A Critical Review of 5 Nursing Journal Editorials on the Topic of Nursology

A recent CINAHL search with the keyword “Nursology” revealed 5 editorials in leading nursing journals that focus on acquainting the journal’s readers with the website and the initiative.  Not surprisingly, 3 of those editors were founding members of the Nursology.net website. Each shared a different aspect of the project.

Jacqueline Fawcett is the facilitator of the Nursology website management team.  In her guest editorial in the Journal of Advanced Nursing,1 she briefly reviewed the history of the term and argued for its revival, citing a previous published work.2 “Use of the term, nursology for the discipline,” she and colleagues had noted in 2015,  “avoids the tautology of using the word, nursing, as the label for the discipline and as a concept of our metaparadigm.” In other words, it identifies and distinguishes what nurses know(nursology) from what nurses do(nursing) by using different words.  Fawcett also identified possible disadvantages of a change in terminology, such as causing confusion, or interfering with progress made towards the goal of increasing the number of baccalaureate prepared nurses, although she did not elaborate on how. Fawcett went on to describe the formation of the website and outlined some of its contents: nursological philosophies, theories, and conceptual models with exemplars of the use of nursing theories in practice, education, and research; a history of disciplinary knowledge development; identification of past landmark events and future nursology-focused events, and resources. She concluded by giving examples of the positive feedback about the website that has been received and inviting readers to champion nursology as a disciplinary name or to offer alternative ideas.

Peggy Chinn is the webmaster of Nursology.net.  Her editorial introduces an issue of Advances in Nursing Science3 for which a call had been issued for articles addressing the focus of the discipline.  She noted this was in part to acknowledge that approximately 50 years had passed since a series of conferences had been initiated to explore the nature, focus, and future of disciplinary knowledge. The issue also appeared a few weeks before a similar conference, held at Case Western Reserve to commemorate those 50 years, and within months of the founding of Nursology.net. Chinn emphasized the nurse-led, nurse-developed nature of the site and  described it as providing “the most current and accurate information about nursing discipline-specific knowledge that advances human betterment globally.” She listed the assumptions and principles that guide the project: that nursology is a distinct discipline, vital to human health; is multidimensional bringing together diverse philosophical and theoretic perspectives; is autonomous and makes a unique contribution to health care; and that although nursology interacts with other disciplines cooperatively and collaboratively, it remains distinct and autonomous because it reflects the distinct perspective arising from caring in the human health experience. Chinn concluded by noting that these assumptions both shape the focus of the discipline and suggest issues that deserve serious consideration and discussion “not to achieve consensus but to appreciate the range of possibilities and diversities that inform and shape our discipline.” Whereas Chinn’s editorial highlights the philosophical underpinnings and beliefs that support the neurology.net initiative, it does not elaborate in detail on what ANS readers might expect to find on the site. 

 Jane Flanagan is a member of the Nursology.net management team and editor of the International Journal of Nursing Knowledge. She noted in her editorial4 that  the Nursology.net website is in keeping with the vision of the American Academy of Nursing Theory Guided Practice Expert Panel and described the purpose of the website is “to further the goals of what all of us as nurses are hoping to achieve…to explore the boundaries of nursing science and move that conversation in to a sphere where it reaches many.”  Flanagan noted the initial intent of the website- to be attractive, easy to read, and “overflowing with substance.” She indicated her hope that it will be a significant source of information for all nurses and those interested in nursing and invited feedback and participation of readers in contributing materials, blogs, and comments. She briefly described various sections of the site to provide examples of the resources that might be helpful to readers. Flanagan concluded by highlighting some of the similar reasons that Fawcett gave in her editorial for identifying the name of the discipline as nursology and those who practice, teach, or research disciplinary knowledge as nursologists. She noted, “ the name itself separates us from the stereotype and the reality in some quarters that we are handmaidens to physicians.” Flanagan’s editorial was the first to be published of all 5 editorials, just a month after the launch of the nursology.net website.  While she could have, perhaps, given more details about site contents, she does direct readers to the website for further information.  Her  palpable excitement at being “on the ground floor” of this project will probably encourage them to do so! 

The 3 editorials from members of the nursology.net management team were, as might be expected, exceedingly positive about the site and the initiative.  Two editorials were written by nursing editors who were not part of the Nursology.net management team. While their perspectives vary considerably, they may offer the most substantive perspectives and may prompt further serious and extensive discussion of these issues.

