Theory’s Reality in Nursing Practice: Florence Nightingale’s Legacy

Contributor: Isabel Faia

The contemporary imbalance in environmental matters predominantly involve climate change and our supposedly beloved home planet’s ecosystems issues. Human beings are continuously disrespectful of their relationships with the universe ecosystem.

Humankind is responsible to a great extent for this state of “dysbiosis” of our planet, which is similar to the state of each person’s gut microbiome. This lack of balance and harmony in nature, is the root cause of the emerging of new and complex pathological challenges, which, like the Covid-19 pandemic, have become impossible to ignore. Countries the globe over have been forced to take very strict contingency measures, with different levels of freedom and restrictions in order to slow down the devastating effects of sickness and death that the virus has caused.

Healthcare professionals have an important role in managing the many menacing threats to populations of our planet, their well-being and survival. Nursing as a professional discipline, has many theories that can use used to as evidence for safe and competent practice. The concepts of Fawcett’s metaparadigm of nursing provide a way to understand and guide nursing during the pandemic – human beings, environment, health, nursing  However, given the reality of our current world, other key concepts also provide paths that guide our understanding of the reality we face in the pandemic. 

I contend that we are closing a cycle, a full 360° spin, that brings us back to Florence Nightingale’s work. From Nightingale’s framework, the nurse’s primary role is caring and helping people in their healing process. Nightingale told us that the environment is a key influencing factor in this process, which when operationalized, can increase the potential for recovery and survival. Nursing care in this framework emphasizes the optimization of ventilation and natural lighting of spaces, noise reduction, frequent hand washing and disinfection, hygiene of spaces, among other aspects of the environment. Nightingale supported the importance of these environmental aspects, by collecting and statistically analyzing data from everyday practice.

We can use the symbol of the lamp to illuminate the paths of what today’s nursing practice can be, and promote multidisciplinary recognition of nurses profound contributions to population health. We face the fact that 200 years since Nightingale’s ideas were first published, widespread recognition nursing at both the ontological and epistemological levels still remains a challenge to overcome. Therefore, we all have to effectively communicate to our communities worldwide a clear vision of what nursing is.

At a personal level, I have just completed two decades of my career as a nurse, predominantly caring for critically ill patients in the context of urgency/emergency rooms and also in an intensive care unit. This led to an experience marked by a great many interdependent nursing activities, which contribute to the progressive distancing from fundamental nursing theoretical thinking. I perceive myself in a state of profound professional numbness. Not meaning that the quality of my autonomous nursing activities were questionable, but instead were automatically executed and with little awareness of theory. This is similar to an experienced car driver, who over the years enters into a state of relative unconsciousness, an automated practice, when driving. This progressive loss of professional identity became evident in the scope of the Masters in Critical Care Nursing Specialty that I am currently attending at Univesidade Católica Portuguesa (Lisbon). When re-visiting in class the evolution of thought in and the production of knowledge throughout nursing’s history, in a short time and instinctively my practice gained the semantics of nurses’ expression, more specifically in content format and other implicit dimensions, as if it were on standby and with a click it would switch on. What seemed difficult to transfer into practice, proved to be the root of my daily professional practice.

That is why when I read the post The Impossibility of Thinking “Atheoretically” (Fawcett, 2019) in Nursology, suggested by the Master’s Nursing Theories Chairwoman, I cathartically identified with it. In my experience of hibernated nursing and of unconscious semantics, in the past I considered myself to be a nurse distant from theories, which would belong to an exclusively academic context. Now I confess that this process was a boost of vital energy, illuminating and motivating me to an increasingly challenging and exciting life as a nurse.

About Isabel Faia

I’m an ICU nurse since 2014, working for the past 20 years in a public hospital in Madeira Island, Portugal. Presently, I am doing a Masters in critical care nursing, at Health Sciences Institute, UCP Lisbon. This post was made in the nursing theories curricular unit of the Masters in Nursing Course of the Health Sciences Institute of UCP (Lisbon), with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).

Examining the Evolving Role of the BSN-Prepared Nurse outside Acute Care Settings: A Nursing – Shared Theory/Conceptual Model Approach

Co-Contributor: Katunzi Mutalemwa

The purpose of this blog is to describe a baccalaureate (BSN) prepared nursologist’s, Katunzi Mutalemwa personal lived pre-internship clinical learning experience in primary care at a local community-based non-governmental outpatient clinic run by The Tanzania Doctors with African CUAMM  in collaboration with a local District hospital.

Katunzi’s reflections have been interpreted within the context of nursology discipline-specific knowledge of Neuman’s Systems Model (NSM), and the Theory of Self-Care of Chronic Illness (TSCC), as well as the Expanded Chronic Care Model, a model shared with public health.

