The Definition of Health: Thoughts from Japan

Health is a central concept in most if not all versions of the metaparadigm of nursology (Fawcett, 2019). I have defined health as “human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6) and conceptualize health as inclusive of wellness, illness, and disease within that process. I deliberately separated wellness from illness and disease when I realized many years ago that the term, promotion of health, could mean that nursologists’ activities were directed toward promotion of illness and disease as well as wellness, rather than indicating that nursologists’ activities are directed toward promoting wellness and preventing illness and disease.

The St. Mary’s College School of Nursing Library. –A Repository of Nursology Knowledge

However, I recently realized that my conceptualization of health is Euro-centric and reflects my privilege as a white, Anglo-Saxon nursologist (Chinn, 2020). Accordingly, when I had the honor of speaking virtually with faculty and graduate program learners at St. Mary’s College Graduate School of Nursing in Kurume, Japan, in February 2021, I invited the learners to share their thoughts about health by responding to three questions. The questions and their responses constitute most of the remainder of this blog.

• The first question is: What is your definition of health?

• Inasmuch as the nursology curriculum at St. Mary’s College School of Nursing is based on the Roy Adaptation Model (RAM), I then asked this question: To what extent is your definition of health consistent with the Roy Adaptation Model definition of health, which is: “A state and process of being and becoming an integrated and whole human being” (Roy, 2009, p. 48).

• Finally, I asked: How does your definition of health affect what you think and do as a nursologist?

GRADUATE PROGRAM LEARNER TAKAKO TANAKA’S THOUGHTS ARE:

I define health as a feeling of harmony between body, mind, and living in society. Even if people have a disease or disability, they can be considered healthy if they feel that they are able to do what they want to do, while coping with their environment. My definition of health is similar to that of the RAM, in that human health in the RAM is not just a high or low level of health. Instead, it is about growth and development as we interact with our environment. Output behavior, when healthy, is positive adaptive behavior. According to the RAM, if energy is not spent on maladaptive coping, this energy can promote healing and enhance health, even in states of illness. I also believe that if people have a lifestyle disease, for example, and can controls the disease by going to the hospital and taking appropriate medication to stabilize the disease, and are able to live as members of society, then they are healthy. My definition of health has been informed by my work in public health nursing, as I learned to always value the concept of health promotion. Individually and collectively, I want to help people understand their health problems and support them to achieve independence and self-determination on their own, which will likely lead to illness prevention. Furthermore, I believe that it is essential to create an environment that supports health.

GRADUATE PROGRAM LEARNER MIHO YOSHIOKA’S THOUGHTS ARE:

I define health as a state in which subjective well-being and objective health indicators are in marvelous harmony. Subjective well-being differs depending on the culture, customs, and environmental values of each individual; and even if they have a disease or handicap, I think that they are in health if they feel well-being within themselves. However, I ask if there is a possibility of being a detriment to themselves, such as leaving the illness to their own discretion, are they truly healthy? Therefore, I dare to consider that a state in which these conflicting things are in marvelous harmony can be called health. The RAM emphasis on an interaction between the person and the environment is consistent with my idea of subjective well-being. The RAM emphasizes that health behaviors based on individual values are adaptive and can never be measured by the values of others, which helps me to understand that whether people consider themselves healthy is a complete affirmation of their diverse values. However, the RAM contention that health behaviors cannot be measured is not consistent with the inclusion of objective aspects of health in my definition. In recent years, people’s lifestyles and values have changed, and subjective well-being, an aspect of my definition of health, has also diversified. The practice of providing sensitive care for the different needs of each individual requires a holistic understanding of that individual. A nursologist is the professional who is closest to the client. By paying attention to and engaging with the client, I think that we can become aware of the needs of that person and provide individualized nursology that protects human consideration and dignity. I also think that nursology, which requires being close to the client, is important in terms of developing trust and respect for their subjective well-being. Moreover, I think that nursology practice is caring for others, which is essential for curing and healing. Therefore, the attitude of facing each individual, the full use of professional knowledge and experience with dignity to maintain and improve well-being, and cooperation with clients while caring for them, are all affected by my definition of health and by our thinking and acting as a nursologist.

GRADUATE PROGRAM LEARNER MASUMI OKA’S THOUGHTS ARE:

I define health as a state of understanding and accepting of one’s condition, and also a quest for health itself. Although the World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” I regard health as the way of understanding the state of experiencing a disease or disability, accepting one’s response to the disease or disability, and trying to become satisfied and fulfilled despite the disease or disability. My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. There are subjective and objective aspects to health, but factors such as ideals, goals, and prejudices toward health are the driving force behind the quest for health. I believe that human beings are creatures that constantly seek “health” and have the power to control their way of life. In other words, the act of pursuing “health” itself becomes human empowerment, and I think that it also affects one’s quality of life. My definition of health has been greatly influenced by the RAM definition of health. Being and becoming a whole and integrated human being can be interpreted as a quest for health, so that process is health itself. The RAM considers health from the perspective of human goals and the significance of existence, and lack of integration is said to denote inadequate health. The facilitation of the process of integration is seen as care for my idea of a “quest for health” and is consistent with all human care required of nursologists. My definition of health has a great influence on my thinking and behavior as a nursologist. I believe that supporting the acceptance of people with a disease or disability and considering together with them is caring for their “quest for health.” Quality of life changes significantly depending on how disease or disorder is perceived and understood. As a nursologist, I think that by being involved in the process of accepting illness and disability and supporting people’s ability to satisfy themselves, they can accept and love their existence. As a nursologist, I would like to continue to study and learn the potential “investigative power of health” of human beings and contribute to the development of the science of nursology in the future.