Rosemarie Rizzo Parse’s editorial in Nursing Science Quarterly5 did not share the excitement and optimism evident in the above editorials.  Her understanding of the goal of the website is “to change the name of the discipline of nursing”. She commented favorably on the site’s “décor” but misleadingly reduced its content to a blog, “where contributors continue to add any material they wish without support evidence for the change.”  It is unfortunate that the readers of NSQ are not informed of the stated mission and purpose  of the website, which include developing a repository of nursing knowledge, disseminating that knowledge, and encouraging collaboration among nursing scholars. Currently the website profiles 45 nursing theories, ranging from conceptual frameworks to situation-specific theories, with the Theory of Humanbecoming among them. Parse posited that efforts would be better directed at “making nursing science the hallmark of the discipline” and then asked a number of important questions about what such a change would mean, including how nursing educational programs could base courses on nursing knowledge when there is pressure by accrediting agencies to include more medical-bio-behavioral content. It is not clear how she sees that conundrum being addressed by either term,  nursology or nursing science. Despite having acknowledged that the “proposed change is consistent with O’Toole’s statement  in Mosby’s Medical Dictionary,” the editorial concluded that the change in name ”lacks semantic consistency with disciplinary knowledge and upends logical coherence.”

Sally Thorne’s editorial in Nursing Inquiry,6 begins with her admission of having a long-standing discomfort with the term “Nursing Science”, first because it sounds like a qualifier to science, “as if nurses take part in a skewed, partial, or watered-down version of the scientific enterprise,” and secondly, because the term nursing science has largely been used to describe nursing theorizing, rather than “formal scientific investigation.” Thorne contextualized the introduction of the Nursology.net website as a response from nursing thought leaders arising from their shared awareness and concerns of external pressures that are increasingly shaping nursing and threatening the further advancement of the discipline, and provided readers of Nursing Inquiry with citations of articles exploring the implications of those pressures for the preservation of “core disciplinary knowledge.” Thorne noted the term, Nursology, has been used in nursing literature at least as early as 1971 and, although she confessed to some discomfort with using the term, preferring to use “the study of nursing”, she enthusiastically endorsed the direction  the conversations that have led to the Nursology.net initiative have taken. She concluded that she will be watching the Nursology.net conversation with great excitement, “hoping that it attracts the attention, engagement, and dialogue it deserves, and that it helps bring a new generation of nurses back into an appreciative understanding of why the study of nursing really matters.”

I think I can speak on behalf of the Nursology.net management team in saying, we share that hope! And, I would ask if “ology” refers to “the study of” and is widely used by many other disciplines, e.g, pharmacology, biology, why is there such a hesitancy (I’ve experienced it in talking to other nurses about neurology as well) to use nursology to refer to the unique body of knowledge that is nursing knowledge?  Is it simply prudent caution to make the change for the reasons a number of the editors raised? To what extent does it feel pretentious, i.e., have we internalized a broader societal message that our body of knowledge is not as substantial or valuable as those of other fields? Is this another manifestation of “I’m just a nurse?” And/or, is it simply that it’s new and unfamiliar?

  1. Fawcett J. Nursology revisted and revived. J Adv Nurs. 2019; 1(2):1-2.
  2. Fawcett J, Aronowitz T, AbuFannouneh A, et al. Thoughts about the Name of Our Discipline. Nurs Sci Q.2015;28(4):330-333.
  3. Chinn PL. Introducing Nursology.net. ANS Adv Nurs Sci.2019;42(Jan-Mar):1.
  4. Flanagan J. Nursology – a Site by nurses, for nurses. Int J Nurs Knowl.2018;29(4).
  5. Parse RR. Nursology: What’s in a Name? Nurs Sci Q.2019;32(2):93-94.
  6. Thorne S. The study of nursing. Nurs Inq.2019;26(1):1-2.

 

 

 

 

 

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

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

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

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

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

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

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

 

Removing/Refusing the Invisibility Cloak

Invisibility cloaks are magical devices that render the wearers invisible

from Inaugural issue of “Revolution: The Journal of Nurse Empowerment,” 1991

and transparent – they simply become part of the background. Furthermore, the wearer of the cloak can see through it and actually be wearing it without being fully conscious of it. Although invisibility cloaks have existed in mythology for centuries, they have recently been brought to public consciousness through the work J.K. Rowlings in the Harry Potter series. But I think they provide a relevant metaphor for what many nurses often experience – instances in which they and/or their contributions to health and healing remain invisible. And, my question is, can a shift to focusing on the nursing knowledge that underpins our practice and making it visible by naming it Nursology, help nurses in general to remove or refuse the cloak of invisibility?

