2020 was the year . . .

Anyone alive today (except the yet unborn!) will forever relate a memorable end to this sentence . “2020 was the year . . . “! For a handful of humans all over the globe, there will be those who end this sentence with “2020 was the year I was born, and I survived the great pandemic.” Some will also add that someone in their family did not survive , or someone was permanently affected by the ravages of the virus – a fact that will follow them in all the years to come. Of course how we each end that sentence (and the paragraphs that follow that sentence) will change with time, but our nursology.net team members pitched in to share how we are remembering this unprecedented year as it comes to a close in this and in the first few posts of 2021.

Peggy Chinn

Dylan in his home “classroom”

2020 was the year that my 5-year old Cuban/Chinese/Hawaiian/Haole grandson Dylan started kindergarten in daily zoom “classes” with his 24 classmates and fortunately with a very talented kindergarten teacher! His parents and I reflect mournfully on what he is missing by not going to his physical school – a school they selected because it is a public dual-language (Spanish/English) immersion school. The school is located in a zip code with one of the highest rates of COVID-19 cases and deaths in the city Oakland CA, and where racial tensions between police and the community have escalated. But they are both public school teachers, deeply committed to social equity and to ending social disparities, and are seeking to be part of the solutions to the many challenges faced in disadvantaged communities. So here we are at the end of 2020, in the midst of so much suffering that could have been prevented if the situation had been managed differently – suffering that is tragically amplified in disadvantaged communities. Like public school teachers and so many other public servants, as nursologists, we know so many ways in which the knowledge of our discipline could re-direct and re-shape the experience of the COVID-19 pandemic, and how our perspectives – our values and priorities as nursologists – could be mobilized to end health disparities. The growing response to Nursology.net over the course of the year suggests that 2020 may have been the year when widespread recognition and respect for the discipline took hold, when nurses all over the world began to see the significance of our disciplinary knowledge. Just as 5-year-old Dylan has learned the basics of reading and writing (in both Spanish and English) in the face of unprecedented circumstances, so too may it come to be recognized that nurses, in 2020, have learned anew the “reading and writing” fundamentals of our discipline.

Chloe Littzen-Brown

2020 was originally destined to be the year of the nurse and midwife, but it really turned out to be a year of uprising. A year of change and adaptation. A year of learning and unlearning. It was a year of putting action behind our thoughts and words, questioning what we know, and standing up for what’s right — even in the most difficult and darkest of times. We protested, marched, wrote letters, and voted. We began to question our role as nurses in the oppression and marginalization of patients and each other. In 2020, I am proud to call myself a nurse but I know that I, and we, still have a lot of work to do. I hope that we never lose the awareness that 2020 has given us and that we can carry it on to the future to better ourselves, better each other, and better the world. 

Chloe Littzen-Brown and Dr. Robert Brown with their two dogs Liberty and Timmy on their Wedding Day

On a personal note, 2020 has catapulted my private and professional life in many directions. In July, my partner graduated from his emergency medicine residency program after spending the previous 4 months straight caring for COVID-19 patients on the frontline during Ohio’s first wave. I won’t lie that I was (and still am) worried about his health and well-being on the frontlines. Simultaneously, he was (and is!) worried about bringing home COVID-19, as I have underlying health conditions that place me at heightened risk. It is not phased on me that many nurses, physicians, and other healthcare providers have lost their lives during the pandemic working on the frontlines. I am grateful that so far we have both maintained our health, and I hope that with a vaccine around the corner that soon we will be able to provide better protection to our frontline workers and the patients they care for.

Since he graduated my partner accepted a job in Washington state as a physician in the emergency room. Because of this, we ended up moving from Ohio to Washington in July. Prior to us moving, I submitted my IRB application for my dissertation, and to my surprise as we crossed the state line into Washington my application was approved! Since then, we got married (outdoor Zoom wedding!), I have completed my data collection, and currently I am diligently working on my data analysis. I hope to defend my dissertation, (probably over Zoom, note the theme here) in the Spring of 2021. But with all of this, I think what I have taken to heart is the only constant is change… and while that change may not have been what you wanted it to be, if you are willing, open, and present, change can have a positive impact in your life – greater than you ever imagined. I can honestly say if you had asked me where I would be five years ago, I would have given you a completely different answer. I am grateful for where I have ended up, but I am excited to see where 2021 takes me (and us).

Jacqui Fawcett

The year 2020 was my year of sustained close encounters o f the healthcare system kind. Although these encounters were not of the third kind, these were potential for encounters with those who could have been aliens to me. These encounters began on February 10th, when my husband, John, fell on ice outside our house in Maine.  I was at UMass Boston at a lunchtime seminar when I received a phone call from a stranger – a woman who was driving by our house and saw John on the ground. She stopped, called 911, and then called me. The local ambulance crew took John to the local hospital about 15 miles away.  An x-ray revealed he had a fracture of the proximal end of his left humerus. The orthopedic surgeon on call discussed options, and he and John decided on a closed reduction. So far, a seemingly reasonable decision, so to avoid surgery. 

I changed my flight reservation (I typically fly on Cape Air between Maine and Boston) to that evening and saw John at the hospital at about 9 PM. He was in some pain controlled by opioids. He was discharged home the next day with referral for home PT and OT, which were helpful.  I arranged for some grab bars to be installed in the house to ease John’s walking between our living quarters  (we have a  large house that also contains our toy museum) and the bathroom –excellent help from the across the road (we live on US Route !) hardware store staff.  PT and OT continued until February 20th when John’s pain became intense.  So, another call to 911, another trip to the local hospital, this time seen by a different orthopedic surgeon.  X-ray revealed that the closed reduction had failed.  Mutual decision to have surgery, especially when the MD told us that he “loves shoulders!”  Surgery on February 24th followed by OT and PT while still in hospital, until March 1, when John woke up at about 2 AM with intense pain, soon discovered to be a massive hematoma. Off to surgery that day (even though it was a Sunday). Finally to a skilled nursing facility at a very nice life care community for rehab on March 3rd until John finally came home on April 9th with referrals to home nursing (John experienced a 3 cm dehiscence of the surgical site, so dressing changes were needed) and PT.  I am very pleased to let you know that John has recovered almost completely now. The surgical site closed eventually, PT and home RN were not needed by about early May (the home health RN continued longer than I thought  necessary, as I can change surgical dressings!), and his arm has almost full mobility. He was finally discharged from orthopedic follow-up visits in September, so no more trips to his office. John now walks very hesitantly so as not to fall, which is a good thing, although difficult for me to witness. 

