Structure and Design as an Expression of Nursing’s Ontology

“When I walk in the door of the College of Nursing building I feel different.  There is something deeply peaceful about this place.” “I can’t put my finger on it, but when I’m here I can think, feel, and connect to myself…I’m present ”. “It’s not like any other building on campus. It’s about studying nursing from the inside out”.

Over the 15 years that I’ve been fortunate enough to call Florida Atlantic University’s Christine E. Lynn College of Nursing (CELCON) my home I’ve heard these and many similar comments about being in the College of Nursing’s building. I joined the faculty in 2006 when the building was new, and my direct experience of the building was one of the factors that drew me to this College. The ontology of nursing was vividly re-presented in the building’s architecture and design. The design of the building was an intentional process, meticulously planned and implemented by Anne Boykin, Dean at the CELCON for over 30 years, co-author of the theory of Nursing as Caring, and a transformational leader. The focus of the discipline of nursing: caring, human wholeness, and the interrelationship of wellbeing to the human-environment relationship (Smith, 2019) informed the creation of this “home” that truly reflected the heart and soul of nursing. Dr. Boykin collaborated with architects who understood her vision and captured it in the structure and design of the building. It is an example of creating living spaces that reflect foundational values (Boykin, Touhy & Smith, 2021).

The College of Nursing building was created to be a healing environment that reflected three guiding ideas: 1) the College’s philosophy of caring, including its definition of nursing; 2) a reverence for the environment and its centrality to wellbeing; and 3) the harmonious flow of energy through attention to structure and design, referred to as feng shui in Chinese philosophy. (Smith, 2019, p. 290). “The purpose of the building was to create a living, breathing place that invites, teaches, houses, protects and nurtures” (Boykin & Raines, 2006, p. 45).

Having a home for the College of Nursing was Anne Boykin’s dream, and a generous philanthropist and fellow nurse and friend, Christine E. Lynn, funded the building. The building is 75,000 square feet with three floors, with a circular design to reflect wholeness and connectedness. “The College is dedicated to Caring: advancing the science, practicing the art, studying its meaning, and living caring day-to-day”. Nursing is defined as “nurturing the wholeness of person-environment through caring” (https://nursing.fau.edu/about/college-at-a-glance/vision-and-mission.php). This core dedication to the mission is cast in the terrazzo floor of the atrium of the building as the “dance of caring persons”. It is a visual reminder of the College’s philosophy and model of relating. The dance is grounded in respect and valuing of all persons who are encouraged and supported in a culture that values persons living caring and growing in caring. (https://nursing.fau.edu/about/college-at-a-glance/index.php).

The atrium faces a garden with trees and plants known for their healing properties, rocking chairs and benches, and a labyrinth, an ancient symbol of self-reflection and wholeness. Walking the labyrinth is a journey to our own center and back again out into to the world. (Boykin & Raines, 2006, p. 46). This labyrinth is unique in that it is oval rather than round; its designer felt that the shape represented the face, the place of human connection between nurses and others. The healing garden is an environment for students, staff and faculty enjoy. Palm trees and other plants are around the building. Bamboo is on each side of the entrance of the building is a symbol of blessings within. The color of the exterior and interior of the building is mostly earth tones, a nurturant element that most closely represents nursing.

View from the 2nd floor of the Atrium that looks out at the garden, featuring the “Dance of Caring Persons” image embedded in the floor.

This unitary perspective on person-environment integrality led to creating a “green” building, one that embraces principles of sustainability and stewardship of the earth. The building is designated as a Leadership in Energy and Environmental Design (LEED) gold-certified building. It features minimal destruction of the earth surrounding the building, water savings through low flow toilets and recycled water for garden irrigation, healthy indoor air and natural light throughout the building, construction using materials and appliances that decrease impact on deforestation and the environment, use of products and supplies that are natural and non-chemical, and energy efficiency. (Boykin & Raines, 2006).

The feng shui design principles are based on creating environments in which people feel comfortable and supported. Feng shui masters and experts in healing architecture consulted from the beginning on the design elements. Before the groundbreaking the feng shui master engaged the College community in a ritual blessing ceremony to honor the land and prepare the earth to accept and nurture this new home. (Boykin & Raines, 2006). The front of the building faces north, the most propitious direction. The back of the building borders on a lake. Water is a source of life, and this water source is visually incorporated through river rock in the garden that visually is contiguous to a swath of black tile that flows throughout the building. A bagua or feng shui blueprint guided the placement of different areas in the College. The five elements of earth, water, fire, wood and metal are used in particular areas of the building along with the colors and shapes they represent. For example, “helpful persons” on the first floor is the office of Student Support Services housing advisors and assistant deans, while on the third floor it is the Dean’s Suite. The element of wood using block shapes permeates the design in this area along with the color green. Another example is that the Office of Research and Scholarship is located in the “prosperity” area of the bagua represented by the fire element with angular shapes and the color red.