 In my years of nursing experience, whether in practice, education, or research,  I have experienced and witnessed many instances of nursing and nurses, myself included, being rendered invisible. Nurses may themselves put on the cloak of invisibility by using the phrase, “I’m just a nurse” or by undervaluing their work.  A participant in one of my studies recounted an amazing example of capacity building in a group of adolescent girls but described her role in the transformation that took place as not “ much of anything” 1.

From Revolution: The Journal of Nurse Empowerment

 We can also put on the cloak of invisibility by valuing the knowledge of related disciplines more highly than nursing knowledge, such as happens when nurses dismiss nursing conceptual frameworks as irrelevant while, at the same time, consciously or unconsciously using knowledge from other fields to inform or define their nursing practice, either in scope or content 2,3.

 Sometimes the cloak of invisibility is put on us by others. We may or may not be conscious of the cultural and societal cloaks put on those of us who are women. And those of us who “trained” to be nurses in the 1960s will also be able to relate to the cloaks we acquired as deference to physicians was instilled in us.  We can only remove these cloaks by becoming conscious of them.  Public health nurses in my studies provided evidence that such cloaking continues. For example, one nurse told me about being required by their employer not to refer to themselves as nurses or the work they did as care; instead they were to refer to themselves as public health professionals, in the name of interdisciplinarity. 

 These reflections came about because of a conversation I had with a friend and colleague in which I related the following incident.  I was attending, on behalf of a national nursing association and by invitation, a media release of interest to health and other workers involved in in promoting healthy populations. After the release we were invited to attend a luncheon to discuss implications of the report from each of our perspectives. One gentleman present clearly represented a biomedical approach to health and he and I exchanged perspectives that were rather diametrically opposed to one another. After the luncheon he made his way across the room to me and asked me what my PhD was in (we each had place card tents which included our credentials).  I told him “nursing”.  He thought I misunderstood him and repeated the  question and received the same answer.  He replied, “no, I can’t have a PhD in medicine and you can’t have one in nursing.”  I assured him I did.  Exasperated, he asked what my dissertation topic was.  I answered that it was an oral history of public health nursing in Ontario.  “Ahh”, he replied, “that’s the answer! Your PhD is in history!”  With that he left, satisfied that he had set me straight! 

 In relating that incident to my friend, we contemplated, would that have been the case if my PhD was in Nursology?  I think probably not. It might have raised the question, “What is Nursology” which I would have welcomed!  

 

1.    Falk-Rafael A, Betker C. The primacy of relationships: a study of public health nursing practice from a critical caring perspective. Adv Nurs Sci. 2012;35(4):315-332.

2.    Rafael A. From rhetoric to reality: The changing face of public health nursing in southern Ontario. Public Health Nurs. 1999;16(1):50-59.

3.    Rafael AR. Nurses who run with the wolves: the power and caring dialectic revisited. ANS Adv Nurs Sci. 1998;21(1):29-42.

 

The Impossibility of Thinking “Atheoretically”

Some nursologists have claimed that they are “atheoretical.” When asked what they mean, they tend to say that they do not subscribe to or use a particular conceptual model or theory when conducting research or practicing. However, it is, according the physicist turned philosopher of science, Sir Karl R. Popper (1965), it is “absurd” to think that each of us does not have a “horizon of expectations” for whatever we are observing or doing (p. 47). Continuing, Popper (1965) claimed that everyone always has expectations, even if not in conscious awareness.

Following from Popper, I submit that it is impossible to think “atheoretically.” Instead, I submit that every nursologist has a “horizon of expectations” in the form of a conceptual frame of reference that guides what she or he is observing or doing as research is conducted, curricula are constructed, interactions are occurring with people who seek nursologist services, and nursologist services are administered. That conceptual frame of reference is what I refer to as a conceptual model or a grand theory.

