Guest Post – Emancipatory Nursing in Chile

Contributor: Luz Galdames, PhD (Nursing)

Today, more than twenty years after nursing was incorporated into the Chilean Health Code in 1997 as an autonomous profession, one begins to see how nurses empower themselves defending their rights at the institutional, social and political level. This is seen through events such as the establishment of the National Nursing Directorate at the Ministry of Health and the role that nursing has had in the Covid-19 pandemic. Nurses are raising their voices. In the political sphere, nurses are campaigning as representativeness to draft the new Chilean Constitution, defending/advocating care as a constitutional right and guarding professional autonomy. Another important example of nursing empowerment is the growing generation/development of nursing scientific associations. These organizations seek to socialize what nurses do, the ongoing research in different areas of care and the development of profession itself. Currently, there are more 40 scientific nursing societies in the country.

In 2005, through the Health Authority Law 19,937, self-managed hospitals were established, which brought with them an important change in their administrative organization. It implied that hospitals in their structure should consider the Medical Directorate and the Subdirectorate of care management, both with direct dependence of the hospital management. Historically, nursing had depended on the medical directorates. In this context, the nursing professional association of the time and, the scientific societies (in that period there were no more than ten) defended before the authority of the Ministry of Health and the Comptroller General of the Republic, that by then nursing was the only profession that in its definition evidenced care management as a component of its role. As a result of these negotiations in 2007, by means of the General Administrative Norm No. 19 of the Ministry of Health, it recognized the nursing profession as the most suitable for implementing the care management model in self-managed hospitals.

In this context, “Nursing Care Management” was defined as the professional practice of the nurse based on the nursing discipline, the science of caring (based on Watson’s philosophy and theory), understanding the exercise of the profession as the application of professional judgment in planning, organization, motivation and control of the provision of timely, safe, comprehensive care that ensures continuity of care and is based on the institution’s strategic policies and guidelines. This achievement was constituted a demonstration of empowerment of the nurses of the decade.

However, even when the definition indicated that “care management” was based on the science of caring, the care provided to people was mainly focused on the biomedical model. The National Directorate of Nursing: it is specified through Exempt Resolution No. 1443, on August 20, 2019, during the mandate of the Minister of Health Jaime Mañalich who formalized the appointment of the National Director of Nursing. Being a milestone for the profession, providing from the central level, support to direct and guide the care of people, develop the nursing structure for the health sector, ensure that the nursing care management sub-directorates are not only considered in in-hospital care, but also in primary care.

In parallel, there have been other relevant events in the country, which show the awakening of nurses as a professional group. An example has been the number of nurses who present themselves to the process of electing representatives to the constituent assembly, in defense of care as a constitutional right, as well as the defense of the autonomy of the profession and the rights of nurses.

Another event that has led to the empowerment of nurses has been the Covid-19 Pandemic, which has resulted in the defense of the right of profession, the union of the group to be in the spaces where decisions are made. Likewise, the growth of scientific Societies that bring together nurses for a common purpose, whether it is around the care of people, such as the defense of the rights of the profession (see the list of Scientific Societies below).

The immunization of the population through the vaccine for Covid-19, means another instance in which the nurses raised their voices to defend the vaccination process as a historical nurse’ s responsibility. To respond to the vaccination demands, other healthcare professionals were called by the authorities as volunteer. This led, the nurses defended before the authorities, that although the voluntary participation of other professionals in vaccination is recognized, the vaccination programmeshould be under the supervision of the nursing staff only. Highlighting that, vaccination does not only imply the act of inoculating the vaccine, but an entire process of organization, administration, register and following up.

One of the last events that brings together nurses as an empowered group is the call that the National Director of Nursing makes to Scientific Societies to be part of a Technical Working Table, with the purpose of generating strategic collaboration links in for the development of protocols for the management of care and research in the discipline of Care.

