So You Want To Be More Equitable, Just, and Inclusive?: A Live Webinar

See Details here!

Watch the first event here!
Read the blog post summarizing the first event here!

Nursing is an act of Justice.” – Canty and McMurray (2020)

Earlier this year, in light of the events surrounding the murders of George Floyd, Breonna Taylor, and many others, the Nursology Theory Collective hosted a live event titled, “Equity, Justice, Inclusion, and the Future of Nursing.” At this event, Dr. Lucinda Canty and Patrick McMurray addressed the critical interrelated concepts of diversity, equity, inclusion, and justice for our discipline. The enduring homogeneity of nursing, Canty and McMurray noted, contributes to persistent inequity, injustice, and exclusion that exists today, both within the discipline and as it is practiced. Lamentably, many of our professional organizations address this in superficial ways, ways that may look good but fail to address the root causes of racism, sexism, homophobia, and more. This has the paradoxical effect of reinforcing hegemony even as these organizations purport to be about justice.

At the end of the event, many attendees raised questions about what we, as nurses, and we, as a discipline, could do to create a future for our discipline that is more equitable, just, and inclusive. In answer to these questions, we are happy to announce that we are going to host a part 2 to event on December 18th, 2020 at 1:00 Pacific Standard Time/4:00 Eastern Standard Time. To join this event, please register here in advance to save your seat. After registering, you will receive a confirmation email containing information about joining the event.

For our next event, we will continue the dialogue, recognizing that inequality, injustice, and exclusion remain systemic issues that we all play a part in. We will recommend tools that all nurses can do and share, no matter the setting, as individuals and within systems, in order to achieve our goal in making nursing and the world more equitable, just, and inclusive. 

If you have any questions you would like addressed at this event, please feel free to ask us on twitter @nursingtheoryco or email us at nursingtheorycollective@gmail.com.

We look forward to seeing you and continuing this important conversation on December 18th!

In solidarity,
The Nursology Theory Collective

Letter to the ANA

On September 26, 2020, the Nursology.net management team sent the following letter to the American Nursses Association, urging the organization to take a stand on the U.S. Presidential election candidates. We believe that given the dual pandemic of COVID-19 and racism, nursing’s strong voice of advocacy for the health of the nation must be heard. Here is the letter in its entirety:

September 26, 2020
Dr. Loressa Cole, ANA Enterprise CEO
Dr. Ernest J. Grant, President, ANA President
Dr. Debbie Hatmaker, Chief Nursing Officer, ANA Enterprise
American Nurses Association

Dear Drs. Cole, Grant and Hatmaker:


The Management Team of Nursology.net is writing to urge the American Nurses Association (ANA) to reverse its position against endorsing any candidate for President/Vice President in the 2020 election. We understand that the ANA reversed its previous policy to endorse presidential candidates based on the desire to “engage nurses in the voting process through providing accurate information and data and promoting nursing’s political advocacy role without alienating an entire contingency…acknowledging the reality of political polarization in this country” (ANA 2019 Membership Assembly Consideration of ANA’s Presidential Endorsement Process).

The recent draft of the document, Nursing’s Scope and Standards (2020), specifies nursing’s social contract with the public. The document includes nursing’s commitment to reject racism and promote equity and social justice for all. In addition, the document points to nursing’s accountability and responsibility to promote the health of all populations and to advocate for social and environmental justice, and access to high quality and equitable health care.

The proposed ANA Scope and Standards contradicts the ANA position against endorsing a presidential candidate if a particular candidate is a threat to equity, social justice, equitable healthcare and health for the population. While we respect that the Board made their decision thoughtfully, the current situation calls for a reconsideration based on the positions of the current administration that threaten public health. Scientific American, a journal who has never endorsed a candidate for president, has broken with their policy because of the dangerous anti-science views of the President

Today, the country needs to hear nursing’s voice related to this election from the ANA. We find ourselves in the midst of a perfect storm fueled by the mismanagement of a global pandemic, a health and environmental crisis from rampant fires, storms and floods attributed by scientists to climate change, and the public health crisis of systemic racism.

Many have referred to this election as the most consequential in recent history, certainly in our lifetimes. This is not the time for the nursing profession to sit out and fail to exercise our unified voice and moral authority. As the discipline focused on caring for the health and well-being of the people with an understanding of how the physical, social, political and economic environment influences health and well-being, and as the most trusted profession, the ANA must speak out against the policies of the current administration and endorse Joe Biden and Kamala Harris for President and Vice President. Please reconsider your position based on the actions taken by President Trump after your vote in 2019.

Here are a few reasons why we urge the ANA to reconsider and endorse the presidential ticket that is aligned with nursing values and actions and protects the public health:

  • The current administration’s lack of leadership to enact policies to stem the rising incidence of COVID-19 infections, including the President’s lack of providing timely information to the public that could have prevented thousands of infections and death
  • The current administration’s policies that have threatened accessibility to healthcare for millions of Americans by working to overturn the advances made through the ACA
  • The current administration’s position that denies human contributions to climate change and fails to support policies to abate its dangers.
  • The current administration’s lack of acknowledgement of the racial injustices experienced by people of color, especially Black people, at the hands of law enforcement.
  • The current administration’s policies of family separation at the border resulting in hundreds of children being placed in inhumane and dangerous conditions to their health and well-being.
  • The current administration’s lack of meaningful responsiveness to address the public health crisis of gun violence.

While the recommendations of the ANA’s Presidential Endorsement Process (2019) advocate for individual nurses to participate in election activities at the local, state and national levels and take advantage of educational opportunities to learn about the candidates that will inform their voting, nurses will look to the ANA for leadership, especially now. The ANA is the voice of the profession, and this is not the time for that voice to be silent. Without a unified position, the nursing profession is invisible, and the public trust in nursing’s commitment to protecting public health is compromised. Individual nurses can always vote their choice, but the unified voice of our profession is critical at this time in our history.

Please reverse your position and endorse the candidates that will advance policies that protect the health of the public. We cannot be silent. To be silent is to be complicit.

Thank you for your serious consideration of this request.

