Aesthetic knowing in nursing is a way of knowing realities that are not empirically observable – the deep meanings in a situation. As nurses grasp these meanings, they can draw on their inner, creative resources to respond to the situation in ways move the situation from what is, to what is possible. Aesthetic knowing is called forth in the face of human experiences that are common for to all human experience such as grief, joy, anxiety, fear, love. Even though these experiences are common, they are expressed in ways that are unique to each and every individual experience. People recognize common expressions of such experiences as anxiety, or fear, or love. But each person’s experience is unique.
The recent spotlight on police brutality and killing of Black Americans prompted widespread reflection and change toward social justice and racial inequities in almost all sectors of society – including the realm of scholarly publishing. The “Scholarly Kitchen,” blog of the Society for Scholarly Publishing, posted a notice of an “Antiracist Framework for Scholarly Publishing” on August 6, 2020 that serves as a guide to re-shape policies and practices in the production of scholarly literature.
I am delighted to share the outcome our initiative to examine and revise guidelines and practices for Advances in Nursing Science. As Editor, I established a workgroup of scholars of color who serve on the ANS Panel of Reviewers to take a deep dive into the journal’s “Information for Authors”. Together we created major anti-racist changes that have now gone into effect.
The changes that we made begin with a fundamental acknowledgement of the power of the published word to shape thought and power structures, and the responsibility of authors in situating their work within existing power structures:
Published scholarly works play a major role in shaping thought and power structures. We encourage authors to include a standpoint statement that describes your position relative to power relations of race, gender, and class. This is particularly important if your work involves disadvantaged populations or issues of social determinants of health and health equity. Examples include:
“The authors Identify as white middle-class nurses. We have drawn on literature authored by scholars of color to inform the design, interpretations and conclusions reported in this article.”
“Our work arises from our experiences as able-bodied nurses, as well as our identities as mixed-race descendants of immigrants from Central and South American countries.”
The following is a new section that specifically addresses guidelines related to racism:
The ANS leadership – Editor, advisory board members, peer reviewers and Publisher recognize that published scholarly works are vehicles that can challenge systemic racism and intersecting forms of power inequities. ANS expects an explicit antiracist stance as a means to provide scholarly resources to support antiracism in research, practice, education, administration, and policymaking. To this end, we offer the following guidelines:
Remain mindful of the many ways in which white privilege is embedded in scholarly writing, and engage in careful rereading of your work to shift away from these explicit and implied messages. As an example, general “norms” are typically taken to reflect white experience only; this is revealed when the experience of people of color are taken to be “other” or “unusual” or worse yet “unhealthy”
When race is included as a research variable or a theoretical concept, racism must be named and integrated with other intersecting forms of oppression such as gender, sexuality, income, and religion.
If your work does include race,
Provide a rationale that clearly supports an antiracist stance.
Be careful not to explicitly or implicitly suggest a genetic interpretation.
Explicitly state the benefit that your work contributes on behalf of people of color.
Refrain from any content that explicitly or implicitly blames the victim or that stereotypes groups of people; situate health inequities clearly in the context of systemic processes that disadvantage people of color.
Focus on unveiling dynamics that sustain harmful and discriminatory systems and beliefs, and on actions that can interrupt these structural dynamics.
We also added a new criterion on which all submissions are evaluated during the peer review process:
Acknowledgement of and challenges to power relations involving race, gender, class, ableism or any other systematic disadvantage.
Please visit the complete ANS Information for Authors to review these changes. We welcome your feedback, comments and questions! Please respond below!
Deep appreciation to the following team of ANS peer reviewers who developed these guidelines:
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.
Nursology.net is issuing a call for blog submissions for an upcoming special issues series on the topics of antiracism and politics. At this critical time in history, we are committed to providing sentinel, contemporary, comprehensive, humanistic and authentic information to facilitate advancement of nursing science. We are calling for blog posts acknowledge antiracism and politics. We welcome you (students, scholars, practitioners, everyone!) to submit blogs on relevant topics of nursing knowledge, including nursing theory and philosophy, and the intersections of antiracism and politics. You are welcome to speak to one topic, or both as they are interconnected.
This call is open for Spring 2021, and notification will be made when our call is closed.
Read previous blogs on racism/antiracism on Nursology.net here. Read previous blogs on politics on Nursology.net here.
For more information on how to submit a blog to Nursology.net please click here. For information on how to write a blog, please click 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 email@example.com.
We look forward to seeing you and continuing this important conversation on December 18th!
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.
Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN firstname.lastname@example.org
. . . . 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)
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.
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.netwebsite. 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.
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!
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!
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!
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!
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.
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?
Liehr, P. & Smith, M.J. (2020). Claiming the narrative wave with story theory. ANS, 43(1), 13-27.
Meyeroff, M. (1971). On caring. Harper & Row: New York.
Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. Louisville, CO: University Press of Colorado.
About the contributors
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 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.