Selling Theory

He lounged in the chair, laptop nestled in his lap. “Here, look at this,” he waived toward his screen.

I bent over, squinting, and saw a colorful graph of lines that reminded me of a holiday decoration. “It’s a stochastic model of cellular growth….” He went on to mention the conditions that were being modeled, and I marveled at how these predictions were created.

He turned to face me. “You know, the problem with social sciences (and nursing) is it’s too imprecise. You can’t replicate the studies and find the same results. The conclusions tend to way over-estimate the sample from which the data are drawn. Your theories don’t really reflect science.”

I studied his face and tried to determine whether he was serious. He knew my work and was aware of my approach to theory as a conduit to build science and expand knowledge. I am steeped in the Continental philosophy of human science; I believe in the Truth, but also with humans living different realities and how our personal narratives intersect to create the political. I believe that language not only reflects reality, it creates it. I subscribe to the notion that discourse is important to deconstruct as power relations (hegemonies) embedded in them are often unnoticed without such analysis.

Perhaps I was taking the conversation too seriously, but such science as this young man described and the data science paradigm are oozing – flooding really – into crevices of thought and science at a pace that makes me queasy. The battle of the empirical way of knowing overshadowing other ways of knowing (Chinn & Kramer, 2018) is amplified in the call to harness the seemingly infinite data collected daily that is supposed to tell us something of the human condition. What are these data trying to tell us? Patterns may be revealed without hypotheses. Theories were unnecessary for machine learning as one statistician told me, “You use machine learning when you don’t know what you’re going to find.”

This seems heretical for a theorist. I wanted to sell theory even harder.

In automatic cognitive reactions, I convey to those around me how important theory is — that the use of theory can inform, organize, and enlighten. I thought of Sarah Szanton and Jessica Gill’s (2010) work, Society-to-Cells Resilience Theory – could it be applied to stochastic methods? I thought of other times when I “sold” theory:

  • One of my colleagues asked for input on a community engagement proposal in the context of substance use and stigma within rural communities. I steered her to the Rural Nursing Theory of Winters and Lee (2018) and their remarkable understanding of concepts unique to rural dwellers, such as insider/outsider, the meaning of work, and so forth.
  • A doctoral student examining physical activity in couples – absolutely, I told her, see Pender’s (2011) health promotion model as this will help organize the co-variates.
  • Teaching advanced theory with enrollment from other healthcare professions, including pharmacy. I boasted about nursing’s rich theoretical foundations and how nursing can inform other disciplines in myriad ways. I applaud the student when she finds a singular concept analysis within her discipline.

But then, I give pause. With recent discussions surrounding racial and ethnic disparities, and decolonizing nursing theory, I question whether I am “selling theory” with a bit too much enthusiasm. I think of all the other Truths out there based on personal experience, which is a microcosm of the political. I think of the mix of what is current politically in juxtaposition with theory, and how the tight weave of beliefs leaves me looking for solid answers and coming up empty at times.

Without reflectivity and critical appraisals of what we believe – and try to sell – we are guilty of stagnation. We are guilty of ignorant exclusion. Now, with calls to examine our fundamental assumptions framed within privilege, do we “sell theory” with the same enthusiasm? I’m uncertain, but certain of caveats. We need to acknowledge the knowledge of other theoretical possibilities we haven’t addressed. We can accept “not knowing what we don’t know,” and with just as much enthusiasm explore our ignorance. We can honor those whose work has moved us forward, and move out of the way, or ask for a place alongside, of those who are informed in new ways or in ways that we didn’t listen to before. We must be committed to inclusion and diversity of thought, of the personal as political. As theorists, we are motivated to refine, refresh, extend, edit, delete, and discount. Only when we stop these activities, only when we think “we’re done,” will we be guilty of over-selling theory.

With a sigh, I look over again at the young man with his stochastic graphs and models. He’s been pushing buttons on his laptop, growing his models, as I have been reflecting on theory’s role in nursing. I kiss him, my son, on the cheek, and say with certainty, “We both have a lot to learn.”

References

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

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6th Edition). Pearson.

Szanton, S. L., & Gill, J. M. (2010). Facilitating resilience using a society-to-cells framework: a theory of nursing essentials applied to research and practice. Advances in Nursing Science, 33(4), 329-343.

Winters, C. & Lee, H. J. (Eds.). (2018). Rural nursing: Concepts, theory and practice. (5th ed.). Springer Publishing Company.

Is Medicine a Trade or a Discipline or Profession?

Nursology is regarded as a discipline and a profession, which means that nursology constitutes distinctive knowledge encompassing nursological philosophies, conceptual models, grand theories, middle-range theories, and situation-specific theories (see all content on https://nursology.net and also https://nursology.net/2018/09/24/our-name-why-nursology-why-net/).Medicine, in contrast, is a trade. This assertion is based on my search of literature for several years and pondering the difference between a discipline or a profession and a trade at least since the publication of Donaldson and Crowley’s now classic 1978 article, The Discipline of Nursing. .

I asserted that medicine is a trade in two 2014 publications (Fawcett, 2014a, 2014b) and in 2017, I wrote, under the heading, Medicine is a Trade:

I have never been able to locate any obvious or explicit knowledge that is distinctly medical. A September 18, 2016 search of the Cumulative Index of Nursing and Allied Health (CINAHL Complete) using the search term “medical model” yielded 816 publications. An admittedly quick review of a random sample of the retrieved publications revealed that the term medical model was not defined but rather used in a way suggesting that any reader would know what the term means. (Fawcett, 2017, p. 77)

I have continued to ponder whether medicine should be considered a trade and have wondered why no one has challenged my assertion, at least in any publications or blogs I have seen. Therefore, on January 4, 2021, I expanded my search to other sources–Taber’s Cyclopedic Dictionary, the Oxford English Dictionary, and Wikepedia.

