Moving from training to educating

More and more discussion is happening about the words we use in nursing. There are many words we need to move away from or change, and it will likely not happen in my lifetime. We are, however, making progress, and that’s what truly matters. Nursing faculty who teach their students more effective, helpful, and empowering messages are making a difference. Articles that focus on (and use!) strengths-based, person-centered language are moving the needle, as they say.

In addition to compliance and adherence, which Jacqueline Fawcett wrote about recently, training is a word that is prevalent in nursing. It’s time to change that. I often say, “we train animals; we educate people.”

Right now, nursing’s world is being rocked by COVID-19. We’re hearing many stories about PPE, which fit in with the training vs. educating question. Nurses are trained in the use of PPE, likely from their very first day. They are told how to put them on, take them off, perform tasks while wearing PPE, and so on. While they may get a little background on stopping the spread of infection through using these precautions, I’m guessing it really is training. When it comes to caring for patients who are sick and isolated; however, nurses call on their education. They use all five patterns of knowing (empiric, aesthetic, ethical, personal, and emancipatory) (Carper, 1978; Chinn & Kramer, 2018) to provide the best and most comprehensive care possible despite the horrific conditions surrounding them. Nurses are comforting those who are dying alone, and administering medications and ventilation to those who are struggling to breathe. Those skills are not the result of training. They come from being taught, supported, and guided, both in the classroom and in the clinical setting.

My work is in diabetes care and education. Training is a word that is prevalent in the diabetes arena. In fact, while diabetes professionals prefer and typically say, diabetes self-management education, the Center for Medicare and Medicaid Services (CMS) insists on calling it diabetes self-management training. I’ve noticed that as a professional group, we seem to have given up on trying to change that.

The reason it matters in diabetes is that we are working with human beings. Training means basically telling someone to do something a certain way. Like I mentioned earlier, we train animals. Animals don’t understand the rationale behind performing a trick or coming when they are called. Teaching means to explain, support, and educate. It is much broader than training, and it leads to autonomy, understanding, and engagement, rather than compliance or nonadherence. Humans not only have the capacity to understand, they deserve to know the why, what, and how.

The reason it matters in nursing, is that it’s the subtle difference between a profession and a trade. Nurse scholars have been asking whether or not nursing is an applied science, a basic science (Barrett, 2017) or a science at all (Whall, 1993). We’ve been asking what sets us apart from other health professionals. We’ve wondered why other professions don’t use or reference our knowledge base.

Peggy Chinn, in her keynote address at last year’s Nursing Theory: A 50 Year Perspective, Past and Future conference, stated that it’s time to examine our own assumptions and actions (Chinn, 2019). When we refer to being trained as a nurse, or having been trained at a particular school, what are the underlying assumptions? Do we really see nursing as a trade, with trained workers? Or do we see ourselves as professionals who are educated and have a distinct body of knowledge that prepares us to work autonomously?

If we ever hope to change the messages in nursing and health, we have to start with ourselves. We have an opportunity to lead by example, and state proudly that we are educated, informed, and engaged in a valuable profession. We teach future nurses to also engage in the discipline, and we teach patients to engage in their health and well-being – at whatever level that is possible.

Transitioning from training to educating is consistent with caring (Chinn & Falk-Rafael, 2018; Newman, Sime, & Corcoran-Perry, 1991; Watson, 1997), humanism (Paterson & Zderad, 1976), empowerment (Funnell, 1991) and many other nursing concepts. Please join me in removing the word and the mentality of training from our messaging in nursing. Let’s educate instead.

 

References

Barrett, E.A.M. (2017). Again, what is nursing science? Nursing Science Quarterly, 30(2), 129-133.

Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-24.

Chinn, P.L. (2019, March). Keynote Address: The Discipline of Nursing: Moving Forward Boldly. Presented at “Nursing Theory: A 50 Year Perspective, Past and Future,” Case Western Reserve University Frances Payne Bolton School of Nursing. Retrieved from https://nursology.net/2019-03-21-case-keynote/

Chinn, P.L. & Falk-Rafael, A. (2018). Embracing the focus of the discipline of nursing: Critical Caring Pedagogy. Journal of Nursing Scholarship, 50(6), 687-694.

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

Funnell M.M. , Anderson, R.M. , Arnold, M.S. , Barr, P.A., Donnelly, M., Johnson, P.D., Taylor-Moon, D., & White, N.H. (1991). Empowerment: An idea whose time has come in diabetes education. The Diabetes Educator, 17, 37-41.

Newman, M.A., Sime, A.M., & Corcoran-Perry, S.A. (1991). The focus of the discipline of nursing. Advances in Nursing Science, 14(1), 1-6.

Paterson, J. G., & Zderad, L. T. (1976). Humanistic nursing. Wiley.

Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10(1), 49-52.

Whall, A.L. (1993). Let’s get rid of all nursing theory. Nursing Science Quarterly, 6(4), 164-165.

Posthumxnism and the Pandemic

Co-contributors with Jessica Dillard Wright:*
Jane Hopkins Walsh
Brandon Blaine Brown

One of the things that’s coming to light is how the global spread of a microscopic virus is placing the ravages of racism and inequity under the microscope. But the fact is, we don’t all see the same thing! Racism has a way of actually DISTORTING our vision. Intertwined with many other forms of social domination, racism is mercurial, innovative, even viral.” (Benjamin, 2020

Celestial Octopus

Our Celestial Octopus, emblem of the Compost Collaborative, created by nurse-artist Christian Tedjasukmana

As the Compost Collaborative,** a posthumxn rhizome of feminist, queer, nursing joy and terror, we wish to acknowledge some of the deep, enduring, and trenchant lessons of our dystopian present. As friends and scholars, we are deeply connected by a shared passion for a radical posthumxn path for the future of nursing. We first wish to convey our deep love, respect, and solidarity for the nurses who are actively engaged in the dangerous daily work of caring for folks infected with COVID19. Second, we recognize our privilege and positionality as white colonizers with access to medical care, physical goods, and material resources, knowing that power and access are not shared by all, deeply contingent on the intersections of race, gender, sexuality, class, colonial positionality. Posthumxnism is a critique of and response to humanism and its anthropocentric fixation, one that seeks to scrutinize the humxn and nonhumxn consequences of capitalism (Bradiotti, 2019). In advancing a posthumxn critique for and of nursing in the time of COVID19, we see our work growing out of the emancipatory tradition, centering critical perspectives, feminist analyses, queer inquiry, justice-oriented praxis as we navigate terra incognita (Kagan et al., 2014; Grace & Willis, 2012).

Here we sit, isolated in distant states recognizing that the dystopian imagined future is suddenly a fervent, fevered reality and nursing along with its healthcare comrades are essentially located in the interstices. Our speculative theorizing about the posthumxn present-future of nursing is in continuity with the future-oriented, space-exploring vision of Martha Rogers (1992), though our cosmic view is tempered with the urgency, pragmatism, and the reality of excavating the past while navigating the crises of our present from pandemic to scarcity to racism to climate change to colonialism to extinctions and more. The urgency for a posthumxn path forward has crashed on the doorstep and posthumxnism is ringing the bell. The posthumxn convergence is calling, Braidotti’s (2019) mash-up vision of posthumxnism and the end of life as we know it. This turn is a critical decentering of humxn in the broad landscape of our ecological terrain that subverts anthropocentric humxnism and its white, ableist, colonial, Eurocentric, cisgender, patriarchal biases, bound up in the neoliberal, capitalist world-ecology, as Jason Moore would call it. 

