Contributor: Rudolf Cymorr Kirby P. Martinez, Ph.D.
Philippine Children’s Medical Center (PCMC) is the largest and the national referral center for pediatric cases in the Philippines. I started my professional journey here as a staff nurse after I finished my MA in nursing, and soon after, I completed my Ph.D. I transitioned to academia. After eight years from the time I resigned as a staff nurse, I was appointed as the consultant nursologist of the hospital. This is the first time a nurse assumes a consultancy role in PCMC and the first time that the official designation is that of consultant nursologist. How it came about was serendipitous, to say the least. It all started during the pandemic when the inherent weakness of health care institutions, especially in a developing country like the Philippines, was exposed because of the pandemic’s burden. During this time, the value of nurses received the much-needed attention they deserve. Also, around this time, I realized the fragility of life and the uncertainty of things because of the pandemic. As I was looking for a way to help nurses working in the service sector, one of my mentees in graduate school mentioned that their hospital is currently creating initiatives for their nurses. This hospital was my former employer, PCMC.
I took the initiative to write a letter offering my expertise as a nursologist to the institution’s executive director, Dr. Julius Lecciones, whose office is taking the lead on creating this initiative for nurses. I wrote in the letter how a nursologist could benefit not only the nurses in the hospital but ultimately the children whose lives they are caring for. As a response to the letter, I was given an audience with the department managers, physicians, and some nurse supervisors. During the presentation, I focused on explaining what nursology is all about and proposed a framework for how the expertise of a nursologist could benefit the hospital and its community.
In the Philippine context, all people educated in nurses are called “nars” (nurse) regardless of where they practice. But most people would associate nurses with those who are working in the service sector as practitioners. (We do not have advanced practice in the Philippines at the moment) so all nurses working in the service sector are “the nurses” in the eyes of the general population. There is a prevailing belief that the penultimate role and function of a nurse in the hospital setting, not academe or research, that to work in the hospital is their reason for being. This is the reason why I deliberately choose “nursologist” to somehow bring into the consciousness of people that nursing is a professional discipline and its practice is not only confined within the four walls of the hospital. From there, I hope that the label we use for nurses will evolve into nursology and its different expressions. I have the same appreciation of nursology similar to some of the contributors from nursology.net, that is it “A name for discipline of nursing, a body of knowledge, a research methodology, and a practice methodology about and for phenomena of concern to nurses” (see “An Invitation to Dialogue about Disciplinary Terms. I am also heavily influenced by Rogerian Science of Unitary Human Beings and the Theory of Nursing as Caring by Boykin & Schoenhoffer: A caring practice means that the knowledge of nursing is expressed by the nurse with the intent to be caring, and their expressions are appreciated by the other person as caring actions. In addition, I believe that nursology is grounded in the fundamental patterns of knowing in nursing, first identified by Barbara Carper in 1978.
Launching the Nursology Initiative
During the initial talk on the establishment of the Nursology Initiative, I gave a presentation and emphasized in it the unique perspective that a nursologist could bring to the table in terms of nursing research, practice innovation, and creating a center for caring practice. After the presentation, they accepted the framework and further suggested that as part of the consultancy, I will also be a part of the institution’s multi-sector governance council (MSGC), where my expertise as a nursologist would provide a unique perspective on various issues tackled within the board.
Besides being part of the MSGC, my role as a consultancy nursologist is to assist the institution by providing insights, technical inputs, and expertise grounded on nursology on the following matters:
Development of a nursing research unit that focuses on human-health research and EBP grounded on nursology
Practice innovation with an emphasis on palliative care and caring science
Creation of a Center for Caring Practice
I also give short lectures on nursology and other nursing-related topics when needed. I was also given a permanent column for their newsletter aptly called “The Nursologist Corner,” where I share my opinion on issues concerning nursing, health, and wellness sent to me by various members of the community
This was the initial nature of my engagement with the institution as we are continuously exploring the nature of this partnership since this is the first of its kind in the Philippines. The PCMC Nursology Initiative Program is initially under the Executive Director’s Office, and the consultant nursologist liaise directly with the executive director.
During the contract signing, I gave a message to the administrators and nurse managers present, emphasizing that although society needs the expertise of nurses as clinicians, it is not the end-of-it of nursing. There is more to nursing than bedside practice. It is not the clinical skill that makes a nurse a nurse; it is our unique perspective and appreciation of things grounded in our disciplinary body of knowledge. I believe that one of the essential roles of a nursologist in a hospital is the empowerment of nurses and, with it, the advancement of their clinical practice. Nursologists help in creating systems and processes that allow for the empowerment of nurses to happen.
For so long, nurses in the Philippines are seen as second-class health care providers, merely skilled technicians, simply because it seems that some nurses have forgotten their unique disciplinary perspectives and are operating in a system that is not grounded in nursing. As I envision, a nursologist could help nurses remember who they are and the unique perspective they could offer.
An initiative such as the consultant nursologist might offer another model for bridging the gap between the science that is nursing and the art by which it is practiced in the clinical setting.
About Rudolf Cymorr Kirby P. Martinez, Ph.D
Rudolf Cymorr Kirby P. Martinez, Ph.D., is currently the consultant nursologist of Philippine Children’s Medical Center and is a full-time Professor at San Beda University College of Nursing. He also teaches part-time at the graduate school program of Arellano University, Florentino Cayco Memorial School Graduate School of Nursing, and Holy Angels University – School of Nursing and Allied Medical Science. He is an advocate of nursology, caring science, and palliative care and consider himself a scholar of Rogerian Science of Unitary Human Being. His current advocacy includes the decolonization of nursing education through the integration of caring science and indigenous culture and folkloric practices into the nursing curricula.
The contemporary imbalance in environmental matters predominantly involve climate change and our supposedly beloved home planet’s ecosystems issues. Human beings are continuously disrespectful of their relationships with the universe ecosystem.
Humankind is responsible to a great extent for this state of “dysbiosis” of our planet, which is similar to the state of each person’s gut microbiome. This lack of balance and harmony in nature, is the root cause of the emerging of new and complex pathological challenges, which, like the Covid-19 pandemic, have become impossible to ignore. Countries the globe over have been forced to take very strict contingency measures, with different levels of freedom and restrictions in order to slow down the devastating effects of sickness and death that the virus has caused.