 My close encounters with the healthcare team members were much more positive than I would have expected. I did not even have to advocate for John, as his medical and nursing care were efficient, effective, and caring. The second orthopedic surgeon (I had not met the first one) included me in all discussions about John’s condition without my asking for this information, even calling me once when I was at work at UMass Boston. The PT and OT persons included me in their plans of care for John. The hospital and skilled nursing facility staff nurses were caring, expressed their concerns about John, and were receptive to my talking with them about nursology – I gave each one of them our nursology.net card, of course!

The most difficult aspect of the healthcare system encounters came on March 12th, when Covid-19 came to Maine, and I was no longer allowed to visit John at the skilled nursing facility. We tearfully said good night that evening, and I promised to call him every day at 5 PM.  John does not enjoy talking on the telephone, so I was surprised that he agreed to my calling him. Obviously, he needed contact with me. Indeed, when I occasionally called a few minutes after 5 PM, he expressed concern that I had had an accident. So, here we are in November 2020, with me at home in Maine all the time—UMass Boston has been doing remote teaching/learning since March 23rd (end of our spring break).  Although occupied by teaching and lots and lots of zoom meetings with colleagues – I think we may have invented extra meetings to maintain contact while not on campus together—and my usual writing projects,  the second half of spring semester and all of fall semester has seemed like a sabbatical – no commuting to work, more time for self-care,  less worry about the possibility of John falling when I am not at home. 2020 is not a year I would like to repeat but it has not been too challenging for me, for which I am forever grateful.  

Jane K. Dickinson

2020 was the year with no break.

I work in diabetes, and we often discuss how there is no break from diabetes. Even then, we find little ways to take “breaks” – have a family member help out; cut down on the number of daily fingersticks for a few days; carb out on a holiday; etc. I recently got an email from an organization that was announcing they are taking a break from December 19th to January 3rd. They are giving their entire staff this time to “rest and rejuvenate.” Reading this message really made me stop and think about how we all need a break. And how many nurses don’t get a break – from working on the front line exposed to health and human trauma, to literally not having time to eat a meal or go to the bathroom.

2020 was the year with no break from uncertainty. Often nurses work with people who are dealing with uncertainty and this year nurses had to deal with uncertainty in so many ways themselves – all the while helping their patients, students, staff, and family members handle the chaos that everyday life dealt us.

2020 was the year with no break from upheaval. Things were constantly changing – messages, scientific reports, numbers, job security – and yet we just kept going.

2020 was the year with no break from distraction and loss. The kids who are supposed to be at college came home. The kids who are supposed to be in elementary, middle, and high school, began homeschooling. Parents became teachers. Teachers became online instructors. People lost jobs and businesses and loved ones.

2020 was also the year with no break from accomplishment and innovation. Nonprofits and churches and schools got creative. Boards met virtually and made important decisions for their organizations. National and international conferences went online and delivered valuable content. Families and friends met through video conferencing – sometimes groups who hadn’t seen each other in a very long time! More and more nurses have become familiar with Nursology.net. They are accessing its abundant resources to further nursing knowledge to improve nursing education, research, and practice and ultimately the human health experience.

My wish for 2021 is that all nurses get some sort of break to rest and renew, and know that our work is vital to humankind. Happy New Year!

Connotations of Research Speak: The Meaning of Words Used in Research Reports

Do we allow or invite people to participate in research? Do we refer to people who volunteer to be in a study as subjects or respondents or informants or participants or people?

This blog is about the language we use when we present or publish our research. The impetus for this blog was a colleague’s recent declaration that people were “allowed” to share their experiences of a health related condition for a study. The blog is a follow up to a previous blog that addressed the implication of power when using words such as compliance and adherence and, perhaps, even concordance (Fawcett, 2020), as well as another previous blog focused on diverse meanings of power (Fawcett et al., 2020).

Upon hearing my colleague state that people were “allowed,” I immediately thought: What is meant by indicating that a researcher “allows” people who volunteer to be in a study so to provide answers to the researcher’s questions in an interview format or via a numeric survey? Does stating that the researcher “allows” the people who volunteer for the study to do whatever the researcher wants them to do mean that the researcher holds power over them? Is a “power over” relationship appropriate for what many nursologists claim as a core value and approach to people, that is, “relationship-centered care?” (See Wyer, Alves Silva, Post, & Quinlan, 2014). Does “allowing” people to share experiences for the purposes of research connote “paternalism, coercion, and acquiescence” (Hess, 1996, p. 19), Should we instead “invite” people to share their experiences or answer our survey questions or accept our experimental interventions?

Although most, if not all, nursologists who conduct research no longer refer to the people who volunteer to be in their studies as “subjects,” these people continue to be referred to as “respondents,” the term frequently used when people respond to a numeric survey, or they continue to be referred to as “informants,” when they answer open-ended interview questions. Perhaps most frequently, the people are referred to as a sample or population of “participants.” Until very recently, I was content with referring to people who volunteered for research projects as “participants.” However, I have begun to think that if we nursologists truly value and support relationship-centered care, we should personalize those who volunteer for our research projects. For example, many of the people who have volunteered for my Roy Adaptation Model-guided program of research (Clarke & Fawcett, 2014; Tulman & Fawcett, 2003).) are women during the childbearing phase of life. Should I refer to these people as women rather than participants?

