Lillian Wald (March 10, 1867 – September 1, 1940)

Guardian of the Discipline

Co-authored by
Deborah Lindell, Adeline Falk-Rafael, Jacqueline Fawcett

Lillian Wald (retrieved from https://www.vnsny.org/timeline/#prettyPhoto)

A recent article in the American Journal of Nursing (Pittman, 2019) reignited our interest in Lillian Wald’s landmark accomplishments, most notably co-founding, with Mary Brewster, of the Henry Street Settlement in New York City in 1893 (Dock & Stewart, 1938).  “Their work” according to Dock and Stewart (1938), “led to the next development of visiting nursing by their relating it to all the social, economic and industrial conditions that affected their patients’ lives” (p. 162).

Pittman (2019) in her recent American Journal of Nursing article highlighting the importance of Wald’s practice as a model for the future, explained, “Wald’s model of care [involved] nurses working side by side with social workers at the intersection of medicine and society” (p. 46). Another perspective would be to think of Wald’s work as an approach to health care delivery that encompasses complementary services provided by nursologists and social workers.

A hallmark of Wald’s approach was prevention of illness and disease and promotion of wellness. Her approach was such that everyone had a nursologist for primary care, and that the nursologist referred those needing treatment for disease to a physician. We can only wonder how differently the health care system would have evolved if Wald’s model had indeed been become THE approach to health care.

Similarly, we can only wonder what would have happened had Wald’s model been incorporated and implemented as part of Grayce Sill’s (1983) proposal for the establishment of nursologist owned and operated corporations that contracted with all clinical agencies for provision of nursologists’ services (see our tribute to Grayce Sills here). Alternatively, we can only wonder would could happen if Wald’s model were to be incorporated into Parse’s (2019) proposal for establishment of “community centers owned and managed by [nursologists] that are regionally situated to offer services to a group of families in a region” (p. 169).

Wald’s delivery model, the focus of Pittman’s recent article. was extremely important because it allowed the nursologists to be, in Wald’s words, in an “organic relationship with the neighbourhood” and, therefore, allowed for the “development of community coalitions for influencing health and social policy” (Falk-Rafael (1999, p. 27).  The delivery model followed Nightingale’s model of district “health nursing,” which Wald re-created as public health nursing. It was a model, however, that facilitated the enactment of Wald’s conceptual model of nursing, which Falk-Rafael has argued followed the Nightingale model (Falk-Rafael, 1999, 2005). Like Nightingale, Wald considered the patient to be the central focus of practice and viewed the “patient” as the individual, family, or community within the context of society; valued caring and compassion; and emphasized a holistic, person-centered, multi-determinant view of health. It is Wald’s conceptual model that informed nursing practice and without which, the delivery model would not have achieved the success alluded to in Pittman’s AJN article.

Wald, as Nightingale before her, understood from providing care to those members of society who were impoverished, disenfranchised, and otherwise vulnerable, that many of the health issues they faced could be prevented by upstream actions focused on changing/enacting public policies. Like Nightingale, Wald’s delivery model ensured nursing care to address immediate health concerns “downstream,” while simultaneously working “upstream” to shape policies affecting health.  She lobbied for health care for those who were impoverished and established rural and school nursing. Moreover, again like Nightingale, Wald recognized the value of measuring outcomes. For example, she published narratives and graphs describing and depicting the dramatically lower death rates, overall and by age group, of 3535 children with pneumonia cared for in the home during 1914 by Henry Street nursologists compared to those admitted to hospitals (Wald, 1915, pp 38-39). Nor was Wald alone in her political activism among nursologists of the Henry Street Settlement (see “The Family” photo below). Lavinia Dock, the noted suffragist, and Margaret Sanger, who defied the Comstock Laws to provide contraceptive information to women and who established the forerunner of Planned Parenthood, were also Henry Street nursologists (Falk-Rafael, 2005).

Lillian Wald’s accomplishments extended beyond, albeit were connected with, the Henry Street Settlement. For example, she was elected the first president of the National Organization for Public Health Nursing “twenty years after [she] had gone to Henry Street to live and her name was known in many countries” (Dock & Stewart, 1938, p. 166). Earlier, Wald had contributed to the initiative to control the spread of tuberculosis, when she and Mary Brewster “bought sputum cups as part of their first equipment” for the Henry Street Settlement (Dock & Stewart, 1938, p. 325). Later, Wald contributed to the life insurance movement when, in 1909, she “arranged with Dr. Lee K. Frankel of the Metropolitan Life Insurance Company to have the Henry Street Visiting Nurses give their service to the sick industrial policy holders of that company, as a certain rate per visit” (Dock & Stewart, 1938, p. 344). In doing so, she increased health care accessibility to people who otherwise could not afford it and hoped to expand such accessibility through more partnerships with both the private and government sectors. In addition, Wald proposed what became the United States Children’s Bureau, which was established by Congress in 1912 (Dock & Stewart, 1938).

Lillian Wald’s work is an exemplar of Critical Caring, a mid-range theory rooted in the conceptual frameworks of Nightingale, Watson, and critical feminist social theories. This theory also emphasizes both downstream and upstream nursing as essential for population health and shares with Nightingale and Wald the tenet that justice-making is a manifestation of caring and compassion (Falk-Rafael, 2005).

