahead of Print. 2018.  doi:10.1097/ans.0000000000000230
  6. Hester, RJ. The promise and paradox of cultural competence. HEC forum. 2012;24(4):279-291. doi.org/10.1007/s10730-012-9200-2.
  7. Ilowite MF. Cronin AM. Kang TI. & Mack JW. Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity. Cancer. 2017; 123(20): 3995-4003.
  8. Brascoupé S. Waters C. Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. Int J Indig Health; 2009; 5(2):6-41.
  9. Carter C. Lapum J. Lavallée L. Schindel ML & Restoule JP (2017). Urban First Nations Men: Narratives of Positive Identity and Implications for Culturally Safe Care. J Transcult Nurs. 2017; 28(5):445-454.
  10. Centers for Disease Control (CDC).  COVID-19 Racial and Ethnic Health Disparities. 10 December 20.  Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/increased-risk-illness.html
  11. Cheetham, J. Navajo Nation: The people battling America’s worst coronavirus outbreak.  BBC News.  15 June 2020.  Retrieved from: https://www.bbc.com/news/world-us-canada-52941984

Note: this post is based on the ANS article published in the spring of 2020 – Weitzel, J., Luebke, J., Wesp, L., Graf, M. D. C., Ruiz, A., Dressel, A., & Mkandawire-Valhmu, L. (2020). The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time. ANS. Advances in Nursing Science, 43(2), 102–113. https://doi.org/10.1097/ANS.0000000000000290

L-R: Jennifer Weitzel, Jeneile Luebke, Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz, Anne Dressel, Lucy Mkandawire-Valhmu

Jennifer Weitzel, MS, RN is a doctoral student and public health nurse with Public Health Madison & Dane County. Her research examines the use of cultural safety in the delivery of humanitarian nursing in Haiti

Jeneile Luebke, PhD, RN is a post-doctoral nurse research fellow at University of Wisconsin-Madison. Her area of research and expertise include violence in the lives of American Indian women and girls, and utilization and application of postcolonial and indigenous feminist methodologies.

Linda Wesp, PhD, FNP, APNP, RN is a Clinical Assistant Professor at University of Wisconsin-Milwaukee in the College of Nursing and Zilber School of Public Health, with a focus on health equity, participatory research, and critical theories. She also works as a family nurse practitioner and HIV Specialist at Health Connections, Inc. in Glendale, WI

Maria del Carmen Graf, MSN, RN, CTN-A, is a PhD candidate at UW-Milwaukee. Her research area includes studying the mental health needs within vulnerable populations with an emphasis on the Latina population and women of color in the US using a Postcolonial Feminist approach.

Ashley Ruiz RN, BSN, is a doctoral nursing student and clinical instructor at the University of Wisconsin-Milwaukee, as well as a Sexual Assault Nurse Examiner (SANE). Her current work focuses on advancing feminist theory in nursing science for the purposes of providing a theoretical foundation for addressing the problem of violence against women. Such advances inform Ashley’s research, which seeks to identify and develop nursing interventions that are tailored towards the unique needs of Black women that disclose sexual assault and seek healthcare services

Anne Dressel, PhD, CFPH, MLIS, MA, is an Assistant Professor in the College of Nursing at the University of Wisconsin-Milwaukee, where she also serves as Director of the Center for Global Health Equity

Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.

Lessons from the COVID-19 pandemic: Changes to the meaning of our experiences based on Newman’s theory of health as expanding consciousness (HEC)

Report from the Newman Theory/Research/Practice Society (a Japanese Nonprofit Organization)

Contributors: Emiko Endo,
Satoko Imaizumi, Minako Kakimoto,
Yayoi Kajiwara, Yoshie Kamiya

We are pleased to write our blog about the 2020 work of the Newman Theory/Research/Practice Society in Japan. We submitted a brief about our Society on January 10, 2019 (scroll down here to see this brief) followed by more detail from Dr. Margaret Pharris, who introduced our society and work on December 17, 2019.

We had the last pre-praxis research course of HEC for 2019 virtually on August 2, 2020, because the COVID-19 pandemic. We read the last chapter, “A transforming arc”, and Appendix A, “HEC Praxis: The process of pattern recognition” in Newman’s “Transforming presence: The difference that nursing makes.” After that, Emiko Endo, as a leader of this course, introduced the blog by Drs. Jones and Flanagan, “COVID-19 – What would Margaret Newman say?”(June 30, 2020) In listening to it, our comprehension expanded, and we feel enlightened, and awakened in new ways.