Respectfully,

Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN peggychinn@gmail.com

Jessica Dillard-Wright, MA, MSN, CNM, RN jdillardwright@gmail.com

Rosemary William Eustace, PhD, RN, PHNA-BC

Jacqueline Fawcett, RN, PhD, ScD(hon), FAAN, ANEF

Jane Flanagan, PhD, RN, ANP-BC, AHN-BC, FNAP, FNI, FAAN

Dorothy Jones, RN, PhD, FAAN

Deborah Lindell, DNP, MSN, RN, CNE, ANEF, FAAN, Deborah.Lindell@gmail.com

Chloe Olivia Rose Littzen, MSN, RN, AE-C

Leslie H. Nicoll, PhD, RN, FAAN leslie@medesk.com

Adeline Falk-Rafael, PhD, RN, FAAN afalk-rafael@rogers.com

Marlaine C. Smith, RN, PhD, AHN-BC, HWNC-BC, FAAN

Marian Turkel, RN, PhD, NEA-BC, FAAN

Danny Willis, DNS, RN, PMHCNS-BC, FAAN

Celebration! 2nd Anniversary of Nursology.net

. . . . it is worth reiterating the point that compared with atheoretical actions, those that are conceptually grounded have a higher probability of achieving their intended consequences. Not just because they are contemplated more intentionally but because the vast majority of . . . . theories/frameworks pay heed to the important messiness of context and the use of power. (1) Patricia Butterfield (2017, p. 9)

Nurses are thirsting for a meaningful practice, one that is based on nursing values and knowledge, one that is relationship centered, enabling the expression of the depth of our mission, and one that brings a much needed, missing dimension to current healthcare. (2) Margaret A. Newman, Marlaine C. Smith, Margaret Dexheimer Pharris and Dorothy Jones (2008, p. E25)

With a strong conviction of the vital importance of nursing’s own theories and frameworks, the Nursology.net management team embarked on the development of a website to provide current and accurate information about discipline-specific knowledge. We started the development of the site in the summer of 2018, with the goal of publicly announcing the site once we had at least 20 theories/models on the site, and at least 1 Exemplar in each of the “Exemplar” sections! We met that goal and officially launched the site on September 18th, 2018! Today, we have

Plus, a new section dedicated to nursing philosophy, a host of resources related to nursology knowledge development, a record of past nursology-related conferences (including proceedings, photos and other materials related to the conferences), information about events that will be happening in the future (despite the pandemic), and an unbroken record of blog posts every Tuesday!

I, Peggy Chinn, have served as the architect of the site and am responsible for the nitty-gritty work of putting it all together, but all of this is only possible because of the work of members of our team of nursology scholars who have identified and composed the content.

Here are reflections from members of our management and blogging teams in response to two questions:

  • How has nursology.net influenced your approach to teaching, research, or practice?
  • What do you anticipate for the future of the discipline, and the role of nursology.net in shaping that future?

How has nursology.net influenced your approach to teaching, research, or practice?

Jacqui Fawcett
The website is exceptionally useful as a resource for the PhD students I have the honor to teach, as well as all other students in our program., and as resource for colleagues who are “thirsting” for information about nursology discipline-specific knowledge. In addition, I cite the blogs in many of my publications—journal articles, book chapters—and presentations at conferences and as a guest lecturer for other nursology programs.

Marlaine Smith
When I’m with any student or faculty group I call attention to the nursology.net site and describe the many resources available.  I’m teaching a course now for PhD students, Evolution of Nursing as a Professional Discipline.  In the first module I introduced students to Nursology and they were invited in the discussion board to respond to a question related to the Nursology site.  I have received so many comments from students and faculty who are amazed at and grateful for the many resources on the site. The Nursology blogs offer short position/perspective pieces that can spark meaningful discussion.

Dr. Eustace

Rosemary Eustice
Nursology.net is a vehicle that highlights the contribution of nursology wisdom to health and health care issues. The website continues to influence my teaching by enabling me to find new teaching and learning strategies that foster students’ acquisition of nursing knowledge to understand nursing phenomena of interest.  One thing that inspires me everyday when I share this website with my students, is to see how much the students appreciate the value of nursing theories and how much they wish for ‘good’ mentors and educators to support the next generation of competent nursologists. On the other note, as a nurse researcher, nursology.net has increased my curiosities on nursing knowledge development and how nursologists can utilize research in clarifying and developing new concepts/ideas using nursing lenses. 

Dorothy Jones
I am impressed with the global response to the nursology.net website. When I have shared this information with faculty and students at a University in Spain where I consult, the reaction has been inspirational. Doctoral students love having “free” access to the nursing theorists and their work in one central space. Faculty describe the site as “a way to connect with the nursing community “globally.” Dr. Emiko Endo from Japan recently translated a nursology blog “Covid 19- What would Margaret Newman Say” into Japanese for her students. She also presented the information to participants attending a virtual Nursing Theory Conference. Dr. Endo reported how moved the audience was by the message. When I shared the web site with a group of International Gordon International Scholars at Boston College, from Italy, Brazil and Africa they were excited to learn about the site and immediately shared it with the other faculty and students.  They noted that they now had immediate access to information about nursing theory never available to them before. The responsiveness of the site to contemporary issues makes nursology.net a living document that promotes nursing knowledge and its potential impact on the health and wellbecoming of all.

Jane Flanagan
I am teaching a new course this year – Philosophical Inquiry for Knowledge Development in Nursing.  I introduced my students to nursology.netas well as the faculty of a companion course – Strategies for Knowledge Development in Nursing. For my course, we will be using the site for the many resources it offers. I have encouraged them to read and respond to the blogs.  I think if I was to have a re-do on my syllabus, I would actually have an assignment include a meaningful contribution to the site. These students are our future nurse leaders and I know like many on this site, we want to hear from them. We have only had one class thus far, but based on the great dialogue, I think they will be joining in on the conversations on nursology.net

Jane Dickinson
I am pointing students to nursology.net in the Nursing Knowledge in Nursing Education course I teach for doctoral students in our Nursing Education program. I also have them write a blog post and an exemplar (if applicable) for submission to nursology.net as course assignments. Nursology.net is an amazing resource where students can learn about nursing theorists and their work. It also provides a wonderful opportunity for them to think and write about their own experiences with nursing knowledge.

Chloe Olivia Rose Littzen
As a PhD candidate, Nursology.net has influenced both my nursing education and the ways in which I know the world. Specifically, Nursology.net was one of the few references I was able to use for specific theory related nursing knowledge content in studying for my comprehensive exams.The organization of theory-related content made it easy for me to find what type of information I needed, and I knew that the information included was substantive in nature. As a nurse, Nursology.net has also informed the ways I know the world by keeping me up-to-date on current issues and events, while simultaneously giving me access to new nursing knowledge content I may have never come across during my own reading. 

