Moving Towards the Next Fifty Years Together

We are delighted to welcome guest bloggers representing the  Nursing Theory Collective
formed March 2019 Case Western Reserve
Nursing Theory Conference:
Chloe Littzen, Jane Hopkins Walsh  and Jessica Dillard Wright

I. Introduction

Chloe Littzen

Jessica Dillard-Wright (L) and Jane Hopkins-Walsh (R)

In March 2019, 130 nurses from all over the world gathered at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio for Nursing Theory: A 50 Year Perspective, Past, and Future, a landmark conference to celebrate the history of nursing theory and elicit discussion for the future of nursing. The attendees were diverse, comprised of seasoned nursing theorists and doctoral students in equal measure, participating in lively and thoughtful conversation across many domains. The future of nursing theory quickly emerged as a critical issue as nurses working at all levels of expertise expressed their concern over the loss of nursing theory at the institutional level, both academic and clinical. What is at stake in this erosion is discipline-specific nursing knowledge, in particular at this 50-year juncture as the great theorists of nursing like Drs. Peggy Chinn, Joyce Fitzpatrick, Pamela Reed, Callista Roy, Marlaine Smith, and many others approach the end of their illustrious careers. The question resonated, “who will carry the nursing theory torch forward?”

To advance the discipline of nursing, the next wave of nursing theorists and thought leaders must actively engage to advance nursing theory, improve nursing praxis, and articulate nursing’s identity leading our profession into the future. This is the rallying cry that led to the blog post you are reading today. In follow-up to this conference, doctoral student Chloe Littzen engaged other students who attended to embark on a collaborative effort to articulate our vision for the future of nursing theory. What follows is a brief discussion of our course so far, the background, plan, and desired outcomes for convening a nursing theory working group as we envision the next fifty years of nursing theory and beyond.

lI. Background

After the landmark conference concluded, a collaborative effort ensued to form a theory working group focused on promoting nursing theory and advancing nursing’s identity. This group is comprised of both scholars and students and is open to all nurses practicing in all settings. Our first meeting was held online via video-conferencing on May 18th, with a total of six participants from Arizona, Massachusetts, and West Virginia. This first meeting was an experimental think-tank where we considered ideas about the future of nursing and our professional identity. Below, we outline our mission and vision for this nursing theory working group.

III. Plan

The primary mission, as established by our working group, is to promote nursing theory and advance the identity of nursing through knowledge development for all nurses in all settings, including practice, education, research, and policy. As a group, we believe that nursing and nursing theory are dynamic and evolving to meet the needs of an increasingly complex healthcare landscape and global environment. In order to keep nursing theory and nursing relevant and current, thinking about theory must be on-going and iterative, with a continuous cycle of critique, testing, and scholarship. Failure to seriously engage these questions has dire consequences for nursing theory and the profession as nursing as it slowly cedes its identity to the economic pressures of the healthcare environment and the supremacy of biomedicine.

The following bullets summarize our discussion and desired outcomes from the first nursing theory workgroup meeting:

  • Discussion Points:
    1. We need a plan to sustain and evolve nursing theory and nursing’s identity with discipline-specific knowledge.
    2. Nursing theory must be derived from and applicable to the practice environment, not just academia.
    3. The purpose of nursing theory must be clarified for nursing practice, education, research, and policy.
    4. Nurses in clinical practice must have an educational foundation grounded in nursing theory that empowers the application of theory in practice.
    5. Nursing students must be educated and mentored in nursing theory, beginning at the pre-licensure level.
    6. This discussion must include considerations of how nursing theory is taught in the academic environment and how that can be linked to and informed by nursing practice.
    7. The need for nursing theory is global, making this an international, even planetary problem.
  • Desired Outcomes:
    1. To write a manuscript demystifying nursing theory for the nurse in the practice environment.
    2. Write a second manuscript demystifying nursing theory for the nurse educator in academia.
    3. Explore the potential of a future study identifying and describing the barriers and facilitators for using nursing theory in practice, education, research, and policy settings.
    4. Share the discussions, experiences, and findings with the community at Nursology.net.

IV. Invitation – Join us!

While we are a new workgroup, we welcome and encourage all nurses, both advanced scholars and novice theorists alike, to consider joining us in this journey in promoting nursing and nursing theory into the future. We currently meet monthly over Zoom video-conferencing. If you are interested, please contact form below to be placed on the email list for future meetings and content.