The 22nd edition of Taber’s (Venes, 2013) includes no entry for medical model. Medicine is defined as “the act of maintenance of health, and prevention and treatment of disease and illness” (Venes, 2013, p. 1474). No reference to the knowledge needed to perform the act of medicine is evident. The Oxford English Dictionary also includes no entry for medical model, with only a mention of the term in quotations pertaining to two words, technologizing and miasmatist.

However, two definitions of medicine imply a knowledge base (although not necessarily distinctive knowledge). One definition is: “The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).” The other definition is: “The medical establishment or profession; professional medical practitioners collectively.”

A search of Wikipedia yielded this statement: “Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the “set of procedures in which all doctors are trained.” It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia). Noteworthy is that Laing did not mention the philosophic, conceptual, or theoretical knowledge that would guide the “set of procedures in which all doctors are trained.”

The content in Wikipedia also included an important negative consequence of adherence to the medical model. This consequence is “In the medical model, the physician was traditionally seen as the expert, and patients were expected to comply with the advice. The physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the medical model, it is necessary and to be expected. In the medical model, the physician may be viewed as the dominant health care professional, who is the professional trained in diagnosis and treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia)

My concern with the very idea of “adherence to the medical model” (or adherence to or compliance with anything put forth by a nursologist or a physician) led me to ask “what [do] we mean when we say that a person (called a patient or a client) does not comply with or adhere to a treatment plan. It seems to me that these words reflect the physician’s or the nursologlist’s prescriptions for the patient, which in turn, reflect the physician’s or the nursologist’s power over and control of the patient.” (Fawcett, 2020)

My concern regarding the physician as a professional person is grounded in my inability to identify any distinctive knowledge of medicine that is necessary for the designation of professional in both the OEDO definition of medicine and in the mention in Wikipedia of the professional being “trained,” a word associated with training for a trade.

Of course, I understand that physicians possess a great deal of scientific knowledge. However, that knowledge is of various disciplines, such as anatomy, physiology, histology, and chemistry, not of medicine per se (as there is no distinctive medical knowledge that I have been able to identify),

I have concluded that the so-called “medical model” is a fiction put forth at least since Laing’s (1971) publication by members of the healthcare team (including nursologists) and the general public to ascribe a particular status to a trade. .

Please note that I acknowledge the importance of trades in society. I certainly cannot survive without many tradespersons in my life. However, I maintain that it is important to be very clear about the words we bestow on the members of healthcare teams, words that clearly reflect whether those members belong to a discipline/profession or trade. If members of a discipline/profession, it is necessary to identify the distinctive knowledge that guides practice, and research and education, too..

What do you, a reader of this blog, think? Have you been able to identify distinctive philosophic, conceptual, and theoretical knowledge that would constitute the discipline of medicine? Please add your thoughts to the comments section of this blog. Thank you very much.

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Fawcett, J. (2014a). Thoughts about collaboration—or is it capitulation? Nursing Science Quarterly, 27, 260-261.

Fawcett, J. (2014b). Thoughts about interprofessional education.Nursing Science Quarterly, 27, 178-179.

Fawcett, J. (2017). Thoughts about nursing conceptual models and the “medical model.” Nursing Science Quarterly, 30, 77-80. (Permission to provide a link to the PDF of this article was granted by the journal editor)
Fawcett, J. (2020, March 17). What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives. Blog.

Laing, R. D. (1971). The politics of the family and other essays. Routledge

Venes, D. (Ed.). (2013). Taber’s cyclopedic medical dictionary (22nd ed.). F. A. Davis.

Be careful what you wish for…

2020 was the year that… “Be careful what you wish for,” once again became imprinted in my brain as truth.

In early 2019, the World Health Organization (WHO) announced that 2020 would be the “International Year of the Nurse and Nurse Midwife.” Among colleagues, there was lots of excitement about this. What would we do to recognize and celebrate this recognition? I heard many ideas—editorials, articles, museum displays, seminars, webinars—maybe we’d even get a stamp! The last time we had a commemorative nurse stamp in the US was 1961, almost 60 years ago. Seems like we were overdue for one.

And then, two months into our memorable year, COVID-19 hit. The world started locking down before the US, but for me, my unforgettable day was March 13 (a Friday, of course) when a symptomatic friend tested positive for the virus. Suddenly, everything changed. We all went into lockdown and remote work became the norm. I tried to figure out how to run a free clinic by phone and email (believe me, it’s not easy). I experienced two weeks of panic, followed by three months of bewilderment, and then settled in for the long haul, which is still ongoing.

Meanwhile, nurses were everywhere. The evening news was flooded with images of nurses in ICUs, EDs, nursing homes, and more. There were interviews with nurses crying, their faces bruised from their PPE googles, mourning their dying and dead patients, wondering if they could have done more. They worried about having enough PPE, their families, and their own health. At the same time, we were celebrated with impromptu parades, celebrations, signs on the street: “Heroes Work Here!”. I was offered a 50% discount at the car wash, but I declined. I figured that as a small business, they needed the money more than I needed a modest saving on washing my car.

We even got a TV show, creatively named NURSES with this tantalizing description: “The series follows five young nurses working on the frontlines of St. Mary’s hospital dedicating their lives to helping others, while figuring out how to help themselves.” Will those nurses be nursologists? Time will tell.