References

Dock, L. L., & Stewart, I. M. (1938). A short history of nursing: From the earliest times to the present day(4thed.). New York, NY: G. P. Putnam’s Sons.

Falk-Rafael, A. R, (1999). The politics of health promotion: Influences on public health promoting nursing practice in Ontario, Canada from Nightingale to the nineties. Advances in Nursing Science,22(1), 23.

Falk-Rafael, A. (2005). Speaking truth to power. Nursing’s legacy and moral imperative. Advances in Nursing Science, 28, 212-223.

Jewish Women’s Archive. “Lillian Wald.” (Viewed on July 26, 2019) <https://jwa.org/womenofvalor/wald>

Parse, R. R. (2019). Healthcare venues in transition: A paradigm shift? Nursing Science Quarterly, 32, 169-170.

Pittman, P. (2019). Rising to the challenge: Re-Embracing the Wald model of nursing. American Journal of Nursing, 119(7) 46-52.

Wald, L. (1915) The house on Henry Street.New York, NY: Henry Holt.

“The Family” about 1905. Standing, left to right: Jane Hitchcock, Sue Foote, Jene Travis. Second row, seated: Mary Magoun Brown, Lavinia Dock, Lillian D. Wald, Ysabella Waters, Henrietta Van Cleft. In Front: ‘Little Sammy’ Brofsky who ran everybody’s errands and ‘Florrie’ Long, the Coob’s little daughter and the “baby of the house.” (retrieved from https://www.vnsny.org/who-we-are/about-us/history/)

Grayce M. Sills (1926-2016)

Guardian of the Discipline

Thank you to Sharon Tucker, PhD, RN, FAAN
and Christina Nyirati, RN, PhD
for their contributions to this post (see bios below).

Grayce M. Sills, circa 1986 while serving as Acting Dean of the Ohio State University School of Nursing. Photo by Charlene Eldridge Wheeler, featured for month of April, 1987 “Everyday Sheroes” Calendar

Grayce Sills, RN. PhD, FAAN, is widely recognized as a “pioneer . . . and supporter . . . of psychiatric mental health nursing . . . a champion for improving care for the chronically mentally ill . . .  [and] a pioneer in interdisciplinary collaboration among health care professionals” (Parrish, 2016, pp. 155-156).

Grayce Sills was born in Bremen, a small town in southeast Ohio. She was raised by her grandparents and extended family from the age of 2 years, after her mother died. Grayce began her undergraduate education with a liberal arts concentration at Ohio University in Athens, close to her family home. Following her sophomore year, Dr. Sills took a federally funded training job in New York to prepare as a psychiatric aide, hoping to raise enough money to complete her college degree. The psychiatric nurses impressed Grayce with their specialized skill. She was particularly impressed by the head nurse, Betty Oliver, who seemed more able than the physicians to soothe and comfort patients by just being present. Inspired, she began her nursing education at Rockland State Hospital School of Nursing in Orangeburg, New York, where she received her diploma in 1950. Grayce then attended the baccalaureate completion program at Teachers College Columbia University in New York from 1950 to 1951 but did not complete the program.

While at Teachers College, Grayce met Hildegard Peplau, just as Dr. Peplau was completing what many consider the first middle range nursing theory, Interpersonal relations in nursing (Peplau, 1952). Many year later Dr. Sills shared stories about the Peplau seminars with The Ohio State University Ph.D. nursing students who were grappling with theory; Dr. Sills admitted to also being initially confounded by Dr. Peplau’s theoretical inquiries. Timidly curious, yet somewhat intimidated, Grayce left New York to return to her Ohio home. She finally received a baccalaureate nursing degree from the University of Dayton in 1956. Fortunately for our discipline in general and psychiatric nursing in particular, Dr. Peplau was invited to present a nursing workshop at Dayton State Hospital in 1957, where Grayce was working. Explaining how her perspective then shifted profoundly, she stated:

“I owe [a large debt to] Hildegard E. Peplau for bringing me a new perspective, a new approach, a theoretically based foundation for nursing practice, for therapeutic work with patients in those problematic settings. Imagine the excitement of making sense out of a patient’s hallucinatory experience through collaborative work! Imagine the joy that came from discovering that a delusion could be dealt with and satisfactorily eliminated through effective verbal work with patients, a new day had dawned! Theory was used to guide nursing practice. Theory was tested in the real world of practice.” (Sills, 1978, p. 122)

Dr. Sills earned a master’s degree in sociology from The Ohio State University (OSU) in 1964, and began teaching in the OSU School of Nursing that same year. She completed a PhD in sociology, also from OSU, in 1968.  At that time, the PhD in Nursing was not yet offered. Dr. Sills described herself as a “tourist” in the discipline of sociology, grateful for a conceptual perspective complementary to nursing, but convinced that nursing knowledge was necessary for nursing practice. With this conviction, Dr. Sills made major contributions to the nursing programs at OSU, including a graduate clinical nurse specialist program in psychiatric mental health nursing. She also chaired the Department of Family and Community Nursing and served as Director of Graduate Studies.