GRADUATE PROGRAM LEARNER TATSUNARI HARA’S THOUGHTS ARE:

My definition of health has two aspects: it is the situation in which people think of their condition as being “good” despite any physical malady they might have, and it is also the process they are going through in changing or adapting to their condition to become “better” in terms of their own understanding of the word. My definition of health has been greatly influenced by the RAM, as I learned nursology through the RAM. My definition of health is, however, more abstract than that of the RAM, as my definition emphasizes the largely subjective nature of health. My definition of health has influenced by thoughts and actions. Thus, I understand that nursologists strive to establish a caring connection to patients by ascertaining what kind of state they think is good, their goals and abilities required to attain that state, how they perceive their current situation, and what their values are. Furthermore, as I work in rehabilitation nursology, I see many of the patients leave the hospital with remaining disabilities to go on with their lives. Therefore, we nursologists may be required to change our ideas about health so that we can work together with the patients while thinking about how to establish health in their lives, and encourage any necessary changes they may need to make.

GRADUATE PROGRAM LEARNER MIHO ISHIBASHI’S THOUGHTS ARE:

I think that health is not a concept that opposes illness, but a process in which a person interacts with the environment as a human being and tries to become a person looking positively toward their hopes and wishes. Health in the RAM is an integrated overall condition or process. Nursologists say that by promoting adaptation, they contribute to human health, quality of life, and dignified death. I think that for people to be the people they are, nursologists have to understand the hopes and wishes of what the people want to be and do, as well as understand and support them physically, mentally, and socially. I believe it is necessary to understand the environment surrounding a person, think about the influences that affect their health, and consider how to manage these aspects to make people healthy. I think it is necessary to act as a nursologist to understand people’s hopes and wishes people and to help them attain these hopes and wishes.

GRADUATE PROGRAM LEARNER YUKIE NAKANISHI’S THOUGHTS ARE:

I think of health as being familiar with one’s self, having the ability to deal with problems, and having the ability to make decisions. The notion of health in the RAM as a state of integration is consistent with my thoughts about health. Until I entered graduate school, I was convinced that “health” was not having any illnesses or disability. However, even if one has an illness or a disability, I have now come to think that true health is the ability to face oneself, accept what one has become, and move forward toward the future. While studying the RAM and bioethics, I have learned it is important to learn that “person” equals “life”, and that it is equally important to think about a person’s “purpose of life” and “meaning of life” while practicing nursology. Nursologists are practitioners of caring, so I have realized that it may be inadequate to not understand what health is. In the future, I would like to continue learning so I can augment my humanity and human power, learn more about the attitudes necessary for caring, and put them to practical use.

CONCLUDING NOTE:

As I began to write this blog, I realized that I did not know the Japanese word for health; Google translate provided an answer: Kenkō, which is written in Japanese characters as 健康 (https://translate.google.com/?sl=en&tl=ja&text=health%20&op=translate)

I was remiss in not having invited the St. Mary’s College Graduate School of Nursing faculty and learners to share the word each uses for health. Therefore, I do not know whether their responses reflect a Euro-centric or Japanese meaning for the word.

When I sent a draft of this blog to Eric Fortin, of the St. Mary’s College School of Nursing faculty, he replied with his interpretation of the Japanese characters for health. I am, therefore, indebted to Mr. Fortin (personal communication, April 26, 2021), who wrote “健 means ‘humans build,’ and ‘康’ means “breathing space, . , , probably implying the lack of obstruction or disease. So, ‘humans building breathing space’ implies being healthy.”

REFERENCES

Chinn, P. (2020, January 14). Decolonizing nursing. nursology.net. https://nursology.net/2020/01/14/decolonizing-nursing/

Fawcett, J. (2019, March 21) Questions and Answers about our Discipline: Name and Metaparadigm. Paper presented at the Nursing Theory: A 50 Year Perspective Past and Future Conference. Sponsored by Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. nursology.net. . https://nursologycom.files.wordpress.com/2019/03/cwru-paper-fawcett-3-28-19.pdf

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.

Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.

World Health Organization. (1948). Preamble to the constitution. World Health Organization. https://www.who.int/about/who-we-are/constitution

Guest Post: Decolonizing the Language of Nursology

Contributor: Daniel Suárez-Baquero
Scroll down for Spanish language version of this post

ENGLISH

Nursing has been characterized by a colonial perspective in which the advancements and developments made in English are over those made in other languages. We forget as Dr. Ricardo Ayala states in his book Towards a Sociology of Nursing (2019): “Nursing is a social discipline.” Society frames the context of Nursing understanding and development. Moreover, Rodrigo, Cais, and Monforte-Royo (2017), in their article titled “The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain,” highlight that those social implications of Nursing in Spain make almost impossible to transfer the conceptual development of nursing theories created and thought in English.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

As a Ph.D. candidate, I lived the experience of being judged as “being wrong” when I provide my assumptions about nursing, rather than receiving an open door for discussion. In Spanish, the discipline’s name is Enfermería from the Latin infirmus, with the Spanish suffix -eria (i.e., as a place in which ill people are treated). In contrast, the English word nursing comes from late Latin nutritia (referring to nourishing and nurture). The use of these words is also different by essence because Enfermería has uses only as a noun, and Nursing can be used as a noun, verb, and adjective.