Healthcare professionals have an important role in managing the many menacing threats to populations of our planet, their well-being and survival. Nursing as a professional discipline, has many theories that can use used to as evidence for safe and competent practice. The concepts of Fawcett’s metaparadigm of nursing provide a way to understand and guide nursing during the pandemic – human beings, environment, health, nursing However, given the reality of our current world, other key concepts also provide paths that guide our understanding of the reality we face in the pandemic.
I contend that we are closing a cycle, a full 360° spin, that brings us back to Florence Nightingale’s work. From Nightingale’s framework, the nurse’s primary role is caring and helping people in their healing process. Nightingale told us that the environment is a key influencing factor in this process, which when operationalized, can increase the potential for recovery and survival. Nursing care in this framework emphasizes the optimization of ventilation and natural lighting of spaces, noise reduction, frequent hand washing and disinfection, hygiene of spaces, among other aspects of the environment. Nightingale supported the importance of these environmental aspects, by collecting and statistically analyzing data from everyday practice.
We can use the symbol of the lamp to illuminate the paths of what today’s nursing practice can be, and promote multidisciplinary recognition of nurses profound contributions to population health. We face the fact that 200 years since Nightingale’s ideas were first published, widespread recognition nursing at both the ontological and epistemological levels still remains a challenge to overcome. Therefore, we all have to effectively communicate to our communities worldwide a clear vision of what nursing is.
At a personal level, I have just completed two decades of my career as a nurse, predominantly caring for critically ill patients in the context of urgency/emergency rooms and also in an intensive care unit. This led to an experience marked by a great many interdependent nursing activities, which contribute to the progressive distancing from fundamental nursing theoretical thinking. I perceive myself in a state of profound professional numbness. Not meaning that the quality of my autonomous nursing activities were questionable, but instead were automatically executed and with little awareness of theory. This is similar to an experienced car driver, who over the years enters into a state of relative unconsciousness, an automated practice, when driving. This progressive loss of professional identity became evident in the scope of the Masters in Critical Care Nursing Specialty that I am currently attending at Univesidade Católica Portuguesa (Lisbon). When re-visiting in class the evolution of thought in and the production of knowledge throughout nursing’s history, in a short time and instinctively my practice gained the semantics of nurses’ expression, more specifically in content format and other implicit dimensions, as if it were on standby and with a click it would switch on. What seemed difficult to transfer into practice, proved to be the root of my daily professional practice.
That is why when I read the post The Impossibility of Thinking “Atheoretically” (Fawcett, 2019) in Nursology, suggested by the Master’s Nursing Theories Chairwoman, I cathartically identified with it. In my experience of hibernated nursing and of unconscious semantics, in the past I considered myself to be a nurse distant from theories, which would belong to an exclusively academic context. Now I confess that this process was a boost of vital energy, illuminating and motivating me to an increasingly challenging and exciting life as a nurse.
About Isabel Faia
I’m an ICU nurse since 2014, working for the past 20 years in a public hospital in Madeira Island, Portugal. Presently, I am doing a Masters in critical care nursing, at Health Sciences Institute, UCP Lisbon. This post was made in the nursing theories curricular unit of the Masters in Nursing Course of the Health Sciences Institute of UCP (Lisbon), with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).
On May 12, 2021, I was honored to present the keynote address for the 2nd International Videoconference Forum, “The Epistemology of Nursing Knowledge: Its Importance in Times of Pandemic,” sponsored by the Benemérita Universidad Autónoma de Puebla, in Puebla, México. The topic I had been asked to address was the epistemology of our discipline. Although I certainly do not consider myself an epistemologist, I accepted the challenge of articulating my version of the epistemology of nursology.
The complete presentation is available below. A summary of the presentation is given here.
Inasmuch as epistemology refers to a theory of knowledge (Zander, 2007), I described the theory of nursology knowledge as embracing and “epistemological plurality . . . [that reflects] . . . a commitment to recognizing different ways of knowing to support [nursology’s disciplinary] mandate to consider the individual holistically and in context” (Ou et al., 2017, p. 7). Epistemology is concerned with
Beliefs about the knowledge
The truth of the knowledge
Justification for the knowledge
My Beliefs about the Knowledge of Nursology
I and at least some other nursologists believe the epistemology of nursology includes a metaparadigm, philosophies, conceptual models, theories, and methods of scholarly inquiry. I acknowledge multiple versions of the metaparadigm; my version is human beings, environment, health, and nursologists’ activities. I believe that multiple philosophies, conceptual models, theories (grand theories, middle-range theories, situation-specific theories), and methods of scholarly inquiry are recognized as valid knowledge about our discipline. I also believe that the findings of every instance of scholarly inquiry constitute a theory, and that methods of scholarly inquiry encompass historical, philosophical, and empirical methods, all of which can include qualitative (subjective) and quantitative (objective) approaches.
My understanding of the knowledge of nursology encompasses five ways of knowing – tenacity, authority, a priori, practice/practice wisdom, and theory—as well as eight fundamental patterns of knowing in nursing—empirical, aesthetic, ethical, personal, sociopolitical, emancipatory, spiritual, and unknowing.
The Truth of the Knowledge
My understanding of the truth of nursology knowledge is that “acting in the best interests of the people for whom [nursologists] care requires valuing both subjective and objective ways of knowing” (Zander, 2007, p. 7), and that the nursology scholarly methods of inquiry encompass both the objective (quantitative) and the subjective (qualitative). Both objective and subjective knowledge can be explicit or implicit/tacit.
Justification for the Knowledge
I maintain that methods for obtaining both objective and subjective knowledge are needed for “multidimensional understanding of the client within the context of situation, family and environment” (Ou et al., 2017, p. 7), which is best determined by conduct of scholarly inquiry for the purpose of development of situation-specific theories. In keeping with the conference theme, my presentation also included content about decolonizing nursology knowledge, which may be accomplished by revising or discarding the existing metaparadigm, philosophies, conceptual models, and theories to eliminate the current dominant Euro-centric worldviews of white privilege (Chinn, 2021).
My presentation also included these suggestions for attaining social justice.