Inasmuch as the ECCM is a shared model, the starting point for the interpretation is the nursology discipline-specific conceptual model that is NSM (Villarruel et al., 2001). Whereas the NSM guided the overall understanding of the reflections, the concepts of the TSCC guided some of the specific actions described, as did the ECCM. The NSM provides a nursology conceptual foundation that takes into considerations the multiple levels of client/client system influences – the physiological, psychological, socio-cultural, developmental and spiritual interacting factors and environmental stressors. The model has the potential of advancing the future of nursology in the area of expanded nursing scope of practices and services in response to chronic disease management.

Katunzi’s reflections highlight the role of the BSN-prepared nursologists in the management and prevention of chronic diseases beyond the walls of the acute care settings (i.e., community-based primary health care settings)

The main ideas seen in this blog are consistent with the World Health Organization’s (2020) State of World Nursing publication, the nursology.net blog Primary-care-primary-nursology-and-the-attending-nursologist, the AACN White-Paper on the Vision-Academic-Nursing; the Health Resources & Services Administration (HRSA) 2018 call for Nurse Education, Practice, Quality and Retention (NEPQR) – Registered Nurses in Primary Care (RNPC) Training Program as well as several journal articles on the role of the primary care nursologist (e.g. Anderson et al., 2012; Bodenheimer, & Mason, 2016; Borgès Da Silva et al., 2018; Epping-Jordan, 2002; Lipstein, et al., 2016; Norful, et al., 2017).  The description of the roles and responsibilities discussed in this blog acknowledge the varied contextual nursing scope of practices across the globe.

Katunzi’s Nursing Context/Situation

The personal reflections demonstrate how a BSN-prepared nursologist practices within the Tanzania Nursing and Midwifery Council (TNMC) (2014) general nurse full scope of practice. The TNMC’s major role definitions of a general nurse prepared at the baccalaureate level are: 1) Accountability, Ethical and Legal Practice; 2) Care Provision, Health Promotion, Leadership and Management and, 3) Professional, Personal and Quality Development. For instance, the care provisions and leadership definition of the TNMC general scope of practice, the BSN-prepared nurse roles includes, but is not limited to developing practice guidelines, representing nursing at the management meetings, preparing and presenting nursing budgets at management team meetings, participating in nursing research and utilizing research results in provision of nursing care, providing comprehensive nursing care and carrying out nursing management independently, formulating relevant policies about patient and client care, and reviewing performance appraisal for nurses. According to the TNMC, if assigned, a BSN-prepared nurse is also allowed to prescribe medications for persons with some acute, emergency conditions and chronic illnesses and to prescribe physical therapy and other rehabilitative treatments in keeping with existing protocols.

Katunzi’s reflections

Community Resources and Policies and, Health Care System (Concepts of the ECCM)

As a BSN-prepared nurse completing a pre-internship clinical learning opportunity in a private community-based clinic (NSM community as the client system), I was mentored into the primary care role by a team of nurses and other healthcare providers. I was involved in the management of clients living with diabetes and heart diseases (adults and adolescents) (NSM developmental variable) trice a week and also participated in conducting monthly supervisions in satellite health centers. I learned to assure patients/clients maintained a maximum level of wellness by keeping stressors and stress responses at a minimum through effective, efficient care at three levels of prevention (NSM prevention as intervention). Utilizing a holistic approach (NSM physiological, psychological, socio-cultural, development, and spiritual variables), I was exposed in health counseling, medication administration, health teaching, case management and care coordination services (NSM prevention as intervention]. I worked closely with nurses in other satellite health centers within the clinic’s catchment area. The collaboration strengthened patient treatments and improved care. I regularly participated in conducting home visits and tracking down patients who were lost to follow-up careI dealt with barriers such as clients’ religious and traditional beliefs that hinder adherence to prescribed regimen (NSM socio-cultural and spiritual variables).

As a part of the learning process, I practiced advocacy and I was able to participate in regular district administrative meetings to negotiate consultation fees and cost of drugs with district authorities (NSM socio-cultural variable). I improved my nursing skills in individual/family and community assessment while fulfilling this role. For instance, I was able to share with the authorities how financial challenges forced clients to take half doses of their prescribed medication and intentionally caused missed follow-up visits. Likewise, I noted that other clients opted to traditional herbal treatments as they were perceived to be cheaper than hospital medications. I was able to see how self-medication practices (Concepts of the TSCC) can harden caring of chronic patients. Some patients opt to buy drugs in stores rather than visit the clinic or hospital. Some of the challenges were attributed to lack of transportation and health illiteracy on disease processes (NSM socio-cultural variable). I called attention to the impact of laxed drug dispensing policies on clients’ lives.  For example, I shared how clients with contraindicated medication can easily procure the drugs from a local drug store, making them at risk of readmissions and possibly death. In addition, as a community health educator, I advised patients and their families to participate in community development projects such as livestock keeping, small scale agricultural that helped them to earn extra money for buying drugs and supporting individual and family their well-being (NSM socio-cultural and spiritual variables ).

