Fostering dialogue about practice knowledge development in a DNP Curriculum; Opportunity for theory innovation?

Guest Contributor: Lydia D. Rotondo, DNP, RN, CNS, FNAP

The practice doctorate in nursing developed in response to an increasingly complex healthcare landscape that requires additional competencies for 21st century advanced nursing practice. Complementing traditional graduate (MS) specialty curricula, the Doctor of Nursing Practice (DNP) program of study incorporates additional curricular content in the areas originally detailed in the 2006 DNP Essential domains (now integrated into AACN’s 2021 Essentials). DNP students complete a summative scholarly practice inquiry project that is theoretically-guided and evidence-based, demonstrating synthesis and application of the tools of clinical scholarship learned throughout the DNP program.

Particularly relevant to the design of DNP projects is the critical importance of context and the application (or adaptation) of best evidence (when available) to specific practice settings or specific populations. As context experts DNPs utilize systems thinking to design, implement, and evaluate interventions within complex adaptive systems revealing new understandings about health care delivery, the healthcare experience, and the role of DNPs as change agents and clinical scholars.

Fifteen years after the release of the DNP Essentials, appropriate focus is now on evaluating the impact of DNP practice on healthcare systems and health outcomes. As a practice discipline, however, there remains little attention by nursing academe regarding the potential impact of the practice doctorate on the discipline of nursing. In other words, how will the growing cadre of DNP-prepared nurses be leveraged to advance the discipline? In today’s interdependent, knowledge–based, digital world, how will advancing the discipline be defined and measured in the coming decades? What additional scholarly tools and curricular content will DNP students need to begin to answer these questions?

As doctoral-prepared nurses, DNPs share stewardship with other doctoral-prepared nursing colleagues to generate disciplinary knowledge. Yet, discussion about DNPs as knowledge producers and theory innovators remains largely unexplored. Scholarly treatment of knowledge generation in nursing practice is not a new phenomenon and has, in fact, been posited and published by several nursing theorists for decades. However, the introduction of the latest iteration of the practice doctorate in nursing, now in its second decade, with more than 36,000 enrolled in DNP programs and close to 8,000 graduates, has not sparked interest among leaders in DNP education to approach practice epistemology from the DNP lens.

Moreover, with a de-emphasis on philosophy of science and theory and stronger attention to evidence-base practice in DNP curricula, DNP programs as currently designed may lack sufficient educational grounding to engage in practice theory development. This further impedes the opportunity for scholarly discourse on practice knowledge production specifically and doctoral roles in nursing knowledge generation more broadly. While the promotion of evidence-based practice among all health professionals is useful to reduce clinical variation in care, there remains nascent opportunity for DNPs to consider how their scholarly work can produce practice-based evidence- knowledge that both improves care outcomes for individuals and populations and illuminates the contributions of nurses to healthcare.

In 2019, we developed a theory and conceptual foundations for clinical scholarship course at the University of Rochester School of Nursing in which students explore the historical and philosophical roots of the practice doctorate in nursing and nursing as a practice discipline. Our early efforts were inspired by Dr. Pamela Reed, Professor at the University of Arizona College of Nursing, whose considerable contributions in the area of practice epistemology provided a framework for course development. In an early course assignment, students are asked to create a concept map using the four nursing metaparadigm concepts to describe their philosophy of nursing. Students present their maps in class which encourages rich discussion about the nature of nursing knowledge related to their role in health care and health/wellness promotion. What is particularly striking is that for many students, this course is their first exposure to nursing’s theoretical grounding and opportunity to reflect on their professional practice from a disciplinary perspective. Several DNP student exemplars from the spring 2021 semester are included below with permission.

Exemplar 1 – Sarah Dunstan, University of Rochester School of Nursing DNP student

Circumnavigating and persevering through life’s most challenging roadblocks, the nurse dutifully guides the most weary and vulnerable of travelers towards safety and solace, both physically and emotionally. Committing to the vision of “Ever Better” and the pursuit of optimal patient wellness, nurse leaders are tasked with the responsibility of advancing the field and creating the new standards of care for the future.

As depicted above, my philosophy of nursing is best explained in the context of a journey. The person, or patient, is represented as a vehicle. Similar to vehicles, each patient is a unique make and model, some with more miles or more baggage than others. The nurse navigating the vehicle must carefully consider these differences and individual patient needs when mapping out the patients’ journey to health. The map, or environment, is laden with roadblocks or barriers to optimal wellness. The barriers may be geographical, financial, cultural, psychological, or physical. Whether few or many, these roadblocks may delay or completely inhibit the patient from reaching their health care goals. The metaparadigm concept of nursing describes the individual caregiver at the bedside that assists the patient around and through these various states of illness in order to reach the ultimate destination of optimal wellness. The destination “Health” is malleable and ever evolving, as depicted with multiple possible end points marked on the map. Health is defined by and dependent on the individual patient and their own informed healthcare goals, as optimal wellness is not always defined as the absence of disease.

The map is in the hands of the DNP-prepared nursing scholar. As a leader and nursing expert in the field, the DNP is the visionary change agent tasked with closing the practice-theory gap at the bedside in the clinical setting. DNPs are the cartographers for the future of nursing, responsible for defining clinical scholarship in nursing, creating, upholding, and disseminating the proposed standards of the discipline.

Exemplar 2 – Christine Boerman, University of Rochester School of Nursing DNP student

My nursing theory and paradigm is composed of many moving parts that work interchangeably and without each of these elements working together, the discipline of nursing would not be complete. My nursing theory is illustrated via the gears that work together in order to create the full working “maChinne” of nursing discipline.

Exemplar 3 – Christina D’Agostino, University of Rochester School of Nursing DNP Student

The figures included within the map are all intended to mirror constellations within that sky, represent the person, the environment and one’s health. Centered at the bottom of the map, shining its beacon of light on the sky is nursing, represented by two hands which provide the foundation. Nursing is a global role. As people around the globe all look up to the same night sky, all people share the benefits of the nursing domain.

My personal philosophy of nursing is a holistic approach of providing culturally-sensitive care for individuals, regardless of locality or ethnicity while being mindful of the interconnectedness that involves the person, environment, and one’s health as the recipient of that care.

