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”

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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.

Donna Diers, PhD, RN, FAAN (1938 – 2013)*

Guardians of the Discipline

To remember Donna Diers is to bring into clear focus what it means to be a guardian of

Donna Diers

our discipline.  Donna died on February 24, 2013, but her influence on the discipline of nursing remains palpable, even for many who never knew her.  Donna was born on May 11, 1938 – just one day before the May 12th birth date shared by  Florence Nightingale and Martha Rogers.   These three figures – Donna Diers, Martha Rogers and Florence Nightingale shared many traits of creative vision and great leadership – not the least of which was sparking lively controversy that led to great leaps forward in our profession.

Donna Diers aspired to be a journalist before she decided on nursing as a career, then came to realize both as Editor of Image: The Journal of Nursing Scholarship from 1985 to 1993. She assumed her editorship the year after her tenure as Dean of the Yale School of nursing ended (1972-1984). During her deanship, she developed the first Graduate Entry Program for people without an undergraduate degree in nursing, a program that continues to this day leading to entry into speciality practice as an advanced practice nurse.

Donna was a prolific writer – she wrote one of the first nursing research methods texts, and her writing appears in almost all major nursing journals and in many texts. Her talent as a journalist came through vividly in her editorials published in Image – editorials that I anticipated and read eagerly as each issue arrived in my mail.

There is no better tribute to Donna Diers than the 2010 “Living Legend” ceremony when the American Academy of Nursing bestowed this honor on her. Her own remarks at this ceremony bring to life the amazing spark that she brought to the world and reveal the ways in which nursing and journalism came together in her career. She also shares a moving tribute to many others whom she names as significant in her own life. I urge you to take a few moments to dwell with the memory of this remarkable guardian of our discipline – Donna Diers.

* Portions of this post appeared previously on the INANE blog 

Public session of the Committee on the Future of Nursing 2020-2030

The Committee on the Future of Nursing 2020-2030 will be holding a public session onWednesday, March 20, 2019, from 1:30 PM to 4:00 PM ET, online and at the National Academy of Sciences building in Washington, DC.

This committee has been tasked by the Robert Wood Johnson Foundation to extend the vision for the nursing profession into 2030 and to chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.

Through the course of the study, the committee will meet several times. This public session is one of the many processes that the committee will use to gather information and assemble evidence that members will examine and discuss in the course of making the committee’s findings, conclusions, and recommendations. The focus of this public session is for the committee to clarify the scope of the charge with the study sponsor and initiate the process of gathering relevant information related to the study. Future public sessions will focus on specific topic areas and be conducted in other locations.

This public session will be accessible via webinar and in-person attendance (seating is limited).

Please register online by 12pm ET on March 20, 2019, to receive an email with the instructions on how to join this public session.

More information about the study can be found here.

What: Public session of the Committee on the Future of Nursing 2020-2030
When: March 20, 2019, from 1:30pm to 4:00 pm ET
Where: Online and in person at National Academy of Sciences building, 2101 Constitution Avenue, NW, Washington, DC 20418
How: Click here to register online by 12 pm ET on March 20, 2019

A dozen (and one) 2019 nursology events!

When we first started building Nursology.net, one of the “sections” that we set out in the plan was a “future events” section.  We all knew of a handful of conferences related to the development of nursing knowledge, but lo and behold – we have now discovered a grand total of twelve!  And there could be more!  If you have not yet browsed the impressive list of conferences, hover over “Future Events” on the main menu, and you can scroll down for an overview that includes locations and dates!

The first event of the year is the 50 Year Perspective conference at Case Western Reserve University in Cleveland, OH, March 21-22, 2019.  This conference will commemorate the very first nursing theory conferences held in 1968 and 1969 that resulted in a number of landmark articles published in Nursing Research – articles that remain a mainstay that launched a widespread effort to develop nursing’s disciplinary knowledge. The focus of the conference will be the disciplinary perspective of nursing, and the structure of nursing knowledge.  Articles in the current issue of Advances in Nursing Science, Volume 42:1 provide a focus that will be a foundation for discussion at the conference – so whether you can attend or not, check out those articles to learn more!