Humxns are a part of – not rulers over – global political economy-cum-world-ecology, underscored currently by the trans-species complexity of COVID19. In advancing posthumxnism, we also wish to respect and amplify ontological views that are foundational within Indigenous ways of knowing. Long erased by settler-colonial nations and scholars, these ontologies fashion a world in which humans exist coequally with the nonhumxn and the nonliving (LaDuke, 2017).

For a speed course in postanthropocentrism and posthumxnism, consider this novel virus, born of a pangolin, a bird, a pig, a lizard, a bat, a monkey. The viral RNA origins are non-humxn, the virus itself nonliving. Witness the impact as the virus quietly infects and swiftly overpowers contemporary humxnity, bringing powerful global enterprises, international trade, healthcare systems, educational structures, and communities to their knees. Here, the boundaries blur between the humxn and the nonhumxn, the posthumxn subject no longer bios but zoe (Braidiotti, 2019). The pandemic also highlights the communitarian imperative of humxn and nonhumxn life on this rock we call home, as we struggle with social distance and mourn the loss of normalcy. Making kin, Haraway’s (2016) concept of reordering multispecies world relations seems especially relevant in the face of this current crisis, underscoring how inextricably intertwined lives are and continue to become. Humxns shelter in place, leaving nonhumxn creatures to reclaim their once and future territories, roads and highways eerily deserted and quiet, free from the imposition of humxn interlopers. Signs of the postanthropos.

As we think of our planetary crisis, we recognize a cosmic unity similar to that advanced by Martha Rogers in her conceptual framework, the “Science of Unitary Human Beings” (1992). But we also recognize a necessary critique of the concept of “unitary,” problematically failing to account for the historical and contemporary power differentials and legacies of oppression between groups of people in the US and around the globe.  Rogers’ (1992) concept of unitary human beings included an irreducible, indivisible union of people and their worlds (p. 28). The concept of “unity,” however, obscures differentials of power that exist between different communities and their world that enforce inequality. 

We see a posthumxn reading of Rogers’ unitary framework in Posthumxnist Rosi Braidotti’s (2019) insistence that “we-are-(all)-in-this-together but we-are-not-one-and-the-same” (p. 52) that accounts for critical perspectives on how power and oppression structure inequality, even as we endure shared experiences. This reflection on our subjective experience is ever more prescient and poignant as United States political decision-making prioritizes economics and return to normal over humxn life, disappointing but far from surprising given our capitalist imperative to extract! Extract! Extract! And extract some more. As scholar Ruha Benjamin points out as governmental powers push to return to normal, the prepandemic normal was not so great for everyone (2020). 

The uneven unfolding of our dystopian crises belies the jingoistic and unitary notion of “we, the people.” “We, the people” will not experience the pandemic in equitable ways, even while viral RNA presumes to be a great equalizer, making no provision for race, gender, creed, color, sexuality, national identity. In truth, COVID19 etches the inequalities between us deeper still. The virus has and will continue to infect both the powerful and the powerless, though with uneven speed and inequitable consequences. The rich and powerful with unlimited access to viral testing with rapid results, symptomatic or no, while most are turned away. As millions lose their jobs, and with it, health insurance, the cracks in the U.S. healthcare “system” extend and grow wider.

The accretional benefits of power, access, economic and educational accumulation, family reserves built and fortified across generations through a legacy of colonial, white, cisgender, able heteropatriarchy buffer the privileged, making social distance and sheltering in place a relative luxury. White-collar workers collect salaries as they work from home facilitated by the endless, spidery connections that link us via technology, further highlighting our interspecies technological cyborg nature (Haraway, 1990). Even with this kind of padded seclusion there is weirdness, alienation, and violence of its own. The imperative to continue to produce belies the severity of the crisis at hand, even while it is bedecked in the privilege of safety from illness conferred by sheltering in place.

These same principles, sheltering in place and social distance, further marginalized those individuals already on the margins. Hourly-wage earners, the billions of global workers like shopkeepers, caterers, restaurant workers, wait staff, ticket takers wonder how they will survive, subjugated by the laws of Cheap Nature, if they do not have enough money for food and rent (Moore, 2016). Or for medical bills. Or a ventilator. The mundane slow violence of life under capitalism is amplified, writ large under times of crisis, as speculative, nightmarish hypotheticals become breathtaking realities, a startling necropolitics of neoliberalism, the biopolitical power to determine who lives and who dies as a function of capitalism (Mbembe, 2019; Nixon, 2011). This doesn’t even begin to account for the racist violence and inequities of mass incarceration and detention, the impossibility of social distancing for individuals within institutions, and the callous disposability this implies for the individuals trapped by incarceration or detention and those charged with their care.

Posthumxnism asks us to consider what we are capable of becoming, together as humxn and nonhumxn for a more just, egalitarian, and equitable future. This is our charge as posthumxn nurses – to imagine AND THEN CREATE a present-future, one that makes space for the plurality of beings and ways of being in the world, building the bridge as we leap. In building this path, we can cultivate zoecentric knowledge that subverts biocentrism, gazing past the anthropocentric, humxnistic, and exclusionary philosophies that privilege extraction and profit over nature, nonhumxns, and dehumxnized humxns.

The present-future requires that we – as nurses and everyone else – embrace methodologies for cross-pollination between, among, alongside, and interconnected with actors from all crevices of our world ecologies: ecological, geological, political, environmental, animal, mineral, pop-culture, art, media and technology. All bets are off: nothing is too weird or too daring, a radical departure from current modes of nursing thought (Braidotti, 2019). The divisions between theory and philosophy come tumbling down as we seek critical reflection, explanations, understanding, connection, fusion. In this apocalyptic present-future, multispecies posthumxn nursing knowledge can be knit, sung, woven, danced, spun, rapped, embroidered, dyed, hummed, planted in a garden, or spray-painted on train cars, the interrelation of humxn and nonhumxn all a part of the process of posthumxn-becoming. And this proposition of posthumxn knowing is congruent with fine threads of nursing thought, as we consider Rogers (1992) ideas of color, humor, sound, Carper’s (1978) aesthetic way of knowing and the emancipatory ways of knowing advanced by Chinn and Kramer (2018). 

In this space-time of pandemic ennui, which coincidentally coincides with the Year of the Nurse and the Midwife, what we must nurse is radical solidarity, a recognition that we are all in this together, even though we aren’t all the same (Haiven & Khasnabish, 2014). And the stakes are ominously high, should we fail to embrace this communitarianism. A future for healthcare, for sky, for nurses, for ALL people, for plants, for animals, for insects, for viruses, for bacteria, for trash, for compost, for kids, for terra, for seas, for space – any future at all – demands that we work together, composting the boundaries that separate us. This is not what we as nurses imagined for “our year,” but it is poetic-ironic that this is what we face. Together. 

“Despair is not a project, affirmation is.” (Bradiotti, 2019, p. 3).


**We call ourselves Compost Collaborative, a nod to feminist multispecies ecologist Donna Haraway, who captivated our collective imagination and informs our approaches to decaying boundaries of all kinds in nursing and in life. We are scholastically and tentacularly connected in our collaborative work as nurse-compost-scholars. This post was written by Jessica Dillard-Wright, Jane Hopkins Walsh, and Brandon Blaine Brown. Our collaborative is fungible, however, and our ideas are collective, part of a social process influenced by people, animals, environments, and ideas far and wide.

References

Benjamin, R. (2020, April 15). Black skin, white masks: Racism, vulnerability and Refuting black pathology. Retrieved from https://aas.princeton.edu/news/black-skin-white-masks-racism-vulnerability-refuting-black-pathology

Braidiotti, R. (2019). Posthuman Knowledge. Polity Press.

Carper, B. A. (1978). Fundamental Patterns of Knowing in Nursing. Advances in Nursing Science, 1(1), 13–24.

