VISCERAL NURSOLOGY

Contributor: Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired)

Recently I had a professional practice story published in the American Holistic Nurses Association journal, “Beginnings”. Several responses to the story motivated me to think about the potential use of professional practice stories in nursing education. I shared with a local nursing professor and the magazine editor the possibility of using professional practice stories to have students identify what nursing theories and ways of knowing they saw in a given story.

This prompted a literature review on the topic of storytelling in nursing. I also recalled that I had a section about storytelling in my graduate position paper of 1998. One of the references for that paper was “To a Dancing God” by Sam Keen (1970; 1990). I reviewed his quote: “A visceral theology majors in the sense of touch rather than the sense of hearing.” (p. 159). I immediately said to myself that if there can be visceral theology, there can be visceral Nursology!

And what would visceral Nursology look like? Definitions of visceral include “proceeding from the instinctive, bodily, or deep abdominal place rather than intellectual motivation.” This brought to mind two concepts: the felt sense and aesthetic knowing.

I first explored the concept of the felt sense in 2007, and continued to read more about it over time. One way I came to understand the felt sense is as an immediate precursor to intuitive insights.

The following statements about ‘felt sense’ are taken from two books which I found quite helpful. The first book is Focusing (1979) by Eugene T. Gendlin. The second book is Waking the Tiger: Healing Trauma (1997) by Peter A. Levine. A more recent book, Your Body Knows the Answer: Using Your Felt Sense to Solve Problems, Effect Change & Liberate Creativity (2014) by David I. Rome teaches how to access the felt sense.

  1. The felt sense is a difficult concept to define with words, as language is a linear process and the felt sense is a non-linear experience. Consequently, dimensions of meaning are lost in the attempt to articulate this experience. (Levine p. 67)
  2. A felt sense is not a mental experience but a physical one. Physical. A bodily awareness of a situation or person or event. An internal aura that encompasses everything you feel and know about the given subject at a given time – encompasses it and communicates it to you all at once rather than detail by detail. (Gendlin p. 32)
  3. Perhaps the best way to describe the felt sense is to say that it is the experience of being in a living body that understands the nuances of its environment by way of its responses to that environment. (Levine p. 69)
  4. In many ways, the felt sense is like a stream moving through an ever-changing landscape…..once the setting has been interpreted and defined by the felt sense, we will blend into whatever conditions we find ourselves. This amazing sense encompasses both the content and climate of our internal and external environments. Like the stream, it shapes itself to fit those environments. (Levine p. 69-70)
  5. The felt sense can be influenced – even changed by our thoughts – yet it’s not a thought, it’s something we feel. (Levine p. 70)
  6. The felt sense is a medium through which we experience the fullness of sensation and knowledge about ourselves. (Levine p. 8)
  7. Nowadays the phrase, “trust your gut” is used commonly. The felt sense is the means through which you can learn to hear this instinctual voice. (Levine p. 72)
  8. The felt sense heightens our enjoyment of sensual experiences and can be a doorway to spiritual states. (Levine p. 72)
  9. One must go to that place where there are not words but only feeling. At first there may be nothing there until a felt sense forms. Then when it forms, it feels pregnant. The felt sense has in it a meaning you can feel, but usually it is not immediately open. Usually you will have to stay with a felt sense for some seconds until it opens. The forming, and then the opening of a felt sense, usually takes about thirty seconds, and it may take you three or four minutes, counting distractions, to give it the thirty seconds of attention it needs. When you look for a felt sense, you look in the place you know without words, in body-sensing. (Gendlin p. 86)

I was so relieved to see how I had practiced nursing for decades put into words. I couldn’t always explain how I knew the effective interventions that seemed to just ‘happen’. I didn’t feel free to explore this in the non-holistic based career roles the first 30 years of my career. My graduate work in the late 1990’s gave me freedom to explore more holistic ways of thinking and practicing, but still doing it all rather privately. Membership in the Minnesota Holistic Nurses Association also gave me colleagues with whom to share more holistically.

The next movement toward being more open about my practice came when I learned about Modeling and Role Modeling Theory in 2012, two years before my retirement! Perhaps if I had been more open to nursing theories earlier, I wouldn’t have felt like I needed to hide how I practiced all those years. Listening, presence, and putting myself in the shoes of the other were always three of my stronger interventions. To see a theory include this latter one was such a relief. And it was in studying Modeling and Role Modeling that I learned there were a variety of ways of knowing, and aesthetic knowing was one of them.

However, I did not understand aesthetic knowing as fully until the more recent Nursology posts. I experience sheer delight with this learning. I can finally acknowledge my way of practicing to my nursing community. Chinn & Kramer (2018 p. 142) define aesthetic knowing as “An intuitive sense that detects all that is going on and calls forth a response, and you act spontaneously to care for the person or family in the moment.” It involves sensations as opposed to intellectuality. Chinn & Kramer (2018) also say “Aesthetic knowing is what makes possible knowing what to do and how to be in the moment, instantly, without conscious deliberation.” In other words, I have to not only let my head get out of the way, but also not let my head talk me out of aesthetic knowing, in both my professional life and personal life.

And so it is for me, that aesthetic knowing is Visceral Nursology. I now have a theory, an organization, and a way of knowing that supports how I practice.

REFERENCES

Chinn, P.L. & Kramer, M.K. (2018). Knowledge Development in Nursing: Theory and Process. (10th Ed.). Elsevier. St. Louis, MO.

Erickson, H.L. (Ed). (2006). Modeling and Role-Modeling: A View from the Client’s World. Unicorns Unlimited. Cedar Park, TX.

Gendlin, E. T. (1979). Focusing. (2nd ed.) Bantam Books. NY.

Keen, S. (1970, 1990). To a Dancing God: Notes of a Spiritual Traveler. Harper Collins. San Francisco.

