A Theory of Parental Post-Adoption Depression: What’s New is New Again

Welcome to guest blogger Karen J. Foli, PhD, RN, FAAN,
Associate Professor,
Director, PhD in Nursing Program
Purdue University School of Nursing
Here she discusses the challenges of interacting with public media
about her theory of parental post-adoption depression (PAD)

Recently, I was contacted by journalists from Denmark and the New York Times. In both cases, they wanted to interview me about my middle range theory of parental terpost-adoption depression (PAD). I was honored to be asked about my work, but what struck me was a feeling of déjà vu. When my book, The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption (2004 and co-authored by John Thompson) was published and then followed by several empirically driven papers published in peer-reviewed journals (see references below), the press was out en masse.

It’s tricky talking to the press. I’ve made my share of mistakes and learned with every interview I’ve given. But back to the content of these interviews – parental post-adoption depression. The first questions I can count on are: “How does this compare with postpartum depression? What about hormonal changes? How common is PAD?” First, I try to explain that we now see postpartum depression as encompassing the perinatal time period. I describe how we really don’t know about hormonal changes with adoptive parents, but there are differences in the experiences of these two parent groups. In terms of prevalence, we’re not sure – my best estimate is 10% to 20% of adoptive parents may experience depressive symptoms.

Adoptive parents reach into society for a license to parent a child born to others. They go through a rigorous, invasive process during which they are waiting, and ultimately matched with an infant or child. Often, parents “sell” themselves as “super parents,” beings that set themselves up with high, often unrealistic expectations. Herein lies the heart of my theory: unmet expectations of themselves as parent, of their child, of family and friends, and of society and others, are associated with depressive symptoms. Based on my research, expectations of themselves are the hardest to meet.

The question becomes: how do nurses and nursology fit into this? Based on my research and writing (see also Nursing Care of Adopted and Kinship Families: A Clinical Guide for Advanced Practice Nurses), the answer is more than you would suppose. Social work is the historical and current default profession that we defer to when children are relinquished and for home studies that evaluate the fitness of adoptive parents. Yet we understand that adoptive children visit healthcare providers more frequently than birth children. Herein lies our opportunity as care providers to support families.

Many adoptive parents experience significant shame when they struggle with PAD. Sometimes, when they share their feelings, they will be met with: “But isn’t this what you’ve wanted?” Nurses in myriad specialty areas can make a positive impact. Pediatric nurses can assess the dynamics between the child and parent and look for cues of impaired or delayed bonding. Nurses providing care to older adults can also assess for PAD – relative placements in foster care and in informal arrangements are surging (also known as kinship caregivers). Primary care providers have multiple opportunities to look for signs of parental depressive symptoms post-adoption and ask about expectations that were or were not met.

To end, when parents experience depression, we know the kids suffer too. Nurses can be savvy caregivers to this special and vulnerable group of parents and their children. While this blog is too brief to relay all that we know about PAD, it’s a welcomed beginning.

References

Foli, K. J., Lim, E., & South, S. C. (2017). Longitudinal analyses of adoptive parents’ expectations and depressive symptoms. Research in Nursing and Health, 40(6), 564-574. doi: 10.1002/nur.21838

Foli, K. J., Hebdon, M., Lim, E., & South, S. C. (2017). Transitions of adoptive parents: A longitudinal mixed methods analysis. Archives of Psychiatric Nursing31(5), 483-492. doi: https://doi.org/10.1016/j.apnu.2017.06.007

Foli, K. J., South, S. C., Lim, E., & Jarnecke, A. (2016). Post-adoption depression: Parental classes of depressive symptoms across time. Journal of Affective Disorders200, 293-302. doi: 10.1016/j.jad.2016.01.049

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2016). Longitudinal course of risk for parental post-adoption depression using the Postpartum Depression Predictors Inventory-Revised.  Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(2), 210-226doi:10.1016/j.jogn.2015.12.011

Foli, K. J., Lim, E., South, S. C., & Sands, L. P. (2014). “Great expectations” of adoptive parents: Theory extension through structural equation modeling. Nursing Research, 63(1), 14-25. doi: 10.1097/NNR.0000000000000006

Foli, K.J., South, S.C., & Lim, E. (2014). Maternal postadoption depression: Theory refinement through qualitative content analysis. Journal of Research in Nursing, 19(4), 303-327. doi: 10.1177/1744987112452183

South, S. C., Foli, K. J., & Lim, E. (2013). Predictors of relationship satisfaction in adoptive mothers. The Journal of Social and Personal Relationships30(5), 545-563. doi: 10.1177/0265407512462681

Foli, K. J., Schweitzer, R., & Wells, C. (2013).  The personal and professional: Nurses’ lived experiences of adoption. The American Journal of
Maternal/Child Nursing, 38
(2), 79-86. doi: 10.1097/NMC.0b013e3182763446

Foli, K. J. South, S. C., Lim, E., & Hebdon, M. (2013). Depression in adoptive fathers: An exploratory mixed methods study. Psychology of Men & Masculinity, 14(4), 411-422. doi: 10.1037/a0030482

Foli, K. J., South, S. C., Lim, E., & Hebdon, M. (2012). Maternal postadoption depression, unmet expectations, and personality traits. Journal of the American
Psychiatric Nurses Association
18(5), 267-277. doi: 10.1177/1078390312457993

Foli, K. J. (2012). Nursing care of the adoption triad. Perspectives in Psychiatric Care, 48(4), 208-217. doi: 10.1111/j.1744-6163.2012.00327.x

Foli, K. J., South, S. C., & Lim, E. (2012). Rates and predictors of depression in adoptive mothers: Moving toward theory. Advances in Nursing Science35(1),
51-63. doi:10.1097/ANS.0b013e318244553e

Foli, K. J., & Gibson, G. C. (2011).  Training ‘adoption smart’ professionals.  Journal of Psychiatric and Mental Health Nursing, 18(5), 463-467. doi:  10.1111/j.1365-2850.2011.01715.x

Foli, K. J. & Gibson, G. C. (2011).  Sad adoptive dads:  Paternal depression in the post-adoption period,International Journal of Men’s Health10(2), 153-162. doi: 10.3149/jmh.1002.153

Foli, K.J. (2010). Depression in adoptive parents: A model of understanding through grounded theory. Western Journal of Nursing Research, 32, 379-400. doi: 10.1177/0193945909351299

Foli, K. J. (2009). Postadoption depression: What nurses should know. American Journal of Nursing, 109, 11. doi: 10.1097/01.NAJ.0000357144.17002.d3

What makes a theory or model “nursing”?

To our readers: the Nursology.net blog exists to prompt thoughtful discussion of critical issues related to the development of nursing knowledge.  We welcome your thoughts, challenges, alternative points of view, and critical questions!  Do not hesitate to comment on this or any other post at any time!  You are our “peer reviewers” and your perspectives contribute to all in our nursology.net community!