Delivery System Design and Self-Management Support(Concepts of the ECCM)

The community clinic was centered at a District Hospital and operated synergically with ten other health centers within our catchment area (NSM community as the client system). I learned to assure the provision of self-care maintenance, self-care monitoring, and self-care management services (Concepts of the TSCC). For instance, I was involved in caring for chronic disease patients especially type 1 diabetic patient by empowering and preparing clients to manage their health through effective and safe self-injection practice. I provided health education on regular testing to control glucose levels as well as insulin-self administration.  Assessing clients’ health literacy levels in the treatment process was a crucial piece of my practice role. I developed peer guided groups with an interpofessional team comprising of a nutritionist and physician. In addition, I conducted monthly supervision at each of the ten assigned health centers. During the supervisory visits, I was involved on assessing the overall patient’s adherence practice to nursing care and follow up (Concepts of the TSCC). I also participated in conducting professional development seminars to nurses on management of patients living with chronic diseases, how to conduct referrals and improve protocols to manage patients with diabetic ketoacidosis and heart failure (NSM variances from wellness). I completed frequent home visits with nurses and other providers to assess the client’s progress, adherence practices and storage of medications (concepts of the TSCC), as well as delivered promotional health messages to patients and families (NSM primary prevention as intervention).

Decision Support and Clinical Information System (Concepts of the ECCM)

I learned how to make clinical decisions in chronic disease management consistent with scientific data and patient preferences. For example, when I saw patients with medical adherence issues, I made sure I educated the clients on possible consequences and let the clients make informed decisions (NSM primary prevention as intervention). I always acknowledged the challenging presence of scientifically unproved treatment plans attributed to the growing number of traditional doctors involved in client’s health care decisions (NSM individual as the client system). I always paid attention to gender-based influences (NSM socio-cultural and spiritual stressors) in medication adherence NMS-. For instance, I was able to determine that men attended treatments when they had severe signs and symptoms of an illness and/or at advanced stage of disease. To address this social determinant among some of the men, I participated in initiating the use of mobile phones to trace patients on monthly basis. This initiative had a positive impact on “no show” clients who had access to mobile phones.

Implications for nursologist scholars

Katunzi’s reflections have implications for advancement of nursology discipline-specific knowledge and future professional transformations. The evolving role of the nursologist  in primary care (Wojnar & Whelan, 2017) calls for a well-rounded RN (Swan, et al, 2006) and, most importantly, a BSN-prepared global nursology  workforce (Wojnar & Whelan, 2017). Use of the ECCM requires ongoing research — or review of existing research – to determine the validity of the model as a shared theory/model (Villarruel et al., 2001) that is useful in new nursing education curricula (Humphrey, 2019),  reimbursement (Funk & Davis, 2015) and regulatory models (Start, 2020) situations that fit BSN-prepared nurses’ full scope of nursologists’ practice and meet clients’ health and social needs in places where people live, learn and play.  

We would like to learn from our nursology.net readers on their perceptions of these questions:

  1. What does the future of nursology hold for the role of the BSN-prepared nursologist in primary care, especially in the United States where primary care is regarded as a major role of advanced practice nursologists holding master’s and/or Doctor of Nursing Practice degrees?
  2. How can nursologists overcome the barriers and maximize contextual opportunities to fulfill their roles? 
  3. What barriers may influence effective adoption of applicable borrowed and shared theories/models in nursology-led chronic disease management interventions?

We welcome nursologists at different levels of practice (i.e., LPN, ADN, BSN, DNP, PhD-prepared) to share their stories of how they provide primary care services (or ambulatory care or community-based care), in private or public health care systems.  Please share your thoughts in comments section below

References

Anderson, D., St. Hilaire, D., Flinter, M., (May, 2012). Primary Care Nursing Role and Care Coordination: An Observational Study of Nursing Work in a Community Health Center OJIN: The Online Journal of Issues in Nursing, 17, 2, http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Primary-Care-Nursing-Role-and-Care-Coordination.html

Barr, V, Robinson, S, Marin-Link, B, Underhill, L, Dotts, A, Ravensdale, D, & Salivaras, S. (2003). The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model, Hospital Quarterly, 7(1), 73-82.

Bodenheimer, T., & Mason, D. (June, 2016). Registered nurses: Partners in transforming primary care. In Proceedings of a conference sponsored by the Josiah Macy Jr. Foundation in June. http://64.62.135.154/docs/macy_pubs/Macy_Monograph_Nurses_2016_webPDF.pdf

Borgès Da Silva, R., Brault, I., Pineault, R., Chouinard, M.-C., Prud’homme, A., & D’Amour, D. (2018). Nursing Practice in Primary Care and Patients’ Experience of Care. Journal of Primary Care & Community Health, 9, 1-7 https://doi.org/10.1177/2150131917747186

Epping-Jordan, J., (Ed.) (2002). Innovative care for chronic conditions: building blocks for action: global report (document no. WHO/NMC/CCH/0201). World Health Organization Global Report. https://www.who.int/diabetes/publications/icccreport/en/

Funk, K. A., & Davis, M. (2015). Enhancing the role of the nurse in primary care: the RN “co-visit” model. Journal of general internal medicine30(12), 1871-1873.