Develop new knowledge of how to increase planetary health equity and reduce or eliminate planetary health disparities
Develop new knowledge of how to eliminate structural and systematic racism
I agree with Chinn (2021) that much of the work of decolonizing and social justice can be achieved through an emphasis on development of situation-specific theories by inviting people to tell their stories of their health experiences. The stories than can be analyzed within the context of the situation and the people’s culture, with attention to avoiding stereotyping of the story-tellers on the basis of their culture. Decolonizing nursology knowledge and focusing on social justice also can be achieved through developing knowledge that “is an interchange between [culturally and contextually relevant] theory and practice and [is] guided by [culturally and contextually relevant] philosophy is like a kind of pendulum where all three elements [[culturally and contextually relevant] philosophy, theory, practice] are treated as equals” (Hoeck & Delmar, 2018, p. 1).
I believe it is crucial to the survival of nursology that we think and act on the basis of our five ways of knowing and a synthesis of our eight types of theories always and especially at this time of the pandemic, when so much emphasis is on doing tasks without sufficient attention to the why of the tasks beyond the pragmatic.
Chinn, P. L. (2021). Equity and social justice in developing theories. In E-O Im & A. I. Meleis (Eds.), Situation specific theories: Development, utilization, and evaluation in nursing (pp. 29-37). Springer Nature Switzerland.
The purpose of this blog is to describe a baccalaureate (BSN) prepared nursologist’s, Katunzi Mutalemwa personal lived pre-internship clinical learning experience in primary care at a local community-based non-governmental outpatient clinic run by The Tanzania Doctors with African CUAMM in collaboration with a local District hospital.
Inasmuch as the ECCM is a shared model, the starting point for the interpretation is the nursology discipline-specific conceptual model that is NSM (Villarruel et al., 2001). Whereas the NSM guided the overall understanding of the reflections, the concepts of the TSCC guided some of the specific actions described, as did the ECCM. The NSM provides a nursology conceptual foundation that takes into considerations the multiple levels of client/client system influences – the physiological, psychological, socio-cultural, developmental and spiritual interacting factors and environmental stressors. The model has the potential of advancing the future of nursology in the area of expanded nursing scope of practices and services in response to chronic disease management.
Katunzi’s reflections highlight the role of the BSN-prepared nursologists in the management and prevention of chronic diseases beyond the walls of the acute care settings (i.e., community-based primary health care settings)
The main ideas seen in this blog are consistent with the World Health Organization’s (2020) State of World Nursing publication, the nursology.net blog Primary-care-primary-nursology-and-the-attending-nursologist, the AACN White-Paper on the Vision-Academic-Nursing; the Health Resources & Services Administration (HRSA) 2018 call for Nurse Education, Practice, Quality and Retention (NEPQR) – Registered Nurses in Primary Care (RNPC) Training Program as well as several journal articles on the role of the primary care nursologist (e.g. Anderson et al., 2012; Bodenheimer, & Mason, 2016; Borgès Da Silva et al., 2018; Epping-Jordan, 2002; Lipstein, et al., 2016; Norful, et al., 2017). The description of the roles and responsibilities discussed in this blog acknowledge the varied contextual nursing scope of practices across the globe.
Katunzi’s Nursing Context/Situation
The personal reflections demonstrate how a BSN-prepared nursologist practices within the Tanzania Nursing and Midwifery Council (TNMC) (2014) general nurse full scope of practice. The TNMC’s major role definitions of a general nurse prepared at the baccalaureate level are: 1) Accountability, Ethical and Legal Practice; 2) Care Provision, Health Promotion, Leadership and Management and, 3) Professional, Personal and Quality Development. For instance, the care provisions and leadership definition of the TNMC general scope of practice, the BSN-prepared nurse roles includes, but is not limited to developing practice guidelines, representing nursing at the management meetings, preparing and presenting nursing budgets at management team meetings, participating in nursing research and utilizing research results in provision of nursing care, providing comprehensive nursing care and carrying out nursing management independently, formulating relevant policies about patient and client care, and reviewing performance appraisal for nurses. According to the TNMC, if assigned, a BSN-prepared nurse is also allowed to prescribe medications for persons with some acute, emergency conditions and chronic illnesses and to prescribe physical therapy and other rehabilitative treatments in keeping with existing protocols.
Community Resources and Policies and, Health Care System (Concepts of the ECCM)
As a BSN-prepared nurse completing a pre-internship clinical learning opportunity in a private community-based clinic (NSM community as the client system), I was mentored into the primary care role by a team of nurses and other healthcare providers. I was involved in the management of clients living with diabetes and heart diseases (adults and adolescents) (NSM developmental variable) trice a week and also participated in conducting monthly supervisions in satellite health centers. I learned to assure patients/clients maintained a maximum level of wellness by keeping stressors and stress responses at a minimum through effective, efficient care at three levels of prevention (NSM prevention as intervention). Utilizing a holistic approach (NSM physiological, psychological, socio-cultural, development, and spiritual variables), I was exposed in health counseling, medication administration, health teaching, case management and care coordination services (NSM prevention as intervention]. I worked closely with nurses in other satellite health centers within the clinic’s catchment area. The collaboration strengthened patient treatments and improved care. I regularly participated in conducting home visits and tracking down patients who were lost to follow-up care. I dealt with barriers such as clients’ religious and traditional beliefs that hinder adherence to prescribed regimen (NSM socio-cultural and spiritual variables).
As a part of the learning process, I practiced advocacy and I was able to participate in regular district administrative meetings to negotiate consultation fees and cost of drugs with district authorities (NSM socio-cultural variable). I improved my nursing skills in individual/family and community assessment while fulfilling this role. For instance, I was able to share with the authorities how financial challenges forced clients to take half doses of their prescribed medication and intentionally caused missed follow-up visits. Likewise, I noted that other clients opted to traditional herbal treatments as they were perceived to be cheaper than hospital medications. I was able to see how self-medication practices (Concepts of the TSCC) can harden caring of chronic patients. Some patients opt to buy drugs in stores rather than visit the clinic or hospital. Some of the challenges were attributed to lack of transportation and health illiteracy on disease processes (NSM socio-cultural variable). I called attention to the impact of laxed drug dispensing policies on clients’ lives. For example, I shared how clients with contraindicated medication can easily procure the drugs from a local drug store, making them at risk of readmissions and possibly death. In addition, as a community health educator, I advised patients and their families to participate in community development projects such as livestock keeping, small scale agricultural that helped them to earn extra money for buying drugs and supporting individual and family their well-being (NSM socio-cultural and spiritual variables ).
