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.

Why Not Nursology?

Photo – Adeline Falk-Rafael © 2018

Dr. Jacqui Fawcett  eloquently argued the case for “Why Nursology “a few weeks back. Another question might be asked – why not nursology? The use of “logy” – the study of – is widely used as a convention for identifying the knowledge base of other disciplines, e.g, biology, sociology, psychology, etc. On the other hand, the word “nursing” can be confusing because it has both popular uses, such as sipping a drink slowly or breastfeeding, and professional uses such as nursing (practice) and nursing (knowledge). It is beyond time for distinguishing between those two professional meanings. I believe doing so will go a long way toward making nursing knowledge visible, not only to other health disciplines and the public, but also to nurses and nursing students themselves. Language is powerful – it is the reason, I have previously advocated for replacing the term “student nurse” with nursing student. I look forward to that becoming nursology students!

I am excited about this initiative! Perhaps that is because my first nursing program was a hospital-based diploma program in the Canadian mid-west during the early 1960s in which the only reference to nursing science that I recall was a textbook called “The Art and Science of Nursing.”  The science of nursing was, sadly,  never explicated. I learned nursing basically as an ancillary medical service, i.e., the care required in the context of specific medical diagnoses and/or treatments. Over the next 15 years, I worked in various units in different hospitals in different cities and provinces. I practiced as I had been taught and consistent with how other Registered Nurses practiced. I say with some shame that I wasn’t reading nursing journals during that time and looking back, I think that was the norm for my colleagues, as well. Hospital or unit procedure books provided the necessary instruction for how to perform essential tasks.

It wasn’t until I moved into a leadership position and took a nursing leadership course that I was introduced to and required to engage with nursing (and other) literature. I marveled at how nursing leaders so articulately argued the contributions nurses make to health and healing, contributions that were based on nurses’ assessments and judgments, independent of medical directives. Nursing  process, nursing diagnoses and nursing theories excited me because they named and provided systematic structure for the work that nurses did in promoting health and healing. In other words, they began to make the invisible, visible! I began to read books and papers on my own, but soon realized I needed more knowledge and returned to school.

I don’t think my journey was unusual for that time. What grieves me is seeing still, much too often, nurses who acknowledge the biological, physiological, psychological, sociological and/or medical knowledge that informs their practice but fail to recognize the critical contribution of nursing knowledge. Nursology is a term that by its very nature emphasizes the disciplinary field of study that informs nursing practice. I can’t wait for the first Nursology programs and for nursing researchers and advanced practioners being recognized as nursologists, in keeping with the conventions of so many other disciplines.

Our Name: Why Nursology? Why .net?

Why Nursology?

At least since the publication of Donaldson and Crowley’s (1978) seminal paper titled The Discipline of Nursing, nurses have been considered members of a discipline. A discipline (the term comes from the Latin disciplina) is a branch of instruction or  learning and is a way of organizing knowledge. Different disciplines are distinguished one from another by the subject matter of interest to their members. In what way does calling our discipline nursing convey a focus on knowledge development and testing, rather than, for example, breast feeding? Those of us involved in founding this web site agreed to use of the term, nursology, as the best way to convey this focus.

The term, nursology, comes from the Latin, Nutrix, [meaning] nurse; and from the Greek, Logos, [meaning] science (O’Toole, 2013, p. 1303). The first mention of nursology apparently is by Paterson, an American nurse, in her 1971 journal article. She coined the term, nursology, “to designate the study of nursing aimed towards the development of nursing theory” (p. 143). Roper (1976), a Scottish nurse, also referred to our discipline as nursology. She explained,

“It could be that nursing might develop as a discipline without using a word to describe its characteristic mode of thinking, but it will have to make the mode explicit and it will have to have the same meaning for nurses anywhere. Should the nursing profession require to use a word, I propose the word nursology for the study of nursing, so that the logical pattern of derivation of an adverb could be followed. (p. 227)

Fitzpatrick (2014) pointed out that use of the term, nursology, as the name for the discipline has not been supported by nurses, although “remnants of this minor movement appear today. Students in current doctoral-level nursing theory classes often express interest in the term as a way to legitimize the scientific enterprise and distinguish nursing science from other disciplines, particularly [other] health disciplines” (p. 5).

Nursology is not only a name for our discipline. It also is regarded and has been used as a research method and a practice method (Fawcett et al., 2015). The name for our schools and department and programs most properly, also is nursology. The members of our discipline—students, practicing nurses, researchers, educators, and administrators—are scholars of nursology, that is, nursologists. Noteworthy is that Josephine Paterson (1978) and Loretta Zderad (1978) held the formal title of nursologists while at the Veterans Administration Hospital in Northport, New York. As nursologists, we clearly no longer regard ourselves or can be regarded by others as handmaidens to physicians, who are members of the trade of medicine (medicine cannot be regarded as a discipline due to no evidence of distinctive knowledge).

Why .net?
.net was selected as the extension for the web site name to,  as Peggy Chinn pointed out, convey a network of nurses who are interested in learning about all things theoretical in nursology, including advances in the knowledge needed and used by nurses to guide their practice.

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28, 330-333.

Fitzpatrick, J. J. (2014). The discipline of nursing. In J. J. Fitzpatrick & G. McCarthy (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit (pp. 3-13). New York: Springer.

O’Toole, M. (Ed.) (2013). Mosby’s medical dictionary (9th ed.). St.Louis: Mosby.
Paterson, J. G. (1971). From a philosophy of clinical nursing to amethod of nursology. Nursing Research, 20, 143-146.

Paterson, J. G. (1978). The tortuous way toward nursing theory. In Theory development: What, why, how? (pp. 49-65). New York, NY: National League for Nursing. (Pub. No. 15-1708)

Roper, N. (1976). A model for nursing and nursology. Journal ofAdvanced Nursing, 1, 219-227.

Zderad, L. T. (1978). From here -and-now to theory: Reflections on“how.” In Theory development: What, why, how? (pp. 35-48).New York< NY: National League for Nursing. (Pub. No. 15-1708)