There is an increased awareness within selves, our nursing care, and our society. No, we will never get back to normal. We will certainly move on in “Satori.” On an annual event of the Study meeting held by zooming on November 22, 2020, three practicing nurses presented their experiences of turbulence and disruption, and then recognition of the changes to the meaning of their experiences in the COVID-19 pandemic. The following are the summaries of each presentation.

Minako Kakimoto

In February, the spread of COVID-19 started in Asian areas, but I was looking at that situation as no concern of ours, and I thought it would disappear sooner or later like SARS and MARS. However, soon after being informed of the cases with COVID-19 in Japan, daily necessities, masks, alcohol, etc. disappeared from every store and the situations in hospital settings dramatically changed. The nurses, including me in a cancer hospital, had very hard time making temporal rules without any exact knowledge.

Soon after, we were informed that some positive cases were found at my hospital. I was on the list of medical staff exposed deeply to the COVID-19. “It finally came to us. We cannot overlook their distress as no concern of ours.” I felt strong fear. I had a test, and was afraid of the result. “If I am positive, what will happen to my family? If I and my husband are positive, how my child should be?” I imagined a dead body in a special bag and a crying child there. But, fortunately my test was negative.

After that, I was in charge of an outpatient clinic for the clients with fever. There were many difficulties because of a pickup setting. There were many inquiries and complaints from clients. The relationship among the staff became so bad because of a sense of unfairness, stress, overwork, etc. “How long does this chaotic situation last?

One day I spoke to my colleague about how to organize this disorder. Astonishingly, she said, “You told me some time ago that a transformation would occur after a chaos!” Her words made me come to my senses. “It is true. After the chaos, there is our growth.” I felt as if I had the scales fall from my eyes. I certainly grasped the meaning of “We will never get to back to normal” as Dr. Newman said.

I looked at the chaotic staff relationship from a different angle. “We do not need to get back to the normal. The confusion is not really bad, but it will bring forth. We do not need to endure the current difficult situation with many complaints until the typhoon has passed. Let’s find a new way to move on.” I approached my colleagues to exchange ideas about how to stand up. Of course, my change of actions prevailed into my family.

Yayoi Kajiwara

In the midst of the pandemic of COVID-19, my father, who had had a so-called incurable disease for a long time, died. As I learned a lot from my sad but meaningful experience, I would talk about it.

I, as a hospital nurse, had asked patients’ families to put restrictions on visiting their loved ones to prevent bringing COVID-19 virus into the hospital. However, the situation has reversed. I was not allowed to visit my father. I was so afraid of not being able to meet his death. When I had been a nurse at the palliative care unit, I valued a patient’s death surrounded with his or her family members before everything else. But, I thought it might be impossible for me to be present with my father.

I wondered why my father was on the brink of death in the midst of the pandemic of COVID-19 ? “If I cannot be present at my father’s death, what does it mean? My father may be telling me something important to get a new meaning in my experience. He may be telling me that the length of the time is not so important. The importance is to be present with the patient.”

When my father ran into a critical condition, I was finally allowed to see him. I could be present with him for a while with all my heart. My father did die after several days from good-bye with my aching heart. However, in spite of his death, the relationship between him and me has changed through the process of our hard experience in the pandemic. Our relationship came closer than ever, and we became deeply united in spirit.

From this experience, I realized that I had been captured by the “good dying moments” which nurses think. I surely comprehended the meaning of “Transforming presence” in terms of HEC. That is, being present together brings the transformation to both. I realized the true meaning of “Vulnerability, suffering, disease, death do not diminish us” which Dr. Newman emphasized.

I am very thankful to my father, and the lesson on the COVID-19 pandemic will help me better care for clients in our community.

Yoshie Kamiya

I am a nurse in charge of an outpatient clinic at a university hospital. The COVID-19 pandemic brought me so many difficulties and at the same time many lessons.

We, nurses, were distributed one mask for several days and one raincoat bought at a $1.00 shop. At an information desk, I received a lot of phone calls, claims, and complaints from clients because of the lack of information and fear. The staff’s fear and offensive attitudes were also increasing, and some co-workers could not show up because of their children’s care at home. I was full of fear and exhaustion as I could not know how things would turn out.