Chinn, P., & Kramer, M. (2018). Knowledge Development in Nursing: Theory and Process (10th ed.). Elsevier.

Grace, P. J., & Willis, D. G. (2012). Nursing responsibilities and social justice: An analysis in support of disciplinary goals. Nursing Outlook, 60(4), 198-207. https://doi.org/10.1016/j.outlook.2011.11.004

Haiven, M., & Khasnabish, A. (2014). The Radical Imagination. Fernwood Publishing.

Haraway, D. (1990). A manifesto for cyborgs: Science, technology, and socialist feminism in the 1980s. In L. Nicholson (Ed.), Feminism/postmodernism (pp. 190–233). Routledge.

Haraway, D. (2016). Staying with the trouble: Making kin in the Chthulucene. Duke University Press.

Kagan, P., Smith, M., & Chinn, P. (2014). Introduction. In P. Kagan, M. Smith, & P. Chinn (Eds.), Philosophy and Practices of Emancipatory Nursing: Social Justice as Praxis (pp. 1–20). Routledge.

LaDuke, W. (2017). All our relations: Native struggles for land and life. Haymarket Books.

Mbembe, A. (2019). Necropolitics (M. Tauch, Trans.). Duke University Press.

Moore, J. (2016). The Rise of Cheap Nature. In Anthropocene or capitalocene: Nature, history, and the crisis of capitalism (pp. 78–115). Kairos Books.

Nixon, R. (2011). Slow violence and the environmentalism of the poor. Cambridge MA:     Harvard University.

Rogers, M. E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5(1), 27-34.

*About the contributors

Jess Dillard-Wright, MA, MSN, CNM, RN

A regular blogger for Nursology.net, Jess is a nurse-midwife and a PhD candidate at Augusta University. Her dissertation is an intellectual history of nursing and feminism, a history of the present untangling the faults and fissures that characterize the interrelationship between feminism and the profession, focusing specifically on Cassandra Radical Feminist Nurses Network. When she is not thinking about nursing, you’ll find Jess hanging out with her three kids and partner. Together, they like to go to the beach, play silly game(may we humbly suggest Throw Throw Burrito?), read books, and *try* to bake amazing things.

Brandon Brown MSN, RN-BC, CNL,

Brandon is a faculty member and Doctor of Education student at the University of Vermont and is one of the founding members of the Nursing Theory Collective. His research interests center upon the philosophical analysis of nursing theory, practice, and pedagogy through a critical posthuman and post-anthropocentric lens. When Brandon is not doing scholarly work, you can find him spending time with his family hiking, canoeing, and camping.

Jane Hopkins Walsh

Jane is a theory loving, Spanish speaking pediatric nurse practitioner at Boston Children’s Hospital. A Nursing PhD Candidate at Boston College, Jane is an immigrant rights activist who is co-enrolled in a certificate program at the Center for Human Rights and International Justice at the Lynch School of Education. Her main areas of interest are global health, im/migrant populations, and community based service delivery models to deliver nursing care for underserved children, emerging adults and families. She was awarded two global grants through Boston Children’s Hospital to coordinate services for children with complex care needs in remote areas of Honduras, and to explore the elevated incidence of chronic kidney disease in Central America with a transnational team. Links to her favorite NGO and volunteer immigrant rights groups can be found at the end of her blog posts on radicalnurses.com

 

 

 

WWFD: What Would Florence Do in the COVID-19 Pandemic?

Florence Nightingale circa 1860. Retrieved from https://en.wikipedia.org/wiki/Florence_Nightingale

On May 12th we celebrate Florence Nightingale’s 200th birthday in the midst of a global pandemic. Nightingale, the acknowledged founder of modern nursing, was no stranger to the unfettered spread of communicable diseases. During her service in the Crimean War ten times more soldiers died from dysentery, cholera, typhoid fever, and typhus than the wounds of war. Nightingale understood how the human-environment relationship influenced health and healing. According to Nightingale, nursing was about putting the person in the best condition for Nature to act (Nightingale, 1859/1969). In other words, the focus of nursing is on nurturing and supporting the process of healing. Nightingale was a social reformer, justice activist, humanitarian, liberally-educated scholar, and bioinformatician, driven to service and care for others from a deep spirituality (Dunphy, 2020).

In her book, Notes on Nursing: What it is and what it is not (1860/1969), Nightingale offers guidance about creating an environment that can prevent disease or support healing. While she is focused on care of “sick” persons in the home, her concepts are applicable beyond this. Here are ten practical tips from Florence Nightingale as we live with COVID-19 pandemic:

  1. Ventilation. Nightingale said that “keeping the air he (sic) breathes as pure as the external air without chilling him (sic)” is the very first canon of nursing. (p. 12). While we are sheltered-in-place it is important to get fresh air. Make an effort to spend some time outdoors by sitting outside, going on a walk or run while maintaining a social distance, or just opening windows. Those with mild to moderate symptoms of the disease will be managing symptoms at home, staying indoors away from others. Even with these restrictions promoting the flow of some fresh air in the home is possible, opening windows even a few minutes every few hours. We can advocate for those in the community who are not able to have a safe place to be outside or depend on others to get some fresh air.
  2. Health of houses (pure air, water, efficient drainage, cleanliness). Nightingale believed that cleanliness was the first defense in preventing disease. When she came to field hospitals in the Crimea her first action was to start cleaning the space. We know that the novel coronavirus that is causing COVID-19 is highly infectious. Because it spreads mainly through respiratory droplets keeping surfaces clean and washing hands after touching anything that could be touched by others, like doorbells, elevator buttons, mailboxes, etc. is important. Having water to wash hands, clothes, and surfaces is essential, but we know that those who are homeless and those whose water has been turned off need our advocacy to turn the water on and to have hand sanitizer available for those without homes. I diffuse antimicrobial essential oils like eucalyptus, tea tree and cajeput in my bedroom and family room to cleanse the air.
  3. Petty management is about the holistic coordination or management of care through environmental scanning, information and planning. I found one passage particularly relevant to our experience with COVID-19. “Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember he is face-to-face with his enemy all the time, internally wrestling with him, having long imaginary conversations with him…Rid him of his adversary quickly” (Nightingale, 1859/1969, p. 38). This is a stressful time in our lives and many are living with fear and anxiety. Receiving clear and consistent messages is important in a crisis. Providing honest information to those we encounter about the transmission of the virus, incubation period, ways to protect self from infection, and what to do when experiencing symptoms may relieve anxiety and help them to plan and gather resources. I find myself providing information to family and friends who call with questions. Nurses are trusted and approachable sources of knowledge for the public. There is so much information on the internet, and we can help to refer people to the most reliable sources. Listening and providing support to others can be helpful as well as caring for self through those activities that work for you such a meditation, exercise, watching a funny movie, journaling, etc.
  4. Noise – In this section, Nightingale calls attention to the sound environment and its potential effect on promoting rest and well-being. With most of us sheltered at home we can cultivate greater awareness of how sounds affect us. For example, it may be tempting to have the television or internet news on; however, the constant information about the pandemic may cause us to become more tense and anxious. Turning on music that is comforting, relaxing, joyful or inspirational, or tuning into sounds from nature from apps, or actually being outdoors are ways to promote serenity.
  5. Variety – We may be at home for another 1-2 months, so Nightingale’s advice on creating variety in the environment is especially relevant. She said, “…the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms” (p. 58). She suggested bringing beauty, color and interesting objects into a confined space. How can we bring variety into our lives when our space is limited? One way is intentionally creating a daily schedule that includes new and interesting activities. It might be creating art, journaling, working on a home project, learning a new skill like a language, touring museums using online apps, reading books, or binging on a Netflix series. Some are caring for and home schooling children, working from home, or continuing their essential work in the community. Variety is already built-in to their lives.
  6. Food – Nightingale focuses on providing food that is nutritious and supportive for healing. The science of nutrition has come a long way since Nightingale. During this pandemic we want to eat food that supports our immune systems, lots of fruits and vegetables if possible. Take a multi-vitamin with minerals or supplements with Vitamin C, D (especially if you are not exposed to much sunlight), A, E, selenium, magnesium and zinc. Shopping and getting groceries or prepared food delivered can be challenging and anxiety-producing. Some may have a tendency to overeat for comfort, boredom, or just having constant access. With the loss of jobs, food insecurity is a concern. We need to support food banks more than ever in this crisis.
  7. Bed and bedding – The message here from Nightingale is to keep bedding fresh and aired out, changing the sheets frequently and airing out the bed with a window open if possible before making it. While she is referring to caring for people bedridden, this is still a useful message to consider.
  8. Light – Nightingale asserts that the need for sunlight is second only to the need for fresh air. (p. 84). She stated that sunlight not only lifts the spirit, but “has real and tangible effects upon the human body…a purifying effect” (p. 85). She suggested either letting the sunlight into the room or better yet, getting out into the sunlight. We know that sunlight is indeed important for health, that ultraviolet light has antiviral properties, and that viral infections tend to decrease when days are longer. When there is sunlight take an opportunity to get some exposure to it.
  9. Cleanliness – Here we go again! In this section, Nightingale is focused on actually scrubbing walls, floors, dusting and cleaning carpets or anything else harboring dirt. I guess this is another activity to keep us busy. In her section on personal cleanliness she emphasizes how vitality is restored by washing the skin and clothes. “Poisoning by the skin is no less certain than poisoning by the mouth—only it is slower in its operation” (p. 93). People feel better after a bath or shower, and she even suggests skin brushing (she calls it “rubbing” the skin). Washing ourselves and our clothes more frequently especially if there are chances of exposure to the virus is important.
  10. Chattering hopes and advices – In this section Nightingale warns against offering unsubstantiated hopeful predictions and giving advice without any foundation to it. She says to “leave off the practice of attempting to ‘cheer’…by making light of danger”…(p. 96). I believe she is telling us that during times of human suffering authentic presence through being with, listening, and following the persons’ lead is essential. Many are suffering during this time. Nurses can be with others by listening and being present with them during this suffering without simplistic platitudes.
Sources