On the other side of the coin, the virus was taking its toll in multiple ways. As of the end of October 2020, the WHO presented an analysis that 1500 nurses worldwide had died of COVID-19, although they admitted that this figure was probably grossly underestimated. The White House put together a coronavirus task force in January that included (according to the New York Times) “internationally known AIDS experts; a former drug executive; infectious disease doctors; and the former attorney general of Virginia” but no nurses. President-elect Biden also put together a task force that seemed more diverse but once again, nurses are conspicuously absent from the membership. At a meeting of nurses in the Oval Office to commemorate National Nurses Day in May, Sophia Thomas, President of the American Association of Nurse Practitioners was rebuked by Donald Trump when she stated that there was sporadic access to PPE throughout the US. “Sporadic for you, but not sporadic for a lot of people,” Trump said. “Because I’ve heard the opposite. I have heard that they are loaded up with PPE now.” Thomas was bullied into politely agreeing and backing down from her original statement. This is not the first time I’ve seen this happen, and it makes me angry every time.

Where is the correct middle ground? Do we want to be “angels,” “heroes,” and members of the “most trusted profession” (according to Gallup, 15 years and running)? Or do we want to be nurses at the table, nurses setting policy, nurses seen as leaders, decision makers, and agents of transformation through research, practice, and education? In other words, nursologists? 2020, our “year” gave us lots of the former, not so much of the latter. And thus I say, “Be careful what you wish for.” I worry that our year of recognition will ultimately reinforce stereotypes and not result in meaningful change. To those in our ranks who have sacrificed their lives, and to others who are dealing with ongoing health issues from COVID-19, both direct and indirect, I hope that is not the case. Maybe with the spotlight off, we can get back to business and work to make incremental, but lasting change, which seems to be what nurses do best. That is my wish for 2021—but I’ll be honest—I would still like a stamp!

Connotations of Research Speak: The Meaning of Words Used in Research Reports

Do we allow or invite people to participate in research? Do we refer to people who volunteer to be in a study as subjects or respondents or informants or participants or people?

This blog is about the language we use when we present or publish our research. The impetus for this blog was a colleague’s recent declaration that people were “allowed” to share their experiences of a health related condition for a study. The blog is a follow up to a previous blog that addressed the implication of power when using words such as compliance and adherence and, perhaps, even concordance (Fawcett, 2020), as well as another previous blog focused on diverse meanings of power (Fawcett et al., 2020).

Upon hearing my colleague state that people were “allowed,” I immediately thought: What is meant by indicating that a researcher “allows” people who volunteer to be in a study so to provide answers to the researcher’s questions in an interview format or via a numeric survey? Does stating that the researcher “allows” the people who volunteer for the study to do whatever the researcher wants them to do mean that the researcher holds power over them? Is a “power over” relationship appropriate for what many nursologists claim as a core value and approach to people, that is, “relationship-centered care?” (See Wyer, Alves Silva, Post, & Quinlan, 2014). Does “allowing” people to share experiences for the purposes of research connote “paternalism, coercion, and acquiescence” (Hess, 1996, p. 19), Should we instead “invite” people to share their experiences or answer our survey questions or accept our experimental interventions?

Although most, if not all, nursologists who conduct research no longer refer to the people who volunteer to be in their studies as “subjects,” these people continue to be referred to as “respondents,” the term frequently used when people respond to a numeric survey, or they continue to be referred to as “informants,” when they answer open-ended interview questions. Perhaps most frequently, the people are referred to as a sample or population of “participants.” Until very recently, I was content with referring to people who volunteered for research projects as “participants.” However, I have begun to think that if we nursologists truly value and support relationship-centered care, we should personalize those who volunteer for our research projects. For example, many of the people who have volunteered for my Roy Adaptation Model-guided program of research (Clarke & Fawcett, 2014; Tulman & Fawcett, 2003).) are women during the childbearing phase of life. Should I refer to these people as women rather than participants?

I invite readers to offer their ideas for words that are most compatible with nursologists’ values about our relationships with people who volunteer for our research projects.

References

Clarke, P.N., & Fawcett, J. (2014). Life as a nurse researcher. Nursing Science Quarterly, 27, 37-41.

Fawcett, J. (2020, March 17). What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives. Blog. https://nursology.net/2020/03/17/what-is-reflected-in-a-label-about-health-non-nursology-and-nursology-perspectives/

Fawcett, J., Shitaki, Y., Tanaka, K., Hashimoto, Y., Fujimoto, R., & Higashi, S. (2020, September 1). Meanings of power. Blog. https://nursology.net/2020/09/01/power-in-nursing/

Hess, J. D. (1996). The ethics of compliance: A dialectic. Advances in Nursing Science, 19(1), 18-27.

Tulman, L., & Fawcett, J. (2003). Women’s health during and after pregnancy: A theory-guided study of adaptation to change. Springer.

Wyer, P. C., Alves Silva, S., Post, S. G., & Quinlan, P. (2014). Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care. Journal of Evaluation in Clinical Practice, 20(6), 881–889. https://doi-org/10.1111/jep.12224

Nursing and Racism: Are We Part of the Problem, Part of the Solution, or Perhaps Both?

One of the first “lessons” in my now-long-ago nursing education was “the nursing process.” This was in the early 1960s, almost a decade before anyone spoke of nursing theory, but the University of Hawaii (my alma mater) had modeled the curriculum on that of the University of California at Los Angeles (UCLA) which was designed around the ideas of Dorothy Johnson. These ideas would ultimately become known as Dorothy Johnson’s Behavioral Systems Model (See also the history of the UCLA School of Nursing, pgs 43-48).