The three floors of the building have different purposes; the first floor is the welcoming space for the community. The second floor is focused on spaces for students including large and smaller classrooms with connectivity for distance learning, a kitchen with communal eating space, the lab area for simulation and skills practice, and individual and group study areas, a large doctoral student study room and the Center for Nursing Research and Scholarship. The third floor has the suites for the Dean, administrative support staff, eminent scholars, associate deans, faculty offices, several conference rooms and a faculty kitchen and eating space.

Other unique features that reflect nursing’s ontology are open spaces for gatherings and events, a museum and the Archives of Caring (the only archive in the world that houses the work of caring scholars), a large yoga or exercise space with a bamboo floor, a holistic space for classes and a room with a massage table, and a “sacred space”, a room for meditation, reflection or contemplation.

The ontology, or essential nature of nursology, is reflected clearly in the structure and design of the Christine E. Lynn College of Nursing. It is an environment that nurtures the growth of students, faculty and staff in bringing the values to life in all missions of the College: teaching, research, practice and service. “Through intentional design features the concepts of reflection/mindfulness, aesthetic appreciation, healing environments, human-environment integrality, holistic health, and the significance of self-care to the being-becoming of the nurse are prominent”. (Smith, 2019, p. 290).

Sources

Boykin, A. & Raines, D. (2006). Design and structure as an expression of caring. International
Journal for Human Caring, 10(4), 45-49.

Boykin, A., Touhy, T.A. & Smith, M.C. (2021). Evolution of a caring-based college of nursing.
In M. Hills, J. Watson & C. Cara (Eds.), Creating a caring science curriculum: An
emancipatory pedagogy for nursing (pp. 187-200). New York, NY: Springer Publishing.

Smith, M.C. (2019). Advancing caring science through the missions of teaching,
research/scholarship, practice and service. In W. Rosa, S. Horton-Deutsch & J. Watson (Eds.), A Handbook for Caring Science: Expanding the Paradigm. (pp. 285-301) New York, NY: Springer Publishing.

Smith, M.C. (2019) Regenerating the focus of the discipline of Nursing. Advances in Nursing
Science. 42(1), 3-16,

Guest Post: Aesthetic Knowing 101

Contributor: Peg Hickey, MSN, RN

For three years, I have been an adjunct clinical instructor. And thanks to a recent course on nursing theory, I have been able to closely examine my own understanding of nursing knowledge and my commitment to the nursing profession. The most extraordinary part about teaching is having the opportunity to impart this knowledge to the future generation of nurses. Students’ primary goal is to focus on the empirical aspects of nursing; however, my unwritten objective for the students is to define nursing by their connection to the human spirit. As an educator, this involves integrating learning experiences related to the patterns of knowing (Chinn & Kramer, 2018).

Day 1

One-by-one, I greeted my six students as they arrived in the lobby on their very first day of their clinical rotation for Fundamentals of Nursing. Their nerves were palpable: they didn’t speak to me or each other and nobody smiled (yes, I have learned to recognize a masked grin by observing the eyes and foreheads). I have never been accused of being a threatening presence in any way, shape, or form, yet the students stood before me with fear in their eyes. (Flashback to my own experiences in nursing school from the early ‘90’s). I was able to discern the truth of this moment and acknowledge the impact of feelings on their very first clinical experience. My aesthetic knowing of being able to recognize a deeper meaning to their human experiences of anxiety and fear laid the foundation for an enriching nursing experience for all of us. I was helping to build the future of nursing (Nursology.net, 2021).