Photo of group meeting from the Scientific Societies

Scientific Societies

  • Agrupación de enfermeras holísticas de Chile (AEHCh)
  • Agrupación de enfermeras y enfermeros ecologistas
  • Agrupación de enfermeros perioperatorios (AGEPCH)
  • Asociación chilena de enfermería en estomas heridas y/o continencias (ACCHIEHC)
  • Asociación chilena de enfermeros educadores en diabetes (ACHIENED)
  • Capítulo de enfermería de la Sociedad Médica de Cuidados paliativos
  • Capítulo de enfermería de SOCHIQUEM
  • División de enfermería intensiva de la sociedad chilena de medicina intensiva (SOCHIMI)
  • Federación Latinoamericana Esterilización FELACEH
  • Fundación de enfermería Gestión del Cuidado
  • Fundación latinoamericana de enfermería en cuidado humanizado (FLECH)
  • Sociedad de Enfermera Latinoamericana en Heridas (SELH)
  • Red Nacional EBE Chile
  • Red Chilena de Enfermería en Lactancia Materna (REDCHIELM)
  • Red Chilena de Enfermeros En Odontología (RECHIENFOD)
  • Red de Enfermería en Informática Chile
  • REDENFI Chile
  • Red Chilena de Gestión del Cuidado REDGECU
  • Red de Enfermería en Salud del Adulto Mayor- Chile (REDESAM)
  • Red Chilena de Historia de la Enfermería
  • Red en Salud Ocupacional (RedENSO Chile)
  • Red iberoamericana de investigación en educación en enfermería-RIIEE Chile
  • Red Internacional de Enfermería en Cuidados Paliativos – Chile (RienCupa)
  • Red internacional de enfermería quirúrgica -RedIEnQu Chile
  • Sociedad Chilena de Enfermería en Salud Ocupacional (SOCHENSO)
  • Sociedad chilena de enfermeras de salud escolar (SOCHIESE)
  • Sociedad Cientíca chilena de enfermeras del niño y adolescente (SOCHENA)
  • Sociedad Chilena de Enfermería en Cardiología y Cirugía Cardiovascular (SOCHICAR)
  • Sociedad Chilena de Enfermería en Donación, Procuramiento y Trasplante (SOCHIENFDPT)
  • Sociedad Chilena de Enfermería Oncológica (SEOC)
  • Sociedad científica de enfermería comunitaria y familiar (SOCHIENFA)
  • Sociedad chilena de enfermeras comunitarias (SOCHIENCO)
  • Sociedad Chilena de Enfermería Prehospitalaria, Agrupación Científico-Técnica. (SOCCHIENPRE)
  • Sociedad chilena de prevención y control de infecciones asociadas a la atención en salud, (SChIAAS)
  • Sociedad Chilena de Enfermeras de Pabellones Quirúrgicos y Esterilización
  • Sociedad Chilena de Terapia de Infusión (SOCHITEIN)
  • Sociedad científica de atención temprana, rehabilitación e inclusión
  • Sociedad Científica Docente Estudiantil de Enfermería UACh Pto Montt (SOCIDENF)
  • Sociedad de enfermeras de diálisis y trasplante renal (SENFERDIALT)
  • Sociedad Chilena de Enfermería Geronto-Geriátrica
  • Sociedad de Enfermeras Dermoestéticas (SOCHIEDE)
  • Sociedad de Profesionales en Esterilización de Chile
  • Sociedad Chilena de Simulación Clínica (SOCHISIM

About Luz Galdames

Luz Galdames Cabrera Ph.D. in Nursing, Mg. Instructional Design, Nurse-Midwife, Research Professor, School of Nursing, Faculty of Sciences, Universidad Mayor. Researcher in project “Development and validation of the prototype dressing with copper nanoformulation for the treatment of infected chronic wounds, Universidad Mayor, Project ID18I10085 Funded by the Fund for the Promotion of Scientific and Technological Development FONDEF 2018-2020. Director of the Nursing Specialization Program in Adult Oncology at the Universidad Mayor. Member of the International Center for Nursing Research CIIENF of the Chilean Association of Nursing Education. Coordinator of the international Care Management Network. Founder and President of the Chilean Network of Care Management Last publication Galdames l., Enders B., Pavez A. Self-regulation, Autonomy and Identity of Nursing as a profession. Science and Nursing Magazine. 2019 24 (4). Doctoral thesis Care Management: Understanding the Meanings of the Social Role and Professional Autonomy of the Nurse in Chile. Funded by the Vice-rectory for Research and Doctorate as a start-up project, Universidad Andrés Bello Chile 2014.

Theorizing as Emancipatory Action; Emancipatory Action as Theorizing

Over the past year those of us managing the Nursology.net website have experienced two unintended consequences – growing awareness of the importance of fundamental nursing/ public health knowledge and action, and the imperative to examine the structural and interpersonal dynamics of racism. As the web manager of this Nursology.net site as well as the NurseManifest.com website, the home of “Overdue Reckoning on Racism in Nursing,” I have had a front-row seat from which to witness and participate in these two complimentary processes.

From the NurseManifest sphere, we have addressed (explicitly and implicitly) questions such as: “How does our activism contribute to our discipline?” “What are the fault-lines in nursing created by our failure to address racism in nursing?” “How can we engage in authentic reckoning with racism in nursing?” “How can this reckoning shift nursing to more fully engage in facilitation of humanization for those who have historically been harmed by racism?” “How can nursing knowledge be decolonized to fully embrace the knowledge and wisdom of Black, Indigenous, Latina/x, and other nurses of color?”

From the Nursology.net sphere, we have addressed (explicitly and implicitly) questions such as: “What does decolonization of nursing knowledge mean?” “What dynamics have persisted to bring us to this point in history where the scholarship and theorizing of Black, Indigenous, Latina/x and other nurses of color are strikingly absent from our historical record?” “How can we move away from performative action, to fully abandon white privilege in nursing, and to welcome nurse scholars of color to the center of our discourse?”