Levine, P.A. with Frederick, A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books. Berkeley, CA.

Rome, D.I. (2014). Your Body Knows the Answer: Using Your Felt Sense to Solve Problems, Effect Change & Liberate Creativity. Shambhala. Boston & London.

About Ellen Swanson

Ellen Swanson

Ellen E. Swanson is retired from a 46 year nursing career that included ortho-rehab, mental health, OR, care management, consulting, and supervision. She also had a private practice in holistic nursing for 15 years, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.
She enjoys writing that incorporates holistic concepts, whether through storytelling or her booklet about Alzheimer’s or her book about healing the hierarchy.

Our Voices: Addressing Racism in Nursing

September 27, 2021. 1-4:30pm Eastern – Virtual Zoom Meeting

Register Here

Join us to learn more about our voices reckoning with racism in nursing. Share your voice in a dialogue, discussion, and future direction inspired by first person interviews and shown through the compelling stories of Black, Indigenous, Latinx, and other nurses of color.

Featuring Nurses from the “Overdue Reckoning on Racism in Nursing” project: Lucinda Canty, Sue Hagedorn, Raeann LeBlanc, Frankie Manning, Melissa Mokel, Gayle Robinson and StoryCenter guides and media production team: Jonny Chang, Joe Lambert, Sharon Mosley, and Daniel Weinshenker.

A Seedworks Foundation Supported Event in Collaboration with StoryCenter

Sept 23 – Panel Discussion -Decolonizing Nursing: What? Why? How?

A webinar panel presentation sponsored by Nursology.net in association with the Center for Nursing Philosophy 

September 23, 2021, 6 – 7:30  PM Eastern (US & Canada)

ALL ARE INVITED!

Panelists

  • Lisa Bourque Bearskin, RN, PhD, Thompson Rivers University (BC)
  • Lucinda Canty, RN, PhD, University of St. Joseph (CT)
  • Barbara Hatcher, PhD, MPH, RN, FAAN, George Mason University
  • Lucy Mkandawire-Valhmu, PhD, RN, University of Wisconsin-Milwaukee
  • Daniel Suárez-Baquero, PhD, MSN, BSN, University of California San Francisco
  • Bukola Salami, RN, MN, PhD, University of Alberta
  • Jennifer Woo, PhD, CNM, WHNP, FACNM, Texas Woman’s University

Moderator  – Miriam Bender, PhD, RN, University of California Irvine

Register in advance. After registering, you will receive a confirmation email containing information about joining the webinar.

A Tribute to Elizabeth Ann Manhart Barrett (July 11, 1934 – August 24, 2021)

Dr. Elizabeth Ann Manhart Barrett, nurse theorist and researcher, Rogerian scholar, and passionate advocate for nursing science, transitioned peacefully on August 24, 2021 surrounded by her family. She was best known for her theory of Power as Knowing Participation in Change derived from Rogers’ Science of Unitary Human Beings (SUHB) More than 100 studies have been conducted using the theory and/or measurement instrument (PKPCT); the PKPCT has been translated into 7 languages.

Elizabeth developed the first practice methodology for Rogerian nursing practice called Health Patterning, and she had an independent nursing theory-guided practice for many years in New York City based on this method. Elizabeth was a member of the American Academy of Nursing’s Nursing Theory-Guided Practice Expert Panel (NTGP-EP), serving as the organizer and first leader of NTGP-EP along with Dr. Rosemarie Parse. In addition, she was a founding member and first president of the Society of Rogerian Scholars. Elizabeth was a passionate champion of nursing science grounded in nursing theory. Her articles “What is Nursing Science?”(2002) and “Again, What is Nursing Science?”(2017) are classics. She edited four books including Rogers Science-based Nursing that received the ANA Book of the Year Award.

Elizabeth was born in Newburgh, Indiana and was blessed with five children, 14 grandchildren and 15 great grandchildren. After 12 years of working in her home and caring for her children she decided to go to college. She credits her mother, a “feminist”, with inspiring her to pursue her dreams and to help people who were suffering, especially those who were less privileged. She graduated with a Bachelor of Science in Nursing summa cum laude from the University of Evansville (UE) and continued as a part-time student at UE while working full-time and eventually earning a Master of Arts in education with a major in psychology and a Master of Science in Nursing. After this she taught psychiatric/mental health (PMH) nursing at UE and continue to work as a PMH nurse.

Elizabeth Barrett at the 2019 Case Western Nursing Theory conference

In 1976 she moved to Greenwich Village in New York City to begin doctoral study at New York University (NYU). It was a different world from her roots, and she loved New York City. It was there that she began working with Martha Rogers studying and advancing the SUHB. While in the PhD program at NYU she worked as a float charge nurse at Bellevue Hospital Center, fulfilling another dream; she considered Bellevue Psychiatry as the greatest challenge and reward in PMH nursing practice. It was her favorite position. While studying Nursing Science with a major in Theory Development and Research at NYU she taught research at Adelphi University and PMH clinical practicums at City University of New York (CUNY). After graduation she was an Assistant Director of Nursing at Mount Sinai Hospital for 5 years and then joined the faculty at Hunter-Bellevue School of Nursing (CUNY) where she held positions of Director of the Graduate Program and Coordinator of the Center for Nursing Research. She retired as Professor Emerita in 2001 and expanded her private practice to full-time. She was a licensed therapist in the state of New York practicing Health Patterning, a nursing theory guided practice with private clients. For 40 years she was active in mentoring many researchers and scholars in the SUHB and Power Theory and conducting her own research testing and advancing the theory.

Those who knew Elizabeth can attest to her kind, loving and supportive nature and playful sense of humor. We will miss her on this Earth, but we will continue to experience her presence in many ways. May she soar in peace and power!