Exemplar 4 – Victoria Mesko, University of Rochester School of Nursing DNP Student

My personal philosophy of nursing is: Caring for individuals with a holistic approach, striving for wellness within the community and the world. Along with all of the skills that nurses develop, what sets nurses apart is their caring nature. Nurses have an all-encompassing view of our patients’ mind, body, and spirit. Nurses see patients in the context of their environment and are able to propose treatments that will consider all of the influences on patient’s lives. Nurses take into account all of the meanings that “health” can have to a person, not just the absence of disease, but a sense of wellness even if they have disease. In my map, there is no one nursing domain that is more important than another, as they all have an influence on patient care. The interlocking circle of different hands represents nurses working to form relationships and connections between patients, the community and the environment across cultural lines.  

Exemplar 5 – Kalin Warshof, University of Rochester School of Nursing DNP Student

My philosophy of the nursing discipline is the utilization of the art and science of nursing care, compassion, and practice interventions to enhance the health and well-bring of the person, within their individual environmental context, including social determinants, culture, and beliefs. The metaparadigm map depicts the person at the center of the diagram, with nursing as a discipline, nursing interventions and compassionate care contributing to the improvement of health and well-being of the person. This is evident by the upward arrow, with health and well-being above the person, portraying the upmost importance to the person and nursing. The background in light blue, labeled the environment, indicates that the person, nursing discipline, health, and well-being interpretation and improvement occurs within the context of the personal environment. My philosophy of the nursing discipline is consistent with the Doctor of Nursing Practice Essentials I objective focusing on the whole person and their interaction with the environment to improve health and well-being (American Association of Colleges of Nursing [AACN], 2006).

Exemplar 6 – Kara Mestnik, University of Rochester School of Nursing DNP Student

Individual nursing philosophy is shaped overtime by individual practice, and life experience. My philosophy has shifted over the past twenty years, I have gained vast clinical experience and growth in intrapersonal interaction and relationships. The term balance is often sought for and emphasized as an indicator of health and wellness, comparable to the concept of homeostasis. My personal philosophy of Nursing is the ability to navigate all facets of human life despite the magnitude of directional force that may attempt to imbalance ones mental, physical, and spiritual well-being. Refer to (figure 1) for metaparadigm map. Consider the patient the pivot at the center of the compass, with a multidirectional view of their own life and well-being, while the nurse is the hand that holds the compass. The hand holding the compass helps both align and balance the direction the patient is aiming to travel. The nurse becomes both the navigational guide and the stable hand that allows for balance to be achieved at any given period or direction in time. The hands holding the compass indicate a personal connection with the patient as well as an oversight into the larger picture in which patients may travel. The acquired achievement of balance despite a directional force is guided by the hands that allow for health and wellness optimization.

About Lydia Rotondo

Lydia Rotondo

Lydia Rotondo, DNP, RN, CNS, FNAP is the associate dean for education and student affairs and director of the doctor of nursing practice program at the University of Rochester School of Nursing. She received her DNP from Vanderbilt University, MSN from the University of Pennsylvania, and BSN from Georgetown University. Lydia is a 2018 AACN Leadership in Academic Nursing Fellow and has actively contributed to the national dialogue on DNP scholarship and curriculum development through presentations at AACN’s doctoral education conference and publications.

Peace and Power Process in Action in Nursing Department Meetings: A Case Study

Jacqueline Fawcett
Lisa Sundean
JoAnn Mulready-Shick

Academic department structures and governance tend to reflect university–wide structures and governance that are typically characterized as hierarchical, competitive, and power-over/power as control. The decision to revise a department of nursing by-laws provided an opportunity to transition to adopt a more egalitarian structure with shared governance between the department faculty and the department and college administrators.

Consequently, during Academic Year (AY) 2017-2018, the faculty of a department of nursing agreed to a new governance structure that involved development of by-laws for the department. Three faculty members then agreed to serve on a committee to revise our department by-laws. The By-Laws Committee members first considered our previous traditional use of Robert’s Rules of Order for department meetings and recognized those rules as a patriarchal power-over/power as control structure. As we questioned assumptions and traditions, we determined that Robert’s Rules no longer served us and did not support our desire for a more progressive, egalitarian structure of group process and shared governance. We therefore suggested using the Peace and Power process .

The purpose of the Peace and Power process is to guide group process “in cooperative and peaceful ways, and in ways that challenge the status quo and lead to social and political change in the direction of equality and justice for all . . . . the process . . . also [is] . . . .a means of creating healthy group interactions and promoting health by reducing stress and distress created by hostile conflict” (Chinn & Falk-Rafael, 2015, p. 62). The theory of Peace and Power “provides a framework for individuals and groups to shape their actions and interactions to promote health and well being for the group and for each individual, using processes based on values of cooperation and inclusion of all points of view in making decisions and in addressing conflicts. Based on the processes . . . individuals and groups can make thoughtful choices about the ways they work together to promote healthy, growthful interactions and avoid harmful, damaging interactions” (Chinn, 2018).

Perhaps most important is that the Peace and Power process is a way to operationalize power-as-freedom, that is, freedom to knowingly participate in change (Barrett, 2010) instead of power-over/power as control. Thus, the emphasis is on the solidarity of our department learners (aka faculty, staff, and students) rather than power held over the group by any one individual or authoritative body.

Following successive drafts and revisions based on faculty feedback, the department by-laws were approved by the department faculty in Spring 2019 and were implemented in Fall 2019. The by-laws included the stipulation that department meetings would be conducted using the Peace and Power process. Faculty also recognized their need to engage in new learning about this innovative method .

The faculty agreed that the Peace and Power process reflects the shared values and commitments formed by the group. Specifically, the faculty agreed that the Peace and Power process is consistent with our department values (Integrity, Inclusion, Diversity, Transparency, Transformation, Resilience, Relationships, Accountability, Collaboration, Equity, and Excellence) and a department goal to implement the department by-laws. Noteworthy is that the department values are consistent with two of the university-wide values–transformation and engagement. The Peace and Power process also supports the initial implementation efforts within the department and the entire university to eliminate structural racism and to promote diversity and inclusion. Incidentally, the transition to Peace and Power process as a means to shared governance and a healthy work environment is supported by the recent release of the Future of Nursing Report 2020-2030: Charting a Path to Achieve Health Equity (National Academy of Medicine, 2021). Specifically, among the 54 sub-recommendations is an emphasis on improved nursologist well-being through healthy work environments that include structural, socio-emotional, justice, and policy foci.

During the first department meeting of Fall 2019, faculty were intentionally reminded of the new by-laws and the Peace and Power process by members of the By-Laws Committee. Implementing the Peace and Power process in the department involves rotating leadership of monthly department meetings. This means that the department chair does not chair each department meeting; instead, after a slow start in AY 19-20, by AY 20-21, a different faculty member volunteers to convene and lead each meeting. Furthermore, the department meetings operate within values-based decision-making and mutual agreement of best options by means of consensus building discussions during department meetings and anonymous online voting as needed, such as elections to committees and final decisions about curriculum and programs. Moving critical voting decisions to the anonymous online format extended over a short period of time, ensures that all voices are included and that votes are not potentially coerced by peer pressure.