Danny Willis
In the PhD course “Nursing Knowledge Development” I have been teaching at the University of Wisconsin-Madison we used the resources on nursology.net to guide our thinking. PhD students  were thirsty to explore the philosophical, conceptual, theoretical, and empirical aspects of the discipline in research, education, practice, and policy. Great examples are showcased on the website, which they enjoyed! As these PhD students prepare for their research and future programs of disciplinary knowledge development as leaders in the discipline, through the website they were better able to understand the value of grounding their work in the discipline, which feels like a Wonderful move in the right direction. Nursology.net is recognized as a go-to resource with the potential for nursologists to contribute to ongoing conversation, like none other! 

Patrick Palmieri
The emerging role of nursology.net in low- and middle-income countries is impactful due to our limited access to nursing knowledge. Unfortunately, knowledge is too expensive for many nurses throughout the world. The limited financial resources in many countries negatively impacts access to nursing literature, including published papers and nursing textbooks. Through nursology.net, student nurses and professors throughout the world have immediate access to contemporary nursing knowledge, including timely theoretical discourse related to current trends and events. Most importantly, nurse scholars such as I, are able to translate the resources, without copyright issues, for immediate application in our courses. This year, we continued to advance a project to translate resources from Nursology.net into Spanish for the history of nursing and theory of nursing courses. Through the efforts of the leaders and many donors at Nursology.net, the barriers to accessing knowledge have been removed. Nursology is linking scholars to students throughout the world!

What do you anticipate for the future of the discipline, and the role of nursology.net in shaping that future?

Jacqui Fawcett
I am both pessimistic and optimistic about the future of nursology—I am very concerned that our disciplinary knowledge will not survive as a continuing way to guide disciplinary advancement—there always is a tension to focus on pragmatic aspects of issues rather than the philosophical, conceptual, and theoretical aspects, and there is much too much emphasis on empirical methods—the primacy of methods for so many people is of great concern to me. In contrast, I am encouraged by the number of people who have been accessing nursology.net and by the continued publication of multiple editions of several books about nursology conceptual models and theories. Nursology.net serves as an ongoing resource for all nursologists, with blogs and other content already shaping what nursologists think about our discipline. We definitely are living our mission to be a repository for all things theory in nursology!

Marlaine Smith
While I can despair at the lack of valuing of nursing theories/models in our research, the lack of content related to nursing theories within the curricula, and the frequent absence of a clear nursing perspective in advanced practice and interprofessional practice, I’m encouraged by signs that there is a renewed appreciation of the importance of generating nursing qua nursing knowledge and practicing from nursing’s disciplinary perspective. Some of those signs… the committed group of scholars who have been attending and contributing to the annual Nursing Theory Conferences…the growing number of AAN members joining the Nursing Theory-Guided Practice Expert Panel…the recognition by CNOs about the value of practicing from a nursing theory-guided model…the lights in the eyes of students who “get it”. Nursology.net will continue to support this emergence. The site has global outreach and can bring the nursing community together around the critical issues of expanding disciplinary knowledge development and application. 

Dr. Eustace

Rosemary Eustace
I am optimistic that the future of the discipline and the role of nursology.net will continue to find a voice in health care, especially in the area of policy making. However, this process will be timely if we continue to value and acknowledge the uniqueness of nursing knowledge in influencing health care outcomes. When I think back at what we have learned so far and are learning each day with the wake of the Covid-19 pandemic, I see a window of opportunity for nursologists to advocate for this unique STEM discipline and use nursing knowledge to make positive changes in health care systems and population outcomes.   

Dorothy Jones
As a discipline we continue to experience many issues, even resistance to articulating nursing science within nursing curricula, research and care delivery.  Emphasis on preparing nurses with essential content that focus on  role development with little grounding in philosophical and theoretical underpinnings of the discipline challenges knowledge development and compromises the visibility of nursing’s impact on care delivery. While the interdisciplinary / intra professional focus on contemporary issues is critical, the unique voice of nursing is essential to informing and reshaping responses to global health concerns. While the threats to advancing nursing science are apparent, there is also indications of a renewed interest in nursing’s identity and expansion of nursing knowledge. Increasing membership in nursing theory groups, attendance at nursing theory conferences and active progress by groups such as the AAN Expert Panel of Nursing Theory Guided Practice to link nursing’s knowledge and policy, offer signs of hope for the future. Nursology.net has been an important catalyst that has supported this renewed dedication to nursing knowledge. The site provides an essential platform for all nurses to share in our history, explore our future, and increase our awareness of new opportunities for nursing’s voice to influence issues of global concern. Thank you nursology.net!

Jane Flanagan
I think we are in a time that has raised our social consciousness and many nurses are questioning our role in power dynamics, sociopolitical movements, structural racism. They are asking are we going to be part of the problem or mobilize and act?  Foundational to our discipline is our ethics aimed at striving for the greater good, health and healing for all people. We can no longer tolerate an inequitable society or health care system that does not meet the needs of those we say we are committed to serve. Nursology.net  is a forum that created the space for us to have the dialogue, work through the sometimes awkward, sometimes obvious and at other times not so obvious issues. It is a safe place that allows all nurses to think, write share and activate. Our future is in not only finding our voice, but in leading the way. Nursology.net is the format and catalyst to accelerating our movement toward a universally experienced wellbecoming.

Jane Dickinson
I see nursing knowledge (and all five ways of knowing!) becoming more prominent in nursing education, research, and practice as we move further into the 21st century. Nursology.net is the preeminent source for nurse educators and leaders in research and practice to share their work, and to inspire newer nurses to take the next step in further developing and refining what we know and what we do.

Chloe Olivia Rose Littzen
I anticipate that nursing theory and philosophy, including our unique disciplinary perspective, will come to the forefront of importance in our nursing practice, research, education, and policy. Additionally, I believe that nursing theory and philosophy will be revealed to play a significant role in the well-being of our nurses and the healthcare environment. I believe Nursology.net will support nurses to be confident and grounded in their own unique disciplinary perspective, promote the use of nursing theory and philosophy in all settings, and provide a forum in which nurses can gather from across the globe to stay up-to-date on relevant issues and events in nursing.