Society of Rogerian Scholars Conference Tribute

The SRS Fall 2021 conference planning committee met together this past week to plan a conference tribute to Dr. Elizabeth Ann Manhart Barrett. We invite you to join with us in organizing a Celebration of Light and Life that will be shared on Saturday October 2, 2021 in the afternoon as special part of the conference program. We are compiling photos and memories that will be organized and shared in a powerpoint presentation.

  1. We invite you to please send digital versions of any photos that you may have of  Dr. Barrett to msmit230@health.fau.edu and leslie@medesk.com. The photos may be scanned or you can take a photo of the photo and send in email. 
  2. We invite you to share any personal memories that you may have of Dr. Barrett or stories of how her work impacted your work or life. The SRS website has an open text box where the memories can be shared publicly or you can email msmit230@health.fau.edu and leslie@medesk.com with content to be shared in the conference tribute. 

We may also pull content form the website so if you write something there we may also include it. Depending on the volume of content we receive  we will have to make choices or edit the stories for use. 

There will also be time for open sharing of stories in real time at the conference during the celebration for those who would be comfortable doing so.

The SRS website link to write a memory  is here  and you can also follow the link to Dr. Barrett’s obituary shared by her family. 

Please feel free to reach out with any questions or concerns. 
As a reminder please register for the conference  here and share the conference information widely in your circles. 

SRS Annual Conference 2021

Join us for our 34th Annual Conference:
A Fantastic and Limitless Future: Nursing Science, Diversity, & Wellbecoming”

Keynote speaker: Marlaine C. Smith, RN; PhD; AHN-BC, HWNC-BC, FAAN

There is no charge to attend the conference but a donation to the Society is always appreciated!

Call for Abstracts for the 2022 Virtual Nursing Theory Week

Now open for submissions – until 11:45 pm EST on November 15, 2021!

The abstracts can be for either a 30-minute “Knowledge Session” or for a virtual poster presentation!

Visit the Nursing Theory Conference website for more details about submitting your abstract! Access to the abstract submission page is also posted in “Due Dates” to the right of each Nursology.net page!

Education Exemplar: St. Mary’s College School of Nursing – Kurame, Japan

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/

We are delighted to announce the addition of an Education Exemplar describing the St. Mary’s College School of Nursing program designed using the Roy Adaptation Model! You can access the new Exemplar any time from the Nursology.net “Education Exemplars” main page. Or go directly to the St. Mary’s Exemplar here

Fostering dialogue about practice knowledge development in a DNP Curriculum; Opportunity for theory innovation?

Guest Contributor: Lydia D. Rotondo, DNP, RN, CNS, FNAP

The practice doctorate in nursing developed in response to an increasingly complex healthcare landscape that requires additional competencies for 21st century advanced nursing practice. Complementing traditional graduate (MS) specialty curricula, the Doctor of Nursing Practice (DNP) program of study incorporates additional curricular content in the areas originally detailed in the 2006 DNP Essential domains (now integrated into AACN’s 2021 Essentials). DNP students complete a summative scholarly practice inquiry project that is theoretically-guided and evidence-based, demonstrating synthesis and application of the tools of clinical scholarship learned throughout the DNP program.

Particularly relevant to the design of DNP projects is the critical importance of context and the application (or adaptation) of best evidence (when available) to specific practice settings or specific populations. As context experts DNPs utilize systems thinking to design, implement, and evaluate interventions within complex adaptive systems revealing new understandings about health care delivery, the healthcare experience, and the role of DNPs as change agents and clinical scholars.

Fifteen years after the release of the DNP Essentials, appropriate focus is now on evaluating the impact of DNP practice on healthcare systems and health outcomes. As a practice discipline, however, there remains little attention by nursing academe regarding the potential impact of the practice doctorate on the discipline of nursing. In other words, how will the growing cadre of DNP-prepared nurses be leveraged to advance the discipline? In today’s interdependent, knowledge–based, digital world, how will advancing the discipline be defined and measured in the coming decades? What additional scholarly tools and curricular content will DNP students need to begin to answer these questions?

As doctoral-prepared nurses, DNPs share stewardship with other doctoral-prepared nursing colleagues to generate disciplinary knowledge. Yet, discussion about DNPs as knowledge producers and theory innovators remains largely unexplored. Scholarly treatment of knowledge generation in nursing practice is not a new phenomenon and has, in fact, been posited and published by several nursing theorists for decades. However, the introduction of the latest iteration of the practice doctorate in nursing, now in its second decade, with more than 36,000 enrolled in DNP programs and close to 8,000 graduates, has not sparked interest among leaders in DNP education to approach practice epistemology from the DNP lens.

Moreover, with a de-emphasis on philosophy of science and theory and stronger attention to evidence-base practice in DNP curricula, DNP programs as currently designed may lack sufficient educational grounding to engage in practice theory development. This further impedes the opportunity for scholarly discourse on practice knowledge production specifically and doctoral roles in nursing knowledge generation more broadly. While the promotion of evidence-based practice among all health professionals is useful to reduce clinical variation in care, there remains nascent opportunity for DNPs to consider how their scholarly work can produce practice-based evidence- knowledge that both improves care outcomes for individuals and populations and illuminates the contributions of nurses to healthcare.

In 2019, we developed a theory and conceptual foundations for clinical scholarship course at the University of Rochester School of Nursing in which students explore the historical and philosophical roots of the practice doctorate in nursing and nursing as a practice discipline. Our early efforts were inspired by Dr. Pamela Reed, Professor at the University of Arizona College of Nursing, whose considerable contributions in the area of practice epistemology provided a framework for course development. In an early course assignment, students are asked to create a concept map using the four nursing metaparadigm concepts to describe their philosophy of nursing. Students present their maps in class which encourages rich discussion about the nature of nursing knowledge related to their role in health care and health/wellness promotion. What is particularly striking is that for many students, this course is their first exposure to nursing’s theoretical grounding and opportunity to reflect on their professional practice from a disciplinary perspective. Several DNP student exemplars from the spring 2021 semester are included below with permission.

