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

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

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

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

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

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

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

Nightingale’s Vision for Nursing in 2020

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

Painting of Nightingale In the Florence Nightingale Museum

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

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

    Turkish lamp from the Florence Nightingale museum

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

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

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

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

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

Sources

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

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

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

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

 

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/)

Inspired by Virginia Henderson

Henderson when she was a research associate at Yale (from https://nurseslabs.com/virginia-henderson/)

I first met Virginia Henderson when I was a student at Yale School of Nursing. She was a guest in one of our courses, and she started the class by saying, “I’m a million years old and deaf as a doornail, so speak up!” She was a force, and I loved her from the start. I had the opportunity to meet with Virginia at her home in New Haven, CT, where she showed a group of us her porcelain box collection. She even gave me one! Virginia was at our graduation from YSN in 1993 – in full academic regalia. The last time I saw Virginia was at her home in a retirement community in Connecticut. I consider myself fortunate to have spent time with such an influential nurse. Although I had no idea at the time, her work and thoughts on nursing shaped my own. Her definition of nursing

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

resonates with me because in my work with people who have diabetes I see the need to help people toward independence. Diabetes and other chronic diseases require knowledge, skills, and understanding so that people can make daily decisions and perform daily tasks to manage their disease and live well. There are times when people need more – education, direct care, or support – and times when they can function independently. The goal is always to help people toward independence and away from a mentality of “compliance” or “adherence.” I think Virginia would support the language movement in diabetes, where we are working hard to get away from judgmental, provider-centric language and move toward person-centered and strengths-based messages.

I also identify with Virginia’s beliefs on nursing as a discipline with a distinct body of knowledge and her emphasis on nursing education and nursing research. Ironically, I was a student at Yale School of Nursing and now teach at Teachers College Columbia University. Both schools had an impact on and were influenced by Virginia Henderson. It’s amazing to me that I have felt her presence throughout my career, despite not being directly connected to her work.

I sometimes wonder what Virginia would think if she were alive today. Is her definition of nursing being upheld? What would she think of nursing practice, nursing education, and nursing research? Are we honoring her legacy in our work today? It’s important for nurses to be aware of those who’ve gone before us, their work, and their influence on our discipline. Some of those nurses are still with us, and my hope is that we will learn from them and be shaped by them as we move nursing forward. When we practice, teach, and study, how often do we think about our own definition of nursing? Are we being true to that definition?

Honoring our Heritage, Building our Future

Today we are adopting a new nursology.net tag line “Honoring our Heritage, Building our Future” in concert with the annual focus in May of each year on nursing and nurses, anchored around  Florence Nightingale’s birth date – May 12, 1820. Almost 100 years later, nursology theorist Martha E. Rogers was born on the same date in 1914.  These two giants of nursology history, and many others, have built the foundation from which we move forward in the quest to understand human health experiences.  We have asked members of our nursology.net management team to share particular “heritages” that stand out for them as significant. Here are our responses:  

Leslie H. Nicoll – The Nursing Editors History Project

Leslie Nicoll

A few years ago, Peggy Chinn and I had an “Aha!” moment when we realized there was no archive or complete listing of the women and men who have served as editors of scholarly nursing journals. We believe this is a serious omission and sought to create such a resource and thus, the Nursing Editors History Project (NEHP) was born. The NEHP is a venture between the Dolan Collection at the School of Nursing at the University of Connecticut; along with Peggy and me, Carol Polfroni is providing leadership to the project. You can visit the site at nehp.uconn.edu.

If we consider Florence Nightingale to be the founder of nursology, then our profession is relatively young, spanning less than 200 years. There has always been a focus on education and scholarship in nursology; the first disciplinary journals were published starting in the 1880s. In the US, the American Journal of Nursing published its inaugural issue in 1900. It has been published continuously ever since. Other journals with long and distinguished histories include Sygeplejersken (“The Nurse,” in Danish, since 1901); the Canadian Nurse (Canada, 1905); Nursing Times (United Kingdom, 1905); Kai Tiaki Nursing New Zealand (1908); and the Philippine Journal of Nursing (1926).