The linguistic barriers between Romances and Anglo-Saxon languages make us see two different perspectives and words of Nursing. The major difference presented in both languages is mainly because of the absence of a verb to express the act of Nursing in Spanish (“Enfermeriar” [sloppy and nonexistent translation]), then nurse’s action was labeled as Cuidado. Cuidado is a word that encompasses the amalgamation of the act of nursing and the act of caring. The restriction of the world Enfermería as a noun makes Care/Caring (Cuidado) the essence of Nursing in Spanish. Therefore, authors such as Brito Brito, in his paper of 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina,” proposes the name of the discipline as CUIDADOLOGÍA considering that the essence and the action of Enfemrería are Cuidado. Hence, the most logical way to name our discipline is Cuidadología (Careology) and not Nursology who limits it use only to English, recognizing that if it is true that not all nurses provide Caring, all the nurses care for others. Brito Brito (2016) states that Cuidadología means the science of Cuidado (Caring) and the science of knowledge.

It is important to highlight that “Spanish [nurses] did not differentiate between the concepts Care, Care for, and Caring, using these words with different nuances indistinctively and translating all equally into one‐word in Spanish, Cuidado” (Suárez-Baquero & Champion, 2020).

I provide an initial insight into this matter in the paper “Expanding the conceptualisation of the Art of Caring.” Further, I proposed the word NURSOLOGÍA in Spanish as a bridge between English and Spanish language in an in-press paper on ANS titled “Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal?” recognizing that the Latin root Nutritia represents also caring. “We propose to rather use the term Nursología as the Spanish equivalent for Nursology, as this term embraces the notion of nursing as the science of caring comprehensively.” (Suárez-Baquero & Walker). This proposal aims to build bridges between perspectives of Nursing instead of imposing and colonize minoritized nurses in the rest of the world as it used to happen in Nursing discipline.

I hope these thoughts provide a little more clarity about our discipline’s name and provide awareness about the importance of the linguistic congruency historically bypassed by English-speaking nurses. Moreover, I agree that this change can’t be made without the contributions of nurses globally in a multilingual framework.

Note: Portions of this post belong to the forthcoming article: Suárez-Baquero, D. F. M. & Walker, L. O. (in press for Volume 44:2). Critical analysis of the nursing metaparadigm in spanish-speaking countries: Is the nursing metaparadigm universal?. Advances in Nursing Science

SPANISH

La Enfermería ha sido caracterizada por una perspectiva colonial, en la que los adelantos y desarrollos hechos en inglés están por encima de aquellos hechos en otros idiomas. Nos olvidamos, como el Dr. Ricardo Ayala indica en su libro Towards a Sociology of Nursing (Hacia una sociología de la Enfermería) (2019) de que “La enfermería es una disciplina social”. Las sociedades enmarcan el entendimiento y desarrollo de la enfermería. Además, Rodrigo, Cais, and Monforte-Royo (2017), en su artículo titulado The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain (La influencia de los modelos teóricos angloamericanos en la evolución de la disciplina enfermera en España) resaltan que las implicaciones sociales de la Enfermería en España hacen casi imposible transferir los desarrollos conceptuales de las teorías de Enfermería creadas y pensadas en inglés.

Original art by Daniel Daniel Suárez-Baquero and Nelson Martinez

Como candidato doctoral, he vivido la experiencia de ser juzgado como “errado” cuando comparto mis supuestos sobre la Enfermería en lugar de recibir una puerta abierta a la discusión. En español, el nombre de la disciplina es Enfermería, que proviene del latín infirmus, con el sufijo español -ería (es decir, un lugar en el que las personas enfermas son tratadas). En contraste, la palabra en inglés, Nursing, viene del latín tardío nutritia (referente a la alimentación y nutrición. Nurturing/Nurture se refiere al nutrir de forma física, moral, mental, espiritual, en todas las dimensiones del ser). El uso de estas palabras también es distinto en esencia porque Enfermería tiene usos únicamente como sustantivo,ñ mientras que Nursing puede ser usado como sustantivo, verbo y adjetivo.

Las barreras lingüísticas entre las lenguas romances y anglosajonas nos hacen ver dos perspectivas y mundos de Enfermería distintos. La mayor diferencia entre los dos idiomas es la ausencia de un verbo que exprese la acción de la Enfermería en español [“Enfermeriar” (traducción chapucera e inexistente)]; por esto, las acciones enfermeras fueron etiquetadas como Cuidado. Cuidado es una palabra que engloba la amalgama del acto de enfermería y el acto de cuidar con amor o cariño. La limitación de la palabra Enfermería como sustantivo hace del Cuidado (Care/Caring) la esencia de la Enfermería en español. Por lo tanto, autores como Brito Brito, en su artículo de 2016 “Cuidadología: Pensamientos sobre el nombre de nuestra disciplina”, propone el nombre de la disciplina como CUIDADOLOGÍA, considerando que la esencia y la acción de la enfermería es el Cuidado. En consecuencia, la forma más lógica de nombrar nuestra disciplina es Cuidadología (Careology) y no Nursology, que limita su uso sólo al inglés, reconociendo que si bien no todas las enfermeras y enfermeros proveen cuidado amoroso/cariñoso (Caring), todas las enfermeras y enfermeros asisten a otros con o sin el componente del Cuidado (sino la mera intervención enfermera). Brito Brito (2016) establece que Cuidadología significa la ciencia del Cuidado (Care/Caring) y la ciencia del conocimiento.

Es importante resaltar que “Las enfermeras que hablan español no diferencian entre los conceptos Care, Care for, y Caring, usando estas tres palabras con diferentes matices y significados indistintamente y traduciéndolas todas en una sola palabra en español, Cuidado” (Suárez-Baquero & Champion, 2020).