If you are planning to go to the 2019 Collaborative K.I.N.G. conference in Washington D.C. from November 14th-15th, we are planning an in-person meeting to take place. We hope to see you there as we drive nursing and nursing theory into the future. Join us!

With optimism and gratitude for the future,
Nursing Theory Collective
(Final group name pending vote at next meeting)

Footnotes:

See more information on the King Conference here.

See more information on the landmark theory conference at Case Western Reserve University Frances Payne School of Nursing here.

Please use this form to contact us if you want to join us, or for more information!

Why Nursology?: The Perspective of an International PhD Student

Guest contributor: Toqa Alanby

Toqa Alanby

Hello, my name is Toqa Alanby MSN, BSN, RN, from Saudi Arabia, a full-time nursing PhD student in Christine E. Lynn College of Nursing at Florida Atlantic University. I have chosen to begin the pursuit of my academic career in Nursing with a sense of determination. Through my B.Sc. in Nursing from Umm Al-Qura University (Mecca, Saudi Arabia), my English program at INTO University of South Florida (Tampa, Florida, US), and my M.Sc. in Nursing from Trinity College Dublin, University of Dublin (Dublin, Ireland), I have dedicated my life to advance my nursing knowledge and skills.

I was introduced to the Nursology website by Dean Marlaine Smith, my advisor, as she said, “websites are vehicles to assist us in coming to know an organization.” The Nursology website is a quantum leap in nursing. Nurse scholars, nurses in clinical settings, and postgraduate students, all of them, can be involved by joining or just by browsing this site. It was designed and maintained by nurse scholars with sufficient experience who can enrich the nursing profession throughout the world. For me as an international PhD student who came from a different background, I found it as a repository for sources about nursing conceptual models, grand theories, middle-range theories, and situation-specific theories, philosophies and related methodologies. It is momentous to nursing practice, education and scientific research because it is a guide to what is already known and what further knowledge and skills are required. Also, I found it as a station that can connect to the pioneers of the nursing profession, a link to enable us to communicate with them easily.

Exploring the website, gave me a better understanding about the history of nursing in the United States. Furthermore, it reminded me of how nursing started in Saudi Arabia. In both cases war had an impact on the development of nursing. For instance, the first mention of nursing in Saudi Arabia was during the time of the Prophet Muhammad in the service of the Muslim armies during periods of war. Women accompanied veterans as companions and caretakers. According to Jan (1996) nursing activities carried over into peacetime when the women served as midwives and continued to nurse the sick and dying.  Subsequently nursing concepts emerged to inform this practice.

Nurses, nursing students and other health professionals understand and view nursing differently. Many definitions have been used to define the concept of nursing. Sapountzi-Krepia (2013) justifies this diversity due to different educational backgrounds, cultures and experiences. Now that nursing is based on the interaction with others, caring appears as one of its central concepts. The concept of care emerged during the decade of the 1950’s; however many factors hampered its progress. It was not until two decades later that not only the first National Caring Research Conference but also the publication of Leininger’s and Watson’s theories stimulated the interest of researchers in the concept (Brilowski & Wendler, 2005). Caring seems to be inherent to nursing practice and originates from respect and concern for the patients, which is a skill that evolves with experience. As for my culture, caring from the Islamic perspective refers to a critical, reflective analysis of what we think we know about our universe and ourselves. Saeed (2006) mentioned that the Islamic philosophy is rooted in the attempt to understand reality rationally. The Qur’an, the Holy book of Muslim faith, and the Sunnah, which documents the life and practices of the prophet, built the Islamic belief system.

Outside of the nursing community, when I talk about nursing science, I always have been asked what distinguishes nursing science from other disciplines? Cowling, Smith & Watson. (2008) answered this question by stating that there are 3 fundamental concepts which are wholeness, consciousness, and caring singled out and positioned in the disciplinary discourse of nursing to distinguish it from other disciplines. In my opinion, nursing implies an intentional activity, attitudes and feelings that shape the professional interaction established between nurses and patients.

Having an understanding of these perspectives will inform health professionals to achieve cultural competence and deliver care that is culturally sensitive (Rassool, 2014). Individualized, holistic care can be achieved by apprehending culture, beliefs and ethnicities, and a display of cultural competence. I saw Dr. Sadat Hoseini’s model on the Nursology website as a model that comes from a Muslim perspective. It is wonderful and informative. However, there is a great diversity of cultural, tribal and linguistic groups among Muslim societies, each of which has its own cultural characteristics and worldview of well-being and sickness. Delivering nursing care to Muslim patients means having an insight of Islamic faith and Islamic beliefs. Thus, what goes on in Saudi Arabia is totally different from what Dr. Hoseini’s model looks for. She is from a different culture, country, and doctrine.