During AY 2020-2021, the By-Laws Committee members engaged in a series of micro-learning sessions to raise awareness about the content and meaning of the by-laws, including a more thorough explanation of PEACE powers (Chinn, 2013). A Fall 2020 micro-leaning session focused on differences between discussions that could be characterized as diversity or divisiveness. This session was added to the meeting agenda and presented by the department chair. The Spring 2021 micro-learning sessions focused on familiarizing faculty more thoroughly with the content of and more fully operationalizing the Peace and Power process. One micro-learning session focused on the outcome of the Peace and Power process as “movement that is ever shifting to the direction of peace” (Chinn, 2013, p. 10), along with the meaning of the word, PEACE, which is the acronym for five powers:

  • Praxis—synchronous reflection and action to transform the world
  • Empowerment—growth of personal ability to enact one’s will in the context of love and respect for others
  • Awareness—growing knowledge of self and others
  • Cooperation—commitment to group solidarity and integrity
  • Evolvement–commitment to deliberate growth and change (Chinn 2013, p 10 ).

The PEACE powers are operationalized when values and commitments are formed by the group (i.e., the faculty), when department meeting leadership rotates among the faculty, and when values-based decision making and mutual agreement of best options occurs.

During the Spring 2021 semester, each department meeting concluded with a request for reflections. Examples of reflection prompts, which were meant to prompt reflections about the process of Peace and Power during department meetings, are:

  • Please share an appreciation for someone or something that has happened during this meeting today.
  • What could have been different in today’s meeting and how would future meetings be shaped?

Faculty were asked to place their answers/reflections in the zoom chat box (department meetings throughout the pandemic were held via zoom technology). Examples of responses are:

  • I appreciate the discussions today which were very civil and constructive.
  • I appreciate the discussions [of] awareness of individuals and their feelings.
  • I enjoy listening to others perspectives and thoughts.
  • I appreciate the open communication and problems solving about common challenges (e.g., email overload for everyone!)
  • The meeting today was a very good example of the Peace and Power Process, so thank you to everyone for your contributions to our dialogue.
  • Appreciate the positive communication and openness to hear all voices
  • Thank you to everyone for sharing their thoughts on this topic…a good question for us to ponder further is how do we operationalize self- care and meet our department goals?

The By-Laws Committee members recognize the ongoing nature of implementation of the structural change for the department. Accordingly, future plans are to create a standing agenda item with the intention to further sustain the Peace and Power process at the monthly meetings. Two specific future actions include additional micro-learning sessions and ending each department meeting with a reflective practice.

We gratefully acknowledge the excellent contributions of undergraduate nursology learner Stephen Miller (BS, December 2021) and PhD nursology learner Julianne Mazzawi (PhD, June 2021) to the micro-learning sessions.

References

Barrett, E. A. M. (2010). Power as knowing participation in change: what’s new and what’s next. Nursing Science Quarterly, 23(1), 47–54. https://doi-org./10.1177/0894318409353797

Chinn, P. L. (2013). Peace and power: New direction for building community. Jones & Bartlett

Chinn, P. L. (2018, August 23). Peace & Power. https://nursology.net/nurse-theorists-and-their-work/peace-power/ See also https://peaceandpowerblog.org/

Chinn, P. L., & Falk-Rafael, A. (2015). Peace and power: A theory of emancipatory group process, Journal of Nursing Scholarship, 47(1), 62–69.. doi: 10.1111/jnu.12101

National Academy of Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. https://nam.edu/publications/the-future-of-nursing-2020-2030/ i

Contributors

Co-contributors with Nursology.net team member Jacqueline Fawcett

Lisa J. Sundean, PhD, MHA, RN is an Assistant Professor at Fairfield University and formerly at the University of Massachusetts Boston. She is Board Chair of the CT Center for Nursing Workforce, Board Member of the CT League for Nursing, a consultant for the Center to Champion Nursing in America, a national leader with the Nurses on Boards Coalition, and a Fellow in the New York Academy of Medicine. Her research and scholarship focus on nurses in board governance roles, health policy, and nursing workforce development. Dr. Sundean is a Daisy Foundation Award recipient for Extraordinary Nurses.

JoAnn Mulready-Shick, EdD, RN, CNE, ANEF, is a Clinical Professor in the Department of Nursing, UMass Boston, and a Nurse Scientist at the Boston VA Healthcare System. Her scholarship centers on nurse educator development, student success, and clinical education innovation.

Culture Shock, Grief and Nursing Theories

Contributor: Aisha Chahal, MSN, CMSRN

Culture shock is a state where people experience the stages of honeymoon, frustration, adaptation and acceptance. It is an intense feeling that follows the grief process. I had first-hand experience with all these stages of culture shock when I came to the land of opportunities, the United States of America, in 2012. I started my first job as a bedside Registered Nurse. It felt like I had accomplished the purpose of my life by getting a job at Yale-New Haven Hospital. Yale seemed like a place in heaven. It was beautiful to see that people could order food over the phone and a beautiful tray with fancy food items arrive at the bedside within a few minutes. Nurses only had four to five patients instead of the thirty that I had cared for earlier in my career. Patients had call bells and people responded to those bells. There were computers, scanners, medication dispensing machines and robots to deliver supplies. I was in the honeymoon phase.

But then came frustration as food items were thrown away if patients did not like them. Computers took away my time to be with my patients. The machines, robots, and technology had turned people into objects. I barely had time to know my patients or colleagues on a personal level. But I adapted and accepted by learning to fit into the situation. I learned that all this was crucial for patient safety, evidence-based practice, patient satisfaction scores and reimbursements.

After 8 years, I relived the stages of culture shock while learning in-depth about nursing theories in my doctorate program and educating nursing students on nursing theories at the same time. Nursing theories fascinated me and sparked my interest to learn more about the focus and identity of nursing discipline. Learning new concepts, making connections, discussing with nurse educators and colleagues, listening to some of the theorists themselves send me into the honeymoon phase once again.

I was determined to start my clinical day with the students by discussing a nursing theory. With all enthusiasm, I showed up at 6.45 am to meet my students and talk about nursing theories starting with Florence Nightingales’ framework and Watson’s Caring theory before we see our patients. Then once again, I experienced the frustration phase as students were disinterested, inattentive, unpassionate, and incurious which was exactly the opposite of what I was prepared for. I stopped the talk in the middle and let them start their routine patient assessments. I was deeply saddened by reliving the experience as I knew that I would have to adapt and accept the reality just like I did a few years back.