Exemplar 1 – Sarah Dunstan, University of Rochester School of Nursing DNP student

Circumnavigating and persevering through life’s most challenging roadblocks, the nurse dutifully guides the most weary and vulnerable of travelers towards safety and solace, both physically and emotionally. Committing to the vision of “Ever Better” and the pursuit of optimal patient wellness, nurse leaders are tasked with the responsibility of advancing the field and creating the new standards of care for the future.

As depicted above, my philosophy of nursing is best explained in the context of a journey. The person, or patient, is represented as a vehicle. Similar to vehicles, each patient is a unique make and model, some with more miles or more baggage than others. The nurse navigating the vehicle must carefully consider these differences and individual patient needs when mapping out the patients’ journey to health. The map, or environment, is laden with roadblocks or barriers to optimal wellness. The barriers may be geographical, financial, cultural, psychological, or physical. Whether few or many, these roadblocks may delay or completely inhibit the patient from reaching their health care goals. The metaparadigm concept of nursing describes the individual caregiver at the bedside that assists the patient around and through these various states of illness in order to reach the ultimate destination of optimal wellness. The destination “Health” is malleable and ever evolving, as depicted with multiple possible end points marked on the map. Health is defined by and dependent on the individual patient and their own informed healthcare goals, as optimal wellness is not always defined as the absence of disease.

The map is in the hands of the DNP-prepared nursing scholar. As a leader and nursing expert in the field, the DNP is the visionary change agent tasked with closing the practice-theory gap at the bedside in the clinical setting. DNPs are the cartographers for the future of nursing, responsible for defining clinical scholarship in nursing, creating, upholding, and disseminating the proposed standards of the discipline.

Exemplar 2 – Christine Boerman, University of Rochester School of Nursing DNP student

My nursing theory and paradigm is composed of many moving parts that work interchangeably and without each of these elements working together, the discipline of nursing would not be complete. My nursing theory is illustrated via the gears that work together in order to create the full working “maChinne” of nursing discipline.

Exemplar 3 – Christina D’Agostino, University of Rochester School of Nursing DNP Student

The figures included within the map are all intended to mirror constellations within that sky, represent the person, the environment and one’s health. Centered at the bottom of the map, shining its beacon of light on the sky is nursing, represented by two hands which provide the foundation. Nursing is a global role. As people around the globe all look up to the same night sky, all people share the benefits of the nursing domain.

My personal philosophy of nursing is a holistic approach of providing culturally-sensitive care for individuals, regardless of locality or ethnicity while being mindful of the interconnectedness that involves the person, environment, and one’s health as the recipient of that care.

Exemplar 4 – Victoria Mesko, University of Rochester School of Nursing DNP Student

My personal philosophy of nursing is: Caring for individuals with a holistic approach, striving for wellness within the community and the world. Along with all of the skills that nurses develop, what sets nurses apart is their caring nature. Nurses have an all-encompassing view of our patients’ mind, body, and spirit. Nurses see patients in the context of their environment and are able to propose treatments that will consider all of the influences on patient’s lives. Nurses take into account all of the meanings that “health” can have to a person, not just the absence of disease, but a sense of wellness even if they have disease. In my map, there is no one nursing domain that is more important than another, as they all have an influence on patient care. The interlocking circle of different hands represents nurses working to form relationships and connections between patients, the community and the environment across cultural lines.  

Exemplar 5 – Kalin Warshof, University of Rochester School of Nursing DNP Student

My philosophy of the nursing discipline is the utilization of the art and science of nursing care, compassion, and practice interventions to enhance the health and well-bring of the person, within their individual environmental context, including social determinants, culture, and beliefs. The metaparadigm map depicts the person at the center of the diagram, with nursing as a discipline, nursing interventions and compassionate care contributing to the improvement of health and well-being of the person. This is evident by the upward arrow, with health and well-being above the person, portraying the upmost importance to the person and nursing. The background in light blue, labeled the environment, indicates that the person, nursing discipline, health, and well-being interpretation and improvement occurs within the context of the personal environment. My philosophy of the nursing discipline is consistent with the Doctor of Nursing Practice Essentials I objective focusing on the whole person and their interaction with the environment to improve health and well-being (American Association of Colleges of Nursing [AACN], 2006).

Exemplar 6 – Kara Mestnik, University of Rochester School of Nursing DNP Student

Individual nursing philosophy is shaped overtime by individual practice, and life experience. My philosophy has shifted over the past twenty years, I have gained vast clinical experience and growth in intrapersonal interaction and relationships. The term balance is often sought for and emphasized as an indicator of health and wellness, comparable to the concept of homeostasis. My personal philosophy of Nursing is the ability to navigate all facets of human life despite the magnitude of directional force that may attempt to imbalance ones mental, physical, and spiritual well-being. Refer to (figure 1) for metaparadigm map. Consider the patient the pivot at the center of the compass, with a multidirectional view of their own life and well-being, while the nurse is the hand that holds the compass. The hand holding the compass helps both align and balance the direction the patient is aiming to travel. The nurse becomes both the navigational guide and the stable hand that allows for balance to be achieved at any given period or direction in time. The hands holding the compass indicate a personal connection with the patient as well as an oversight into the larger picture in which patients may travel. The acquired achievement of balance despite a directional force is guided by the hands that allow for health and wellness optimization.