Commitment

First experiences are memorable for students. Some may consider their initial attempts at nursing to be insignificant and only equate success with tasks: starting an IV, changing a wound dressing, or administering medication. Of course, on our first day we didn’t perform any of those tasks, but one student did display an intangible act of commitment: she followed through with a patient’s request for tissues. Keep in mind, this was her first clinical exposure; we were only minutes on the unit in and in the midst of a tour. Yet during those moments, this student spoke to a patient, asked a staff member where the tissues were, located them, and carried them with her until the tour ended, when she brought the tissues to the patient. At face value, simplicity. Yet it was important for her to know that she performed critical acts of nursing in this seemingly simple task: communication, commitment, and caring. Baillie (2007) reminds us of Henderson’s definition of commitment: Nurses who “responded to patients’ needs in a timely manner were perceived as caring; patients were dissatisfied when nurses apparently forgot patients and their needs” (p.6). I complimented my student, and her smile was beaming beneath her mask.

Compassion

The following week, my students were assigned to obtain a patient history, a conventional start to the development of communication and interpersonal skills. During post-conference, one student reported that she was unable to complete the assignment; instead, she had connected with a young woman with a terminal disease who requested a foot rub. She decided to fulfill the wishes of the patient and put off asking about her medical history, demonstrating an appropriate and meaningful prioritization of care. The lesson in post-conference focused not on an incomplete assignment, but on the ability of nurses to recognize significant and meaningful moments and to take action (Chinn & Kramer, 2018). This student completed a patient history the following week and that was OK with me.

Caring

During an attempt at a physical assessment, my student and I encountered a Mandarin-speaking patient who was visibly distressed. While using an audiovisual interpreter, our patient kept repeating a phone number over and over and over. The interpreter told us “she wants to call her husband.” Recognizing that nothing else mattered to this patient at that moment, we stopped our assessment, dialed the number, and the patient spoke to her husband. Following their conversation, she was smiling, grabbing to hold our hands, and visibly relieved that we understood. This encounter allowed us to distinguish between the science and art of nursing and to feel how the experience of being understood is both inspiring for the patient and gratifying for the nurse.

What better way to introduce the aesthetic pattern of knowing by calling it out in the clinical setting and defining what it is: “An intuitive sense that detects all that is going on and calls forth a response, and you act spontaneously to care for the person or family in the moment” (Chinn & Kramer, 2018, p. 142). Another idea for incorporating the meta-paradigms in nursing education is to change the course titles “Fundamentals” and “Foundations” to “Aesthetic Knowing in Nursing” so beginning students feel empowered by authentic nursing actions of communication, commitment, and caring behaviors.

The first introduction to a clinical experience lays a crucial foundation for nursing students. My hope is to impart a meaningful impression about the interpersonal nature of nursing; one they will be reminded of when they miss that first IV or administer a medication late. My students are off to a great start and I hope they know that every week when our clinical day ends, I am smiling beneath my mask.

References

Bailie, L. (2007). An exploration of the 6Cs as a set of values for nursing practice. British Journal of Nursing, 26(10), 558–563. https://doi.org/10.12968/bjon.2017.26.10.558

Chinn, P. L., & Kramer, M. K. (2018). Knowledge development in nursing: Theory and process (10th ed.). Elsevier.

Henderson, A., Van Eps, M. A., Pearson, K., James, C., Henderson, P., & Osborne, Y. (2007). “Caring for” behaviours that indicate to patients that nurses “care about” them. Journal of Advanced Nursing, 60(2), 146–153. https://doi-org.ezproxy.cul.columbia.edu/10.1111/j.1365-2648.2007.04382.x

About Peg Hickey

Peg lives in Queens, NY and has been a nurse since 1993. She is currently a nurse educator at Columbia University Medical Center working on a program designated to incorporate diabetes-related simulation into the curriculum for medical and nursing students. Peg is also an adjunct instructor at Hunter-Bellevue and Pace University Schools of Nursing.

Guest post: Aesthetic Knowing: A Transformative Encounter

Contributor: Bibiane Dimanche Sykes

Knowing is an elusive concept. It is fluid, and it is internal to the knower (Chinn & Kramer, 2018). Carper (1978) identified four fundamental patterns of knowing for an understanding of the conceptual structure of nursing knowledge. The four patterns are classified logically to elucidate aspects of empirics, personal knowledge, ethics and aesthetic knowing in nursing. Here, the pattern of aesthetic knowing is demonstrated through the actions, comportment, thoughts, behaviors and exchanges of the nurse’s relationship with the patient. It is aesthetic knowing that allows us to navigate when faced with nuanced situations.