I am often asked (as are many of my colleagues):  What makes a theory or model a nursing theory or model?  This question is close to the challenge that I addressed in my keynote address in March at the Case Western Reserve Frances Payne Bolton School of Nursing Theory conference.  This question deserves serious reflection and discussion, because how each of us responds to this question is at the heart of what we envision for our discipline moving forward. In my keynote, I noted that various definitions of nursing as a discipline point to two essential matters: 1) knowledge of the human health experience, and 2) knowledge of nursing healing [well-becoming] actions.  Here I explore the issue of nursing theories and models, and propose that like the definitions, nursing theories and models are characterized by a focus on these same two essential characteristics.

One reason that questions concerning the nature of nursing theory keep surfacing is the fact that so many nurses who embarked on activities related to the development of nursology (nursing science) were educated to be scholars (researchers, theory developers) in fields outside of, but related to nursing.  There are contemporary nurses who opt to pursue their preparation for scholarship in other disciplines, influenced by the appeal of certain lines of inquiry that are already well developed in another discipline, and recognizing the significant connection between nursing’s interests and the interests of other lines of thought.  When I say “related” what I mean is that the gaze of these other disciplines is certainly pertinent to what concerns nursing, but the central concern of nursology is not actually “at the center.”  When a nurse scholar’s central focus is on the periphery, it is likely to be better placed within the scope of another discipline.

Sally Thorne (2014) has addressed this tension often in her work, most specifically in her chapter that appears in the text “Philosophies and Practices of Emancipatory Nursing.” In this chapter titled “A Case for Emancipatory Disciplinary Theorizing” (pages 79-90), Dr. Thorne pointed to the habits of “false dichotomizing” and the allure of borrowing theories from other disciplines, both of which lead to valorizing constructions from other disciplines, while neglecting the distinct focus of nursing. False dichotomizing, in the the case of social justice concerns, is the tendency to pigeon-hole a theory as either being focused on “the individual” or on “the community” (social justice), failing to recognize that from the earliest days of theorizing in nursing, scholars have explicitly embraced both the individual and the community and the  social injustices that require nursing action.  Likewise, immersion in and borrowing from the theoretical traditions of other disciplines can lead to neglect of the complex social mandate that is central to the discipline of nursing.  Unlike other disciplines, many of which focus on building knowledge as an end in itself, nursing’s mandate to act shifts the disciplinary focus so that knowledge related to a phenomena must include a focus, or point the way to “right” or “good” nursing action.  I have addressed the challenge in nursing of developing theory with this extremely complex perspective as one of the reasons for turning to theory in other disciplines, where the focus is more limited, and this complexity is typically unacknowledged and undeveloped or underdeveloped.  (see “Thoughts About Advancement of the Discipline: Dark Clouds and Bright Lights”)

From my perspective, regardless of the theorist’s background, or the origin of methodological approaches, what defines a theoretical construction as nursing arises from a clear orientation to the values and priorities of the discipline – the direction in which nursologists focus their “gaze.”  The focus of nursing must include the two elements that centrally define our discipline: knowledge of the human health experience, and knowledge of nursing actions leading to health and well-becoming.

Every discipline has the right and the responsibility to define and to conceptualize its own knowledge, domain, practice – the field which it covers. Of course people from other disciplines, and the public, have a responsibility to challenge the discipline in any way that is needed – a process that contributes to the ongoing development of the discipline. This process was prominent during the early phases of feminist thought in which feminist scholars from all disciplines developed a “gaze” focused on the rights and well-being of women, challenged the parameters, assumptions and practices of their own, and other disciplines as well. This led to vast changes for the better in all of the sciences and the humanities.

Where nursing is concerned, or more specifically nursology, disciplinary knowledge must derive from those who have been immersed in the history, philosophy, theory, and the practices of the discipline – something that is required for any discipline. Even though, for example, I do know a lot about the field of educational psychology where I earned my PhD degree and where I completed many courses in psychology and educational psychology, I do not have the background and experience to even begin to claim that I could contribute to the knowledge base of that discipline. I have used theories and insights from other disciplines in my own work contributing to the discipline of nursing, but that is quite a different kind of scholarship than would be required to contribute to the discipline of psychology (or sociology, or anthropology, etc.). My own theorizing in nursing reflects my educational psychology background, particularly the work of Brazilian educator Paulo Friere.  While the very relevant focus of Friere’s work is on human liberation from oppressive conditions, in my work the focus shifts to the health experience involved in group interactions,  conditions which influence, perhaps even threaten human health and well-being.  Health-promoting group interactions in my work draw on the methods of Friere’s  liberation theory,  but are specifically directed toward creating group actions and interactions that are life-affirming, nurturing, and support human well-becoming.

I do not think it is helpful to dwell on the simple fact of whether or not a person contributing to the knowledge of the discipline is a nurse — not all nurses are prepared to contribute to the knowledge base of the discipline, nor should they be expected to. And there are certainly nurses whose “gaze” is directed primarily on phenomena that are rooted in other disciplines.  The key to me is where a theory or model focuses the gaze – what phenomena are central, and are those central ideas consistent with the defining focus of the discipline.  I find it difficult to imagine how someone could contribute to nursing knowledge without a nursing background, or without experience in nursing healing/ well-becoming actions, as well as a background in the history and foundational knowledge of the discipline.  Beyond this essential background from which the theoretical ideas emerge, nursing theories and models are defined by the substantive focus on the phenomena of the experience of human health and well-being, and the dynamics that contribute to nursing healing and well-becoming practices.   As we have demonstrated in gathering together for this website information about the theories and models we do have, there are many more than many nurses have as yet imagined!  But the task of clearing our mental images to more fully appreciate the possibilities in the development of the knowledge of our discipline is a huge challenge, and further focusing our gaze on these possibilities and priorities is at the heart of what matters for our own discipline.

Moving Towards the Next Fifty Years Together

We are delighted to welcome guest bloggers representing the  Nursing Theory Collective
formed March 2019 Case Western Reserve
Nursing Theory Conference:
Chloe Littzen, Jane Hopkins Walsh  and Jessica Dillard Wright

I. Introduction

Chloe Littzen

Jessica Dillard-Wright (L) and Jane Hopkins-Walsh (R)

In March 2019, 130 nurses from all over the world gathered at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio for Nursing Theory: A 50 Year Perspective, Past, and Future, a landmark conference to celebrate the history of nursing theory and elicit discussion for the future of nursing. The attendees were diverse, comprised of seasoned nursing theorists and doctoral students in equal measure, participating in lively and thoughtful conversation across many domains. The future of nursing theory quickly emerged as a critical issue as nurses working at all levels of expertise expressed their concern over the loss of nursing theory at the institutional level, both academic and clinical. What is at stake in this erosion is discipline-specific nursing knowledge, in particular at this 50-year juncture as the great theorists of nursing like Drs. Peggy Chinn, Joyce Fitzpatrick, Pamela Reed, Callista Roy, Marlaine Smith, and many others approach the end of their illustrious careers. The question resonated, “who will carry the nursing theory torch forward?”

