WWFD: What Would Florence Do in the COVID-19 Pandemic?

Florence Nightingale circa 1860. Retrieved from https://en.wikipedia.org/wiki/Florence_Nightingale

On May 12th we celebrate Florence Nightingale’s 200th birthday in the midst of a global pandemic. Nightingale, the acknowledged founder of modern nursing, was no stranger to the unfettered spread of communicable diseases. During her service in the Crimean War ten times more soldiers died from dysentery, cholera, typhoid fever, and typhus than the wounds of war. Nightingale understood how the human-environment relationship influenced health and healing. According to Nightingale, nursing was about putting the person in the best condition for Nature to act (Nightingale, 1859/1969). In other words, the focus of nursing is on nurturing and supporting the process of healing. Nightingale was a social reformer, justice activist, humanitarian, liberally-educated scholar, and bioinformatician, driven to service and care for others from a deep spirituality (Dunphy, 2020).

In her book, Notes on Nursing: What it is and what it is not (1860/1969), Nightingale offers guidance about creating an environment that can prevent disease or support healing. While she is focused on care of “sick” persons in the home, her concepts are applicable beyond this. Here are ten practical tips from Florence Nightingale as we live with COVID-19 pandemic:

  1. Ventilation. Nightingale said that “keeping the air he (sic) breathes as pure as the external air without chilling him (sic)” is the very first canon of nursing. (p. 12). While we are sheltered-in-place it is important to get fresh air. Make an effort to spend some time outdoors by sitting outside, going on a walk or run while maintaining a social distance, or just opening windows. Those with mild to moderate symptoms of the disease will be managing symptoms at home, staying indoors away from others. Even with these restrictions promoting the flow of some fresh air in the home is possible, opening windows even a few minutes every few hours. We can advocate for those in the community who are not able to have a safe place to be outside or depend on others to get some fresh air.
  2. Health of houses (pure air, water, efficient drainage, cleanliness). Nightingale believed that cleanliness was the first defense in preventing disease. When she came to field hospitals in the Crimea her first action was to start cleaning the space. We know that the novel coronavirus that is causing COVID-19 is highly infectious. Because it spreads mainly through respiratory droplets keeping surfaces clean and washing hands after touching anything that could be touched by others, like doorbells, elevator buttons, mailboxes, etc. is important. Having water to wash hands, clothes, and surfaces is essential, but we know that those who are homeless and those whose water has been turned off need our advocacy to turn the water on and to have hand sanitizer available for those without homes. I diffuse antimicrobial essential oils like eucalyptus, tea tree and cajeput in my bedroom and family room to cleanse the air.
  3. Petty management is about the holistic coordination or management of care through environmental scanning, information and planning. I found one passage particularly relevant to our experience with COVID-19. “Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember he is face-to-face with his enemy all the time, internally wrestling with him, having long imaginary conversations with him…Rid him of his adversary quickly” (Nightingale, 1859/1969, p. 38). This is a stressful time in our lives and many are living with fear and anxiety. Receiving clear and consistent messages is important in a crisis. Providing honest information to those we encounter about the transmission of the virus, incubation period, ways to protect self from infection, and what to do when experiencing symptoms may relieve anxiety and help them to plan and gather resources. I find myself providing information to family and friends who call with questions. Nurses are trusted and approachable sources of knowledge for the public. There is so much information on the internet, and we can help to refer people to the most reliable sources. Listening and providing support to others can be helpful as well as caring for self through those activities that work for you such a meditation, exercise, watching a funny movie, journaling, etc.
  4. Noise – In this section, Nightingale calls attention to the sound environment and its potential effect on promoting rest and well-being. With most of us sheltered at home we can cultivate greater awareness of how sounds affect us. For example, it may be tempting to have the television or internet news on; however, the constant information about the pandemic may cause us to become more tense and anxious. Turning on music that is comforting, relaxing, joyful or inspirational, or tuning into sounds from nature from apps, or actually being outdoors are ways to promote serenity.
  5. Variety – We may be at home for another 1-2 months, so Nightingale’s advice on creating variety in the environment is especially relevant. She said, “…the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms” (p. 58). She suggested bringing beauty, color and interesting objects into a confined space. How can we bring variety into our lives when our space is limited? One way is intentionally creating a daily schedule that includes new and interesting activities. It might be creating art, journaling, working on a home project, learning a new skill like a language, touring museums using online apps, reading books, or binging on a Netflix series. Some are caring for and home schooling children, working from home, or continuing their essential work in the community. Variety is already built-in to their lives.
  6. Food – Nightingale focuses on providing food that is nutritious and supportive for healing. The science of nutrition has come a long way since Nightingale. During this pandemic we want to eat food that supports our immune systems, lots of fruits and vegetables if possible. Take a multi-vitamin with minerals or supplements with Vitamin C, D (especially if you are not exposed to much sunlight), A, E, selenium, magnesium and zinc. Shopping and getting groceries or prepared food delivered can be challenging and anxiety-producing. Some may have a tendency to overeat for comfort, boredom, or just having constant access. With the loss of jobs, food insecurity is a concern. We need to support food banks more than ever in this crisis.
  7. Bed and bedding – The message here from Nightingale is to keep bedding fresh and aired out, changing the sheets frequently and airing out the bed with a window open if possible before making it. While she is referring to caring for people bedridden, this is still a useful message to consider.
  8. Light – Nightingale asserts that the need for sunlight is second only to the need for fresh air. (p. 84). She stated that sunlight not only lifts the spirit, but “has real and tangible effects upon the human body…a purifying effect” (p. 85). She suggested either letting the sunlight into the room or better yet, getting out into the sunlight. We know that sunlight is indeed important for health, that ultraviolet light has antiviral properties, and that viral infections tend to decrease when days are longer. When there is sunlight take an opportunity to get some exposure to it.
  9. Cleanliness – Here we go again! In this section, Nightingale is focused on actually scrubbing walls, floors, dusting and cleaning carpets or anything else harboring dirt. I guess this is another activity to keep us busy. In her section on personal cleanliness she emphasizes how vitality is restored by washing the skin and clothes. “Poisoning by the skin is no less certain than poisoning by the mouth—only it is slower in its operation” (p. 93). People feel better after a bath or shower, and she even suggests skin brushing (she calls it “rubbing” the skin). Washing ourselves and our clothes more frequently especially if there are chances of exposure to the virus is important.
  10. Chattering hopes and advices – In this section Nightingale warns against offering unsubstantiated hopeful predictions and giving advice without any foundation to it. She says to “leave off the practice of attempting to ‘cheer’…by making light of danger”…(p. 96). I believe she is telling us that during times of human suffering authentic presence through being with, listening, and following the persons’ lead is essential. Many are suffering during this time. Nurses can be with others by listening and being present with them during this suffering without simplistic platitudes.
Sources

Nightingale, F. (1860/1969). Notes on Nursing: What It Is and What It Is Not. New York: Dover Publications.