Based on my experience, non-Muslim nurses who work in my country are not able to utilize the existing knowledge and framework of health from Islam to enhance the nursing profession. The inability to shape nursing practice, education, and policy from an Islamic perspective can be attributed to multiple factors such as social status of nursing in the country, professional identity of nurses, and societal approval and recognition (Ismail et al., 2015). Therefore, the professional development of nursing among Muslim nurses is based on utilizing Western practice, education, and ethical models instead of integrating the holistic view of Islam (Gharaibeh & Al-Maaitah, 2012). The curricula of our colleges in Saudi Arabia still follow the theories that come from the United States (F. AlShaibany, personal communication, April 25, 2019). Though, in general, the development of nursing theories and models are almost neglected in Saudi Arabia, whether in education or practice. While nursing students know about nursing theories, they most likely don’t see them as a part of their practice. They also tend more to use theories from other disciplines such as change theories instead of nursing theories.

I was eager to explore nursing from another perspective and the Nursology website was a vehicle to achieve this purpose.  The Western concept is the most visible and distinctive in the site. I believe this site will be a real connection for other nurses around the world to the study of Western nursing. Thus, I hope one day to join the great scholars here to advance Nursology forward and perhaps contribute by sharing my theoretical work from a different cultural point of view. My goal is to embark on an academic career and to conduct research.  In other words, scholars absorb and integrate information coming from the world around them as they create their own work. The role they play calls for the development and maintenance of collective learning and comprehension. A scholar’s work, according to Boyer’s (1990) definition, calls for taking a step backwards from the investigation, searching for connection, and bridging the gap between theory and practice while having one’s knowledge communicated effectively (p.16).

Being able to comprehend and associate with nurses of different cultures is vital for nursing advancement. Understanding cultural differences among nursing perspectives is essential. By educating ourselves about different cultures through communication with diverse nurses in conferences, organized meetings, and engagement with a website like Nursology can prepare us well to broaden our perspectives on nursing knowledge from all over the world in multiple cultures.

References

Boyer, E. L. (1990). Scholarship reconsidered. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching.

Brilowski, A., & Wendler, C. (2005). An evolutionary concept analysis of caring. J Adv Nurs (50), 641-50.

Cowling, W.R., Smith, M.C. & Watson, J. (2008). The power of wholeness, consciousness, and caring: A dialogue on nursing science, art, and healing. Advances in Nursing Sciences, 31(1), 41-51.

Alshaibany, F. (2019, April 25). Personal Interview.

Gharaibeh, K. & Al-Maaitah, R. (2012). Islam and Nursing, in Religion, Religious Ethics, and Nursing. Spinger New York, NY. p. 229-249.

Ismail, S., Hatthakit, U., & Chinawong, T. (2015). Caring science within islamic contexts: a literature review. Nurse Media Journal of Nursing, 5(1), 34. doi:10.14710/nmjn.v5i1.10189

Jan, R. (1996). Rufaida Al-Asalmiya, the first Muslim nurse. Image: Journal of Nursing Scholarship, 28, 267-268.

Rassool, G. H. (2014). Cultural competence in caring for Muslim patients. Palgrave Macmillan.

Saeed, A. (2006). Islamic Thought: An Introduction. New York, USA: Routledge.

Sapountzi-Krepia, D. (2013). Some thoughts on nursing. Int J Caring Sci (6), 127-133.

Student response to a doctoral “Knowledge Development in Nursing” course

The University of Wisconsin-Madison School of Nursing PhD program offers a required course entitled Knowledge Development in Nursing. In the Fall 2018 semester, the course was co-taught by Dr. Anne Ersig and Dr. Danny Willis. The course examines the history of knowledge development in the discipline of nursing. PhD students are prepared to understand nursing philosophical perspectives; scientific thinking; conceptual models; conceptual analysis; grand, middle-range, and situation-specific theory; the nature, sources, syntax, and development of knowledge in the discipline.