But this time, instead of accepting, I felt challenged to change the norm. Students viewed the content of nursing theories as dry, complicated to understand, of no practical use, and grade-lowering. The next week, I planned to discuss Neumann’s System Model with the vision that students can feel and experience the essence of the theory and view clients as an open system responding to various stressors in the environment. Instead of theory, I started our discussion with the theorist, Betty Neumann. We discussed how she grew up on a farm and took care of her sick father who died at the age of 36, which created her passion for nursing. Her mother was a devoted self-taught midwife. We talked about her academic, professional, and volunteer work. I shared images and videos depicting her life and vision. Then we discussed her vision of creating the nursing theory and related concepts of the theory.

Students were completely engaged, asked questions, and seemed ready to minimize the theory-practice gap. In the post- clinical conference that day, students were able to identify intra, inter and extra-personal stressors for their clients. They also identified the interventions they performed or planned to perform at primary, secondary and tertiary levels of prevention. They developed a deeper connection to the theorist, theory, clients and themselves. They identified who they are in relation to the focus of nursing discipline. After that week, we continued discussing a theorist and a nursing theory each week before clinical and each student-patient interaction is now guided by the concepts of that theory. Every week, we now look forward to our discussion of nursing theories and viewing people from different perspectives to provide competent and compassionate nursing care

I invite all the nursing students, nurse educators, nurse scholars, and nurse researchers to prevent nursing theories from following the similar pattern of stages of culture shock and grief. Instead of frustration, anger, denial, adaptation, and acceptance, our collaborative efforts can lead to a focused nursing discipline in which every nurse is changing lives by using the strong foundational pillars of nursing theories.

About Aisha Chahal

Aisha Chahal, MSN, CMSRN, is a doctoral nursing student in the Online Nursing Education EdD program at Teachers College, Columbia University. Aisha has completed her Masters of Science in Nursing Education in 2019. She is a clinical instructor at Western Connecticut State University. She has have 10 years of clinical experience in medical-surgical nursing. Her passion is exploring effective teaching-learning strategies to educate nursing students on Transcultural Nursing.

Guest Post: Aesthetic Knowing 101

Contributor: Peg Hickey, MSN, RN

For three years, I have been an adjunct clinical instructor. And thanks to a recent course on nursing theory, I have been able to closely examine my own understanding of nursing knowledge and my commitment to the nursing profession. The most extraordinary part about teaching is having the opportunity to impart this knowledge to the future generation of nurses. Students’ primary goal is to focus on the empirical aspects of nursing; however, my unwritten objective for the students is to define nursing by their connection to the human spirit. As an educator, this involves integrating learning experiences related to the patterns of knowing (Chinn & Kramer, 2018).

Day 1

One-by-one, I greeted my six students as they arrived in the lobby on their very first day of their clinical rotation for Fundamentals of Nursing. Their nerves were palpable: they didn’t speak to me or each other and nobody smiled (yes, I have learned to recognize a masked grin by observing the eyes and foreheads). I have never been accused of being a threatening presence in any way, shape, or form, yet the students stood before me with fear in their eyes. (Flashback to my own experiences in nursing school from the early ‘90’s). I was able to discern the truth of this moment and acknowledge the impact of feelings on their very first clinical experience. My aesthetic knowing of being able to recognize a deeper meaning to their human experiences of anxiety and fear laid the foundation for an enriching nursing experience for all of us. I was helping to build the future of nursing (Nursology.net, 2021).

Commitment

First experiences are memorable for students. Some may consider their initial attempts at nursing to be insignificant and only equate success with tasks: starting an IV, changing a wound dressing, or administering medication. Of course, on our first day we didn’t perform any of those tasks, but one student did display an intangible act of commitment: she followed through with a patient’s request for tissues. Keep in mind, this was her first clinical exposure; we were only minutes on the unit in and in the midst of a tour. Yet during those moments, this student spoke to a patient, asked a staff member where the tissues were, located them, and carried them with her until the tour ended, when she brought the tissues to the patient. At face value, simplicity. Yet it was important for her to know that she performed critical acts of nursing in this seemingly simple task: communication, commitment, and caring. Baillie (2007) reminds us of Henderson’s definition of commitment: Nurses who “responded to patients’ needs in a timely manner were perceived as caring; patients were dissatisfied when nurses apparently forgot patients and their needs” (p.6). I complimented my student, and her smile was beaming beneath her mask.

Compassion

The following week, my students were assigned to obtain a patient history, a conventional start to the development of communication and interpersonal skills. During post-conference, one student reported that she was unable to complete the assignment; instead, she had connected with a young woman with a terminal disease who requested a foot rub. She decided to fulfill the wishes of the patient and put off asking about her medical history, demonstrating an appropriate and meaningful prioritization of care. The lesson in post-conference focused not on an incomplete assignment, but on the ability of nurses to recognize significant and meaningful moments and to take action (Chinn & Kramer, 2018). This student completed a patient history the following week and that was OK with me.

Caring

During an attempt at a physical assessment, my student and I encountered a Mandarin-speaking patient who was visibly distressed. While using an audiovisual interpreter, our patient kept repeating a phone number over and over and over. The interpreter told us “she wants to call her husband.” Recognizing that nothing else mattered to this patient at that moment, we stopped our assessment, dialed the number, and the patient spoke to her husband. Following their conversation, she was smiling, grabbing to hold our hands, and visibly relieved that we understood. This encounter allowed us to distinguish between the science and art of nursing and to feel how the experience of being understood is both inspiring for the patient and gratifying for the nurse.

What better way to introduce the aesthetic pattern of knowing by calling it out in the clinical setting and defining what it is: “An intuitive sense that detects all that is going on and calls forth a response, and you act spontaneously to care for the person or family in the moment” (Chinn & Kramer, 2018, p. 142). Another idea for incorporating the meta-paradigms in nursing education is to change the course titles “Fundamentals” and “Foundations” to “Aesthetic Knowing in Nursing” so beginning students feel empowered by authentic nursing actions of communication, commitment, and caring behaviors.

The first introduction to a clinical experience lays a crucial foundation for nursing students. My hope is to impart a meaningful impression about the interpersonal nature of nursing; one they will be reminded of when they miss that first IV or administer a medication late. My students are off to a great start and I hope they know that every week when our clinical day ends, I am smiling beneath my mask.