Dunphy, L.M.H. (2020). Florence Nightingale’s conceptualizations of nursing. In Nursing Theories and Nursing Practice (5th edition). M. Smith (Ed.). Philadelphia: F.A. Davis, (pp. 35-54).

Nightingale’s Vision for Nursing in 2020

It will take 150 years for the world to see the kind of nursing I envision

Painting of Nightingale In the Florence Nightingale Museum

The year 2020 marks the bicentennial of Nightingale’s birth and approximately, at least, the 150th anniversary of her prediction that “It will take 150 years for the world to see the kind of nursing I envision.”  What was that vision, in what ways is it relevant today, and to what extent has it been realized? Although volumes could be written to answer these questions, for the purposes of this blog, it is possible only to highlight a few: her founding of and contribution to documented nursing disciplinary knowledge, i.e., nursology, her contribution to nursing education, and her championing of evidence-based practice and policy.

  • In 1860, Nightingale published the first recorded conceptual framework for nursing, in  “Notes on Nursing.”  in it, she clearly differentiated nursing from medicine; she saw medicine as removing obstructions to nature’s ability to heal  but nursing as creating the best conditions e.g., nutrition, cleanliness, ventilation, etc. for that healing to occur. I think she would be pleased to see the Nursology.net site, dedicated to furthering nursing knowledge.  The site currently hosts 53 nursing theories, from conceptual frameworks to mid-range and situational theories, but each focused on health, as opposed to disease, and on the nurse’s role in promoting healing. And, I think Nightingale would be pleased to see the large numbers of nurses who practice, teach, and.or conduct research guided by nursing

    Turkish lamp from the Florence Nightingale museum

    disciplinary knowledge.  But, I think she would be dismayed at the powerful influence the medical model still has on health care generally and on many nurses, whose practice consciously or unconsciously is strongly influenced by it (Bradley & Falk-Rafael, 2011). It is not possible to practice nursing without an idea of what the scope and nature of that practice is (i.e., a conceptual framework) and if that framework is not solidly rooted in nursing’s disciplinary knowledge, it is vulnerable to dominant influences from other disciplines (Rafael, 1999, 1998).

  • It is no coincidence that also in 1860, Nightingale founded her training school for nursing. Before the introduction of a trained nursing workforce, people who provided patient care (if there were any) might be called nurses  but who, according to McDonald, “were mainly low-paid, disreputable hospital cleaners, notorious for demanding bribes from patients and stealing their gin” (McDonald, 2013, p.36). Some of the important features of the Nightingale program were the requirement that all nurses be trained in a hospital setting, regardless of where they intended to work (e.g., the military, district nursing, midwifery, administrative roles), some of which required additional training. It became a model for many other schools of nursing in Europe, North America, and Australia.  Undoubtedly, some readers of my vintage who initially trained in general hospitals as late as the 1960s, would recognize familiar aspects of her model. (I recall reciting the “Florence Nightingale pledge” on the occasion of my completing the first 6 month’s probationary period of my training)!  Nightingale’s approach  was basically an apprenticeship model in which nursing students provided hands-on nursing care under the supervision of more senior nurses (e.g, clinical co-ordinators/headnurses/ward sisters). The learning that took place on the wards was augmented by classes given by physicians.  McDonald further notes that while Nightingale did not envision university schools of nursing, she advocated for “a professorship of hospital administration, hospital construction, and hospital nursing.”  While admission to universities remained off-limits for women in Nightingale’s time, I believe she would be most pleased to see the  progress that has been made in university education for nurses, both at an entry-to-practice level and in graduate education. In her time,  without regulatory bodies and examinations, graduation from a training school was the only guarantee that a nurse was indeed qualified to practice. My guess is that she would have welcomed regulatory bodies to allow a more diversely qualified nursing workforce.  I would guess that she might even support the use of personal support workers if they were under the supervision of adequately prepared nursing staff.  I fear she would not be in favour of the extensive use of personal support workers seen in some settings, without that supervision.
  • Nightingale’s use of statistics to demonstrate the effects of nursing care in the Crimean War are legend.  What is less known is what McDonald describes as her reputation as the  “the ultimate statistician. Nightingale was deeply influenced by the work of Quetelet, a renowned Belgian mathematician and statistician and author of “Social Physics.” McDonald noted that Nightingale advocated for pilot projects to evaluate the effects of changes to policy and practice. Similarly she stressed evaluation, including cost-benefit analyses, of existing programs and/or policies,  frequently developing the appropriate questionnaires for data collection herself if none were available.  Nightingale used empirical evidence to support approaches to making childbirth safer. Although initially intending to open a lying-in hospital, she decided against it after finding that the mortality data among women giving birth  where they were in contact with medical personnel (e.g. lying-in hospitals) were higher than when they gave birth at home or even in workhouses. Likewise, although her initial rejection of germ theory is well known, her acceptance of it when presented with the evidence by Joseph Lister is less well known. Nightingale’s reputation as a statistician resulted in her  nomination by William Farr, a renowned British statistician, to be the first woman to become a fellow of the Royal Statistical Society in Britain. Her reputation was international; in 1874, she  was elected an honorary member of the American Statistical Association.  I think Nightingale would be pleased to see the growth in the number of nurse researchers, the number of nursing journals that report that research, the existence of hospital libraries and librarians to facilitate access to that research, and the emphasis on evidence-informed practice. Is it enough? I suspect that Nightingale would still see room for improvement!   