Of course this same problem-solving process is widely used in many walks of life, and many see it as a mere pragmatic outline for making good decisions and forming appropriate action – a necessary process but several degrees removed from developing foundational knowledge of the discipline. In reflecting on the situation in which we find ourselves today I fear that as a discipline we have not adequately faced the realities before us as a discipline and as a society – both as a problem, and as a health experience. As I wrote in my January 20th post titled “Decolonizing Nursing”

Despite the fact that race and racism so repeatedly rise to the surface with a clear intent to address this issue, there is typically little or no substantive discussion that begins to reach deep down into explanations or understanding of what is really going on (see https://nursology.net/2020/01/14/decolonizing-nursing/)

I know that I am not alone in recognizing this challenge, but I continue to wonder — when and how will this begin to change? This is not merely a “political” matter — it is a matter of life and death, of health and sickness. It is a pandemic of proportions far beyond the COVID-19 pandemic, and it has been infecting our lives for decades. In recent weeks we have witnessed the public killing of George Floyd by a Minneapolis police officer, of Ahmaud Arbery shot down while jogging in February, and Breonna Tayler, an EMT with plans of becoming a nurse, killed by police in her own home in March. Then just a few days before this post published, the killing in Atlanta of 27-year-old Rayshard Brookes, shot in the back several times by police after indicating that he was able and willing to walk home to his sister’s house.

These tragic murders in plain sight, coupled with widespread recognition of the over-proportioned number of Black and Brown people suffering from COVID-19 – give us a glimmer of opportunity to finally act. The calls for change are so pervasive and so sustained, that those of us ready and willing to make change have a real opportunity to do so. And so I return to my earliest nursing education and the foundational ideas that have been baked into my very fabric – the processes of active listening and observation that are vital to assessing and “diagnosing” a problem(1).

One of the notable signs that appears in all of the protests says “I see you, I hear you.” For me, this is a key to meeting the challenge before us. It starts with our interactions among our own colleagues. Throughout my nursing career I have seen many Black nurse colleagues come and go, and every single one of the nursing faculty I have served with have repeatedly decried how “difficult” it is to recruit and retain Black nurse faculty. Yet all too rarely have I witnessed concerted, deliberate efforts by the predominantly White(2) faculty to stop, step away from our privilege, seek the authentic stories of our Black colleagues, and actively hear (understand) their experience. Equally egregious is the fact that there are myriads of situations that, viewed through a lens of anti-racist awareness, could be instantly recognized as potentially harmful to a Black person, even dangerous. But over and over again we turn a blind eye, and fail to act. I have all too often been just as complicit in all of this as anyone else – we have all been caught up, and participate in a systemic web of injustice. And I suspect that this pattern is not unique to academics – that it runs deep in every setting where nursing is practiced.

Further, there is the all-too often deflection of the problem by the insistence that the “problem” is not unique to Black people – that all lives matter. Of course all lives matter and Black people are not the only ones who suffer injustice and discrimination. But this sentiment turns the lens away from the specific voices, experiences, and challenges faced Black people. We can listen to all people – but until we listen to, and sincerely seek to understand, Black people and recognize the experiences of trauma and harm that Black people uniquely suffer, and how we participate, we will not be able to truly understand the problem.

It is undeniable that the prejudice and hate toward Black Americans, and people of African descent in many other countries is profound and amplified by the historical trauma of slavery and in the United States, the fall-out of the civil war fought to end slavery in the United States. I hear many White nurses in my circle expressing true outrage about this situation and we are all sincere in our desire to see it change, yet the problem persists. Until we White nurses face the reality of our privilege and the injustices that flow from this, until we learn ways to step away from our privilege and engage in serious anti-racism work, until we create spaces in which we can authentically engage with our Black colleagues to understand the problem, the injustices in our own house will remain.

We can all shift in the direction of being part of the solution. There are signals that point us in the direction of actions we can all take – particularly those of us who are White – to seize this moment, start to address the scourge of racism in our own house, and make real change. The circumstance of the COVID-19 shift to virtual reality offers ample opportunities for all of us to engage in antiracism work! Here are a few examples that I can personally recommend – if you start searching, you will find many many others!