To advance the discipline of nursing, the next wave of nursing theorists and thought leaders must actively engage to advance nursing theory, improve nursing praxis, and articulate nursing’s identity leading our profession into the future. This is the rallying cry that led to the blog post you are reading today. In follow-up to this conference, doctoral student Chloe Littzen engaged other students who attended to embark on a collaborative effort to articulate our vision for the future of nursing theory. What follows is a brief discussion of our course so far, the background, plan, and desired outcomes for convening a nursing theory working group as we envision the next fifty years of nursing theory and beyond.

lI. Background

After the landmark conference concluded, a collaborative effort ensued to form a theory working group focused on promoting nursing theory and advancing nursing’s identity. This group is comprised of both scholars and students and is open to all nurses practicing in all settings. Our first meeting was held online via video-conferencing on May 18th, with a total of six participants from Arizona, Massachusetts, and West Virginia. This first meeting was an experimental think-tank where we considered ideas about the future of nursing and our professional identity. Below, we outline our mission and vision for this nursing theory working group.

III. Plan

The primary mission, as established by our working group, is to promote nursing theory and advance the identity of nursing through knowledge development for all nurses in all settings, including practice, education, research, and policy. As a group, we believe that nursing and nursing theory are dynamic and evolving to meet the needs of an increasingly complex healthcare landscape and global environment. In order to keep nursing theory and nursing relevant and current, thinking about theory must be on-going and iterative, with a continuous cycle of critique, testing, and scholarship. Failure to seriously engage these questions has dire consequences for nursing theory and the profession as nursing as it slowly cedes its identity to the economic pressures of the healthcare environment and the supremacy of biomedicine.

The following bullets summarize our discussion and desired outcomes from the first nursing theory workgroup meeting:

  • Discussion Points:
    1. We need a plan to sustain and evolve nursing theory and nursing’s identity with discipline-specific knowledge.
    2. Nursing theory must be derived from and applicable to the practice environment, not just academia.
    3. The purpose of nursing theory must be clarified for nursing practice, education, research, and policy.
    4. Nurses in clinical practice must have an educational foundation grounded in nursing theory that empowers the application of theory in practice.
    5. Nursing students must be educated and mentored in nursing theory, beginning at the pre-licensure level.
    6. This discussion must include considerations of how nursing theory is taught in the academic environment and how that can be linked to and informed by nursing practice.
    7. The need for nursing theory is global, making this an international, even planetary problem.
  • Desired Outcomes:
    1. To write a manuscript demystifying nursing theory for the nurse in the practice environment.
    2. Write a second manuscript demystifying nursing theory for the nurse educator in academia.
    3. Explore the potential of a future study identifying and describing the barriers and facilitators for using nursing theory in practice, education, research, and policy settings.
    4. Share the discussions, experiences, and findings with the community at Nursology.net.

IV. Invitation – Join us!

While we are a new workgroup, we welcome and encourage all nurses, both advanced scholars and novice theorists alike, to consider joining us in this journey in promoting nursing and nursing theory into the future. We currently meet monthly over Zoom video-conferencing. If you are interested, please contact form below to be placed on the email list for future meetings and content.

If you are planning to go to the 2019 Collaborative K.I.N.G. conference in Washington D.C. from November 14th-15th, we are planning an in-person meeting to take place. We hope to see you there as we drive nursing and nursing theory into the future. Join us!

With optimism and gratitude for the future,
Nursing Theory Collective
(Final group name pending vote at next meeting)

Footnotes:

See more information on the King Conference here.

See more information on the landmark theory conference at Case Western Reserve University Frances Payne School of Nursing here.

Please use this form to contact us if you want to join us, or for more information!

Why Nursology?: The Perspective of an International PhD Student

Guest contributor: Toqa Alanby

Toqa Alanby

Hello, my name is Toqa Alanby MSN, BSN, RN, from Saudi Arabia, a full-time nursing PhD student in Christine E. Lynn College of Nursing at Florida Atlantic University. I have chosen to begin the pursuit of my academic career in Nursing with a sense of determination. Through my B.Sc. in Nursing from Umm Al-Qura University (Mecca, Saudi Arabia), my English program at INTO University of South Florida (Tampa, Florida, US), and my M.Sc. in Nursing from Trinity College Dublin, University of Dublin (Dublin, Ireland), I have dedicated my life to advance my nursing knowledge and skills.

I was introduced to the Nursology website by Dean Marlaine Smith, my advisor, as she said, “websites are vehicles to assist us in coming to know an organization.” The Nursology website is a quantum leap in nursing. Nurse scholars, nurses in clinical settings, and postgraduate students, all of them, can be involved by joining or just by browsing this site. It was designed and maintained by nurse scholars with sufficient experience who can enrich the nursing profession throughout the world. For me as an international PhD student who came from a different background, I found it as a repository for sources about nursing conceptual models, grand theories, middle-range theories, and situation-specific theories, philosophies and related methodologies. It is momentous to nursing practice, education and scientific research because it is a guide to what is already known and what further knowledge and skills are required. Also, I found it as a station that can connect to the pioneers of the nursing profession, a link to enable us to communicate with them easily.

Exploring the website, gave me a better understanding about the history of nursing in the United States. Furthermore, it reminded me of how nursing started in Saudi Arabia. In both cases war had an impact on the development of nursing. For instance, the first mention of nursing in Saudi Arabia was during the time of the Prophet Muhammad in the service of the Muslim armies during periods of war. Women accompanied veterans as companions and caretakers. According to Jan (1996) nursing activities carried over into peacetime when the women served as midwives and continued to nurse the sick and dying.  Subsequently nursing concepts emerged to inform this practice.

Nurses, nursing students and other health professionals understand and view nursing differently. Many definitions have been used to define the concept of nursing. Sapountzi-Krepia (2013) justifies this diversity due to different educational backgrounds, cultures and experiences. Now that nursing is based on the interaction with others, caring appears as one of its central concepts. The concept of care emerged during the decade of the 1950’s; however many factors hampered its progress. It was not until two decades later that not only the first National Caring Research Conference but also the publication of Leininger’s and Watson’s theories stimulated the interest of researchers in the concept (Brilowski & Wendler, 2005). Caring seems to be inherent to nursing practice and originates from respect and concern for the patients, which is a skill that evolves with experience. As for my culture, caring from the Islamic perspective refers to a critical, reflective analysis of what we think we know about our universe and ourselves. Saeed (2006) mentioned that the Islamic philosophy is rooted in the attempt to understand reality rationally. The Qur’an, the Holy book of Muslim faith, and the Sunnah, which documents the life and practices of the prophet, built the Islamic belief system.

Outside of the nursing community, when I talk about nursing science, I always have been asked what distinguishes nursing science from other disciplines? Cowling, Smith & Watson. (2008) answered this question by stating that there are 3 fundamental concepts which are wholeness, consciousness, and caring singled out and positioned in the disciplinary discourse of nursing to distinguish it from other disciplines. In my opinion, nursing implies an intentional activity, attitudes and feelings that shape the professional interaction established between nurses and patients.