Would Nightingale have envisioned a pandemic in which, at the time of writing this blog, more that 3 million people in the world had contracted COVID-19, with approximately 1/3 of those cases being in one of its wealthiest, powerful, and most advanced countries, the United States?  I’m guessing that were she alive today, she might have seen it coming.  Nightingale was a systems thinker; just as she reflected on the cholera outbreaks by noting facetiously “I sometimes wondered why we prayed to be ‘delivered from plague, pestilence and famine’ when all the common sewers of London ran into the Thames”, she might made a similar remark about prevailing economic trends.  Nightingale was a keen advocate for a comprehensive public health system and for government involvement in providing a social safety net, including income security and pensions.

Last evening, I read an article  in the Toronto Star  which spoke to the increased vulnerability to COVID-19 of people with low incomes, who, for a variety of reasons that include the need often  to  work in jobs in which they are more likely to be exposed to the virus. In addition, they tend to be able only to afford housing far from where they work, requiring the use of public transportation, creating further risk. Among the author’s suggestions was one that seemed very familiar:  “It would be far cheaper for society . . .to take a significant portion of . . . public funds and put them into . . . housing that’s affordable for all income cohorts within a reasonable[distance]  . . . of where they have to work, so that there would be more choices throughout any metropolitan region for people than they are given now.”  I was reminded of Nightingale’s famous quote made in 1868: “And if all the money that is spent on hospitals were spent on improving the habitations of those who go to hospitals, and (on prisons) of those who go to prison,  we should want neither prisons nor hospitals.”

Do I believe she would have seen a pandemic coming? Yes, because it seems, unfortunately, society has not learned important lessons from history.

Sources

Bradley, P. & Falk-Rafael, A. (2011). Instrumental care and human-centred caring: Rhetoric and lived reality. Advances in Nursing Science 34(4), 297-314.

McDonald, L. (2013). The timeless wisdom of Florence Nightingale. Canadian Nurse, 109(2), 36.

Rafael, A.R.F. (1999). From rhetoric to reality: The changing face of public health nursing in Southern Ontario. Public Health Nursing, 16(1), 50-59.

Rafael, A.R.F. (1998). Nurses who run with the wolves: The power/caring dialectic revisited. Advances in Nursing Science. 21(1), 29-42.

 

Nurse Trauma in the Face of COVID-19

Guest Contributor
Catherine Quay*

On a rainy night in October 2019, I watched and celebrated as nursing students walked across the stage to receive their hard earned nursing pins. Little did we know that they would be entering the nursing workforce just prior to a global pandemic unlike one that has been seen in over 100 years. Some of these students have reached out to me recently to express their frustration. Just four months into their careers and they are stressed, anxious, exhausted, and scared, and as their recent instructor and mentor I feel helpless. Understanding the mental health impact this pandemic and the shortage of resources is having on nurses is essential. We also must understand the impact on new graduate nurses so we can prevent them from joining the ranks of nurses who leave within their first year of practice.

Anyone with access to an electronic device has heard the stories of the shortage of supplies as the result of COVID-19. Not enough masks, gowns, gloves, and ventilators to care for the growing number of individuals infected with this virus. Nurses and healthcare providers are being required to act in ways that only weeks ago would have been unthinkable. They are being required to make decisions that are often in conflict with the nursing knowledge and values that we, as educators, worked so hard to develop and nurture within them. Such ethical dilemmas are creating psychological discord that over time will result in lasting harm (Foli and Thompson, 2019).
Foli and Thompson’s (2019) middle range theory, Nurses’ Psychological Trauma, addresses this situation. The authors identify insufficient resource trauma as a nurse-specific trauma that with repeated exposure, can result in diminished physical and mental health, unsafe patient care, and can potentially lead to the nurse abandoning the profession (Foli & Thompson, 2019).

The trauma of not being able to carry out one’s ethical, professional, and organizational obligations due to a shortage of resources is what practicing nurses and health care professionals are experiencing every day during the COVID-19 pandemic (Foli, 2019). As educators, have we prepared students for this current reality? Where does this fit in with the patterns of knowing? According to this theory, personal knowing addresses the self-awareness and resilience needed to overcome trauma as each individual’s perception of an event is influenced by multiple personal factors and experiences. However, this kind of self-awareness as a nurse takes time to develop. Where does this leave our new nurses in the face of this pandemic? Are they receiving the support they need from their organizations and experienced nurses to develop the resiliency and ability to grow in the face of trauma?

The search for an understanding of how to help my former students has left me with more questions than answers. If the nursing profession and the organizations that depend on them do not address these questions, we will potentially lose large numbers of nurses. The psychological traumas nurses face on a regular basis must be acknowledged. “If we don’t strategize to sustain and restore our psyches and souls, we are just as vulnerable as our patients”(Foli & Thompson, 2019, p.34). A multipronged approach is necessary to address the reality of nurse-specific trauma. The profession needs to openly discuss the mental health impact that practicing with insufficient resources has on a health care professional.

We are currently seeing this in the media as nurses across the country speak out against the conditions they are being subjected to. Nurses must bring their authentic voice to the current crisis. Additionally, from a nursing educator perspective, there needs to be a focus throughout curriculum on developing personal and ethical knowing. Through self-reflection activities that focus on personal, historical, and patient trauma, a nursing student can begin to develop self-awareness, resiliency, and coping skills (Foli & Thompson, 2019). Lastly, health care organizations need to take a vested interest in the psychological well-being of their health care professionals by providing the necessary physical and emotional support resources and by creating a culture that supports emotional and professional growth. The return on investment is worth it.

The current COVID-19 pandemic has brought the reality of practicing with insufficient resources in health care to the forefront of society. Nurses must take the opportunity to speak out about the conditions they are facing and the choices they are being forced to make. For the nurses who have recently entered the workforce, we know this is not what you imagined. Reach out for help if you need it. Experienced nurses, let them know that you are there for them. Provide them emotional support, be present, and actively listen to the trauma they are experiencing. Nurses will get through this but only if we support each other. Together we are resilient.

Sources

Foli, K. (2019, November 12). Nurse-specific trauma: Let’s give it a name. Nursology. https://nursology.net/2019/11/12/nurse-specific-trauma-lets-give-it-a-name/

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, Indiana: Sigma.

About Catherine Quay


Catherine Quay

I am a doctoral student at Teacher’s College, Columbia and am currently taking a course with Jane Dickinson. We have been spending time exploring this site as part our class. Thank you for your insight and for providing us with many discussion topics. I hope you and your family are staying safe.