I invite readers to offer their ideas for words that are most compatible with nursologists’ values about our relationships with people who volunteer for our research projects.

References

Clarke, P.N., & Fawcett, J. (2014). Life as a nurse researcher. Nursing Science Quarterly, 27, 37-41.

Fawcett, J. (2020, March 17). What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives. Blog. https://nursology.net/2020/03/17/what-is-reflected-in-a-label-about-health-non-nursology-and-nursology-perspectives/

Fawcett, J., Shitaki, Y., Tanaka, K., Hashimoto, Y., Fujimoto, R., & Higashi, S. (2020, September 1). Meanings of power. Blog. https://nursology.net/2020/09/01/power-in-nursing/

Hess, J. D. (1996). The ethics of compliance: A dialectic. Advances in Nursing Science, 19(1), 18-27.

Tulman, L., & Fawcett, J. (2003). Women’s health during and after pregnancy: A theory-guided study of adaptation to change. Springer.

Wyer, P. C., Alves Silva, S., Post, S. G., & Quinlan, P. (2014). Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care. Journal of Evaluation in Clinical Practice, 20(6), 881–889. https://doi-org/10.1111/jep.12224

Celebration! 2nd Anniversary of Nursology.net

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

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

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

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

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

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

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

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

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

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

Dr. Eustace

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

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

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

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

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

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

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

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

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

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

Dr. Eustace

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

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

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

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

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

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

Sources for the opening quotes:

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

Throwing Shade at Nursing Theory: a Millennial’s Perspective

Welcome to Shannon Constantinides,
who is joining the Nursology.net blogging team!
Shannon also contributed the content on
Jane Georges’ Theory of Emancipatory Compassion

Dear Colleagues,

Shannon Constantinides

As a current PhD candidate (Yay! I’m making progress) and experienced NP of about a decade (Yikes! Time flies!), I have a few thoughts on Dr. Foli’s well articulated post and associated call for action/ questions regarding nursing theory in academics. It is with a great reverence for the bright minds of this community that I share these ideas with you all. Please consider my comments simply for no more than what they are: some thoughts from a novice scholar (who happens to be a millennial).

First, the humor and humility with which Dr. Foli broached the topic of “nursing students throwing shade at nursing theory” made her post fun to read and so relatable!

Second, and not entirely related to the topic at hand (which I’ll get to), as an NP who often precepts students, I loved the question posed to students, “Are you running from something in your current job, or running toward a goal of being a nurse practitioner?” I think probably too often nurses go to NP (Nurse Practitioner) school without a clear idea of what the role and day-to-day of the job entails. On a number of occasions, I’ve gently refused to write letters of recommendation to NP school for newly graduated BSN students, because I truly believe that the knowledge and experience gained by working as a nurse is beyond measure. First and foremost, NPs are nurses. I can’t underscore enough the importance of building a strong professional foundation. Equally as important is taking the time and opportunities to explore the endless possibilities that come with nursing practice (finding what sets one’s soul on fire, so to speak). I think this goes for new-grad RNs who are fixated on any one speciality, as well. I would not be on the path that has lead me down my professional and academic journey without first practicing in a number of areas (being in the military made this an easy possibility). Having experience in a number of areas has been invaluable to my career as an APN – clinically and in broadening my understanding healthcare systems and the lived experience of health, itself.

Third, I think the struggle to connect theory to practice comes from a few places. Overall, however, I think it may be time we re-envision and modernize how we approach teaching theory, in the first place. We did this for clinical practice, right? How many of our colleagues ever trained in a sim lab, for example? Updating the what, how, and environment in which we teach doesn’t have to be limited to the parameters of the clinical side of practice. I think the sample principles apply to teaching theory, especially if we want students to learn how to integrate the two. So a few thoughts…

Why is there SO MUCH reading!?

I’ve deduced that what has seemed like an ungodly amount of reading over the course of my education has served the following purposes: 1) taught me the practical knowledge needed not kill my patients (literally), 2) exposed me to new ideas, and 3) exercised my brain and made it grow in its ability to comprehend complex and abstract ideas – just like exercising a muscle.

In regard to the amount of reading that goes along with nursing education: I had NO idea! And I say that as a naturally voracious reader who grew up in a home that purposely had no tv! Honestly, I think 99.99% of students have no idea what they’re getting into when they sign up for nursing education – at any place on the educational spectrum. Students need to be reassured, probably on repeat, that the reading has a purpose. As much as the discourse in nursing espouses that we ascribe to the anti-handholding/ law-of-equal-suffering/ eat-our-young narrative, reassuring your students is more than being nice or helpful. On a deeper level, reassuring your students demonstrates the ethics of compassion and caring that is preached in the pedagogy of the discipline.

To that point, your millennial students will also to be curious as to why you’ve selected specific reading material. I’m not saying you need to, or should, justify each reading assignment. However, giving students a general idea of why certain material is important, especially for theory and philosophy, will help create a connection to the content. I say this with love for my generation, but millennials (and post-millennials) are a different animal. We’re a “special” breed, if you will. We have been raised to question everything. Every. Thing. It’s in our DNA. And you’re just in luck, because there’s A LOT of us! By many accounts, we’re the largest generation in history! (That is, millennials – people born between 1981 and 1996, and post-millennials – people born between 1997 and the present day).

Now, to that point, let’s not also forget that the frontal lobe doesn’t fully develop until late adolescence/ early adulthood. So, some of your students who are innately left-brained, “linear” thinkers (who, inherently, may have a harder time wrapping their heads around some of the non-linear concepts in theory and philosophy), will also be young, concrete thinkers. Their brains literally have just only developed to a point of abstract thinking understanding the basic concepts related to the more esoteric ideas we talk about in theory. And this issue is compounded by unique educational, professional, and personal backgrounds and upbringings of each student.

