It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

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

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

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

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

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

About the contributors:

Christina Nyirati, RN, PhD

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

Sharon Stout-Shaffer, PhD, RN

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

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

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

Moral ecology in nursing

by Darcy Copeland, RN, PhD*

Darcy Copeland

I have the good fortune to have two professional roles that compliment one another beautifully. As a hospital based nurse scientist I have focused my research on workforce issues including workplace violence, professional quality of life, moral distress, and the spiritual/emotional elements of providing care. I am a member of the ethics committee and participate in educational and consultation activities. I am also an associate professor of nursing and teach master’s, PhD and DNP level nursing theory courses. My days are literally sometimes spent filling the “theory-practice” gap on both sides of that gap.

One “gap”, maybe dissonance is more accurate, I notice is how messy ethical decision making is in practice compared to how clean it seems in academia. Nursing students spend time learning about the ANA Code of Ethics, written specifically to be both aspirational and normative. The nine provisions articulate values, duties, and ideals that are foundational to our discipline. Most students probably also learn principles of bioethics and research ethics and at least have a cursory understanding of these when entering clinical practice. Nursologists have debated whether or not we should develop our own ethical framework or adopt an existing framework. Personally, I oppose both of those ideas and would advocate for a pluralistic approach to addressing ethical issues in practice.

There is no debating that nurses are moral agents who must make decisions and be held accountable for their actions. Those decisions, however, occur in complex, dynamic (I’ll say messy) environments involving multiple stakeholders whose perspectives often conflict with one another. In the grand scheme of things nurses receive very little formal education related to ethics. In my experience, it is rare for a practicing nurse to justify an ethical decision by articulating anything from the code of ethics or principles of bioethics. The first thing I hear is most often something like, “it felt like the right thing to do.” This response alone would lead me to believe that the decision was based on the person’s individual moral awareness or personal value system. With more dialogue, however, it becomes clear that the nurse’s own moral compass is the starting point for ethical decision-making, not the end point. Nurses may justify their actions because it is what the patient wanted, because people have the right to make their own decisions, because it was the best way to use available resources, because it is wrong to with-hold information, because that is our policy, etc. Any and all of these are acceptable justifications to act in one way instead of another. Each of these justifications can be traced back to an ethical framework, but not the ethical framework of nursing.

It was from these experiences in teaching and applying ethics that I developed a model of moral ecology in nursing (see below). It is based on the social ecological model in which behavior is contextualized and understood as occurring within a web of complex social systems in which the individual is placed. It was developed from the perspective of American nursing, but could be modified to include the ICN code of ethics and eastern philosophy for example. I plan to use this model in my own teaching as a way to introduce students to the messiness of ethical decision making in practice.

An ecological model of ethics in nursing. © 2019 Darcy Copeland

 

Copeland, D. (in press). Moral ecology in nursing: A pluralistic approach. Sage Open Nursing DOI: 10.1177/2377960819833899

  • Darcy Copeland is an associate professor of nursing at the University of Northern Colorado and a nurse scientist at St Anthony Hospital in Lakewood, CO. She has undergraduate degrees in nursing and psychology from the University of Northern Colorado, a master’s degree in forensic nursing from Fitchburg State College in Massachusetts, a PhD in nursing from UCLA, and is pursuing a master’s degree in health humanities and ethics at the University of Colorado. Her clinical background is in mental health and forensic nursing; her research interests involve the psychosocial work environment including issues of workplace violence, moral distress, professional quality of life, and the spiritual effects of caregiving.