The Value of Primary Prevention

The COVID-19 pandemic reminds us of the primacy of primary prevention to maintain wellbecoming. The governmental recommendations or requirements for quarantines or sheltering in place during the pandemic are targeted to primary prevention.

However, few people worldwide unfortunately think primary prevention. Instead, far too many global citizens avoid vaccinations or screening tests and wait until they are obviously ill to seek care. Furthermore, governments rarely fund primary prevention efforts until such massive disruption as a major epidemic or pandemic occurs, as we have learned from media reports of no funds to prepare at least possibly effective vaccines and screening tests ahead of outbreaks of novel viruses. According to a recent report on public radio, proposals for studies of the effectiveness of quarantines have not been funded for many years, although the current pandemic may loosen the governmental purse strings.

As always, nursology has an answer to how to emphasize primary prevention. Specifically, Florence Nightingale successfully advocated for a clean environment (clean air, clean water, etc.) as a way to maintain wellness.

Nightingale’s ideas have been translated into contemporary nursology, especially in the Neuman Systems Model. This nursology conceptual model includes primary prevention as intervention as one of three intervention modalities (the others are secondary prevention as intervention and tertiary prevention as intervention (see neumansystemsmodel.org). Although other conceptual models do not explicitly focus on primary prevention, the intention certainly is to promote wellness.

© 2018 Jacqueline Fawcett

My understanding of our history tells me that nursologists have always had the moral courage to advocate for and implement primary prevention while at the same time providing superb secondary and tertiary prevention for all people worldwide.

Poremba (2019), who has studied the 1918-1919 pandemic, pointed out that then and now, nurses are best positioned to care for people. She declared, “If there is anything positive to come from the coronavirus, it may be that we recognize the essential value of skilled nurses. This means expanding our nursing workforce and advancing their training in caring for patients with acute and infectious diseases in hospitals and homes.” Although her focus is on secondary and tertiary prevention, we can expand her message to include the essential value of nursologists in providing primary prevention.

Reference

Poremba, B. A. (2019, March 15). Column: Nurses needed now. Gloucester [Massachusetts] Daily Times. Retrieved from https://www.gloucestertimes.com/opinion/column-nurses-needed-now/article_d1553519-f489-55c9-a1f9-4fe7d0820312.html

Keeping the Spark: How to Maintain your Humanism During the COVID-19 Pandemic

Guest Contributor: Erin Dolen, MS, RN, CNE

The country, and the world, is at war. War against the virus SARS-CoV-2 that causes Coronavirus Disease 2019 or “COVID-19” (FDA, 2020). As nurses, we must be on the front lines. Our dedication to the community to provide high-quality care should not end despite the complications associated with this pandemic. But how? How can we stay dedicated, humanistic, and compassionate when we are stretched beyond the limits of what we can accomplish? Josephine Paterson and Loretta Zderad have the answer.

Josephine Paterson (left), Loretta Zderad (right)

Paterson and Zderad (2007) first published their Humanistic Nursing Theory in 1975. Their hope was to help nurses understand that nursing is “an experience lived between human beings” (p.14). Through this experience, nurses can bring meaning and understanding to each patient’s life, the patient’s family’s life, and their own life. Paterson and Zderad maintained that this experience is important and effects the existence of all human beings.

So, what would they think about this global pandemic we currently find ourselves in? What does their theory propose that can help us now? These theorists also maintained that through having this shared experience with patients, nurses may hopefully remember why they chose to answer the calling of the nursing profession and stay dedicated to nursing despite the challenges that most certainly lie ahead. They could not be more right. We need this dedication to our profession now more than ever. We need to all remember why we chose to become nurses. What life experiences led us to this profession? What patients have we had during our careers that only further solidified that meaning in our lives? We have all had them. That older gentleman who was living his last moments on earth and grabbed our hands, and simply said “thank you”. That teenager who made a choice and found themselves in a life-changing situation who actually listened to us. I mean, really listened. That mother who lost a child who found solace in our embrace during the most difficult time in her life.

We need to remember these experiences but we also need to make new ones. Remember that each patient is a human being with needs, fears, and desires. Live this experience with them, not around them. Help them see meaning and understanding in their current situation. Help them see that they are not alone, nurses are with them. When you feel the need to rush out of the room, take the extra moment to lay a therapeutic hand on the patient’s shoulder, and simply smile. The smile may be behind your mask, but let it light up your eyes. The humanistic approach to nursing isn’t just for verbal interactions, but non-verbal as well (McCamant, 2006). For the pediatric patient who needed to have an x-ray and was taken from their mother, hold them PPE and all.

The humanistic nursing theory also has a subset of five phenomenological phases of nursing: preparation for coming to know, intuitive knowledge of others, scientific knowledge of others, synthesis of current knowledge to supplement practice and the inner transition from “many to the paradoxical one” (Lelis, Pagliuca, & Cardoso, 2014, p. 1117). As structured as this sounds, when you think about it, all nurses need to prepare to accept new knowledge, utilize their own intuitive knowledge, recall and retain scientific knowledge, apply that knowledge to guide their practice, and become one with their patients and their profession. Regardless of whether they know it or not, every nurse has been practicing the humanistic nursing theory their entire careers. Keep going. Keep accepting new knowledge and new experiences. Keep trusting your intuition and your scientific knowledge. Keep guiding your actions with evidence-informed practice. Keep becoming one with your patients and their families.

During this pandemic, when nurses feel exhausted, powerless, and ill-prepared, these experiences will help get us through. They will bring meaning and understanding to our lives. This meaning and understanding will help us remember that spark that lights our way to humanism. Most importantly, this lived experience with our patients will help us stay dedicated to our vital profession during this pandemic, and during any challenging times that lie ahead, just as Paterson and Zderad had hoped.

References

Lelis, A.L.P.A., Pagliuca, L.M.F., & Cardoso, M.V.L.M.L. (2014). Phases of humanistic theory: Analysis of applicability in research. Text Context Nursing, Florianopolus, 23(4), 1113-1122. https://doi.org/10.1590/0104-07072014002140013

McCamant, K.L. (2006). Humanistic nursing, interpersonal relations theory, and the empathy-altruism hypothesis. Nursing Science Quarterly, 19(4), 334-338. doi: 10.1177/0894318406292823

Paterson, J.G. & Zderad, L.T. (2007). Humanistic nursing [ebook]. Wiley. (Original work published 1975).