For example, it wasn’t until my masters-level (and more so, PhD) studies, that I really started understanding some of the more abstruse, Delphic concepts in nursing theory. As a BSN and MSN grad of the CU system, I naturally gravitated to Watson’s work – but generally – the more experienced I became professionally, academically, and in life, the more I came to understand the “other” theories I was learning about in school. As an 18-year-old, direct-entry BSN student I could understand (because I saw a way to concretely apply) Orem’s self care theory, Leininger’s cultural care theory, or Carper’s Pattens of Knowing (and, yes, I now know and understand why Carper said in a 2015 interview with Eisenhauer that her work was never meant to be a theory – but try telling that to a young, brand-new, nursing student! There’s no denying a certain level of concreteness to aspects of Carper’s work. This is something I love about Carper’s model – she wanted it to be readily tangible to the user, and it is!)

In reality, it’s taken me nearly two decades to “get the hang of nursing theory” and be able to digest and truly understand the works of such thinkers as Rogers, Patterson and Zderad, or Newman. Or actually appreciate the depth, intricacy, salience, and beauty of Watson’s work. In fact, as a BSN student, I remember sitting in a guest-lecture with Dr. Newman, and being the left-brainer that I am, raised my hand said, “Um, Dr. Newman, I don’t get it…” Looking back, I’m still mortified by this encounter! I was THAT student (insert #facepalm here!).

#facepalm

So, really, it’s taken the better part of my adult life to develop the intellectual ability and emotional maturity needed to sit with and understand complex ideas. There are articles, book chapters, and entire texts I now consider the Holy Grail, which when I first read them specifically remember thinking, “WT_?? Is this even in English???” And to that point: don’t forget that your students are literally learning new languages! They’re not only learning the technical language of healthcare, but also the language the informs the epistemology of nursing. So, again, I think showing your students a little patience, forgiving, and compassionate grace is key.

Likewise, it’s my opinion that once we get to a certain point in our careers (as a clinicians, scholars, educators, administrators, etc.) we take for granted knowledge that has become second-nature. I can say, with complete certainty, that I fall prey to this with my own clinical NP students. What do you mean you don’t have a clear, concise, and evidence-based plan for managing your older adult patient who has insanely complicated medial, psycho-emotional, and social needs?? We have to remember that knowledge for students – whether clinical or related to theory and philosophy – is often entirely new or being presented at a depth they weren’t expected to go to in the past. In addition, with APN students where we’re building off the knowledge and experience that comes from working as an RN and RN education. As far as theory and philosophy are concerned – that knowledge is really complicated, is often brand-new, and often isn’t intuitively grounded in day-to-day nursing work and education. Your students are learning new stuff, a new language, and and learning to think in an entirely different way. Patience is key. Finding a way to foster connection to the content is key. My suggestion would be to keep Benner’s Novice-to-Expert model in the forefront of your minds when you’re working with students – especially when it comes to teaching theory and philosophy.

Middle range theory & the ladder of abstraction.

I think a lot of students aren’t exposed to middle-range theories. This statement is, of course, purely based off anecdote consisting of my own academic and professional experiences, and what sound to be similar experiences shared by my colleagues. It’s my opinion that middle-range theory may an optimal place to bridge the theory-practice gap. Certainly, this bridge will be influenced by the paradigm framing the theory or the paradigm to that which the nurse knowingly or unknowingly ascribes. However, as Smith and Liehr (2014) stated, middle range theories are more straightforward and lie in-between that which is all-inclusive and that which is highly situation-specific. In this regard, a few exemplars that made sense to me and my peers included Story Theory, the Theory of Unpleasant Symptoms, and the Theory of Caregiving Dynamics.

I also think teaching the levels of theory abstraction as described by Smith and Liehr, even at the BSN level, could help make a little more sense of nursing theory in terms of applicability. Do I apply this theory at the bedside? In a specific situation? Does it guide a certain aspect of my practice? Or, is it something that will guide the entirety of how I approach practice, patients, and the general experience of health?

I think it’s so tempting to start off with the classics: the grand nursing theories. But honestly, some (ok, basically all) of those theories are super complicated! For your newer, less experienced learners, maybe initially include something a little more concrete, like a micro theory? Help your students dip their toes in the water, so to speak, rather than throwing them directly into the deep end. I think a lot of harm can be done when faculty knowingly or unknowingly teach at a level that is over the students’ heads. Your students will get there, trust me, but keep it simple in the beginning. Help your students build a strong foundation. You’d do the same with patient care knowledge and skills, right? So, same idea for nursing theory.

Aging-out and aging-into the current sociopolitical & cultural context

I can’t stress this enough: nursing faculty have a critical place not only as clinical and scholarly role models, but in modeling the language and behavior of advocates and voice-givers. When I started my BSN in 2000, and even by the time I graduated with my NP in 2011,  I didn’t really know what social justice was. I couldn’t really answer the question, “What are you doing to be an advocate?” Over the course of my PhD program, however (and thankfully so), I’ve had the amazing fortune to work with and be mentored by some exceptionally stellar minds in my quest to figure out my place as an advocate and voice-giver (especially Dr’s Peggy Chinn, Patricia Liehr, Jane Georges, Debra Hain and Deb D’Avolio… to name a few). And, boy, do I wish I’d had a social justice/ emancipatory focused curriculum as a BSN or MSN student, like our students do at FAU!