Nightingale, F. (1860/1969). Notes on Nursing: What It Is and What It Is Not. New York: Dover Publications.

Dunphy, L.M.H. (2020). Florence Nightingale’s conceptualizations of nursing. In Nursing Theories and Nursing Practice (5th edition). M. Smith (Ed.). Philadelphia: F.A. Davis, (pp. 35-54).

Nightingale’s Vision for Nursing in 2020

It will take 150 years for the world to see the kind of nursing I envision

Painting of Nightingale In the Florence Nightingale Museum

The year 2020 marks the bicentennial of Nightingale’s birth and approximately, at least, the 150th anniversary of her prediction that “It will take 150 years for the world to see the kind of nursing I envision.”  What was that vision, in what ways is it relevant today, and to what extent has it been realized? Although volumes could be written to answer these questions, for the purposes of this blog, it is possible only to highlight a few: her founding of and contribution to documented nursing disciplinary knowledge, i.e., nursology, her contribution to nursing education, and her championing of evidence-based practice and policy.

  • In 1860, Nightingale published the first recorded conceptual framework for nursing, in  “Notes on Nursing.”  in it, she clearly differentiated nursing from medicine; she saw medicine as removing obstructions to nature’s ability to heal  but nursing as creating the best conditions e.g., nutrition, cleanliness, ventilation, etc. for that healing to occur. I think she would be pleased to see the Nursology.net site, dedicated to furthering nursing knowledge.  The site currently hosts 53 nursing theories, from conceptual frameworks to mid-range and situational theories, but each focused on health, as opposed to disease, and on the nurse’s role in promoting healing. And, I think Nightingale would be pleased to see the large numbers of nurses who practice, teach, and.or conduct research guided by nursing

    Turkish lamp from the Florence Nightingale museum

    disciplinary knowledge.  But, I think she would be dismayed at the powerful influence the medical model still has on health care generally and on many nurses, whose practice consciously or unconsciously is strongly influenced by it (Bradley & Falk-Rafael, 2011). It is not possible to practice nursing without an idea of what the scope and nature of that practice is (i.e., a conceptual framework) and if that framework is not solidly rooted in nursing’s disciplinary knowledge, it is vulnerable to dominant influences from other disciplines (Rafael, 1999, 1998).

  • It is no coincidence that also in 1860, Nightingale founded her training school for nursing. Before the introduction of a trained nursing workforce, people who provided patient care (if there were any) might be called nurses  but who, according to McDonald, “were mainly low-paid, disreputable hospital cleaners, notorious for demanding bribes from patients and stealing their gin” (McDonald, 2013, p.36). Some of the important features of the Nightingale program were the requirement that all nurses be trained in a hospital setting, regardless of where they intended to work (e.g., the military, district nursing, midwifery, administrative roles), some of which required additional training. It became a model for many other schools of nursing in Europe, North America, and Australia.  Undoubtedly, some readers of my vintage who initially trained in general hospitals as late as the 1960s, would recognize familiar aspects of her model. (I recall reciting the “Florence Nightingale pledge” on the occasion of my completing the first 6 month’s probationary period of my training)!  Nightingale’s approach  was basically an apprenticeship model in which nursing students provided hands-on nursing care under the supervision of more senior nurses (e.g, clinical co-ordinators/headnurses/ward sisters). The learning that took place on the wards was augmented by classes given by physicians.  McDonald further notes that while Nightingale did not envision university schools of nursing, she advocated for “a professorship of hospital administration, hospital construction, and hospital nursing.”  While admission to universities remained off-limits for women in Nightingale’s time, I believe she would be most pleased to see the  progress that has been made in university education for nurses, both at an entry-to-practice level and in graduate education. In her time,  without regulatory bodies and examinations, graduation from a training school was the only guarantee that a nurse was indeed qualified to practice. My guess is that she would have welcomed regulatory bodies to allow a more diversely qualified nursing workforce.  I would guess that she might even support the use of personal support workers if they were under the supervision of adequately prepared nursing staff.  I fear she would not be in favour of the extensive use of personal support workers seen in some settings, without that supervision.
  • Nightingale’s use of statistics to demonstrate the effects of nursing care in the Crimean War are legend.  What is less known is what McDonald describes as her reputation as the  “the ultimate statistician. Nightingale was deeply influenced by the work of Quetelet, a renowned Belgian mathematician and statistician and author of “Social Physics.” McDonald noted that Nightingale advocated for pilot projects to evaluate the effects of changes to policy and practice. Similarly she stressed evaluation, including cost-benefit analyses, of existing programs and/or policies,  frequently developing the appropriate questionnaires for data collection herself if none were available.  Nightingale used empirical evidence to support approaches to making childbirth safer. Although initially intending to open a lying-in hospital, she decided against it after finding that the mortality data among women giving birth  where they were in contact with medical personnel (e.g. lying-in hospitals) were higher than when they gave birth at home or even in workhouses. Likewise, although her initial rejection of germ theory is well known, her acceptance of it when presented with the evidence by Joseph Lister is less well known. Nightingale’s reputation as a statistician resulted in her  nomination by William Farr, a renowned British statistician, to be the first woman to become a fellow of the Royal Statistical Society in Britain. Her reputation was international; in 1874, she  was elected an honorary member of the American Statistical Association.  I think Nightingale would be pleased to see the growth in the number of nurse researchers, the number of nursing journals that report that research, the existence of hospital libraries and librarians to facilitate access to that research, and the emphasis on evidence-informed practice. Is it enough? I suspect that Nightingale would still see room for improvement!   