  • Nurse Caroline Ortiz organized a “platica” (Spanish for discussion) held on March 9th over Zoom. Caroline recorded the session, which you can access here: https://vimeo.com/397047962. You can organize similar discussions – we are all now expert Zoom organizers!
  • African-American activist Nanette Massey holds a weekly discussion with White people from all walks of life to discuss the ideas in Robin DiAngelo’s book “White Fragility: Why It Is So Hard for White People to Talk About Race.” I have participated in many of these informative, interesting and affirming Sunday discussions. Learn more here.
  • The “Everyday Feminism” website has pages and pages of content on ethnicity and racism – https://everydayfeminism.com/tag/race-ethnicity/. Just browsing titles is a rich experience! Their 2014 post of 10 Simple Ways White People Can Step Up to Fight Everyday Racism is precisely relevant today!
  • Invest 1.5 hours into Everyday Feminism’s founder, Sandra Kim’s excellent session on “Why Healing from Internalized Whiteness is a Missing Link in White People’s Anti-Racism Work.” White nurses can benefit especially, but knowing that White people are facing this challenge, and how this can happen, can be helpful for everyone.
  • Practice generosity of spirit toward your nursing colleagues – each of us are being challenged in this moment to examine our own attitudes, actions and words. Many of us are just starting on this journey. This demands kindness and understanding toward one another as we work together, often in uncomfortable situations, to make meaningful change. Let us call forth the best we can be, and support one another with compassion and understanding when we mis-step.
  • Consider how application of many tenets of our own nursing theories can be activated in the quest to address racism. Consider Peplau’s approach to meaningful interpersonal relationships, the very important insights from Margaret Newman “Health as Expanded Consciousness,” and any one of several theories of caring such as Watson’s Theory of Human Caring, or Boykin and Schoenhofer’s Theory of Nursing as Caring, While these and other nursing theories were not created specifically to address racism and social injustice, we certainly can draw on their wisdom to bring nursing perspectives to the center in our anti-racism work.
  • Follow the opportunities provided by the Nursology Theory Collective to join discussions focused on creating equity in nursing
  • Find, read and cite nursing literature authored by nurses of color. Learn the names of these authors, and seek out their work. If you teach, make sure you include this literature in your syllabi(3).
  • Explore the work of scholars in other disciplines who are also committed to anti-racism work. The “Scholarly Kitchen” blog posts regularly on matters of racism and discrimination – see their June 15, 2020 post titled Educating Ourselves: Ten Quotes from Researchers Exploring Issues Around Race
  • Make your own video, as a nurse, speaking to these issues and how your values, ideas, nursing perspectives inform your actions to fight racism! Post it on YouTube or Vimeo .. and then share it with us – we can consider posting on Nursology.net or another nursing website. See this wonderful video (below) by de-cluttering expert Mel Robertson for inspiration!
Notes
  1. Ultimately the concept of active listening formed a basis for the essential processes of “critical reflection” and “conflict transformation” in my heuristic theory of Peace and Power.
  2. See this excellent article from the Center for the Study of Social Policy on the capitalization of the terms “Black” and “White,” which I consulted in refining this post: Nguyễn, A. T., & Pendleton, M. (2020, March 23). Recognizing Race in Language: Why We Capitalize “Black” and “White” | Center for the Study of Social Policy. Center for the Study of Social Policy. https://cssp.org/2020/03/recognizing-race-in-language-why-we-capitalize-black-and-white/
  3. See Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge. This collection includes many of the leading authors, including many nurse scholars of color, whose work focuses on social justice.

What is Real Nursing and Who are Real Nurses? Perspectives from Japan

Thank you to the graduate students and faculty
from St. Mary’s College, Kurume, Japan, who

contributed to this blog!

Hayes (2018) published a thought-provoking article, “Is OR Nursing Real Nursing,” in the September 2018 issue of the Massachusetts Report on Nursing. Her article was the catalyst for my invitation to students enrolled in the Fall 2018 University of Massachusetts Boston PhD Nursing Program course, NURS 750, Contemporary Nursing Knowledge, to join me in sharing our perspectives about “real nursing.” The result was published in the October 2019 issue of Nursing Science Quarterly (Fawcett et al., 2019).

Photo of the Misericordia Bell, The bell, which hangs In the tower of the St. Mary’s College Library, is a symbol of Misericordia et Caritus, which is the founding philosophy of St Mary’s College. Retrieved from http://st-mary-ac.sblo.jp/

This blog has provided an opportunity for six graduate students and three faculty members at St. Mary’s College Graduate School of Nursing, in Kurume, Japan to share their perspectives about “real nursing.” My invitation to them was given as part of a January 2019 video conference lecture I gave in my position as a visiting professor at St. Mary’s College. I am grateful to Eric Fortin, a St. Mary’s College School of Nursing faculty member, for his translation of the students’ and faculty’s contributions from Japanese to English.  Noteworthy is that St. Mary’s College School of Nursing is the first to include nursology as part of the name for their research center–the Roy Academia Nursology Research Center

Graduate Students’ Perspectives

Junko Fukuya: Throughout my nursing career, I have always used a nursing conceptual model to guide care of hospitalized patients from admission to discharge. I would like to become a better nursologist, a “real nurse,” who allows nursing knowledge to permeate my mind and impresses its importance on other nurses.

Akemi Kumashiro: Nursing is practiced in many settings, including clinical agencies and local communities, with people who are well and those who are ill. Real nursing occurs when the nurse continually gains the knowledge and experience required to help people to adapt to a new life style when changes in environment occur.

Takako Shoji: Patients are persons who are important to and loved by someone. By recognizing patients as people with life experiences and families, I do not merely provide knowledge and technology, instead, as a real nurse, I work to establish a relationship with each patient that respects the values he or she has formed through life experiences.

Chizuko Takeishi: The real nurse endeavors to meet the universal needs of individuals, families, groups, and communities of all ages. Real nursing is directed to helping people to make decisions directed toward maintenance and promotion of wellness, prevention of illness, recovery from illness, relief from pain, maintenance of dignity, and promotion of happiness.

Tomomi Yamashita: As a real nurse, I know that patients are waiting for me and support me in establishing mutual and warm relationships. Real nursing involves actions, thoughts, and words that affect patients’ lives. It is a process of talking with patients about their perceived needs and anticipating those needs they have not yet identified.

Yuko Yonezawa: Real nursing involves seeing human beings as holistic beings consisting of body, mind, and spirit, who are deserving of respect and compassion from the very first moment of their existence to the end. Real nursing also involves knowledgeably helping people to help themselves to live their lives how they want.

Faculty Members’ Perspectives

Tsuyako Hidaka, Ikuko Miyabayashi, and Satsuki Obama: As a real nurse, the nursologist interacts with patients while providing daily care and obtains a lot of quantitative and qualitative data as he or she builds therapeutic relationships with patients. These data are the basis for what may be considered “invisible mixed methods nursing research” (Fawcett, 2015). Real nursing is a very noble profession in which real nurses learn “Life and Love” from patients as human beings and can thus grow as human beings themselves.