Health resources & Services Administration (2018).  Nurse Education, Practice, Quality and Retention (NEPQR) – Registered Nurses in Primary Care (RNPC) Training Program. Retrieved from https://www.hrsa.gov/grants/find-funding/hrsa-18-012

Humphrey, B., L., Mixer, S. J., Thompson, K., Davis, S., Elliott, L., Lakin, B., … & Niederhauser, V. (2019). Transforming RN roles in community-based integrated primary care (TRIP): Background and content. Issues in mental health nursing40(4), 347-353.

Lipstein, S. H, Kellermann, A. L., Berkowitz, B., Phillips, R., Sklar, D., Steele, G. D., & Thibault, G. E. (September, 2016). Workforce for 21st century health and health care: A vital direction for health and health care. National Academies of Medicine. https://nam.edu/wp-content/uploads/2016/09/Workforce-for-21st-Century-Health-andHealth-Care.pdf.

Norful, A., Martsolf, G., de Jacq, K., & Poghosyan, L. (2017). Utilization of registered nurses in primary care teams: A systematic review. International journal of nursing studies74, 15-23.

Start, R., Brown, D. S., May, N., Quinlan, S., Blankson, M., Rodriguez, S. R., & Matlock, A. M. (2020). Strategies for creating a business case that leverages the RN role in care coordination and transition management. Nursing Economics38(4), 203-217.

Swan, B. A., Conway-Phillips, R., & Griffin, K. F. (2006). Demonstrating the value of the RN in ambulatory care. Retrieved from https://jdc.jefferson.edu/cgi/viewcontent.cgi? article=1012&context=nursfp

The Tanzania Nursing and Midwifery Council (2014). Scope of Practice for Nursing and Midwives in Tanzania. United Republic of Tanzania.

Wojnar, D. M., & Whelan, E. M. (2017). Preparing nursing students for enhanced roles in primary care: The current state of pre-licensure and RN-to-BSN education. Nursing Outlook65(2), 222-232.

Villarruel, A.M., Bishop, T.L., Simpson, E.M., Jemmott, L.S., & Fawcett, J. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly, 14, 158-163. 

The Definition of Health: Thoughts from Japan

Health is a central concept in most if not all versions of the metaparadigm of nursology (Fawcett, 2019). I have defined health as “human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6) and conceptualize health as inclusive of wellness, illness, and disease within that process. I deliberately separated wellness from illness and disease when I realized many years ago that the term, promotion of health, could mean that nursologists’ activities were directed toward promotion of illness and disease as well as wellness, rather than indicating that nursologists’ activities are directed toward promoting wellness and preventing illness and disease.

The St. Mary’s College School of Nursing Library. –A Repository of Nursology Knowledge

However, I recently realized that my conceptualization of health is Euro-centric and reflects my privilege as a white, Anglo-Saxon nursologist (Chinn, 2020). Accordingly, when I had the honor of speaking virtually with faculty and graduate program learners at St. Mary’s College Graduate School of Nursing in Kurume, Japan, in February 2021, I invited the learners to share their thoughts about health by responding to three questions. The questions and their responses constitute most of the remainder of this blog.

• The first question is: What is your definition of health?

• Inasmuch as the nursology curriculum at St. Mary’s College School of Nursing is based on the Roy Adaptation Model (RAM), I then asked this question: To what extent is your definition of health consistent with the Roy Adaptation Model definition of health, which is: “A state and process of being and becoming an integrated and whole human being” (Roy, 2009, p. 48).

• Finally, I asked: How does your definition of health affect what you think and do as a nursologist?

GRADUATE PROGRAM LEARNER TAKAKO TANAKA’S THOUGHTS ARE:

I define health as a feeling of harmony between body, mind, and living in society. Even if people have a disease or disability, they can be considered healthy if they feel that they are able to do what they want to do, while coping with their environment. My definition of health is similar to that of the RAM, in that human health in the RAM is not just a high or low level of health. Instead, it is about growth and development as we interact with our environment. Output behavior, when healthy, is positive adaptive behavior. According to the RAM, if energy is not spent on maladaptive coping, this energy can promote healing and enhance health, even in states of illness. I also believe that if people have a lifestyle disease, for example, and can controls the disease by going to the hospital and taking appropriate medication to stabilize the disease, and are able to live as members of society, then they are healthy. My definition of health has been informed by my work in public health nursing, as I learned to always value the concept of health promotion. Individually and collectively, I want to help people understand their health problems and support them to achieve independence and self-determination on their own, which will likely lead to illness prevention. Furthermore, I believe that it is essential to create an environment that supports health.

