Who Will be the First? More Random Thoughts of a Sleeper Awake

Once again, with apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake, these are my random thoughts of “Who Will be the First?” among nursology leaders while I was a sleeper awake one very early morning (see our first “sleepers awake” post: What if?). Here are my random “Who will be the first?” musings:

  • Who will be the first dean/director/chairperson to re-name the college/school/department/ program nursology?
  • Who will be the first Chief [Nursology] Officer to re-name the clinical agency department nursology?
  • Who will be the first journal editor to re-name the journal … Nursology or Journal of … Nursology?
  • Who will be the first “edge runner” or other nursologist recognized for innovative work to be referred to as a nursologist?
  • Who will be the first president or executive officer to re-name the association/academy/ council [Country or State] Nursology Association or [Country] Academy of Nursology or International Council of Nursology?

Again inspired by imagining these possibilities, I asked other Nursology.net management team members!

Adeline Falk-Rafael

  • Who will be the first newscaster/journalist to refer to nursologists or Nursology In the media?

Margaret Dexheimer Pharris

  • Who will be the first political leader to propose a Universal Access to Nursologists system for a country, state/department/region, city, and/or community?

Danny Willis

  • Who will be the first nursologist to lead peace, social justice, caring, and healing efforts throughout the world toward universal wellbeing/wellbecoming for all of humanity?

Rosemary William Eustace

  • Who will be the first nursologist to theorize “task shifting of nursing services and roles” in advancing nursing knowledge and the future of nursing as a profession within other “traditional” and “emerging” disciplines in health care?

Marian Turkel

  • Who will be the first academic dean to say we are advancing the discipline and profession of nursology by preparing nursologists? Nursologists practice nursology through the lens of nursological theory and the multiple patterns of knowing, with a focus on holistic practices such as mindfulness, centering, healing arts, aromatherapy, and coming to know the patient and family as person. The clinical practice sites for nursologists would expand beyond the hospital into healing centers, physician practices, and community centers.

Marlaine Smith

  • Who will be the first to graduate with a PhD in Nursology?

We invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “Who Will be the First?”

Opportunities for Advancing Nursing Knowledge: A Personal Journey of Appreciation

24 years ago while completing the first baccalaureate nursing degree program offered in Tanzania, East Africa at Muhimbili University of Health and Allied Sciences (MUHAS); I sat in a nursing theory class trying to grasp concepts and principles that shape nursing as a professional discipline (i.e. the grand and middle range nursing theories and models). Surprisingly, most of the concepts I learned mirror concepts I have since encountered in my academic career as a graduate student and nurse scholar. For instance, self-care concepts in chronic disease management mirror concepts in Orem’s self-care theory; concepts in interprofessional models mirror concepts in nursing interpersonal and interactional theories (e.g. Imogene King’s theory and Peplau’s theory); Systems thinking concepts mirror concepts in Roy’s conceptual model  and Betty Neumann’s conceptual model; concepts in psychotherapeutic approaches mirror concepts in the nursing humanistic theories (e.g. relational and caring concepts) and concepts in the acculturation theories (e.g. Gordon’s theory, John Berry’s theory) mirror those in Leininger’s cultural care theory. These are just a few examples on how rich nursing theoretical underpinnings play a key role guiding health care actions and outcomes in addition to the medical disease-centered perspective.  In this case, I think we need to strategically revisit the existing models, refine and adapt them to our changing health care environments as well as develop new approaches and educational models that have an impact on health outcomes of interest.

This critical reflective query originates from a quote I read in the 2010 Institute of Medicine Future of Nursing: Focus on Nursing Education Research Brief stating that, “New approaches and educational models must be developed to respond to burgeoning information in the field. For example, fundamental concepts that can be applied across all settings and in different situations need to be taught, rather than requiring rote memorization” (p2). This statement made me think further: Have we adequately synthesized the existing key concepts and principles? Is it time to re-visit the nursing metaparadigm concepts? What new concepts do we need to develop and how can we develop them? Which concepts and principles of the disciplines should we teach in undergraduate vs graduate nursing programs to avoid rote memorization? Are we at risk of re-inventing wheels of nursing knowledge? Have we been instrumental in advancing implementation science to promote “empirical and practical generalizability” of nursing theories and models? 