As the first OSU Nursing Acting Dean, by 1985 Dr. Sills had managed to re-position Nursing in the academic structure of OSU by establishing the College of Nursing with its own budget and self-governance. This, she believed, was the necessary foundation for creating a community of nurse scholars who would advance nursing education and nursing scholarship. Self-governance, she reasoned, would contribute significantly to the power of nursing to develop the scholarly discipline, as well as the practice profession of nursing. Her conviction that borrowed knowledge from established disciplines was useful to nursing – although that knowledge was not  nursing knowledge – influenced her vision for the Ph.D. Program in Nursing at OSU, established in 1985.

Dr. Sills retired from OSU College of Nursing in 1993 as Emeritus Professor. She holds the rare distinction of receiving three awards from OSU: a Distinguished Teaching Award, a Distinguished Service Award, and an honorary doctorate in public service. She also was awarded honorary doctoral degrees from Indiana University and from Fairfield University.

Dr. Sills’ contributions expanded beyond OSU. She chaired the Study Committee on Mental Health Services for Ohio and, in 1986, was chosen as a Woman of Achievement by the Columbus YWCA. As a past chair of the OSU Hospitals Board of Trustees, she was instrumental in gaining board support for magnet hospital status, achieved in 2005. Beyond Ohio, she held visiting professorships at several universities throughout her career and provided international consultation for community based mental health nursing in Italy, Japan, and South Korea. Dr. Sills was a founder of American Psychiatric Nursing Association and the American Nurses’ Association (ANA) Commission on Human Rights. She was elected to the American Academy of Nursing (AAN), and in 1999, was designated as an AAN Living Legend.  She received several other awards, including the ANA Hildegard Peplau Award.

Dr. Sills record of scholarly work includes more than 60 journal articles and book chapters. One of many innovations put forth by Dr. Sills in the idea of nurse corporations. She explained,

“The conceptual key to the corporation proposal is that it changes the fundamental nature of the social contract. The professional nurse would no longer be an employee of the hospital or agency, but rather a member of a professional corporation which provides nursing services to patients and clients on a fee‑for-service basis. . . . Such a change in the nature of the social contract is, it seems to me, fundamentally necessary for the survival of nursing as a profession rather than an occupational group of workers employed by other organizations.” (Sills, 1983, p. 573)

Inasmuch as nurse corporations would operate on a fee-for-service basis, the corporation would determine the costs of nurses’ work, which changes the economics of practice in a profound way. Furthermore, nurse corporations are a solution to the problem of collective bargaining by nurses, such that contracts are between the nurse corporation, which is a professional entity rather than a union, and individuals or organizations (Sills, 1983).

Christina Nyirati recalls that when she was a student at OSU several years ago, Dr. Sills had championed nursology as the name for our discipline.  Peggy Chinn recalls that at an American Nurses’ Conferene of many years ago, Dr. Sills was among the first nurse leaders to propose that the “doctor’s orders” be changed to the “physician’s prescriptions,” to serve as a parallel to the nurse’s prescriptions. ”One wonders what Dr. Sills now would think about the“nursologist’s prescriptions” or the “patient’s self-directed prescriptions”?

Given Dr. Sills’ substantial contributions to our discipline, it is not surprising that she was “affectionately referred to as ‘Amazing Grace’ by everyone who knew her” (Parrish, 2016, p. 166). See this video of an interview of Dr. Sills by Jeanne Clement:

References

Parrish, E., (2016). Remembering a pioneer of psychiatric mental health nursing. Perspectives in Psychiatric Care, 52, 155-156.

Peplau, H.E. (1952). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York, NY: G.P. Putnam’s Sons. [Reprinted 1989. London, UK: Macmillan Education Ltd. Reprinted 1991. New York, NY: Springer.] (Translated into nine languages) .

Sills G. (1978). Hildegard E. Peplau: Leader, practitioner, academician, scholar and theorist. Perspectives in Psychiatric Care, 16, 122–128.

Sills, G. M. (1983). The role and function of the clinical nurse specialist. In N.L. Chaska (Ed.), The nursing profession: A time to speak (pp. 563–579). New York: McGraw‑Hill.

About our guest Contributors

Christina Nyirati, RN; PhD
Photo retrieved from http://www.heritage.edu/faculty-staff/directory/staff-bio/

Christina Nyirati, PhD, RN – 

Professor, Department of Nursing, Chair and BSN Program Director, College of Arts & Sciences, Heritage University, Toppenish, WA.

Grayce Sills became Christina’s mentor when she was admitted to the first OSU PhD nursing cohort in 1985 after several years of experience as a family nurse practitioner (FNP). At their initial meeting Dr. Sills questioned whether, as an FNP, Christina had disavowed her nursing knowledge. Dr. Sills ventured Christina would have to work a little harder than her classmates to question her assumptions about the Discipline of Nursing. Christina recalls Dr. Sills spoke be-musingly about Drs. Paterson and Zderad, Sills’ former OSU faculty colleagues, who had referred to themselves as Nursologists. At a recent American Association of Colleges of Nursing (AACN) Dean’s meeting, Christina reminisced with erstwhile PhD classmate, Dr. Janet Fulton, (now Professor and Associate Dean for Graduate Programs at Indiana University-Purdue University) about their seminars with Dr. Sills, who, with a twinkle in her eye, challenged the doctoral students to ponder nursing as a discipline rather than an applied discipline, and to consider Nursology the organizing concept for our discipline.