Danny Willis
The future is in our hands and the website will continue to play a major role in orienting nurses and our PhD, DNP, Masters, and Baccalaureate students. Nurse leaders and educators in practice settings would benefit from having this website as a part of their orientation. Therefore, I see it as my responsibility to let every Chief Nursing Officer I meet with know about this resource and offer to speak to anyone in educational leadership roles in practice settings about the website. Faculty leaders must also be aware and able to speak to the substance of the discipline, which the website acts as a vehicle for. Nurse leaders will be called upon to champion ready access to the fundamentals of nursing depicted on the website and to further the ongoing evolution of disciplinary thought and communication. The future of the discipline can be bright as we nurses promote humanization, caring, healing, relationship, love for one another, diversity, belongingness, transitioning through living and dying, meaning in living and dying, and well-becoming. The future can be bright if we nurses promote openness, dialogue, healing transformative power with each other, critique, intellectual curiosity, community, and nursing ethics of our shared humanity and a deep commitment to the greater good for all of humankind and planet Earth in all its complexity and beauty. Onward nursologists! 

Sources for the opening quotes:

  1. Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. ANS. Advances in Nursing Science, 40(1), 2–11. https://doi.org/10.1097/ANS.0000000000000161
  2. Newman, M. A., Smith, M. C., Dexheimer-Pharris, M., & Jones, D. A. (2008). The focus of the discipline revisited. ANS. Advances in Nursing Science, 31(1), E16–E27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

How the Nursing Philosophy of Intermodernism Changed the Way I See the World as a Novice Nurse Scientist

When I started my PhD program, I had no idea how important philosophy would become in my life. Fast forward to now, as a PhD candidate, my nursing philosophy is the cornerstone for how I look at the world and how I perform research as novice nurse scientist. But, this is not to say that prior to my PhD program I didn’t value philosophy! I always had a strong affection for philosophy. When I was in 6th grade, I remember sitting in my government and politics course and being absolutely enthralled with discussions about John Locke (I mean, how cool is the idea of tabula rasa?). In my late teens and early twenties, I began my fascination with eastern philosophies related to yoga and Buddhism. But, even though I had been a nurse since I was 22, I never learned about the philosophy of nursing. It wasn’t until I started my PhD program at age 27 where nursing philosophy even became a part of my nursing knowledge base. Once I wrapped my head around complex areas of philosophical inquiry such as epistemology and ontology, it was like a light bulb went off in a dark room that I had previously been stumbling around in — I finally had a way to make sense of the world as a nurse!

Pamela Reed

            The philosophy that changed it all for me was the philosophy of nursing science and practice called Intermodernism (Reed, 2019). Intermodernism, which was originally titled as neomodernism (1995, 2006a, 2006b), is unique in that it is an expanded view of epistemology where practice and science partner to create new knowledge originally developed by Dr. Pamela Reed (Reed, 2018). Nursing practice, and the nurses within, thus become a source of knowledge, and not just a repository of the knowledge (Reed, 2018) developed in the ivory tower. This is not to say the academe is not important, instead, intermodernism acknowledges the necessity of partnership in knowledge development; the theory-practice gap becomes the theory-practice connection, and ALL nurses are recognized as the theorists they are. Being a theorist is often put on a pedestal, where theory is an intimidating and unrelatable aspect of the academic world. Intermodernism cleverly acknowledges that nurses theorize every day in their practice. And, if you don’t believe that, just ask a nurse to explain how they solved a problem on their last shift, this is theorizing at its finest.

            This is just the tip of the iceberg with intermodernism, and as much as I could ramble on about the ins-and-outs about intermodernism, I invite you to explore some of the literature related to intermodernism on your own. My rationale for this invitation is that it is important in philosophical inquiry to take time for “arm chair work” (as Dr. Reed has very wisely taught me), which is sitting, thinking, reading, and repeating that process – and for me I would add, when you run into a philosophical conundrum or question talk to someone about it!

Comic Art by XKCD

That is why I invite you to explore the new philosophy section on Nursology.net. If you are new to philosophy, don’t get intimidated as we have provided some beginning definitions of at first kind of scary but actually really interesting words such as epistemology and ontology. You will also find lists of substantive literature in both nursing ontology and epistemology. Intermodernism also has it’s very own page here, where I have listed the most relevant articles for your enjoyment. These pages will be continued to be added to, so be sure to check back, and if you think something is missing we would love to hear your suggestions!

References

Reed, P. G. (1995). A treatise on nursing knowledge development for the 21st century: beyond postmodernism. Advances in Nursing Science, 17(3), 70-84. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7778892

Reed, P. G. (2006a). The practice turn in nursing epistemology. Nursing Science Quarterly, 19(1), 36-38. https://doi.org/10.1177/0894318405283545

Reed, P. G. (2006b). Commentary on neomodernism and evidence-based nursing: implications for the production of nursing knowledge. Nurs Outlook, 54(1), 36-38. https://doi.org/10.1016/j.outlook.2005.01.001

Reed, P. G. (2018). A philosophy of nursing science and practice: Intermodernism. In P. G. Reed & N. B. C. Shearer (Eds.), Nursing knowledge and theory innovation: Advancing the science of practice (2nd ed., pp. 21-46). Springer Publishing Company.

Reed, P. G. (2019). Intermodernism: A philosophical perspective for development of scientific nursing theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ans.0000000000000249

We ARE the theory-practice connection; COVID-19 tells us so!

Guest Contributors*:
Andra Opalinski and Patricia Liehr

We are responding to Dr. Foli’s request in her blog titled “Say It Ain’t So:  Graduate Students Shade Nursing Theory!” where she stated…What about you?  If you have suggestions for me on how to strengthen the theory-to-primary care advanced practice connection in a master’s level course, please forward them…”

WE BEGIN WITH DEFINITIONS

Throwing Shade: (verb) subtly disrespecting or ridiculing someone or something.

Shade: (noun) a comparative darkness caused by shelter from direct light.

We ARE the theory-practice connection.