Editors of professional journals play an important role as gatekeepers of practice innovations, research findings, and other information that is disseminated through the published literature. The impact of the editor is profound and influential. Given that, you might think that an easy-to-use listing of editors would have been maintained over the years–but it has not. In the absence of such a list, you might think you could go to the online home of a journal and search through the digitized collection to find editor information. Go ahead and try to do that. You will find, as we did, that journal archives include that published articles but they do not include the “front matter,” that is, the pages that list the editor, associated editorial staff, editorial board members, and information about the publisher. Thus, the archive for a journal represents just one dimension of the publication. What is missing is the knowledge of the people who were in charge, in particular, the editor–whose voice was important, influential, and must be heard.

The NEHP has been growing slowly. At present, it includes 34 journals with publishing histories ranging from 100+ years to 9. We have learned that tracking down editor information–especially for some of the older journals–takes time and effort. Finding pictures is even harder! This realization has impressed upon us the importance of the NEHP and the need to capture this information before it disappears completely. Our goal is to be comprehensive, both at the individual journal level as well as in the breadth of nursology journals that are included in the NEHP. We welcome submissions to the NEHP from editors, publishers, and librarians. When submitted information is comprehensive and accurate we are able to quickly list the journal in the database. You can read more about the process here: https://nehp.uconn.edu/submissions/

Florence Nightingale was a meticulous data collector, prodigious correspondent, and author of books and articles. As far as I can determine, she was never a journal editor, but I am sure she held the editors those journals published in her life in high esteem–as we should. The NEHP truly “honors our heritage” by capturing essential information about the leaders of scholarly publication in nursology.

Adeline Falk-Rafael – Returning to our Roots

Adeline Falk-Rafael

It is only fitting that we honor nursing’s past each year around the time of Florence Nightingale’s birthday.   She was a remarkable woman and visionary. In many ways, she reflected the thinking of her day, i.e., that social, economic, and political factors greatly influenced (often adversely in vulnerable populations) the potential to be healthy. She believed that compassion, therefore, must include social and political activism focused on changing laws and the conditions that adversely affected health for many and  led by example (Falk Rafael 1999). Many examples have been documented and extend beyond policies in the UK to international efforts (Falk-Rafael 2005).  Nightingale’s focus on promoting the health of populations was evident in the first nursing program she established, in which one entire year was dedicated to health nursing of communities.

Her model of health nursing, including social and political advocacy influenced early nursing leaders elsewhere in the world, as well.  I know first hand of her influence in Canada, e.g, in the work of the Victorian Order of Nurses, and the U.S., in the work of Lillian Wald who added the word public to health nursing. She and other nurses of the Henry Street Settlement (more information here)  followed Nightingale’s example in advocating for social and political reform to create conditions that were more conducive to health (Falk-Rafael 2005) .  I hope nurses from other parts of the world will add  further examples of Nightingales influence on nursing elsewhere.

Finally, honoring our heritage  must, I believe include those women who provided nursing and health care before or during Nightingales time. Mary Seacole, was a Jamaican nurse who also cared for soldiers in the Crimean War. In Canada, centuries before Nightingale, women in religious orders and pioneer women, such as Jeanne Mance in the 17th and 18th century provided nursing care to communities. They also understood the necessity of advocating for laws and societal reforms to move toward social justice and health equity.  And, I think of the nurses who fought for womens rights and the abolition of slavery like Sojourner Truth  and Harriet Tubman. Many others are also profiled on the Nurse Manifest Gallery of Activism Inspirations.

Our heritage is nursing practiced from a nursing paradigm before the rise of a dominant biomedical model that can shape and limit our conceptualizations of health and its promotion. We can learn from the examples of those who have gone before. I believe that Nursology, by making visible the nursing science which informs nursing practice can help nurses reclaim their authentic nursing identity.

Jacqueline Fawcett – Florence Nightingale’s Contributions to Martha E. Rogers’ Thinking and Development of the Science of Unitary Human Beings

Jacqueline Fawcett

Martha E. Rogers (1992) contributed a marvelous essay to the Commenorative edition of Florence Nightingale’s classic book, Notes on nursing: What it is and what it is not. She began her essay with these words:

Florence Nightingale’s Notes on Nursing is an exciting and far-reaching compendium of ideas and statements concerning the purposes and scope of nursing, the essentials of good nursing practice, and the variety of providers of nursing that existed in her purview. With consummate skill and cogent humor, she decries the fallacies of health practices and the superstitions that existed among the public and in particular health workers. (p. 58)   

Rogers went on to point out that much of what Nightingale wrote is as relevant today as it was in the middle 1800s. She noted that Nightingale’s vision of the need for “human compassion, a broad knowledge base, intelligent reasoning, and understanding” (p. 58) were particularly relevant in the 1990s, and I will add, are even more relevant—indeed crucial—in the 21st century.    