References

Bailie, L. (2007). An exploration of the 6Cs as a set of values for nursing practice. British Journal of Nursing, 26(10), 558–563. https://doi.org/10.12968/bjon.2017.26.10.558

Chinn, P. L., & Kramer, M. K. (2018). Knowledge development in nursing: Theory and process (10th ed.). Elsevier.

Henderson, A., Van Eps, M. A., Pearson, K., James, C., Henderson, P., & Osborne, Y. (2007). “Caring for” behaviours that indicate to patients that nurses “care about” them. Journal of Advanced Nursing, 60(2), 146–153. https://doi-org.ezproxy.cul.columbia.edu/10.1111/j.1365-2648.2007.04382.x

About Peg Hickey

Peg lives in Queens, NY and has been a nurse since 1993. She is currently a nurse educator at Columbia University Medical Center working on a program designated to incorporate diabetes-related simulation into the curriculum for medical and nursing students. Peg is also an adjunct instructor at Hunter-Bellevue and Pace University Schools of Nursing.

It’s Time We Raise Nursologists!

Report from the 2021 Virtual Nursing Theory Week

Contributors:
Christina Nyirati
Sharon Stout-Shaffer

At the time of the 2021 Virtual Nursing Theory Week, Christina Nyirati and Sharon Stour-Shaffer presented the baccalaureate curriculum they designed and now implement at Heritage University located on the Yakama Reservation in Washington State. This is the only session that was recorded during the conference; it represents the value of nursing knowledge in shaping the present and future of nursing as a discipline. The following is a brief description and a video of their presentation.

The first Heritage University BSN Program Outcome reads “The Graduate of the Heritage University BSN Program explains how nursing’s fundamental patterns of knowing –personal, aesthetic, ethical, empirical and emancipatory –contribute to understanding the complexity of nursing care in the treatment of human response”.

Carper’s (1978) Fundamental Patterns of Knowing in Nursing is the foundation of the BSN Program. Freshmen study discrete courses in each of Carper’s fundamental patterns: personal, aesthetic, ethical, and empirical knowing. The Personal Knowing course is founded on personal knowing as a precondition for nursing care. Students practice various methods of reflection to develop personal knowing in every moment of nursing care. The Aesthetics of Nursing course is grounded in assumptions from Nightingale’s theory of nursing arts and aesthetics as a fundamental pattern of knowing in nursing. An experiential course, based in the principles of performing arts, the focus is on the act of care; Students explore and apply dramatic arts foundational to holistic nursing care competencies. The Ethical Knowing course emphasizes the practice of ethical comportment in nursing care. The Empirical Knowing course students introduces students to fundamental theories, concepts, evidence, and competencies pertaining to generation of nursing knowledge.

Senior year features the community as the unit of nursing care, and is founded on Chinn and Kramer’s (2019) emancipatory knowing in nursing. The Policy, Power & Politics of Nursing course focuses on the professional nurse role in taking responsibility for shaping social policy. The two Community Oriented Nursing Inquiry and Practice and the Community Based Participatory Research courses center on principles of socially just reflective action to overcome health inequities.

Faculty developed rubrics to evaluate how students integrate the fundamental patterns of knowing nursing into clinical practice. Students complete reflective writing assignments during clinical practice each semester from sophomore through senior year.

About the contributors:

Christina Nyirati, RN, PhD

Christina Nyirati is Professor of Nursing at Heritage University on the Yakama Nation Reservation in Washington, where she serves as the founding Director of the BSN Program. Dr. Nyirati came to Heritage from Ohio University and The Ohio State University, where she directed the Family Nurse Practitioner (FNP) Programs. She practiced more than 30 years as an FNP in primary care of vulnerable young families in Appalachian Ohio, and worked to reduce dire neonatal and maternal outcomes. Dr. Nyirati challenges FNP educators to consider nursing knowledge as the essential component of the FNP program as the Doctor of Nursing Practice (DNP) evolves and becomes requisite for entry into advanced practice. Now at Heritage Dr. Nyirati prepares nurses in an innovative undergraduate curriculum faithful to the epistemic foundations of nursing. Two cohorts have graduated from the Heritage BSN Program. They openly proclaim and use their powerful nursing knowledge to correct inequities in their communities.

Sharon Stout-Shaffer, PhD, RN

Sharon Stout-Shaffer, PhD, RN, Professor Emerita, Capital University, Columbus, Ohio; Adjunct Faculty, Heritage University, Toppenish, Washington; Nursing Education Specialist, S4Netquest, Columbus, Ohio. Sharon has over 30 years of experience in educational administration and teaching in both hospital and academic settings. Her career has focused on developing education based on a nursing model that includes concepts of holism and healing.

Her Ph.D. in Nursing from The Ohio State University focused on the psychophysiology of stress and relaxation-based interventions to promote autonomic self-regulation and immune function in people living with HIV. She has attained certification in Psychosynthesis, Guided Imagery, and more recently, the Social Resilience Model; she has presented numerous papers on integrating holism into curricula as well as caregiver wellbeing and resilience including Adelaide, Australia, 2011; Reykjavik, Iceland, 2015; American Holistic Nurses Association Phoenix, 2016 & Niagara Falls, 2018.

During her tenure as Director, Post-Graduate Programs at Capital University, Sharon taught the graduate theory course and co-developed a theoretically grounded holistic healing course as the foundation for graduate study; the graduate program has been endorsed by the American Holistic Nurses Credentialing Center. Since her retirement, she has co-developed and implemented numerous educational interventions designed to develop the Therapeutic Capacity of working nurses and nursing students. This work includes concepts of centering, compassion, managing suffering, the psychophysiology of resilience and essential contemplative practices to develop stress resilience, deal with moral distress and promote long-term wellness. She is currently teaching courses in Personal Knowing and Nursing Ethics for undergraduate nursing students at Heritage University. Her most recent publication is dedicated to holistic self-care and self-development. (Shields, D. & Stout-Shaffer, S. 2020). Self-Development: The foundation of holistic self-care. In Helming, M., Shields, D., Avino, K., & Rosa, W. Holistic nursing: A handbook for Practice (8th). Jones and Bartlett Learning, Burlington MA.)

Foundations of Nursology Syllabus: Another New Resource on Nursology.net

Coauthor: Rosemary William Eustace, PhD, RN, PHNA-BC

We, along with all members of the nursology.net management team, are very pleased to offer another resource for nursology – the Foundations of Nursology syllabus. The syllabus is offered in conjunction with our teaching strategies resources (Fawcett, 2019) as well as other nursology website resources about nursing conceptual models, grand theories, middle-range theories, situation-specific theories, and philosophies.