Delivery System Design and Self-Management Support(Concepts of the ECCM)
The community clinic was centered at a District Hospital and operated synergically with ten other health centers within our catchment area (NSM community as the client system). I learned to assure the provision of self-care maintenance, self-care monitoring, and self-care management services (Concepts of the TSCC). For instance, I was involved in caring for chronic disease patients especially type 1 diabetic patient by empowering and preparing clients to manage their health through effective and safe self-injection practice. I provided health education on regular testing to control glucose levels as well as insulin-self administration. Assessing clients’ health literacy levels in the treatment process was a crucial piece of my practice role. I developed peer guided groups with an interpofessional team comprising of a nutritionist and physician. In addition, I conducted monthly supervision at each of the ten assigned health centers. During the supervisory visits, I was involved on assessing the overall patient’s adherence practice to nursing care and follow up (Concepts of the TSCC). I also participated in conducting professional development seminars to nurses on management of patients living with chronic diseases, how to conduct referrals and improve protocols to manage patients with diabetic ketoacidosis and heart failure (NSM variances from wellness). I completed frequent home visits with nurses and other providers to assess the client’s progress, adherence practices and storage of medications (concepts of the TSCC), as well as delivered promotional health messages to patients and families (NSM primary prevention as intervention).
Decision Support and Clinical Information System (Concepts of the ECCM)
I learned how to make clinical decisions in chronic disease management consistent with scientific data and patient preferences. For example, when I saw patients with medical adherence issues, I made sure I educated the clients on possible consequences and let the clients make informed decisions (NSM primary prevention as intervention). I always acknowledged the challenging presence of scientifically unproved treatment plans attributed to the growing number of traditional doctors involved in client’s health care decisions (NSM individual as the client system). I always paid attention to gender-based influences (NSM socio-cultural and spiritual stressors) in medication adherence NMS-. For instance, I was able to determine that men attended treatments when they had severe signs and symptoms of an illness and/or at advanced stage of disease. To address this social determinant among some of the men, I participated in initiating the use of mobile phones to trace patients on monthly basis. This initiative had a positive impact on “no show” clients who had access to mobile phones.
Implications for nursologist scholars
Katunzi’s reflections have implications for advancement of nursology discipline-specific knowledge and future professional transformations. The evolving role of the nursologist in primary care (Wojnar & Whelan, 2017) calls for a well-rounded RN (Swan, et al, 2006) and, most importantly, a BSN-prepared global nursology workforce (Wojnar & Whelan, 2017). Use of the ECCM requires ongoing research — or review of existing research – to determine the validity of the model as a shared theory/model (Villarruel et al., 2001) that is useful in new nursing education curricula (Humphrey, 2019), reimbursement (Funk & Davis, 2015) and regulatory models (Start, 2020) situations that fit BSN-prepared nurses’ full scope of nursologists’ practice and meet clients’ health and social needs in places where people live, learn and play.
We would like to learn from our nursology.net readers on their perceptions of these questions:
What does the future of nursology hold for the role of the BSN-prepared nursologist in primary care, especially in the United States where primary care is regarded as a major role of advanced practice nursologists holding master’s and/or Doctor of Nursing Practice degrees?
How can nursologists overcome the barriers and maximize contextual opportunities to fulfill their roles?
What barriers may influence effective adoption of applicable borrowed and shared theories/models in nursology-led chronic disease management interventions?
We welcome nursologists at different levels of practice (i.e., LPN, ADN, BSN, DNP, PhD-prepared) to share their stories of how they provide primary care services (or ambulatory care or community-based care), in private or public health care systems. Please share your thoughts in comments section below
Barr, V, Robinson, S, Marin-Link, B, Underhill, L, Dotts, A, Ravensdale, D, & Salivaras, S. (2003). The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model, Hospital Quarterly, 7(1), 73-82.
Borgès Da Silva, R., Brault, I., Pineault, R., Chouinard, M.-C., Prud’homme, A., & D’Amour, D. (2018). Nursing Practice in Primary Care and Patients’ Experience of Care. Journal of Primary Care & Community Health,9, 1-7 https://doi.org/10.1177/2150131917747186
Humphrey, B., L., Mixer, S. J., Thompson, K., Davis, S., Elliott, L., Lakin, B., … & Niederhauser, V. (2019). Transforming RN roles in community-based integrated primary care (TRIP): Background and content. Issues in mental health nursing, 40(4), 347-353.
Norful, A., Martsolf, G., de Jacq, K., & Poghosyan, L. (2017). Utilization of registered nurses in primary care teams: A systematic review. International journal of nursing studies, 74, 15-23.
Start, R., Brown, D. S., May, N., Quinlan, S., Blankson, M., Rodriguez, S. R., & Matlock, A. M. (2020). Strategies for creating a business case that leverages the RN role in care coordination and transition management. Nursing Economics, 38(4), 203-217.
Health is a central concept in most if not all versions of the metaparadigm of nursology (Fawcett, 2019). I have defined health as “human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6) and conceptualize health as inclusive of wellness, illness, and disease within that process. I deliberately separated wellness from illness and disease when I realized many years ago that the term, promotion of health, could mean that nursologists’ activities were directed toward promotion of illness and disease as well as wellness, rather than indicating that nursologists’ activities are directed toward promoting wellness and preventing illness and disease.
However, I recently realized that my conceptualization of health is Euro-centric and reflects my privilege as a white, Anglo-Saxon nursologist (Chinn, 2020). Accordingly, when I had the honor of speaking virtually with faculty and graduate program learners at St. Mary’s College Graduate School of Nursing in Kurume, Japan, in February 2021, I invited the learners to share their thoughts about health by responding to three questions. The questions and their responses constitute most of the remainder of this blog.
• The first question is: What is your definition of health?
• Inasmuch as the nursology curriculum at St. Mary’s College School of Nursing is based on the Roy Adaptation Model (RAM), I then asked this question: To what extent is your definition of health consistent with the Roy Adaptation Model definition of health, which is: “A state and process of being and becoming an integrated and whole human being” (Roy, 2009, p. 48).
• Finally, I asked: How does your definition of health affect what you think and do as a nursologist?