The Call

It was late on a Tuesday morning. I was pleased to finally have a few days of rest from work and was already planning how I was going to spend my second day off, when I heard the ring tone from my phone. I glimpsed at the phone screen and noticed that it was a number I was unfamiliar with, so I decided to skip the call and told myself that they can always leave me a voice message if it is important. Ten minutes later, I heard the same familiar ringtone of my phone. This time it was coming from work. “Oh my,” I thought, what could it be…. did I forget to enter a note on the computer, or have I failed to sign the medication sheet? When I picked up the phone, the Director of Nursing at the subacute nursing facility I worked for was on the line. She mentioned that Ms. Smith’s situation took a turn for the worse; her condition had weakened overnight. According to Nancy, the Director of Nursing, Ms. Smith had been asking to see me since yesterday, and it was her nephew whose desperate call I had moments earlier ignored.

Nurse-Patient Relationship

Ms. Smith was a 75-year-old widow who moved about 7 months ago to the hospice unit where I worked as a charge nurse. Her overall health and well-being had since deteriorated. Her cancer had metastasized to other adjacent organs of her body, and treatment was no longer a viable option. She had very little family support. Her only living relative was a nephew who visited occasionally. Although she had many other disciplines assigned to her care, she seemed to gravitate more towards me. I also enjoyed her company and spent many hours of my free time listening to her joys and regrets about life. I would play her favorite songs, encourage her to eat, to bathe, and to take her medications, before her pain became unbearable. She looked forward to the days I was at work, and I would always stop by her room for a chat whenever I had the chance. She confided in me and shared many of her life and death expectations, which included the minute details of her imminent death and funeral wishes. She and I developed a bond and maintained a caring nurse-patient relationship that encompassed understanding, trust and compassion.

The Encounter

It was already afternoon when I rushed into Ms. Smith’s room that Tuesday. She seemed agitated; however, she immediately became calm at the sound of my voice, telling her that it was going to be okay. As I was helping her take her prescribed medications, she appeared to be hallucinating. She kept on saying something about not being able to get on the bus. She was becoming restless and continued to repeat this for about an hour. I finally approached her and asked why she was not able to get on the bus. She opened her eyes for the first time since I entered her room and mumbled, “they wouldn’t let me, I don’t have money to pay for it.” I was devastated at the thought of that. I knew this day would come but still I was becoming emotional. I reminded myself that I needed to stay on course to help fulfill her wish of an undisturbed, smoothed transition. I thought for a second, what could I do to alleviate her suffering at this moment? I searched in my pocket and found a quarter. I slipped it into her hand and whispered in her ear, “use this for your bus fare, it’s going to be fine.” I felt her tight squeeze as she received the quarter, and less than five minutes later, Ms. Smith peacefully took her last breath with poise and dignity.

Aesthetic Knowing

Aesthetic knowing is what makes possible knowing what to do and how to be in the moment, instantly, without conscious deliberation (Chinn & Kramer, 2018). I am currently an adjunct professor, teaching nursing fundamental to first year students. Every semester, I share this experience with my students. It serves as the perfect introduction to the conceptual framework of the nursing discipline through the patterns of knowing (Carper, 1978). The patterns of knowing in nursing ultimately presents a tool for developing abstract and theoretical thinking in the classroom. It allows for broader, clearer perspectives and self-integration of the concepts of empirics, personal knowledge, ethics and finally aesthetic in nursing education (Carper, 1978). This transformative encounter that I had experienced with my patient embodies the true essence and elements of aesthetic knowing.

Sources

Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004

Chinn, P. L. & Kramer, M. K. (2018). Knowledge Development in Nursing: Theory and Process. 10th Ed. Elsevier. St. Louis, MO.

Aesthetic Knowing. (2021, February 2). https://nursology.net/aesthetic-knowing/

About Bibiane Dimanche Sykes

Bibiane Dimanche Sykes is a student in the Doctorate of Nursing Education (EdD) Program at Teachers College, Columbia University. She earned a Master of Science degree in Nursing Education at Mercy College in Dobbs Ferry, New York. She’s an Adjunct Professor at Mercy College in Dobbs Ferry, New York and also works as a Clinical Nurse Quality Assurance in New York City. Bibiane is a wife and mother of 4 sons. She enjoys reading, traveling and prides herself in giving back to the community. She serves her community through various philanthropic and nursing organizations.

It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

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

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

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

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

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

About the contributors:

Christina Nyirati, RN, PhD

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

Sharon Stout-Shaffer, PhD, RN

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

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

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

New on Nursology.net – Aesthetic Knowing

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

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

From Introduction to Aesthetic Knowing

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

View the Scholar/Artist Gallery

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