Aporto una primera visión de este asunto en el artículo Expanding the conceptualisation of the Art of Caring (Expandiendo la conceptualización del arte del Cuidar). Además, propongo la palabra NURSOLOGÍA en español como un Puente entre los idiomas inglés y español en un artículo en producción en ANS titulado Critical analysis of the nursing metaparadigm in Spanish-speaking countries: Is the nursing metaparadigm universal? (Análisis crítico del metaparadigma de Enfermería en países hispanos: ¿Es el metaparadigma de enfermería universal?, reconociendo que la raíz latina Nutritia representa también Cuidar. “Nosotros proponemos en vez el uso del término Nursología como el equivalente en español para Nursology, dado que este término abarca ampliamente la noción de la enfermería como la ciencia del cuidado” (Suárez-Baquero & Walker). Esta propuesta busca construir puentes entre las perspectivas de la Enfermería en vez de imponer y colonizar enfermeras y enfermeros minorizados en el resto del mundo, como suele suceder en la disciplina enfermera.

Espero que estos pensamientos provean un poco más de claridad acerca del nombre de nuestra disciplina, así como conciencia sobre la importancia de la congruencia lingüística históricamente obviada por las enfermeras angloparlantes. Además, concuerdo que este cambio no puede hacerse sin las contribuciones de las enfermeras y enfermeros del mundo en un marco multilingüístico.

REFERENCES/REFERENCIAS

References

Ayala, R. A. (2020). Towards a Sociology of Nursing. In Towards a Sociology of Nursing. Springer Singapore. https://doi.org/10.1007/978-981-13-8887-3

Brito Brito, P. R. (2017). Cuidadología: Pensamientos sobre el nombre de nuestra disciplina. Ene, 11(2).
Rodrigo, O., Caïs, J., & Monforte-Royo, C. (2017). The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain. Nursing Inquiry, 24(3), e12175. https://doi.org/10.1111/nin.12175

Suárez‐Baquero, D. F. M., & Champion, J. D. (2020). Expanding the conceptualisation of the Art of Caring. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12903

About Daniel Suárez-Baquero

Mr. Suárez Baquero received his BSN and MSN in Maternal/Perinatal Nursing Care from the Universidad Nacional de Colombia. He is currently completing a Nursing Ph.D. at the University of Texas at Austin. His research and practice concern women/maternal/perinatal health, risk reduction for urban/rural ethnic minority women, and nursing theory.

Practice and Research Speak: The Words We Use to Describe Ourselves and Others

In March 2020, I posted a blog about the meaning of words used to describe the extent to wish a person’s (patient or client) behavior does not comply with, adhere to, or is concordant with what has been prescribed by nursologists or physicians. In December 2020, I posted a blog about the meaning of words researchers use in their research reports, such as allow, respondents, and informants. In these blogs, I pointed to the power differential that is implied in the use of these words. In the first blog, I asked why do we use compliance, adherence, and even concordance instead of a term that more accurately reflects relationship-based care; and in the second blog, why do we use allow rather than invite, and why do we use respondent or informant rather than people.

The purpose of this blog is to discuss the words we use to describe ourselves and others in the context of healthcare. Collectively, we tend to refer to ourselves (nursologists) as healthcare providers, using the same term for physicians, physical therapists, occupational therapists, social workers, and others who “provide” healthcare “services.” We refer to others (patients, clients, people) as recipients of these services.

Copyright 2021 Jacqueline Fawcett

I have used these terms in my publications for many years. Now, as I become more sensitive to the connotative meaning of words, I must question how my use of these words – provider, recipient – conveys a huge power differential, a clear instance of power-over (Chinn & Falk-Rafael, 2015; https://nursology.net/nurse-theorists-and-their-work/peace-power/), and power-as-control (Barrett, 2010; https://nursology.net/nurse-theorists-and-their-work/theory-of-power-as-knowing-participation-in-change/

In the compliance etc. blog, I referred to co-created narrative, and a comment from a reader of that blog replied that a co-created narrative is one “in which the healthcare consultant and the person consulting with him/her engage in dialogue around the recommendations offered, within an environment of mutual respect and honesty, arriving at a mutually agreed upon plan led by the person seeking input” (https://nursology.net/2020/03/17/what-is-reflected-in-a-label-about-health-non-nursology-and-nursology-perspectives/).

I thank that reader very much for her comment. Healthcare consultant instead of healthcare provider is a better term, as it at least implies peace as power (Chinn & Falk-Rafael, 2015) and power-as-freedom (Barrett 2010) perspectives, as does person who is consulting instead of recipient. I shall do my best to use these words in all future publications until the potential awkwardness or unfamiliarity with these words evolves to the familiar, conveying the dignity and mutual respect of the encounter. (Note that I wrote “do my best” rather than “try,” as I am committed to removing “try” from my vocabulary, for as Yoda tells us: DO OR DO NOT; THERE IS NO TRY.) .

Yoda Says: Do or do not. There is no try.
Yoda in Fawcett’s Art, Antiques, and Toy Museum in Waldoboro. Maine
Photo by Jacqueline Fawcett

I very much look forward to comments from readers of this blog–what are your thoughts about words that convey different types of power? Do you have suggestions for other words to convey who we are and who others are?

References

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23(1), 47-54.doi: 10.1177/089431840935379

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: a theory of emancipatory group process. Journal of Nursing Scholarship, 47(1), 62–69. https://doi.org/10.1111/jnu.12101

Is Medicine a Trade or a Discipline or Profession?