GRADUATE PROGRAM LEARNER TAKAKO TANAKA’S THOUGHTS ARE:
I define health as a feeling of harmony between body, mind, and living in society. Even if people have a disease or disability, they can be considered healthy if they feel that they are able to do what they want to do, while coping with their environment. My definition of health is similar to that of the RAM, in that human health in the RAM is not just a high or low level of health. Instead, it is about growth and development as we interact with our environment. Output behavior, when healthy, is positive adaptive behavior. According to the RAM, if energy is not spent on maladaptive coping, this energy can promote healing and enhance health, even in states of illness. I also believe that if people have a lifestyle disease, for example, and can controls the disease by going to the hospital and taking appropriate medication to stabilize the disease, and are able to live as members of society, then they are healthy. My definition of health has been informed by my work in public health nursing, as I learned to always value the concept of health promotion. Individually and collectively, I want to help people understand their health problems and support them to achieve independence and self-determination on their own, which will likely lead to illness prevention. Furthermore, I believe that it is essential to create an environment that supports health.
GRADUATE PROGRAM LEARNER MIHO YOSHIOKA’S THOUGHTS ARE:
I define health as a state in which subjective well-being and objective health indicators are in marvelous harmony. Subjective well-being differs depending on the culture, customs, and environmental values of each individual; and even if they have a disease or handicap, I think that they are in health if they feel well-being within themselves. However, I ask if there is a possibility of being a detriment to themselves, such as leaving the illness to their own discretion, are they truly healthy? Therefore, I dare to consider that a state in which these conflicting things are in marvelous harmony can be called health. The RAM emphasis on an interaction between the person and the environment is consistent with my idea of subjective well-being. The RAM emphasizes that health behaviors based on individual values are adaptive and can never be measured by the values of others, which helps me to understand that whether people consider themselves healthy is a complete affirmation of their diverse values. However, the RAM contention that health behaviors cannot be measured is not consistent with the inclusion of objective aspects of health in my definition. In recent years, people’s lifestyles and values have changed, and subjective well-being, an aspect of my definition of health, has also diversified. The practice of providing sensitive care for the different needs of each individual requires a holistic understanding of that individual. A nursologist is the professional who is closest to the client. By paying attention to and engaging with the client, I think that we can become aware of the needs of that person and provide individualized nursology that protects human consideration and dignity. I also think that nursology, which requires being close to the client, is important in terms of developing trust and respect for their subjective well-being. Moreover, I think that nursology practice is caring for others, which is essential for curing and healing. Therefore, the attitude of facing each individual, the full use of professional knowledge and experience with dignity to maintain and improve well-being, and cooperation with clients while caring for them, are all affected by my definition of health and by our thinking and acting as a nursologist.
GRADUATE PROGRAM LEARNER MASUMI OKA’S THOUGHTS ARE:
I define health as a state of understanding and accepting of one’s condition, and also a quest for health itself. Although the World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” I regard health as the way of understanding the state of experiencing a disease or disability, accepting one’s response to the disease or disability, and trying to become satisfied and fulfilled despite the disease or disability. My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. There are subjective and objective aspects to health, but factors such as ideals, goals, and prejudices toward health are the driving force behind the quest for health. I believe that human beings are creatures that constantly seek “health” and have the power to control their way of life. In other words, the act of pursuing “health” itself becomes human empowerment, and I think that it also affects one’s quality of life. My definition of health has been greatly influenced by the RAM definition of health. Being and becoming a whole and integrated human being can be interpreted as a quest for health, so that process is health itself. The RAM considers health from the perspective of human goals and the significance of existence, and lack of integration is said to denote inadequate health. The facilitation of the process of integration is seen as care for my idea of a “quest for health” and is consistent with all human care required of nursologists. My definition of health has a great influence on my thinking and behavior as a nursologist. I believe that supporting the acceptance of people with a disease or disability and considering together with them is caring for their “quest for health.” Quality of life changes significantly depending on how disease or disorder is perceived and understood. As a nursologist, I think that by being involved in the process of accepting illness and disability and supporting people’s ability to satisfy themselves, they can accept and love their existence. As a nursologist, I would like to continue to study and learn the potential “investigative power of health” of human beings and contribute to the development of the science of nursology in the future.
GRADUATE PROGRAM LEARNER TATSUNARI HARA’S THOUGHTS ARE:
My definition of health has two aspects: it is the situation in which people think of their condition as being “good” despite any physical malady they might have, and it is also the process they are going through in changing or adapting to their condition to become “better” in terms of their own understanding of the word. My definition of health has been greatly influenced by the RAM, as I learned nursology through the RAM. My definition of health is, however, more abstract than that of the RAM, as my definition emphasizes the largely subjective nature of health. My definition of health has influenced by thoughts and actions. Thus, I understand that nursologists strive to establish a caring connection to patients by ascertaining what kind of state they think is good, their goals and abilities required to attain that state, how they perceive their current situation, and what their values are. Furthermore, as I work in rehabilitation nursology, I see many of the patients leave the hospital with remaining disabilities to go on with their lives. Therefore, we nursologists may be required to change our ideas about health so that we can work together with the patients while thinking about how to establish health in their lives, and encourage any necessary changes they may need to make.
GRADUATE PROGRAM LEARNER MIHO ISHIBASHI’S THOUGHTS ARE:
I think that health is not a concept that opposes illness, but a process in which a person interacts with the environment as a human being and tries to become a person looking positively toward their hopes and wishes. Health in the RAM is an integrated overall condition or process. Nursologists say that by promoting adaptation, they contribute to human health, quality of life, and dignified death. I think that for people to be the people they are, nursologists have to understand the hopes and wishes of what the people want to be and do, as well as understand and support them physically, mentally, and socially. I believe it is necessary to understand the environment surrounding a person, think about the influences that affect their health, and consider how to manage these aspects to make people healthy. I think it is necessary to act as a nursologist to understand people’s hopes and wishes people and to help them attain these hopes and wishes.
GRADUATE PROGRAM LEARNER YUKIE NAKANISHI’S THOUGHTS ARE:
I think of health as being familiar with one’s self, having the ability to deal with problems, and having the ability to make decisions. The notion of health in the RAM as a state of integration is consistent with my thoughts about health. Until I entered graduate school, I was convinced that “health” was not having any illnesses or disability. However, even if one has an illness or a disability, I have now come to think that true health is the ability to face oneself, accept what one has become, and move forward toward the future. While studying the RAM and bioethics, I have learned it is important to learn that “person” equals “life”, and that it is equally important to think about a person’s “purpose of life” and “meaning of life” while practicing nursology. Nursologists are practitioners of caring, so I have realized that it may be inadequate to not understand what health is. In the future, I would like to continue learning so I can augment my humanity and human power, learn more about the attitudes necessary for caring, and put them to practical use.