Throughout her career Dr. Nyirati has endeavored to fulfill her mentor’s admonition. When she became the founding director of the FNP program at OSU she integrated nursing theory with primary care concepts into the curriculum. 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 [See article by Nyirati, C. M., Denham, S. H., Raffle, I., & Ware, J. (2012). Journal of Family Nursing, 18, 378-408).

Now as BSN program director at Heritage University on the Yakama Reservation in Washington State, Christina honors Grayce’s legacy as she prepares nurses in a curriculum faithful to the epistemic foundation of nursing. BSN students develop their reflective practices from The Fundamental Patterns of Knowing in Nursing  (See article by Carper, B. A. (1978). Advances in Nursing Science, 1(1), 13-24.) Before her death in 2016, Dr. Sills used to Skype with the first cohort of Heritage BSN students, reminding them to recognize and use their powerful nursing knowledge to correct the inequities in their communities.

Sharon Tucker, PhD, RN, FAAN
Photo retrieved from https://nursing.osu.edu/faculty-and-staff/sharon-tucker

Sharon Tucker, PhD, RN, APRN-CNS, F-NAP, FAAN – 

Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing, College of Nursing; Translational/Implementation Research Core Director, Helene Fuld Health Trust National Institute for EBP; Nurse Scientist, Wexner Medical Center, The Ohio State University

Faculty and staff at OSU are privileged to continue to advance the work of the amazing Dr. Sills through an endowed professorship established in her name by a generous gift from Dr. Sills and her family. Dr. Tucker was hired in 2017 as the Grayce Sills Endowed Professor of Psychiatric Mental Health Nursing. She has practiced, taught, and conducted research in behavioral and mental health interventions and outcomes for decades. She was recognized in 1997 with an Award for Excellence in Research by the American Psychiatric Nurses Association, at which time Dr. Sills was recognized with the Psychiatric Nurse of the Year Award.

Dr. Tucker seeks to advance Dr. Sills’ work in promoting independent nursing practice (she is a board certified Advanced Practice Psychiatric Clinical Nurse Specialist), teaching interpersonal and health coaching skills, studying mental health assessment strategies and behavior change interventions, and advocating for individuals living with mental illness who are underserved and undertreated.

 

 

 

 

 

 

 

Ann C. Wolbert Burgess, RN, APRN, FAAN

Guardians of the Discipline
Boston College web page

Dr. Burgess is perhaps best known for her scholarly work about and guiding practice of forensic nursing. She and Lynda Lytle Holmstrom, a sociologist at Boston College, described rape trauma syndrome and founded the first rape crisis counseling program at Boston City Hospital (now Boston University Medical Center). Dr. Burgess played a major role in developing the Federal Bureau of Investigation’s (FBI) Behavioral Science Unit, which focuses on profiling serial killers and other criminals. She also has provided exemplary testimony at trials for sexual assault, murder, and other criminal acts. She is the author or co-author or editor of many, many journal articles, book chapters, and books. In addition, she is the co-developer of the Comprehensive Sexual Assault Assessment Tool (CSAAT), which is based on Roy’s Adaptation Model. Collectively, this work has placed nursing in the forefront of assessment, treatment, and prosecution of many forensic matters.

Dr. Burgess received her baccalaureate and Doctor of Nursing Science degrees from Boston University, and her master’s degree from the University of Maryland. She holds an honorary Doctor of Humane Letters from the University of San Diego.

Dr. Burgess has held faculty appointments at Boston University, Boston College, and the University of Pennsylvania. She developed and taught a graduate program course in forensic nursing, first at the University of Pennsylvania and currently at Boston College.

Dr. Burgess’ major contributions as a Guardian of our Discipline have been widely recognized. She has received many awards, including American Academy of Nursing Living Legend, the inaugural Ann Burgess Forensic Nursing Award by the International Association of Forensic Nurses, the Sigma Theta Tau International Audrey Hepburn Award, the Sigma Theta Tau International Episteme Laureate Award, and the American Nurses Association Hildegard Peplau Award.

Dr. Burgess’ work with the FBI has been portrayed by a character in the television program, Mindhunters. Many years ago, during some of the time that Dr. Burgess was at the University of Pennsylvania School of Nursing, she shared a group faculty house with other nursing faculty colleagues. We often shared dinner and discussed cases about which Ann was providing consultation for the FBI. We would then refer to her as “Annie and the G-Men.” Imagine our surprise when a television program (many years before Mindhunters) soon appeared with a character named Annie, a psychiatric nurse just as Ann is, whose role was consultation with the FBI Behavioral Science Unit!

Portions of this blog were adapted from https://en.wikipedia.org/wiki/Ann_Burgess

Rozella May Schlotfeldt, RN, PhD, FAAN (1914-2005)

Guardian of the Discipline
Nursology author Leslie Nicoll
Guest contributor: Elizabeth R. Berrey

Rozella M. Schlotfeldt (photo credit)

Rozella Schlotfeldt was among the great leaders in nursing in the years when nursing education was first shifting away from hospitals and becoming established in universities.  Students were educated for entry into the nursing profession and graduate programs were established to prepare them to take on roles as leaders in practice and as scientists equipped to advance nursing knowledge through research and theory development.