A memorable photo of the burn patient I cared for in the surgical ward.

Let me flashback on my personal educational and career journey to make the case: I was trained to understand and embrace the art and science of nursing within the realities of closing my own personal knowledge gap on nursing theory (didactic), research and practice.  My first taste of nursing knowledge application and development started when I was assigned to take care of a burn patient for my clinical case study assignment during my medical-surgical clinical rotation. As a BSN prepared student, the ‘why” of what we do as nurses was emphasized.  In this case, the nursing action of “turning and repositioning patients every two hours to prevent pressure sores” opened new insights on my nursing knowledge application beyond just doing a task. I was intrigued by the Braden scale for predicting pressure sores risk developed by Drs. Barbara Braden and Nancy Bergstrom from a conceptual schema that attributed key determinants of pressure ulcers from current evidence–intensity and duration, tissues tolerance of the skin, and supporting structure or pressure (Braden & Bergstrom, 1987). I continued my inquiry by completing my fourth year BSN capstone project on the topic of pressure sores in the medical and surgical population. Moreover, as part of my training, I was introduced to a course on principles of teaching and learning in our curriculum. Nursing students were expected to learn how to write up a philosophy in teaching, practice and research. Learning about philosophy helped me appreciate the importance of nursing values, beliefs, the different ways of knowing and different approaches to nursing education and practice that continue to shape our discipline to this day. I can truly attest to Bruce, Reitz and Lim’s (2014) statement that: “Philosophy is not only understood as relevant but vital to our discipline and professional practice (p. 70).

Completing my Carnegie African Diaspora Fellowship (CADFP) at MUHAS in 2017. Top: Group photo with nursing students and faculty at the MUHAS scientific conference

Later, as part of my graduate studies, I was exposed to concept analysis methods and how to evaluate and apply theories/models to a problem of interest. My graduate education provided me with a great foundation in nursing knowledge grounded within the health promotion and preventive care paradigms at the individual, family, population, community and systems levels of practice (i.e., MS Community/Public Health Clinical Nurse Specialist, MS and PhD in Family Science (focus on Family Life Education and Consultation).  Armed with this knowledge, I was successful in completing a concept analysis paper in my nursing theory class (Eustace & Ilagan, 2010), evaluated the family socio-ecological theory for my family theory class, and applied Berry’s acculturation theory in my doctoral dissertation to study acculturative stress (Eustace, 2007, 2010). Additionally, I learned how to appreciate the difference between conceptualization and operationalization of variables (concepts) across studies and disciplines.

Group photo with nursing students enrolled in the community/public health course. Invited guest lecture to teach concepts and principles of health promotion theories and models.

Overall, this knowledge has been instrumental in my nursing career as a nurse educator and scholar. I continue to learn and try to understand key concepts of interest to further my research agenda in the field of family nursing and how it impacts chronic disease prevention and risk reduction outcomes: “HIV/AIDS family interventions” (Eustace, 2013), “family health nursing intervention” (Eustace, Gray & Curry, 2015),  “male involvement” (Eustace, 2018) and “family nursing” (Eustace, in press). I am currently in the process of conceptualizing a “Family Health Strength-Based Socio-Ecological Model of Breast Cancer in Sub-Saharan Africa” (Eustace, Nyamhanga & Lee, 2018) to guide my international collaborative research agenda. This model is grounded in the theoretical foundations for nursing of families: the Bioecological systems theory (Bronfenbrenner & Lerner, 2004) and Strength based-nursing (SBN) approach (Gottlieb & Gottlieb, 2017).

An inspirational reunion with my undergraduate dean and mentor –a pioneer of the BSN program in Tanzania, Professor Pauline P. Mella, (middle) with her sponsor Dr Eileen Stuart-Shor at the 2016 American Academy of Nursing Conference

Along the way, I must give credit to my professors early on in my nursing career as well as faculty mentors and external reviewers who have inspired me in the utilization of nursing theories and the process of theorizing nursing knowledge. I wish all nursing students today are exposed to these kind of learning and critical reflective discovery opportunities in their undergraduate or graduate studies.  Similarly, I wish junior and mid-level career nurses interested in nursing theories and the process of theorizing nursing knowledge have access to qualified educators and mentors.