Furthermore, Rogers (1978, 1992) traced her own dual concern with human beings and their environments to Nightingale. She explained, “Rogerian science of irreducible human beings provides a framework rooted in a new reality and directed toward moving us from what might be called a pre-scientific era to a scientific era. Certainly Nightingale laid a firm foundation for this kind of an approach to nursing knowledge and its use” (Rogers, 1992, p. 61).

oward the end of her essay, Rogers (1992) further emphasized the importance of Nightingale’s work for all of us today. She wrote that Nightingale’s ideas not only are meaningful today but also provide a firm foundation as nurses move forward in the development of nursing as a science in its own right, and make way for knowledgable directions that enable nurses to practice based on their own phenomena of concern. It is the uniqueness of nursing that makes it important, not the ways in which it is like other fields.

Rogers (1992) concluded that section of her essay by exhorting us to carefully consider Nightingale’s comment “that medicine and nursing should never be mixed up, since it spoils both” (p. 61).

I am certain that both Florence Nightingale and Martha E. Rogers would agree that the proper name for our discipline is nursology and that the members of the discipline are appropriately referred to as nursologists. I also am certain that both would applaud the development of nursology.net as a repository for all things theoretical in nursology!

References

Rogers, M. E. (1978, December). Nursing science: A science of unitary man. Paper presented at Second Annual Nurse Educator Conference, New York. [Audiotape.]

Rogers, M. E. (1992). Nightingale’s notes on nursing: Prelude to the 21st century. In F.N. Nightingale, Notes on nursing: What it is, and what it is not (Commemorative edition, pp. 58–62). Philadelphia: Lippincott.

Marlaine Smith – Standing on the Shoulders of the Giants of Nursology

Marlaine Smith

As we approach the birthdays of Florence Nightingale and Martha Rogers on May 12th I’m reminded that we are standing on the shoulders of the giants of nursology.  What is my responsibility as I stand on these shoulders? First, is to acknowledge and cite the work of the giants who have come before us. At times I hear newer ones to our discipline speak of a great new idea or concept that I know was actually something that was advanced by previous scholars and is in the literature.  This certainly is not the fault of the newer members coming into our professional discipline. It is our responsibility of faculty and mentors to expose students of nursology to the wisdom of our heritage. As Peggy Chinn admonished us in her blog, let’s  get rid of the instructions to students that they should only review the past five years of the literature.  Our students need to be introduced in the most engaging way to the seminal writings of our foremothers and forefathers.  Would any undergraduate psychology student not be introduced to  Freud, Piaget, Erikson? Absolutely not! Our challenge is to create opportunities for the past work of our scholarly giants to come from the shadows into the light.  In my BSN program I was briefly introduced to Florence Nightingale…just by name…Do you know what I remember? …only that I heard that Florence Nightingale died of syphilis.  While this is not true, that myth was propagated widely and it diminished us. When I began my Masters program I had to read Notes on Nursing as part of my theory course.  I was filled with amazement and pride that this courageous, brilliant woman discovered the human-health-environment-caring connections that ground nursology today.  Let’s give this gift to our students by studying the giants of the past. By standing on the shoulders of the giants of nursology we can reach lofty heights. The most beautiful buildings need strong foundations.  They cannot exist without them. In order to build our professional discipline to new heights we must build on our disciplinary, theoretical foundations. In this way, we are truly building NURSOLOGY. This doesn’t mean staying within the limits of the past.  We are free to innovate, create, change, renovate, regenerate as we reach for the possibilities of what nursology can bring to the world.

 

Update on early nursing theory think tanks facilitated by Margaret Newman

On November 13th, I posted information about early nursing theory think tanks organized by Margaret Newman!  A few days ago, I happened to be looking for something entirely unrelated in the early issues of Advances in Nursing Science and discovered a little notice announcing the second nursing theory think tank!   I have added the link to the announcement as an addendum to the November post, but also believe it is important to add here the information in this notice for its historic significance.