This week, nurse scholars are gathered at the Frances Payne Bolton (FPB) School of Nursing at Case Western Reserve in Cleveland, OH, to recognize the earliest conferences dedicated to the development of nursing theory. Held one-half century ago, in 1967, 1968 and 1969, these landmark conferences were recognized with the publication of the proceedings in Nursing Research (see volume 17, issue 3; volume 17, issue 6; and volume 18, issue 5). The first symposium, held October 7, 1967, was the third in the series of conferences held at FPB but the first on theory development. Rozella Schlotfeldt was the Dean of the School at the time; regarding the conference, she noted, “Publication of the proceedings was sought with a view toward assisting in promoting discussion and debate among nursing’s intellectuals,” (Schlotfeldt, 1986, p. 98). Lucille Notter, then Editor of Nursing Research, commented in 1986, “I had the pleasure of being invited to attend this symposium…I was most enthusiastic about the papers given. Now, in retrospect, the symposium has proved to be a landmark in nursing…The decision to publish the symposium proceedings was a good one. Students…often use these papers in their quest for understanding the meaning of nursing theory and how nursing theory evolves,” (Notter, 1986, p. 97).

Rozella Schlotfeldt served as Dean at FBP from 1960-1972 and continued as a Professor until her retirement in 1982. Even after that, she continued to be active on the international, national, and local levels. I (Leslie) was fortunate to have Rozella serve as a member of my dissertation committee in the mid-1980s. She provided the leadership and vision to establish the PhD program at FPB in 1972, the third PhD program in nursing at that time.

Like any doctoral student, I was a little intimidated to have her as a committee member–she was invited at the request of my chair–but once I got to know Rozella, I appreciated her kindness, insight, intelligence, and warmth. Every doctoral student has “pearls” that they pick up through their studies; one pearl from Rozella was that “time has no points.” Never write, “At this point in time,” she said, “Just say, ‘At this time.’” I think of her practically every time I sit down to write something and remember the pointless time in which we exist! She also taught me how to always remember the difference between affect and effect: “Affect is to influence; effect is to bring about.” See the quote further on which uses “effect”–pure Rozella, and perfectly used.

Elizabeth R. Berrey’s doctoral dissertation was a feminist critical hermeneutic study to identify the themes and patterns in Rozella’s life that informed her thinking about nursing. Using oral history as a tool, Rozella’s remarkable life was documented, along with the unprecedented vision that Rozella brought to the development of the discipline of nursing.  Elizabeth and I were in the same PhD cohort at FPB; she provided the following summary of her work, focusing on those dimensions that exemplify Rozella as a “guardian of our discipline.”

In 1918, when Rozella Schlotfeldt was 4 years old, the Great Flu Epidemic claimed her father’s life. Her mother, along with Rozella and her younger sister, were spared. Her mother immediately went to work as a nurse to support her family. She impressed Rozella with her creativity and innovation in caring for her patients, greatly influencing Rozella’s choice of profession. “From an early age, no doubt about it, I determined to be a nurse!” The household in which she grew up was characterized by practicality, hard work, and doing that which needed to be done, as well as busyness, energy, and vigor. These generative themes and patterns of her life are reflected in, and affected, her thinking about nursing.

Rozella received her BSN in 1935 (in a time when that was uncommon) from the University of Iowa. She served in the Army in the European Theater during WWII, then earned her MS in Nursing Education/Administration in 1947 from the University of Chicago. In her words, “I already had a notion of being influential and not let anything encroach upon that.” She said, “I suppose that translates itself into mapping out what you do with your personal life, as well. She speculated that getting married to a man “would have stood in the way” and “I would have been bored to death …. maybe I was 30 years ahead of my time so far as independence of women.”

Rozella took a leave of absence from Wayne State University, where she was Professor and Associate Dean for Research, to earn her doctorate in 1956 from the University of Chicago in Education and Curriculum Development. While at Wayne State, she “was bitten with the research bug and did all kinds of research… we really got the [nursing] faculty going for research while I was there.” While at the University of Chicago, Rozella met Rosemary Ellis. Hallmarks of their friendship were their “mutual respect for and admiration for one another, their love of and commitment to nursing, and their readiness to share their best critical thinking for advancing nursing knowledge.” When Dr. Schlotfeldt, came to Case Western Reserve University (CWRU) as the Dean at FPB, she recruited Dr. Ellis to the faculty.

It was at CWRU that Dr. Schlotfeldt made what she considered her most significant contributions to nursing: the “collaboration model” between the faculty of the school of nursing and University Hospitals; her paradigm of nursing–to attain, retain, and regain health; and the Nursing Doctorate (ND) in which she was “shifting the emphasis from learning how to do, to learning how to know.” As she liked to say, “Nothing like knowledge!” With these aforementioned innovations, and her leadership locally, nationally, and internationally, Rozella Schlotfeldt changed forever the face of nursing, first in Cleveland and, as her ideas reverberated more widely, throughout the world. During her tenure as Dean, amongst several boards and commissions on which she served, she was a co-founder of the Midwest Nursing Research Society, held leadership roles in both Sigma Theta Tau and the International Council of Nurses, and was the first nurse member of the Council & Executive Committee of the Institute of Medicine.