In those days, I participated in the last class of the pre-praxis study course and we read the blog by Drs. Jones and Flanagan. I vividly remember the shock I felt after reading the blog. “I feel very relieved.” I thought, “What we need to do is not to go back, but to move on even in the process of confusion.” I thought, “Now is a pinch point, but it is not, really. Now is a chance.” Then, I looked back the past experiences and tried to get a new meaning from them. I will tell you about my change.

As the charge nurse at an out-patient clinic, I was always thinking, “I should take a determined attitude,” “I should not make mistakes,” “I should not be afraid of COVID-19,” “I should meet patients with fever by myself.” One day, when I was working the information desk, I spoke with a patient who turned out to be COVID-19 positive. When I was informed of this fact, I was afraid. Moreover, I felt so sorry for my family. However, I did not tell anyone, not even my family, though I was so worried about my contagion.

Finally, COVID-19 had invaded into our hospital. Some nurses were on a watch list for the virus. One day, one nurse came to me and told me, “I feel very afraid, and I feel very sorry for my family.” She told her feeling openly. At this time, I was startled and recognized my pattern. I realized that I was not honest. I piled up “should do” every day.

The pattern recognition, which is the most important concept in HEC, helped me realize my situation. Since then, I tried to be open and to tell what I am thinking and feeling to people. Especially, I tried to be honest and open with the staff. I realize now that our relationship is changing and expanding. This is one of the great lessons to me during the COVID-19 pandemic. There is another one. At the out-patient clinic, we started to receive clients’ words of appreciation. I can accept their thanks honestly and my relationship with clients became more genuine. This is the other lesson from the pandemic. Thank you for listening to me.

All participants were deeply touched by their presentations. “Yes, we will move on!!!” We will continue to search for ‘caring in the human health experience’ during the COVID-19 pandemic.

Guest Post – Nursing’s call to action to address the social determinants of health

Guest contributors:
Kelli DePriest, PhD, RN
Paul Kuehnert, DNP, RN, FAAN 
Teddie Potter, PhD, RN, FAAN

Recently, several Expert Panels of the American Academy of Nursing collaborated to draft a new conceptual framework and consensus statement related to social determinants of health. The year-long endeavor integrated the thoughts and expertise of 15 nursing leaders. The outcome of our work directs nursing actions toward health policies supporting actions at multiple levels (i.e., upstream, midstream, and downstream) to promote equity in planetary health-related quality of life. We propose that planetary health-related quality of life, individual and population factors, and environments are the overarching societal contexts in which population health concerns arise. These population health concerns are articulated by stakeholders who, in turn, are the catalyst for population-focused nursing actions.

These population-focused nursing actions occur at multiple levels, in a variety of settings with a variety of persons and groups, and shape health policies, systems and services. Over time, the actions and interactions depicted by the cycle change the societal contexts and may lead to enhanced planetary health-related quality of life. We underscore the crucial need to eliminate systemic and structural racism if equity in planetary health-related quality of life is to be attained. We presented our findings and implications for action during a policy dialogue at the American Academy of Nursing Policy Conference in October 2020. Collaboration on this project inspired the following call-to-action.

Call to Action

Nurses are consistently ranked the most trusted profession by the American people. This trust is earned by the demonstration of care for people, day in and day out, in a wide variety of settings. It is time for all nurses do something to address the social determinants of health. We propose three concrete approaches.

The first two approaches can be summarized as praxis. According to Paulo Freire in Pedagogy of the Oppressed (1972), praxis is reflection and action on the world  to transform it.  

Reflection, the first approach, is often overlooked in calls for action. Yet we need to take a moment to reflect on what we mean by social determinants of health and what nursing actions in this space will help us achieve health equity. The consensus makes clear that equity cannot be achieved at any level (local, national, or global) until all forms of structural racism are eliminated. Eliminating structural racism should be a shared goal for all nurses.

We have work to do around structural racism in nursing. Nursologists are starting this type of reflection and discussion through nursology.net. (see https://nursology.net/about/nursology-management-team-statement-on-racism/). These conversations need to occur wherever we live and work, in the classroom, in the community, on social media, and with colleagues inside and outside of nursing. The consensus paper can be used to spark reflection and prompt discussions to support action.