Would Nightingale have envisioned a pandemic in which, at the time of writing this blog, more that 3 million people in the world had contracted COVID-19, with approximately 1/3 of those cases being in one of its wealthiest, powerful, and most advanced countries, the United States?  I’m guessing that were she alive today, she might have seen it coming.  Nightingale was a systems thinker; just as she reflected on the cholera outbreaks by noting facetiously “I sometimes wondered why we prayed to be ‘delivered from plague, pestilence and famine’ when all the common sewers of London ran into the Thames”, she might made a similar remark about prevailing economic trends.  Nightingale was a keen advocate for a comprehensive public health system and for government involvement in providing a social safety net, including income security and pensions.

Last evening, I read an article  in the Toronto Star  which spoke to the increased vulnerability to COVID-19 of people with low incomes, who, for a variety of reasons that include the need often  to  work in jobs in which they are more likely to be exposed to the virus. In addition, they tend to be able only to afford housing far from where they work, requiring the use of public transportation, creating further risk. Among the author’s suggestions was one that seemed very familiar:  “It would be far cheaper for society . . .to take a significant portion of . . . public funds and put them into . . . housing that’s affordable for all income cohorts within a reasonable[distance]  . . . of where they have to work, so that there would be more choices throughout any metropolitan region for people than they are given now.”  I was reminded of Nightingale’s famous quote made in 1868: “And if all the money that is spent on hospitals were spent on improving the habitations of those who go to hospitals, and (on prisons) of those who go to prison,  we should want neither prisons nor hospitals.”

Do I believe she would have seen a pandemic coming? Yes, because it seems, unfortunately, society has not learned important lessons from history.

Sources

Bradley, P. & Falk-Rafael, A. (2011). Instrumental care and human-centred caring: Rhetoric and lived reality. Advances in Nursing Science 34(4), 297-314.

McDonald, L. (2013). The timeless wisdom of Florence Nightingale. Canadian Nurse, 109(2), 36.

Rafael, A.R.F. (1999). From rhetoric to reality: The changing face of public health nursing in Southern Ontario. Public Health Nursing, 16(1), 50-59.

Rafael, A.R.F. (1998). Nurses who run with the wolves: The power/caring dialectic revisited. Advances in Nursing Science. 21(1), 29-42.

 

Nurse Trauma in the Face of COVID-19

Guest Contributor
Catherine Quay*

On a rainy night in October 2019, I watched and celebrated as nursing students walked across the stage to receive their hard earned nursing pins. Little did we know that they would be entering the nursing workforce just prior to a global pandemic unlike one that has been seen in over 100 years. Some of these students have reached out to me recently to express their frustration. Just four months into their careers and they are stressed, anxious, exhausted, and scared, and as their recent instructor and mentor I feel helpless. Understanding the mental health impact this pandemic and the shortage of resources is having on nurses is essential. We also must understand the impact on new graduate nurses so we can prevent them from joining the ranks of nurses who leave within their first year of practice.

Anyone with access to an electronic device has heard the stories of the shortage of supplies as the result of COVID-19. Not enough masks, gowns, gloves, and ventilators to care for the growing number of individuals infected with this virus. Nurses and healthcare providers are being required to act in ways that only weeks ago would have been unthinkable. They are being required to make decisions that are often in conflict with the nursing knowledge and values that we, as educators, worked so hard to develop and nurture within them. Such ethical dilemmas are creating psychological discord that over time will result in lasting harm (Foli and Thompson, 2019).
Foli and Thompson’s (2019) middle range theory, Nurses’ Psychological Trauma, addresses this situation. The authors identify insufficient resource trauma as a nurse-specific trauma that with repeated exposure, can result in diminished physical and mental health, unsafe patient care, and can potentially lead to the nurse abandoning the profession (Foli & Thompson, 2019).

The trauma of not being able to carry out one’s ethical, professional, and organizational obligations due to a shortage of resources is what practicing nurses and health care professionals are experiencing every day during the COVID-19 pandemic (Foli, 2019). As educators, have we prepared students for this current reality? Where does this fit in with the patterns of knowing? According to this theory, personal knowing addresses the self-awareness and resilience needed to overcome trauma as each individual’s perception of an event is influenced by multiple personal factors and experiences. However, this kind of self-awareness as a nurse takes time to develop. Where does this leave our new nurses in the face of this pandemic? Are they receiving the support they need from their organizations and experienced nurses to develop the resiliency and ability to grow in the face of trauma?

The search for an understanding of how to help my former students has left me with more questions than answers. If the nursing profession and the organizations that depend on them do not address these questions, we will potentially lose large numbers of nurses. The psychological traumas nurses face on a regular basis must be acknowledged. “If we don’t strategize to sustain and restore our psyches and souls, we are just as vulnerable as our patients”(Foli & Thompson, 2019, p.34). A multipronged approach is necessary to address the reality of nurse-specific trauma. The profession needs to openly discuss the mental health impact that practicing with insufficient resources has on a health care professional.

We are currently seeing this in the media as nurses across the country speak out against the conditions they are being subjected to. Nurses must bring their authentic voice to the current crisis. Additionally, from a nursing educator perspective, there needs to be a focus throughout curriculum on developing personal and ethical knowing. Through self-reflection activities that focus on personal, historical, and patient trauma, a nursing student can begin to develop self-awareness, resiliency, and coping skills (Foli & Thompson, 2019). Lastly, health care organizations need to take a vested interest in the psychological well-being of their health care professionals by providing the necessary physical and emotional support resources and by creating a culture that supports emotional and professional growth. The return on investment is worth it.

The current COVID-19 pandemic has brought the reality of practicing with insufficient resources in health care to the forefront of society. Nurses must take the opportunity to speak out about the conditions they are facing and the choices they are being forced to make. For the nurses who have recently entered the workforce, we know this is not what you imagined. Reach out for help if you need it. Experienced nurses, let them know that you are there for them. Provide them emotional support, be present, and actively listen to the trauma they are experiencing. Nurses will get through this but only if we support each other. Together we are resilient.

Sources

Foli, K. (2019, November 12). Nurse-specific trauma: Let’s give it a name. Nursology. https://nursology.net/2019/11/12/nurse-specific-trauma-lets-give-it-a-name/

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, Indiana: Sigma.

About Catherine Quay


Catherine Quay

I am a doctoral student at Teacher’s College, Columbia and am currently taking a course with Jane Dickinson. We have been spending time exploring this site as part our class. Thank you for your insight and for providing us with many discussion topics. I hope you and your family are staying safe.

The Value of Primary Prevention

The COVID-19 pandemic reminds us of the primacy of primary prevention to maintain wellbecoming. The governmental recommendations or requirements for quarantines or sheltering in place during the pandemic are targeted to primary prevention.

However, few people worldwide unfortunately think primary prevention. Instead, far too many global citizens avoid vaccinations or screening tests and wait until they are obviously ill to seek care. Furthermore, governments rarely fund primary prevention efforts until such massive disruption as a major epidemic or pandemic occurs, as we have learned from media reports of no funds to prepare at least possibly effective vaccines and screening tests ahead of outbreaks of novel viruses. According to a recent report on public radio, proposals for studies of the effectiveness of quarantines have not been funded for many years, although the current pandemic may loosen the governmental purse strings.