From March on, we have roughly one event every month until the end of the year – occasionally more than one!   Most of these are focused on one particular theoretic or philosophic focus, but are still of general interest for many nursologists!  Many are accepting abstracts, so watch our sidebar “Due Dates” feature to keep up with these opportunities.

The November KING conference is a collaborative conference for everyone, featuring participation from a number of groups focused on the development of nursing knowledge – including:

  • International Association of Human Caring
  • International Caritas Consortium
  • International Consortium of Parse Scholars
  • Neuman Systems Model Trustees Group, Inc.
  • Orem International Society
  • Roy Adaptation Association
  • Society for the Advancement of Modeling and Role Modeling
  • Society of Rogerian Scholars
  • Transcultural Nursing Society
  • Watson Caring Science Institute

Abstracts for this Collaborative conference are not due until May 1st — so consider this great opportunity now!

The (and one) conference is the annual Nursing Journal Editors (INANE) conference in July 30 – August 2 in Reno, Nevada – an event that welcomes all of those interested in and participating in the process of editing and producing nursing literature.  The conference this year features a day-long workshop for new editors and those who want to pursue a journal editing career!

The opportunities abound!  If you cannot participate in person, watch Nursology.net for reports and resources from each of these events!  If you know of an event that we have not yet listed, please let us know!  After each event concludes, we will move the conference “page” to our “history” section and add reports, papers, photos and videos that the conference planners provide for archiving. By keeping an eye on these important resources, you can benefit from being informed of the important outcomes and advances that will be sure to enrich our discipline!

 

Notable Works on “Medicalization” by Beverly Hall and Janet Allan

Note:  we are delighted to introduce a new Nursology.net series featuring notable works exploring concepts and issues that are related to the development of nursing knowledge. As this series evolves, you can see the posts in the series “Notable Works” under the main menu “Series/Collections”

In 1988, Janet Allan and Beverly Hall, both prominent nursology scholars and leaders

Janet Allan

in the discipline, published an article titled “Challenging the focus on technology: A critique of the medical model in a changing health care system.” Drawing on a rich body of literature from nursing and other disciplines, and their own insights as nursing scholars, they called on nurses to examine and challenge the dominant model that derives from a model that views the body as a machine, one that needs to be “fixed” if something goes awry, and the process of disease as an evil force to be obliterated.  They called for nurses to question the reification of

Beverly Hall

this model, and to engage in dialogue to explore alternatives that are derived more directly from the values and goals of nursing. In particular, they pointed to the lack of established efficacy of the model (despite claims to the contrary), the serious unaddressed ethical and iatrogenic questions the model engenders, the harmful effects on health and well-being that derive from the model, and the economic consequences (Allan & Hall, 1988).

In 1996, Hall specifically addressed the challenges of medicalization in undermining nursing approaches to chronic mental illness. In her critique, she discussed the ways in which the disease framework of chronic mental illness creates barriers to understanding the person as a person, and creates an unequal power structure that draws attention away from the personhood of the patient and their experience. Stated succinctly, Hall noted: “Nursing, in its attempt to be scientific, has embraced objective theories and diagnostic schemes that are devoid of practical reasoning that has as its inherent focus humanistic values, personal meanings, and subjective language” (Hall, 1996, p. 24).

In 2003, Hall published another remarkable work that represented a departure from the purely “scientific” approach to show what can emerge from an approach that uses practical reasoning, humanistic values, personal meanings and subjective language in exploring what is recognized as the focus of the discipline of nursing- the human response, the human experience.  In this moving essay Hall draws on her own experience of having a life threatening diagnosis of breast cancer, reflecting on the effects of medicalization on her experience.  As she summarized in the abstract, these effects were “(a) giving useless treatments to keep the patient under medical care; (b) demeaning and undermining efforts at self-determination and self-care; and (c) keeping the patient’s life suspended by continual reminders that death is just around the corner, and that all time and energy left must be devoted to ferreting out and killing the disease” (Hall, 2003, p, 53).