So how does this relate to teaching theory? As feminist Holly Whitaker (2019) wrote in her book, “Quit Like a Woman,” we are now, likely more so than ever, aware of our own oppression, the oppression of others, and aware of how our actions or inactions have abetted the oppression and marginalization of others. Whitaker states, and I whole-heartedly agree, that thanks to movements started by the LGBTQIA community, radical feminists, and women of color, our common vernacular now includes words like privilege, misogyny, and patriarchy. (I would also add terms like toxic masculinity and inclusivity). Likewise, I contend that our language reflects a paradigmatic shift that is occurring in society: we are moving toward a more humanistic way in how we view and interact with others. For example, we’re moving away from socially constructed and derogatory descriptors. Rather than calling someone “disabled” we acknowledge that the individual is of other-ability. Rather than being called “elderly” or “geriatric” we honor the experience that comes with older adulthood. We recognize that someone is involved in “sex work” is a “sex worker,” not a “prostitute.” We now see that the term “violence against women” is problematic in that it is passive and alleviates the blame of the perpetrator.

Students, especially millennials, are probably hip to these issues and this type of language, but this is not an assumption to make. It is your responsibility as a faculty member to stay informed and engaged in this regard. Just like you would teach from a place of best evidence regarding clinical practice and patient care, stay up to date on what’s going on in the world, the language being used, and the issues that matter to your students.

The good news is that we now have theories and books that are grounded in a social-justice paradigm! Take, for example, Georges’ (2013) Emancipatory Theory of Compassion (or really, any of Dr. Georges’ work dealing with the nature of human suffering). I adore Georges’ work (and work she’s done collaboratively with Dr. Susan Benedict) for a number of reasons, especially how she takes the concept of suffering head-on, and calls out nursing in regard to the profession’s historical (and generally unspoken) complicit involvement in oppression. Intentionally moving away from the traditional, Western narrative that has a propensity for the patriarchy, Georges’ work focuses instead on alleviating suffering through compassion, empowerment, and deconstruction of power relations. Falk-Rafael’s Critical Caring model, for example, also goes in this direction as it looks at role power relations have in public health outcomes. Likewise, I consider Kagan, Smith, and Chinn’s (2016) Philosophies and Practices of Emancipatory Nursing, and the works there within, a critical must-read for anyone wanting to study or practice nursing theory in context of today’s sociopolitical climate. To that point, a quick search on Amazon revealed a number of nursing textbooks centered around contemporary theory-based approaches for caring for vulnerable populations, approaches to healthcare policy, and approaches for healthcare advocacy.

And, to very briefly touch on the topic of technology in nursing theory: if your students are my age (I’m 37) or younger, we never knew what it was like to live without technology (let alone practice nursing without computers, smart phones, apps, EHRs, or the internet!). My husband, a physician (I know, I married the enemy), is 10 years older than me. We work in the same primary care practice. Even though he is fairly tech savvy, it’s astonishing how much longer it takes him to adapt clinical technology compared to those of us in the clinic who are a decade younger. I’m not saying this is true across the spectrum: I absolutely interact with younger clinicians who have less tech know-how than our colleagues a few decades our senior. What I’m saying is that those of us who were born into and grew up practicing nursing in the information age have a different relationship and understanding of healthcare (and view of the world, in general) than those even a decade ahead of us.

Several years ago, at the suggestion of my fairly tech savvy entrepreneur dad, I read “The World is Flat” by Thomas Friedman. My dad thought this work was incredibly forward-thinking. The concept and manifestation of a globalized humanity secondary to advances in technology was mind-blowing to him. However, I remember thinking, “yeah… so this is not a new thing to me, Dad…” Keep in mind that the world has always looked so different to those of us in the millennial and post-millennial generations. In terms of nursing theory, Watson’s work – I think especially Caring Science as Sacred Science and Unitary Caring Science – both hit the nail on the head in terms of addressing globalization and caring for a global humanity.

Additionally, the exciting thing about nursing theory in the information age is that new theories are emerging to deal with contemporary, tech-related issues! Dr. Rosario Locsin’s Theory of Technological Competency as Caring, for example, is pertinent and relatable for today’s students. A few years ago, I had the opportunity to listen to Dr. Locsin speak about his theory. I was, again, THAT student. I asked Dr. Locsin, “Are your theory and views on artificial intelligence and humanoids questioning how we define existence?” “No. Not necessarily,” he said, “But what if A.I. develops to the point where it can’t be differentiated from naturally living beings? What if a humanoid develops feelings? Can they develop feelings?” These may sound far-fetched, but the future is not that far away and technology is developing at a screaming pace! The philosophic questions, ethical dilemmas, and reality your students will face in the future will undoubtedly look like something out of a sci-fi novel – and for that I applaud Dr. Locsin for boldly going where no nursing theorist has gone before!

This next statement might be considered heresy, but for the sake of discussion, hear me out: I believe some theories are aging-out, or at least need to update their language. This is absolutely not a dig on older theories: let me be very clear about that! Some of the older theories were the embryonic origins of what, over time, have evolved into modern nursing theory and practice. Due to the social and political culture of the time, and in order to be taken seriously, the structure and verbiage of early nursing theories were informed by a patriarchal/ paternalistic, medical narrative that was dictated by an aristocracy of upper class, white, male physicians, scientists, politicians, and power-elite. People were either ill or well. Self-agency was not a thing if you were not a straight, white, cis-male. Social justice was not a thing. Human rights were not a thing. The right to health was not a thing (and arguably is still not a thing). Hearing the critical voices of underserved, under-represented, vulnerable, or marginalized populations was not a thing. Talking about energy (let alone shared energy) was definitely not a thing – or at least not a thing that was spoken of publicly or in circles of “hard science.” The male doctor gave the female nurse orders, and the female nurse would then perform prescribed actions.