GRADUATE PROGRAM LEARNER MIHO YOSHIOKA’S THOUGHTS ARE:

I define health as a state in which subjective well-being and objective health indicators are in marvelous harmony. Subjective well-being differs depending on the culture, customs, and environmental values of each individual; and even if they have a disease or handicap, I think that they are in health if they feel well-being within themselves. However, I ask if there is a possibility of being a detriment to themselves, such as leaving the illness to their own discretion, are they truly healthy? Therefore, I dare to consider that a state in which these conflicting things are in marvelous harmony can be called health. The RAM emphasis on an interaction between the person and the environment is consistent with my idea of subjective well-being. The RAM emphasizes that health behaviors based on individual values are adaptive and can never be measured by the values of others, which helps me to understand that whether people consider themselves healthy is a complete affirmation of their diverse values. However, the RAM contention that health behaviors cannot be measured is not consistent with the inclusion of objective aspects of health in my definition. In recent years, people’s lifestyles and values have changed, and subjective well-being, an aspect of my definition of health, has also diversified. The practice of providing sensitive care for the different needs of each individual requires a holistic understanding of that individual. A nursologist is the professional who is closest to the client. By paying attention to and engaging with the client, I think that we can become aware of the needs of that person and provide individualized nursology that protects human consideration and dignity. I also think that nursology, which requires being close to the client, is important in terms of developing trust and respect for their subjective well-being. Moreover, I think that nursology practice is caring for others, which is essential for curing and healing. Therefore, the attitude of facing each individual, the full use of professional knowledge and experience with dignity to maintain and improve well-being, and cooperation with clients while caring for them, are all affected by my definition of health and by our thinking and acting as a nursologist.

GRADUATE PROGRAM LEARNER MASUMI OKA’S THOUGHTS ARE:

I define health as a state of understanding and accepting of one’s condition, and also a quest for health itself. Although the World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” I regard health as the way of understanding the state of experiencing a disease or disability, accepting one’s response to the disease or disability, and trying to become satisfied and fulfilled despite the disease or disability. My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. There are subjective and objective aspects to health, but factors such as ideals, goals, and prejudices toward health are the driving force behind the quest for health. I believe that human beings are creatures that constantly seek “health” and have the power to control their way of life. In other words, the act of pursuing “health” itself becomes human empowerment, and I think that it also affects one’s quality of life. My definition of health has been greatly influenced by the RAM definition of health. Being and becoming a whole and integrated human being can be interpreted as a quest for health, so that process is health itself. The RAM considers health from the perspective of human goals and the significance of existence, and lack of integration is said to denote inadequate health. The facilitation of the process of integration is seen as care for my idea of a “quest for health” and is consistent with all human care required of nursologists. My definition of health has a great influence on my thinking and behavior as a nursologist. I believe that supporting the acceptance of people with a disease or disability and considering together with them is caring for their “quest for health.” Quality of life changes significantly depending on how disease or disorder is perceived and understood. As a nursologist, I think that by being involved in the process of accepting illness and disability and supporting people’s ability to satisfy themselves, they can accept and love their existence. As a nursologist, I would like to continue to study and learn the potential “investigative power of health” of human beings and contribute to the development of the science of nursology in the future.

GRADUATE PROGRAM LEARNER TATSUNARI HARA’S THOUGHTS ARE:

My definition of health has two aspects: it is the situation in which people think of their condition as being “good” despite any physical malady they might have, and it is also the process they are going through in changing or adapting to their condition to become “better” in terms of their own understanding of the word. My definition of health has been greatly influenced by the RAM, as I learned nursology through the RAM. My definition of health is, however, more abstract than that of the RAM, as my definition emphasizes the largely subjective nature of health. My definition of health has influenced by thoughts and actions. Thus, I understand that nursologists strive to establish a caring connection to patients by ascertaining what kind of state they think is good, their goals and abilities required to attain that state, how they perceive their current situation, and what their values are. Furthermore, as I work in rehabilitation nursology, I see many of the patients leave the hospital with remaining disabilities to go on with their lives. Therefore, we nursologists may be required to change our ideas about health so that we can work together with the patients while thinking about how to establish health in their lives, and encourage any necessary changes they may need to make.

GRADUATE PROGRAM LEARNER MIHO ISHIBASHI’S THOUGHTS ARE:

I think that health is not a concept that opposes illness, but a process in which a person interacts with the environment as a human being and tries to become a person looking positively toward their hopes and wishes. Health in the RAM is an integrated overall condition or process. Nursologists say that by promoting adaptation, they contribute to human health, quality of life, and dignified death. I think that for people to be the people they are, nursologists have to understand the hopes and wishes of what the people want to be and do, as well as understand and support them physically, mentally, and socially. I believe it is necessary to understand the environment surrounding a person, think about the influences that affect their health, and consider how to manage these aspects to make people healthy. I think it is necessary to act as a nursologist to understand people’s hopes and wishes people and to help them attain these hopes and wishes.

