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.

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)