The ANS notice confirms that the purpose of the  first nursing theory think tank in October 1978 was to “bring together persons involved in theory development in nursing to explore areas of needed theory development and to devise a means whereby continuing dialogue between theorists can occur” (page 105).

The October 1978 think tank participants were:

Margaret Newman, facilitator (The Pennsylvania State University)
June Brody (Herbert Lehman College),
Carol Deets (Indian University),
Ellen Egan (University of Minnesota),
Rosemary Ellis (Case Western Reserve University),
Jacqueline Fawcett (University of Pennsylvania),
Joyce Fitzpatrick (Wayne State University),
Beverly Hall (University of Washington),
Margaret Hardy (Boston University),
Joan Rinehart (The Pennsylvania State University),
Elizabeth See (Wayne State University)
Marilyn Sime (University of Minnesota),
Ardis Swanson (New York University),
Gertrude Torres (Wright State University), and
Lorraine Walker (The University of Texas).

An Introduction to the Canadian Nursing Theories Perspective

In a previous blog, I admitted my ignorance of nursing science during both my early diploma nursing education, and at least the first 18 years of my nursing practice.  But in the mid 1980s, I became aware of an increasing trend in Toronto area hospitals to adopt nursing theoretical frameworks.  Long after the fact, I also learned there had been nursing theory conferences held in Toronto around that time and set out to learn about those conferences, the experiences of the nursologists who attended, and with those in other provinces to discover other such events or activities.  What I found far exceeded what could be captured in 1 blog and yet I know I have barely scratched the surface!  My purpose here is first to thank everyone who has been so generous in sharing their time and archival documents (which will eventually be included in the Landmark Events section of the History tab of this website), and second, to invite nursologists from across Canada to add to my limited findings with what I’m sure is a wealth of information.

In pursuing information on the nursing theory conferences, I was reminded also of the other contributions to nursing knowledge made by Canadian nursologists, such as the:

  • Nursing Philosophy conferences organized by the Unit for Philosophical Research in the Faculty of Nursing, University of Alberta, proceedings of which were published;
  • Conceptual nursing frameworks used to guide curriculum development and pedagogy in Canadian University Schools of Nursing. At least one such model-the McGill model, also known as the Allen model or Developmental Health Model-has been explicated by research and used in nursing practice;1,2,3(3 articles of Ford-Gilboe and Margy Warner)
  • The development and or use of nursing conceptual frameworks to guide nursing practice in some hospitals and public health agencies;
  • The critique, comparison, and explication of nursing theories by Canadian nursing scholars.

Each of these areas will be explored in more detail in the weeks and months to come, hopefully by some of the key scholars who have been involved in these efforts. For the remainder of this blog, I will return to the Canadian nursing theory conferences

I have been able to identify 5 Canadian nursing theory conferences. One was held at the University of British Columbia, in 1988, and four in Ontario – two in Toronto in 1986 and 1988, one in Ottawa in 1989, and one at the Hamilton Psychiatric Hospital in 1993, in celebration of 20 years of theory-based nursing practice.4  Indeed HPH may well have been the first hospital in Canada to have adopted a nursing conceptual framework  (first Orlando, and later Peplau) to guide nursing practice.4

Many of the prominent nursing theorists of the time participated in the 1986 conference, including Dickoff and James, Imogene King, Myra Levine, Betty Neuman, Rosemary Parse, Martha Rogers, and Sister Callista Roy.  Some returned for the 1988 Toronto conference and notable additions for this conference included Virginia Henderson and Jean Watson.

Dorothea M. Fox Jakob, a retired public health nurse and nursing activist was a keen

Dorothea Fox-Jakob

participant in both nursing theory and NANDA conferences and, has generously provided proceedings from the 2 Toronto conferences as well as from many of the NANDA conferences.  Those proceedings are in the process of digitization and will be added to this website in the near future. Information about the other 3 conferences would be a great addition, as would information about any other Canadian nursing theory conferences.

Dorothea tells the story of meeting Virginia Henderson at a reception at the 1988 conference and telling her about her work in advocating for poverty reduction. Dorothea had prepared a resolution for the Registered Nurses Association of Ontario (RNAO), arguing that poverty was a health issue and urged RNAO to lobby for poverty reduction at the provincial and federal levels. The resolution was passed and promptly acted upon by RNAO. Dr. Henderson enthusiastically supported Dorothea’s actions and asked her to send her a copy of the resolution, which she did.  In return she received she received a letter in which she says she is encouraged by Dorothea’s efforts in “trying to do something about basic problems in society like poverty. We too often in the States leave this to others thinking that if we do our particular work well that we have fulfilled our role in society.” The handwritten letter, its transcribed content, and a brief statement of context have been framed and hang in the York University School of Nursing.