Having an understanding of these perspectives will inform health professionals to achieve cultural competence and deliver care that is culturally sensitive (Rassool, 2014). Individualized, holistic care can be achieved by apprehending culture, beliefs and ethnicities, and a display of cultural competence. I saw Dr. Sadat Hoseini’s model on the Nursology website as a model that comes from a Muslim perspective. It is wonderful and informative. However, there is a great diversity of cultural, tribal and linguistic groups among Muslim societies, each of which has its own cultural characteristics and worldview of well-being and sickness. Delivering nursing care to Muslim patients means having an insight of Islamic faith and Islamic beliefs. Thus, what goes on in Saudi Arabia is totally different from what Dr. Hoseini’s model looks for. She is from a different culture, country, and doctrine.

Based on my experience, non-Muslim nurses who work in my country are not able to utilize the existing knowledge and framework of health from Islam to enhance the nursing profession. The inability to shape nursing practice, education, and policy from an Islamic perspective can be attributed to multiple factors such as social status of nursing in the country, professional identity of nurses, and societal approval and recognition (Ismail et al., 2015). Therefore, the professional development of nursing among Muslim nurses is based on utilizing Western practice, education, and ethical models instead of integrating the holistic view of Islam (Gharaibeh & Al-Maaitah, 2012). The curricula of our colleges in Saudi Arabia still follow the theories that come from the United States (F. AlShaibany, personal communication, April 25, 2019). Though, in general, the development of nursing theories and models are almost neglected in Saudi Arabia, whether in education or practice. While nursing students know about nursing theories, they most likely don’t see them as a part of their practice. They also tend more to use theories from other disciplines such as change theories instead of nursing theories.

I was eager to explore nursing from another perspective and the Nursology website was a vehicle to achieve this purpose.  The Western concept is the most visible and distinctive in the site. I believe this site will be a real connection for other nurses around the world to the study of Western nursing. Thus, I hope one day to join the great scholars here to advance Nursology forward and perhaps contribute by sharing my theoretical work from a different cultural point of view. My goal is to embark on an academic career and to conduct research.  In other words, scholars absorb and integrate information coming from the world around them as they create their own work. The role they play calls for the development and maintenance of collective learning and comprehension. A scholar’s work, according to Boyer’s (1990) definition, calls for taking a step backwards from the investigation, searching for connection, and bridging the gap between theory and practice while having one’s knowledge communicated effectively (p.16).

Being able to comprehend and associate with nurses of different cultures is vital for nursing advancement. Understanding cultural differences among nursing perspectives is essential. By educating ourselves about different cultures through communication with diverse nurses in conferences, organized meetings, and engagement with a website like Nursology can prepare us well to broaden our perspectives on nursing knowledge from all over the world in multiple cultures.

References

Boyer, E. L. (1990). Scholarship reconsidered. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching.

Brilowski, A., & Wendler, C. (2005). An evolutionary concept analysis of caring. J Adv Nurs (50), 641-50.

Cowling, W.R., Smith, M.C. & Watson, J. (2008). The power of wholeness, consciousness, and caring: A dialogue on nursing science, art, and healing. Advances in Nursing Sciences, 31(1), 41-51.

Alshaibany, F. (2019, April 25). Personal Interview.

Gharaibeh, K. & Al-Maaitah, R. (2012). Islam and Nursing, in Religion, Religious Ethics, and Nursing. Spinger New York, NY. p. 229-249.

Ismail, S., Hatthakit, U., & Chinawong, T. (2015). Caring science within islamic contexts: a literature review. Nurse Media Journal of Nursing, 5(1), 34. doi:10.14710/nmjn.v5i1.10189

Jan, R. (1996). Rufaida Al-Asalmiya, the first Muslim nurse. Image: Journal of Nursing Scholarship, 28, 267-268.

Rassool, G. H. (2014). Cultural competence in caring for Muslim patients. Palgrave Macmillan.

Saeed, A. (2006). Islamic Thought: An Introduction. New York, USA: Routledge.

Sapountzi-Krepia, D. (2013). Some thoughts on nursing. Int J Caring Sci (6), 127-133.

Tribute to our Nurse Friends!

We welcome this guest post by Shannon Constantinides, MSN, NP-C, FNP, UCHealth Primary Care,  PhD Student, Florida Atlantic University.  Shannon also contributed the content on Jane Georges’ Theory of Emancipatory Compassion

Shannon Constantinides

In trying to explain to my husband (an osteopathic physician) why Nurses’ Week is an important week, I asked him, “Do you ever notice that I have my “friends” … but that I also have my “nurse friends?” He looked back at me, a bit quizzically, shrugged his shoulders and said, “yeah…? I guess so?” In a conversation a day or so later, he said, “Now that you’ve mentioned it, I guess I have heard you mention your Nurse Friends.” He then gave me a somewhat perplexed look and said, “I have friends who are physicians, but I don’t think I have Physician Friends. At least not in the way you talk about your Nurse Friends.” You’re right, my dear, you don’t.

From the inception of the profession, nurses have been working together, side by side in the figurative and literal “trenches.” Whereas our physician colleagues are trained to be the lone wolves, or as I’ve heard it described, “the captain of the ship,” nurses are from the onset of training, trained to work as part of a team.

This Nurses’ Week, I set an intention to celebrate and honor all my Nurse Friends. To me, Nurses’ Week is a reminder about the joy we find in work – not just the experiences that arise from patient care – but also joy we find from the relationships we’ve built with one another along the way.

In 2018, I had the honor and privilege to interview Dr. Jane Georges, Dean of the Hahn School of Nursing at the University of San Diego and the author of the Emancipatory Theory of Compassion. During the course of our conversation, we got onto the topic of finding joy in work and Nurse Friends. Until Dr. Georges pointed it out, I hadn’t given much thought to the concept of Nurse Friends. My mom, a 30-year NICU RN, had Nurse Friends. Dr. Georges’ mother was also a nurse who had Nurse Friends. “NurseFriends” was simply a word we’d always known, because we both grown up with the knowledge that there are two kinds of friends: your friends, and your NurseFriends.

In discussing ways in which we can recapture joy in work and joy in nursing, Dr. Georges circled back to the concept of NurseFriends and the deep connection nurses share with one another; the connection that allows us to find so much meaning in what we do. “I call it the nurse-nurse bond,” Dr. Georges said, “It’s knowing that we can’t do it alone, which is one of the most beautiful parts of nursing.” In recalling some of the most healing environments in which she’d worked, Dr. Georges commented on the presence of joy, respect, and connection with other nurses.

“We just had this crew,” I mentioned as I reminisced about a group night-shift NurseFriends I worked with during my tenure working in an emergency department. Dr. Georges agreed, “I think the idea of the nurse-nurse bond, or NurseFriends, is worth exploring… how do we build back that community where we’re not adversarial to each other?” I think that the answer lies within ourselves and within the community of our discipline: building up our NurseFriends to strengthen one another, to strengthen the profession, to strengthen ourselves, and ultimately, to strengthen the care we give our patients.