Nursology is regarded as a discipline and a profession, which means that nursology constitutes distinctive knowledge encompassing nursological philosophies, conceptual models, grand theories, middle-range theories, and situation-specific theories (see all content on https://nursology.net and also https://nursology.net/2018/09/24/our-name-why-nursology-why-net/).Medicine, in contrast, is a trade. This assertion is based on my search of literature for several years and pondering the difference between a discipline or a profession and a trade at least since the publication of Donaldson and Crowley’s now classic 1978 article, The Discipline of Nursing. .

I asserted that medicine is a trade in two 2014 publications (Fawcett, 2014a, 2014b) and in 2017, I wrote, under the heading, Medicine is a Trade:

I have never been able to locate any obvious or explicit knowledge that is distinctly medical. A September 18, 2016 search of the Cumulative Index of Nursing and Allied Health (CINAHL Complete) using the search term “medical model” yielded 816 publications. An admittedly quick review of a random sample of the retrieved publications revealed that the term medical model was not defined but rather used in a way suggesting that any reader would know what the term means. (Fawcett, 2017, p. 77)

I have continued to ponder whether medicine should be considered a trade and have wondered why no one has challenged my assertion, at least in any publications or blogs I have seen. Therefore, on January 4, 2021, I expanded my search to other sources–Taber’s Cyclopedic Dictionary, the Oxford English Dictionary, and Wikepedia.

The 22nd edition of Taber’s (Venes, 2013) includes no entry for medical model. Medicine is defined as “the act of maintenance of health, and prevention and treatment of disease and illness” (Venes, 2013, p. 1474). No reference to the knowledge needed to perform the act of medicine is evident. The Oxford English Dictionary also includes no entry for medical model, with only a mention of the term in quotations pertaining to two words, technologizing and miasmatist.

However, two definitions of medicine imply a knowledge base (although not necessarily distinctive knowledge). One definition is: “The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).” The other definition is: “The medical establishment or profession; professional medical practitioners collectively.”

A search of Wikipedia yielded this statement: “Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the “set of procedures in which all doctors are trained.” It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia). Noteworthy is that Laing did not mention the philosophic, conceptual, or theoretical knowledge that would guide the “set of procedures in which all doctors are trained.”

The content in Wikipedia also included an important negative consequence of adherence to the medical model. This consequence is “In the medical model, the physician was traditionally seen as the expert, and patients were expected to comply with the advice. The physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the medical model, it is necessary and to be expected. In the medical model, the physician may be viewed as the dominant health care professional, who is the professional trained in diagnosis and treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia)

My concern with the very idea of “adherence to the medical model” (or adherence to or compliance with anything put forth by a nursologist or a physician) led me to ask “what [do] we mean when we say that a person (called a patient or a client) does not comply with or adhere to a treatment plan. It seems to me that these words reflect the physician’s or the nursologlist’s prescriptions for the patient, which in turn, reflect the physician’s or the nursologist’s power over and control of the patient.” (Fawcett, 2020)

My concern regarding the physician as a professional person is grounded in my inability to identify any distinctive knowledge of medicine that is necessary for the designation of professional in both the OEDO definition of medicine and in the mention in Wikipedia of the professional being “trained,” a word associated with training for a trade.

Of course, I understand that physicians possess a great deal of scientific knowledge. However, that knowledge is of various disciplines, such as anatomy, physiology, histology, and chemistry, not of medicine per se (as there is no distinctive medical knowledge that I have been able to identify),

I have concluded that the so-called “medical model” is a fiction put forth at least since Laing’s (1971) publication by members of the healthcare team (including nursologists) and the general public to ascribe a particular status to a trade. .

Please note that I acknowledge the importance of trades in society. I certainly cannot survive without many tradespersons in my life. However, I maintain that it is important to be very clear about the words we bestow on the members of healthcare teams, words that clearly reflect whether those members belong to a discipline/profession or trade. If members of a discipline/profession, it is necessary to identify the distinctive knowledge that guides practice, and research and education, too..

What do you, a reader of this blog, think? Have you been able to identify distinctive philosophic, conceptual, and theoretical knowledge that would constitute the discipline of medicine? Please add your thoughts to the comments section of this blog. Thank you very much.

References

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

Fawcett, J. (2014a). Thoughts about collaboration—or is it capitulation? Nursing Science Quarterly, 27, 260-261.

Fawcett, J. (2014b). Thoughts about interprofessional education.Nursing Science Quarterly, 27, 178-179.

Fawcett, J. (2017). Thoughts about nursing conceptual models and the “medical model.” Nursing Science Quarterly, 30, 77-80. (Permission to provide a link to the PDF of this article was granted by the journal editor)
Fawcett, J. (2020, March 17). What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives. Blog.

Laing, R. D. (1971). The politics of the family and other essays. Routledge

Venes, D. (Ed.). (2013). Taber’s cyclopedic medical dictionary (22nd ed.). F. A. Davis.

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

Power in Nursing

Power has been a concern to all living beings – humans and animals – since the beginning of time. Nursologists have been sensitive to power issues at least since Florence Nightingale’s time. It is likely, however, that power has different meanings for different people, including those who hold positions associated with power and those who regard themselves as subjected to power and may think they are powerless.

Very specific meanings of power are evident in a nursology theory developed by Elizabeth Barrett and a nursology theory developed by Peggy Chinn. Elizabeth Barrett developed the theory of power as knowing participation in change. This theory focuses on power-as-freedom, which contrasts with power-as-control. Barrett (2010) explained that power-as-freedom comes from and is associated with participating knowingly in life changes.