GRADUATE PROGRAM LEARNER YUKIE NAKANISHI’S THOUGHTS ARE:

I think of health as being familiar with one’s self, having the ability to deal with problems, and having the ability to make decisions. The notion of health in the RAM as a state of integration is consistent with my thoughts about health. Until I entered graduate school, I was convinced that “health” was not having any illnesses or disability. However, even if one has an illness or a disability, I have now come to think that true health is the ability to face oneself, accept what one has become, and move forward toward the future. While studying the RAM and bioethics, I have learned it is important to learn that “person” equals “life”, and that it is equally important to think about a person’s “purpose of life” and “meaning of life” while practicing nursology. Nursologists are practitioners of caring, so I have realized that it may be inadequate to not understand what health is. In the future, I would like to continue learning so I can augment my humanity and human power, learn more about the attitudes necessary for caring, and put them to practical use.

CONCLUDING NOTE:

As I began to write this blog, I realized that I did not know the Japanese word for health; Google translate provided an answer: Kenkō, which is written in Japanese characters as 健康 (https://translate.google.com/?sl=en&tl=ja&text=health%20&op=translate)

I was remiss in not having invited the St. Mary’s College Graduate School of Nursing faculty and learners to share the word each uses for health. Therefore, I do not know whether their responses reflect a Euro-centric or Japanese meaning for the word.

When I sent a draft of this blog to Eric Fortin, of the St. Mary’s College School of Nursing faculty, he replied with his interpretation of the Japanese characters for health. I am, therefore, indebted to Mr. Fortin (personal communication, April 26, 2021), who wrote “健 means ‘humans build,’ and ‘康’ means “breathing space, . , , probably implying the lack of obstruction or disease. So, ‘humans building breathing space’ implies being healthy.”

REFERENCES

Chinn, P. (2020, January 14). Decolonizing nursing. nursology.net. https://nursology.net/2020/01/14/decolonizing-nursing/

Fawcett, J. (2019, March 21) Questions and Answers about our Discipline: Name and Metaparadigm. Paper presented at the Nursing Theory: A 50 Year Perspective Past and Future Conference. Sponsored by Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. nursology.net. . https://nursologycom.files.wordpress.com/2019/03/cwru-paper-fawcett-3-28-19.pdf

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

Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.

World Health Organization. (1948). Preamble to the constitution. World Health Organization. https://www.who.int/about/who-we-are/constitution

Guest Post: Decolonizing the Language of Nursology

Contributor: Daniel Suárez-Baquero
Scroll down for Spanish language version of this post

ENGLISH

Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.

The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.

It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).

I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.

I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.

Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science

SPANISH

La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.

Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.

Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).

Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.

Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.

REFERENCES/REFERENCIAS

References

Ayala, R. A. (2020). Towards a Sociology of Nursing. In Towards a Sociology of Nursing. Springer Singapore. https://doi.org/10.1007/978-981-13-8887-3

Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2).
Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175

Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903

About Daniel Suárez-Baquero

Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.

Volume 2 of the Roy Academia Nursology Research Center (RANRC, Japan) now published!

The Roy Academia Nursology Research Center (RANRC) publishes a yearly Nursology Letter. Volume 2 has just been published! See information about volume 1 (2019) on our January 7, 2020 blog post celebrating the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan.

The RNARC is named for Callista Roy, the nursology theorist who developed the Roy Adaptation Model. Congratulations to our colleagues at St. Mary’s College for this notable achievement!

COVID-19 – What would Margaret Newman say?

Dorothy Jones and Jane Flanagan
See also Newman’s Theory of Health
as Expanded Consciousness

Although not the only global challenge we face, COVID-19 has the world’s attention while disrupting so many familiar routines. For those so fortunate, there is the new normal of working from home and countless conference calls that seem to blur one day into the next, almost erasing the confines of time while confining us to a physical space.  When things get back to “normal” what will that look like?

For those in service industries, there is the chaos of being the person in the midst of unsafe places whether the grocery store, a bus or as an employee in a hospital.  Making connections while fearing, am I safe? Do I have what I need to protect myself/ my family? And, sometimes knowing you do not have what you need, and in that moment, your awareness of the disparity of those who have and those who do not is heightened.  What will it be like when things get back to “normal?