Two years ago, I had to tell a NurseFriend who’d become my primary care patient that I’d found lymphoma on her MRI. That was one of the worst days of my professional career. I remember sitting in my office, sick to my stomach. Delivering bad news to a patient is never easy; delivering bad news to a NurseFriend will break your heart.

This NurseFriend is doing great. Her cancer is in remission. She’s healthy. She’s now the clinical manager of my primary care office. I’m lucky: we caught her cancer early, got her great treatment, and I get to see her smiling face every day.

To all of my NurseFriends, thank you for sharing your light with me. You are my heros not just during Nurses’ Week, but every week!

Honoring our Heritage, Building our Future

Today we are adopting a new nursology.net tag line “Honoring our Heritage, Building our Future” in concert with the annual focus in May of each year on nursing and nurses, anchored around  Florence Nightingale’s birth date – May 12, 1820. Almost 100 years later, nursology theorist Martha E. Rogers was born on the same date in 1914.  These two giants of nursology history, and many others, have built the foundation from which we move forward in the quest to understand human health experiences.  We have asked members of our nursology.net management team to share particular “heritages” that stand out for them as significant. Here are our responses:  

Leslie H. Nicoll – The Nursing Editors History Project

Leslie Nicoll

A few years ago, Peggy Chinn and I had an “Aha!” moment when we realized there was no archive or complete listing of the women and men who have served as editors of scholarly nursing journals. We believe this is a serious omission and sought to create such a resource and thus, the Nursing Editors History Project (NEHP) was born. The NEHP is a venture between the Dolan Collection at the School of Nursing at the University of Connecticut; along with Peggy and me, Carol Polfroni is providing leadership to the project. You can visit the site at nehp.uconn.edu.

If we consider Florence Nightingale to be the founder of nursology, then our profession is relatively young, spanning less than 200 years. There has always been a focus on education and scholarship in nursology; the first disciplinary journals were published starting in the 1880s. In the US, the American Journal of Nursing published its inaugural issue in 1900. It has been published continuously ever since. Other journals with long and distinguished histories include Sygeplejersken (“The Nurse,” in Danish, since 1901); the Canadian Nurse (Canada, 1905); Nursing Times (United Kingdom, 1905); Kai Tiaki Nursing New Zealand (1908); and the Philippine Journal of Nursing (1926).

Editors of professional journals play an important role as gatekeepers of practice innovations, research findings, and other information that is disseminated through the published literature. The impact of the editor is profound and influential. Given that, you might think that an easy-to-use listing of editors would have been maintained over the years–but it has not. In the absence of such a list, you might think you could go to the online home of a journal and search through the digitized collection to find editor information. Go ahead and try to do that. You will find, as we did, that journal archives include that published articles but they do not include the “front matter,” that is, the pages that list the editor, associated editorial staff, editorial board members, and information about the publisher. Thus, the archive for a journal represents just one dimension of the publication. What is missing is the knowledge of the people who were in charge, in particular, the editor–whose voice was important, influential, and must be heard.

The NEHP has been growing slowly. At present, it includes 34 journals with publishing histories ranging from 100+ years to 9. We have learned that tracking down editor information–especially for some of the older journals–takes time and effort. Finding pictures is even harder! This realization has impressed upon us the importance of the NEHP and the need to capture this information before it disappears completely. Our goal is to be comprehensive, both at the individual journal level as well as in the breadth of nursology journals that are included in the NEHP. We welcome submissions to the NEHP from editors, publishers, and librarians. When submitted information is comprehensive and accurate we are able to quickly list the journal in the database. You can read more about the process here: https://nehp.uconn.edu/submissions/

Florence Nightingale was a meticulous data collector, prodigious correspondent, and author of books and articles. As far as I can determine, she was never a journal editor, but I am sure she held the editors those journals published in her life in high esteem–as we should. The NEHP truly “honors our heritage” by capturing essential information about the leaders of scholarly publication in nursology.

Adeline Falk-Rafael – Returning to our Roots

Adeline Falk-Rafael

It is only fitting that we honor nursing’s past each year around the time of Florence Nightingale’s birthday.   She was a remarkable woman and visionary. In many ways, she reflected the thinking of her day, i.e., that social, economic, and political factors greatly influenced (often adversely in vulnerable populations) the potential to be healthy. She believed that compassion, therefore, must include social and political activism focused on changing laws and the conditions that adversely affected health for many and  led by example (Falk Rafael 1999). Many examples have been documented and extend beyond policies in the UK to international efforts (Falk-Rafael 2005).  Nightingale’s focus on promoting the health of populations was evident in the first nursing program she established, in which one entire year was dedicated to health nursing of communities.

Her model of health nursing, including social and political advocacy influenced early nursing leaders elsewhere in the world, as well.  I know first hand of her influence in Canada, e.g, in the work of the Victorian Order of Nurses, and the U.S., in the work of Lillian Wald who added the word public to health nursing. She and other nurses of the Henry Street Settlement (more information here)  followed Nightingale’s example in advocating for social and political reform to create conditions that were more conducive to health (Falk-Rafael 2005) .  I hope nurses from other parts of the world will add  further examples of Nightingales influence on nursing elsewhere.

Finally, honoring our heritage  must, I believe include those women who provided nursing and health care before or during Nightingales time. Mary Seacole, was a Jamaican nurse who also cared for soldiers in the Crimean War. In Canada, centuries before Nightingale, women in religious orders and pioneer women, such as Jeanne Mance in the 17th and 18th century provided nursing care to communities. They also understood the necessity of advocating for laws and societal reforms to move toward social justice and health equity.  And, I think of the nurses who fought for womens rights and the abolition of slavery like Sojourner Truth  and Harriet Tubman. Many others are also profiled on the Nurse Manifest Gallery of Activism Inspirations.

Our heritage is nursing practiced from a nursing paradigm before the rise of a dominant biomedical model that can shape and limit our conceptualizations of health and its promotion. We can learn from the examples of those who have gone before. I believe that Nursology, by making visible the nursing science which informs nursing practice can help nurses reclaim their authentic nursing identity.

Jacqueline Fawcett – Florence Nightingale’s Contributions to Martha E. Rogers’ Thinking and Development of the Science of Unitary Human Beings

Jacqueline Fawcett

Martha E. Rogers (1992) contributed a marvelous essay to the Commenorative edition of Florence Nightingale’s classic book, Notes on nursing: What it is and what it is not. She began her essay with these words:

Florence Nightingale’s Notes on Nursing is an exciting and far-reaching compendium of ideas and statements concerning the purposes and scope of nursing, the essentials of good nursing practice, and the variety of providers of nursing that existed in her purview. With consummate skill and cogent humor, she decries the fallacies of health practices and the superstitions that existed among the public and in particular health workers. (p. 58)   

Rogers went on to point out that much of what Nightingale wrote is as relevant today as it was in the middle 1800s. She noted that Nightingale’s vision of the need for “human compassion, a broad knowledge base, intelligent reasoning, and understanding” (p. 58) were particularly relevant in the 1990s, and I will add, are even more relevant—indeed crucial—in the 21st century.    