As always, nursology has an answer to how to emphasize primary prevention. Specifically, Florence Nightingale successfully advocated for a clean environment (clean air, clean water, etc.) as a way to maintain wellness.

Nightingale’s ideas have been translated into contemporary nursology, especially in the Neuman Systems Model. This nursology conceptual model includes primary prevention as intervention as one of three intervention modalities (the others are secondary prevention as intervention and tertiary prevention as intervention (see neumansystemsmodel.org). Although other conceptual models do not explicitly focus on primary prevention, the intention certainly is to promote wellness.

© 2018 Jacqueline Fawcett

My understanding of our history tells me that nursologists have always had the moral courage to advocate for and implement primary prevention while at the same time providing superb secondary and tertiary prevention for all people worldwide.

Poremba (2019), who has studied the 1918-1919 pandemic, pointed out that then and now, nurses are best positioned to care for people. She declared, “If there is anything positive to come from the coronavirus, it may be that we recognize the essential value of skilled nurses. This means expanding our nursing workforce and advancing their training in caring for patients with acute and infectious diseases in hospitals and homes.” Although her focus is on secondary and tertiary prevention, we can expand her message to include the essential value of nursologists in providing primary prevention.

Reference

Poremba, B. A. (2019, March 15). Column: Nurses needed now. Gloucester [Massachusetts] Daily Times. Retrieved from https://www.gloucestertimes.com/opinion/column-nurses-needed-now/article_d1553519-f489-55c9-a1f9-4fe7d0820312.html

Keeping the Spark: How to Maintain your Humanism During the COVID-19 Pandemic

Guest Contributor: Erin Dolen, MS, RN, CNE

The country, and the world, is at war. War against the virus SARS-CoV-2 that causes Coronavirus Disease 2019 or “COVID-19” (FDA, 2020). As nurses, we must be on the front lines. Our dedication to the community to provide high-quality care should not end despite the complications associated with this pandemic. But how? How can we stay dedicated, humanistic, and compassionate when we are stretched beyond the limits of what we can accomplish? Josephine Paterson and Loretta Zderad have the answer.

Josephine Paterson (left), Loretta Zderad (right)

Paterson and Zderad (2007) first published their Humanistic Nursing Theory in 1975. Their hope was to help nurses understand that nursing is “an experience lived between human beings” (p.14). Through this experience, nurses can bring meaning and understanding to each patient’s life, the patient’s family’s life, and their own life. Paterson and Zderad maintained that this experience is important and effects the existence of all human beings.

So, what would they think about this global pandemic we currently find ourselves in? What does their theory propose that can help us now? These theorists also maintained that through having this shared experience with patients, nurses may hopefully remember why they chose to answer the calling of the nursing profession and stay dedicated to nursing despite the challenges that most certainly lie ahead. They could not be more right. We need this dedication to our profession now more than ever. We need to all remember why we chose to become nurses. What life experiences led us to this profession? What patients have we had during our careers that only further solidified that meaning in our lives? We have all had them. That older gentleman who was living his last moments on earth and grabbed our hands, and simply said “thank you”. That teenager who made a choice and found themselves in a life-changing situation who actually listened to us. I mean, really listened. That mother who lost a child who found solace in our embrace during the most difficult time in her life.

We need to remember these experiences but we also need to make new ones. Remember that each patient is a human being with needs, fears, and desires. Live this experience with them, not around them. Help them see meaning and understanding in their current situation. Help them see that they are not alone, nurses are with them. When you feel the need to rush out of the room, take the extra moment to lay a therapeutic hand on the patient’s shoulder, and simply smile. The smile may be behind your mask, but let it light up your eyes. The humanistic approach to nursing isn’t just for verbal interactions, but non-verbal as well (McCamant, 2006). For the pediatric patient who needed to have an x-ray and was taken from their mother, hold them PPE and all.

The humanistic nursing theory also has a subset of five phenomenological phases of nursing: preparation for coming to know, intuitive knowledge of others, scientific knowledge of others, synthesis of current knowledge to supplement practice and the inner transition from “many to the paradoxical one” (Lelis, Pagliuca, & Cardoso, 2014, p. 1117). As structured as this sounds, when you think about it, all nurses need to prepare to accept new knowledge, utilize their own intuitive knowledge, recall and retain scientific knowledge, apply that knowledge to guide their practice, and become one with their patients and their profession. Regardless of whether they know it or not, every nurse has been practicing the humanistic nursing theory their entire careers. Keep going. Keep accepting new knowledge and new experiences. Keep trusting your intuition and your scientific knowledge. Keep guiding your actions with evidence-informed practice. Keep becoming one with your patients and their families.

During this pandemic, when nurses feel exhausted, powerless, and ill-prepared, these experiences will help get us through. They will bring meaning and understanding to our lives. This meaning and understanding will help us remember that spark that lights our way to humanism. Most importantly, this lived experience with our patients will help us stay dedicated to our vital profession during this pandemic, and during any challenging times that lie ahead, just as Paterson and Zderad had hoped.

References

Lelis, A.L.P.A., Pagliuca, L.M.F., & Cardoso, M.V.L.M.L. (2014). Phases of humanistic theory: Analysis of applicability in research. Text Context Nursing, Florianopolus, 23(4), 1113-1122. https://doi.org/10.1590/0104-07072014002140013

McCamant, K.L. (2006). Humanistic nursing, interpersonal relations theory, and the empathy-altruism hypothesis. Nursing Science Quarterly, 19(4), 334-338. doi: 10.1177/0894318406292823

Paterson, J.G. & Zderad, L.T. (2007). Humanistic nursing [ebook]. Wiley. (Original work published 1975).

U.S. Food and Drug Administration (FDA). (2020). Coronavirus disease 2019 (COVID-19). https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus- disease-2019-covid-19

About Guest Contributor Erin Dolen

E Dolen PictureErin is an Assistant Professor of Practice at Russell Sage College in Troy, NY. She is a doctoral student in the EdD Nursing Education Program at Teachers College, Columbia University. She has her MSN with a focus in Nursing Education from Excelsior College. Erin has her national certification as a Certified Nurse Educator. Her nursing background is in emergency medicine. She lives in Delmar, NY with her husband and two children.

 

COVID-19 and Psychological Trauma

I feel guilty as I write this. You see, I’m home with my family, safe and warm. Protected. Others, my comrades and fellow nurses are not. But I can guess, and have read and been informed of what they are facing on the front lines: reassigned to new hospitals and new duties, rendering care, sometimes coerced by employers, without adequate protective equipment. No masks. No gowns. No testing to know who is indeed positive for the virus. One of my students wrote to me, expressing her ethical dilemma of whether to care for patients while she went unprotected, potentially cross-pollinating other patients and her family. They – her employers – had reminded her that she has ethically pledged to do so. Her note brought it to a personal level to me. What could she do, she asked me? I advised her to document, to bring others into the demands of adequate protection, and to consult the CDC guidelines, contact her county health department and so forth. I felt my advice was not nearly enough, a defective response to an impossible riddle.

We are in a pandemic, a global disaster, if you will. The United Nations Office of Disaster Risk Reduction: International Strategy for Disaster Reduction (2017) defines disaster as:

A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts. Annotations: The effect of the disaster can be immediate and localized, but is often widespread and could last for a long period of time. The effect may test or exceed the capacity of a community or society to cope using its own resources, and therefore may require assistance from external sources, which could include neighbouring jurisdictions, or those at the national or international levels (n.p.).

That about sums it up, doesn’t it? But what of the nurses’ psychological trauma experienced in the disaster?

My student described insufficient resource trauma, the lack of tangible and intangible resources necessary to render safe and quality care. The resources include knowledge, supplies, nursing staff, and other professionals.