U.S. Food and Drug Administration (FDA). (2020). Coronavirus disease 2019 (COVID-19). https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus- disease-2019-covid-19

About Guest Contributor Erin Dolen

E Dolen PictureErin is an Assistant Professor of Practice at Russell Sage College in Troy, NY. She is a doctoral student in the EdD Nursing Education Program at Teachers College, Columbia University. She has her MSN with a focus in Nursing Education from Excelsior College. Erin has her national certification as a Certified Nurse Educator. Her nursing background is in emergency medicine. She lives in Delmar, NY with her husband and two children.

 

COVID-19 and Psychological Trauma

I feel guilty as I write this. You see, I’m home with my family, safe and warm. Protected. Others, my comrades and fellow nurses are not. But I can guess, and have read and been informed of what they are facing on the front lines: reassigned to new hospitals and new duties, rendering care, sometimes coerced by employers, without adequate protective equipment. No masks. No gowns. No testing to know who is indeed positive for the virus. One of my students wrote to me, expressing her ethical dilemma of whether to care for patients while she went unprotected, potentially cross-pollinating other patients and her family. They – her employers – had reminded her that she has ethically pledged to do so. Her note brought it to a personal level to me. What could she do, she asked me? I advised her to document, to bring others into the demands of adequate protection, and to consult the CDC guidelines, contact her county health department and so forth. I felt my advice was not nearly enough, a defective response to an impossible riddle.

We are in a pandemic, a global disaster, if you will. The United Nations Office of Disaster Risk Reduction: International Strategy for Disaster Reduction (2017) defines disaster as:

A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts. Annotations: The effect of the disaster can be immediate and localized, but is often widespread and could last for a long period of time. The effect may test or exceed the capacity of a community or society to cope using its own resources, and therefore may require assistance from external sources, which could include neighbouring jurisdictions, or those at the national or international levels (n.p.).

That about sums it up, doesn’t it? But what of the nurses’ psychological trauma experienced in the disaster?

My student described insufficient resource trauma, the lack of tangible and intangible resources necessary to render safe and quality care. The resources include knowledge, supplies, nursing staff, and other professionals.

My Middle Range Theory of Psychological Trauma includes this type of psychological trauma and the trauma experienced by being a social actor in the midst of an unfolding disaster (see Figure). Nurses will surely face secondary/vicarious trauma as they witness patients’ suffering and offer comfort and caring. They may participate in system or medically-induced trauma as patients are placed on ventilators, relinquishing control of their bodies. For some patients who lived through the Great Depression, memories of austere times may be invoked, causing anxiety and reflective of historical trauma.

Physicians are often tasked with triaging during disasters as the resources become more strained. But I have met with nurses who were involved in the California fires not too long ago. They felt forgotten and overlooked when the post-fire debriefings took place, as if their place in the healthcare hierarchy removed them from sitting at the healing table.

Another graduate nursing student emailed me about her class assignment. She probably won’t be able to finish it because of all the activities she is being called to do in her hospital, an ever changing world filled with chaos and uncertainty. When I weigh the final paper with saving lives, is there any doubt about what priority I should endorse?  But this is territory I’m unfamiliar with.

What I can do is remind myself that my world should be revised, amended, and my teaching should be trauma-informed. I should lace my work with compassion and an understanding of the overwhelming need for people to feel safe, their voices to be heard, and their recovery to be purposeful and inclusive. I can give names to the trauma they are exposed to and by doing so, offer them a path to express this psychological injury now and in the future so that recovery can unfold.

References

Foli, K. J., & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Indianapolis, IN: Sigma.

United Nations Office of Disaster Risk Reduction. (2017). Terminology. Retrieved from:  https://www.unisdr.org/we/inform/terminology.

 

Hidden Risks of Physical Distancing and Social Isolation

The single most important and essential step being taken worldwide to contain the spread of the COVID19 crisis is what is widely known as “social distancing.” But in fact this is physical distancing that heightens the risk of social isolation, conflict and stress. This necessary physical distancing is only tolerable for the most introverted of introverts, leaving the rest of the population in a state of periodic unrest at best, and deep distress at worst.  We are then faced with not only the possibility of disease/illness caused by the novel corona virus – we are faced with the dis-ease of daily living.  When the environment to which someone is compelled to retreat is a relatively safe haven that provides nurturing and encourages creative solutions to the inevitable frustrations and stress, the outcome will probably be okay at least – perhaps even resulting in some new and healthier patterns of daily living!  But the reality is that for far too many, the environment of “home” is a place of emotional tension, sometimes even emotional and/or physical danger.  For those who are “essential” workers – like many nurses – the workplace where they are now compelled to spend a considerable amount of time is one where their own physical well-being is at risk, and the culture may be also less than nurturing or pleasant – even abusive.  Even the best of circumstances can easily erupt into harmful conflict and emotional tension at a moment’s notice, ignited by the stress and tension of the uncertainties and dangers that we all face in this pandemic.

Now more than ever the world needs nursing – the practice of caring for others informed by the knowledge and the wisdom passed along in the theories and philosophies of nursology.  To me the unifying unique characteristic that is so vital as we face the COVID19 pandemic is the holistic nature of nursing theory and practice.  There are many insights that any of us can tap into in any of our theories – now documented on this website and accessible through the site’s galleries.

My theory and practice of “Peace and Power” is among those that directly address the challenges of social and emotional conflict and distress – distress that also compromises physical well-being.  The theory was developed as an approach to group process that shifts away from the power-over (often damaging) approaches that dominate group interactions, and toward an approach that nurtures all, that respects each person’s humanity, and that deals with conflict in ways that nurture growth and healing – not harm and hurt.  The “group” can  be as small as two people!  Shifting to this approach is not easy and it is especially hard to start learning in a context already stressed by the current pandemic – but it can be done!  The specific theoretical concept and practice is “conflict transformation.”  This abstract concept is possible to translate directly into practice – into the realities of every-day life – starting with awareness of the potential for unrest during this challenging time, and the commitment to  start practicing even with the smallest tension!   Here are a few practical ideas for using this approach where you live and work now.

