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?
Please feel free to share your comments to this blog.
Benner, P. (1984). From novice to expert. Addison‐Wesley .
Self-care is an integral part of nursing care delivery systems. Pioneered by Dr. Dorothea Orem, the self-care theory offers nurses with unique opportunities for health promotion, disease prevention and rehabilitation care worldwide. Self-care supportive-educative strategies through health promotion and prevention initiatives have been instrumental in health care service delivery in Tanzania, especially in primary care clinics. The emerging COVID-19 pandemic has delineated new care demands on self-care requisites that Tanzania populations need to meet in order to stay healthy and free of the illness. With such a pandemic, nurses are being tasked to find new ways of assisting clients to effectively meet their self-care needs that best fit the cultural context. So the following question remains to be answered: What kind of nursing system(s) are in demand in Tanzania in this COVID-19 era?
The Orem’s Self-care theory guided the practice exemplar “Self Care Theory in Tanzania.” This exemplar highlights two common self-care strategies utilized in Tanzania in the wake of COVID-19, that we identify as Non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care nursing interventions. The first example is focused on hand washing as a basic NP self-care strategy. The second example relates to complimentary alterative medicines (CAM) as an Alternative pharmaceutical (AP) self-care strategy in particular herbal steam therapy (commonly known as kujifukiza in Kiswahili).
As the most trusted health care professionals in the world, we “nurses” have the duty and responsibility to help individuals, families and communities to be able to choose and select the right information for self-care. In the wake of COVID-19, nursing self-care delivery systems should focus on prevention and health promotion in a safe and cost-effective manner. This approach supports Dr Jacqueline Fawcett assertion that “Nursology has an answer to how to emphasize primary prevention.” [Read her blog The Value of Primary Prevention]. This is the right time to do so. We have to be part of the solution by being proactive and advocating for effective non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care policies through the lens of unique nursing perspectives, in this case, Orem’s Self-Care theory.
The two exemplars clearly tell the story that upon planning of any successful health-related project, it is important to understand the extent of self-care practices in a community, collaboration, training needs in self-care and development of guidelines/protocols. The “Kujifukiza” (i.e. herbal steam therapy) phenomenon was eye opening. It is not surprising to see that Sub-Saharan nurses are receptive of alternative modalities but lack appropriate knowledge about complementary health therapies (Gyasi, 2018). For example, I (Katunzi) am one of those nurses who lack appropriate knowledge about CAM. I was not fortunate to have this kind of education in my nursing program beside a one-day CAM observational opportunity during a palliative care rotation. I am now compelled to advocate for nursology-led initiatives to study and promote evidence-based protocols or guidelines.
There is a lot to be done and a lot to learn from each other about Orem’s self-care theory guided practice related to NP and AP self-care strategies. To continue this dialogue on NP and AP self-care strategies, we would like to invite nurses and nursing students around the world to reflect on the COVID-19 pandemic as it relates to these important self-care issues:
How has hand washing, a non-pharmaceutical (NP) self-care public health strategy been utilized within your cultural context (family, workplace or community)?
How has alternative pharmaceutical (AP) self-care public health strategies been utilized in your cultural context (family, work place or community)?
If Dorothea Orem lived to see the COVID-19 pandemic, what do you think she would say about nurses, nursing and self-care?
Please share your thoughts in the comment chat box. We look forward to hearing from you!
Gyasi, R. M. (2018). Unmasking the practices of nurses and intercultural health in sub-Saharan Africa: a useful way to improve health care?. Journal of evidence-based integrative medicine, 23 2515690X18791124.
Katunzi Mutalemwa, BScN is an evolving young Tanzanian nurse leader who just completed his baccalaureate nursing education in the Fall 2019. He is currently working on a Non-Communicable Diseases (NCDs) project in Tanzania and waiting to start his one year nursing internship at Kilimanjaro Christian Medical Center in November 2020. Mr. Katunzi was honored to write his BScN thesis on ‘Nurses Experiences of Caring LGBTQ Patients with HIV Infections guided by Travelbee’s Human-to-Human Relationship Model’ at Swedish Red Cross University in Sweden. He recently published a book titled “Nurses the Cornerstone of Health Care System” to inspire his fellow nurses in Tanzania. He is the former Chairperson of the University Nursing Students Association of Tanzania (UNSATA). He would like to thank Dr Rosemary Eustace for her mentorship in preparing this information for Nursology.net.
What is meaningful practice? How might we create a meaningful care environment? The Newman Theory/Research/Practice Society in Japan sent the Nursology.net team an update on their efforts to provide transformative nursing theory-guided care for patients in Japan, and a mutual action research process they created for nursing teams to reflect on meaningful practice and shape meaningful care environments.
This work began in the 1990s when Emiko Endo was a PhD student studying with nurse theorist, Margaret Newman, PhD, RN, FAAN. Endo tested Newman’s theory of health as expanding consciousness in women with ovarian cancer in Japan. As a result of the caring partnership with Endo, who followed Newman’s theory and research method, the women reported finding greater meaning in their lives and experiencing personal growth and insight into the future.