Furthermore, Rogers (1978, 1992) traced her own dual concern with human beings and their environments to Nightingale. She explained, “Rogerian science of irreducible human beings provides a framework rooted in a new reality and directed toward moving us from what might be called a pre-scientific era to a scientific era. Certainly Nightingale laid a firm foundation for this kind of an approach to nursing knowledge and its use” (Rogers, 1992, p. 61).

oward the end of her essay, Rogers (1992) further emphasized the importance of Nightingale’s work for all of us today. She wrote that Nightingale’s ideas not only are meaningful today but also provide a firm foundation as nurses move forward in the development of nursing as a science in its own right, and make way for knowledgable directions that enable nurses to practice based on their own phenomena of concern. It is the uniqueness of nursing that makes it important, not the ways in which it is like other fields.

Rogers (1992) concluded that section of her essay by exhorting us to carefully consider Nightingale’s comment “that medicine and nursing should never be mixed up, since it spoils both” (p. 61).

I am certain that both Florence Nightingale and Martha E. Rogers would agree that the proper name for our discipline is nursology and that the members of the discipline are appropriately referred to as nursologists. I also am certain that both would applaud the development of nursology.net as a repository for all things theoretical in nursology!

References

Rogers, M. E. (1978, December). Nursing science: A science of unitary man. Paper presented at Second Annual Nurse Educator Conference, New York. [Audiotape.]

Rogers, M. E. (1992). Nightingale’s notes on nursing: Prelude to the 21st century. In F.N. Nightingale, Notes on nursing: What it is, and what it is not (Commemorative edition, pp. 58–62). Philadelphia: Lippincott.

Marlaine Smith – Standing on the Shoulders of the Giants of Nursology

Marlaine Smith

As we approach the birthdays of Florence Nightingale and Martha Rogers on May 12th I’m reminded that we are standing on the shoulders of the giants of nursology.  What is my responsibility as I stand on these shoulders? First, is to acknowledge and cite the work of the giants who have come before us. At times I hear newer ones to our discipline speak of a great new idea or concept that I know was actually something that was advanced by previous scholars and is in the literature.  This certainly is not the fault of the newer members coming into our professional discipline. It is our responsibility of faculty and mentors to expose students of nursology to the wisdom of our heritage. As Peggy Chinn admonished us in her blog, let’s  get rid of the instructions to students that they should only review the past five years of the literature.  Our students need to be introduced in the most engaging way to the seminal writings of our foremothers and forefathers.  Would any undergraduate psychology student not be introduced to  Freud, Piaget, Erikson? Absolutely not! Our challenge is to create opportunities for the past work of our scholarly giants to come from the shadows into the light.  In my BSN program I was briefly introduced to Florence Nightingale…just by name…Do you know what I remember? …only that I heard that Florence Nightingale died of syphilis.  While this is not true, that myth was propagated widely and it diminished us. When I began my Masters program I had to read Notes on Nursing as part of my theory course.  I was filled with amazement and pride that this courageous, brilliant woman discovered the human-health-environment-caring connections that ground nursology today.  Let’s give this gift to our students by studying the giants of the past. By standing on the shoulders of the giants of nursology we can reach lofty heights. The most beautiful buildings need strong foundations.  They cannot exist without them. In order to build our professional discipline to new heights we must build on our disciplinary, theoretical foundations. In this way, we are truly building NURSOLOGY. This doesn’t mean staying within the limits of the past.  We are free to innovate, create, change, renovate, regenerate as we reach for the possibilities of what nursology can bring to the world.

 

The problem with the 5-10 year “rule” for citations

Recently I have encountered more and more students who tell me that their advisors are indicating that all of their citations be within the past 10 years – preferably the past 5.  This is one of many damaging myths about scholarship and writing that I encounter (the other most common is to never use personal pronouns – wrong – see “Finding Your Voice“).  I am not sure where the notion comes from that citations must be limited to only the most recent, but in nursing in particular, this is especially damaging to the development of our discipline.  Of course as scholars we all want to know that an author has thoroughly investigated the very latest writings related to their topic, and the fact is that by the time a work is published in a journal or book, any literature cited is already fading into the distant past.  So of course currency is vital, but today becomes yesterday very fast!

The problem is that only indicating the most recent background renders any work void of the context, the roots, the historical perspectives that bestow wisdom and understanding. The work becomes sterile and relatively meaningless, regardless of how valuable it might be for the present. In a particular journal article, with limited space, obviously an author has to make difficult choices about what to include, and it might not be possible to explain the rich background that informs their work.  Nevertheless, if that background has been developed, the work will reflect that understanding, and the content, even the list of references, will include hints about the context and the history that informs today’s ideas.  What better “place” for emerging scholars to explore the rich  connections between works from years gone by than in their student experiences!

Ignoring, or encouraging students to overlook the important works of the past is one factor that has led us to a point in time when past nursing scholarship has been more and more neglected.  Theories and philosophies in the discipline place current work within the disciplinary context.  If students are required to only consider works published in the past 5 to 10 years, they will miss the rich foundations that place their work within the the discipline.  Theoretical ideas, at the same time, are not static, nor are they meant to be.  There is an evolution over time, and current work that is situated within a theoretical and philosophic tradition contributes to that development.  The work becomes significant for the discipline as a whole, not simply significant to the topic of the specific inquiry.  To achieve participating in this “lineage” the early works must be acknowledged, and the lineage laid out, even if in very abbreviated form.

Overlooking the disciplinary context within which a work is developed leaves the author vulnerable to shifting into another disciplinary perspective, and struggling to find meaning with the context of nursing’s most important contributions to the discipline.  Take for example the recent popularity of using “self-efficacy” theory in nursing.  Taken alone, this theory is not unlike nursing’s own “self-care” theories, but bereft of acknowledging the evolution, criticisms and challenges to “self-care” in nursing, works based on this theory perpetuate the relatively limited perspectives inherent in “self-efficacy” (or “self-care.” (I might note that these theories are “older” than 5-10 years!)

To me, the missing “nursology” pieces here are the vital importance of relationship between those cared for and those providing the care, and the social context, the “social determinants.” Without a more complete nursology perspective, these fade into the background, even into oblivion.  I am reminded of the notable work by Joanne Hess in her dialectic critique of the notion of “compliance.”  (Hess, J. D. (1996). The Ethics of Compliance: A Dialectic. ANS. Advances in nursing science, 19, 18–27.).  Any work in nursing that deals with self-efficacy or self-care must, in my view, address these fundamental nursology perspectives.  Hess’s work addresses the nature of the relationship between the one who is expected to “comply” (often a self-efficacy or self-care “task”) and the one prescribing the desired compliance. Scholars bear a responsibility to dig deep into this kind of foundational literature – even looking in nooks and crannies that might, at first glance seem tangential.

I welcome your comments and responses to this!  I know I am taking a rather strident position on this – so maybe voices from other sides of the issue, or more moderate voices can contribute to our understanding!  Please share yours!