Jacqueline Fawcett: My position is that all nursologists (that is, all nurses) are real nurses who are engaged in real nursing. However, various perspective of what real nursing is (or is not) exist, as Hayes (2018) had indicated.

I am grateful to the graduate students and faculty at St. Mary’s College Graduate School of Nursing for sharing their perspectives about “real nursing” with the readers of this blog. I now invite students and faculty worldwide to send their perspectives about “real nursing” to me (jacqueline.fawcett@umb.edu) for inclusion in future nursology.net blogs. As we gather worldwide perspectives, we will be able to identify and describe what Leininger (2006) called universalities and diversities in who we are, what we do, and why and how we do what we do.

References

Fawcett, J. (2015). Invisible nursing research: Thoughts about mixed methods research and nursing practice. Nursing Science Quarterly, 28, 167-168.

Fawcett, J., Derboghossian, G., Flike, K., Gómez, E., Han, H.P., Kalandjian, N., Pletcher, J. E., & Tapayan, S. (2019). Thoughts about real nursing. Nursing Science Quarterly, 32, 331-332.

Hayes, C. (2018). Is OR nursing real nursing? Massachusetts Report on Nursing, September, 11.

Leininger, M. M. (2006). Culture care diversity and universality theory and evolution of the ethnonursing method. In M. M. Leininger & M. R. McFarland, Culture care diversity and universality: A worldwide nursing theory (2nd ed., pp. 1-41). Boston: Jones and Bartlett.

Are We Ready to Utilize Concept Analyses To Advance Nursology? Could This Be a Way Forward?

Rosemary, we found a recent citation of your research”, is a message I receive from ResearchGate whenever there is a new citation to my work! One message was another citation to one of my early papers (Eustace & Ilagan, 2010), which was the report of a concept analysis of HIV disclosure, published in the Journal of Advanced Nursing. Noteworthy is that this message was a report of the 50th citation to that paper. In the world of knowledge generation, this was particularly exciting news because I realized the impact the paper had for other scholars.  What I didn’t realize was the magnitude of influence the paper had in advancing nursing knowledge. This led me to some random thoughts on who exactly are these authors who cited my work and what was the context of their citations of my paper? A brief review of the citations and literature about the topic indicated that majority were from papers published in non-nursing journals and authored by non-nursing scholars. In addition, I found that some publications from nursing that examined closely related concepts did not cite my work. This surprised me but increased my curiosity about what all of this meant to me as a nursology scholar.

During a recent search of literature, I found an inspiring article by Rodgers et al. (2018) about the limitations of concept analysis. They underscored the importance of “moving knowledge development beyond the level of ‘concept analysis’ to developing a clear linkage to the resolution of problems in the discipline” (p. 451).  I asked myself, how can we do that? Do we have the theoretical and methodological knowledge to do that?  If we do, why are we still “stuck” on concept analysis per se?

These questions prompted me to reflect on my concept analysis of HIV disclosure (Eustace & Ilagan, 2010). I asked myself, what has been done to move beyond the concept analysis of HIV disclosure during the intervening years? A search for the citations using the Semantic Scholar impact search engine (https://www.semanticscholar.org) revealed that one replication of my concept analysis has been published (Kanyamura, Ncube, Mhlanga, & Zvinavashe 2016). Surprisingly, although the impact of the publication indicated was highly influential to others work, especially for background data, the impact of the analysis findings was very limited (see Figure 1). What this meant to me was that there was no indication of linkage of the concept analysis results with knowledge development. Inasmuch as this finding is consistent with Rodgers et al.’s (2018) concern that concept analyses are not being extended to resolve disciplinary problems, how, can we help nurse scholars advance science in this area? Is there a way?

Figure 1: Semantic Scholar Impact Output for the concept of HIV Disclosure by Eustace and Ilagan (2010)

One way forward is to develop clear guiding structures for nursing knowledge development as an essential step in closing the gaps between theory, research, and practice (Marrs & Lowry (2006). To help find a solution, I turned to the well-known approach of Conceptual-Theoretical-Empirical (CTE) structures in nursing that have been advocated for many years by Dr Jacqueline Fawcett (e.g. Fawcett, 1988; Fawcett, 2012). So, where do we start? I propose that nurse scholars consider the following 3 critical steps:

Step 1: Nurse Scholars need to examine where a nursing concept of interest is derived from within our nursing models/theories. For example, the case of the concept of HIV disclosure can be situated within the nursing model of HIV Disclosure developed by Bairan et al. (2007) (i.e. relationship model). It is important for the nurse scholar to indicate the purpose of the concept analysis: is there a need for clarification, development, or refinement or is there little or no literature about the concept? These queries will guide the scholar to the appropriate concept analyses methods. The selection of HIV disclosure, in my case was the lack of a clear definition and a broader perspective of the HIV disclosure process in both the Bairan et al. (2007) model and in other HIV disclosure models (e.g. disease progression (Kalichman, 1995 ); consequences model (Serovich, 2001).

Step 2: Nurse Scholars need to develop a conceptual theoretical empirical (CTE) structure for linking concept analyses to the next step in theory generation. As described by Fawcett and Gigliotti (2001), theory generation studies usually proceed from the “conceptual model directly to the empirical research methods and the data obtained is analyzed creating a new middle range theory” (p. 342). Thus, the CTE structure should direct the nurse scholar to the relevant literature for the concept analysis, which will be summarized and synthesized to identify the antecendents, attributes and consequences of the new descriptive middle-range theory of the concept of interest (see Figure 2 for an example of the CTE structure for the concept analysis of HIV Disclosure). The “C” in the CTE structure represents the HIV Disclosure Conceptual Model by Bairan et al. (2007). The “T” represents the specific concept to be analyzed, which is “HIV disclosure.” The E of the CTE structure indicates the empirical research methods used to generate the antecendents, attributes and consequences of the studied concept, as explained in Walker and Avant’s (2019) approach to concept analysis.