About Lydia Rotondo

Lydia Rotondo

Lydia Rotondo, DNP, RN, CNS, FNAP is the associate dean for education and student affairs and director of the doctor of nursing practice program at the University of Rochester School of Nursing. She received her DNP from Vanderbilt University, MSN from the University of Pennsylvania, and BSN from Georgetown University. Lydia is a 2018 AACN Leadership in Academic Nursing Fellow and has actively contributed to the national dialogue on DNP scholarship and curriculum development through presentations at AACN’s doctoral education conference and publications.

Psychoneuroimmunology in Nursing

Contributor: Christine Hodgson, MSN, RN, CPNP-PC

In the first week of my nursing Ph.D. program, I heard a brief presentation from a professor who taught “psychoneuroimmunology.”  I had never heard that word, but I knew I had to take that class.  I was entering my Ph.D. journey after a long career as a primary care pediatric nurse practitioner. I had started to feel a thirst for knowledge about the mind-body-spirit connection, how it relates to wellness, and how we can implement integrative healthcare across cultures. Fortunately, my first year included a class on nursing theory development and evaluation, so I was prepared to enter this mysterious class with my newly solidified personal worldview, epistemology, ontology, and favorite nursing theories.

“Complexity” by Owen Hodgson (age 17)

Psychoneuroimmunology (PNI) did not strike me as a theory at first. I had just finished refresher classes in endocrinology and immunology, wherein having an old textbook didn’t matter too much because these reductionist sciences were slowly changing. On the other hand, I quickly learned that PNI was a young theory about bi-directional communication among the mind-brain-immune-endocrine systems that was gaining an evidence base and interest across many disciplines. My professor, Dr. Pace, noted that he loved teaching nurses because we “are so good with theories.” I stopped to think about how PNI contrasted with the nursing theories I had learned…as well as how it aligned with nursing theories (more on that later).

What is PNI?

PNI is a re-emergence of ancient beliefs that organisms are integrated systems (Daruna, 2012, p.13). Robert Ader was a psychologist who, along with Nicholas Cohen, originated PNI and advanced the field of mind-body science in 1980 (Daruna, 2012, p.21). Ader’s discovery that rats could be trained to have a particular immune response came at a time when biomedical science was ready for a new holistic theory. PNI has established that the immune system crosses the blood-brain barrier affecting physical, cognitive, psychological, and behavioral functions. Probably the most well-known model within PNI is that of the Stress Response (Pace, 2020, October 26). Acute psychological or physical stress activates pro-inflammatory cytokines such as IL-1 and IL-6. Acute stress also shifts the body’s homeostasis to a sympathetic (fight or flight) response and triggers the hypothalamus-pituitary-adrenal axis (HPA) to release cortisol. These acute immune mechanisms help protect the human organism in the short term. However, chronic or cumulative stress can lead to inflammation and cortisol dysfunction. In addition to physiologic changes, cytokines affect neurotransmitters leading to changes in cognition and behavior. Pace summarized how multiple complex pathways related to stress and inflammation increase the risk for physical and mental illness throughout life.

What are PNI Interventions?

We can measure immune biomarkers through blood or saliva, so scientists have been able to test interventions that prevent or disrupt the stress-immune pathway. Mindfulness, meditation, nutrition, exercise, sleep, and counseling are just a few PNI interventions that have an evidence base for various illnesses (Pace, 2020, November 23). Nursing practice already values these nurturing and accessible tools, so we are all PNI practitioners.

PNI and Nursing Theory

I believe our very first nurse theorist, Florence Nightingale, would have appreciated the tenets of PNI. Not only did Nightingale’s prescient focus on infection control address the immune system’s role in health, but her methodical and statistical approach to nursing also laid the foundation for complex knowledge discovery (Nelson & Rafferty, 2011). Grand nursing theories that followed Nightingale’s work included those in the integrative-interactive paradigm, which views a patient as an interactive whole capable of a multitude of adaptation responses to their environment. Examples of integrative-interactive conceptual models include Sr. Callista Roy’s adaptation model, Betty Neuman’s systems model, and Barbara Dossey’s theory of integral nursing (Smith & Parker, 2015, p. 88). The field of PNI is producing voluminous empiric evidence that the human body is an interconnected whole, which supports these holistic nursing theories.

For a more specific example of how a nursing theory could guide a hypothetical PNI research study about the long-term effects of stress, I will refer to Betty Neuman’s systems model (NSM) (Lowry & Aylward, 2015) and provide a conceptual-theoretical-empirical structure (Gigliotti & Manister, 2012). I hypothesize, based on previous research (Felitti et al., 1998), that adverse childhood events (ACEs) cause inflammation that leads to cardiovascular disease (CVD) later in life, and smoking behaviors mediate the relationship. NSM is a model about a client’s adaptation to internal or external stressors and includes the client concepts of stressor, invasion of the normal line of defense, lines of resistance, and core response (Lowry & Aylward, 2015). The theoretical linkages of PNI in my study are ACEs, cortisol response via the HPA axis; inflammation/cognitive changes/maladaptive behaviors; and cardiovascular disease, respectively. The empirical measures of these links are a self-report ACE questionnaire; salivary cortisol levels; attenuated cortisol response measures/depression and anxiety symptom survey; and blood pressure/cholesterol/smoking behaviors, respectively. Here physiological and psychological variables of the hypothesis are directly measured, allowing us to understand the more abstract concepts of the NSM and their relationships to one another. The NSM also includes a concept of intervention as prevention that aligns with the wellness focus of PNI.