 

Reflections on the 6th National Nursing Ethics Conference

by Guest Blogger Darcy Copeland

See Conference details page

Ethics of Caring ®– the 6th National Nursing Ethics Conference was held at the University of California, Los Angeles March 21-22.  The theme of this year’s conference was Vulnerability and Presence:  An invitation to explore the intersection of vulnerability and the power of presence.  The two days were packed with keynote, plenary, breakout sessions and case discussions.

Joan Liaschenko

Joan Liaschenko delivered the opening keynote session: “The Moral Work of Nursing, Vulnerability, and Moral Community.”  The moral work of nursing involves acting for patients, helping patients have a life, and advocacy and relationship with others is the vehicle for nursing, our instrument.  Attendees were challenged to transform our work environments into moral communities. We are all vulnerable to the actions of others.  Nursing has a very important role in healthcare and we must hold others accountable to take our concerns seriously because our part is just as important as any other.

Denise Dudzinski then led a discussion, “Tackling Moral Distress with the Moral Distress Map”.  Nurses are susceptible to moral distress in part because of our strong commitment to the wellbeing of others.  We have a heightened sense of moral responsibility – and in general, we have more responsibility in our work than we do authority.  Our moral responsibility coming into contact with powerlessness can result in moral distress.  A challenging situation an audience member experienced was used to walk through the steps of a moral map:  identifying emotions, sources, constraints, conflicting responsibilities, possible actions, and final action.

Amy Haddad

Amy Haddad, a Hastings Center Fellow, described the poetry of witness and confessional writing in her closing, “Can You Describe This? Bearing Witness to Vulnerability”.  In sharing some of her own poetry she illustrated what is means to bear witness to the suffering of others.  Powerful examples of vulnerability from the perspectives of patients and providers were read, and felt, through the medium of poetry.

Kathy Brown-Saltzman led a discussion with Marsha Fowler who described her love affair with the ANA Code of Ethics.  She shared her personal journey to her ethics and spirituality work in nursing and inspired us all to envision the Code of Ethics as a document capable of guiding us in virtually any situation in which we find ourselves.

Jay Baruch, an assistant professor of medicine and author, described caring for others as caring for their stories during “Can We Write a Better Story for Ourselves”.  He embodied the conference’s vulnerability theme by sharing excerpts from some of his own, unpublished stories.

Daniel Goldberg

Daniel Goldberg, a historian and public health ethicist, connected the dots between stigma and vulnerability with “Vulnerability, Ethics, and Nursing:  Considering Health Stigma”.  Stigmatization results in certain groups of people experiencing worse morbidity and mortality outcomes when compared to groups who are not stigmatized. It is antithetical to our professional values.  Despite these both being the case, stigmatization of patient groups by providers is common.  The complexity of this structural/social phenomenon was discussed.

In between these phenomenal presentations were two case based small group discussions and a variety of break-out sessions focused on moral distress, vulnerability, stigma, healthcare ethics consultation, and the power and uses of stories and poetry.

Thank you to all members of the planning committee for putting together a truly remarkable conference.

Reflections on Case Western Reserve “Nursing Theory: A 50 Year Perspective Past and Future”

Download conference program
Download Chinn keynote
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On March 21-22, 2019, about 120 nurse scholars gathered in Cleveland, Ohio to celebrate 50 years since the earliest nursing theory conferences were held at Case Western Reserve and the University of Colorado.  (see 1967, 1968 and 1969 details). I believe this vibrant conference will be recognized as another landmark event in the history of nursing, a time when we renewed our appreciation of our core nursology ideas, ideals, mission and purposes, a time when we envisioned new possibilities, and a time when we launched significant initiatives to bring our values into action. The many doctoral students who attended, and who presented their work, speak to the significance of this event for the future.

We will be posting many of the presentations on the Nursology.net page for this conference as soon as they become available!

Here are reflections from a few of our nursology.net management team members who were there!

Leslie Nicoll –
It was a great conference overall–I am glad I went and had the opportunity to present. It was wonderful being with “like minded” folks and having the chance to spend two days thinking about nursing theory, science, and knowledge. I haven’t done that for awhile and it was a good exercise for my brain!
Looking around the room, certainly we skewed older, but I was encouraged by the younger people–doctoral students–and their enthusiasm. I think we definitely need to think about how we “pass the baton” from us oldsters to those who will be carrying on this work. This did get mentioned in the closing discussion but I think we need to be explicit and supportive. As many noted, nursing theory can get pushed aside or taken out of nursing curricula and that is not a good thing, since it underpins all of what we think and do.
One other thought–I was struck by how much Cleveland has changed, and in a good way! I am a CWRU alum from the mid-1980s. Although I didn’t spend a lot of time on campus/in Cleveland since I was a long-distance, summer student, my impression at the time was that Cleveland was definitely a city that was experiencing a very rough patch in its history. It’s nice to see the positive changes–the city looks much more vibrant, is cleaner, and feels safer. I would enjoy going back for another conference and have more time to look around!
Dorothy Jones –

Comments from students and others attending the Theory Conference.

This was a conference to enjoy…it resonated with what I believe nursing knowledge brings to patients, families and communities and reinforces in me that ‘ this is the work I want to do to move the discipline forward”,

This work is my passion, meetings like this reinforces the fact that others think so to.

“The work done to promote the Nursology site as well as the amazing discussions at this meeting reflect a wealth of nursing knowledge yet to be explored and expanded”.

as one student described the meeting…”you are my hero’s … what I read about… what I believe and value.”

Hearing the voices of nursologists … reinforces my dedication to nursing knowledge development. “You must keep these meetings going”.

“It was wonderful, exciting and inspiring meeting”.

Jacqueline Fawcett –

The conference was filled with exceedingly stimulating papers and discussions by “stars” and “rising stars” of nursology.  My “take away” from Peggy Chinn’s keynote address is that we DO have a focus for the discipline of nursology, although the specific focus varies. This message propels us into the future, where ALL nursologists will clearly articulate the disciplinary focus of their choice and progress to much more explicit theory development, with the understanding that the research findings = theory and theory = evidence for practice.

Danny Willis –

The 50th Anniversary for Nursing Theory at Case Western Reserve University was an excellent conference bringing together the past, present, and future!! Powerful and relevant messages were delivered by all the presenters throughout the two days. However, in this blog, I will focus only on the opening panel presentation and keynote. One of the most inspiring overarching messages coming out of the conference was delivered in the keynote address by Dr. Peggy Chinn when she indicated that we in the discipline and profession of nursing (Nursology) do have a clear focus and identity that we are communicating widely to the world. She gave more than one example of how this is occurring. This and other messages about the central themes clarifying the discipline were timely and significant. Dr. Marlaine Smith clarified central themes of the discipline from an historical view/analysis of the literature on the focus of the discipline to identify human wholeness, health/healing/wellbeing, human-environment-health relationship, and caring.  Dr. Callista Roy promoted the central unifying focus statement of Willis, Grace, & Roy (2008) namely, facilitating humanization, meaning, choice, quality of life and healing in living and dying as the overarching goals for knowledge/theory development.  Dr. Joyce Fitzpatrick and Dr. Mary Jane Smith clarified the unitary transformative perspective of person-environment-health process; and Dr. Pamela Reed advanced a philosophical perspective (Intermodernism) for the development of scientific theory. The convergence of ideas was clarifying and powerful and still provided space for future developments. I walked away from the conference inspired to continue writing and researching and with a healthy hope for the future of nursing. It was a pleasure to interact with students from various programs and to see their lights shine when discussing the future of theory in the discipline! We must continue this work and have biennial events in which we bring together all the best of our thinkers to advance theory with all of its worth to humankind.