Take action on social determinants to create transformative change is the second recommended approach. Action differs depending on our role. The consensus paper draws on the conceptual framework to provide several examples of population-focused nursologists’ actions to address policy issues. The common themes from the examples are that nursologists need to have a seat at the table when all policies are developed, using a Health in All Policies approach, which  includes policymaking across sectors, not only  those policies directly related to health, and nursologists need to advocate for policies that have been shown to effectively advance health equity.

Black, Indigenous, and Hispanic people in this country are experiencing disproportionately high rates of illness and death from the COVID-19 pandemic. To address this syndemic (Poteat, Millett, Nelson, & Beyrer, 2020), we need to address the structural racism at the root cause of these disparities. Who better to forge the path forward, than this group of nursology  leaders? It is time to move to action.

Inspire action on the environment and social determinants of health is the third approach. Another population-focused nursologists’ action from the conceptual framework posits that nursologists must build coalitions to be successful in this work. Others need to be inspired to join the effort. If nursologists are unsure of how to inspire, or lack inspiration themselves, they can read a few blog posts on nursology.net or nursesdrawdown.org for examples. Nursologists can also go to #nursetwitter where there are conversations about nursologists addressing the social determinants of health along with reflection and discussion on how to dismantle structural racism within nursology. Nursologists  can also be inspired by leaders who advocate for nursology by serving on boards, writing op-eds, acting as expert sources for the media, reaching out to legislators, and/or running for office themselves. Inspiration comes in many forms. There is an energy and passion required to do this work and if you have the capacity, please help inspire others to join the movement.

We leave you with the call-to-action to reflect, act, and inspire. We look forward to continuing this conversation.

References

Freire, P. (1972). Pedagogy of the oppressed. Herder and Herder.

Poteat, T., Millett, G. A., Nelson, L. E., & Beyrer, C. (2020). Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics. Annals of Epidemiology47, 1–3. https://doi.org/10.1016/j.annepidem.2020.05.004

About the contributors;

The authors are writing as nursology colleagues who have worked together through the Environmental and Public Health Expert Panel at the American Academy of Nursing (AAN). Paul and Teddie are the past and current chair of the expert panel and fellows of AAN and Kelli worked with the expert panel through the AAN Jonas Policy Scholars Fellowship program.

Kelli DePriest, PhD, RN

Dr. DePriest is a health policy and research fellow at the Institute for Medicaid Innovation and adjunct faculty at the Johns Hopkins University School of Nursing. Her research mission is to investigate strategies to leverage innovation in the Medicaid program to improve and/or inform the development of interventions and policies designed to achieve health equity for children and families living in poverty. Twitter: @kellidepriest

Paul Kuehnert, DNP, RN, FAAN

Dr. Paul Kuehnert is President and CEO of the Public Health Accreditation Board, the national non-profit organization that sets standards for and accredits governmental public health departments in the United States. Dr. Kuehnert’s career spans nearly 30 years of providing executive leadership to private and governmental organizations to build and improve systems to address complex community health needs. Dr. Kuehnert is a pediatric nurse practitioner and holds the Doctor of Nursing Practice in executive leadership as well as the Master of Science in public health nursing degrees from University of Illinois at Chicago. He was named a Robert Wood Johnson Foundation Executive Nurse Fellow in 2004, a Fellow in the National Academies of Practice in 2010, and a Fellow in the American Academy of Nursing in 2015. Twitter: @PaulKuehnert

Teddie Potter PhD, RN, FAAN

Saintelmophotography.com

Dr. Potter is Clinical Professor, specialty coordinator of the Doctor of Nursing Practice in Health Innovation and Leadership, and Director of Planetary Health for the University of Minnesota School of Nursing.

Guest post: The Role of Nurses and Women’s Health Advocates in Advancing a Social Justice Agenda in the Current Climate: The Case of Wisconsin

Contributors (see bios below)
Lucy Mkandawire-Valhmu, PhD, RN; Jeneile Luebke, PhD, RN;
Carolyn Eichner, PhD; Kaboni Gondwe, PhD, RN;
Diane Schadewald, DNP, RN; Peninnah Kako, PhD, RN;
Jacqueline Callari-Robinson, BSN, RN; Brittany Ochoa-Nordstrum;
Nicole Weiss; Jacqueline Campbell, PhD, RN, FAAN

As nursing professionals and women’s health advocates, we have watched in disbelief events unfolding in Barron County, Wisconsin. Embrace, a shelter serving survivors of sexual assault and domestic violence in Barron County, is facing backlash for displaying a Black Lives Matter (BLM) sign. Reacting to the sign, local officials stripped the organization of funding worth $25,000 and law enforcement are unwilling to continue collaborating with Embrace.