I was remiss in not having invited the St. Mary’s College Graduate School of Nursing faculty and learners to share the word each uses for health. Therefore, I do not know whether their responses reflect a Euro-centric or Japanese meaning for the word.
When I sent a draft of this blog to Eric Fortin, of the St. Mary’s College School of Nursing faculty, he replied with his interpretation of the Japanese characters for health. I am, therefore, indebted to Mr. Fortin (personal communication, April 26, 2021), who wrote “健 means ‘humans build,’ and ‘康’ means “breathing space, . , , probably implying the lack of obstruction or disease. So, ‘humans building breathing space’ implies being healthy.”
Today, more than twenty years after nursing was incorporated into the Chilean Health Code in 1997 as an autonomous profession, one begins to see how nurses empower themselves defending their rights at the institutional, social and political level. This is seen through events such as the establishment of the National Nursing Directorate at the Ministry of Health and the role that nursing has had in the Covid-19 pandemic. Nurses are raising their voices. In the political sphere, nurses are campaigning as representativeness to draft the new Chilean Constitution, defending/advocating care as a constitutional right and guarding professional autonomy. Another important example of nursing empowerment is the growing generation/development of nursing scientific associations. These organizations seek to socialize what nurses do, the ongoing research in different areas of care and the development of profession itself. Currently, there are more 40 scientific nursing societies in the country.
In 2005, through the Health Authority Law 19,937, self-managed hospitals were established, which brought with them an important change in their administrative organization. It implied that hospitals in their structure should consider the Medical Directorate and the Subdirectorate of care management, both with direct dependence of the hospital management. Historically, nursing had depended on the medical directorates. In this context, the nursing professional association of the time and, the scientific societies (in that period there were no more than ten) defended before the authority of the Ministry of Health and the Comptroller General of the Republic, that by then nursing was the only profession that in its definition evidenced care management as a component of its role. As a result of these negotiations in 2007, by means of the General Administrative Norm No. 19 of the Ministry of Health, it recognized the nursing profession as the most suitable for implementing the care management model in self-managed hospitals.
In this context, “Nursing Care Management” was defined as the professional practice of the nurse based on the nursing discipline, the science of caring (based on Watson’s philosophy and theory), understanding the exercise of the profession as the application of professional judgment in planning, organization, motivation and control of the provision of timely, safe, comprehensive care that ensures continuity of care and is based on the institution’s strategic policies and guidelines. This achievement was constituted a demonstration of empowerment of the nurses of the decade.
However, even when the definition indicated that “care management” was based on the science of caring, the care provided to people was mainly focused on the biomedical model. The National Directorate of Nursing: it is specified through Exempt Resolution No. 1443, on August 20, 2019, during the mandate of the Minister of Health Jaime Mañalich who formalized the appointment of the National Director of Nursing. Being a milestone for the profession, providing from the central level, support to direct and guide the care of people, develop the nursing structure for the health sector, ensure that the nursing care management sub-directorates are not only considered in in-hospital care, but also in primary care.
In parallel, there have been other relevant events in the country, which show the awakening of nurses as a professional group. An example has been the number of nurses who present themselves to the process of electing representatives to the constituent assembly, in defense of care as a constitutional right, as well as the defense of the autonomy of the profession and the rights of nurses.
Another event that has led to the empowerment of nurses has been the Covid-19 Pandemic, which has resulted in the defense of the right of profession, the union of the group to be in the spaces where decisions are made. Likewise, the growth of scientific Societies that bring together nurses for a common purpose, whether it is around the care of people, such as the defense of the rights of the profession (see the list of Scientific Societies below).
The immunization of the population through the vaccine for Covid-19, means another instance in which the nurses raised their voices to defend the vaccination process as a historical nurse’ s responsibility. To respond to the vaccination demands, other healthcare professionals were called by the authorities as volunteer. This led, the nurses defended before the authorities, that although the voluntary participation of other professionals in vaccination is recognized, the vaccination programmeshould be under the supervision of the nursing staff only. Highlighting that, vaccination does not only imply the act of inoculating the vaccine, but an entire process of organization, administration, register and following up.
One of the last events that brings together nurses as an empowered group is the call that the National Director of Nursing makes to Scientific Societies to be part of a Technical Working Table, with the purpose of generating strategic collaboration links in for the development of protocols for the management of care and research in the discipline of Care.