When you are directly involved in a stressful interaction:
  • If you can, acknowledge the situation as soon as you even suspect that this might escalate.  Do not try to “fix” the conflict, simply acknowledge that it is happening, and ask for others to take time to reflect and find a new direction.  If it is now already escalated, step in to share (briefly) your sense of what is happening, and to ask everyone to take time to breathe and reflect on what is happening. This may be a few minutes, or a few hours – maybe a couple of days.
  • During this time, take deep breaths every few minutes to calm and center your spirit.  Focus on your own body/mind/spirit feelings and your own hopes for how this situation will unfold. Recognize and take into account the stress of the situation around you – in this case the pandemic and the real-life stress everyone is experiencing.
  • Shift to a place of inner calm, where you move away from blame and toward understanding of the situation as a whole.
  • Clarify the underlying values that you believe everyone in the situation shares.
  • Prepare your own “critical reflection” that you will share with the others involved.  This reflection consists of these elements:
    • I feel … focus on your own feelings without blaming others
    • When (or about) … describe factually what happened when your feelings came to the surface.
    • I want, I offer .. describe what you envision happening next to move away from or resolve (transform) the conflict, even if it seems impossible to happen.
    • Because … name the value, goals or ideals that you share with the others who are involved.
  • Take a deep breath, and return to the situation ready share your reflection and invite the others to also move away from conflict toward peaceful and health-promoting interactions. Listen carefully to what everyone shares, and join with them in finding a path forward.  The path might still be rocky along the way, but you will now have a foundation from which you can build.  Keep the process of transforming conflict alive and well as you navigate troubled waters.
When you observe a stressful, potentially harmful interaction:
  • Acknowledge what you are observing, even if it is not immediately clear that something harmful is happening.
  • Offer to serve as a mediator or facilitator, bringing awareness of the situation to light, and encouraging a move away from harm and toward understanding
  • If others are open, share the “Peace and Power” process of conflict transformation as an approach to deal with the situation.

Your Well-Being as a Nurse and the COVID-19 Pandemic

We are in an unprecedented time in history with the coronavirus (COVID-19) pandemic. Nurses and other crucial healthcare providers are at the frontline navigating uncharted and uncertain territory. There are limited supplies, including personal protective equipment, and little is understood regarding the pathway to healing with COVID-19. As such, the management team at Nursology.net has decided to dedicate a series of blog posts to COVID-19 using nursing knowledge as our framework. We hope that with these posts you become more informed about the unknown, and also find some stability during these shaky times. Our first post is dedicated to you, the nurses, and your well-being by PhD candidate Chloe Littzen.

Conceptual Framework for Young Adult Nurse Work-Related Well-Being

As a PhD student, I focused my studies on understanding the well-being of nurses, while specifically emphasizing young adult nurses. Over time, and with the guidance of my trusty advisor and committee, I developed a conceptual framework on the work-related well-being of young adult nurses. This framework and its development are based on my philosophical perspective as an intermodernist (Reed, 1995; 2019), nursing and non-nursing theories (Benner, 1982; Kramer, 1974; Baltes, 1987), salient knowledge on nurse well-being (Paatalo & Kyngas, 2016), relevant nursing knowledge (Fawcett, 1993; Newman, 1992; Parse, 1987; Terry, 2018), and my personal experiences as a young adult nurse. While this is in-process work, this framework has the potential of being a practical tool for nurses’ looking for a resource to help manage their well-being in these uncertain times. 

For a quick refresher, a conceptual framework is a type of theoretical thinking that is abstract, broad in scope, and uses general concepts (Reed, 2018). Within my conceptual framework on young adult nurse work-related well-being there are four main concepts: 1) generational differences in philosophical worldviews; 2) perceived co-worker social support; 3) resilience; and, 4) young adult nurse work-related well-being. The takeaway message is these concepts may all have a significant role in our well-being as nurses. Additionally, there may be things that we can do to sustain and enhance our well-being with these concepts in mind; especially now when our well-being is more vulnerable than ever. So below is a beginning theoretical how-to guide for you to sustain and enhance your well-being at work during this time of unease.

A Theory Guided Approach for Nurse Work-Related Well-Being

  1. We All Don’t See The World The Same Way

This proposition is based upon my concept of generational differences in philosophical worldviews. What this proposition infers is that while we would like to think as nurses we see the world the same way we don’t always.

This is not a bad thing and is quite normal in diverse groups such as the discipline of nursing (there are over 3.8 million nurses in the United States alone!). That being said, it can be stressful when you are faced with a situation where you and colleagues have a disagreement. 

So what can you do to aid these disagreements, especially in crisis times like now?
Try these five easy steps: 
  1. Stop and take a breath. Everything’s better when you breathe, and you have to breathe to do whatever it is you need to do, even critical situations.
  2. Acknowledge your colleagues’ perspective. Whether you agree with it or not, meet them with kindness and respect.
  3. Ask your colleague to explain, when appropriate, why they think about the situation the way they do. If you can’t do this when the event occurs due to the criticality of the situation, ask them to talk afterward even if it is uncomfortable.
  4. Whatever happens, don’t harbor negative thoughts because of disagreements. This can not only be harmful to you but also those around you.
  5. Ask yourself how you have grown from this interaction. What did you learn? Will you do something differently next time you interact during a disagreement?

2. Put Your Oxygen Mask On First

I think this is something we all know intuitively, but because we are nurses (there are some similarities among us I think), we are often more concerned about helping those around us than ourselves. While this is a wonderful character trait, this often leaves us depleted and burned out, ultimately negatively impacting our well-being. So this proposition is focused on building your resilience capacity, where every day you put your oxygen mask on before stepping out the front door.

How do I do that? 

First and foremost identify something that makes you happy.
Not your family member, not your friend, you

Nourish to Flourish

Image by @dlhamptom

You can call this self-care, but whatever it is it has to make you happy and you have to take time out for it. Everyone is different but ask yourself, what works for you? Every day select an amount of time that fits your schedule, whether 5, 20, or 60 minutes, and block it off on your calendar. Treat it like an appointment with your boss, do not break it. Be bigger than your biggest excuse and show up for yourself. If you need to, talk to your family about how you are feeling and see how they can support you during this time. 

So to refresh, here are four steps for you to build your resilience capacity: 
  1. Identify what makes you happy. Alternatively, if you are so depleted that you can’t think of something that makes you happy, try something new!

    For Example:
    Start a daily yoga practice using an online platform (follow the link to a 14-day free trial).
    Try a daily meditation using an app.
    Read a non-work related book, even a page a day counts.
    Go outside (while practicing appropriate physical distancing) for a walk.
  2. Decide upon an amount of time you can dedicate to yourself every day.
  3. Schedule an appointment on your calendar
  4. Show up, every day, even when you don’t want to.  