Source

Embrace, located in Northern Wisconsin, serves a predominantly White populace, but also has a significant population of migrant farmworkers and Somali refugees. Migrant farmworker women face difficulties in accessing help following an experience of violence due to transportation and language barriers. Many refugee women also often have a history of sexual violence and trauma. Black women make up less than 2% of the population in Baron County yet constitute 10% of the population accessing help at Embrace’s shelter. Part of the St. Croix Chippewa tribe is also located in Embrace’s service area. Black women and American Indian (AI) women are disproportionately impacted by violence, but do not ordinarily seek help despite the potential for severe negative impacts such as injury or even loss of life.

The National Intimate Partner and Sexual Violence Survey (NISVS) report shows that 84.3% of AI women have experienced lifetime violence (Rosay, 2016). The NISVS shows 41% of Black women have experienced physical IPV in their lifetime with homicide being one of the leading causes of death for women aged 44 and younger. It is in this context that Embrace seeks to serve the most vulnerable populations of women in a four-county area where they are the only available domestic violence shelter.

 We are in unprecedented times with an ongoing COVID-19 pandemic that not only disproportionately affects the lives of Black and Brown women and their communities, but also increases their risk of violence and homicide. A recent US study showed a surge in the incidence of severe intimate partner violence (IPV) during the Covid-19 pandemic compared to the previous 3 years, and a decrease in the number of people seeking hospital care (Gosangi et al., 2020). It is important to be clear that this supports the idea that the stressors of Covid-19 including the economic fallout may exacerbate existing IPV but probably does not start IPV that has not existed before.  Consistent with what has been seen in some other countries, IPV and sexual assault advocates across the state began to report an increase in self and police referrals to their agencies after the pandemic began (Luthern, 2020).

Domestic violence related homicides have been on the increase in Wisconsin even before the pandemic.  According to End Abuse Wisconsin’s Domestic Violence Homicide Report (2020), there were 47 domestic violence related homicide deaths in 2018, and 72 in 2019.  And frighteningly, as of September 29, 2020, domestic violence homicide has taken 69 Wisconsin lives this year.   If that pattern continues, it is estimated that 93 lives will be lost this year. Also concerning is that 22% of the victims, so far in 2020, were age 18 or under. 

Black communities in urban metropolitan areas like Milwaukee are disproportionately impacted by violence in general while also experiencing tensions with law enforcement. Recent acts of police brutality captured on video and circulated widely on social media have implications for community relations with law enforcement. The fear that community members have about police officers potentially using excessive and unjustified force in the policing of Black bodies (Frazer, Mitchell, Nesbitt, et al., 2018) can impact women’s help-seeking following an experience of violence. Black women may want to call the police if they feel like they are in danger from their partner’s abuse but they do not want that partner to be harmed and they usually do not want him to go to jail.  They, like most abused women, just want the violence to stop.  At the same time, there needs to be a non-racist police response available to abused women who are in fear for their and their children’s lives.  There needs to be carefully informed triage (a concept well known to nursing) for 911 calls for IPV so that police are not brought in when not needed but can be brought to homes where there is a high risk for homicide.  

Our state has also been the site of civil unrest in the past few months. In Kenosha, the police shooting of Jacob Blake in August resulted in protests requiring the declaration of a state of emergency. Clashes have also ensued between law enforcement and community members in Wauwatosa in the last few weeks as a result of protests for the February, 2020 shooting and killing of Alvin Cole by a police officer. Apart from these incidents that have created not only unrest but also continued mistrust between Black and Brown communities and law enforcement, there have also been concerns about the prevalence of the trafficking and sexual violation of young Black and Brown women. In Kenosha, Chrystul Kizer, a 19-year-old African American woman, was released this year after being charged for killing a man who sexually abused her as a child in what her defense team argued was self-defense (Fortin, 2020).  Her defense team spoke of how the criminal justice system fails to protect Black and Brown women and girls and yet also holds them disproportionately ‘accountable’ for crimes that would not be charged in cases of White women and girls. This is eloquently detailed by Beth Richie in Arrested Justice