I conducted a review of caring theories as a part of my comprehensive exam last summer. Again, let me be very clear: these theories were crafted by minds much more brilliant than I could ever hope mine to be, and there is indescribable wealth, depth, knowledge, and wisdom imbedded in these works. Truly, many will remain as enduring masterpieces of the discipline, and their authors have become beacons of progressive, forward-though. However. …. However, in conducting this review, I found that a few theories that by their nature of being framed by a context that no longer matches the current sociopolitical and cultural climate, have perpetuated the aforementioned narrative informed by the patriarchy and the notion of power imbalance. I believe this is antithetical to the emancipatory movement we are experiencing in nursing – and society, as a whole – where, for example, the out-dated adage of “enabling” the other should be updated to a focus on empowerment.

So, some closing thoughts:

Your students live and will work in a world that that changing at an unfathomable pace. While I believe that a great many works and ideas in nursing theory and philosophy are truly timeless and relevant, some are not. Stay up to date on what is pertinent and what is being published. Teach the classics, but also teach new, relevant theories. Try new articles. Try new textbooks. Talk to your students about what they think is timely and relevant.

And more importantly …. talk to your students. Connect with them. Millennials, in particular, like to be engaged and involved! Finding innovative and creative ways to connect with your students is especially important with the proliferation of online programs, where many students will never set foot campus. Trust me: your effort in this regard will be well worth it! Whether in the classroom or the online environment, I got the most from faculty who taught from a place of compassion and connection – where they openly and earnestly worked to understand the student perspective and got us involved and invested in what we were learning. In fact, I’m still in touch with a few faculty from both my BSN and MSN programs! (Dr’s Lea Gaydos, Lynne Bryant, Amy Silva-Smith…). Dr. Gaydos and Dr. Bryant were my BSN and MSN theory and philosophy professors, respectively, and were two of the first people I called when I had my first theory-related article published in 2019 in NSQ. It’s been nearly 20 years since I took Dr. Gaydos’ class, and I still have my term paper from that course. All I can say is: what an abomination! I was in tears, laughing, when I reread that “gem” last year!

My point is, these professors planted the seed of interest in nursing scholarship at the doctoral level. You will have THAT student. I was THAT student. Who am I kidding… I’m still THAT student! The student who wants to know “why” about everything. The student who will question everything. The student who will argue every last point on an assignment. Trust me when I say this: no matter how much shade your students throw at theory, you ARE making a difference. Because THAT one student … the one who pushed you and nearly drove you crazy … that student may be the one who grows up and wants to continue this dialogue.

Finally, and most importantly: I truly admire and respect Dr. Foli for putting herself out there. The issue she raises (students throwing shade at nursing theory) is very real and very much alive and well in the world of nursing academics. As Dr. Jane Georges once said to me, “violence can be done to students’ ideas,” and I applaud Dr. Foli in her quest to improve the academic experience for her learners.

Sources

Benedict, S. & Georges, JM. Nurses in the Nazi “euthanasia” program. Advances in Nursing Science: 2009; 32(1): 63-74.

Chinn, PL. & Falk-Rafael, A. Embracing the focus of the discipline of nursing: critical caring pedagogy. Journal of Nursing Scholarship: 2018; 50(6): 687-984.

Eisenhauer, ER. An interview with Dr. Barbara Caper. Advances in Nursing Science: 2015; 38(2): 73-81.

Falk-Rafael, A. Nursology: Critical Caring. https://nursology.net/nurse-theorists-and-their-work/critical-caring/. Accessed June 2, 2019.

Falk-Rafael, A. Advancing nursing theory through theory-guided practice: the emergence of a critical caring theory. Advances in Nursing Science: 2005; 28(1): 38-49.

Georges, HM. Biopower, compassion, and nursing. In: Philosophies and practices of emancipatory nursing: social justice as praxis. Kagan, PL., Smith, MC., & Chinn, PL. (eds). New York: Routledge; 2014: 51-63.

Georges, JM. An emancipatory theory of compassion for nursing. Advances in Nursing Science: 2013; 36(1): 2-9.

Georges, JM. Evidence of the unspeakable: biopower, compassion, and nursing. Advances in Nursing Science: 2011; 34(2): 130-135.

Georges, JM. Bio-power, Agamben, and emerging nursing knowledge. Advances in Nursing Science: 2008(A); 31(1): 4-12.

Georges, JM. The politics of suffering: implications for nursing science. Advances in Nursing Science: 2004; 27(4): 250-256.

Kagan, P.N., Smith, M.C. & Chinn, P. (eds.) (2014). Philosophies and practices of emancipatory nursing. Routledge.

Lenz, E.R. & Pugh, L.C. (2014). The theory of unpleasant symptoms. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

Locsin R. Technological competency as caring in nursing: co-creating moments in nursing occurring within the universal technological domain. The Journal of Theory Construction & Testing: 2016; 20(1): 5-11.

Smith, M.J. & Liehr, P.R. (eds). (2014). Middle range theory for nursing, 3rd ed. Springer.

Smith, M.J. & Liehr, P.R. (2014). Story theory. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

Watson, J. Unitary caring science: the philosophy and praxis of nursing. Louisville: The University Press of Colorado; 2018.

Watson, J. Caring science as sacred science. Philadelphia: F.A. Davis Company; 2005.

Whitaker, H. (2020). Quit like a woman: the radical choice not to drink in a culture obsessed with alcohol. Random House.

Williams, L. (2014). Theory of caregiving dynamics. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

Guest Post – The Big, Bad, Terrible Dissertation Defense

Guest Contributor: Ashley Rivera, PhD, RN
See “About the Author” below

“The best thesis defense is a good thesis defense.” Retrieved from https://xkcd.com/1403/.
Comic available under a Creative Commons Attribution-NonCommercial 2.5 License.

In my head, I built the entire day up to be a terror of being questioned for every decision I made throughout my study. All the prep-work from making draft revisions and polishing off the speech to accompany my slides did not prepare me for joy. My joy is not about the strength of my study or the loving support that my graduate school, Florida Atlantic University, bestowed upon me during my entire program. It’s about who showed up at my defense.