3. We All Need to Feel Supported

Grow Together

Image from @dommaraju

One of the biggest take-home messages about nurses’ I learned while pouring over the well-being literature is that we need each other, and we need to feel supported. Nurses seem to do better in every organizational outcome if they feel supported by their colleagues and management, which during times of crisis can easily crumble. So what can you do to help yourself feel supported, and simultaneously help your colleagues feel supported?

Find an accountability buddy!

What is an accountability buddy? This is a person that supports you in your well-being, while you simultaneously support their well-being. If you are currently working in the hospital or clinic, this should be a person at your place of work, and optimally each shift you work. If you cannot identify an accountability buddy at work, then identify someone outside of work that you can talk to after your shift. Lastly, if you’re in quarantine or physical distancing (otherwise referred to as social distancing, but more on that at a later time), identify a colleague who you can talk with throughout the day from home over email, texting, or a chat app such as WhatsApp or MarcoPolo. Just because you’re at home doesn’t mean you don’t need support. 

So what do I do with my accountability buddy?

Below are some suggestions to promote support during these uncertain times. But take the time to ask yourself what you need, and also ask your buddy what they need, and then revise as you learn more about each other!

In the Work Environment Physical Distancing or Quarantining After Work
  • Check-in with each other at the beginning, and throughout your shift. Ask each other how you are doing.
  • Advocate for each other to take breaks and lunch, when appropriate.
  • Promote a work environment where you both have someone to talk to if you feel anxious or overwhelmed.
  • Look out for each other to make sure you’re not taking on too much responsibility.
  • Give kudos to each other for positive well-being behaviors (e.g., you did yoga today, that’s so great!).
  • Send each other a daily message and ask each other how you are doing.
  • Advocate for each other to take scheduled breaks and lunch.
  • Promote a space where you both have someone to talk to if you feel anxious or overwhelmed.
  • Share your daily goals with each other, both work and self-care related.
  • Check in to see how you are both progressing through the day.
  • Give kudos to each other for positive well-being behaviors (i.e., you went outside for a walk today, that’s great!) 
  • Check-in with each other after work and share how you are doing over the phone, FaceTime, or Zoom.
  • Reflect on how you took care of yourself today, did you take time for yourself? Did you take a break or lunch?
  • Make a well-being goal for the next day at work. Ask your buddy if this is realistic and achievable, and reform as needed.
  • Check-in daily regarding your well-being goals.
  • Give kudos to each other for positive well-being behaviors (i.e., you asked for help when you needed it, that’s awesome!)

Where to start? 

We are all different, and one of these propositions may have spoken to you more than the others. Start there! Maybe you are already doing one of these suggested, if so, keep it up and try another suggestion to see if it help even more. Above all, just do something! As nurses, our well-being is a critical piece to making it through this difficult time, not just for ourselves, but for everyone on this planet. Change is never easy. We can’t go back and start a new beginning, but we can start today and make a new ending.

Stay safe and please take care of your well-being. 

References

Baltes, P. B. (1987). Theoretical propositions of life-span development psychology: On the dynamics between growth and decline. Developmental Psychology, 23(5), 611-626. https://doi.org/10.1037/0012-1649.23.5.611

Benner, P. (1982) From novice to expert. The American Journal of Nursing, 82(3), 402-407. https://doi.org/

Fawcett, J. (1993). From a plethora of paradigms to parsimony in worldviews. Nursing Science Quarterly, 6(2), 56-58. https://doi.org/10.1177/089431849300600202

Kramer, M. (1974). Reality shock: Why nurses leave nursing. The C.V. Mosby Company.

Newman, M. A. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-13.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. A. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1), e16-e27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Parse, R. R. (1987). Nursing science: Major paradigms, theories, and critiques. W. B. Saunders Company.

Paatalo, K., & Kyngas, H. (2016). Measuring hospital nurses’ well-being at work – psychometric testing of the scale. Contemporary Nurse, 52(6), 722-735. https://doi.org/10.1080/10376178.2016.1246072

Reed, P. (1995). A treatise on nursing knowledge development for the 21st century: Beyond postmodernism. Advances in Nursing Science, 17(3), 70-84. https://doi.org/10.1097/00012272-199503000-00008

Reed, P. G. (2018). A philosophy of nursing science and practice: Intermodernism. In P. G. Reed & N. B. C. Shearer (Eds.), Nursing knowledge and theory innovation: Advancing the science of practice. Springer Publishing Company.

Reed, P. G. (2019). Intermodernism: A philosophical perspective for development of scientific nursing theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ANS.0000000000000249

Terry, H. (2018). Critical inquiry into philosophical perspectives underlying nursing research on acute coronary syndrome [Unpublished doctoral dissertation]. The University of Arizona.

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/)

Part 1 – Access to Nursing Knowledge: A Privilege or a Right?

In the practice environment, nurses are guided by evidence-based practice, policy, and procedures specific to their institutions. Comparably, nurses in academia refer to recent and relevant academic literature based upon institutional licenses. In preparation for the Nursing Theory Annual Conference, a gap was revealed among members of the Nursology Theory Collective dependent upon their work environment as it related to access to nursing knowledge. As described by a member of the Nursology Theory Collective who has worked in the practice environment, I attempted to access a nursing research article from fifty years ago and found that I would have to pay $49, when the same article was freely available to my academic colleagues through their organizational access.” This member’s experience was not in isolation, and ended up being more of a norm than a rarity. At the publishers permission the article was able to be shared by academics to those without appropriate access in practice, but this is not a permanent solution and nor should it be a norm.

The question then arose: should access to nursing knowledge be a privilege or a right? Dependent upon our organizational affiliation (or lack thereof) nurses are blocked from relevant and essential nursing knowledge. Practicing nurses then have to consider purchasing academic literature, whether per article or journal subscription, at prices that may be unaffordable for their salary. Nurses in academics face similar issues when they are limited by what specific journal licenses their organizations may have. Ultimately, this may lead to nurses reaching out to colleagues located in other institutions in order to gain access to literature that is needed for their work.