Within the past few months, Wisconsin has had a number of Indigenous women murdered and missing.  Kozee Medicinetop Decorah (Ho-Chunk Nation) was found deceased on May 16, 2020, a victim of domestic violence related homicide (Volpenheln, 2020).  Stephanie Greenspon was found deceased on August 19, 2020. It is suspected that she was also a victim of violence related homicide. Her case is still being investigated by the FBI (Menominee Nation, 2020).  Kaitlyn Kelly has been missing since June 17th (Conklin, 2020). There has been little mention of the missing and murdered Indigenous women in local or national media, particularly taking into account the extent of national and even global media attention drawn to the missing of Jamie Closs;  Closs went missing in the area where Embrace is located, but she was eventually located.

Given all this, dialogue from law enforcement and local officials indicating willingness and commitment to community safety and wellbeing would be helpful. Instead, the response of law enforcement to Embrace’s display of a Black Lives Matter sign intensifies tensions and mistrust between the police and the communities they serve. It also seriously undermines the vital work of the only shelter in a four-county area, further endangering the most vulnerable populations Embrace serves.

 Employing relevant theories to our practice as nurses and liaising with our colleagues across disciplines has now become urgent. Together with colleagues across disciplines, nurses need to support and advocate for survivors of violence. Screening and identification of resources for women is of utmost importance, and shelters like Embrace both ensure the provision of shelter and connect women with urgently needed health and social services. As nurse scholars, we wrote this blog post in collaboration with our colleagues at Women’s and Gender Studies at University of Wisconsin-Milwaukee as part of building coalitions. But we also did so for the purposes of deepening our understanding of the urgent healthcare challenges experienced by the most vulnerable across our state, in the context of the rising tensions and mistrust among various institutions and agencies that exist to enhance the health, wellbeing and safety of all Wisconsin communities.

Violence is central and even essential to the sustaining of social hierarchies that inform the oppression of some groups while enhancing the privilege of others (Collins, 2017). Patricia Hill Collins (2017) points out how without human agency and resistance, institutions can engage in bureaucracies that replicate power dynamics, and even perpetuate normalized violence that maintains dominance and inequities. Law enforcement is one institution, and healthcare, of which nurses are a part, is another.

Robin Walter’s theory of Emancipatory Nursing Praxis comes to mind as one that guides us towards allyship in advancing a social justice agenda in pursuit of health equity, which is central to ensuring the health and wellbeing of the most marginalized in our communities during this time. In order to advance a social justice agenda, there is need for nursing as a profession to partner closely with domestic violence advocates and shelters like Embrace as well as law enforcement officers, who play an important role in enhancing the safety and wellbeing of our communities. We must engage in research and dialogue that would help us reimagine a criminal justice response that acknowledges the context of racism in which Black and Brown women experience violence.

As professionals, we need to respond and to meet their urgent needs for health and safety. It has never been more urgent to engage in the learning processes that Walter outlines, critically reflecting on our social location in relation to those we serve, shifting our worldview and experiencing transformation by expanding our consciousness (Walter, 2017).

References

Campbell, J. C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, … & Laughon, K. (2003). Risk factors for femicide in abusive relationships: results from a multisite case control study. American journal of public health, 93(7), 1089–1097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447915/

Collins, P. H. (2017). On violence, intersectionality and transversal politics. Ethnic and Racial Studies, 40(9), 1460-1473. https://www.fbi.gov/news/stories/operation-cross-country/operation-cross-country

Conklin, M. (July 28, 2020). Searching for Katelyn Kelley: The 22-year-old Menominee woman is part of a crisis of missing Indigenous people that Wisconsin is just beginning to confront. Wisconsin Examiner.  https://wisconsinexaminer.com/2020/07/28/searching-for-katelyn-kelley/

Fortini, J.  (June 23, 2020). Chrystul Kizer, teen charged with killing abuser, is released on bond. The New York Times. https://www.nytimes.com/2020/06/23/us/chrystul-kizer-free-bond.html