The syllabus is offered to all interested nurse educators in academic and practice settings. Our intent in developing the syllabus was to provide a starting point for the teaching of nursology discipline-specific knowledge, with emphasis on nursology philosophies, conceptual models, and theories. We envision the syllabus as a key foundational tool for teaching and learning the essence of the philosophic, conceptual, theoretical, and application knowledge of our discipline as a foundation for transforming health care and health care delivery.

The syllabus has been designed to address the Future of Nursing documents and various nursology organizations initiatives as well as accreditation criteria for nursology programs (such as the National League for Nursing accreditation criteria for all programs and the American Association of Colleges of Nursing criteria for undergraduate and for graduate programs).

A sample 15 week outline is provided to introduce nursology students to the history and contemporary status of the discipline of nursology and the value and approaches to nursology theory-guided practice, quality improvement projects, and research. Depending on program level, students will use, translate, and/or develop new knowledge in coming to know and engage individuals, families, and communities in the praxis of nursology and wellbecoming, as well as coming to know healthcare systems. The syllabus provides course objectives, suggested methods of instruction, course delivery methods, examples of recommended readings and resources, examples of learning activities, and a sample topical/content outline and course schedule.

We invite readers to post any questions or comments they may have about the syllabus and to recommend development of resources for any other nursology theory-related teaching needs that need to be addressed.

Reference

Fawcett, J. (2019, August 20). How to teach nursology: A new resource on nursology.net. Blog. https://nursology.net/2019/08/20/how-to-teach-nursology-a-new-resource-on-nursology-net/

Trauma-informed teaching in the era of COVID-19

See Dr. Foli’s “Middle Range Theory of Nurses’ Psychological Trauma

2020 was the year I applied trauma-informed approaches to my teaching. This was the year I learned being kind and compassionate were also good pedagogical practices. In previous years, I have been recognized as an “award-winning” teacher. I did all the things a good teacher in a research-intensive university was supposed to do: Incorporated students into research studies that also met course learning objectives, developed innovative teaching/learning methods, integrated solid student accountability into my syllabi, and so forth. And I wasn’t an uncaring teacher before 2020, but perhaps I wasn’t quite so compassionate. Perhaps I was fearful that by showing compassion, I would be less likely to hold students to a high standard of performance.

2020 was different. Many of my master’s students enrolled in the theory course became ill with COVID, or their family members did, or they endured significant traumas or confronted and processed past traumas. Several of the students were frontline workers, faced with COVID on a daily basis. This year, I used the resources on nursology.net by asking them to read two blogs and critique them in their discussion forum – many selected the blogs on issues the nation confronted this year, especially racism and racial disparities. This exercise brought theory to them in a way that no textbook ever could. These blog-writing nursologists were living narratives of those actively advocating for nursing knowledge and theory. As the students prepared their final papers, I saw this year’s learning was at a higher level than previous years and in the context of a virtual platform. Students, preparing for an advanced practice role, stated, “I think differently now.” Nursing knowledge and the distinction between nursing and medicine at the nurse practitioner level has never been more important for us as a discipline.

As a teacher, I learned that I didn’t have to diminish student accountability. But in order for them to take responsibility, I had to gain their trust by authentically showing compassion. Each week, I crafted an email to the class with reminders and updates, and this year, a bit more. I offered hope by reminding them the pandemic would be over at some point. I offered validation that what they were accomplishing wasn’t easy. And I offered them purposeful access to me through technology if they got “stuck.” When I would meet with students, they would thank me for these emails, describing how they would revisit them if they felt “down.” Several wrote me messages of gratitude and described how they looked forward to them every week. In a trauma-informed way, I created a transparent, safe space and established a connection as their teacher. I know now that listening, recognizing trauma, taking time to meet one-on-one, reaching out to “missing in action” students to inquire if they’re okay, giving grace on assignments, and still holding students to a high level can be compatible, and more than that, best practices in trauma-informed education.

Guest post: “Let’s talk theory”; Perspectives from the Associate Degree Nursing World

Contributors:
Emma Crocker, DNP, RN
Patrick McMurray, BSN, RN
Shelley Mitchell, BA, BSN, MS, RN
Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN,
CNE, FAEN, PhD Candidate
Timothy Joseph Sowicz, Ph.D., NP-C

Authors’ Disclosure:
The authors would like to note that all members
put in equal amounts of work in this project. 


Nursing theory is the foundation of our practice, the way we differentiate nursing from other professions and disciplines. As readers of the Nursology blog, we assume that we do not need to discuss why nursing theory is essential to our practice. We would instead like to call your attention to a concerning trend – the lack of nursing theory in associate degree nursing programs. Please note that we are making generalizations based on our experience of graduating from and/or working in associate degree programs. There is a paucity of current research surrounding theory in associate degree programs.

According to the National Council of State Boards of Nursing (NCSBN), in 2019 50% licensure applicants were graduates from ADN and diploma schools of nursing; this number has historically been even higher. In other words, half of our newly practicing nurses may not have foundational knowledge of nursing theory to apply to their practice, further widening the theory practice gap. If theory content is not being integrated into the initial nursing education for half of our profession, how can we convince them it is important, let alone essential to their praxis? 

 We suspect that several factors contribute to the lack of theory in some ADN programs. Many nursing education programs are externally accredited by agencies such as the Accreditation Commission on Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Previous accreditation standards required nursing education programs to explicitly name the nursing theorists that guide the curriculum. This emphasis has been removed from current standards, allowing nursing education programs to use general educational theorists such as Knowles Adult Learning Theory.

 Another critical point is that ADN programs do not usually require doctoral-level preparation for nurse faculty. According to the 2018-2019 National League of Nursing’s annual survey of nursing schools, 74% of schools replied that it was “somewhat difficult” or “challenging” to hire new faculty. The primary reasons cited were an inability to offer competitive salaries and a lack of qualified candidates. ADN programs usually have fewer financial resources and do not have research missions. Therefore, they have difficulty attracting and retaining faculty with research-focused doctorates and higher educational credentials. This may result in ADN faculty who do not have the knowledge and/or experience with integrating theory into pre-licensure education.

Without the requirements of accreditation and with faculty who are not supported and enabled to the inclusion of nursing theory, it is our anecdotal observation that many ADN programs have dropped the emphasis on nursing theory. We have personally worked in nursing education programs where theory is either given cursory attention or not included in the curriculum at all. This has resulted in removing or deemphasizing nursing theory from a large portion of the nursing professional population.