The lack of equity in access to nursing and other disciplinary knowledge further perpetuates issues in nursing, such as the theory-practice gap also, referred to as the academic-practice gap. How can nurses in practice be expected to consider recent and relevant knowledge if they do not have access to it? Some nurses may never realize what they are, and are not able, to access. For example, when nurses’ are on-boarded or oriented into their healthcare institutions, if they are not educated on their resources (such as journal subscriptions or medical libraries – also, why aren’t there nursing or nursology libraries?), how can they be expected to use it for practice, education, or research? Similarly, how can nurses in academia educate or complete research on relevant nursing issues if they are blocked by paywalls (or should we say, selective paywalls – something to consider)? Reaching out to colleagues can result in loss of time/productivity, and coincidentally can place a colleague in an awkward situation. Moreover, this lack of equity in access to knowledge perpetuates a delay in translational research. Remember the old saying that it takes 17 years for research to become practical knowledge? In this day in age where knowledge is produced at such exponential rates, this shouldn’t be the norm.

Solutions for Change: Making Nursing Knowledge a Right

Instead of perseverating on the identified gap at hand, perhaps it’s time to discuss potential solutions and make nursing knowledge a right and not a privilege. Our hope is with this blog you can begin to educate yourself on what is equitable access to nursing knowledge, including potential solutions for change. With this, perhaps you can take some of these solutions back to your institution and colleagues, and keep some in mind for your future work. The following list contains potential identified solutions to creating equity in access to nursing knowledge.

1. Blogs on Nursing and Nursology

Blogging, as well as reading nursing blogs, is a great way to engage with the global nursing community without borders. Through these interactions, you have the capability to learn more about the work of others (whether in-process or complete) be exposed to new ways of thinking, have discussions around important topics, receive feedback on your work, and be referred to relevant and available resources. For example, on Nursology.net you can find blogs on resources for teaching, sociopolitical issues, student perspectives, and exemplars for theories, philosophies, and more. Other notable nursing blogs (such as at the American Journal of Nursing or Advances in Nursing Science) offer an opportunity for nurses to read about and discuss scholarly issues without a fee. Interestingly though, many academic journals do not have an adjacent blog. Perhaps it’s time for editors to consider integrating a blog for their journal, and maybe it is time for you to consider writing a blog about something you are passionate about?

2. Journal Clubs

While journal clubs get a bad reputation for disorganization and/or low participation, they are an effective way to develop community for equitable knowledge access. Whether internal to your institution, or external with colleagues (what about a journal club for practicing nurses AND nurses in academia?!), a journal club can be a great way to help disseminate relevant nursing knowledge to colleagues who otherwise wouldn’t be exposed. Additionally, journal clubs help stimulate discussion on potentially overlooked issues and knowledge gaps, driving our discipline into the future.

3. Nurses On Boards

Often when we think about boards, we picture a dry and unproductive boardroom meeting that could have been summed up in an email (also referred to as CHBAE). This is not to say that this doesn’t occur… but, nurses are hugely underrepresented on boards across the U.S. (and probably the world). The Nurses on Boards Coalition “represents national nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions.” How does this relate to knowledge equity in nursing you ask? Well, if nurses are underrepresented on boards, ultimately, what is approved as valid knowledge within an institution (think about hospitals here) will lack a nursing voice. Conversely, if nurses have a voice on boards, they can bring their unique disciplinary perspective to the institution and help drive what IS considered as valid knowledge. Think back to the medical library versus nursing library comment above, or maybe you have another example in mind? That being said, think how your voice could impact your institution on a board, and how that voice could help shape the future of knowledge equity in nursing.

4. Development of Anthology’s on Nursing Knowledge

In 1986, the book titled “Perspectives on Nursing Theory” was published by Dr. Leslie Nicoll which “is an anthology of classic and contemporary peer-reviewed articles that address various theoretical and philosophical perspectives on knowledge development in research and practice” (Reed & Shearer, 2012, p. vii). Since the original publication, there have been six editions of this book, most recently by Dr. Pamela Reed and Dr. Nelma Shearer. This book is an exemplar of what nurses in academia can do to promote access to knowledge for those in the practice environment. Dependent upon the area of expertise (whether theory or perhaps another topic) similar books can be developed that are a collection of the classic and contemporary peer-reviewed articles that address the area of interest. Moreover, as new editions are developed (hopefully faster than 17 years), practicing nurses have an ability to access essential knowledge which helps bridge the theory-practice gap, and simultaneously, translate research into practice. In addition, in light of environmental concerns related to book production, authors, editors, and publishers should consider decreased prices on electronic book versions to decrease their carbon footprint, and also to increase access to nursing knowledge.

5. Open Access Nursing Repositories and Journals

Open access journals and repositories make original research freely available via the internet. While there are concerns around the quality of articles contained within open access repositories and journals, there are acceptable options provided by notable nursing organizations. For example, Sigma Theta Tau International hosts the Virginia Henderson Global Nursing e-Repository (otherwise referred to as the Henderson Repository). The Henderson Repository “is the only repository solely dedicated to sharing works created by nurses around the world. It is an open digital academic and clinical focused service that freely collects, preserves, and disseminates full-text nursing research, educational, and evidence-based practice materials in a variety of formats and item types.” You can even find posters that have been presented at conferences, such as the Nursology Theory Collective’s poster at the King Conference in 2019. Lastly, there is also an underlying community collection that contains theses and dissertations that have been completed and defended, making it easier to access unpublished works (which is also important!). That being said, have you shared your important work with a nursing repository?

6-?. You decide!

Image copyright of Shannon Wheller

While this list is not exhaustive, this is just the beginning. If you have any further solutions to suggest on how to promote equity in access to nursing knowledge, please comment below. Remember, there are no wrong answers! We believe in the incorporation of nursing theory into practice, and practice into nursing theory, and we suggest that to support our discipline we need to close the gap in access to knowledge. Nurses in academia and practice need each other. We are interdependent and better together. We hope that in the process of closing this gap, we can foster collaboration across settings between nurses, ultimately bettering the health and well-being for all. 

Nursing knowledge should be a right and not a privilege, and we all need to work together to enable it to be that way.

Note: The Nursology Theory Collective would like to thank Mike Taylor for bringing up this important issue to discuss with the Nursology community.

References

Reed, P. G., & Shearer, N. B. C. (2012). Perspectives on nursing theory (6th ed.). Lippincott Williams & Wilkins.