V Henderson letter-1.jpgReferences

  1. Ford-Gilboe, M. (2002). Developing knowledge about family health promotion by testing the developmental model of health and nursing. Journal of Family Nursing (8)2, 140-156.
  2. Warner, M. (2002). Postscript to “A Developmental Model of Health and Nursing” by F. Moyra Allen. Journal of Family Nursing, (8)2, 136-139.
  3. Ford-Gilboe, M. (1994). A comparison of two nursing models: Allen’s developmental Health Model and Newman’s Theory of Health as Expanding Consciousness. Nursing Science Quarterly (7)2, 113-118.
  4. Forchuk, C. & Tweedell, D. (2001). Celebrating our past: The history of Hamilton Psychiatric Hospital. Journal of Psychosocial Nursing and Mental Health Services (39)10, 16-24.

 

 

 

 

 

Nursology think tanks, anyone?

Addendum
Notice in ANS 1:3 (April 1979) of 2nd NTTT gathering

What if we had a host of small nursology think tanks happening all over the world?  Sound impossible?  No, it is not impossible, and we have an historial model from which to build!  As Jacqueline Fawcett observes in her reflections below, this Nursology blog can be viewed as a think tank of sorts.  And, we can also envision ways for face-to-face nursology think tanks to happen! If you are inspired by this idea, don’t wait for someone else to do it – invite a few friends and colleagues, and do it!   Here is the model as Jacqui and I experienced it:

Dr. Margaret Newman

In 1978, Margaret Newman initiated a very simple idea with great influence – she called for a few of her colleagues around the country to gather at a designated airport hotel and spend a couple of days in deep discussion about the development of nursing theory.  She called the gathering a “Nursing Theory Think Tank (NTTT)”   There was no agenda, no note-taking, and no expectation for outcomes.  Everyone who was invited to participate each year made their own hotel reservation at a designated hotel near an airport hub, and Margaret arranged with the hotel to provide a small conference room for two days free of charge.  There were about a dozen people invited each year – often a handful of people who had attended in the past, and typically 2 or 3 who had not attended before and were doing significant work in the realm of nursing theory or philosophy (now of course known as nursology!). Margaret’s own book Health as Expanding Consciousness was in production at the time of the first gathering, and published early in 1979.

I attended about 2 or 3 of the gatherings – and the photo shown below is my only record of anything that happened one of the years I attended!  I know Margaret was there (she always was!), and since she is not in the photograph I am guessing that she might have taken the photo!  As you can see from the photo, this event happened in an era when nurses generally “dressed up” for such an occasion, but the fact is that the gatherings were very informal, and often peppered with humor, story-telling and sharing of life experiences.  There was always someone quick to remind the group that we were under no obligation to be “productive” – but of course, significant “productive” things happened as a result of these gatherings. Since we were all as busy as we could be with our very productive careers, we more than welcomed the opportunity to have this kind of discussion with no pressure – not even the pressure of taking notes!

My experience of these discussions had a lasting influence, affirming some of the ideas I was working on, challenging me to think at a deeper level about specific aspects of my work, and prompting me to take my ideas to a deeper level of understanding, But equally important, I had the opportunity to hear from other nursologists, learn about their perspectives, and come to appreciate not only who they were as individuals, but the importance of their ideas. So I have always carried with me the importance of this kind of free-flowing opportunity to just talk, challenge one another and deepen our understandings of our ideas and of one another as individuals.

It was at the NTTT that Jacqueline Fawcett and I first met in person – probably in about 1981 or 2.  When I founded Advances in Nursing Science  in  1978, someone suggested that Jacqui was a young scholar who would be a wonderful addition to the review panel – and she has served faithfully in this capacity ever since! While we have known one another all these years, serving together on the management team for Nursology.net is our first opportunity to work closely together.  Here are Jacqui’s reflections of the NTTT:

My notes indicate that that the Nursing Theory Think Tank (NTTT) began in
1978 and ended in 1988. My recall of the decade of existence of the NTTT
are as follows.