Margaret Dexheimer-Pharris –

Underneath the umbrella of Danny Willis’s overview of the keynotes, I would like to bring in a few highlights from just a few of the 66 stellar breakout sessions. Marry Antonelli cautioned that the “mismeasure” of the significance of nursing knowledge blurs the unique contribution nursing brings to interdisciplinary collaboration. Pamela Grace called for nursing faculty to steep themselves in nursing theory lest they be coopted; Grace proposed a definition of nursing science that resolves the question of whether nursing science is a basic or applied science (to be published in a forthcoming issue of Nursing Philosophy). Helen Erickson, Elizabeth Cunniff and colleagues, and Debra Hanna addressed various aspects of designing and delivering nursing curricula steeped in nursing theory. Leslie Nicoll awoke the audience at the end of the day with research findings on how often nurse scholars cite the work of other nurse scholars. We all left that presentation with a new sensitivity to and passion for uplifting the knowledge of the discipline. Finally, Brandon Brown from the University of Vermont gave a riveting presentation on “The Convergence of Indigenous Knowledge, Ecology, and Nursing Theory,” calling us to use an Indigenous lens to more fully envision nursing’s responsibility to all living beings, nature, and our entire environment. I came away from this conference with a renewed spirit and a sense of resurgence, convergence, and urgency. It is obvious that nurses and nursing students around the world are eager to articulate and embrace nursing knowledge—there is a resurgence. We are finding ways to come together to advance the knowledge of the discipline—there is a convergence. Finally, we are realizing that the earth and all her inhabitants need an expanded commitment of nurse caring—there is an urgency.

Marian Turkel –

Peggy thank you for your profound commitment to Nursology and the Nursology website. Danny thank you for starting the Nursology discussion thread. Your thoughts are prolific and visionary and will advance the future of Nursology . For me the conference was intellectually stimulating and the presentations from the Nursologists  in attendance will continue to advance disciplinary specific Nursology knowledge. Being at the conference affirmed for me the importance of advancing nursing theory in education, practice and research and sharing the Nursology website more intentionally with students and colleagues. I am proud to call my self a Nursologist.

Jane Flanagan –
As Danny and Jacqui said, this was a wonderful conference during which many ideas were shared and great conversations were had. It was stimulating and I feel honored to have been a part of it. My takeaway in addition to what has already been said is that nursing theory is alive and well! As we individually and collectively move our work forward, grounded in nursing theory, this will become clear to all those who now wander not yet fully knowing of nursology!
See more photos here

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

Opening panel: Pamela Reed speaking. Seated: Joyce Fitzpatrick, Mary Jane Smith, Marlaine Smith, Callista Roy

Mary Antonelli breakout session.

Rosemary Eustace breakout session

PhD student Beth Cunniff with Peggy Chinn

Dorothy Jones presenting, Jane Flanagan seated.

Nursology cookies contributed by Christina Nyirati (prepared by Christina’s daughter)

Jane Flanagan, Pam Grace, Dorothy (Dotty) Jones, Danny Willis, Cathy Cuchetti, Sister Callista Roy, Mary Antonelli, Jane Hopkins Walsh ~~Boston College past and present

L-R Jane Hopkins-Walsh, Brandon Brown, Peggy Chinn, Jessica Dillard-Wright, Christina Nyirati

Moral ecology in nursing

by Darcy Copeland, RN, PhD*

Darcy Copeland

I have the good fortune to have two professional roles that compliment one another beautifully. As a hospital based nurse scientist I have focused my research on workforce issues including workplace violence, professional quality of life, moral distress, and the spiritual/emotional elements of providing care. I am a member of the ethics committee and participate in educational and consultation activities. I am also an associate professor of nursing and teach master’s, PhD and DNP level nursing theory courses. My days are literally sometimes spent filling the “theory-practice” gap on both sides of that gap.

One “gap”, maybe dissonance is more accurate, I notice is how messy ethical decision making is in practice compared to how clean it seems in academia. Nursing students spend time learning about the ANA Code of Ethics, written specifically to be both aspirational and normative. The nine provisions articulate values, duties, and ideals that are foundational to our discipline. Most students probably also learn principles of bioethics and research ethics and at least have a cursory understanding of these when entering clinical practice. Nursologists have debated whether or not we should develop our own ethical framework or adopt an existing framework. Personally, I oppose both of those ideas and would advocate for a pluralistic approach to addressing ethical issues in practice.

There is no debating that nurses are moral agents who must make decisions and be held accountable for their actions. Those decisions, however, occur in complex, dynamic (I’ll say messy) environments involving multiple stakeholders whose perspectives often conflict with one another. In the grand scheme of things nurses receive very little formal education related to ethics. In my experience, it is rare for a practicing nurse to justify an ethical decision by articulating anything from the code of ethics or principles of bioethics. The first thing I hear is most often something like, “it felt like the right thing to do.” This response alone would lead me to believe that the decision was based on the person’s individual moral awareness or personal value system. With more dialogue, however, it becomes clear that the nurse’s own moral compass is the starting point for ethical decision-making, not the end point. Nurses may justify their actions because it is what the patient wanted, because people have the right to make their own decisions, because it was the best way to use available resources, because it is wrong to with-hold information, because that is our policy, etc. Any and all of these are acceptable justifications to act in one way instead of another. Each of these justifications can be traced back to an ethical framework, but not the ethical framework of nursing.

It was from these experiences in teaching and applying ethics that I developed a model of moral ecology in nursing (see below). It is based on the social ecological model in which behavior is contextualized and understood as occurring within a web of complex social systems in which the individual is placed. It was developed from the perspective of American nursing, but could be modified to include the ICN code of ethics and eastern philosophy for example. I plan to use this model in my own teaching as a way to introduce students to the messiness of ethical decision making in practice.

An ecological model of ethics in nursing. © 2019 Darcy Copeland

 

Copeland, D. (in press). Moral ecology in nursing: A pluralistic approach. Sage Open Nursing DOI: 10.1177/2377960819833899

  • Darcy Copeland is an associate professor of nursing at the University of Northern Colorado and a nurse scientist at St Anthony Hospital in Lakewood, CO. She has undergraduate degrees in nursing and psychology from the University of Northern Colorado, a master’s degree in forensic nursing from Fitchburg State College in Massachusetts, a PhD in nursing from UCLA, and is pursuing a master’s degree in health humanities and ethics at the University of Colorado. Her clinical background is in mental health and forensic nursing; her research interests involve the psychosocial work environment including issues of workplace violence, moral distress, professional quality of life, and the spiritual effects of caregiving.