Nursing Knowledge Development and the Future of PNI

Despite congruence with existing nursing theories, incorporating PNI in developing a new middle-range nursing theory could move down the ladder of abstraction to a more concrete explanation of concepts (Smith & Liehr, 2018, chapter 2). For example, a middle-range PNI nursing theory might focus on the prevention and treatment of ACEs with children and their families. PNI emphasizes the natural healing processes of humans, is adaptable to the personalized or the public health level, and even has economic benefits to a healthcare system (Daruna, 2012, p. 280-83). If we adopt a nursing PNI conceptual model for wellness and prevention, we can improve outcomes such as depression, diabetes, cancer, heart disease, autoimmune diseases, and more.

Two years after my introduction to the term psychoneuroimmunology, I am preparing for my comprehensive exams. As I reflect on my Ph.D. curriculum, I realize the degree to which nursing theories and PNI have already informed my nursing research and practice. I hope to contribute to a future where nurses, guided by theory, have more understanding and tools to care for the complex human being…but first, back to studying!

References

Daruna, J. H. (2012). Introduction to psychoneuroimmunology. (2nd ed.) Elsevier, Inc.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Gigliotti, E., & Manister, N. N. (2012). A beginner’s guide to writing the nursing conceptual model-based theoretical rationale. Nursing Science Quarterly25(4), 301–306. https://doi.org/10.1177/0894318412457060

Lowry, L. W. & Alyward, P. D. (2015). Betty Neuman’s Systems Model. In M. C. Smith & M. E. Parker (Eds.) Nursing theories & nursing practice. (4th ed., pp. 165-181) F. A. Davis Company.

Nelson, A. M. & Rafferty, S. (Eds). (2011). Notes on Nightingale: the influence and legacy of a nursing icon. (1st ed.) Cornell University.

Pace, T. W. W. (2020, October 26). Stress as a risk factor for illness. [Powerpoint slides]. University of Arizona College of Nursing, Psychoneuroimmunology: Foundations and Clinical Implications. D2L: https://d2l.arizona.edu/d2l/home

Pace, T. W. W. (2020, November 23). PNI mechanisms of wellness I. [Powerpoint slides]. University of Arizona College of Nursing, Psychoneuroimmunology: Foundations and Clinical Implications. D2L: https://d2l.arizona.edu/d2l/home

Smith, M. J.  & Liehr, P. R. (2018). Middle range theory for nursing. (4th ed.). Springer.

Smith, M. C. & Parker, M. E. (Eds.) (2015). Nursing theories & nursing practice. (4th ed.). F. A. Davis Company.

About Christine Hodgson

Christine Hodgson has been a pediatric nurse practitioner for over 20 years. She currently works in school-based health clinics, including one on an Indian reservation. She lives in Montana with her husband who is a pediatrician, three sons, and two golden retrievers. She loves to hike, bike and ski in the mountains, travel and read. She plans to study the resilience of indigenous children around the globe.

Peace and Power Process in Action in Nursing Department Meetings: A Case Study

Jacqueline Fawcett
Lisa Sundean
JoAnn Mulready-Shick

Academic department structures and governance tend to reflect university–wide structures and governance that are typically characterized as hierarchical, competitive, and power-over/power as control. The decision to revise a department of nursing by-laws provided an opportunity to transition to adopt a more egalitarian structure with shared governance between the department faculty and the department and college administrators.

Consequently, during Academic Year (AY) 2017-2018, the faculty of a department of nursing agreed to a new governance structure that involved development of by-laws for the department. Three faculty members then agreed to serve on a committee to revise our department by-laws. The By-Laws Committee members first considered our previous traditional use of Robert’s Rules of Order for department meetings and recognized those rules as a patriarchal power-over/power as control structure. As we questioned assumptions and traditions, we determined that Robert’s Rules no longer served us and did not support our desire for a more progressive, egalitarian structure of group process and shared governance. We therefore suggested using the Peace and Power process .

The purpose of the Peace and Power process is to guide group process “in cooperative and peaceful ways, and in ways that challenge the status quo and lead to social and political change in the direction of equality and justice for all . . . . the process . . . also [is] . . . .a means of creating healthy group interactions and promoting health by reducing stress and distress created by hostile conflict” (Chinn & Falk-Rafael, 2015, p. 62). The theory of Peace and Power “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. Based on the processes . . . individuals and groups can make thoughtful choices about the ways they work together to promote healthy, growthful interactions and avoid harmful, damaging interactions” (Chinn, 2018).

Perhaps most important is that the Peace and Power process is a way to operationalize power-as-freedom, that is, freedom to knowingly participate in change (Barrett, 2010) instead of power-over/power as control. Thus, the emphasis is on the solidarity of our department learners (aka faculty, staff, and students) rather than power held over the group by any one individual or authoritative body.

Following successive drafts and revisions based on faculty feedback, the department by-laws were approved by the department faculty in Spring 2019 and were implemented in Fall 2019. The by-laws included the stipulation that department meetings would be conducted using the Peace and Power process. Faculty also recognized their need to engage in new learning about this innovative method .

The faculty agreed that the Peace and Power process reflects the shared values and commitments formed by the group. Specifically, the faculty agreed that the Peace and Power process is consistent with our department values (Integrity, Inclusion, Diversity, Transparency, Transformation, Resilience, Relationships, Accountability, Collaboration, Equity, and Excellence) and a department goal to implement the department by-laws. Noteworthy is that the department values are consistent with two of the university-wide values–transformation and engagement. The Peace and Power process also supports the initial implementation efforts within the department and the entire university to eliminate structural racism and to promote diversity and inclusion. Incidentally, the transition to Peace and Power process as a means to shared governance and a healthy work environment is supported by the recent release of the Future of Nursing Report 2020-2030: Charting a Path to Achieve Health Equity (National Academy of Medicine, 2021). Specifically, among the 54 sub-recommendations is an emphasis on improved nursologist well-being through healthy work environments that include structural, socio-emotional, justice, and policy foci.