I do not have direct answers to any of these questions. In fact I believe there are no specific “action” prescriptions that can provide “answers.” The response to all of these questions is what I believe to be critical emancipatory process — a process that begins with a recognition of the fundamental realities of racism and dedication to the hard work of deepened awareness and action for change. In the first chapter of the text “Philosophies and Practices of Emancipatory Nursing,”(1) Kagan, Smith and Chinn identified the following characteristics of emancipatory knowledge and critical theory that informs emancipatory action, as revealed by the chapter authors who contributed to the text:

What is “critical’ –

  • Unpacking hegemonies
  • Upstream thinking
  • Interrogating historical/social context
  • Framing/anticipating transformative action

What is “emancipatory”

  • Facilitating humanization
  • Disrupting structural inequities
  • Self-reflection
  • Engaging communities

Taken together, these characteristics point to a deep understanding of what it might mean to bring knowledge and action together as one – the process and understanding that emerges from “knowing what we do, and doing what we know.” In my experience growing up and becoming an “elder” as a fully colonized white woman, I know all too well the experience of separation of mind and body, of understanding and experience. But there is a glimmer of recognition when I encounter instances – my own and those revealed to me in stories others recount – when experience and understanding come together as one – when we recognize the importance of personal knowing and doing. And, recognize when that unified experience reveals new knowledge, new understanding. This process of action/reflection is theorizing at its best. African American scholar Anthony James Williams described this process of theorizing that he observed in his mother and grandmother:

Everyday black women theorists are often forgotten, undervalued and rarely considered theorists due to their lack of formal training and scholarly publications. But for my maternal lineage, the social patterns they observed became lessons. Those lessons then became theories about the social world they incorporated into their daily lives. Keen observation on their part lead to mental maps of where it would be safe to walk as black women, raise their children and avoid white violence. As the wife of a man in the military, my grandmother inevitably had her own theory of residential redlining based on her lived experience well before any academics published on the topic. (2)

Now is the time to engage in the critical emancipatory act of centering the voices of nurses of color who have been undervalued and discounted, only rarely recognized as theorists. The privileged white gaze from which nursing scholarship views the world recognizes only that which appears consistent with white experience, white culture. To face the realities surrounding white complicity that perpetuates racism is a possibility that is either far too frightening, or simply not comprehensible. But comprehend we must if we are to ever move to a reality where all experience is celebrated as valid and valuable, where skin color is not a determinant of whether you live or die.

The time has now come for all in our discipline – nursologists, nurses, students, educators, administrators, policy-makers – to make a strong and unequivocal turn away from all words and actions that render advantage for those whose skin is “white” and that disadvantage all of those with dark skin. It is time to abandon performative words and actions that claim to care for all, and turn instead to dismantle dehumanizing forces of racism and restore full humanization for all. For those who have white skin, it is time to reckon with your own complicity, unveiling the fault-lines (rifts, splits) created by the persistence of racism, and engage in the healing that must be done. For those who have dark skin, it is time to gather the courage to speak your truth, calling on your keen capabilities to discern injustice. For all of us together, it is time to form strong bonds of connection and support for this difficult path. It is a difficult path, but it is the path that will lead us to mental maps – to theorizing the healing that must take place. As we have experienced in our “Overdue Reckoning on Racism in Nursing” journey, it is also a path that is lined with moments of pure joy!

Sources:

  1. Kagan, P. N., Smith, M. C., & Chinn, P. L. (2014). Introduction. In P. N. Kagan, M. C. Smith, & P. L. Chinn (Eds.), Philosophies And Practices Of Emancipatory Nursing: Social Justice As Praxis (pp. 1–20). Routledge Taylor & Francis Group.
  2. Williams, A. J. (2018, June 15). Who Teaches Academics to Theorize? Inside Higher Ed. https://www.insidehighered.com/advice/2018/06/15/theorizing-black-scholars-differs-white-western-academic-standards-no-less-valid

Launch of BILNOC Leaders Database

We are delighted to launch a database that provides information about Black, Indigenous, Latina/x and other Nurses of Color (BILNOCs) who are (or have been) leaders and scholars who have contributed to the development of the discipline. This will be a significant resource for scholars and students who seek to recognize and honor BILNOC leaders. This database will fill a huge gap that contributes to the underrecognition of the contributions of nurses of color to the discipline.

View the BILNOC Submission Form to review the information we are seeking. You can find a link to the this form from the website “Resources” menu anytime later.

Guest post: The Role of Nurses and Women’s Health Advocates in Advancing a Social Justice Agenda in the Current Climate: The Case of Wisconsin

Contributors (see bios below)
Lucy Mkandawire-Valhmu, PhD, RN; Jeneile Luebke, PhD, RN;
Carolyn Eichner, PhD; Kaboni Gondwe, PhD, RN;
Diane Schadewald, DNP, RN; Peninnah Kako, PhD, RN;
Jacqueline Callari-Robinson, BSN, RN; Brittany Ochoa-Nordstrum;
Nicole Weiss; Jacqueline Campbell, PhD, RN, FAAN

As nursing professionals and women’s health advocates, we have watched in disbelief events unfolding in Barron County, Wisconsin. Embrace, a shelter serving survivors of sexual assault and domestic violence in Barron County, is facing backlash for displaying a Black Lives Matter (BLM) sign. Reacting to the sign, local officials stripped the organization of funding worth $25,000 and law enforcement are unwilling to continue collaborating with Embrace.