The NTTT was begun by Dr. Margaret A. Newman. The first meeting, in 1978,
was at State College, PA, when Margaret was on the faculty at Pennsylvania
State University. I was exceptionally honored to be invited to join the NTTT in 1978. The members, including those who were invited and those who joined later,
included Margaret, of course, as well as Ellen Egan (Margaret’s former NYU
classmate), Ardis Swanson (Margaret’s former NYU faculty colleague), June
Brodie and me (former students in Margaret’s NYU theory development course),
Beverly Hall, Lorraine Walker, Kay Avant, Elizabeth See, Peggy Chinn, Afaf
Meleis, and Barbara Carper. We met approximately once each year, typically
for a weekend in the fall season, at a hotel near an airport.

The NTTT discussions focused on the current and desired future state of
nursing knowledge. Most discussions were informal and wide-ranging; others
were more formal discussions, based on papers presented by NTTT members. I
presented a paper for discussion at the NTTT meeting in Dallas, TX, in
September 1982, which was published along with a critique by June Brody in
1984: Fawcett, J. (1984). The metaparadigm of nursing: Present status and
future refinements. *Image: The Journal of Nursing Scholarship, 16*,
84‑87; Brodie, J. N. (1984). A response to Dr. J. Fawcett’s paper: “The
metaparadigm of nursing: Present status and future refinements. Image: *The
Journal of Nursing Scholarship, 16,* 87-89.

I presented another paper for discussion at the NTTT meeting in Austin, TX,
in October 1986, which was published in 1989: Fawcett, J. (1989). Spouses’
experiences during pregnancy and the postpartum: A program of research and
theory develop­ment. *Image. The Journal of Nursing Scholarship, 21,*
149-152.

Although the NTTT ended in 1988, many of the members have continued to
contribute to the development of nursology. To the extent that the blog
posts on nursology.net might be considered a contemporary NTTT, all
nursologists are invited to submit blogs and publish their ideas about all
matters nursology in journal articles, book chapters, and books.

Addendum – added to this post on December 2, 2018 – I discovered a notice published in ANS 1:3 (April, 1979) describing the first NTTT in October, 1978, announcing the second think tank planned for March 1979, and inviting interested nursologists to contact Margaret Newman.

“Seated, L to R, Peggy Chinn, Beverly Hall, Jacqueline Fawcett, Elizabeth See
Standing, L to R, Afaf Meleis, Kay Avant, Lorraine Walker, Ellen Egan, Ardis Swanson”

Today – the official launch of Nursology.net!

Today, September 18, 2018, we are formally unveiling Nursology.net — the nurse led, nurse developed repository providing the most current and accurate information about nursing discipline-specific knowledge that advances human betterment globally.  We are a team of nurse scholars who believe in the power of nursing ideas, honor the heritage of nursing ideas that form the foundation of our discipline, and are dedicated to advancing the development of nursing knowledge for the future.

Creating Nursology.net has been an amazing experience!  Each of us who have developed the site and its content have vested interests, as nurse scholars, in seeing this project come to fruition. But I am not sure if any of us could envision the reality until now. As one of the developers, and as someone who is known to have a certain degree of expertise in nursing knowledge development, being a witness to the unfolding reality of this site has been a remarkable awakening.  Yes, I already had a degree of familiarity with every element that we have developed so far. But as I began to see all the pieces start to appear all together, in a collection that represents the whole, I have been in awe of the enormity, the significance and the power of nursing ideas, how these ideas shape nursing actions, and how nursing actions shape our ideas.

We have great expectations for this resource, as described in our mission and goals. We have an impressive start, and we invite you to participate in any way you can.  Here are some ideas to get involved:

  • If you know of something you would like us to include, we have forms scattered throughout the site that you can use to send us your suggestions. Or, use our contact form.
  • From today going forward we will have a weekly blog post (perhaps more) to highlight what is happening in the realm of developing nursing knowledge. Follow our Nursology.net blog by entering your email in the space at the top of the right sidebar on any Nursology.net page.
  • Do you have an idea for a blog?  We welcome you to be a guest blogger – use our blog submission form.
  • Comment  on our blog posts any time to participate in discussions, which we hope will be lively and thought-provoking.
  • And, contact us any time – we want to hear from you!