In the early 1980s when Maeona Kramer and I first began to put together ideas for a text on theory development in nursing, we were committed to addressing nursing knowledge development beyond the typical boundaries of empirical research and theory development. We had both completed, in 1971, doctoral degrees in Educational Psychology (Maeona at Wayne State University in Detroit, and me at the University of Utah) focusing on theory development in education (nursing doctoral degrees at the time were few and far between). For that first edition we drew on the work of a psychologist named Zygmunt Piotrowsky (1971) who had proposed that the development of knowledge required contributions from scholars with different personalities, some who were drawn to theoretical abstract thought, and some who were drawn to concrete empirical “laboratory” science.
In 1987 when we embarked on the 2nd revision of our book now titled “Knowledge Development in Nursing” we introduced Carper’s fundamental patterns of knowing in nursing, which gave us a starting point for narrative clearly grounded in the discipline of nursing. In the 3rd edition (1991) we turned our attention to revising our language from the stilted tradition of what was once considered scholarly writing to language that was more accessible and gender neutral. By 1999, we realized that simply listing and describing Carper’s patterns of knowing fell short; we needed to project ways in which knowledge is developed for each pattern of knowing. This evolution made it possible to articulate our belief that nursing knowledge encompasses so much more than that which can be studied empirically. However, we continued to have this sense that something was missing, and in 2008 we articulated the emancipatory pattern of knowing.
It was the growing and compelling body of nursing literature focused on critical social theory, socio-political knowing, and social justice that gave us the impetus, in 2008, to develop the emancipatory pattern of knowing. We see this not as simply a fifth pattern of knowing, but rather as the fundamental human capability to see a situation, recognize that something is amiss, and create ways to change the situation – an ongoing process in creating nursing knowledge that is necessary for the development of knowledge related to any of the four fundamental patterns of knowing.
We had finally arrived at the intersection of social activism and the development of nursing knowledge. But what does this really mean? It is now over a decade since we first conceptualized what emancipatory knowing means, and the possibilities that this pattern of knowing holds for the future development of nursing. We have been puzzled by the fact that it took us so long to see the connections and have speculated why this might be so (the long-standing subservient positions of women and nurses, the socialization to avoid that which is political, the dominant concern with one-to-one “bedside” care, etc. etc.).
The fact has been that nurses, dating from the earliest days of the profession, have engaged in social and political activism, but have remained reticent to fully embrace social activism as a core nursing concern. Maeona and I both had been actively involved in the 1980’s effort to advance feminism in nursing through the work of “Cassandra: Radical Feminist Nurses Network.” In 2000, Richard Cowling, Sue Hagedorn and I wrote “A Nursing Manifesto: A Call to Conscience and Action,” acknowledging that at its core, nursing itself is “political” in the sense that politics is the ability to advance one’s own values in a public context. Every time a nurse acts to bring nursing values into action, bends over backwards, jumps through hoops, and does cartwheels to obtain what individuals and families and communities need to be healthy, we are acting politically. We are activists.
The values of our discipline, expressed eloquently in the theories and conceptual models that form our foundation, guide our thoughts, words and actions. At the same time, our intimate engagement with others as we practice nursing, also informs what we think and do, opening awareness of ways to challenge, question and re-design the nature of our discipline. The social and political contexts we face in this moment call for a new awareness of distortions, prejudices, stereotypes, social injustices amplified by racism. What is happening in this moment of time has raised alarm bells and demands that we turn our gaze on ways in which we nurses, individually and collectively have been complicit. The situation we find ourselves in today calls for nurses, and particularly white nurses, to finally recognize the dynamics of racism that infect our own “house” and start the tedious, and yet ultimately rewarding, process of healing.