Frazer, Eva et al. “The Violence Epidemic in the African American Community: A Call by the National Medical Association for Comprehensive Reform.” Journal of the National Medical Association vol. 110,1 (2018): 4-15. doi:10.1016/j.jnma.2017.08.009 https://pubmed.ncbi.nlm.nih.gov/29510842/

Gosangi B., Park H., Thomas R., Gujrathi R., Bay C. P., Raja A. S., …  Khurana, B. (2020). Exacerbation of Physical Intimate Partner Violence during COVID-19 Lockdown. Radiology, 202866, Epub ahead of print. https://pubs.rsna.org/doi/10.1148/radiol.2020202866

Luthern, A. (May 18, 2020). Milwaukee is seeing a spike in homicides, and nearly half of them are related to domestic or family violence. Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/crime/2020/05/18/milwaukee-homicides-nearly-half-linked-domestic-family-violence/3121220001/

Menominee Nation (October 22, 2020).  Press Release: Vehicle Arson and Discovery of Human Remains on Menominee Indian Reservation. Menominee Indian Tribal Newshttps://www.menominee-nsn.gov/NewsPages/NewsItem.aspx?NewsID=Vehicle%20Arson%20and%20Discovery%20of%20Human%20Remains%20on|10/22/2020

Richie, B. (2012).  Arrested Justice: Black women, violence and the America’s prison nation. NY: NYU Press.

Rosay, A. (2016). Violence Against American Indian and Alaska Native Women and Men. NIJ Journal, 277, 38-45.  Retrieved from:  http://nij.gov/journals/277/pages/violence-against-indians-alaska-natives.aspx

U.S. Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis (2017). Sex, Race, and Ethnic Diversity of U.S, Health Occupations (2011-2015), Rockville, Maryland.

Volpenheln, S. (June 29, 2020).  Wisconsin family calls for harsher charges in ‘heinous’ killing of Ho-Chunk woman.  Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/2020/06/29/wisconsin-family-calls-harsher-charges-homicide-ho-chunk-woman/3239543001/

Walter, R. (2017). Emancipatory nursing praxis. A theory of social justice in nursing. Advances in Nursing Science, 40(3), 225-243. Also see Walter’s Theory on Nursology.net

Acknowledgement:

We are grateful for the support and input of the following colleagues from Women’s and Gender Studies: Anna Mansson McGinty, PhD, Xin Huang, PhD, Kristin Pitt, PhD, Gwynne Kennedy, PhD, Melinda Brennan, PhD, & Jeremiah Favarah, PhD

About the contributors

Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.

Jeneile Luebke, PhD, RN is a post-doctoral nurse research associate at University of Wisconsin-Madison. She in an enrolled member of Bad River Band of Lake Superior Chippewa Indians. She received her early nursing degrees (LPN and ADN) in Bemidji, MN, and her BS and MS Nursing from the University of Wisconsin- Madison, and her PhD at UW-Milwaukee. Her area of research and expertise include intimate partner violence in the lives of American Indian women, community health nursing and utilization and application of postcolonial and indigenous feminist methodologies. She is a survivor of intimate partner violence and is passionate about sharing her knowledge and personal experiences to help to support and empower other women to transition to survivorhood.

Carolyn J. Eichner is Associate Professor of History and Women’s & Gender Studies at the University of Wisconsin, Milwaukee. She was a Member at the Institute for Advanced Study in Princeton, New Jersey, in 2015-2016. Eichner is the author of Surmounting the Barricades: Women in the Paris Commune (Indiana University Press); published in French as Franchir les barricades: les femmes dans la Commune de Paris (Editions de la Sorbonne). She has two forthcoming books: Feminism’s Empire, which traces the roots of nineteenth-century French anti-imperialism in the race, gender, and class politics of the era’s first French feminists to engage with empire; and A Brief History of the Paris Commune for the 2021 sesquicentennial of the 1871 revolution (Rutgers University Press). Eichner he is currently writing The Name: Legitimacy, Identity, and Gendered Citizenship. She has published in journals including Feminist Studies, Signs: Journal of Women in Culture & Society, French Historical Studies, and Journal of Women’s History

Kaboni Gondwe, PhD, RN is an assistant professor at University of Wisconsin-Milwaukee College of Nursing. Her research interests are on maternal and child health and she is focused on studying effects on how chronic life stressors moderates the effects of perinatal stress on preterm biomarkers in African American /Black mothers and Malawian Black mothers. She completed her PhD in Nursing from Duke University in 2018 where her research focused on relationship between preterm birth with postpartum stress and mother-infant relationship. She received her undergraduate degree and midwifery training from University of Malawi, Kamuzu College of Nursing and her Master in Nursing Education and Nursing Administration from Ohio University. 