During the first department meeting of Fall 2019, faculty were intentionally reminded of the new by-laws and the Peace and Power process by members of the By-Laws Committee. Implementing the Peace and Power process in the department involves rotating leadership of monthly department meetings. This means that the department chair does not chair each department meeting; instead, after a slow start in AY 19-20, by AY 20-21, a different faculty member volunteers to convene and lead each meeting. Furthermore, the department meetings operate within values-based decision-making and mutual agreement of best options by means of consensus building discussions during department meetings and anonymous online voting as needed, such as elections to committees and final decisions about curriculum and programs. Moving critical voting decisions to the anonymous online format extended over a short period of time, ensures that all voices are included and that votes are not potentially coerced by peer pressure.

During AY 2020-2021, the By-Laws Committee members engaged in a series of micro-learning sessions to raise awareness about the content and meaning of the by-laws, including a more thorough explanation of PEACE powers (Chinn, 2013). A Fall 2020 micro-leaning session focused on differences between discussions that could be characterized as diversity or divisiveness. This session was added to the meeting agenda and presented by the department chair. The Spring 2021 micro-learning sessions focused on familiarizing faculty more thoroughly with the content of and more fully operationalizing the Peace and Power process. One micro-learning session focused on the outcome of the Peace and Power process as “movement that is ever shifting to the direction of peace” (Chinn, 2013, p. 10), along with the meaning of the word, PEACE, which is the acronym for five powers:

  • Praxis—synchronous reflection and action to transform the world
  • Empowerment—growth of personal ability to enact one’s will in the context of love and respect for others
  • Awareness—growing knowledge of self and others
  • Cooperation—commitment to group solidarity and integrity
  • Evolvement–commitment to deliberate growth and change (Chinn 2013, p 10 ).

The PEACE powers are operationalized when values and commitments are formed by the group (i.e., the faculty), when department meeting leadership rotates among the faculty, and when values-based decision making and mutual agreement of best options occurs.

During the Spring 2021 semester, each department meeting concluded with a request for reflections. Examples of reflection prompts, which were meant to prompt reflections about the process of Peace and Power during department meetings, are:

  • Please share an appreciation for someone or something that has happened during this meeting today.
  • What could have been different in today’s meeting and how would future meetings be shaped?

Faculty were asked to place their answers/reflections in the zoom chat box (department meetings throughout the pandemic were held via zoom technology). Examples of responses are:

  • I appreciate the discussions today which were very civil and constructive.
  • I appreciate the discussions [of] awareness of individuals and their feelings.
  • I enjoy listening to others perspectives and thoughts.
  • I appreciate the open communication and problems solving about common challenges (e.g., email overload for everyone!)
  • The meeting today was a very good example of the Peace and Power Process, so thank you to everyone for your contributions to our dialogue.
  • Appreciate the positive communication and openness to hear all voices
  • Thank you to everyone for sharing their thoughts on this topic…a good question for us to ponder further is how do we operationalize self- care and meet our department goals?

The By-Laws Committee members recognize the ongoing nature of implementation of the structural change for the department. Accordingly, future plans are to create a standing agenda item with the intention to further sustain the Peace and Power process at the monthly meetings. Two specific future actions include additional micro-learning sessions and ending each department meeting with a reflective practice.

We gratefully acknowledge the excellent contributions of undergraduate nursology learner Stephen Miller (BS, December 2021) and PhD nursology learner Julianne Mazzawi (PhD, June 2021) to the micro-learning sessions.

References

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

Chinn, P. L. (2013). Peace and power: New direction for building community. Jones & Bartlett

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

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

National Academy of Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. https://nam.edu/publications/the-future-of-nursing-2020-2030/ i

Contributors

Co-contributors with Nursology.net team member Jacqueline Fawcett

Lisa J. Sundean, PhD, MHA, RN is an Assistant Professor at Fairfield University and formerly at the University of Massachusetts Boston. She is Board Chair of the CT Center for Nursing Workforce, Board Member of the CT League for Nursing, a consultant for the Center to Champion Nursing in America, a national leader with the Nurses on Boards Coalition, and a Fellow in the New York Academy of Medicine. Her research and scholarship focus on nurses in board governance roles, health policy, and nursing workforce development. Dr. Sundean is a Daisy Foundation Award recipient for Extraordinary Nurses.

JoAnn Mulready-Shick, EdD, RN, CNE, ANEF, is a Clinical Professor in the Department of Nursing, UMass Boston, and a Nurse Scientist at the Boston VA Healthcare System. Her scholarship centers on nurse educator development, student success, and clinical education innovation.

Structure and Design as an Expression of Nursing’s Ontology

“When I walk in the door of the College of Nursing building I feel different.  There is something deeply peaceful about this place.” “I can’t put my finger on it, but when I’m here I can think, feel, and connect to myself…I’m present ”. “It’s not like any other building on campus. It’s about studying nursing from the inside out”.

Over the 15 years that I’ve been fortunate enough to call Florida Atlantic University’s Christine E. Lynn College of Nursing (CELCON) my home I’ve heard these and many similar comments about being in the College of Nursing’s building. I joined the faculty in 2006 when the building was new, and my direct experience of the building was one of the factors that drew me to this College. The ontology of nursing was vividly re-presented in the building’s architecture and design. The design of the building was an intentional process, meticulously planned and implemented by Anne Boykin, Dean at the CELCON for over 30 years, co-author of the theory of Nursing as Caring, and a transformational leader. The focus of the discipline of nursing: caring, human wholeness, and the interrelationship of wellbeing to the human-environment relationship (Smith, 2019) informed the creation of this “home” that truly reflected the heart and soul of nursing. Dr. Boykin collaborated with architects who understood her vision and captured it in the structure and design of the building. It is an example of creating living spaces that reflect foundational values (Boykin, Touhy & Smith, 2021).