In facing this challenge, we will begin to understand the dynamics of the widespread public health crisis of racism in ways never before attempted. The development of knowledge demands that we understand the problem, explore the dynamics that sustain the problem, seek new ways to prevent and change those circumstances that perpetrate the crisis, and heal those who are affected. There are theories and philosophies of our discipline that can guide us as we move forward. Here are a few to consider:
- Falk-Rafael’s Critical Caring Theory https://nursology.net/nurse-theorists-and-their-work/critical-caring/
- Walter’s Emancipatory Nursing Praxis https://nursology.net/nurse-theorists-and-their-work/emancipatory-nursing-praxis/
- George’s Emancipatory Theory of Compassion https://nursology.net/nurse-theorists-and-their-work/theory-of-emancipatory-compassion-for-nursing/
- And the foundation underlying the “Overdue Reckoning on Racism in Nursing” actions – Chinn’s Peace and Power – https://nursology.net/nurse-theorists-and-their-work/peace-power/
This website – Nursology.net – is accomplishing the very important purpose of bringing to the fore the rich traditions and values expressed in the theories, models and philosophies of our discipline. And now the time has come to recognize the ways in which the practices, attitudes, philosophies and thought patterns that derived predominantly from white perspectives are lacking. This reality now calls for activism of a type not often recognized – a sustained and determined challenge that can change our own disciplinary ways of thought and action. This does not mean in any way that we discard or denigrate our foundation, or that we disrespect the ways in which our own scholarly work has real value. What it does mean is that we examine our accomplishments through a new lens, and recognize ways in which we need to re-direct course.
Take as an example my theory and practice of “Peace and Power.” This theory was inspired in part by the Brazilian scholar and activist Paulo Freire (1970), and is closely aligned with practices commonly used in native American cultures and in Quaker communities. Yet people of color have also challenged this process as reflecting colonized white privilege – despite the commitment embedded in the processes that seek to dismantle power inequities in group processes. Part of this challenge came from the early descriptions of the process that clearly reflected the concerns of white women and defined by white feminists. The fact is that the lens through which I view these ideas bear “decolonization.” What this means exactly is still in process, requiring a deep deconstruction of the Euro-centric assumptions on which the theory and process is built. How this will affect the theory itself remains to be seen, and may be actually accomplished by scholars of the future!
The time has come to shift this process in to high gear – to recognize the ways we have silenced the voices of many of those we claim to serve, ways in which we have excluded nurses of color from participating in our efforts to develop the knowledge of the discipline, and ways in which white nurses have in fact dehumanized, disrespected and excluded nurses of color from full participation in the practices, leadership and development of the discipline. This is not an activist project that can happen in one or two “training” sessions addressing “diversity, inclusion and equity.” Nor can it be accomplished by performative actions such as recruiting more people of color, or curriculum revisions. Although of course these kinds of actions are warranted and need to happen they will not in themselves end the inequities and injustices of racism. There are no formulas.
I believe that the activist commitment of all nurses now and going forward is to learn all we can about the mechanisms of both systemic and everyday racism, question each choice we make in light of our growing awareness, challenge one another with loving kindness, and create spaces that challenge white privilege. The “Overdue Reckoning on Racism in Nursing” discussion series has now ended but in those discussions we established a starting point, including important resources for becoming well informed about the challenges we face. Now we have new actions to continue this work, centering nurses of color and engaging white nurses in meaningful processes consistent with the ideals of “truth and reconciliation.”
While these actions are labeled as “activism” they are also vital in shaping nursing knowledge going forward. Becoming immersed in social and political activism to address the public health crisis of racism, guided by the values of our discipline, we provide the best of nursing care to heal ourselves, to heal the damaging effects of racism in our communities, and build a stronger future. We create the ‘hermeneutic circle” of thought and action – where our actions inform how we think, and how we think shapes our action in a constant process that changes and shapes both thought and action going forward.
Freire, P. (1970). Pedagogy 0f the oppressed. Seabury Press.
Piotrowski, Z. A. (1971). Basic System of All Sciences. In H. J. Vetter & B. D. Smith (Eds.), Personality Theory: A Source Book (pp. 2–18). Appleton-Century-Crofts.