What If? Random Thoughts of Sleepers Awake

With apologies to J. S. Bach, composer of Cantata no. 140, Sleepers Awake these are my random thoughts of “What If?” about our discipline while I was a sleeper awake one very early morning.

  • What if Florence Nightingale (circa 1859) founded modern nursology (rather than nursing), titled her book, Nursology: What it is and What it is not, and established the first college/school/department/program of nursology to prepare nursologists?
  • What if we referred to ourselves as nursologists, rather than nurses or advanced practice nurses or nurse practitioners or even “practitioners of nursing” (Orem & Taylor, 1986, p. 39)?
  • What if Dock and Stewart (1938) wrote A Short History of Nursology (instead of A Short History of Nursing)?
  • What if our conceptual models originally were called paradigms, as these abstract and general “horizon[s] of expectation” (Popper, 1965, p. 47) for disciplinary activities are called in other disciplines?
  • What if health was widely regarded as encompassing wellness, illness, and disease, so that wellness would be promoted, and illness and disease would be prevented, rather than health being promoted (who would want to promote illness and disease)?
  • What if NANDA-I was NATA, such that D = Diagnosis were replaced with T = Trophicognosis, which Levine (1966) used as the label for judgments stemming from assessments of each patient’s health (wellness, illness, disease) condition?

Inspired by these possibilities, I asked my Nursology.net management team colleagues to also share their “sleepers awake” inspirations!

Peggy L. Chinn

  • What if all healthcare providers (regardless of discipline) were to base their interactions with patients on nursology fundamental principles and values? If we did this, there would be no computer screens in the room where the interactions take place, or at least they would be way off in the corner and ignored until a basic relationship was established. Every person in the room would be acknowledged, there would be lots of eye contact, and a focus on hearing and listening. That would be for starters!
  • What if there were nursology think tanks happening regularly and often all over the world?
  • What if all undergraduate students had a “Nursology 101” course?
  • What if all current nurses were required to have a continuing education “Nursology 101” course to maintain licensure?
  • What if the accreditation criteria for all nursing programs at all levels addressed the nature of the focus of the discipline in the structure of the curriculum?

Margaret Dexheimer Pharris

  • What if the National Institute for Nursing Research (NINR) only funded proposals based on nursology and contributing to nursology?
    • Jacqueline Fawcett: Following from Dr. Pharris’ question, What if NINR was called the National Institute of Nursology (NIN) or the National Nursology Institute (NNI)?
  • What if there was a nursologist in every community who could know and attend to people across care settings (community, hospital, homeless shelter, long-term care. etc.)? The nursologist–rooted in nursology’s patterns of knowing–would truly know and care for each person and the people who are important to that person, and would collaborate with other nursologists and other healthcare providers within each setting to ensure that the person’s sense of health is honored and nurtured.

Danny Willis

  • What if nursologists always clearly communicated the value added by our knowledge and presence?

Rosemary William Eustace

  • What if all nursologists worldwide are made aware of the impact of nursology on our diverse roles, specialties, training and contributions in meeting overall health outcomes and challenges as part of the 21st century (so-called) nursing campaigns?
  • What if nursologists claim that meaningful healthcare transitions, mutual goal attainments and positive client outcomes would not be possible without the nursologist–client interactions as a vital step to quality health care, such as in keeping with King’s (1992) Theory of Goals Attainment? (See https://nursology.net/nurse-theorists-and-their-work/kings-conceptual-system/)

Marian Turkel

  • What if there was another curriculum revolution and nursologists would have a curriculum focused on nursing as a human science/caring science? For academics this would mean letting go of sacred cows to advance nursing knowledge focused on caring, ethics, health as expanding consciousness, meaning, patterning, presence, and relationships.
  • What if the curriculum for nursologists moved beyond the traditional patterns of knowing (aesthetic, empirical, ethical, and personal (Carper, 1978) to include intuitive, mystical, and spiritual patterns of knowing
    • Jacqueline Fawcett
      Following from Marian Turkel’s second question, readers of this blog may want to read a recently published paper about spirituality as another pattern of knowing (Willis & Leone-Sheehan, 2019). In addition, White (1995) identified sociopolitical knowing as another pattern of knowing. Since that time, Chinn and Kramer (2019) have identified and refined the meaning of emancipatory knowing as still another pattern of knowing. And lest we forget, Munhall (1973) wrote about unknowing as a pattern of knowing, “as a condition of openness” whereas knowing “leads to a form of confidence that has inherent in it a state of closure” (p. 125).