Agrupación de enfermeras holísticas de Chile (AEHCh)
Agrupación de enfermeras y enfermeros ecologistas
Agrupación de enfermeros perioperatorios (AGEPCH)
Asociación chilena de enfermería en estomas heridas y/o continencias (ACCHIEHC)
Asociación chilena de enfermeros educadores en diabetes (ACHIENED)
Capítulo de enfermería de la Sociedad Médica de Cuidados paliativos
Capítulo de enfermería de SOCHIQUEM
División de enfermería intensiva de la sociedad chilena de medicina intensiva (SOCHIMI)
Federación Latinoamericana Esterilización FELACEH
Fundación de enfermería Gestión del Cuidado
Fundación latinoamericana de enfermería en cuidado humanizado (FLECH)
Sociedad de Enfermera Latinoamericana en Heridas (SELH)
Red Nacional EBE Chile
Red Chilena de Enfermería en Lactancia Materna (REDCHIELM)
Red Chilena de Enfermeros En Odontología (RECHIENFOD)
Red de Enfermería en Informática Chile
Red Chilena de Gestión del Cuidado REDGECU
Red de Enfermería en Salud del Adulto Mayor- Chile (REDESAM)
Red Chilena de Historia de la Enfermería
Red en Salud Ocupacional (RedENSO Chile)
Red iberoamericana de investigación en educación en enfermería-RIIEE Chile
Red Internacional de Enfermería en Cuidados Paliativos – Chile (RienCupa)
Red internacional de enfermería quirúrgica -RedIEnQu Chile
Sociedad Chilena de Enfermería en Salud Ocupacional (SOCHENSO)
Sociedad chilena de enfermeras de salud escolar (SOCHIESE)
Sociedad Cientíca chilena de enfermeras del niño y adolescente (SOCHENA)
Sociedad Chilena de Enfermería en Cardiología y Cirugía Cardiovascular (SOCHICAR)
Sociedad Chilena de Enfermería en Donación, Procuramiento y Trasplante (SOCHIENFDPT)
Sociedad Chilena de Enfermería Oncológica (SEOC)
Sociedad científica de enfermería comunitaria y familiar (SOCHIENFA)
Sociedad chilena de enfermeras comunitarias (SOCHIENCO)
Sociedad Chilena de Enfermería Prehospitalaria, Agrupación Científico-Técnica. (SOCCHIENPRE)
Sociedad chilena de prevención y control de infecciones asociadas a la atención en salud, (SChIAAS)
Sociedad Chilena de Enfermeras de Pabellones Quirúrgicos y Esterilización
Sociedad Chilena de Terapia de Infusión (SOCHITEIN)
Sociedad científica de atención temprana, rehabilitación e inclusión
Sociedad Científica Docente Estudiantil de Enfermería UACh Pto Montt (SOCIDENF)
Sociedad de enfermeras de diálisis y trasplante renal (SENFERDIALT)
Sociedad Chilena de Enfermería Geronto-Geriátrica
Sociedad de Enfermeras Dermoestéticas (SOCHIEDE)
Sociedad de Profesionales en Esterilización de Chile
Sociedad Chilena de Simulación Clínica (SOCHISIM
About Luz Galdames
Luz Galdames Cabrera Ph.D. in Nursing, Mg. Instructional Design, Nurse-Midwife, Research Professor, School of Nursing, Faculty of Sciences, Universidad Mayor. Researcher in project “Development and validation of the prototype dressing with copper nanoformulation for the treatment of infected chronic wounds, Universidad Mayor, Project ID18I10085 Funded by the Fund for the Promotion of Scientific and Technological Development FONDEF 2018-2020. Director of the Nursing Specialization Program in Adult Oncology at the Universidad Mayor. Member of the International Center for Nursing Research CIIENF of the Chilean Association of Nursing Education. Coordinator of the international Care Management Network. Founder and President of the Chilean Network of Care Management Last publication Galdames l., Enders B., Pavez A. Self-regulation, Autonomy and Identity of Nursing as a profession. Science and Nursing Magazine. 2019 24 (4). Doctoral thesis Care Management: Understanding the Meanings of the Social Role and Professional Autonomy of the Nurse in Chile. Funded by the Vice-rectory for Research and Doctorate as a start-up project, Universidad Andrés Bello Chile 2014.
Contributor: Daniel Suárez-Baquero Scroll down for Spanish language version of this post
Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.
As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.
The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.
It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).
I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.
I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.
Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science
La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.
Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.
Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.
Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).
Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.
Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.
Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2). Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175
Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903
About Daniel Suárez-Baquero
Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.
We are pleased to write our blog about the 2020 work of the Newman Theory/Research/Practice Society in Japan. We submitted a brief about our Society on January 10, 2019 (scroll down here to see this brief) followed by more detail from Dr. Margaret Pharris, who introduced our society and work on December 17, 2019.
We had the last pre-praxis research course of HEC for 2019 virtually on August 2, 2020, because the COVID-19 pandemic. We read the last chapter, “A transforming arc”, and Appendix A, “HEC Praxis: The process of pattern recognition” in Newman’s “Transforming presence: The difference that nursing makes.” After that, Emiko Endo, as a leader of this course, introduced the blog by Drs. Jones and Flanagan, “COVID-19 – What would Margaret Newman say?”(June 30, 2020) In listening to it, our comprehension expanded, and we feel enlightened, and awakened in new ways.
There is an increased awareness within selves, our nursing care, and our society. No, we will never get back to normal. We will certainly move on in “Satori.” On an annual event of the Study meeting held by zooming on November 22, 2020, three practicing nurses presented their experiences of turbulence and disruption, and then recognition of the changes to the meaning of their experiences in the COVID-19 pandemic. The following are the summaries of each presentation.
In February, the spread of COVID-19 started in Asian areas, but I was looking at that situation as no concern of ours, and I thought it would disappear sooner or later like SARS and MARS. However, soon after being informed of the cases with COVID-19 in Japan, daily necessities, masks, alcohol, etc. disappeared from every store and the situations in hospital settings dramatically changed. The nurses, including me in a cancer hospital, had very hard time making temporal rules without any exact knowledge.
Soon after, we were informed that some positive cases were found at my hospital. I was on the list of medical staff exposed deeply to the COVID-19. “It finally came to us. We cannot overlook their distress as no concern of ours.” I felt strong fear. I had a test, and was afraid of the result. “If I am positive, what will happen to my family? If I and my husband are positive, how my child should be?” I imagined a dead body in a special bag and a crying child there. But, fortunately my test was negative.
After that, I was in charge of an outpatient clinic for the clients with fever. There were many difficulties because of a pickup setting. There were many inquiries and complaints from clients. The relationship among the staff became so bad because of a sense of unfairness, stress, overwork, etc. “How long does this chaotic situation last?
One day I spoke to my colleague about how to organize this disorder. Astonishingly, she said, “You told me some time ago that a transformation would occur after a chaos!” Her words made me come to my senses. “It is true. After the chaos, there is our growth.” I felt as if I had the scales fall from my eyes. I certainly grasped the meaning of “We will never get to back to normal” as Dr. Newman said.
I looked at the chaotic staff relationship from a different angle. “We do not need to get back to the normal. The confusion is not really bad, but it will bring forth. We do not need to endure the current difficult situation with many complaints until the typhoon has passed. Let’s find a new way to move on.” I approached my colleagues to exchange ideas about how to stand up. Of course, my change of actions prevailed into my family.
In the midst of the pandemic of COVID-19, my father, who had had a so-called incurable disease for a long time, died. As I learned a lot from my sad but meaningful experience, I would talk about it.
I, as a hospital nurse, had asked patients’ families to put restrictions on visiting their loved ones to prevent bringing COVID-19 virus into the hospital. However, the situation has reversed. I was not allowed to visit my father. I was so afraid of not being able to meet his death. When I had been a nurse at the palliative care unit, I valued a patient’s death surrounded with his or her family members before everything else. But, I thought it might be impossible for me to be present with my father.
I wondered why my father was on the brink of death in the midst of the pandemic of COVID-19 ? “If I cannot be present at my father’s death, what does it mean? My father may be telling me something important to get a new meaning in my experience. He may be telling me that the length of the time is not so important. The importance is to be present with the patient.”