My Middle Range Theory of Psychological Trauma includes this type of psychological trauma and the trauma experienced by being a social actor in the midst of an unfolding disaster (see Figure). Nurses will surely face secondary/vicarious trauma as they witness patients’ suffering and offer comfort and caring. They may participate in system or medically-induced trauma as patients are placed on ventilators, relinquishing control of their bodies. For some patients who lived through the Great Depression, memories of austere times may be invoked, causing anxiety and reflective of historical trauma.

Physicians are often tasked with triaging during disasters as the resources become more strained. But I have met with nurses who were involved in the California fires not too long ago. They felt forgotten and overlooked when the post-fire debriefings took place, as if their place in the healthcare hierarchy removed them from sitting at the healing table.

Another graduate nursing student emailed me about her class assignment. She probably won’t be able to finish it because of all the activities she is being called to do in her hospital, an ever changing world filled with chaos and uncertainty. When I weigh the final paper with saving lives, is there any doubt about what priority I should endorse?  But this is territory I’m unfamiliar with.

What I can do is remind myself that my world should be revised, amended, and my teaching should be trauma-informed. I should lace my work with compassion and an understanding of the overwhelming need for people to feel safe, their voices to be heard, and their recovery to be purposeful and inclusive. I can give names to the trauma they are exposed to and by doing so, offer them a path to express this psychological injury now and in the future so that recovery can unfold.

References

Foli, K. J., & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, IN: Sigma.

United Nations Office of Disaster Risk Reduction. (2017). Terminology. Retrieved from:  https://www.unisdr.org/we/inform/terminology.

 

Hidden Risks of Physical Distancing and Social Isolation

The single most important and essential step being taken worldwide to contain the spread of the COVID19 crisis is what is widely known as “social distancing.” But in fact this is physical distancing that heightens the risk of social isolation, conflict and stress. This necessary physical distancing is only tolerable for the most introverted of introverts, leaving the rest of the population in a state of periodic unrest at best, and deep distress at worst.  We are then faced with not only the possibility of disease/illness caused by the novel corona virus – we are faced with the dis-ease of daily living.  When the environment to which someone is compelled to retreat is a relatively safe haven that provides nurturing and encourages creative solutions to the inevitable frustrations and stress, the outcome will probably be okay at least – perhaps even resulting in some new and healthier patterns of daily living!  But the reality is that for far too many, the environment of “home” is a place of emotional tension, sometimes even emotional and/or physical danger.  For those who are “essential” workers – like many nurses – the workplace where they are now compelled to spend a considerable amount of time is one where their own physical well-being is at risk, and the culture may be also less than nurturing or pleasant – even abusive.  Even the best of circumstances can easily erupt into harmful conflict and emotional tension at a moment’s notice, ignited by the stress and tension of the uncertainties and dangers that we all face in this pandemic.

Now more than ever the world needs nursing – the practice of caring for others informed by the knowledge and the wisdom passed along in the theories and philosophies of nursology.  To me the unifying unique characteristic that is so vital as we face the COVID19 pandemic is the holistic nature of nursing theory and practice.  There are many insights that any of us can tap into in any of our theories – now documented on this website and accessible through the site’s galleries.

My theory and practice of “Peace and Power” is among those that directly address the challenges of social and emotional conflict and distress – distress that also compromises physical well-being.  The theory was developed as an approach to group process that shifts away from the power-over (often damaging) approaches that dominate group interactions, and toward an approach that nurtures all, that respects each person’s humanity, and that deals with conflict in ways that nurture growth and healing – not harm and hurt.  The “group” can  be as small as two people!  Shifting to this approach is not easy and it is especially hard to start learning in a context already stressed by the current pandemic – but it can be done!  The specific theoretical concept and practice is “conflict transformation.”  This abstract concept is possible to translate directly into practice – into the realities of every-day life – starting with awareness of the potential for unrest during this challenging time, and the commitment to  start practicing even with the smallest tension!   Here are a few practical ideas for using this approach where you live and work now.

When you are directly involved in a stressful interaction:
  • If you can, acknowledge the situation as soon as you even suspect that this might escalate.  Do not try to “fix” the conflict, simply acknowledge that it is happening, and ask for others to take time to reflect and find a new direction.  If it is now already escalated, step in to share (briefly) your sense of what is happening, and to ask everyone to take time to breathe and reflect on what is happening. This may be a few minutes, or a few hours – maybe a couple of days.
  • During this time, take deep breaths every few minutes to calm and center your spirit.  Focus on your own body/mind/spirit feelings and your own hopes for how this situation will unfold. Recognize and take into account the stress of the situation around you – in this case the pandemic and the real-life stress everyone is experiencing.
  • Shift to a place of inner calm, where you move away from blame and toward understanding of the situation as a whole.
  • Clarify the underlying values that you believe everyone in the situation shares.
  • Prepare your own “critical reflection” that you will share with the others involved.  This reflection consists of these elements:
    • I feel … focus on your own feelings without blaming others
    • When (or about) … describe factually what happened when your feelings came to the surface.
    • I want, I offer .. describe what you envision happening next to move away from or resolve (transform) the conflict, even if it seems impossible to happen.
    • Because … name the value, goals or ideals that you share with the others who are involved.
  • Take a deep breath, and return to the situation ready share your reflection and invite the others to also move away from conflict toward peaceful and health-promoting interactions. Listen carefully to what everyone shares, and join with them in finding a path forward.  The path might still be rocky along the way, but you will now have a foundation from which you can build.  Keep the process of transforming conflict alive and well as you navigate troubled waters.
When you observe a stressful, potentially harmful interaction:
  • Acknowledge what you are observing, even if it is not immediately clear that something harmful is happening.
  • Offer to serve as a mediator or facilitator, bringing awareness of the situation to light, and encouraging a move away from harm and toward understanding
  • If others are open, share the “Peace and Power” process of conflict transformation as an approach to deal with the situation.

Your Well-Being as a Nurse and the COVID-19 Pandemic

We are in an unprecedented time in history with the coronavirus (COVID-19) pandemic. Nurses and other crucial healthcare providers are at the frontline navigating uncharted and uncertain territory. There are limited supplies, including personal protective equipment, and little is understood regarding the pathway to healing with COVID-19. As such, the management team at Nursology.net has decided to dedicate a series of blog posts to COVID-19 using nursing knowledge as our framework. We hope that with these posts you become more informed about the unknown, and also find some stability during these shaky times. Our first post is dedicated to you, the nurses, and your well-being by PhD candidate Chloe Littzen.

Conceptual Framework for Young Adult Nurse Work-Related Well-Being

As a PhD student, I focused my studies on understanding the well-being of nurses, while specifically emphasizing young adult nurses. Over time, and with the guidance of my trusty advisor and committee, I developed a conceptual framework on the work-related well-being of young adult nurses. This framework and its development are based on my philosophical perspective as an intermodernist (Reed, 1995; 2019), nursing and non-nursing theories (Benner, 1982; Kramer, 1974; Baltes, 1987), salient knowledge on nurse well-being (Paatalo & Kyngas, 2016), relevant nursing knowledge (Fawcett, 1993; Newman, 1992; Parse, 1987; Terry, 2018), and my personal experiences as a young adult nurse. While this is in-process work, this framework has the potential of being a practical tool for nurses’ looking for a resource to help manage their well-being in these uncertain times. 