Peggy Chinn developed the theory of peace and power. This theory focuses on peace-power, which contrasts with power-over. Chinn (2018) explained, “This theory provides a framework for individuals and groups to shape their actions and interactions to promote health and well being for the group and for each individual, using processes based on values of cooperation and inclusion of all points of view in making decisions and in addressing conflicts.

My interpretation of these theories is that both emphasize power as a beneficial attribute that enables the individual or group to thrive and evolve, as opposed to power as a detrimental attribute that often prevents others from thriving and evolving. But what, I wondered, are meanings of power held by other nursologists?

St. Mary’s College Campus (from http://www.st-mary.ac.jp/about/)

Therefore, I invited graduate students at St. Mary’s College School of Nursing in Kurume, Japan, where I am a visiting professor, to share their meanings of power. I asked the students to respond to two questions:

  • How do you define power?
  • How does power affect what you think and do as a nursologist

The students’ responses are given here. I am indebted to Eric Fortin, who is a faculty member at St. Mary’s College School of Nursing, for translating the students’ responses from Japanese to English. (See notes below for more information about St. Mary’s College School of Nursing)

How do you define power?

Yukari Shitaki wrote: Power is generally defined as authority, motive power, energy, and so on. In nursing, I think that there are many things that are demonstrated through relationships among people, such as manpower, empowerment, and power augmentation, which improve technical skills and abilities. In addition, I think that the way people, whether individuals, groups, or society at large, perceive that power changes according to the situation at any particular time. Therefore, for me, power is defined as the force in the fellowship among people that produces synergistic effects and is further demonstrated through the interactions among them.

Kiyoko Tanaka wrote: We as nursologists work to maintain and promote human health, prevent health problems, create an environment that promotes health, and share and resolve issues related to the destruction of the natural environment and the deterioration of the social environment. In contrast, nursology is caring and has the power to realize and maintain a peaceful human society by fulfilling its role

Yoko Hashimoto wrote: In Japan, some nurses work in the government as licensed nurses and are involved in devising national policies. Many other nurses are involved with patients and local residents in hospitals and communities. Nurses see problems and other issues in their daily practice. Therefore, as nurses, we are working to improve the quality of nursing to solve these issues. I believe that nurses consider motivation and the ability to improve the quality of nursing to be power

Risa Fujimoto wrote: I think that nursologists’ power can be defined as action. As nursologists, everything should be done for the patient. It is very important to possess the ability to do something useful for people and to act on and realize what we want to do, including even little things. I also think that studying at graduate school may be the first step that will lead to having the power of a nursologist.

Saki Higashi wrote: The power of a nursologist for me is defined as the ability to constantly grow from the soul and to spread that around to others. I categorize power into three aspects. The first is the core, the second is influences absorbed from one’s surroundings, and the third is action. The core is latent and spiritual and includes one’s thoughts on nursing. The aspect of power that is absorbed from one’s surroundings is the power that can exert influence and that can be taken in from all external stimuli such as patients and other staff through one’s experiences of being a nursologist. Action is the aspect of power that derives from what has been cultivated up to now, including from the first and second aspects, and it works by giving back what has been absorbed from others through one’s practice and by diffusing one’s own power to those around us. Power is not always constant, but fluctuates; and power, although being influenced by others, also gives of itself and continues to grow.

How does power affect what you think and do as a nursologist?

Yukari Shitaki wrote: The reason I wanted to raise the level of my expertise was that I strongly believe in the importance of education. In my work environment as a perinatal nursologist, I encounter situations in which induced abortions are easily requested due to undesired, unexpected, or young pregnancies. One of the reasons for this involves the issue of sex education. I have thought about what I could do to change the consciousness of the women in these cases by inculcating in them the value of life and the desire to protect its dignity. It is difficult to face such a problem through one individual’s power alone, so it is necessary to first acquire the ability to judge the essence of one’s role as a professional and to think about what kind of method is possible to implement an action from an educational perspective. I also think it is possible to augment an individual’s power by utilizing the power of a larger group through fellowship with its members, and thereby be better able to put necessary actions into practice.

Kiyoko Tanaka wrote: As a pediatric nurse, I realize that the family is very important in child development. If families cannot fully understand children with developmental disabilities and cannot understand the characteristics of their own children, it will not be possible to support those children, and it will be difficult to expand their possibilities with adequate developmental support. It will also be difficult to improve their future health in connection with possible secondary disabilities. The risk of ruining a healthy life can also develop. Conversely, with regard to the mental health of parents, especially mothers, of children with developmental disabilities, feelings of difficulty in raising these c)hildren have led to depression and reduced self-esteem. Based on this situation, we, as nursologists have the power of specialized knowledge to offer counseling, guidance, and a positive nursing environment for children with developmental disabilities and their families in cooperation with related organizations such as prefectures, municipalities, hospitals, and schools. We can also provide information about services available for children with developmental disabilities and their families so that they can maintain, promote, recover from, and prevent illness. In addition, we believe that such support will promote the health of caregivers, promote a better understanding of children with developmental disabilities, and lead to their healthy development.

Yoko Hashimoto wrote: Japan has had a background of advanced medical care catering to the needs of an aging society having an increasingly long lifespan, and medical care is moving from the hospital to the home. However, there are few nurses who are practicing in the field of home nursing, so evidence in this field is weak and, therefore, has failed to lead to policies. In the future, it will be necessary to conduct research and establish evidence for issues arising from daily practice to provide high-quality nursing in response to social changes. It is difficult to act alone, so it is necessary to become involved with others and to work together. Through the power of nurses, nursing practice will be better visualized, which will hopefully allow it to occupy a more important position among government circles, thus leading to improved nursing and medical care.