 Nursing theory is currently situated in a place where it feels like it only belongs to some nurses, those embedded in academia or research, never practice. This has created a culture where most nurses and students cringe at the thought of theory-based content, with some complaining it has very little to do with “real-world” nursing practice. Nursing theory has not been made relevant to the modern nurse.

 Many nurse scholars might use this conversation as yet another reason why the entry level of nursing practice should be raised. Students seeking nursing education in the U.S. encounter many barriers, such as socioeconomic status, geography, structural racism, and more. Many of these students choose to attend ADN programs rather than seek a BSN, especially as their entry to practice. If we want to continue to grow the practice of nursing in the US, we need to support and encourage ADN programs, especially in the integration of nursing theory in practice.

The authors of this blog post greatly value the contributions of ADN programs, ADN graduates, and ADN educators. We would like to challenge all educators, scholars, and researchers to consider how we might restore nursing theory to its rightful place in all levels of nursing education. Nursing theory belongs to all nurses – not just those in higher education. 

Nursologists, what do you think?

About the contributors:

Emma Crocker

Emma Crocker, DNP, RN – CHIPS Health and Wellness Center, St, Louis, Missouri. Emma is a equity driven, population health quality improvement doctorate and advocate, devoted to ensuring the implementation of constituent-centered health policies, enabling communities to thrive located in St. Louis, Missouri. Twitter: @EmmaCrockerDNP.

Patrick McMurray

Patrick McMurray, BSN, RN – Adjunct nursing faculty, Robeson Community College, Lumberton, North Carolina. Patrick is a Adjunct Nursing Faculty at Robeson Community College, in N.C. Patrick is patient about community college nursing education and championing social change via equitable access to nursing education. Twitter: @nursePatMacRN.

Shelley Mitchell

Shelley Mitchell, BA, BSN, MS, RN – Professor of Nursing, Austin Community College, Austin, Texas. Shelley contains multitudes. She teaches full-time in Austin Community College’s Professional Nursing Program, which has been voted as the best in the region for three years in a row, and she is deeply involved in the college’s equity and inclusion work. She has a BA in English from Oberlin College in addition to her nursing education, and she reads comics and writes queer romance in her spare time. Twitter: @ProfShelleyRN

Elizabeth Mizerek

Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN, CNE, FAEN, PhD Candidate – Director of Nursing Education, Mercer County Community College, West Windsor, New Jersey.  Elizabeth is the Director of Nursing Education at Mercer County Community College in New Jersey. She is currently a PhD candidate at Widener University in Chester, Pennsylvania pursuing a doctoral degree in Nursing Science. Her research interests include nursing education, patient safety, and emergency preparedness.

Tim Sowicz

Timothy Joseph Sowicz, Ph.D., NP-C – Assistant Professor, UNC Greensboro, Greensboro, NC. Tim is an assistant professor at UNC Greensboro. His research is concerned with aspects of living with heroin and opioid use disorders, especially following an overdose.

Abstract Thoughts with Aphantasia: Learning Nursing Theory without the Ability to Imagine

Guest contributor: Elizabeth “Ellis” Meiser, MSN, RN-BC, CNE

            When I took a nursing theory course for the first time in my educational experience (at the doctorate level, mind you), I found myself grateful to finally be able to identify what may make learning theory difficult for me. A few years ago I was listening to a podcast in my car from the BBC. It began with a discussion on spatial navigation and transitioned into mental visualization. The topic was on how some people have a limited ability to imagine. The podcast asked listeners to close their eyes (I waited until I got to my destination to complete the exercise, don’t worry!) and picture a beach. Go ahead and do this if you can. Close your eyes and call to mind beautiful white sand, a palm tree, blue waves crashing under a clear blue sky. I settled into my seat and closed my eyes. But when I tried to see a beach, nothing happened. It was then I realized that I had a processing condition called aphantasia.

            Individuals with aphantasia have difficulty imagining visually. For me, it means when I close my eyes all that happens is I stop seeing. Most people are on a spectrum of capability when it comes to visualization. Some can recall only things they have seen before, for some it may appear like something from a cartoon, and for others it is as realistic as if it were before their eyes. Perhaps it seems shocking that I would not be aware of this until my mid-twenties, but how often does it come up in conversation? I suppose I always thought when someone said “mind’s eye” or that they could “picture it” these were expressions but that they couldn’t actually do it. Turns out, most people can actually picture things when my mind is woefully dark. With an impact on my ability to remember things, I just always assumed I had a poor memory.

My lifelong struggle with having to learn about and analyze abstract ideas suddenly made sense! The blog posts from Dr. Foli and Shannon Constantinides about the concerns with teaching theory in nursing education, along with the potential impact of generational differences, jumpstarted my questioning of my own journey through abstract learning. I cannot envision physical things, words, shapes, or even colors. Without those capabilities, I wonder: what could be the main factor impacting my ability to truly grasp abstract concepts? There could even be a combination of many contributing factors. Then I wondered, does it even matter? Why do I even need to understand theories?

As I mentioned, I’ve been through nearly ten years of formal education for nursing and cannot recall a course dedicated to nursing theory. I became faculty armed with a master’s in nursing leadership and management and a handful of education classes from my music education undergrad. I had been exposed to Piaget’s developmental theory and Maslow’s hierarchy of needs. I knew how to write objectives using Blooms, and in my master’s had been introduced to a variety of leadership theories. I had not, however, explored anything on Benner, Henderson, or even anything beyond the fact that Nightingale had something to do with a lamp. I didn’t even know nursing theories existed, and when presented with them in my doctorate program, I struggled understanding them and their purpose. However, in my practice of simulation, I have recognized the impact of Jefferies on how frameworks can guide development of scenarios. I have embraced Benner by recognizing how to consider the learners, where they are within the program, and within their own growth process. Much of this required me to evaluate how to learn abstract concepts.

Ultimately, a huge hurdle on abstract thought for me must involve aphantasia, which presents for me as the inability to daydream and the absence of visual recollection. It can be hard for me to remember what I’ve read or seen. As a learner, and now as a nursing educator, I feel as if it is taken for granted that all learners have the capacity to visualize mental images. Despite this having implications for learning, aphantasia is not currently considered a learning disability. Furthermore, there has been no progress on aiding those with aphantasia in developing the ability to produce mental imagery as it seems to be a neurological deficit. I am unsure of whether identifying students with aphantasia, or to what extent they are capable of visualizing, is important. Instead, what we need to do is create a holistic learning environment that is accessible to a variety of learners and learners need to be equipped with tools that suit their learning style. Using varied education techniques to address learning styles has long since been routine, but how often have we considered the student’s ability for mental imagery? How are we sharing abstract ideas? Is it in a tangible way? Do we encourage students to reflect on how they think, process, and picture things? Perhaps we need to consider adding this to the conversation to help students assess their learning needs before we begin introducing abstract concepts.