Diane Schadewald, DNP, MSN, RNC, WHNP-BC, FNP-BC joined the faculty of the University of Wisconsin-Milwaukee, College of Nursing in 2013 and is currently a Clinical Professor. I have been certified as a Family Nurse Practitioner and a Women’s Health Nurse Practitioner since 1993. As a board-certified Women’s Health Nurse Practitioner, I have experience providing care for Black women as well as AI women who are at risk for or who have experienced IPV. Since working in academia, I have practiced in primary care and am currently working for an online nurse practitioner service. Prior to working in academia, I practiced in an OB/GYN clinic setting. I’m a co-author of Women’s Health: A Primary Care Clinical Guide which is in its 5th edition. I have also lectured on care of women who have experienced female genital cutting and IPV. I’m currently working on an educational research project about female genital cutting.

Peninnah Kako, PhD, RN, FNP-BC, APNP is an Associate Professor at the University of Wisconsin-Milwaukee (UWM) College of Nursing. Dr. Kako’s research focus includes improving health care access for underserved populations, issues affecting women living with HIV in sub-Saharan Africa. Her research also focuses on violence in the lives of women. Her research aims to contribute to efforts that meet primary and secondary HIV prevention needs in sub-Saharan Africa; and build sustainable, timely, and effective interventions to assist African women and their families in accessing treatment and managing chronic HIV illness. Clinically, Dr, Kako has served in underserved populations including corrections as a family nurse practitioner.

Jacqueline Callari-Robinson, BSN, RN is a Doctoral student at the University of Wisconsin, Milwaukee, School of Nursing, Research Assistant for Tracking our Truth, and an on-call SANE Nurse for United Concierge TELESAFE Program. Previously, Jacqueline was the Director of Sexual Assault Prevention and Statewide SANE Coordinator for the Wisconsin Coalition Against Sexual Assault and the Wisconsin Department of Justice. In that role, she developed the Wisconsin adult, adolescent, and pediatric SANE training courses. Jacqueline was also instrumental in the facilitation and creation of the Wisconsin Attorney General Sexual Assault Response Team (SART). Working collaboratively with SANE programs, law enforcement communities, and the Wisconsin Crime Lab, the AG SART addressed patient access to advocacy driven medical forensic care and the composition, handling, and processing of sexual assault kits. 

Brittany Ochoa-Nordstrum is set to graduate with a Bachelor’s degree in Sociology in the spring of 2021. As a recipient of a SURF (support for undergraduate research fellow) award, Brittany is working under the mentorship of Dr. Lucy Mkandawire-Valhmu on various projects pertaining to advocacy for marginalized communities of color. Brittany’s area of study is medical racism and its impacts on maternal mortality amongst African American women in Milwaukee. She is applying to Ph.D. programs across the country in Sociology and African Diaspora studies. As a third generation Mexican American, her life experiences often inform her passion for these areas of study. When Brittany is not researching, she is often involved in planning and organizing community grassroots demonstrations and fundraisers to benefit marginalized groups around the city of Milwaukee.

Nicole Weiss is a current graduate student at the University of Wisconsin-Milwaukee pursing a Masters of Sustainable Peacebuilding. Nicole is the project coordinator for the Department of Justice funded project: Tracking our Truth, Providing Access to Advocacy Driven Medical Forensic Care. She received her BA in International Studies at the University of Wisconsin-Milwaukee. Her areas of focus include undertaking a holistic, systems approach to complex issues within our community through facilitation and conflict resolution strategies.

Jacqueline Campbell, PhD, RN, FAAN is a national leader in research and advocacy in the field of domestic and intimate partner violence (IPV). She has authored or co-authored more than 230 publications and seven books on violence and health outcomes. Her studies paved the way for a growing body of interdisciplinary investigations by researchers in the disciplines of nursing, medicine, and public health. Her expertise is frequently sought by national and international policy makers in exploring IPV and its health effects on families and communities.

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.