Risa Fujimoto wrote: For nursologists, power is the ability to help people by being useful to them. In my clinical experience, I often wondered whether I could really help others or if there was something more I could do for them. Therefore, I decided to undertake graduate study with the goal of improving my knowledge level and nursologists’ practice skills. As a rehabilitation nurse, I want to become a nursologist with a wide range of knowledge and be involved in primary through tertiary stroke prevention. We can only become useful to people by taking action and practicing what we know. However, to take action, we cannot act entirely alone; we need the knowledge and skills of other nursologists. Personally, if I obtain enough knowledge in graduate school, I am confident that I will have to play a role in creating an opportunity for many nursologists to understand the value of nursology. So, I think that that would be one of my responsibilities as a nursologist. As a practitioner, I will keep in my heart and mind what I believe to be useful for people and will work to obtain knowledge and skills so that I can better perform the actions of a nursologist.

Saki Higashi wrote: Power influences my activities as a nursologist. In the future, by incorporating my experiences and various influences from the external environment and applying them to my nursology activities, I am confident that I will not only grow as a nursologist, but also expand my influence to people, regions, countries, and the world at large.

References

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23(1), 47-54. doi:10.1177/0894318409353797 

Chinn, P. L. (2018, August 23). Peace & Power. Retrieved from https://nursology.net/nurse-theorists-and-their-work/peace-power/

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: A theory of emancipatory group process. Journal of Nursing Scholarship, 47, 62–69.

More about St. Mary”s College School of Nursing on Nursology.net

Who IS the First?

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

What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives

Posted the first week of March, which is designated as
National Words Matter Week

A long time ago, I read an editorial in a journal decrying the labels for women’s reproductive health issues. The point was that labels such as incompetent cervical os are pejorative words. At about the same time, I began to think about what we mean when we say that a person (called a patient or a client) does not comply with or adhere to a treatment plan. It seems to me that these words reflect the physician’s or the nursologlist’s prescriptions for the patient, which in turn, reflect the physician’s or the nursologist’s power over and control of the patient.

Indeed, Hess (1996) pointed to “connotations of paternalism, coercion, and acquiescence” (p. 19), and Bissonnette (2008) and Garner (2015) noted the power imbalance and loss of patient autonomy inherent in referring to a patient as non-compliant or non-adherent. I doubt that few if any nursologists would knowingly sanction paternalism, coercion, acquiescence, power imbalances, and loss of patient autonomy. Yet we continue to label patients as compliant or adherent if they do whatever they were supposed to do and as non-compliant or non-adherent if they do not do whatever they were supposed to do.

The issue, of course, is to identify a label that can be used to accurately reflect what happens between a person who is a patient and a person who is a healthcare worker as they interact in matters of health without an overlay of paternalism, coercion, acquiescence, power imbalance, or loss of autonomy.

Most, if not all, nursology conceptual models and theories include consideration of the person’s perspective of the health-related situation and may include a process that addresses how the situation is viewed and resolved. For example, the practice methodology associated with Neuman’s Systems Model includes the perspectives of both the person and the healthcare worker throughout the entire process of diagnosis, goals, and outcomes. The practice methodology associated with King’s Conceptual System is even more explicit, with mutual goal setting, exploration of means to achieve goals, and agreement on means to achieve goal. However, the practice methodologies associated with these nursology conceptual models and theories do not include a label for what happens if the patient does or does not do what had been agreed upon.

I have not yet identified a satisfactory label for what actually happens. However, I suspect that turning to nursology theories of power may provide at least the beginning of an appropriate label. For example, Barrett’s theory of power as knowing participation in change sensitizes us to the distinction between power-as-control and power-as-freedom. Barrett maintained that power-as-freedom involves awareness of what is happening, knowingly participating in choices to be made about what is happening, having the freedom to act intentionally, and being fully involved in creating changes in whatever is happening. Perhaps, then, the label could be knowing participation.

Another example is Chinn’s peace as power theory, which sensitizes us to the distinction between peace-power and power-over. The process of peace as power encompasses cooperation and inclusion of all points of view in making decisions. Accordingly, healthcare decisions are based on thoughtful choices as the person and the healthcare worker work together to promote wellness and growth. Perhaps, then, the label could be thoughtful cooperative choices.

What other label might be even more accurate? How can nursologists actualize our moral goal to do “good for the one for whom the [nursologist]” cares”? (Hess, 1996, p. 19). What label should we use to clearly reflect our ethical knowing? Hess’ (1996) discussion of ethical narrative suggests that cocreated narrative may be the accurate term. She explained, “ethical narrative is crafted by the client and [nursologist] to express the good they are seeking” and that ethical narrative is achieved “through engagement” (p. 20).

Labels, which are words, matter for many, many reasons. Labels may reflect paternalism, coercion, acquiescence, power imbalances, and loss of patient autonomy. Labels also may reflect racism and privilege and other words that perpetuate colonialism (McGibbon, Mulaudzi, Didham, Barton, & Sochan, 2014). We must, therefore, identify and consistently use labels that are consistent with ethical knowing in nursology, with clear understanding of “their meanings and the underlying philosophies or perspectives that they connote” (Lowe, 2018, p. 1).

This blog is adapted from Fawcett, J. (in press). Thoughts about meanings of compliance, adherence, and concordance. Nursing Science Quarterly.