Marlaine Smith

  • What if Nursology 101 was offered for students, or better yet, required for all students enrolled in a university? The course would focus on an introduction to phenomena such as human wholeness, human-environment-health relationships, the nature of health, healing, well-being/becoming, and caring in the human health experience.

In closing, we invite all readers of this blog to contribute their own random thoughts–whether generated as a sleeper awake or during another phase of living–of “What Ifs?”

References

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23.

Chinn, P. L., & Kramer, M. K. (2019). Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO: Elsevier Mosby.

Dock, L. L., & Stewart, I. M. (1938). A short history of nursing: From the earliest times to the present day (4th ed.). New York: G. P. Putnam.

King, I. M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5, 19–26.

Levine, M. E. (1966)Trophicognosis: An alternative to nursing diagnosis. In American Nurses’ Association Regional Clinical Conference (Vol. 2, pp. 55–70). New York: American Nurses’ Association.

Munhall, P. L. (1973). ‘Unknowing’: Toward another pattern of knowing in nursing. Nursing Outlook, 41, 125-128.

Orem, D. E., & Taylor, S. G. (1986). Orem’s general theory of nursing. In P. Winstead-Fry (Ed.), Case studies in nursing theory (pp. 37–71). New York: National League for Nursing.

Popper, K. R. (1965). Conjectures and refutations: The growth of scientific knowledge. New York, NY: Harper and Row.

White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86.

Willis, D. G., & Leone-Sheehan, D. M. (2019). Spiritual knowing: Another pattern of knowing in the discipline. Advances in Nursing Science, 42, 58–68. https://doi.org/10.1097/ANS.0000000000000236

 

Nursology think tanks, anyone?

Addendum
Notice in ANS 1:3 (April 1979) of 2nd NTTT gathering

What if we had a host of small nursology think tanks happening all over the world?  Sound impossible?  No, it is not impossible, and we have an historial model from which to build!  As Jacqueline Fawcett observes in her reflections below, this Nursology blog can be viewed as a think tank of sorts.  And, we can also envision ways for face-to-face nursology think tanks to happen! If you are inspired by this idea, don’t wait for someone else to do it – invite a few friends and colleagues, and do it!   Here is the model as Jacqui and I experienced it:

Dr. Margaret Newman

In 1978, Margaret Newman initiated a very simple idea with great influence – she called for a few of her colleagues around the country to gather at a designated airport hotel and spend a couple of days in deep discussion about the development of nursing theory.  She called the gathering a “Nursing Theory Think Tank (NTTT)”   There was no agenda, no note-taking, and no expectation for outcomes.  Everyone who was invited to participate each year made their own hotel reservation at a designated hotel near an airport hub, and Margaret arranged with the hotel to provide a small conference room for two days free of charge.  There were about a dozen people invited each year – often a handful of people who had attended in the past, and typically 2 or 3 who had not attended before and were doing significant work in the realm of nursing theory or philosophy (now of course known as nursology!). Margaret’s own book Health as Expanding Consciousness was in production at the time of the first gathering, and published early in 1979.