 Then there are those who in a whirlwind, may have lost their job.  Now they are struggling to pay bills, perhaps visiting food banks for the first time mixed in with home schooling young children or a full house of grown children now back to the safety of their childhood home.  When and what will be that return to “normal”?  For every scenario, there is opportunity, freedom and new ways of being. There is also potential binding or unraveling.  But no matter the reality, there are the chants to “get back to normal”

Dr. Margaret Newman

This idea of “getting back to normal” raises the question; “What would Margaret say?” We think the answer is …actually, not very much.  She would smile gently and acknowledge each person who spoke and told his or her personal story. She would be present and authentically listen.  Her silence would spur more stories until in the sheer dizziness of it all, the cacophony would stop and everyone would look to her and wonder what she is thinking. Again, silence and this time the room would go quiet.  Finally, she would speak: “I’m just curious about people wanting to go back to normal, what do people think of that?”  Then she would sit and wait for us to react…and we would.  We would discuss how we cannot “go back” and about the opportunity in the chaos. What went well in nursing practice during COVID – 19 that was reflective of nursing and what did not?  She would smile, as we would envision a new future that informed by COVID-19, and the inequities of an illness, linked to an environmental crisis and manifested in our most vulnerable. An illness that has stuck down older adults, minorities and is on a path to literally destroying second and third world countries.  Go back?  No, we would not be going back we would be envisioning a new future, one with boundaryless opportunities.

There is for some, an increased awareness, that the inequities of COVID-19 along with the murder of George Floyd and other racial incidences has heightened the issue of structural racism that has always been simmering under the surface. Go back?  Oh no, we will not go back. Not to complacency, not to a world where nurses today are lauded for their actions during a crisis, but who will return to being a hidden entity, part of the bed charge.  No, we are now in a world that recognizes, yes there were many deaths, but because of nursing care, because of nursing’s commitment to meeting the person where they were at, commitment to delving into knowing other, upward of 85% of those who had COVID and were hospitalized were successfully discharged.  Yes, nursing care! It was the authentic presence of nurses who connected with patients in new ways and journeyed with them on a path of discovery, nurses learning to recognize the pattern of the critically ill when the normal mode of communication was no longer possible, and nurses who transformed the care environment. It was not a cure or a vaccine that made the difference; it was “the difference nursing makes” that made the difference.

The COVID-19 virus made visible a pattern of turbulence and disruption within the global whole.  Lack of awareness to growing social challenges, loss of freedom creation of boundaries and isolation confounded the environment within which the virus emerged. Within this context, the virus took on new meaning and yielded variety of responses. Using the theoretical lens of Health as Expanding Consciousness, Margaret would reflectively and carefully suggest that being exposed to the global and dramatic changes of the day has already begun to reshape/repattern us. She would envision the voice of nurses advocating on behalf of patients, on behalf of the myth of curing rather than healing, on behalf of older adults, racial and ethnic minorities.  Margaret would not support “going back”; instead, she would reflect on the meaning of the unfolding pattern emerging before us …within the context of an illness.

The event COVID-19 has served to make visible the invisible for society as a whole.  Recognition that we are all connected and interrelated. The actions and behaviors of one individual directly affecting the very life of another. Response to the virus has revealed a complex, dynamic human pattern of the whole within a dynamic and changing environment. As the illness experience is unfolding, individual responses shaped by factors including  vulnerability,  gender, age and the older adults, race, ethnicity, compromised health status, poverty, lack of insurance, homelessness, exposure to environmental stressors and population density, and personal responses to life challenges have been made visible. Compromised relationships, sustained loneliness and disconnection challenged human becoming and threatened choices about health and wellness. Rather than creating new problems, COVID-19 has manifested not only a serious disease but made visible longstanding global societal challenges that have gone unnoticed or suppressed.

Margaret would caution that “fixing” the illness (i.e. treating to cure) without addressing the whole person/environment interaction that include people and events surrounding the individual experience, could lead to a reoccurring manifestation of the underlying pattern in new ways (e.g. inequities and disparities in care). She would stress the importance of collaborating with individuals and groups in dialogue, she would identify what is meaningful, to acknowledge the collective increased awareness, and seek to uncover an underlying pattern of the whole. COVID-19 then becomes a stimulus for active discussion, identifying barriers that compromise moving forward as individuals and as a society. The insights gained through information and connecting with another create opportunities for new insights, actions and freedom to participate knowingly in actions that promote transformative change.

The importance of relationship is core to advancing the process of discovery. Partnerships that are open and evolving allow pattern to emerge and potentially increase the realization that we are all interdependent and connected within and across environments. Recognizing that what affects one-person or community can have a reciprocal impact on another. Within the discovery process there is freedom to hold on to what gives new meaning to one’s being and what binds and threatens our freedom  to become and engage in sustainable holistic healing. No, Margaret we are not going back. And she would smile, knowing we are with new heightened awareness and renewed energy, accelerating toward new potentials and  transformation.