Source

Embrace, located in Northern Wisconsin, serves a predominantly White populace, but also has a significant population of migrant farmworkers and Somali refugees. Migrant farmworker women face difficulties in accessing help following an experience of violence due to transportation and language barriers. Many refugee women also often have a history of sexual violence and trauma. Black women make up less than 2% of the population in Baron County yet constitute 10% of the population accessing help at Embrace’s shelter. Part of the St. Croix Chippewa tribe is also located in Embrace’s service area. Black women and American Indian (AI) women are disproportionately impacted by violence, but do not ordinarily seek help despite the potential for severe negative impacts such as injury or even loss of life.

The National Intimate Partner and Sexual Violence Survey (NISVS) report shows that 84.3% of AI women have experienced lifetime violence (Rosay, 2016). The NISVS shows 41% of Black women have experienced physical IPV in their lifetime with homicide being one of the leading causes of death for women aged 44 and younger. It is in this context that Embrace seeks to serve the most vulnerable populations of women in a four-county area where they are the only available domestic violence shelter.

 We are in unprecedented times with an ongoing COVID-19 pandemic that not only disproportionately affects the lives of Black and Brown women and their communities, but also increases their risk of violence and homicide. A recent US study showed a surge in the incidence of severe intimate partner violence (IPV) during the Covid-19 pandemic compared to the previous 3 years, and a decrease in the number of people seeking hospital care (Gosangi et al., 2020). It is important to be clear that this supports the idea that the stressors of Covid-19 including the economic fallout may exacerbate existing IPV but probably does not start IPV that has not existed before.  Consistent with what has been seen in some other countries, IPV and sexual assault advocates across the state began to report an increase in self and police referrals to their agencies after the pandemic began (Luthern, 2020).

Domestic violence related homicides have been on the increase in Wisconsin even before the pandemic.  According to End Abuse Wisconsin’s Domestic Violence Homicide Report (2020), there were 47 domestic violence related homicide deaths in 2018, and 72 in 2019.  And frighteningly, as of September 29, 2020, domestic violence homicide has taken 69 Wisconsin lives this year.   If that pattern continues, it is estimated that 93 lives will be lost this year. Also concerning is that 22% of the victims, so far in 2020, were age 18 or under. 

Black communities in urban metropolitan areas like Milwaukee are disproportionately impacted by violence in general while also experiencing tensions with law enforcement. Recent acts of police brutality captured on video and circulated widely on social media have implications for community relations with law enforcement. The fear that community members have about police officers potentially using excessive and unjustified force in the policing of Black bodies (Frazer, Mitchell, Nesbitt, et al., 2018) can impact women’s help-seeking following an experience of violence. Black women may want to call the police if they feel like they are in danger from their partner’s abuse but they do not want that partner to be harmed and they usually do not want him to go to jail.  They, like most abused women, just want the violence to stop.  At the same time, there needs to be a non-racist police response available to abused women who are in fear for their and their children’s lives.  There needs to be carefully informed triage (a concept well known to nursing) for 911 calls for IPV so that police are not brought in when not needed but can be brought to homes where there is a high risk for homicide.  

Our state has also been the site of civil unrest in the past few months. In Kenosha, the police shooting of Jacob Blake in August resulted in protests requiring the declaration of a state of emergency. Clashes have also ensued between law enforcement and community members in Wauwatosa in the last few weeks as a result of protests for the February, 2020 shooting and killing of Alvin Cole by a police officer. Apart from these incidents that have created not only unrest but also continued mistrust between Black and Brown communities and law enforcement, there have also been concerns about the prevalence of the trafficking and sexual violation of young Black and Brown women. In Kenosha, Chrystul Kizer, a 19-year-old African American woman, was released this year after being charged for killing a man who sexually abused her as a child in what her defense team argued was self-defense (Fortin, 2020).  Her defense team spoke of how the criminal justice system fails to protect Black and Brown women and girls and yet also holds them disproportionately ‘accountable’ for crimes that would not be charged in cases of White women and girls. This is eloquently detailed by Beth Richie in Arrested Justice

Within the past few months, Wisconsin has had a number of Indigenous women murdered and missing.  Kozee Medicinetop Decorah (Ho-Chunk Nation) was found deceased on May 16, 2020, a victim of domestic violence related homicide (Volpenheln, 2020).  Stephanie Greenspon was found deceased on August 19, 2020. It is suspected that she was also a victim of violence related homicide. Her case is still being investigated by the FBI (Menominee Nation, 2020).  Kaitlyn Kelly has been missing since June 17th (Conklin, 2020). There has been little mention of the missing and murdered Indigenous women in local or national media, particularly taking into account the extent of national and even global media attention drawn to the missing of Jamie Closs;  Closs went missing in the area where Embrace is located, but she was eventually located.