I suspect that every nursologist agrees that she or he “talk[s] nursing” (Chalmers, as cited in Chalmers, Kershaw, Melia, & Kendrich,, 1990, p. 34), thinks nursing (Nightingale, 1993; Perry, 1985), and engages in thinking nursing (Allison & Renpenning, 1999) rather than mindlessly doing tasks and carrying out physicians’ orders (Le Storti et al., 1999). But what do those nursologists regard as nursing? What is meant by talking or thinking nursing? I also suspect that every nursologist agrees that she or he engages in critical thinking and clinical reasoning. If so, what is the frame of reference for the thinking or reasoning? Something has to capture one’s attention (Myra Levine (1991),  developer of the Conservation Model, called what captures one’s attention provocative facts, which are noticed within the context of conservation of energy, structural integrity, personal integrity, and social integrity.

Thus, the challenge for each nursologist who regards self as thinking “atheoretically” is to identify what her or his frame of reference (horizon of expectations) is. What is that person’s view of who are the human beings or documents that are appropriate for whatever activity is being done (i.e., research, practice, education, administration)? What is the person’s view of the relevant environment? What is the person’s view of what constitutes wellness, illness, and disease? What is the person’s view of what nursologists’ do in practice – what is worthy of assessment, how are priorities set when planning, what interventions are appropriate, and most of all, what outcomes are expected?

It is possible that my claim that being “atheoretical” is impossible. Therefore, in closing, I urge those of you who claim you are “atheoretical” to respond to this blog and let everyone know what you mean by being “atheoretical” in all of your nursologist activities.

References

Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.

Chalmers, H., Kershaw, B., Melia, K., & Kendrich, M. (1990). Nursing models: Enhancing or inhibiting practice? Nursing Standard, 5(11), 34–40.

Le Storti, L. J., Cullen, P. A., Hanzlik, E. M., Michiels, J. M., Piano, L. A., Ryan, P. L., & Johnson, W. (1999). Creative thinking in nursing education: Preparing for tomorrow’s challenges. Nursing Outlook, 47, 62–66.

Levine, M. E. (1991). The conservation principles: A model for health. In K. M. Schaefer & J. B. Pond (Eds.), Levine’s conservation model: A framework for nursing practice (pp. 1–11). Philadelphia, PA: F.A. Davis.

Nightingale, K. (1993). Editorial. British Journal of Theatre Nursing, 3(5), 2.

Perry, J. (1985). Has the discipline of nursing developed to the stage where nurses do “think nursing?” Journal of Advanced Nursing, 10, 31–37.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

What are Legitimate Nursology Specialties?

 Bittencourt, Marques, and Mendes Diniz de Andrade Barroso’s (2018) paper, published in Revista de Enfermagem Referência, catalyzed my thoughts about labels for legitimate specialties in the discipline of nursology. (Scroll down for information about the authors and access to the article website.) Clearly, concern for nursology-discipline specific knowledge is of interest to our scholar colleagues from Brazil (Dr. Bittencourt) and Portugual (Dr. Dias Marques and Dr. Mendes Diniz de Andrade Barroso). They presented an innovative approach to further development of nursology by placing a traditional specialty (mental health) within the context of various nursological conceptual models and theories. (Download the PDF of the English open-access article here).

Bittencourt and colleagues (2018) pointed out that although nursologists “have been conducting studies with the purpose of promoting mental health in schools and other settings . . . based on evidence that clearly points to the effectiveness of promotion strategies, [nursological] theories are rarely put forward as a basis for these nurse-led mental health promotion strategies” (Bittencourt et al., 2018, p. 126). They recommended that nursological conceptual models and theories should be used to expand thinking about the practice of mental health promotion and described the contributions of Meleis’ Transitions Theory, Pender’s Health Promotion Model, Peplau’s Theory of Interpersonal Relations, and Roy’s Adaptation Model  to research and practice for promotion of mental health.

The starting point for Bittencourt and colleagues’ (2018) proposal is a traditional specialty area that imitates a medical specialty, that is, mental health. Nursologists typically identify with this and other specialties drawn from medicine, including but not limited to medical, surgical, obstetrical, and pediatric specialties. These specialties comprise many undergraduate and graduate educational curricula, the broad areas of nursologists’ research, and the naming of departments in clinical agencies. Thus, just as Bittencourt et al. (2018) did for the specialty of mental health, nursological conceptual models and theories could be used as guides for the content of the courses, research, and practice in other specialty areas.