One of the major strengths we witnessed in co-teaching the Knowledge Development in Nursing course together is the diversity of perspectives and ways of knowing that the students were exposed to given our complementary ways of approaching our phenomenon of interest (see more about our own approaches below). We were inspired every time the course met. The students enrolled in our course represented life experience and perspectives from around the world – China, Jordan, South Korea, Turkey, Uganda, and the United States. It was such a wonderful experience! We were particularly moved by Yuanyuan Jin’s reflection on her learning journey through the Knowledge Development in Nursing course and felt compelled to ask her to share her story with Nursology.net. When we asked YuanYuan, she commented to Dr. Willis that she hopes to be one of the future professors and leaders in nursing theory and knowledge development for the future. We could not have been prouder to hear this as it offers hope for the future of our discipline. Enjoy Yuanyuan’s reflection as much as we did!!

Question: Reflect on how your thinking about your identity as a nurse scholar and researcher has evolved over this semester. How do you think this might influence your future as a nurse scholar?

Yuanyuan Jin, MSN, RN, PhD student

For me, this was a very short but intensive semester. I guess I will never say that the 4-year nursing PhD program is too long again!

I greatly appreciated the learning experience in N815 (Knowledge Development in Nursing) during the 15 weeks. In short, it was like a journey. Dan and Anne took us to a place where we have heard of and never been there before. We were curious about everything we saw during this journey. Local people in that place communicated with each other by using a language we were not familiar with and sometimes we even had difficulty understanding their dialogue. But Dan and Anne were very good guides and interpreters, they gave us a lot of important resources and information to help us understand the history of this place, where the local people came from, what they are doing there, and where they are heading to.

The place we went to is called Nursing Knowledge Development, the local people were the theorists like Dr. Fawcett, Dr. Chinn, Dr. Roy, Dr. Rogers, Dr. Johnson and many other nursing scientists who have/had dedicated themselves to nursing knowledge development. The language we had difficulty understanding including metaparadigm, paradigm, philosophies, conceptual models, theories, empirical indicators, ontology and epistemology, etc. The resources and information Dan and Anne gave to us were readings before the class, explanations during the class and summaries after the class. The history of Nursing Knowledge Development was that nursing used to be a task-oriented occupation, subservient to medicine with little autonomy and had no place in the academic setting. During the mid-twentieth century and the years that followed, nursing leaders in the US saw theory development as a means of firmly establishing nursing as a profession. Therefore, they are developing a unique body of nursing knowledge and using nursing theory to guide professional practice and making contribution to the health and wellbeing of people.

I like the analogy of journey because firstly, not every nurse/nursing student has the chance to go on this kind of trip (i.e., he/she is not exposed to nursing theory development), and secondly, when we are back from our trip, we can always share our experience with those who have been or have never been to that place. One big new thing I learned from this course is that we do need theory to guide our research intervention, and also how to select an appropriate theory and how to integrate theories if we are using more than one theory — this is very important. In the future, I still need to dig into how to align the theory with research question and research design and how to correctly synthesize different concepts in different theories.

Therefore, the end of the course of N815 is the very beginning of my nursing scholarship. I will be more eager and open to discussions about nursing knowledge development; I will take the responsibility to reduce people’s stereotype that nurses are just assistants of doctors; I will de-mystify theory and sensitize people to the significance of theory in their research and practice; and I will carry on nursing theorists’ lifelong learning spirits and cultivate my own academic expertise so as to contribute to the nursing knowledge development.

About the Professors’ Research

Dr. Willis has a program of research focused on explicating mental health, wellbeing, and healing for boys and men in the aftermath of experiencing traumatic and marginalizing situations of violence and abuse, primarily using qualitative approaches to knowledge development.  Dr. Willis positions his work in the central unifying focus of the discipline/values of humanization, meaning, choice, quality of life, and healing in living and dying (Willis, Grace, & Roy , 2008). In terms of nursing conceptual models and theories, his work is closely aligned with Watson’s Unitary Caring Science (Watson, 2018) and Rogers’ Science of Unitary Human Beings (Rogers, 1992). Within nursing paradigms, he locates his work within the unitary-transformative perspective (Newman, 1997) with its focus on pattern recognition and caring-healing for unitary human beings in mutual process with their environments.

Dr. Ersig’s program of research focuses on chronic stress among children, adolescents, and young adults with chronic health conditions, including biological stress and genetic influences on the human response to stress. Dr. Ersig aligns her work with Roy’s Adaptation Model. She identifies strongly with Roy’s delineation of the physiological, self-concept, role function, and interdependence modes. Roy’s model provides essential support for Dr. Ersig’s inclusion of physiological, biological, and genetic measures in her work. To obtain a more holistic view of individuals, families, and the broader social context, Dr. Ersig also incorporates measures of psychological and behavioral responses to stress.