As nurse educators who appreciate the theory-practice connection, we had been pondering Foli’s post and then Constantinide’s follow-up about graduate students throwing shade at nursing theory. Not knowing the meaning, we took the “throwing shade” descriptor quite literally and thought how we often prefer to find shade on sunny Florida days!!!  In the midst of our extended pondering and thoughtful conversations came COVID-19; and a virtual class that we co-hosted with NP students to discuss the use of Story theory in practice; and THEN, we serendipitously came across a 2020 calendar page with a haiku by Tomihiro Hoshino entitled “In the Shade.” This haiku accompanies his calendar painting of a redbud tree with hanging red pods amidst green foliage:

In the shade of leaves,
They shyly sway,
Pods like strips of paper
With girlish wishes
Written on them

Moving along to a class with NP students.  

In this class, we were talking about Story theory and the practicality of using it when working with patients. Story Path, a way to pursue story-sharing was the specific lesson (Liehr & Smith, 2020). Clare, an ER nurse, volunteered to share a recent practice story with the class.

“I was caring for an elderly patient in the Emergency Room who had just tested positive for COVID-19. However, this day, the provider I was working with was resistant to putting the patient on a ventilator.” As Clare reflected  on the situation she shared, “I remember asking myself, is the provider just being lazy because the patient is elderly with a poor prognosis? However, I also knew, this doctor reads a lot of research. I still couldn’t help but question the decision. The patient did in fact improve without ventilator assistance,” giving Clare pause….thinking about the juxtaposition of knowledge with practice. As Clare’s recounting of the story concluded, Clare was asked to consider how her COVID-19 experiences may influence the future. The rawness of her sharing was palpable as she elaborated on the pause noted in her story: “I never knew nursing would get to this point. I am becoming suspicious of everyone, even co-workers. I stand away from everyone and wear masks all the time. I am challenged with what feels like lacking compassion. I don’t spend time in the rooms like I always did before, or place a hand on an arm to show comfort because we are thinking, is this the next COVID patient. I do make sure there is a phone in every room and I call often to check on the patients. It just feels less personal. It feels unnatural.”

Hmmm…lacking compassion feels unnatural. There is a theory and/or a philosophical perspective in this sentiment. We could go with Meyeroff’s ideas (1971) about caring as a way of ordering one’s values so that one feels “in place” rather than “out of place” in the world. We could go with Watson’s Transpersonal Caring Moment (Watson, 2018) where people come together in a human-to-human, spirit-to-spirit connection that is meaningful, authentic and intentional. These are just two examples providing context that allows for locating self in the theory-practice connection; many others could be the philosophical/theoretical lens providing context.   

Then the class was asked, “What have you learned from Clare’s story that resonates with your own practice?” Anna was quick to answer, “Everything is fluid and flexible right now, we have protocols, but they change day by day, they are evolving and there is a lot of uncertainty. We have to be able to allow flexibility in new ways. I can’t get into my usual groove.” Then THE question was posed. “Is theory real for you in your everyday practice? If not, it’s ok to say so.” Perhaps the most insightful answer was Brad’s response. “We are taught many theories, but challenged to know how to apply them. I don’t have theory on my mind when I am in front of my patient. It may be subconscious, but I’m not thinking, I’m applying Leininger or Watson right at this moment.”

Brad is right…we don’t expect that nurses live real-time practice checking in with theoretical/philosophical perspectives. However…the perspectives are there and stepping back and reflecting on nursing circumstances may enable forward movement with theory-guided intention and with knowledge-building for the discipline.

Pondering We ARE the theory-practice connection

As the nurse theorist-practitioner team that we are, we have great appreciation for the comments of these practicing nurses who happen to be graduate students. We wondered …Could the shade granted by COVID-19 bring theory out of the shade for students when they don’t even know it? You see, we are educators in a setting where nursing theory is highly valued and caring theory is the organizing spine of our curriculum. Has caring theory become so naturally interwoven in their practice that these NP students know something is amiss but they have difficulty naming it beyond descriptors like “unnatural” or “I can’t get in my groove”? We can only hope….but we can also plan to honor the shade by:  

  • remembering that we are always working from a theoretical perspective – we have only to step back from any nursing situation and consider the principles/concepts that are guiding our actions;
  • creating opportunities to share our practice stories with the knowledge that the implicit theory woven into the practice threads can come alive through scholarly engagement that is open to authentic expression and that gently supports exploration and maturing of an individual nurse’s own thinking;
  • holding the theory-practice connection as a truth that just takes time and professional maturity for appreciation but it is a truth that can be readily described when nurses have a mentor who helps with connecting the practice-theory dots;
  • pairing theorists and nurse practitioners to forge opportunities for growing nursing knowledge grounded in our practice.

Though there is little positive to say about COVID-19 these days, it may be that the pandemic granted some shade for us to reflect on the theory-practice connection in a way that can guide  understanding. After all, We ARE the theory-practice connection. Let’s own it.

Now….what do you think – we would like to hear from you.  How do you see our plan to honor the shade as an integral dimension of developing practice-scholars AND growing the discipline of nursing?  

  1. Liehr, P. & Smith, M.J. (2020). Claiming the narrative wave with story theory. ANS, 43(1), 13-27.
  2. Meyeroff, M. (1971). On caring. Harper & Row: New York.
  3. Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. Louisville, CO: University Press of Colorado.

About the contributors

Andra S. Opalinski

Andra Opalinski, PhD, CPNP-PC, NC-BC is a pediatric nurse practitioner and an Associate Professor at the Christine E. Lynn College of Nursing, Florida Atlantic University. She is an advocate for child and adolescent mental health promotion. Her current areas of interest include community-based participatory research with elementary through high school students using mindfulness interventions for self-regulation and stress management skill building. She also uses visual anthropology through photographs to explore perspectives of health of vulnerable populations. Right now, you’ll find her working remotely, doing the best she can to keep her household of 5 under strict physical distancing, and using the visual anthropology approach to document her family’s physical distancing experiences.

Patricia Liehr

Patricia Liehr PhD RN is currently the Associate Dean for Nursing Research and Scholarship at the Christine E. Lynn College of Nursing, Florida Atlantic University (FAU). She is the co-author of story theory and the co-editor of Middle Range Theory for Nursing. Most of her scholarly work has focused on peace, from personal through mindfulness; to global through coming to know both sides (Pearl Harbor; Hiroshima) of surviving the bombings of WWII. Story-gathering has played a major role in her research endeavors and she highly values the place of nursing practice stories for disciplinary knowledge development. Right now, as she moves toward an August retirement from FAU, she is imagining all the things she will do with new-found time.