Therefore, the following question remains to be answered: As a community of nurse scholars and practitioners, how are we strategic in building our capacity to meet the demands of developing a generation of nurses who will advance nursing knowledge as part of the future of nursing?  We need a well-trained and competent nurse educator and mentor workforce that is capable of offering the next generation of nurses (i.e., LPNs, RNs, DNPs, PhDs) and nursing paraprofessionals (e.g., nursing assistants, community health workers, and traditional attendants) the opportunity to learn and translate nursing knowledge that will impact health outcomes of interest.  For example, a nursing workforce with expertise in theory who will teach nursing theory and serve on dissertation and doctoral project committees, nursing research grant applications and nursing practice committees. If that were to happen, we will need proactive and revolutionary nurse scholars and leaders to lead the way in the areas of nursing education, nursing research, evidence based-practice, and policy-making as part of the future of nursing.

Food for thought: Why don’t we have clear standards to measure how nursing theoretical concepts and principles are integrated into nursing program curricula as part of our accreditation systems, as part of magnets status applications, and as part of nursing research agenda? Will taking this “backward step (to revisit our standards) as a way forward” be asking for too much from our leaders? Should we do this? How should we do this? If we should not do this, why not?  I welcome readers of nursology.net to reflect and share their thoughts on these epistemological issues and practical challenges in the comments section of this blog.

References

Braden, B., & Bergstrom, N. (1987). A conceptual schema for the study of the etiology of pressure sores. Rehabilitation Nursing, 12(1), 8-16.

Bronfenbrenner, U. & Lerner, R. M. (EdS.) (2004). Making human beings human: Biological perspective on human development. Thousand Oaks, CA: Sage Publications.

Bruce, A., Rietze, L., & Lim, A. (2014). Understanding Philosophy in a Nurse’s World: What, Where and Why? Nursing and Health, 2(3), 65-71. doi: 10.13189/nh.2014.020302

Eustace, R.W (in press). Family Nursing. Macmillan Encyclopedia of Families, Marriages, and Intimate Relationships,

Eustace, R.W. (2018) Male Involvement: An Evolving Global Cross-Cultural Concept inFamily-Centered Health Care. NCFR Report, Family Focus: Families and Cultural Intersections, p 4.

Eustace, R. W. (2010). Factors Influencing Acculturative Stress among International Students: From the International Students’ Perspectives. Germany: VDM Verlag Dr. Muller Aktiengesellschaft & Co. KG.

Eustace, R. W. (2007). Factors influencing acculturative stress among international students in the United States (Doctoral dissertation, Kansas State University).

Eustace, R. W. (2013). A discussion of HIV/AIDS family interventions: implications for family‐focused nursing practice. Journal of Advanced Nursing, 69(7), 1660-1672.

Eustace, R.W. (1994). The prevalence of pressure sores in the Medical surgical patients at Muhimbili Medical Center (Undergraduate Research Report). Muhimbili University of Health and Allied Sciences.

Eustace, R.W, Gray, B. & Curry. D. (2015). The meaning of family nursing intervention: what do acute care nurses think? Research and theory for nursing practice, 29(2), 125.

Eustace, R. W., & Ilagan, P. R. (2010). HIV disclosure among HIV positive individuals: a concept analysis. Journal of Advanced Nursing, 66(9), 2094-2103.

Eustace, R. W., Nyamhanga, T. Lee, E. (2018). A Discussion of Social Determinants of Breast Cancer among Women in Tanzania: Advantages, Gaps and Future Directions in Family Scholarship. The 2018 Annual NCFR Conference, San Diego, California, November 7-10, 2018

Gottlieb, L. N., & Gottlieb, B. (2017). Strengths-Based Nursing: A Process for Implementing a Philosophy into Practice. Journal of family nursing, 23(3), 319-340.

Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2010). The future of nursing: Focus on nursing education. Washington, DC: National Academies Press. http://www.nationalacademies.org/hmd/ ~/media/  Files/Report %20Files/2010/The-Future-of-Nursing/Nursing%20Education %202010%20Brief.pdf

Nursologists and Their Comic Character Avatars


Once upon a time, I had a faculty colleague who had a wonderful sense of humor. She

could even inject humor into the statistics and research methods courses she taught. Unfortunately, I did not have anything close to her sense of humor. However, she assured me that it was very difficult to find humor in meta-theory, which is what I taught (and still teach), alas without any humor included.

Imagine my surprise when Peggy Chinn sent me an internet posting  by Jan Friesen and Skander Elleuche, who “developed a method that provides a simple, flexible framework to translate a complex scientific publication into a broadly accessible comic format” (italics in the original).

In an attempt to finally inject some humor into nursology, I started thinking of how comic characters could be transformed into nursologist avatars. I selected comic characters I knew from my childhood and, more recently, from the exhibits in Fawcett’s Art, Antiques, and Toy Museum, a small art gallery, shop, and toy museum that I co-own with my artist husband, John Fawcett. He is the creative one; I keep track of the finances.

My ideas for avatars for nursologists are:

  • Wonder nursologist (aka Wonder woman), whose special wrist cuffs

    deflect all negative concerns about theory

  • Super nursologist (aka Superman), who leaps over complex philosophical, conceptual,  theoretical, and methodological ideas with a single keystroke
  • Star nursologist (aka Star Trek), who goes where other nursologists are not yet ready to go
  • Fantastic nursologist (aka from

    Disney’s Fantasia movie) who converts theoretical knowledge to practice protocols.

  • Mighty nursologist (aka Mighty Mouse), who establishes nurse corporations that contract with clinical agencies to provide nursological qua nursological services to participants in practice (nurse corporations are Grayce Sills’ idea, nursing qua nursing is Jean Watson’s idea)
  • Terminator nursology (aka The Terminator), who eliminates all negative thoughts about conceptual models and theories
  • Spider nursologist (aka Spiderman), who climbs to the heights of nursology

    glory.

  • Yoda nursologist (aka Yoda from Star Wars), whose light saber illuminates all that is nursology.

I invite readers of this blog to contribute their ideas for comic character avatars for nursologists!

Values and Ethics: Foundations of Nursology.net

There are sections of many websites that are seldom visited – the mission, goals, or “About” pages that set forth the purposes that shape the content, focus and direction of the site.  Nursology.net is no exception, other than the fact that many first-time visitors may be intrigued by the name of this site and might explore the “About” menu item to learn more!

We have recently added to our “About” page a section we believe to be central to this project – our “Values and Ethics.”  These statements of value are not just words – they are the principles that guide every decision and that shape the content of this site.  Notice that central to what we value is your involvement!  Nursology.net belongs to every member of our discipline, and we welcome you to respond to any part of this site, including our statement of values and ethics!  Here is what we have posted – let us know your thoughts and ideas!

Values and Ethics

The development and maintenance of this site are guided by the following values:

  • We take every step possible to assure accuracy of content on this site by
    • Assuring review of content by members of the management team prior to activation of pages and posts.
    • Securing review and approval from any nurses who are central to the content presented (e.g. authors, key nurses involved), if those individuals are available.
    • Inviting corrections and updates from viewers who have the best information available.
    • Welcoming feedback, discussion and critique from viewers where there are issues of controversy or different points of view.
  • We assure accountability and transparency of the content on this site by:
    • Showing the name or names of the contributors who have provided the information displayed on specific pages
    • Providing the dates when content was initially posted and revised.
    • Providing links or references to sources from which content is derived, or is quoted.
  • We welcome submissions of content for each section of the website and have provided submission forms tailored to each section.  These forms are found on main pages of each section.  In addition, we welcome:
  • We will respond promptly to all communications, including requests to correct, change or remove any content that violates our commitment to  be accountable and transparent in using content from other sources.

Confronting Cultural Noise Pollution

Much earlier in my career a group of colleagues and I conducted a survey published in the American Journal of Nursing that addressed friendship in nursing*.  We were motivated to confront the message that nurses are their own worst enemies, and not friends. The results of the survey affirmed that although the message persists, and sometimes accurately describes relationships and interactions, there is ample evidence that nurses are more often than not our own best supporters and friends. I call these kinds of repeated negative messages cultural noise pollution that obscure the realities of the more accurate and complete situation – messages that obscure what is real and what is possible.