The College of Nursing building was created to be a healing environment that reflected three guiding ideas: 1) the College’s philosophy of caring, including its definition of nursing; 2) a reverence for the environment and its centrality to wellbeing; and 3) the harmonious flow of energy through attention to structure and design, referred to as feng shui in Chinese philosophy. (Smith, 2019, p. 290). “The purpose of the building was to create a living, breathing place that invites, teaches, houses, protects and nurtures” (Boykin & Raines, 2006, p. 45).

Having a home for the College of Nursing was Anne Boykin’s dream, and a generous philanthropist and fellow nurse and friend, Christine E. Lynn, funded the building. The building is 75,000 square feet with three floors, with a circular design to reflect wholeness and connectedness. “The College is dedicated to Caring: advancing the science, practicing the art, studying its meaning, and living caring day-to-day”. Nursing is defined as “nurturing the wholeness of person-environment through caring” (https://nursing.fau.edu/about/college-at-a-glance/vision-and-mission.php). This core dedication to the mission is cast in the terrazzo floor of the atrium of the building as the “dance of caring persons”. It is a visual reminder of the College’s philosophy and model of relating. The dance is grounded in respect and valuing of all persons who are encouraged and supported in a culture that values persons living caring and growing in caring. (https://nursing.fau.edu/about/college-at-a-glance/index.php).

The atrium faces a garden with trees and plants known for their healing properties, rocking chairs and benches, and a labyrinth, an ancient symbol of self-reflection and wholeness. Walking the labyrinth is a journey to our own center and back again out into to the world. (Boykin & Raines, 2006, p. 46). This labyrinth is unique in that it is oval rather than round; its designer felt that the shape represented the face, the place of human connection between nurses and others. The healing garden is an environment for students, staff and faculty enjoy. Palm trees and other plants are around the building. Bamboo is on each side of the entrance of the building is a symbol of blessings within. The color of the exterior and interior of the building is mostly earth tones, a nurturant element that most closely represents nursing.

View from the 2nd floor of the Atrium that looks out at the garden, featuring the “Dance of Caring Persons” image embedded in the floor.

This unitary perspective on person-environment integrality led to creating a “green” building, one that embraces principles of sustainability and stewardship of the earth. The building is designated as a Leadership in Energy and Environmental Design (LEED) gold-certified building. It features minimal destruction of the earth surrounding the building, water savings through low flow toilets and recycled water for garden irrigation, healthy indoor air and natural light throughout the building, construction using materials and appliances that decrease impact on deforestation and the environment, use of products and supplies that are natural and non-chemical, and energy efficiency. (Boykin & Raines, 2006).

The feng shui design principles are based on creating environments in which people feel comfortable and supported. Feng shui masters and experts in healing architecture consulted from the beginning on the design elements. Before the groundbreaking the feng shui master engaged the College community in a ritual blessing ceremony to honor the land and prepare the earth to accept and nurture this new home. (Boykin & Raines, 2006). The front of the building faces north, the most propitious direction. The back of the building borders on a lake. Water is a source of life, and this water source is visually incorporated through river rock in the garden that visually is contiguous to a swath of black tile that flows throughout the building. A bagua or feng shui blueprint guided the placement of different areas in the College. The five elements of earth, water, fire, wood and metal are used in particular areas of the building along with the colors and shapes they represent. For example, “helpful persons” on the first floor is the office of Student Support Services housing advisors and assistant deans, while on the third floor it is the Dean’s Suite. The element of wood using block shapes permeates the design in this area along with the color green. Another example is that the Office of Research and Scholarship is located in the “prosperity” area of the bagua represented by the fire element with angular shapes and the color red.

The three floors of the building have different purposes; the first floor is the welcoming space for the community. The second floor is focused on spaces for students including large and smaller classrooms with connectivity for distance learning, a kitchen with communal eating space, the lab area for simulation and skills practice, and individual and group study areas, a large doctoral student study room and the Center for Nursing Research and Scholarship. The third floor has the suites for the Dean, administrative support staff, eminent scholars, associate deans, faculty offices, several conference rooms and a faculty kitchen and eating space.

Other unique features that reflect nursing’s ontology are open spaces for gatherings and events, a museum and the Archives of Caring (the only archive in the world that houses the work of caring scholars), a large yoga or exercise space with a bamboo floor, a holistic space for classes and a room with a massage table, and a “sacred space”, a room for meditation, reflection or contemplation.

The ontology, or essential nature of nursology, is reflected clearly in the structure and design of the Christine E. Lynn College of Nursing. It is an environment that nurtures the growth of students, faculty and staff in bringing the values to life in all missions of the College: teaching, research, practice and service. “Through intentional design features the concepts of reflection/mindfulness, aesthetic appreciation, healing environments, human-environment integrality, holistic health, and the significance of self-care to the being-becoming of the nurse are prominent”. (Smith, 2019, p. 290).

Sources

Boykin, A. & Raines, D. (2006). Design and structure as an expression of caring. International
Journal for Human Caring, 10(4), 45-49.

Boykin, A., Touhy, T.A. & Smith, M.C. (2021). Evolution of a caring-based college of nursing.
In M. Hills, J. Watson & C. Cara (Eds.), Creating a caring science curriculum: An
emancipatory pedagogy for nursing (pp. 187-200). New York, NY: Springer Publishing.

Smith, M.C. (2019). Advancing caring science through the missions of teaching,
research/scholarship, practice and service. In W. Rosa, S. Horton-Deutsch & J. Watson (Eds.), A Handbook for Caring Science: Expanding the Paradigm. (pp. 285-301) New York, NY: Springer Publishing.

Smith, M.C. (2019) Regenerating the focus of the discipline of Nursing. Advances in Nursing
Science. 42(1), 3-16,