One of the first to arrive was an entry-level BSN student who had responded to the mass-dispersed open defense email sent out by the College of Nursing. When I was a student, I would probably have just dumped that email in the trash bin. The student who showed up truly felt that in nursing she could achieve anything, which was a refreshing sight to my battle-wounded soul from the years of micro-managing and counterintuitive policies that are experienced on the job. The memory of her being there is a reminder for me that there is a need to shine a light on the quiet strength that comes from being a nurse. This quiet strength is what guides nursing through the bad days, like when four call lights are going off and they all have to be answered in less than 3 minutes, or the code that just won’t end because nobody wants to tell mom her baby won’t be back. I didn’t see her leave, but I remember her clap and the light in her eyes at the end of the defense.

I didn’t think much of it when the crowd of fresh PhD students wandered in, after all, they were in school to do the very same thing. However, the feedback I received from them truly reinforced my passion for teaching. The best part was that the comments didn’t come from them directly, it came from the professor of Qualitative Research. As part of my defense, I explained my choice to use Charmaz’s constructive grounded theory by contrasting it with classic grounded theory and Straussian grounded theory. The professor was thrilled by the explanation I gave. She also stated that the PhD students indicated that my explanation was so clear that they now truly understood the differences between all three approaches to grounded theory. To me, that was the icing on the cake of such a momentous day. Their feedback is the start of my living my dream to inspire passion and clarity for research and theory in classes that so many students describe as the bane of their existence.

Defenses are an opportunity to inspire those who watch and fuel the passion of those who defend. This should be the goal at the end of a very long road in the PhD journey. I wouldn’t take a single step back, but the dissertation defense isn’t so big, bad, or terrible—in fact, it’s probably the most inspiring part of the whole PhD.

The newly minted,
Dr. Ashley Rivera

Left to right: Dr. Marlaine Smith, myself, Dr. Patricia Leihr, and Dr. Yash Bhagwanji

About Dr. Rivera

Ashley Rivera

Not known for being a wall-flower, I believe in the power of a positive attitude and a smile. I keep centered through my loving husband, my three rambunctious children and being outdoors in my organic garden. My practice experience includes Pediatric Hematology/Oncology, Liver Transplant, Medical Surgical, High Risk Pregnancy, Diabetic Education, Telemetry, and Epilepsy Monitoring. I started my health care journey as an EMT, but came to love nursing for the continuation of care aspects. I have worked in both inpatient and outpatient at different stages of my nursing journey. I also have experience as adjunct faculty and as a research assistant. I entered the PhD program at Florida Atlantic University in August of 2015 and received a Jonas Scholarship in 2016. In my immediate future, I plan to continue working on getting my dissertation, “The Social Process of Caregiving in Fathers” published, and growing the resulting mid-range theory, “Caregiving in Fathers”. I will be presenting my recruitment methodology at the upcoming K.I.N.G Collaborative Research Conference in D.C. and, eventually, I hope to teach  and accept a full-time position teaching.

What is Real Nursing and Who are Real Nurses? Perspectives from Japan

Thank you to the graduate students and faculty
from St. Mary’s College, Kurume, Japan, who

contributed to this blog!

Hayes (2018) published a thought-provoking article, “Is OR Nursing Real Nursing,” in the September 2018 issue of the Massachusetts Report on Nursing. Her article was the catalyst for my invitation to students enrolled in the Fall 2018 University of Massachusetts Boston PhD Nursing Program course, NURS 750, Contemporary Nursing Knowledge, to join me in sharing our perspectives about “real nursing.” The result was published in the October 2019 issue of Nursing Science Quarterly (Fawcett et al., 2019).

Photo of the Misericordia Bell, The bell, which hangs In the tower of the St. Mary’s College Library, is a symbol of Misericordia et Caritus, which is the founding philosophy of St Mary’s College. Retrieved from http://st-mary-ac.sblo.jp/

This blog has provided an opportunity for six graduate students and three faculty members at St. Mary’s College Graduate School of Nursing, in Kurume, Japan to share their perspectives about “real nursing.” My invitation to them was given as part of a January 2019 video conference lecture I gave in my position as a visiting professor at St. Mary’s College. I am grateful to Eric Fortin, a St. Mary’s College School of Nursing faculty member, for his translation of the students’ and faculty’s contributions from Japanese to English.  Noteworthy is that St. Mary’s College School of Nursing is the first to include nursology as part of the name for their research center–the Roy Academia Nursology Research Center

Graduate Students’ Perspectives

Junko Fukuya: Throughout my nursing career, I have always used a nursing conceptual model to guide care of hospitalized patients from admission to discharge. I would like to become a better nursologist, a “real nurse,” who allows nursing knowledge to permeate my mind and impresses its importance on other nurses.

Akemi Kumashiro: Nursing is practiced in many settings, including clinical agencies and local communities, with people who are well and those who are ill. Real nursing occurs when the nurse continually gains the knowledge and experience required to help people to adapt to a new life style when changes in environment occur.

Takako Shoji: Patients are persons who are important to and loved by someone. By recognizing patients as people with life experiences and families, I do not merely provide knowledge and technology, instead, as a real nurse, I work to establish a relationship with each patient that respects the values he or she has formed through life experiences.

Chizuko Takeishi: The real nurse endeavors to meet the universal needs of individuals, families, groups, and communities of all ages. Real nursing is directed to helping people to make decisions directed toward maintenance and promotion of wellness, prevention of illness, recovery from illness, relief from pain, maintenance of dignity, and promotion of happiness.

Tomomi Yamashita: As a real nurse, I know that patients are waiting for me and support me in establishing mutual and warm relationships. Real nursing involves actions, thoughts, and words that affect patients’ lives. It is a process of talking with patients about their perceived needs and anticipating those needs they have not yet identified.