Additional References

Newman, M. A. (2008). Transforming presence: The difference that Nursing makes. Philadelphia: F. A. Davis.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. (2008). The focus of the discipline of nursing revisited. Advances in Nursing Science, 31(1), E16-E27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Smith, M. C. (2011). Integrative Review of Research Related to Margaret Newman’s Theory of Health as Expanding Consciousness. In Nursing Science Quarterly (Vol. 24, Issue 3, pp. 256–272). https://doi.org/10.1177/0894318411409421

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

 

 

 

Visions for 2020 – the Year of the Nurse

To all Nursology.net visitors – welcome to the Year 2020!  As we enter this year, we members of the site management and blogging teams join in celebrating the “Year of the Nurse and Midwife” and offer our visions for the coming year and beyond!

The year 2020 was designated In January 2019 by the World Health Organization (WHO) as the “Year of the Nurse and Midwife”  in honor of the 200th birth anniversary of Florence Nightingale.  Far from being a mere sentimental expression recognizing the importance of nursing and midwifery worldwide, this designation is part of a worldwide effort to improve health globally by raising the status of nursing and midwifery.  Here is the statement issued in establishing this designation:

The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.

Nurses and midwives are essential to the achievement for universal heath coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals. (from https://www.who.int/hrh/news/2019/2020year-of-nurses/en/)

As members of the Nursology.net management team, we are welcoming the 2020 “Year of the Nurse and Midwife” with our visions for this coming year and beyond.  We hope our ideas will inspire you to join in making these values and visions a reality!

Maggie Dexheimer Pharris –

2020 vision. During an eye exam, there is a moment when just the right corrective lens falls into place and suddenly we appreciate 20/20 clarity of vision. Remarkable!  So too it is with theory. In this new decade may nurses around the world find just the right nursology theory to clearly see the path to creating a meaningful practice and equitable, accessible, and healing systems of care!

Karen Foli – 

Unity among nurses based on the care we offer and the universal experiences we share. kindness directed toward patients and fellow nurses, even when they may be unable to reciprocate in that moment. Wisdom to understand how nursing power can be harnessed to forward a sustainable, balanced work life and advocate for improvements in patient and family care. And for nurses’ truth to be spoken freely, a reality to be heard and honored.

Peggy Chinn – 

A renewal of deep respect and tireless dedication for the core values of our discipline – protection of the dignity of each individual, advocacy for the needs of those we serve, and belief in the healing potential of our caring relationships.

Marlaine Smith – 

An accelerating appreciation for the distinctive knowledge of the discipline and the unique contribution that this knowledge can make to the health, well-becoming and quality of life of those we serve. With this appreciation will come the growth of research that is focused on the theories of nursology and practice models that are theory-guided.  Our focus on human wholeness, health as well-being/becoming, the human-environment-health interrelationship and caring is what is missing and most needed in healthcare.

Jane K. Dickinson  –

My vision is that all nurses will know, value, and be guided by nursing knowledge and take caring to the next level in education, practice, and research.

Jessica Dillard-Wright – 

Because 2020 has been declared the Year of the Nurse by the World Health Organisation, my vision for the year is that nursing will embrace the emancipatory potential of our discipline, recognizing the interface between nursing knowledge, nursing praxis, and wellbeing on a global scale. In so doing, we can dismantle injustice and mobilize our profession to nurse the world.

Jacqueline Fawcett

 Now is the perfect time to accept NURSOLOGY as the proper name for our discipline and profession. Now is the perfect time to realize that all individuals licensed as Registered Nurses or equivalent designation worldwide are NURSOLOGISTS. Now is the perfect time for all nursologists to realize they are “knowledge workers” who engage in development, application, and dissemination of nursology discipline-specific knowledge so that we know and everyone else knows the what, why, how, where, and when of our work with those individuals and groups who  seek our services.

Chloe Littzen – 

My vision for nursing in 2020 is that we find unity among our diversity, despite settings, education levels, or beliefs, and work collaboratively to advance the discipline, enabling all nurses epistemic authority and well-being.

Rosemary Eustace – 

The year 2020 is a great reminder of the “200” unique contributions nurses and midwives make each day to improve health, health care, health policy and nursing across diverse settings.  As we celebrate this milestone, let us light our lamps in unity to advance nursing knowledge that is congruent with contemporary health care demands. Let us keep the Power of Nursology alive!

Marian Turkel – 

Vision for 2020: Nursing theory will guide nursing education, nursing practice and nursing research. RN-BSN, BSN and MSN programs will have at least one nursing theory course in the curriculum.  DNP and PhD curriculum will have 2 nursing theory courses.  Nursing faculty and Registered Nurses in the practice setting doing research will use a nursing theory to guide their practice and research.  The Nursology leaders will collaborate with the American Academy of Nursing to organize a conference similar to the Wingspread Conference. The American Nurses Credentialing Center will collaborate with the Magnet Recognition Program©® to require hospitals to have a nursing theory as the foundation for achieving Magnet©® Status Recognition.