In case you missed it – Nursing and Racism

There seems to have been a glitch in our June 16th post titled “Nursing and Racism: Are We Part of the Problem, Part of the Solution, or Perhaps Both?” So just in case you missed it, follow this link to view, and please add your thoughts and comments to this important challenge! https://nursology.net/2020/06/16/nursing-and-racism-are-we-part-of-the-problem-or-part-of-the-solution-perhaps-both/

Nursing and Racism: Are We Part of the Problem, Part of the Solution, or Perhaps Both?

One of the first “lessons” in my now-long-ago nursing education was “the nursing process.” This was in the early 1960s, almost a decade before anyone spoke of nursing theory, but the University of Hawaii (my alma mater) had modeled the curriculum on that of the University of California at Los Angeles (UCLA) which was designed around the ideas of Dorothy Johnson. These ideas would ultimately become known as Dorothy Johnson’s Behavioral Systems Model (See also the history of the UCLA School of Nursing, pgs 43-48).

Of course this same problem-solving process is widely used in many walks of life, and many see it as a mere pragmatic outline for making good decisions and forming appropriate action – a necessary process but several degrees removed from developing foundational knowledge of the discipline. In reflecting on the situation in which we find ourselves today I fear that as a discipline we have not adequately faced the realities before us as a discipline and as a society – both as a problem, and as a health experience. As I wrote in my January 20th post titled “Decolonizing Nursing”

Despite the fact that race and racism so repeatedly rise to the surface with a clear intent to address this issue, there is typically little or no substantive discussion that begins to reach deep down into explanations or understanding of what is really going on (see https://nursology.net/2020/01/14/decolonizing-nursing/)

I know that I am not alone in recognizing this challenge, but I continue to wonder — when and how will this begin to change? This is not merely a “political” matter — it is a matter of life and death, of health and sickness. It is a pandemic of proportions far beyond the COVID-19 pandemic, and it has been infecting our lives for decades. In recent weeks we have witnessed the public killing of George Floyd by a Minneapolis police officer, of Ahmaud Arbery shot down while jogging in February, and Breonna Tayler, an EMT with plans of becoming a nurse, killed by police in her own home in March. Then just a few days before this post published, the killing in Atlanta of 27-year-old Rayshard Brookes, shot in the back several times by police after indicating that he was able and willing to walk home to his sister’s house.

These tragic murders in plain sight, coupled with widespread recognition of the over-proportioned number of Black and Brown people suffering from COVID-19 – give us a glimmer of opportunity to finally act. The calls for change are so pervasive and so sustained, that those of us ready and willing to make change have a real opportunity to do so. And so I return to my earliest nursing education and the foundational ideas that have been baked into my very fabric – the processes of active listening and observation that are vital to assessing and “diagnosing” a problem(1).

One of the notable signs that appears in all of the protests says “I see you, I hear you.” For me, this is a key to meeting the challenge before us. It starts with our interactions among our own colleagues. Throughout my nursing career I have seen many Black nurse colleagues come and go, and every single one of the nursing faculty I have served with have repeatedly decried how “difficult” it is to recruit and retain Black nurse faculty. Yet all too rarely have I witnessed concerted, deliberate efforts by the predominantly White(2) faculty to stop, step away from our privilege, seek the authentic stories of our Black colleagues, and actively hear (understand) their experience. Equally egregious is the fact that there are myriads of situations that, viewed through a lens of anti-racist awareness, could be instantly recognized as potentially harmful to a Black person, even dangerous. But over and over again we turn a blind eye, and fail to act. I have all too often been just as complicit in all of this as anyone else – we have all been caught up, and participate in a systemic web of injustice. And I suspect that this pattern is not unique to academics – that it runs deep in every setting where nursing is practiced.

Further, there is the all-too often deflection of the problem by the insistence that the “problem” is not unique to Black people – that all lives matter. Of course all lives matter and Black people are not the only ones who suffer injustice and discrimination. But this sentiment turns the lens away from the specific voices, experiences, and challenges faced Black people. We can listen to all people – but until we listen to, and sincerely seek to understand, Black people and recognize the experiences of trauma and harm that Black people uniquely suffer, and how we participate, we will not be able to truly understand the problem.

It is undeniable that the prejudice and hate toward Black Americans, and people of African descent in many other countries is profound and amplified by the historical trauma of slavery and in the United States, the fall-out of the civil war fought to end slavery in the United States. I hear many White nurses in my circle expressing true outrage about this situation and we are all sincere in our desire to see it change, yet the problem persists. Until we White nurses face the reality of our privilege and the injustices that flow from this, until we learn ways to step away from our privilege and engage in serious anti-racism work, until we create spaces in which we can authentically engage with our Black colleagues to understand the problem, the injustices in our own house will remain.

We can all shift in the direction of being part of the solution. There are signals that point us in the direction of actions we can all take – particularly those of us who are White – to seize this moment, start to address the scourge of racism in our own house, and make real change. The circumstance of the COVID-19 shift to virtual reality offers ample opportunities for all of us to engage in antiracism work! Here are a few examples that I can personally recommend – if you start searching, you will find many many others!