In Safier’s 1977 publication, Rozella was named as “one of nursing’s most original thinkers” and as “an educator with innovative, progressive and sometimes startling concepts of education for nurse[s]” (p. 338). Rozella loved this! After her retirement from the deanship, she remained highly sought after for her intelligence, wit, creativity, and sheer clarity about, as she often said, “nursing qua nursing.” (Once she said to me with a chuckle, “I know exactly what nursing is! And if they’d just ask me, I’d tell them!”). And while Rozella wanted to be influential, she worried that she should not be seen as an exemplar of nursing excellence, some so-called ideal, whom all nurses should emulate. Rozella was simply and uniquely herself, a woman who was passionate about our discipline and, as she said, “I just think there is nobody more passionately involved in having nursing move toward what it could become. I always say, ‘what it could become,’ because it’s not there yet.” Rozella’s sights were set on nursing as a combination of her mother’s example, her liberalizing, research-oriented undergraduate education, and her own competitive ambition that helped her to emerge with a vision of herself in nursing. “Vision of herself in nursing” is a purposeful statement, for there exists little separation of her vision of nursing from her vision of herself in nursing.

In her first published article in 1949, addressing the nursing care component of educating a patient with the medical diagnosis of TB, she opened with a strong statement that includes nurses as professional members of the healthcare team that are responsible for prevention of communicable disease, based upon “constant scientific study and research… [by these] competent professional workers,” (p. 375). (Note: this flew in the face of the extant practice of nurses employed by hospitals and physicians of the era.) In 1960 she made a point in an article with Safford, that nursing care was defined as care rendered by, or that took place under the direct supervision of, the registered nurse, a clear statement of the autonomy of nursing practice.

During the mid-60s and into the early 70s, Rozella repeatedly called upon nurses to recognize their profession’s rightful role in society and to support that role through increased research, education, and leadership. Examples of her actions include a symposium she held at CWRU, through the Legislative Committee of the Ohio Nurses Association, and through forthright challenges to nurses and legislators to “fulfill their public trust” to enact a mandatory nurse licensure act. She brought her extensive political and social savvy to bear to speak for the profession and the discipline and thereby be recognized for her effectiveness.

In 1969, along with Janetta MacPhail, she published a series of three articles describing the nationally-known and heralded “experiment in nursing,” aka, “the collaboration model.”  The three articles themselves are landmarks for the clarity, care, and specificity with which the new concept was presented to the nursing community. Briefly, the new concept of inter-institutional organization invested the school of nursing with the authority and responsibility for controlling the quality of nursing education, nursing care, and nursing research in the health center.  The heads in the clinical departments were the heads in both practice and education, with 50/50 appointments in each institution. Example: head nurse given the new title: Senior Clinical Nurse to help with the transition. Rather than waiting on physicians or spending all her time charting or ordering supplies, “she spent her time being the authority on nursing.” Here’s another example that Rozella remembered with relish: The medical director of OB/GYN came over to see her at FPB because some physicians’ noses were getting out of joint “due to the sophisticated care being provided by the master’s prepared nurse clinician.”  He demanded that this nurse be fired.  “I said to him, ‘I don’t think you can tell me that. What is your rank?’ He said he was an assistant professor…in the medical school. I said, ‘Well, I happen to be a full professor. I’ll be very happy to listen to what you have to say and then I suggest that you go to your Dean and I’ll talk to your Dean.’”

The following year (1970), tired of medicine’s intrusion into nursing, she wrote an article, an unequivocal assessment of the relationship of nursing and medicine, in response to an AMA Board action, devoid of any appeasing, deference, or gratuitous caveats.  She audaciously defined medicine, concluding that, “the physician’s contacts with patients of necessity are episodic, with each episode of relatively short duration. The primary focus of the physician‘s work is to effect cure.” She further wrote a statement intended to counterbalance, and serve as a contrast to, her definition of medicine, which was purposive in its intention to draw a marked distinction between the practice of medicine and the practice of nursing, concluding with, “Each discipline represents some but not all of the skills needed to keep people well.”

In 1972, determined to “set forth a straightforward and unambiguous conceptualization of nursing in terms of the profession’s goal and the phenomena with which nurses must be concerned,” she stated succinctly and unequivocally, “nursing…is healthcare.” She claimed that “nurses are independent, professional practitioners…the goal of nursing is to attain, retain, and regain health.”

When the American Nurses Association came out with a statement about the Baccalaureate degree being the degree for entry into practice she said, “I even wrote to the ANA President…and said, ‘We already have programs that recognize that nursing is a complex profession and that we should have first professional degrees that are based upon liberalizing education and a strong scientific, humanistic base.’”

Rozella readily gave her successor as Dean, Janetta MacPhail, credit for completion and implementation of the ND, while counting her early work in conceptualizing the ND as one of her own significant contributions to the profession. Due to her dissatisfaction with the amount of knowledge that nursing students had, she “began cooking in my head about the ND…. The result was an educational model designed to give students a solid foundation in nursing’s knowledge base prior to caring for patients: shifting the emphasis from learning how to do to learning how to know.” It was also designed to put nursing parallel with two other major professions, medicine (MD) and law (JD).