Figure2: Conceptual-Theoretical-Empirical Structure for Linking Concept Analyses to Theory Generation

Figure2

Step 3.  Nurse Scholars need to utilize the findings from the concept analyses to advance nursing knowledge by using the results of the concept analysis to develop/refine theory constructs, develop instruments and then progress to explanatory and predictive theories by linking other concepts of the conceptual model to theory concepts.  So how can scholars use the descriptive middle range theory from the concept analyses to advance existing theory/model development?  Figure 3 provides a CTE structure for a hypothetical study of linking the concept analysis of HIV disclosure to advance the HIV disclosure model by Bairan et al. (2007). The vital step within the CTE structure is the re-evaluation process of the theory of which I have named the “theory refinement” process. In the HIV disclosure example, the original guiding conceptual model by Bairan et al. (2007) needs to be refined utilizing the antecedents, attributes and consequences derived from the concept analysis of the HIV disclosure concept. Scholars should utilize the results of the analysis to assess the adequacy of the constructs of the HIV disclosure model and propose directions for further empirical inquiry to determine the theory’s credibility in clinical practice and advancing the discipline.

Figure 3 – A hypothetical Conceptual-Theoretical-Empirical Structure for the HIV Disclosure Concept Analysis by Eustace et al. (2010)

Here are some epistemological considerations if we choose to move forward with this approach:

  1. How can we best approach T in the CTE structure? In this case, how should nursology theorists guide scholars on how to systematically develop constructs from the descriptive middle range theory to be utilized in refining the concept for the existing theory/model?
  2. What strategic and systematic approaches should we employ to retrieve, summarize, and synthesize the evidence for concept analyses, report findings and, lastly evaluate empirical studies on the concept analyses -theory generation linkage? How can we standardize the documentation process during knowledge dissemination? For example, documenting the specific date ranges when evidence was retrieved, dates when the publication was received, revised, accepted, published online and in the journal.
  3. How should we move forward in designing shared CTE structures that are empirically adequate in nursing situations (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001). For instance, how can we generate a global nursing HIV theory model and also contribute to knowledge development of a global interprofessional HIV Disclosure model?

 

A Call to Action:

ARE YOU READY to end what Draper (2014) calls the “intellectual dead end” (p. 1208) of concept analyses in nursing? If so, join me in articulating and advocating for approaches that facilitate the use of concept analyses as the starting point for advancing nursing knowledge. Developing nursology focused CTE structures that link concept analyses to other relevant practice phenomena are timely and very much needed to meet the demands of the complex 21st health care delivery systems. I welcome any comments or suggestions from nursologist around the world on how we can better address this ongoing concern as we think about advancing nursing science for the Future of Nursing 2030.

References

Bairan, A., Taylor, G. A. J., Blake, B. J., Akers, T., Sowell, R., & Mendiola Jr, R. (2007). A model of HIV disclosure: Disclosure and types of social relationships. Journal of the American Academy of Nurse Practitioners, 19, 242-250.

Draper, P. (2014). A critique of concept analysis. Journal of Advanced Nursing70, 1207-1208.

Eustace, R. W., & Ilagan, P. R. (2010). HIV disclosure among HIV positive individuals: A concept analysis. Journal of Advanced Nursing66, 2094-2103.

Fawcett, J. (1988). Conceptual models and theory development. Journal of Obstetric, Gynecologic, & Neonatal Nursing17, 400-403.

Fawcett, J. (2013a). Thoughts about conceptual models and measurement validity. Nursing Science Quarterly26, 189-191.

Fawcett, J. (2013b). Thoughts about multidisciplinary, interdisciplinary, and transdisciplinary research. Nursing Science Quarterly26, 376-379.

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). Philadelphia, PA: F. A. Davis.

Kalichman, S. C. (1995). Understanding AIDS: A guide for mental health professionals.  Washington, DC: American Psychological Association.

Kanyamura, D., Ncube, B., Mhlanga, M., & Zvinavashe, M. (2016). HIV Disclosure: Concept AnalysisJournal of Research in Pharmaceutical Science, 3(4), 1-4.

Marrs, J. A., & Lowry, L. W. (2006). Nursing theory and practice: Connecting the dots. Nursing Science Quarterly19, 44-50.

Rodgers, B. L., Jacelon, C. S., & Knafl, K. A. (2018). Concept analysis and the advance of nursing knowledge: State of the science. Journal of Nursing Scholarship50, 451-459.

Serovich J.M. (2001). A test of two HIV disclosure theories. AIDS Education Prevention, 13(4), 355–364

Villarruel, A. M., Bishop, T. L., Simpson, E. M., Jemmott, L. S., & Fawcett, J. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly14, 158-163.

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing. New York, NY: Pearson Education Inc.

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.

Why Not Nursology?

Photo – Adeline Falk-Rafael © 2018

Dr. Jacqui Fawcett  eloquently argued the case for “Why Nursology “a few weeks back. Another question might be asked – why not nursology? The use of “logy” – the study of – is widely used as a convention for identifying the knowledge base of other disciplines, e.g, biology, sociology, psychology, etc. On the other hand, the word “nursing” can be confusing because it has both popular uses, such as sipping a drink slowly or breastfeeding, and professional uses such as nursing (practice) and nursing (knowledge). It is beyond time for distinguishing between those two professional meanings. I believe doing so will go a long way toward making nursing knowledge visible, not only to other health disciplines and the public, but also to nurses and nursing students themselves. Language is powerful – it is the reason, I have previously advocated for replacing the term “student nurse” with nursing student. I look forward to that becoming nursology students!