I attended about 2 or 3 of the gatherings – and the photo shown below is my only record of anything that happened one of the years I attended!  I know Margaret was there (she always was!), and since she is not in the photograph I am guessing that she might have taken the photo!  As you can see from the photo, this event happened in an era when nurses generally “dressed up” for such an occasion, but the fact is that the gatherings were very informal, and often peppered with humor, story-telling and sharing of life experiences.  There was always someone quick to remind the group that we were under no obligation to be “productive” – but of course, significant “productive” things happened as a result of these gatherings. Since we were all as busy as we could be with our very productive careers, we more than welcomed the opportunity to have this kind of discussion with no pressure – not even the pressure of taking notes!

My experience of these discussions had a lasting influence, affirming some of the ideas I was working on, challenging me to think at a deeper level about specific aspects of my work, and prompting me to take my ideas to a deeper level of understanding, But equally important, I had the opportunity to hear from other nursologists, learn about their perspectives, and come to appreciate not only who they were as individuals, but the importance of their ideas. So I have always carried with me the importance of this kind of free-flowing opportunity to just talk, challenge one another and deepen our understandings of our ideas and of one another as individuals.

It was at the NTTT that Jacqueline Fawcett and I first met in person – probably in about 1981 or 2.  When I founded Advances in Nursing Science  in  1978, someone suggested that Jacqui was a young scholar who would be a wonderful addition to the review panel – and she has served faithfully in this capacity ever since! While we have known one another all these years, serving together on the management team for Nursology.net is our first opportunity to work closely together.  Here are Jacqui’s reflections of the NTTT:

My notes indicate that that the Nursing Theory Think Tank (NTTT) began in
1978 and ended in 1988. My recall of the decade of existence of the NTTT
are as follows.

The NTTT was begun by Dr. Margaret A. Newman. The first meeting, in 1978,
was at State College, PA, when Margaret was on the faculty at Pennsylvania
State University. I was exceptionally honored to be invited to join the NTTT in 1978. The members, including those who were invited and those who joined later,
included Margaret, of course, as well as Ellen Egan (Margaret’s former NYU
classmate), Ardis Swanson (Margaret’s former NYU faculty colleague), June
Brodie and me (former students in Margaret’s NYU theory development course),
Beverly Hall, Lorraine Walker, Kay Avant, Elizabeth See, Peggy Chinn, Afaf
Meleis, and Barbara Carper. We met approximately once each year, typically
for a weekend in the fall season, at a hotel near an airport.

The NTTT discussions focused on the current and desired future state of
nursing knowledge. Most discussions were informal and wide-ranging; others
were more formal discussions, based on papers presented by NTTT members. I
presented a paper for discussion at the NTTT meeting in Dallas, TX, in
September 1982, which was published along with a critique by June Brody in
1984: Fawcett, J. (1984). The metaparadigm of nursing: Present status and
future refinements. *Image: The Journal of Nursing Scholarship, 16*,
84‑87; Brodie, J. N. (1984). A response to Dr. J. Fawcett’s paper: “The
metaparadigm of nursing: Present status and future refinements. Image: *The
Journal of Nursing Scholarship, 16,* 87-89.

I presented another paper for discussion at the NTTT meeting in Austin, TX,
in October 1986, which was published in 1989: Fawcett, J. (1989). Spouses’
experiences during pregnancy and the postpartum: A program of research and
theory develop­ment. *Image. The Journal of Nursing Scholarship, 21,*
149-152.

Although the NTTT ended in 1988, many of the members have continued to
contribute to the development of nursology. To the extent that the blog
posts on nursology.net might be considered a contemporary NTTT, all
nursologists are invited to submit blogs and publish their ideas about all
matters nursology in journal articles, book chapters, and books.

Addendum – added to this post on December 2, 2018 – I discovered a notice published in ANS 1:3 (April, 1979) describing the first NTTT in October, 1978, announcing the second think tank planned for March 1979, and inviting interested nursologists to contact Margaret Newman.

“Seated, L to R, Peggy Chinn, Beverly Hall, Jacqueline Fawcett, Elizabeth See
Standing, L to R, Afaf Meleis, Kay Avant, Lorraine Walker, Ellen Egan, Ardis Swanson”