  • Nurse Caroline Ortiz organized a “platica” (Spanish for discussion) held on March 9th over Zoom. Caroline recorded the session, which you can access here: https://vimeo.com/397047962. You can organize similar discussions – we are all now expert Zoom organizers!
  • African-American activist Nanette Massey holds a weekly discussion with White people from all walks of life to discuss the ideas in Robin DiAngelo’s book “White Fragility: Why It Is So Hard for White People to Talk About Race.” I have participated in many of these informative, interesting and affirming Sunday discussions. Learn more here.
  • The “Everyday Feminism” website has pages and pages of content on ethnicity and racism – https://everydayfeminism.com/tag/race-ethnicity/. Just browsing titles is a rich experience! Their 2014 post of 10 Simple Ways White People Can Step Up to Fight Everyday Racism is precisely relevant today!
  • Invest 1.5 hours into Everyday Feminism’s founder, Sandra Kim’s excellent session on “Why Healing from Internalized Whiteness is a Missing Link in White People’s Anti-Racism Work.” White nurses can benefit especially, but knowing that White people are facing this challenge, and how this can happen, can be helpful for everyone.
  • Practice generosity of spirit toward your nursing colleagues – each of us are being challenged in this moment to examine our own attitudes, actions and words. Many of us are just starting on this journey. This demands kindness and understanding toward one another as we work together, often in uncomfortable situations, to make meaningful change. Let us call forth the best we can be, and support one another with compassion and understanding when we mis-step.
  • Consider how application of many tenets of our own nursing theories can be activated in the quest to address racism. Consider Peplau’s approach to meaningful interpersonal relationships, the very important insights from Margaret Newman “Health as Expanded Consciousness,” and any one of several theories of caring such as Watson’s Theory of Human Caring, or Boykin and Schoenhofer’s Theory of Nursing as Caring, While these and other nursing theories were not created specifically to address racism and social injustice, we certainly can draw on their wisdom to bring nursing perspectives to the center in our anti-racism work.
  • Follow the opportunities provided by the Nursology Theory Collective to join discussions focused on creating equity in nursing
  • Find, read and cite nursing literature authored by nurses of color. Learn the names of these authors, and seek out their work. If you teach, make sure you include this literature in your syllabi(3).
  • Explore the work of scholars in other disciplines who are also committed to anti-racism work. The “Scholarly Kitchen” blog posts regularly on matters of racism and discrimination – see their June 15, 2020 post titled Educating Ourselves: Ten Quotes from Researchers Exploring Issues Around Race
  • Make your own video, as a nurse, speaking to these issues and how your values, ideas, nursing perspectives inform your actions to fight racism! Post it on YouTube or Vimeo .. and then share it with us – we can consider posting on Nursology.net or another nursing website. See this wonderful video (below) by de-cluttering expert Mel Robertson for inspiration!
Notes
  1. Ultimately the concept of active listening formed a basis for the essential processes of “critical reflection” and “conflict transformation” in my heuristic theory of Peace and Power.
  2. See this excellent article from the Center for the Study of Social Policy on the capitalization of the terms “Black” and “White,” which I consulted in refining this post: Nguyễn, A. T., & Pendleton, M. (2020, March 23). Recognizing Race in Language: Why We Capitalize “Black” and “White” | Center for the Study of Social Policy. Center for the Study of Social Policy. https://cssp.org/2020/03/recognizing-race-in-language-why-we-capitalize-black-and-white/
  3. See Kagan, P. N., Smith, M. C., & Chinn, P. L. (Eds.). (2014). Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge. This collection includes many of the leading authors, including many nurse scholars of color, whose work focuses on social justice.

Another First for Nursology!

The Roy Academia Nursology Research Center (RANRC, see http://www.ranrc.com/) recently published the first issue of the Nursology Letter (see http://www.ranrc.com/nursology-letter/). This is the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan –see http://www.st-mary.ac.jp/

The Nursology Letter is another first for our discipline. Specifically, the Nursology Letter is another answer to our Who Will be the First? blog on May 21, 2019. The first “answer” to the question was publicized on our June 11, 2019 blog post announcing the establishment of the Roy Academic Nursology Research Center. The founding of the Nursology Letter is a wonderful and very significant means of communication from the St. Mary’s College RANRC. Indeed, the Nursology Letter is the perfect way to share the very important research done by the faculty and students at St. Mary’s College.

The Nursology Letter, Volume 1, 2019, includes a statement of the concept guiding the RANRC; an introduction to the inaugural issue of the Nursology Letter by Tsuyako Hidaka, RANRC Director, who also noted that the Roy Adaptation Model has been used to guide education and practice at St. Mary’s College for 30 years. The first issue of the Nursology Letter also includes greetings and message of congratulations from Nobu Ide, Chancellor of St. Mary’s Education Foundation; Callista Roy, for whom the RANRC is named; Jacqueline Fawcett, a visiting professor at St. Mary’s College School of Nursing; Debra Hanna, President of the Roy Adaptation Association-International; and Leah Fitzgerald, Dean of Mount St. Mary’s University School of Nursing in Los Angeles, CA.

In addition, the Nursology Letter includes messages about the research interests of the RANRC members, including Eric Fortin, Masako Momoi, Mayumi Sakita, Akemi Tsuruta, Michiru Asano, Satsuki Obama, Sachiko Ishimoto, Akina Ide, Chidori Hashiguchi, Ikuko Miyabayashi, and Miyuki Ichinose.

Congratulations to everyone who has made this notable publication possible!  We of the nursology.net leadership team,  are delighted to also let the entire nursology.net universe know about this remarkable achievement!

The Environment, Climate Change, and the #Climate Strike: A Nursology Perspective

with contributions by Peggy Chinn
Also see Adeline Falk-Rafael’s “addendum” to this post below

The nursology.net management team agreed to participate in the September 20, 2019 #Climate Strike – Nursology.net went to a  green screen acknowledging the importance of this public action for the entire day on September 20th. By doing so, we joined people “[i]n over 150 countries . . , to support young climate strikers and demand an end to the age of fossil fuels. The climate crisis won’t wait, so neither will we.” (from Global Climate Strike)

Climate can be defined as “characteristic weather conditions of a country or region; the prevalent pattern of weather in a region throughout the year, in respect of variation of temperature, humidity, precipitation, wind, etc., esp. as these affect human, animal, or plant life” (Oxford English Dictionary, 1889/2008)

The lack of sufficient attention to widely documented climate change by so many people, is, of course, the impetus for #Climate Strike. Climate change is defined as “an alteration in the regional or global climate; esp. the change in global climate patterns increasingly apparent from the mid to late 20th cent. onwards and attributed largely to the increased levels of atmospheric carbon dioxide produced by the use of fossil fuels .”(Oxford English Dictionary, 1889/2008).

The nursology.net management team’s concern with climate reflects our heritage of Florence Nightingale’s emphasis on environment and the effects of environment on human beings’ health status. Climate is, of course, a major aspect of environment, although climate is rarely mentioned in nurse theorists’ discussions of environment. An exception is found in the content of Orem’s self-care framework. Orem (2001) referred to two dimensions of what she labeled environmental features–physical, chemical, and biological features; and socioeconomic cultural features. Physical and chemical features include what typically is thought of as at least part of the climate—the atmosphere of the earth, gaseous composition of air, solid and gaseous pollutants, smoke, [and] weather conditions (Orem, 2001). Another exception is found in the content of a new conceptual model—the Conceptual Model of Nursology for Enhancing Equity and Quality—Population Health and Health Policy (Fawcett, in press). Following a suggestion from a PhD nursology student at the University of Massachusetts 2018 Five Campus PhD Forum, climate was explicitly included in this conceptual model in the definition of the physical environment.