For a quick refresher, a conceptual framework is a type of theoretical thinking that is abstract, broad in scope, and uses general concepts (Reed, 2018). Within my conceptual framework on young adult nurse work-related well-being there are four main concepts: 1) generational differences in philosophical worldviews; 2) perceived co-worker social support; 3) resilience; and, 4) young adult nurse work-related well-being. The takeaway message is these concepts may all have a significant role in our well-being as nurses. Additionally, there may be things that we can do to sustain and enhance our well-being with these concepts in mind; especially now when our well-being is more vulnerable than ever. So below is a beginning theoretical how-to guide for you to sustain and enhance your well-being at work during this time of unease.

A Theory Guided Approach for Nurse Work-Related Well-Being

  1. We All Don’t See The World The Same Way

This proposition is based upon my concept of generational differences in philosophical worldviews. What this proposition infers is that while we would like to think as nurses we see the world the same way we don’t always.

This is not a bad thing and is quite normal in diverse groups such as the discipline of nursing (there are over 3.8 million nurses in the United States alone!). That being said, it can be stressful when you are faced with a situation where you and colleagues have a disagreement. 

So what can you do to aid these disagreements, especially in crisis times like now?
Try these five easy steps: 
  1. Stop and take a breath. Everything’s better when you breathe, and you have to breathe to do whatever it is you need to do, even critical situations.
  2. Acknowledge your colleagues’ perspective. Whether you agree with it or not, meet them with kindness and respect.
  3. Ask your colleague to explain, when appropriate, why they think about the situation the way they do. If you can’t do this when the event occurs due to the criticality of the situation, ask them to talk afterward even if it is uncomfortable.
  4. Whatever happens, don’t harbor negative thoughts because of disagreements. This can not only be harmful to you but also those around you.
  5. Ask yourself how you have grown from this interaction. What did you learn? Will you do something differently next time you interact during a disagreement?

2. Put Your Oxygen Mask On First

I think this is something we all know intuitively, but because we are nurses (there are some similarities among us I think), we are often more concerned about helping those around us than ourselves. While this is a wonderful character trait, this often leaves us depleted and burned out, ultimately negatively impacting our well-being. So this proposition is focused on building your resilience capacity, where every day you put your oxygen mask on before stepping out the front door.

How do I do that? 

First and foremost identify something that makes you happy.
Not your family member, not your friend, you

Nourish to Flourish

Image by @dlhamptom

You can call this self-care, but whatever it is it has to make you happy and you have to take time out for it. Everyone is different but ask yourself, what works for you? Every day select an amount of time that fits your schedule, whether 5, 20, or 60 minutes, and block it off on your calendar. Treat it like an appointment with your boss, do not break it. Be bigger than your biggest excuse and show up for yourself. If you need to, talk to your family about how you are feeling and see how they can support you during this time. 

So to refresh, here are four steps for you to build your resilience capacity: 
  1. Identify what makes you happy. Alternatively, if you are so depleted that you can’t think of something that makes you happy, try something new!

    For Example:
    Start a daily yoga practice using an online platform (follow the link to a 14-day free trial).
    Try a daily meditation using an app.
    Read a non-work related book, even a page a day counts.
    Go outside (while practicing appropriate physical distancing) for a walk.
  2. Decide upon an amount of time you can dedicate to yourself every day.
  3. Schedule an appointment on your calendar
  4. Show up, every day, even when you don’t want to.  

3. We All Need to Feel Supported

Grow Together

Image from @dommaraju

One of the biggest take-home messages about nurses’ I learned while pouring over the well-being literature is that we need each other, and we need to feel supported. Nurses seem to do better in every organizational outcome if they feel supported by their colleagues and management, which during times of crisis can easily crumble. So what can you do to help yourself feel supported, and simultaneously help your colleagues feel supported?

Find an accountability buddy!

What is an accountability buddy? This is a person that supports you in your well-being, while you simultaneously support their well-being. If you are currently working in the hospital or clinic, this should be a person at your place of work, and optimally each shift you work. If you cannot identify an accountability buddy at work, then identify someone outside of work that you can talk to after your shift. Lastly, if you’re in quarantine or physical distancing (otherwise referred to as social distancing, but more on that at a later time), identify a colleague who you can talk with throughout the day from home over email, texting, or a chat app such as WhatsApp or MarcoPolo. Just because you’re at home doesn’t mean you don’t need support. 

So what do I do with my accountability buddy?

Below are some suggestions to promote support during these uncertain times. But take the time to ask yourself what you need, and also ask your buddy what they need, and then revise as you learn more about each other!

In the Work Environment Physical Distancing or Quarantining After Work
  • Check-in with each other at the beginning, and throughout your shift. Ask each other how you are doing.
  • Advocate for each other to take breaks and lunch, when appropriate.
  • Promote a work environment where you both have someone to talk to if you feel anxious or overwhelmed.
  • Look out for each other to make sure you’re not taking on too much responsibility.
  • Give kudos to each other for positive well-being behaviors (e.g., you did yoga today, that’s so great!).
  • Send each other a daily message and ask each other how you are doing.
  • Advocate for each other to take scheduled breaks and lunch.
  • Promote a space where you both have someone to talk to if you feel anxious or overwhelmed.
  • Share your daily goals with each other, both work and self-care related.
  • Check in to see how you are both progressing through the day.
  • Give kudos to each other for positive well-being behaviors (i.e., you went outside for a walk today, that’s great!) 
  • Check-in with each other after work and share how you are doing over the phone, FaceTime, or Zoom.
  • Reflect on how you took care of yourself today, did you take time for yourself? Did you take a break or lunch?
  • Make a well-being goal for the next day at work. Ask your buddy if this is realistic and achievable, and reform as needed.
  • Check-in daily regarding your well-being goals.
  • Give kudos to each other for positive well-being behaviors (i.e., you asked for help when you needed it, that’s awesome!)

Where to start? 

We are all different, and one of these propositions may have spoken to you more than the others. Start there! Maybe you are already doing one of these suggested, if so, keep it up and try another suggestion to see if it help even more. Above all, just do something! As nurses, our well-being is a critical piece to making it through this difficult time, not just for ourselves, but for everyone on this planet. Change is never easy. We can’t go back and start a new beginning, but we can start today and make a new ending.

Stay safe and please take care of your well-being. 

References

Baltes, P. B. (1987). Theoretical propositions of life-span development psychology: On the dynamics between growth and decline. Developmental Psychology, 23(5), 611-626. https://doi.org/10.1037/0012-1649.23.5.611

Benner, P. (1982) From novice to expert. The American Journal of Nursing, 82(3), 402-407. https://doi.org/

Fawcett, J. (1993). From a plethora of paradigms to parsimony in worldviews. Nursing Science Quarterly, 6(2), 56-58. https://doi.org/10.1177/089431849300600202

Kramer, M. (1974). Reality shock: Why nurses leave nursing. The C.V. Mosby Company.

Newman, M. A. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-13.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. A. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1), e16-e27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. W. B. Saunders Company.

Paatalo, K., & Kyngas, H. (2016). Measuring hospital nurses’ well-being at work – psychometric testing of the scale. Contemporary Nurse, 52(6), 722-735. https://doi.org/10.1080/10376178.2016.1246072

Reed, P. (1995). A treatise on nursing knowledge development for the 21st century: Beyond postmodernism. Advances in Nursing Science, 17(3), 70-84. https://doi.org/10.1097/00012272-199503000-00008

Reed, P. G. (2018). A philosophy of nursing science and practice: Intermodernism. In P. G. Reed & N. B. C. Shearer (Eds.), Nursing knowledge and theory innovation: Advancing the science of practice. Springer Publishing Company.

Reed, P. G. (2019). Intermodernism: A philosophical perspective for development of scientific nursing theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ANS.0000000000000249

Terry, H. (2018). Critical inquiry into philosophical perspectives underlying nursing research on acute coronary syndrome [Unpublished doctoral dissertation]. The University of Arizona.