Given all this, dialogue from law enforcement and local officials indicating willingness and commitment to community safety and wellbeing would be helpful. Instead, the response of law enforcement to Embrace’s display of a Black Lives Matter sign intensifies tensions and mistrust between the police and the communities they serve. It also seriously undermines the vital work of the only shelter in a four-county area, further endangering the most vulnerable populations Embrace serves.

 Employing relevant theories to our practice as nurses and liaising with our colleagues across disciplines has now become urgent. Together with colleagues across disciplines, nurses need to support and advocate for survivors of violence. Screening and identification of resources for women is of utmost importance, and shelters like Embrace both ensure the provision of shelter and connect women with urgently needed health and social services. As nurse scholars, we wrote this blog post in collaboration with our colleagues at Women’s and Gender Studies at University of Wisconsin-Milwaukee as part of building coalitions. But we also did so for the purposes of deepening our understanding of the urgent healthcare challenges experienced by the most vulnerable across our state, in the context of the rising tensions and mistrust among various institutions and agencies that exist to enhance the health, wellbeing and safety of all Wisconsin communities.

Violence is central and even essential to the sustaining of social hierarchies that inform the oppression of some groups while enhancing the privilege of others (Collins, 2017). Patricia Hill Collins (2017) points out how without human agency and resistance, institutions can engage in bureaucracies that replicate power dynamics, and even perpetuate normalized violence that maintains dominance and inequities. Law enforcement is one institution, and healthcare, of which nurses are a part, is another.

Robin Walter’s theory of Emancipatory Nursing Praxis comes to mind as one that guides us towards allyship in advancing a social justice agenda in pursuit of health equity, which is central to ensuring the health and wellbeing of the most marginalized in our communities during this time. In order to advance a social justice agenda, there is need for nursing as a profession to partner closely with domestic violence advocates and shelters like Embrace as well as law enforcement officers, who play an important role in enhancing the safety and wellbeing of our communities. We must engage in research and dialogue that would help us reimagine a criminal justice response that acknowledges the context of racism in which Black and Brown women experience violence.

As professionals, we need to respond and to meet their urgent needs for health and safety. It has never been more urgent to engage in the learning processes that Walter outlines, critically reflecting on our social location in relation to those we serve, shifting our worldview and experiencing transformation by expanding our consciousness (Walter, 2017).

References

Campbell, J. C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, … & Laughon, K. (2003). Risk factors for femicide in abusive relationships: results from a multisite case control study. American journal of public health, 93(7), 1089–1097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447915/

Collins, P. H. (2017). On violence, intersectionality and transversal politics. Ethnic and Racial Studies, 40(9), 1460-1473. https://www.fbi.gov/news/stories/operation-cross-country/operation-cross-country

Conklin, M. (July 28, 2020). Searching for Katelyn Kelley: The 22-year-old Menominee woman is part of a crisis of missing Indigenous people that Wisconsin is just beginning to confront. Wisconsin Examiner.  https://wisconsinexaminer.com/2020/07/28/searching-for-katelyn-kelley/

Fortini, J.  (June 23, 2020). Chrystul Kizer, teen charged with killing abuser, is released on bond. The New York Times. https://www.nytimes.com/2020/06/23/us/chrystul-kizer-free-bond.html

Frazer, Eva et al. “The Violence Epidemic in the African American Community: A Call by the National Medical Association for Comprehensive Reform.” Journal of the National Medical Association vol. 110,1 (2018): 4-15. doi:10.1016/j.jnma.2017.08.009 https://pubmed.ncbi.nlm.nih.gov/29510842/

Gosangi B., Park H., Thomas R., Gujrathi R., Bay C. P., Raja A. S., …  Khurana, B. (2020). Exacerbation of Physical Intimate Partner Violence during COVID-19 Lockdown. Radiology, 202866, Epub ahead of print. https://pubs.rsna.org/doi/10.1148/radiol.2020202866

Luthern, A. (May 18, 2020). Milwaukee is seeing a spike in homicides, and nearly half of them are related to domestic or family violence. Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/crime/2020/05/18/milwaukee-homicides-nearly-half-linked-domestic-family-violence/3121220001/

Menominee Nation (October 22, 2020).  Press Release: Vehicle Arson and Discovery of Human Remains on Menominee Indian Reservation. Menominee Indian Tribal Newshttps://www.menominee-nsn.gov/NewsPages/NewsItem.aspx?NewsID=Vehicle%20Arson%20and%20Discovery%20of%20Human%20Remains%20on|10/22/2020

Richie, B. (2012).  Arrested Justice: Black women, violence and the America’s prison nation. NY: NYU Press.