When my father ran into a critical condition, I was finally allowed to see him. I could be present with him for a while with all my heart. My father did die after several days from good-bye with my aching heart. However, in spite of his death, the relationship between him and me has changed through the process of our hard experience in the pandemic. Our relationship came closer than ever, and we became deeply united in spirit.
From this experience, I realized that I had been captured by the “good dying moments” which nurses think. I surely comprehended the meaning of “Transforming presence” in terms of HEC. That is, being present together brings the transformation to both. I realized the true meaning of “Vulnerability, suffering, disease, death do not diminish us” which Dr. Newman emphasized.
I am very thankful to my father, and the lesson on the COVID-19 pandemic will help me better care for clients in our community.
I am a nurse in charge of an outpatient clinic at a university hospital. The COVID-19 pandemic brought me so many difficulties and at the same time many lessons.
We, nurses, were distributed one mask for several days and one raincoat bought at a $1.00 shop. At an information desk, I received a lot of phone calls, claims, and complaints from clients because of the lack of information and fear. The staff’s fear and offensive attitudes were also increasing, and some co-workers could not show up because of their children’s care at home. I was full of fear and exhaustion as I could not know how things would turn out.
In those days, I participated in the last class of the pre-praxis study course and we read the blog by Drs. Jones and Flanagan. I vividly remember the shock I felt after reading the blog. “I feel very relieved.” I thought, “What we need to do is not to go back, but to move on even in the process of confusion.” I thought, “Now is a pinch point, but it is not, really. Now is a chance.” Then, I looked back the past experiences and tried to get a new meaning from them. I will tell you about my change.
As the charge nurse at an out-patient clinic, I was always thinking, “I should take a determined attitude,” “I should not make mistakes,” “I should not be afraid of COVID-19,” “I should meet patients with fever by myself.” One day, when I was working the information desk, I spoke with a patient who turned out to be COVID-19 positive. When I was informed of this fact, I was afraid. Moreover, I felt so sorry for my family. However, I did not tell anyone, not even my family, though I was so worried about my contagion.
Finally, COVID-19 had invaded into our hospital. Some nurses were on a watch list for the virus. One day, one nurse came to me and told me, “I feel very afraid, and I feel very sorry for my family.” She told her feeling openly. At this time, I was startled and recognized my pattern. I realized that I was not honest. I piled up “should do” every day.
The pattern recognition, which is the most important concept in HEC, helped me realize my situation. Since then, I tried to be open and to tell what I am thinking and feeling to people. Especially, I tried to be honest and open with the staff. I realize now that our relationship is changing and expanding. This is one of the great lessons to me during the COVID-19 pandemic. There is another one. At the out-patient clinic, we started to receive clients’ words of appreciation. I can accept their thanks honestly and my relationship with clients became more genuine. This is the other lesson from the pandemic. Thank you for listening to me.
All participants were deeply touched by their presentations. “Yes, we will move on!!!” We will continue to search for ‘caring in the human health experience’ during the COVID-19 pandemic.
Although many experienced nurses consider themselves as experts in their fields of practice, it is important to keep in mind that they, too, become novices when they encounter a new clinical challenge or situation such as the Covid-19 pandemic. Benner’s (1984) theory, FromNovice to Expert, is an excellent nursology theory that can guide clinical practice in the context of current health care challenges related to Covid-19. The theory includes five stages–novice, advanced beginner, competence, proficiency, and expertise. As nurses pass through these various levels of proficiency, they develop holistic clinical knowledge influenced by nursology education, experience, and intuition (Benner, 1984).
The purpose of this blog is to summarize an exemplar of a “novice to expert” nursology educational strategy developed in response to the Covid-pandemic Global Nursing Education exemplar. The exemplar is about a non-profit 501c3 organization, Dr. Gabone QHSC (Quality Healthcare Solutions and Consulting) Inc., which served global novice nurses experiencing a surge in Covid-19 cases in their clinical practice. These novice nurses, especially those assigned to “Covid-19” units experienced common challenges reported in the literature such as exposure and anxiety related to the lack of personal protective equipment and fear of the unknown (Chen, Lai, & Tsay, 2020) . As a result, they relied heavily on emerging knowledge from public health experts as well as clinical expertise from frontline workers who had already experienced the impact and management of the disease in their practice settings. Hence, to better serve the novice nurses, the organization assembled teams of interprofessional Covid-19 frontline healthcare workers from various Covid-19 affected areas to share knowledge about how they utilized their highly skilled analytical problem solving abilities, experience, and education to grasp the emerging situation, events, and behaviors via Zoom meetings.
Six educational sessions were offered as resources to heighten the opportunities for novice nurses around the world, in particular targeting Tanzanian nursologists. The topics covered included:
Challenges of Covid-19 in nursing practice across various practice settings
Typical nursing care shifts for Covid-19 patients
Medication administration and medical protocols
Infectious disease management
Effective use of PPE to prevent spread of COVID-19
Effective coping strategies to promote nurses’ individual and family well-being
Creating a culture of safety
Challenges faced by prospective health care workers.
As the frontline workers described their expert practice, they widened the novice nursologists’ perspectives and acceptance of actual and potential challenges and situations they might encounter in their practice settings. For example, the meetings provided demonstrations of how nursologists are interconnected and how they face similar challenges such as lack of PPE and fear of becoming infected. In addition, some nursologists shared ways they reused supplies while ensuring safety and efficiency for patient care.
Overall, the feedback from the participants was positive. The online mode of delivery included interactive elements such as chats, polling, and emails to facilitate discussions to move beyond the content elements and also facilitate experiential learning to develop expertise. Future recommendations for effective online global education delivery and programming include consideration of delivery time for synchronous presentations, as well as access to technology and internet service in resource poor countries and communities.
As we move forward, I call upon nursology scholars worldwide to utilize Benner’s (1984) Novice to Expert theory to examine how the lived experiences of frontline nurses during the Covid-19 pandemic facilitate knowledge development among novice nurses in clinical practice. Questions to ponder are: 1) How and what did frontline nursolgists learn during the Covid-19 pandemic? 2) What new nursing knowledge was generated by the frontline nursologists as they became the experts? 3) How can we utilize the new knowledge in nursology education and practice to manage future outbreaks/pandemics?
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Benner, P. (1984). From novice to expert. Addison‐Wesley .