We created Nursology.net with a  similar motivation to confront the often repeated message that nursing theory is irrelevant, not necessary, or too abstract to be useful in practice.  These messages obscure the realities of the vital importance of nursing knowledge in the context of systems that serve to address the healthcare needs of our time.  They interrupt serious consideration, discussion and thought concerning who we are as nurses, what we are really all about, and why we persist in our quest to improve our practice. Failing to recognize the value of our own discipline’s knowledge, we fall prey to serving the interests of others, and neglect our own interests.

My favorite pithy definition of theory is this – theory is a vision.  Theory provides a view of concrete realities that makes it possible to mentally construct all sorts of dimensions that are not obvious to our limited perception of a situation in the moment.  It provides ways to understand how a particular “thing” comes about, what it means, what might happen next,  how the trajectory of a situation might unfold, and how human actions might change that trajectory.   In the practice of nursing, this is precisely what we are all about – we take a close look at a situation that presents a health challenge, we set about to understand what is going on beneath the surface, we examine evidence related to the situation, and we chart a course of action that might move the situation in a way that would not otherwise be possible.  People in other healthcare disciplines are doing much the same thing, but we have a nursing lens through which we as nurses view the situation.  Our  lens determines what we deem to be important in the evolution of the situation, and shapes the sensibilities we bring to the actions we take.  Our lens derives from nursology – the knowledge of the discipline.

If you take even a brief tour of Nursology.net, you will soon see that nursing theories, models and philosophies represent a coherent message focused on visions of health and well-being in the face of complex, sometimes tragic,  health challenges. You will also find a vast diversity of lenses that give a particular focus on this central message.  Some of the lenses give us a vision that is a lofty “30-thousand foot altitude” view. Some of the lenses focus in more closely on particular aspects of health challenges. There is no “right or wrong,” “better or worse.” Each lens simply brings about a different vision. Just as a camera can bring a different tone, hue or filter to see a single image in different ways, our nursing theories open possibilities and alternatives that would never be possible if we did not have the various lenses through which to view the situations we encounter. Taken together, these theories, models, philosophies form an ever-expanding nursology. Our theories, models and philosophies open possibilities for practice that can make a huge difference in the lives of real people.

We have an amazing, vast and rich heritage of nursing knowledge – and we are nowhere near done with the task!  Our vision for Nursology.net is to document and honor the serious knowledge-work that has been accomplished in the past, draw on this foundation, and inspire new directions that are yet unimagined!  We hope nurses everywhere, regardless of how or where you practice as a nurse, will join us in this journey, and add your voice to help shape what is possible! And importantly, we invite you to join us in confronting the negative, self-destructive effects of various forms of cultural noise pollution that cloud our vision!

*Friendship Study references

Chinn, P. L., Wheeler, C. E., Roy, A., Berrey, E. R., & Madsen, C. (1988). Friends on friendship. The American journal of nursing, 88, 1094–1096.

Chinn, P. L., Wheeler, C. E., Roy, A., & Mathier, E. (1987). Just between friends: AJN friendship survey. The American journal of nursing, 87, 1456–1458.

“Florence” as metaphor and reality

Nursology.net was officially launched on September 18,  2018, just as hurricane-turned-tropical storm “Florence” raged through the U.S. southeast!  The name of this storm, and the timing of our launch, seemed more than a simple coincidence, considering the significance of this name in nursing history, and for the new beginnings that each “Florence” catalyzed for the global community.

Consider:

Florence Nightingale – 1820-1910 

  • Vision of nurses as agents of societal and individual reform
  • Coupled care with political activism directed at laws and social conditions contributing to ill health – used the results of statistical analyses to convince politicians and military leaders and others about what people needed for high-quality wellness.
  • Laid foundation for professional nursing by establishing world’s first secular school for nurses at St. Thomas’ Hospital in London

 

Florence Wald – 1917-2008 

  • Dean of Yale University School of Nursing 1958-1968
  • Opened the first hospice in the United States in 1971.
  • Initiated training for inmates in Connecticut to become hospice volunteers for dying inmates, an approach that became a model for prisons worldwide.