References

Bissonnette, J. M. (2008). Adherence: A concept analysis. Journal of Advanced Nursing, 63, 634-643. Available from: http://dx.doi.org/10.1111/j.1365-2648.2008.04745.x

Gardner, C. L. (2015). Adherence: A concept analysis. International Journal of Nursing Knowledge, 26, 96-101. Available from: http://dx.doi.org/10.1111/2047-3095.12046

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

Lowe, N. K. (2018). Words matter. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 47, 1-2.  Available from: http://dx.doi.org/10.1016/j.jogn.2017.11.007

McGibbon, E., Mulaudzi, P. M., Didham, P., Barton, S., & Sochan, A. (2014). Toward decolonizing nursing: The colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21. 179-191. Available from: http://dx.doi.org/10.1111/nin.12042 (See also https://nursology.net/2020/01/14/decolonizing-nursing/)

Perspectives of Nurses on the Term Nursology: An Informal Twitter Poll

First described by Paterson in 1971, the term nursology was originally coined to capture the essence of “the study of nursing aimed towards the development of nursing theory” (p. 143). Since this definition, nursing scholars have continued discourse around the name of our discipline. In 1997, for example, Reed suggested a name change from a verb, nursing, to a noun, nursology, while still retaining nursing within the metaparadigm. In 2015, Fawcett and colleagues re-presented the idea of changing the name of the discipline of nursing to nursology. Again in 2019, the term emerged as a topic for discussion at the Case Western Nursing Theory Conference.

To understand the perspectives of nurses on the use of the term nursology, an informal Twitter* poll was conducted by the Nursology Theory Collective asking the question, “what do you think about using the term Nursology instead of nursing to describe our discipline?” Twitter polls enable individuals to voluntarily respond to questions posed by individuals or organizations on Twitter (Twitter, 2020), and are not meant to be scientific. The informal poll also included the ability for nurses to comment and share their thoughts on the topic. All participants, but one, gave permission for the use of their write-in responses to be included in this blog post. Only participants who gave permission were included in this post.

A total of 34 responses were received with six comments; not all of the participants were current followers of the Nursology Theory Collective. The responses revealed that 32% of participants thought that Nursology as the name of our discipline made sense, whereas 27% were unsure. 41% of participants responded that they were not supportive of Nursology as the name for the discipline.

For the write-in responses, participants shared various reasons they were in favor of or opposed to, the name change. The use of the suffix -ology seemed to represent a primary concern for participants. For example, one participant stated, “using the term -ology feels like it discounts the art of nursing. It is a science and an art. It’s more than biology, physiology and psychology. It’s about the whole not the sum of parts!” Comparably, another participant in favor of the change stated, “as disciplines have specialized areas within the “ology”. How about nursing practice, nursing education, nursing science as some examples for us within the ology?” Others suggested that utilizing the suffix of -ology “feels like an attempt to assimilate into an existing hierarchy of medical disciplines, instead of a staking out of nursing knowledge as more than another silo-ing of medical ology, but as an entirely different paradigm…” Lastly, while some commented that they liked the term nursology and looked forward to learning more from the group, others expressed concerns that Nursology as a term “suggests disciplinary insecurity,” conveying the idea that nurses somehow do not see ourselves as legitimate as we are, investing energy in an endeavor that ultimately changes little about the work we do.  

While more voters opposed adopting the term ”nursology” than were in favor of adopting it, 27% of voters were neutral to the change. This suggests that nurses may not have strong feelings about the name nursing for our discipline as it stands today, or perhaps the term was too new to them. One of the participants raised concerns of “disciplinary insecurity,” potentially supporting the idea that nurses may need to examine what it means to practice nursing versus study nursing as a body of knowledge, a stance that very well could reinscribe the theory-practice gap. Alternatively, this finding may support that nurses are open to change, but need more information in order to make an appropriate judgment. Nursing scholars should take this as an opportunity to open discussions with nurses outside of academia, especially in the practice environment, and publish relevant literature to stimulate future discourse on the name of our discipline. 

Finally, the write-in responses raise the concern related to the use of the suffix -ology. As expressed by one of the participants, this suffix is commonly used in the medical sciences, but this suffix does not originate in medicine (e.g., Geology and Mythology). The question is then raised why the suffix -ology is so controversial? One of the participants discussed how the use of -ology discounts the art of nursing, although they expressed nursing is still a science. Perhaps nurses today with their understanding of nursing and nursology, see nursing as the art, and nursology as the substantive study of nursing? Further discourse and individual reflection are needed on this topic as we navigate the perceived duality that exists among art and science, nursing and nursology, and nurse and nursologist. The question then becomes, is every nurse a nursologist?

For more information on the Nursology Theory Collective, please email us as nursingtheorycolletive@gmail.com, or follow us at @NursingTheoryCo on Twitter.

*Twitter is a microblogging and social media networking platform where individuals and organizations interact and message each other using “tweets,” 140-character messages designed for brevity and quick exchange of ideas. Please see the following link for more information: https://about.twitter.com/en_us.html


References

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. doi: 10.1177/0894318415599224

Paterson, J. G. (1971). From a philosophy of clinical nursing to a method of nursology. Nursing Research, 20(2), 143-146. Retrieved from https://pubmed.ncbi.nlm.nih.gov/5205160-from-a-philosophy-of-clinical-nursing-to-a-method-of-nursology/

Reed, P. G. (1997). Nursing: The ontology of the discipline. Nursing Science Quarterly, 10, 76-79. doi: 10.1177/089431849701000207

Twitter. (2020). About twitter polls. Retrieved from https://help.twitter.com/en/using-twitter/twitter-polls

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.