Rosay, A. (2016). Violence Against American Indian and Alaska Native Women and Men. NIJ Journal, 277, 38-45.  Retrieved from:  http://nij.gov/journals/277/pages/violence-against-indians-alaska-natives.aspx

U.S. Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis (2017). Sex, Race, and Ethnic Diversity of U.S, Health Occupations (2011-2015), Rockville, Maryland.

Volpenheln, S. (June 29, 2020).  Wisconsin family calls for harsher charges in ‘heinous’ killing of Ho-Chunk woman.  Milwaukee Journal Sentinel. https://www.jsonline.com/story/news/2020/06/29/wisconsin-family-calls-harsher-charges-homicide-ho-chunk-woman/3239543001/

Walter, R. (2017). Emancipatory nursing praxis. A theory of social justice in nursing. Advances in Nursing Science, 40(3), 225-243. Also see Walter’s Theory on Nursology.net

Acknowledgement:

We are grateful for the support and input of the following colleagues from Women’s and Gender Studies: Anna Mansson McGinty, PhD, Xin Huang, PhD, Kristin Pitt, PhD, Gwynne Kennedy, PhD, Melinda Brennan, PhD, & Jeremiah Favarah, PhD

About the contributors

Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.

Jeneile Luebke, PhD, RN is a post-doctoral nurse research associate at University of Wisconsin-Madison. She in an enrolled member of Bad River Band of Lake Superior Chippewa Indians. She received her early nursing degrees (LPN and ADN) in Bemidji, MN, and her BS and MS Nursing from the University of Wisconsin- Madison, and her PhD at UW-Milwaukee. Her area of research and expertise include intimate partner violence in the lives of American Indian women, community health nursing and utilization and application of postcolonial and indigenous feminist methodologies. She is a survivor of intimate partner violence and is passionate about sharing her knowledge and personal experiences to help to support and empower other women to transition to survivorhood.

Carolyn J. Eichner is Associate Professor of History and Women’s & Gender Studies at the University of Wisconsin, Milwaukee. She was a Member at the Institute for Advanced Study in Princeton, New Jersey, in 2015-2016. Eichner is the author of Surmounting the Barricades: Women in the Paris Commune (Indiana University Press); published in French as Franchir les barricades: les femmes dans la Commune de Paris (Editions de la Sorbonne). She has two forthcoming books: Feminism’s Empire, which traces the roots of nineteenth-century French anti-imperialism in the race, gender, and class politics of the era’s first French feminists to engage with empire; and A Brief History of the Paris Commune for the 2021 sesquicentennial of the 1871 revolution (Rutgers University Press). Eichner he is currently writing The Name: Legitimacy, Identity, and Gendered Citizenship. She has published in journals including Feminist Studies, Signs: Journal of Women in Culture & Society, French Historical Studies, and Journal of Women’s History

Kaboni Gondwe, PhD, RN is an assistant professor at University of Wisconsin-Milwaukee College of Nursing. Her research interests are on maternal and child health and she is focused on studying effects on how chronic life stressors moderates the effects of perinatal stress on preterm biomarkers in African American /Black mothers and Malawian Black mothers. She completed her PhD in Nursing from Duke University in 2018 where her research focused on relationship between preterm birth with postpartum stress and mother-infant relationship. She received her undergraduate degree and midwifery training from University of Malawi, Kamuzu College of Nursing and her Master in Nursing Education and Nursing Administration from Ohio University. 

Diane Schadewald, DNP, MSN, RNC, WHNP-BC, FNP-BC joined the faculty of the University of Wisconsin-Milwaukee, College of Nursing in 2013 and is currently a Clinical Professor. I have been certified as a Family Nurse Practitioner and a Women’s Health Nurse Practitioner since 1993. As a board-certified Women’s Health Nurse Practitioner, I have experience providing care for Black women as well as AI women who are at risk for or who have experienced IPV. Since working in academia, I have practiced in primary care and am currently working for an online nurse practitioner service. Prior to working in academia, I practiced in an OB/GYN clinic setting. I’m a co-author of Women’s Health: A Primary Care Clinical Guide which is in its 5th edition. I have also lectured on care of women who have experienced female genital cutting and IPV. I’m currently working on an educational research project about female genital cutting.

Peninnah Kako, PhD, RN, FNP-BC, APNP is an Associate Professor at the University of Wisconsin-Milwaukee (UWM) College of Nursing. Dr. Kako’s research focus includes improving health care access for underserved populations, issues affecting women living with HIV in sub-Saharan Africa. Her research also focuses on violence in the lives of women. Her research aims to contribute to efforts that meet primary and secondary HIV prevention needs in sub-Saharan Africa; and build sustainable, timely, and effective interventions to assist African women and their families in accessing treatment and managing chronic HIV illness. Clinically, Dr, Kako has served in underserved populations including corrections as a family nurse practitioner.