 

 

Florence Downs – 1925-2005 

  • Director of Post Graduate and Research Programs, New York University 1972-1977
  • Associate Dean and Director of Graduate Studies, University of Pennsylvania 1977-1993
  • Served as Chairperson for more than 100 doctoral dissertation committees
  • Editor, Nursing Research 1979-1997. As the first academic editor of Nursing Research, Dr. Downs changed the editorial policies of the journal from publication of “one shot studies” and infrequent publication of the same researcher’s work to the new policies that enhanced the publication of programs of research by the same researcher or team of researchers
  • “Florence Downs, a well-recognized nursing leader, educator, editor, and Scholar helped shape nursing as an intellectual discipline and wrote extensively about the importance of links between research and practice” In Memoriam: Florence Downs. Nursing Research, 54, 373. .
  • The Florence S. Downs PhD Program in Nursing Research and Theory Development at New York University Rory Myers College of Nursing is named for Florence Downs

Each of these pre-eminent nurses who bore the name “Florence” emerged from circumstances in which they recognized that something significant needed to change – the status-quo was not sufficient. Their actions and the direction they set for the future were based on the premise that Nightingale put forward – it is the things that people do that cause illness and disease.  Like a hurricane, human actions can chart a new course, can change the lives and life-ways of so many people.

Nursology.net, is based on the belief that nursing itself holds the power to change the direction of healthcare, and to set a course toward health – for thriving in the face of hardship, and for peace in the midst of turbulent times.

Peggy L. Chinn, RN, PhD, FAAN and Jacqueline Fawcett, RN; PhD; ScD(hon); FAAN; ANEF

References for Information on Florence Downs:

Fairman J, & Mahon MM. (2001). Oral history of Florence Downs: the early years. Nursing Research, 50, 322–328.
In Memoriam: Florence Downs. Nursing Research, 54, 373.
Vessey J, & Gennaro S. (2005). The gardener: Florence Downs, August 20, 1925-September 8, 2005. Nursing Research, 54, 374–375.

Nursing theory groups: why join, my story

I serve as the president of the Society of Rogerian Scholars (SRS). I was encouraged years ago to attend the annual conference by my now colleague, but former mentor, Dottie Jones. My timing was not great for my first conference – it was the one following the death of Martha Rogers. In some ways, I felt like I was a spy at a wake, and in reality, I was. Being Irish, for whom wakes are a sport, I am comfortable in this sort of setting so being an outsider did not deter me. I watched as members who had not seen each other in months or perhaps years, hug one another, cry and laugh as they shared memories of Martha. People seemed intrigued by my being there, yet only welcomed my presence. I knew from stories I had heard before the conference that Martha was special. It was a gift to bear witness to the event and see how she influenced so many.

Once the conference kicked off and I heard the papers being presented, I was hooked. Where had these nurses been all my life? I listened to the research, practice and education presentations that focused on Martha Rogers’ Science of Unitary Human Beings (SUHB) and knew I was home – well not exactly because NYU was not my home – but home in the sense of connecting with nurses with whom I could relate. With apologies to James Joyce – Yes! A person is so much more than their disease! Yes! We need new ways of knowing, discovery and measuring outcomes beyond the empirical sciences! Yes! There is room for art, music, literature, mystery, science fiction and spirituality in nursing!

I came back from the conference knowing I would return annually. I am now a nurse educator and when I integrate my thinking about SUHB into the classroom, it resonates with my students as it had with me. I also practice as a NP in a psychiatric facility and I find that incorporating what John Phillips calls wellbecoming into my practice changes the focus from trying to fix the problem to one that maximizes personal resolve and opportunities for self-care. My research on older persons with chronic conditions is framed by SUHB and infused with Newman’s Health as Expanding Consciousness and Barrett’s Knowing Participation in Change. I see the difference nurses make when they practice from a nursing theory guided perspective.

I cannot imagine ever not being a member of SRS.  Being part of such a welcoming group of colleagues provides me with the energy, language and thinking to test out my ideas and bring them back to my academic and practice settings. It gives me the permission to be the nurse I choose to be. If you like a nursing theory or just wonder what a nursing theory group is all about, I encourage you to join one.  It might be one of the best things you do for your career and for yourself.