Eager to share what she had learned, Endo returned to Japan and worked with a hospital-based nursing praxis team to incorporate Newman’s theory and research method into their nursing practice with women with cancer. Realizing the power of the process and the strain family members were experiencing, the nurses extended their attention to use Newman’s method with families of women with cancer. The praxis teams were expanded to include nurse educators, nursing graduate students, and clinical nurse specialists as co-researchers. On one unit, a head nurse assisted her staff to recognize their own patterns as they moved through the chaos of care with clients. The process of recognizing patterns of meaning expanded from the patients, to patients and families, and eventually to nursing care teams. It did not stop there.
Endo developed a process of Mutual Action Research and initiated monthly project meetings for the nurses to capture the meaning of their work as it unfolded. In these meetings, nurses recognized transformation in their caring partnerships with patients and families and visualized ways to improve the care environment. Nurses reflected on their pattern of relating to clients and others and how much more meaningful their practice was when rooted in nursing theory rather than simply in the medical model. The personal reflection and subsequent collective dialogue revealed the ways in which not only had they and their patients been transformed, but also the influence of their transformation on the entire interprofessional team and the care environment. Endo and colleagues realized a need to share what they had learned with nursing teams throughout Japan.
In 2016, the Newman Theory/ Research/ Practice Society was established as a Japanese Nonprofit Organization (NPO) to host national study meetings, dialogues, and seminars in Japan. The intent of the Society is to expend every effort for the development of nursing guided by Newman’s theory of health in Japanese society. Members of the society have been major contributors to international Newman Scholars Dialogues.
As you read the following entry that the Newman Theory/ Research/ Practice Society board members Emiko Endo, Mari Mitsugi, Tomoko Miyahara and Satoko Imaizumi submitted to Nursology.net, you will see that they ended with words from Margaret Newman’s foreword to the Japanese edition of her book, “Transforming Presence: The Difference that Nursing Makes.” The last word is “Satori!”
Satori embodies understanding, enlightenment, awakening to see into one’s true nature, comprehension. In 2020, which the World Health Organization has declared the Year of the Nurse, and in light of Nursing being considered the most trusted profession for improving the U.S. healthcare system (The Commonwealth Fund, The New York Times, and Harvard T.H. Chan School of Public Health, October 2019, p. 17), the international nursing community looks to the wisdom of our colleagues in Japan for Satori.
Report from the Newman Theory/Research/Practice Society in Japan
Contributed by:* Emiko Endo, Mari Mitsugi,
Tomoko Miyahara and Satoko Imaizumi
We are pleased to post the 2019 work of the Newman Theory/ Research/ Practice Society in Japan.
In memory of Dr. Margaret Newman, we are devoted to understanding the theory of health as expanding consciousness (HEC) and her life as a nursing theorist, researcher, and educator.
Emiko and Mari, today’s leader and sub-leader, are talking about HEC in the study meeting on June 2, 2019
At the first 2019 study meeting held on June 2, 54 participants gathered together. We read Dr. Newman’s 1994 theory book together chapter by chapter with a facilitator until Chapter Six, and had a dialogue within each small group. The second study meeting was the afternoon of October 19 followed by the annual HEC Dialogue Meeting on the next day. In the first half, we read some articles on Dr. Newman’s life and missed her. In the latter half, we read Chapter Seven (Practice: Order out of Chaos), connecting it with our own nursing practice within 7 small groups.
The participants are having dialogue in each small group about HEC and their nursing practice
The next day at the 13th HEC Dialogue Meeting, the topic was “A challenge to develop an HEC study group at your clinical nursing unit or hospital.” Two presenters talked about their experiences. They noted that these experiences were not easy, because nurses were working in their irregular working time and mostly under the medical model. But they added, in having continued these meetings patiently, they realized that the nurses were enjoying the meetings and were moving toward the HEC model gradually. The last presenter spoke about a trial to introduce HEC theory into a practicing Chemotherapy Nursing Course. The next study meeting will be held in February, 2020, with the topic of “More efforts to develop study meetings at one’s own working place.”
The praxis research course on HEC and the pre-praxis research course to understand HEC theory are moving forward. Each time in the process, nurses reached a new realization in terms of HEC.
In the foreword for the translation of her 2008 book into Japanese, Dr. Newman wrote to us:
“… The search leads
in different directions
and along new paths
To unanticipated horizons.
Stay with the search.
Understanding will come
( Margaret Newman, June 2009)
The following are two videos from the October 2019 meetings.
*About the contributors
Emiko Endo, PhD, RN
Chair, Board of Directors and Professor Emerita, Musashino University
Mari Mitsugi, PhD, RN
Vice-chair of the Board of Directors and Associate Professor, Musashino University, Faculty of Nursing
Tomoko Miyahara, PhD, RN, OCNS
Vice-chair of the Board of Directors and Chief of Outpatient Clinic Kanagawa Prefectural Ashigarakami Hospital
Satoko Imaizumi, PhD, RN
Secretary-general and Professor, Tokai University, School of Medicine, Faculty of Nursing
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.
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.
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.
Warner, M. (2002). Postscript to “A Developmental Model of Health and Nursing” by F. Moyra Allen. Journal of Family Nursing, (8)2, 136-139.
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.
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.