Yuko Yonezawa: Real nursing involves seeing human beings as holistic beings consisting of body, mind, and spirit, who are deserving of respect and compassion from the very first moment of their existence to the end. Real nursing also involves knowledgeably helping people to help themselves to live their lives how they want.

Faculty Members’ Perspectives

Tsuyako Hidaka, Ikuko Miyabayashi, and Satsuki Obama: As a real nurse, the nursologist interacts with patients while providing daily care and obtains a lot of quantitative and qualitative data as he or she builds therapeutic relationships with patients. These data are the basis for what may be considered “invisible mixed methods nursing research” (Fawcett, 2015). Real nursing is a very noble profession in which real nurses learn “Life and Love” from patients as human beings and can thus grow as human beings themselves.

Jacqueline Fawcett: My position is that all nursologists (that is, all nurses) are real nurses who are engaged in real nursing. However, various perspective of what real nursing is (or is not) exist, as Hayes (2018) had indicated.

I am grateful to the graduate students and faculty at St. Mary’s College Graduate School of Nursing for sharing their perspectives about “real nursing” with the readers of this blog. I now invite students and faculty worldwide to send their perspectives about “real nursing” to me (jacqueline.fawcett@umb.edu) for inclusion in future nursology.net blogs. As we gather worldwide perspectives, we will be able to identify and describe what Leininger (2006) called universalities and diversities in who we are, what we do, and why and how we do what we do.

References

Fawcett, J. (2015). Invisible nursing research: Thoughts about mixed methods research and nursing practice. Nursing Science Quarterly, 28, 167-168.

Fawcett, J., Derboghossian, G., Flike, K., Gómez, E., Han, H.P., Kalandjian, N., Pletcher, J. E., & Tapayan, S. (2019). Thoughts about real nursing. Nursing Science Quarterly, 32, 331-332.

Hayes, C. (2018). Is OR nursing real nursing? Massachusetts Report on Nursing, September, 11.

Leininger, M. M. (2006). Culture care diversity and universality theory and evolution of the ethnonursing method. In M. M. Leininger & M. R. McFarland, Culture care diversity and universality: A worldwide nursing theory (2nd ed., pp. 1-41). Boston: Jones and Bartlett.

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?”

Removing/Refusing the Invisibility Cloak

Invisibility cloaks are magical devices that render the wearers invisible

from Inaugural issue of “Revolution: The Journal of Nurse Empowerment,” 1991

and transparent – they simply become part of the background. Furthermore, the wearer of the cloak can see through it and actually be wearing it without being fully conscious of it. Although invisibility cloaks have existed in mythology for centuries, they have recently been brought to public consciousness through the work J.K. Rowlings in the Harry Potter series. But I think they provide a relevant metaphor for what many nurses often experience – instances in which they and/or their contributions to health and healing remain invisible. And, my question is, can a shift to focusing on the nursing knowledge that underpins our practice and making it visible by naming it Nursology, help nurses in general to remove or refuse the cloak of invisibility?

 In my years of nursing experience, whether in practice, education, or research,  I have experienced and witnessed many instances of nursing and nurses, myself included, being rendered invisible. Nurses may themselves put on the cloak of invisibility by using the phrase, “I’m just a nurse” or by undervaluing their work.  A participant in one of my studies recounted an amazing example of capacity building in a group of adolescent girls but described her role in the transformation that took place as not “ much of anything” 1.

From Revolution: The Journal of Nurse Empowerment

 We can also put on the cloak of invisibility by valuing the knowledge of related disciplines more highly than nursing knowledge, such as happens when nurses dismiss nursing conceptual frameworks as irrelevant while, at the same time, consciously or unconsciously using knowledge from other fields to inform or define their nursing practice, either in scope or content 2,3.

 Sometimes the cloak of invisibility is put on us by others. We may or may not be conscious of the cultural and societal cloaks put on those of us who are women. And those of us who “trained” to be nurses in the 1960s will also be able to relate to the cloaks we acquired as deference to physicians was instilled in us.  We can only remove these cloaks by becoming conscious of them.  Public health nurses in my studies provided evidence that such cloaking continues. For example, one nurse told me about being required by their employer not to refer to themselves as nurses or the work they did as care; instead they were to refer to themselves as public health professionals, in the name of interdisciplinarity. 

 These reflections came about because of a conversation I had with a friend and colleague in which I related the following incident.  I was attending, on behalf of a national nursing association and by invitation, a media release of interest to health and other workers involved in in promoting healthy populations. After the release we were invited to attend a luncheon to discuss implications of the report from each of our perspectives. One gentleman present clearly represented a biomedical approach to health and he and I exchanged perspectives that were rather diametrically opposed to one another. After the luncheon he made his way across the room to me and asked me what my PhD was in (we each had place card tents which included our credentials).  I told him “nursing”.  He thought I misunderstood him and repeated the  question and received the same answer.  He replied, “no, I can’t have a PhD in medicine and you can’t have one in nursing.”  I assured him I did.  Exasperated, he asked what my dissertation topic was.  I answered that it was an oral history of public health nursing in Ontario.  “Ahh”, he replied, “that’s the answer! Your PhD is in history!”  With that he left, satisfied that he had set me straight! 

 In relating that incident to my friend, we contemplated, would that have been the case if my PhD was in Nursology?  I think probably not. It might have raised the question, “What is Nursology” which I would have welcomed!  

 

1.    Falk-Rafael A, Betker C. The primacy of relationships: a study of public health nursing practice from a critical caring perspective. Adv Nurs Sci. 2012;35(4):315-332.

2.    Rafael A. From rhetoric to reality: The changing face of public health nursing in southern Ontario. Public Health Nurs. 1999;16(1):50-59.

3.    Rafael AR. Nurses who run with the wolves: the power and caring dialectic revisited. ANS Adv Nurs Sci. 1998;21(1):29-42.

 

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!