Jacqueline Callari-Robinson, BSN, RN is a Doctoral student at the University of Wisconsin, Milwaukee, School of Nursing, Research Assistant for Tracking our Truth, and an on-call SANE Nurse for United Concierge TELESAFE Program. Previously, Jacqueline was the Director of Sexual Assault Prevention and Statewide SANE Coordinator for the Wisconsin Coalition Against Sexual Assault and the Wisconsin Department of Justice. In that role, she developed the Wisconsin adult, adolescent, and pediatric SANE training courses. Jacqueline was also instrumental in the facilitation and creation of the Wisconsin Attorney General Sexual Assault Response Team (SART). Working collaboratively with SANE programs, law enforcement communities, and the Wisconsin Crime Lab, the AG SART addressed patient access to advocacy driven medical forensic care and the composition, handling, and processing of sexual assault kits. 

Brittany Ochoa-Nordstrum is set to graduate with a Bachelor’s degree in Sociology in the spring of 2021. As a recipient of a SURF (support for undergraduate research fellow) award, Brittany is working under the mentorship of Dr. Lucy Mkandawire-Valhmu on various projects pertaining to advocacy for marginalized communities of color. Brittany’s area of study is medical racism and its impacts on maternal mortality amongst African American women in Milwaukee. She is applying to Ph.D. programs across the country in Sociology and African Diaspora studies. As a third generation Mexican American, her life experiences often inform her passion for these areas of study. When Brittany is not researching, she is often involved in planning and organizing community grassroots demonstrations and fundraisers to benefit marginalized groups around the city of Milwaukee.

Nicole Weiss is a current graduate student at the University of Wisconsin-Milwaukee pursing a Masters of Sustainable Peacebuilding. Nicole is the project coordinator for the Department of Justice funded project: Tracking our Truth, Providing Access to Advocacy Driven Medical Forensic Care. She received her BA in International Studies at the University of Wisconsin-Milwaukee. Her areas of focus include undertaking a holistic, systems approach to complex issues within our community through facilitation and conflict resolution strategies.

Jacqueline Campbell, PhD, RN, FAAN is a national leader in research and advocacy in the field of domestic and intimate partner violence (IPV). She has authored or co-authored more than 230 publications and seven books on violence and health outcomes. Her studies paved the way for a growing body of interdisciplinary investigations by researchers in the disciplines of nursing, medicine, and public health. Her expertise is frequently sought by national and international policy makers in exploring IPV and its health effects on families and communities.

The Intersections of Nursing Scholarship and Nursing Activism

In the early 1980s  when Maeona Kramer and I first began to put together ideas for a text on theory development in nursing, we were committed to addressing nursing knowledge development beyond the typical boundaries of empirical research and theory development.  We had both completed, in 1971,  doctoral degrees in Educational Psychology (Maeona at Wayne State University in Detroit, and me at the University of Utah) focusing on theory development in education (nursing doctoral degrees at the time were few and far between).  For that first edition we drew on the work of a psychologist named Zygmunt Piotrowsky (1971)  who had proposed that the development of knowledge required contributions from scholars with different personalities, some who were drawn to theoretical abstract thought, and some who were drawn to concrete empirical “laboratory” science. 

In 1987 when we embarked on the 2nd revision of our book now titled “Knowledge Development in Nursing” we introduced Carper’s fundamental patterns of knowing in nursing, which gave us a starting point for narrative clearly grounded in the discipline of nursing. In the 3rd edition (1991) we turned our attention to revising our language from the stilted tradition of what was once considered scholarly writing to language that was more accessible and gender neutral.  By 1999, we realized that simply listing and describing Carper’s patterns of knowing fell short; we needed to project ways in which knowledge is developed for each pattern of knowing.  This evolution made it possible to articulate our belief that nursing knowledge encompasses so much more than that which can be studied empirically.  However, we continued to have this sense that something was missing, and in 2008 we articulated the emancipatory pattern of knowing. 

It was the growing and compelling body of nursing literature focused on critical social theory, socio-political knowing, and social justice that gave us the impetus, in 2008, to develop the emancipatory pattern of knowing. We see this not as simply a fifth pattern of knowing, but rather as the fundamental human capability to see a situation, recognize that something is amiss, and create ways to change the situation – an ongoing process in creating nursing knowledge that is necessary for the development of knowledge related to any of the four fundamental patterns of knowing.   

We had finally arrived at the intersection of social activism and the development of nursing knowledge.  But what does this really mean?  It is now over a decade since we first conceptualized what emancipatory knowing means, and the possibilities that this pattern of knowing holds for the future development of nursing.  We have been puzzled by the fact that it took us so long to see the connections and have speculated why this might be so (the long-standing subservient positions of women and nurses, the socialization to avoid that which is political, the dominant concern with one-to-one “bedside” care, etc. etc.). 