Two recent nursing scholars have given primary focus on the environment in their work; their work provides important foundations for nursing action. Patricia Butterfield’s Upstream Model for Population Health (BUMP Health) provides a framework for addressing general issues related to health and the environment at a population level (Butterfield, 2017).  Dorothy Kleffel has been a thought-leader in nursing for more than 2 decades pointing the way toward a nursing focus on the environment and its effect on health (Kleffel, 1996).

A recent search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete), using the search terms, climate AND nursing, yielded 1,875 publications. However, a search using the terms, climate change AND nursing, yielded only 186 publications Two particularly informative publications are scoping reviews of the literature (Hosking & Campbell-Lendrum, 2012; Lilienfeld, Nicholas, Breakey, & Corless, 2018). Another informative publication is a call for action (Travers, Schenk, Rosa, & Nicholas, 2019).

Contemporary interest in environment and climate change has been prompted by two global initiatives–the 2008 World Health Organization (WHO) Member States World Health Assembly resolution (Hosking & Campbell-Lendrum, 2012) and the United Nations (UN) Sustainable Development Goals (Lilienfeld et al., 2018). The WHO resolution supports progress on studies of the effects of climate change on human health, including health vulnerability, health protection and its costs, the impact of migration and adaptation policies, and decision-support and other tools. Other health effects of climate change include an increase in communicable and noncommunicable diseases, weather-related injuries, mental health disorders, and effects of nutritional deficiencies on growth and development (Lilienfeld et al., 2018).

Hosking and Campbell-Lendrum’s (2012) scoping review of literature published between 2008 and June 2010 yielded 40 relevant papers. Of concern is that none of the papers were reports of studies of effective interventions, which clearly was a major gap in our literature of that time. Lilienfeld et al.’s (2018) scoping review placed climate change with the context of nursology. They identified and categorized 48 papers in their search of literature from 1996 to 2018, only a few of which were research reports. The categories are;

  • Background of climate change
  • Health consequences
  • Nursing knowledge and attitudes
  • Reference to UN Millennium Development Goals and/or the UN Sustainable Development Goals
  • Migration and/or adaptation strategies
  • Urgency
  • Plan
  • Climate justice

Once again, a major gap is research, especially the design and testing of interventions.

Travers, Schenk, Rosa, and Nicholas’ (2019) call for action by nurses may be the catalyst needed to advance nursology’s contribution to filling the gap in the literature. They underscored the findings of previous literature reviews revealing the effects of climate change on the environment and, consequently, on human health. Their call for action, which encompasses research, education, advocacy, and practice, exhorts nurse “to step up and see themselves as part of the solution to climate change” (Travers et al., 2019, p. 11).

There is, however, little evidence that nurses have begun to step up, to move beyond “talk about what needs to be done” (Travers et al., 2019, p. 11). As reported in The Washington Post (Tan, 2019), nurses are continuing to talk about climate change. An encouraging development is nurses’ willingness to join climate-oriented organizations as they increase their awareness of and even experiences of recent natural disasters, including hurricanes, wild fires, floods, and tornados (Tan, 2019).

The global action of the #Climate Strike, including worldwide demonstrations led by teenagers on Friday, September 20, 2019, and planned future Friday demonstrations certainly is encouraging. Perhaps these demonstrations will be a catalyst to actions by nursology students, faculty, and practitioners to conduct the research needed to identify effective interventions to mitigate the deleterious effects of climate change on human health. Perhaps, too, these demonstrations will move the UN and federal governments worldwide to fund that research.

Nursology is founded on a holistic conceptual orientation that points the way to recognizing the role of environment on human health, and toward nursing action to respond to this global crisis. It is time for nursologists and nursing as a discipline to step up to the challenge and provide a leading voice for healing the planet, for healing those who are harmed by the climate crisis, and join the many others who are demanding social and political action now to turn this crisis around.

Addendum by Adeline Falk-Rafael: Watson’s early publications of her philosophy and science of caring also explicitly identified the provision for “supportive protective and(or) corrective” environments, including specifically the physical environment as a carative factor. Although her language has changed, I believe the intent has not. That aspect of her theory was one key which led me to develop the mid-range theory of Critical Caring, based on her and Nightingale’s work (although my thinking has also been influenced by Butterfield’s and Kleffel’s work). Note: Adeline  (who is on our management team) was hiking in the Alps when we prepared this post!  Thank you Adeline for adding this important information to this post!)

References

Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. Advances in Nursing Science, 40, 2–11. http://dx.doi.org/10.1097/ANS.0000000000000161

Fawcett, J. (in press). The conceptual model of nursology for enhancing equity and quality: Population health and health policy. In M. Moss & J. Phillips (Eds.), Health equity and nursing: Achieving equity through population health & public policy. New York, NY: Springer.

Hosking, J. & Campbell-Lendrum, D. (2012). How well does climate change and human health research match the demands of policymakers? A scoping review. Environmental Health Perspectives, 8, 1076-1082.

Kleffel, D. (1996). Environmental Paradigms: Moving Toward an Ecocentric Perspective. Advances in Nursing Science, 18, 1–10. https://doi.org/10.1097/00012272-199606000-00004

Lilienfeld, E., Nicholas, P. K., Breakey, S., & Corless, I. B. (2018). Addressing climate change through a nursing lens within the framework of the United Nations sustainable development goals. Nursing Outlook, 66, 482-494.

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St. Louis, MO: Mosby.

Oxford English Dictionary (1889/2008). Definitions of climate and climate change.

Tan, R. (2019, September 20). Why nurses, America’s most trusted professionals, are demanding “climate justice.” The Washington Post. Retrieved from
https://www.washingtonpost.com/local/why-nurses-americas-most-trusted-profession-are-speaking-out-against-climate-change/2019/09/19/1c5314d8-dae2-11e9-a688-303693fb4b0b_story.html

Travers, J. L., Schenk, E. C., Rosa, W. E., & Nicholas, P. K. (2019). Climate change, climate justice, and a call for action. Nursing Economic$, 37, 9–12.