Hall’s essay prompted three nurse scholars/practitioners, each with different experiences related to diagnosis and treatment in the current health care system, to respond to Hall’s call for ongoing dialogue.  Richard Cowling, Mona Shattell, and Marti Todd (2006)  added their own personal narrative to the dialogue — Richard as a person who experienced a mitral valve prolapse; Marti living through the experience of ovarian cancer, and Mona who has had very little experience as a patient, but wrote as a nurse and stated:

“Upon reflection on my personal experience with medicalization, I separate myself from my colleagues, to use Hall’s term, “not-yet-diagnosed, against the sick.” (Hall, 2003, p62). I am not conscious of this; however, it is a part of me. Even as I write about my support of Hall’s personal experience of medicalization, I am simultaneously betrothed, naively, to medicalization.

Naivety is not an excuse. In fact, it is what angers me most about medicalization—this overreaching power that silences me.” (Cowling, Shattell & Todd, 2006, p. 299).

Responding to Cowling, Shattell and Todd’s reflections, Hall affirmed their work, and stated: “As a reader, I feel privileged to be on an inside track with personal narrations that are conceived within such a sensitive context” (Hall,2006, p. 305).  She also observed that her own 2003 article, and in the Cowling, Shattell and Todd article, there could be a misunderstanding as to the nature of “medicalization” – that this dynamic is not about helpful or not helpful medical care.  Rather,

“medicalization is a form of organized and systemic oppression that is so culturally entrenched, powerful, and invisible, that everyone’s choices, including those practicing in the biomedical field are manipulated, and options are precluded with scant awareness on the part of any of the actors (Hall, 2006, p. 305.)

Medicalization is the exercise of a power dynamic that restricts the possibility to see any alternatives other than those prescribed by the “canon,” and that insists on excluding any other possibility.  From this frame of reference, western medicine is not the only source of “medicalization” – other forms that we sometimes call “alternatives” can be equally drawn in to the same type of power dynamic that uses the power of prescription to diminish human experience, and that destroys the possibility of an authentic human relationship that nurtures meaning and authenticity in the experience.

Parallel to the writing and deep thought that produced these notable articles, Hall was simultaneously engaged in her own nursing practice in the community, working with people who were experiencing life-threatening illness.  Drawing on her own experiences as a patient and as a nurse, she wrote and self-published a book that provides a glimpse into possibilities beyond the realms in which medicalization has taken hold.  The second edition of her book, published in 2008, explains three challenges of surviving and thriving after a life-threatening diagnosis – the challenge of preparing yourself mentally for surviving and thriving, the challenge of learning that help lies within you and all around you, and the challenge of focusing your attention on what your body needs to heal (Hall, 2008).  These challenges are relevant, as Bev shows, to anyone – whether they continue to live, or they move through dying.

I invite Nursology.net viewers to explore these notable works, and find ways to contribute to the ongoing dialogue that raises awareness of this dynamic, and in doing so explore pathways to shift our focus in the direction of nursing’s own perspectives.

Sources cited:

Allan, J. D., & Hall, B. A. (1988). Challenging the focus on technology: A critique of the medical model in a changing health care system. ANS. Advances in Nursing Science, 10, 22–34.

Cowling, W. R., 3rd, Shattell, M. M., & Todd, M. (2006). Hall’s authentic meaning of medicalization: An extended discourse. ANS. Advances in Nursing Science, 29(4), 291–304; discussion 305–7. https://www.ncbi.nlm.nih.gov/pubmed/17135798

Hall, B. A. (1996). The psychiatric model: A critical analysis of its undermining effects on nursing in chronic mental illness. ANS. Advances in Nursing Science, 18(3), 16–26.  https://www.ncbi.nlm.nih.gov/pubmed/8660009

Hall, B. A. (2003). An essay on an authentic meaning of medicalization: The patient’s perspective. ANS. Advances in Nursing Science, 26(1), 53–62. https://www.ncbi.nlm.nih.gov/pubmed/12611430

Hall, B. A. (2006). Author’s Response to “Hall’s Authentic Meaning of Medicalization: An Extended Discourse.” ANS. Advances in Nursing Science, 29(4), 305.

Hall, B. A.. (2008). Surviving and thriving after a life-threatening diagnosis. AuthorHouse.  https://market.android.com/details?id=book-giE2mx62bAwC . Also available here,