The fact has been that nurses, dating from the earliest days of the profession, have engaged in social and political activism, but have remained reticent to fully embrace social activism as a core nursing concern. Maeona and I both had been actively involved in the 1980’s effort to advance feminism in nursing through the work of “Cassandra: Radical Feminist Nurses Network.”  In 2000, Richard Cowling, Sue Hagedorn and I  wrote “A Nursing Manifesto: A Call to Conscience and Action,” acknowledging that at its core, nursing itself is “political” in the sense that politics is the ability to advance one’s own values in a public context.  Every time a nurse acts to bring nursing values into action, bends over backwards, jumps through hoops, and does cartwheels to obtain what individuals and families and communities need to be healthy, we are acting politically.  We are activists.  

The values of our discipline, expressed eloquently in the theories and conceptual models that form our foundation, guide our thoughts, words and actions. At the same time, our intimate engagement with others as we practice nursing, also informs what we think and do, opening awareness of ways to challenge, question and re-design the nature of our discipline.  The social and political contexts we face in this moment call for a new awareness of distortions, prejudices, stereotypes, social injustices amplified by racism. What is happening in this moment of time has raised alarm bells and demands that we turn our gaze on ways in which we nurses, individually and collectively have been complicit. The situation we find ourselves in today calls for nurses, and particularly white nurses, to finally recognize the dynamics of racism that infect our own “house” and start the tedious, and yet ultimately rewarding, process of healing.

In facing this challenge, we will begin to understand the dynamics of the widespread public health crisis of racism in ways never before attempted.  The development of knowledge demands that we understand the problem, explore the dynamics that sustain the problem, seek new ways to prevent and change those circumstances that perpetrate the crisis, and heal those who are affected.  There are theories and philosophies of our discipline that can guide us as we move forward.  Here are a few to consider:

This website – Nursology.net – is accomplishing the very important purpose of bringing to the fore the rich traditions and values expressed in the theories, models and philosophies of our discipline.  And now the time has come to recognize the ways in which the practices, attitudes, philosophies and thought patterns that derived predominantly from white perspectives are lacking.  This reality now calls for activism of a type not often recognized – a sustained and determined challenge that can change our own disciplinary ways of thought and action.  This does not mean in any way that we discard or denigrate our foundation, or that we disrespect the ways in which our own scholarly work has real value.  What it does mean is that we examine our accomplishments through a new lens, and recognize ways in which we need to re-direct course.  

Take as an example my theory and practice of “Peace and Power.” This theory was inspired in part by the Brazilian scholar and activist Paulo Freire (1970), and is closely aligned with practices commonly used in native American cultures and in Quaker communities. Yet people of color have also challenged this process as reflecting colonized white privilege – despite the commitment embedded in the processes that seek to dismantle power inequities in group processes.  Part of this challenge came from the early descriptions of the process that clearly reflected the concerns of white women and defined by white feminists. The fact is that the lens through which I view these ideas bear “decolonization.” What this means exactly is still in process, requiring a deep deconstruction of the Euro-centric assumptions on which the theory and process is built.  How this will affect the theory itself remains to be seen, and may be actually accomplished by scholars of the future!  

The time has come to shift this process in to high gear – to recognize the ways we have silenced the voices of many of those we claim to serve, ways in which we have excluded nurses of color from participating in our efforts to develop the knowledge of the discipline, and ways in which white nurses have in fact dehumanized, disrespected and excluded nurses of color from full participation in the practices, leadership and development of the discipline.  This is not an activist project that can happen in one or two “training” sessions addressing “diversity, inclusion and equity.” Nor can it be accomplished by performative actions such as recruiting more people of color, or curriculum revisions.  Although of course these kinds of actions are warranted and need to happen they will not in themselves end the inequities and injustices of racism.  There are no formulas.  

I believe that the activist commitment of all nurses now and going forward is to learn all we can about the mechanisms of both systemic and everyday racism, question each choice we make in light of our growing awareness, challenge one another with loving kindness, and create spaces that challenge white privilege.  The “Overdue Reckoning on Racism in Nursing” discussion series has now ended but in those discussions we established a starting point, including important resources for becoming well informed about the challenges we face. Now we have new actions to continue this work, centering nurses of color and engaging white nurses in meaningful processes consistent with the ideals of “truth and reconciliation.”  

While these actions are labeled as “activism” they are also vital in shaping nursing knowledge going forward.  Becoming immersed in social and political activism to address the public health crisis of racism, guided by the values of our discipline, we provide the best of nursing care to heal ourselves, to heal the damaging effects of racism in our communities, and build a stronger future.  We create the ‘hermeneutic circle” of thought and action – where our actions inform how we think, and how we think shapes our action in a constant process that changes and shapes both thought and action going forward.

Sources

Freire, P. (1970). Pedagogy 0f the oppressed. Seabury Press.

Piotrowski, Z. A. (1971). Basic System of All Sciences. In H. J. Vetter & B. D. Smith (Eds.), Personality Theory: A Source Book (pp. 2–18). Appleton-Century-Crofts.

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