Dr. Schlotfeldt’s  papers are archived at the University of Pennsylvania Library.  The collection includes her addresses, articles, and files, reflecting her association with various academic institutions and professional nursing organizations; her personal correspondence, and photographs.

Sources:

Berrey, Elizabeth R. (1987). Researching the lives of eminent women in nursing: Rozella M. Schlotfeldt. Unpublished doctoral dissertation, Frances Payne Bolton School of Nursing, Case Western Reserve University.

Notter, L.E. (1986). The author comments.  In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 97.

Safford, B. J., & Schlotfeldt, R. M. (1960). Nursing service staffing and quality of nursing care. Nursing Research, 9, 149-154.

Safier, G. (1977). Contemporary American leaders in nursing: an oral history.  New York, NY: McGraw-Hill.

Schlotfeldt, R.M. (1949).  Safer ways in nursing to prevent spread of Tubercle Bacilli. National Tuberculosis Association Transactions, 45, 375-377.

Schlotfeldt, R.M. (1970). Nurses and physicians: Professional associates and assistants to patients, Ohio Nurses Review, 45(March), 6-12.

Schlotfeldt, R.M. (1972). This I believe: Nursing is health care, Nursing Outlook, 20(4) 246-246.

Schlotfeldt, R.M. (1986). A colleague comments. In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 98.

Schlotfeldt, R.M., & MacPhail, J. (1969a). Experiment in nursing: Characteristics and rationale, American Journal of Nursing, 69(5), 1018-1023.

Schlotfeldt, R.M., & MacPhail, J. (1969b). Experiment in nursing: Introducing planned change, American Journal of Nursing, 69(6), 1247-1251.

Schlotfeldt, R.M., & MacPhail, J. (1969c). An experiment in nursing: Implementing planned change, American Journal of Nursing, 69(7), 1475-1480.

 

About Guest Contributor Elizabeth R. Berrey, RN, PhD

Now retired, Elizabeth has been a featured speaker at nursing conferences and conventions, focusing on the importance of nurses as agents for change and advocates for better healthcare.  She was the first nurse appointed to the Cleveland MetroHealth Hospital Board of Trustees (1985-1990), the first private practice in nursing in Ohio (1980-1986), and appointed to the Ohio Board of Nursing (1987-1992) as the first clinical nurse specialist to serve on the Board, advocating for nursing autonomy and control of our own practice.  She now lives in New Mexico and remains a leader in the Albuquerque community, focusing on political advocacy on behalf of nurses and nursing.

In describing her relationship with Rozella, Elizabeth says: “. . .  not only did I write my dissertation on the themes & patterns of Rozella Schlotfeldt’s life, I was in her life right up until the end, as her power of attorney for healthcare. So in addition to knowing Rozella since the mid-1970s, as my dean, then Dean Emerita, I spent close to 2 decades with her at the end of her life, spending time at least weekly with her in the last 15 years.”

 

Donna Diers, PhD, RN, FAAN (1938 – 2013)*

Guardians of the Discipline

To remember Donna Diers is to bring into clear focus what it means to be a guardian of

Donna Diers

our discipline.  Donna died on February 24, 2013, but her influence on the discipline of nursing remains palpable, even for many who never knew her.  Donna was born on May 11, 1938 – just one day before the May 12th birth date shared by  Florence Nightingale and Martha Rogers.   These three figures – Donna Diers, Martha Rogers and Florence Nightingale shared many traits of creative vision and great leadership – not the least of which was sparking lively controversy that led to great leaps forward in our profession.

Donna Diers aspired to be a journalist before she decided on nursing as a career, then came to realize both as Editor of Image: The Journal of Nursing Scholarship from 1985 to 1993. She assumed her editorship the year after her tenure as Dean of the Yale School of nursing ended (1972-1984). During her deanship, she developed the first Graduate Entry Program for people without an undergraduate degree in nursing, a program that continues to this day leading to entry into speciality practice as an advanced practice nurse.

Donna was a prolific writer – she wrote one of the first nursing research methods texts, and her writing appears in almost all major nursing journals and in many texts. Her talent as a journalist came through vividly in her editorials published in Image – editorials that I anticipated and read eagerly as each issue arrived in my mail.

There is no better tribute to Donna Diers than the 2010 “Living Legend” ceremony when the American Academy of Nursing bestowed this honor on her. Her own remarks at this ceremony bring to life the amazing spark that she brought to the world and reveal the ways in which nursing and journalism came together in her career. She also shares a moving tribute to many others whom she names as significant in her own life. I urge you to take a few moments to dwell with the memory of this remarkable guardian of our discipline – Donna Diers.

* Portions of this post appeared previously on the INANE blog 

Martha E. Rogers, RN, MSc , EdD (Canada)

Guardians of the Discipline
Downlaads (used by permission)
Transformative Learning article
Canadian Nursing in the Year 2020
Enchantment of the Soul
Syllabus: Conceptual Basis of Nursing Practice
Syllabus: The Nature of Nursing Knowledge

Note: we are delighted to introduce a new Nursology.net series – “Guardians of the Discipline” featuring notable nurse leaders who have made significant achievements to assure the integrity and protection of nursology values and ideals.  We begin this series with Canada’s outstanding leader and scholar, Martha E. Rogers.