When it comes to theory, abstract instruction, or other types of instruction, I have found myself having to use a range of resources. For example, graphs, images, and diagrams may help explain concepts, but they are difficult to recall as I cannot recreate them in my mind. Instead, I found myself using a mixture of media, videos, and having to use my trusty gel pens and notebook paper. As it is in any pool of learners, these will have different effects for different learners but include:

  • Make personal or emotional links to content
    • I find relating theories to stories extremely helpful. This means grounding abstract ideas to something that I can relate to, or experience.
  • Listen to podcasts or a recording of a lecture
    • This may be difficult for some with aphantasia as there is no visual imagery to which to connect the audio.
  • Write notes and draw concept maps on paper to physically forge connections
    • An age-old recommendation that should never have been replaced by typing and is even more effective when summarizing in my own words.
  • Use Flash cards, mnemonics or other rote memory tasks
    • While I can’t bring these to mind at a later date, I can force memorize the basic concepts before scaffolding the more abstract ones.
  • Involve music or rhythm
    • Again, this is helpful for the more basic concepts. However, there has been some evidence of links between those with aphantasia also having difficulty remembering sounds, tones, or music so this is very dependent on ability.
  • Teaching others or simply reading notes out loud
    • Yet another traditional method of evaluating learning and using kinesthetics and physicality to the party. When I get lost in reading about theory, I find that reading it out loud helps me stay on track.

It is crucial to remember that while linking learning to visual memory reportedly leads to better academic outcomes, it does not equate to higher intelligence. It certainly has an impact, but it is not the only variable to consider. Reflecting on how important the mind’s eye is to learning leads me to wonder how different schooling would have been had I known about aphantasia. For myself, I can apply it to what remains of my terminal degree and my continued lifelong learning. For others, I can write about its impact and attempt to add to the discussion on what influences how, when, and to whom we teach nursing theory and knowledge. Ultimately, we need to work with all learners to be advocates for what they need to succeed regardless of the topic at hand.

About Elizabeth “Ellis” Meiser

Ellis is a Clinical Educator of Nursing at Longwood University in Farmville, VA. They have their MSN with a focus on leadership and management, is a Certified Nurse Educator, and is certified in medical-surgical nursing. They are in their first year as a doctoral student in the online EdD Nursing Education program at Teachers College, Columbia University.

Being True to Yourself: A Career as a Nurse Educator Guided by Critical Caring Pedagogy

Guest Contributor: Erin Dolen, MS, RN, CNE*

My career in nursing education has spanned the better part of a decade. For the majority of that time, I taught in an associate’s degree nursing program. At first, I was not sure if nursing education was for me. I was always a preceptor on the nursing units during my time in the hospitals, but that does not necessarily equate to being a good educator. After a semester, I was hooked. I found so much joy in showing my students not just how to do nursing, but how to be nurses. Forget “teaching to the test”! I would teach through experience, stories, relationships, respect, and caring.

Over the years, I thought I was developing into an expert nurse educator. I obtained my MSN, I passed my Certified Nurse Educator (CNE) exam, and I achieved quite a following among the student body. Until one day, it all changed. I was accused of being too personal, too attached to my stories and experiences, too outward in my sharing. I couldn’t understand why this faculty member was attacking me for being who I am, for valuing my relationship with my students, for giving them a part of me so they know I am human too. The lateral violence (let’s face it, that is what it was) became too much and I decided to move on to where I currently am, a baccalaureate nursing program.

My world has changed. I am now valued for giving my students everything that I have. For sharing not just my experiences but who I am as a person, a nurse, a mom, a friend. I care about them, and they know this. I want them to succeed beyond all ways they could imagine. I want them to learn from me; not just how to be a nurse but how to be someone who cares, who is empathetic, moral, ethical, a life-long learner, and is committed to the profession of nursing. Through my own education at Teacher’s College, Columbia University in the Online Nursing Education EdD program, now I know why. My whole nursing education career I have been guided by the Critical Caring Pedagogy (CCP).

CCP provides a framework for nursing education that, all at once, encompasses ontology, epistemology, ethics, and praxis (Chinn & Falk-Rafael, 2018). This framework consists of seven critical caring health-promoting processes: preparing oneself to be in relation, developing and maintaining trusting-helping relationships, using a systematic reflective approach to caring, transpersonal teaching-learning, creating and supporting sustainable environments, meeting needs and building capacity of students, and being open and attending to spiritual-mysterious and existential dimensions (Chinn & Falk-Rafael, 2018).

Isn’t this what I have been doing all along? All seven?! I have just come to the realization that my own practice as a nurse educator for the last decade has consisted of being in a caring and guiding relationship with my students, the foundation of CCP. I have been guided by a theory I had no formal knowledge of until now. And yet, I was faulted for it. Told I was giving too much of myself to my students. Told that I was to teach the material, not cultivate relationships. Told I made the two students out of HUNDREDS uncomfortable (yes, you guessed it, these students were academically unsuccessful and reaching for reasons for their appeal to be upheld). I almost gave up teaching. I knew I could not work in an environment that did not support my own values and approach to the teaching-learning relationship. Until I moved into my current position, where my foundation in CCP is respected, appreciated, and celebrated. To where my colleagues also practice with the guidance of CCP, whether they know it or not.

Now I can put into words what I have felt all along. Thank you, Peggy Chinn and Adeline Falk-Rafael, for providing the framework and empirics to support what I felt was the right way to teach deep down in my core. Critical Caring Pedagogy has given my teaching practice meaning and validity. I will carry this knowledge with me wherever I go, and I will never give up teaching.

Source

Chinn, P.L. & Falk-Rafael, A. (2018). Embracing the focus of the discipline of nursing: Critical caring pedagogy. Journal of Nursing Scholarship, 50(6), 687-694. Doi: 10.1111/jnu.12426

*About Guest Contributor Erin Dolen
E Dolen Picture

Erin is an Assistant Professor of Practice at Russell Sage College in Troy, NY. She is a doctoral student in the EdD Nursing Education Program at Teachers College, Columbia University. She has her MSN with a focus in Nursing Education from Excelsior College. Erin has her national certification as a Certified Nurse Educator. Her nursing background is in emergency medicine. She lives in Delmar, NY with her husband and two children.