I am excited about this initiative! Perhaps that is because my first nursing program was a hospital-based diploma program in the Canadian mid-west during the early 1960s in which the only reference to nursing science that I recall was a textbook called “The Art and Science of Nursing.”  The science of nursing was, sadly,  never explicated. I learned nursing basically as an ancillary medical service, i.e., the care required in the context of specific medical diagnoses and/or treatments. Over the next 15 years, I worked in various units in different hospitals in different cities and provinces. I practiced as I had been taught and consistent with how other Registered Nurses practiced. I say with some shame that I wasn’t reading nursing journals during that time and looking back, I think that was the norm for my colleagues, as well. Hospital or unit procedure books provided the necessary instruction for how to perform essential tasks.

It wasn’t until I moved into a leadership position and took a nursing leadership course that I was introduced to and required to engage with nursing (and other) literature. I marveled at how nursing leaders so articulately argued the contributions nurses make to health and healing, contributions that were based on nurses’ assessments and judgments, independent of medical directives. Nursing  process, nursing diagnoses and nursing theories excited me because they named and provided systematic structure for the work that nurses did in promoting health and healing. In other words, they began to make the invisible, visible! I began to read books and papers on my own, but soon realized I needed more knowledge and returned to school.

I don’t think my journey was unusual for that time. What grieves me is seeing still, much too often, nurses who acknowledge the biological, physiological, psychological, sociological and/or medical knowledge that informs their practice but fail to recognize the critical contribution of nursing knowledge. Nursology is a term that by its very nature emphasizes the disciplinary field of study that informs nursing practice. I can’t wait for the first Nursology programs and for nursing researchers and advanced practioners being recognized as nursologists, in keeping with the conventions of so many other disciplines.

Our Name: Why Nursology? Why .net?

Why Nursology?

At least since the publication of Donaldson and Crowley’s (1978) seminal paper titled The Discipline of Nursing, nurses have been considered members of a discipline. A discipline (the term comes from the Latin disciplina) is a branch of instruction or  learning and is a way of organizing knowledge. Different disciplines are distinguished one from another by the subject matter of interest to their members. In what way does calling our discipline nursing convey a focus on knowledge development and testing, rather than, for example, breast feeding? Those of us involved in founding this web site agreed to use of the term, nursology, as the best way to convey this focus.

The term, nursology, comes from the Latin, Nutrix, [meaning] nurse; and from the Greek, Logos, [meaning] science (O’Toole, 2013, p. 1303). The first mention of nursology apparently is by Paterson, an American nurse, in her 1971 journal article. She coined the term, nursology, “to designate the study of nursing aimed towards the development of nursing theory” (p. 143). Roper (1976), a Scottish nurse, also referred to our discipline as nursology. She explained,

“It could be that nursing might develop as a discipline without using a word to describe its characteristic mode of thinking, but it will have to make the mode explicit and it will have to have the same meaning for nurses anywhere. Should the nursing profession require to use a word, I propose the word nursology for the study of nursing, so that the logical pattern of derivation of an adverb could be followed. (p. 227)

Fitzpatrick (2014) pointed out that use of the term, nursology, as the name for the discipline has not been supported by nurses, although “remnants of this minor movement appear today. Students in current doctoral-level nursing theory classes often express interest in the term as a way to legitimize the scientific enterprise and distinguish nursing science from other disciplines, particularly [other] health disciplines” (p. 5).

Nursology is not only a name for our discipline. It also is regarded and has been used as a research method and a practice method (Fawcett et al., 2015). The name for our schools and department and programs most properly, also is nursology. The members of our discipline—students, practicing nurses, researchers, educators, and administrators—are scholars of nursology, that is, nursologists. Noteworthy is that Josephine Paterson (1978) and Loretta Zderad (1978) held the formal title of nursologists while at the Veterans Administration Hospital in Northport, New York. As nursologists, we clearly no longer regard ourselves or can be regarded by others as handmaidens to physicians, who are members of the trade of medicine (medicine cannot be regarded as a discipline due to no evidence of distinctive knowledge).

Why .net?
.net was selected as the extension for the web site name to,  as Peggy Chinn pointed out, convey a network of nurses who are interested in learning about all things theoretical in nursology, including advances in the knowledge needed and used by nurses to guide their practice.

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28, 330-333.

Fitzpatrick, J. J. (2014). The discipline of nursing. In J. J. Fitzpatrick & G. McCarthy (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit (pp. 3-13). New York: Springer.

O’Toole, M. (Ed.) (2013). Mosby’s medical dictionary (9th ed.). St.Louis: Mosby.
Paterson, J. G. (1971). From a philosophy of clinical nursing to amethod of nursology. Nursing Research, 20, 143-146.

Paterson, J. G. (1978). The tortuous way toward nursing theory. In Theory development: What, why, how? (pp. 49-65). New York, NY: National League for Nursing. (Pub. No. 15-1708)

Roper, N. (1976). A model for nursing and nursology. Journal ofAdvanced Nursing, 1, 219-227.

Zderad, L. T. (1978). From here -and-now to theory: Reflections on“how.” In Theory development: What, why, how? (pp. 35-48).New York< NY: National League for Nursing. (Pub. No. 15-1708)