Martha E. Rogers (York University, Toronto, Ontario, Canada)

Martha E. Rogers is a Canadian nursing scholar and consultant who has made substantial contributions to advancing nursing knowledge. She is currently a Senior Scholar at York University, Toronto, Ontario and was the founder, and remains the director, of Canadian Nursing Consultants. Her contributions in advancing an appreciation of nursing knowledge cross both those roles and fall into 3 major categories that overlap and inform each other:  1). curricular design and pedagogy; 2) consulting work with nursing organizations to promote conscious application of conceptual models practice and in organizational design, and 3) her work on transformative learning in nursing, alternative nursing futures, and development of the concept of enchantment of the nursing soul. 

 Being In a unique position as a nurse who had focused  on future studies during her doctorate, Martha was commissioned by the Canadian Nurses Association in 1995 to develop future scenarios for nursing in Canada in the year 2020.  The book, Canadian Nursing in the Year 2020 was published by the Canadian Nurses Association for a number of years after it was written.  Download this document here (by permission of the author and copyright holder). That work was clearly informed by Martha’s extensive involvement in the previous decade in helping nurses to understand and embrace nursing conceptual frameworks, whether teaching post-RN baccalaureate students or practicing nurses in their workplace.

 In Canadian Nursing in the Year 2020, Martha created 4 scenarios of nursing in 2020 and invited readers to create a 5th.  On the eve of 2020, it is as relevant and sobering to read as it was when it was first published. Elements of each of the scenarios are recognizable in the present time, likely to significantly different degrees in different countries, cultures, and health care systems.  At the end of each scenario, readers  are invited to reflect on their reactions to the scenario and consider what action is necessary to increase or decrease the chances of them happening.

Canadian Nursing in the Year 2020 concludes with a section entitled, “Can one person make a difference.” Believing that to be possible, Martha asserted that maintaining hope and the personal power to take action requires engaging nurses’ minds , hearts, and souls. Critical minds (mind), caring about people (heart), and connecting with the meaning and purpose of nursing  (soul) are among the essentials she identifies as necessary for us to believe that each of us can make a difference. Martha explored in considerably more depth, the concept of the nursing soul in an unpublished article entitled Enchantment of the Soul

 These ideas were informed by Martha’s early nursing practice and education.  In meeting with her recently, I asked her what first sparked her interest in nursing conceptual frameworks and she replied it was the professors in her Post-RN baccalaureate degree. So, it is not surprising that she began to take action in her position as as a Clinical Nurse Specialist at Mount Sinai Hospital in Toronto, where she also served as Conceptual Framework Coordinator. Later, as an academic, Martha taught in a Post-RN BScN program at York.  One course she developed and taught focused on The Nature of Nursing Knowledge, and a second on the Conceptual Basis of Nursing Practice nursing. The transformative learning  approaches she developed in an unpublished manuscript as an approach to “facilitate “nurses’ learning and use of nursing conceptual frameworks” are evident in both course outlines.  As the School of Nursing evolved, Martha’s influence was evident again as the School adopted a caring-human science philosophy as a conceptual framework.1

 As a nursing consultant, Martha conducted many workshops and spoke at numerous conferences in Canada and the U.S. about transformative learning and facilitating nurses’ understanding and use of nursing conceptual frameworks. An example of this approach is seen in one of the videos she produced, “Conceptual Frameworks in Nursing Practice”, which is included below.

 Both through her academic and consulting roles, Martha was involved in research reporting the implementation and/or evaluation of use of nursing conceptual models in practice.  2,3, 4,5, 4 

Martha was passionate about the uniqueness of nursing knowledge and hoped to pass that passion on to others. Her goal was to facilitate nurses’ critical examination of dominant assumptions and values and the practice norms based upon them, and help them instead to value and give voice to their own nursing knowledge and imagine how nursing practice and health care institutions might be different if nursing values and knowledge were  a valued priority. I asked her recently what she thought her greatest contribution was as a “guardian of the discipline.”  This was her reply:  “If there is anything to be said about my work it would be that I held a belief about the beauty and potential power of unique nursing knowledge. It was my quest to explore nursing knowledge and to help others explore it through deep personal reflection and through critical appraisal of and emancipation from dominant paradigms.

References

 1.   Lewis S, Rogers M, Naef R. Caring-Human Science Philosophy in Nursing Education: Beyond the Curriculum Revolution. Int J Hum Caring. 2006;10(4):31-38.

2.   Rogers ME. Creating a Climate for the Implementation of a Nursing Conceptual Framework. JCEN. 1989;20(3):112-116.

3.   Shea H, Rogers M, Ross E, Tucker D, Fitch M, Smith I. Implementation of nursing conceptual models: observations of a multi-site research team. Can J Nurs Adm. 1989;2(1):15-20.

4.   Rogers, M., Jones Paul, L., Clarke, J., MacKay, C. Potter, M. Ward, W. The use of the Roy Adaptation Model in Nursing Administration. Can J Nurs Adm. 1991, June:21-26.

5.       Fitch, M., Rogers, M., Ross, E., Shea, H., Smith I., Tucker, D. Developing a plan to evaluate the use of nursing conceptual frameworks. Can J Nurs Adm. 1991, March/April:22-27.