But what if the content of each nursological conceptual model and theory was used to designate specialties? For example, many years ago, Rogers (1973) proposed that the subsystems of Johnson’s Behavioral System Model could be nursology-specific specialties. Accordingly, specialties for curriculum content, research, and practice could be the aggressive subsystem, the attachment subsystem, the achievement subsystem, the ingestive subsystem, the eliminative subsystem, the dependency subsystem, and the sexual subsystem. Similarly, specialties within the context of Neuman’s Systems Model could be physiological variables, psychological variables, sociocultural variables, developmental variables, and spiritual variables.
Although the proposal that specialties should be within the context of each nursological conceptual model and theory may be regarded as preposterous, at least some nursologists have understood the value and importance of labels for specialties that differentiate the discipline and profession of nursology from other sciences and especially from the trade of medicine. For example, Batey and Eyres (1979) explained that “Language is fundamental to the evolution of all disciplines [and] [w]ithin any discipline, selected terminology evolves to become the concepts that denote the specific knowledge domains and methodologies of that discipline” (p. 139). Moreover, “Every science has its own peculiar terms, concepts and principles which are essential for the development of its knowledge base. In [nursology] , as in other sciences, an understanding of these is a prerequisite to a critical examination of their contribution to the development of knowledge and its application to practice” (Akinsanya, 1989, p. ii). Barrett (2003) added, “How would one understand anatomy and physiology, microbiology, pharmacology, . . . without the precise use of language reflecting those domains of knowledge? . . . How else is substantive knowledge to be communicated without saying it is what it is that it is!” (p. 280).

As we think about the admittedly potential choas of having such diverse nursology-specific specialties, we may move to an innovative and integrative way of identifying the specialities that accurately delineate what nursologists actually teach, study, and practice. Clearly, we need to move to (paraphrasing) what Allison and Renpenning (1999) called thinking nursology, what Watson (1996) called nursology qua nursology, and certainly what Meleis (1993) pointed out is the need to progress from thinking like and pretending to be junior doctors to being senior nursologists.

Noteworthy is that many of the ideas included in this blog come from publications of decades ago. Yet, no progress has been made in all that time. So, what do you think nursology-specific specialties should be? Should we continue with the status quo of using the same terms as does medicine with the added value of the context of nursological conceptual models and theories? Or, should we be finally be bold and use the languge of our nursological conceptual models and theories to name and structure our specialties?

References

Akinsanya, J.A. (1989). Introduction. Recent Advances in Nursing, 24, i–ii.

Allison, S. E., & Renpenning, K. (1999). Nursing administration in the 21st century. Thousand Oaks, CA: Sage.

Barrett. E. A. M. (2003). Response to Letter to the Editor. Nursing Science Quarterly, 16, 27-28.

Batey, M. V., & Eyres, S. J. (1979). Interdisciplinary semantics: Implications for research. Western Journal of Nursing Research, 1, 139-141.

Bittencourt, M. N., Dias Marques, M. I., & Mendes Diniz de Andrade Barroso, T. M. (2018). Contributions of nursing theories in the practice of the mental health promotion. Revista de Enfermagem Referência, 4(18), 125–132.

Meleis, A. I. (1993, April). Nursing research and the Neuman model: Directions for the future. Panel discussion at the Fourth Biennial International Neuman Systems Model Symposium (B. Neuman, A. I. Meleis, J. Fawcett, L. Lowry, M. C. Smith, and A. Edgil, participants), Rochester, NY.

Rogers, C. G. (1973). Conceptual models as guides to clinical nursing specialization. Journal of Nursing Education, 12(4), 2–6.

Watson, M. J. (1996). Watson’s theory of transpersonal caring. In P. Hinton Walker & B. Neuman (Eds.), Blueprint for use of nursing models (pp. 141–184). New York, NY: NLN Press.

About the authors

  • Marina Nolli Bittencourt, RN; Ph.D. is an Adjunct Professor, at the Federal University of Amapá, in Macapá, Brazil
  • Maria Isabel Dias Marques, Ph.D., is a Coordinating Professor, in the Nursing School of Coimbra,in Coimbra, Portugal
  • Tereza Maria Mendes Diniz de Andrade Barroso, Ph.D., is an Adjunct Professor in the Nursing School of Coimbra, in Coimbra, Portugal

Access the article

The file for their journal article, Contributions of nursing theories in the practice of the mental health promotion, is available in English and Portuguese at https://doi.org/10.12707/RIV18015. The abstract is available in English, Portuguese, and Spanish.

The journal, Revista de Enfermagem Referência, is the property of the Escola Superior de Enfermagem de Coimbra.