Recently, several Expert Panels of the American Academy of Nursing collaborated to draft a new conceptual framework and consensus statement related to social determinants of health. The year-long endeavor integrated the thoughts and expertise of 15 nursing leaders. The outcome of our work directs nursing actions toward health policies supporting actions at multiple levels (i.e., upstream, midstream, and downstream) to promote equity in planetary health-related quality of life. We propose that planetary health-related quality of life, individual and population factors, and environments are the overarching societal contexts in which population health concerns arise. These population health concerns are articulated by stakeholders who, in turn, are the catalyst for population-focused nursing actions.
These population-focused nursing actions occur at multiple levels, in a variety of settings with a variety of persons and groups, and shape health policies, systems and services. Over time, the actions and interactions depicted by the cycle change the societal contexts and may lead to enhanced planetary health-related quality of life. We underscore the crucial need to eliminate systemic and structural racism if equity in planetary health-related quality of life is to be attained. We presented our findings and implications for action during a policy dialogue at the American Academy of Nursing Policy Conference in October 2020. Collaboration on this project inspired the following call-to-action.
Call to Action
Nurses are consistently ranked the most trusted profession by the American people. This trust is earned by the demonstration of care for people, day in and day out, in a wide variety of settings. It is time for all nurses do something to address the social determinants of health. We propose three concrete approaches.
The first two approaches can be summarized as praxis. According to Paulo Freire in Pedagogy of the Oppressed (1972), praxis is reflection and action on the world to transform it.
Reflection, the first approach, is often overlooked in calls for action. Yet we need to take a moment to reflect on what we mean by social determinants of health and what nursing actions in this space will help us achieve health equity. The consensus makes clear that equity cannot be achieved at any level (local, national, or global) until all forms of structural racism are eliminated. Eliminating structural racism should be a shared goal for all nurses.
Take action on social determinants to create transformative change is the second recommended approach. Action differs depending on our role. The consensus paper draws on the conceptual framework to provide several examples of population-focused nursologists’ actions to address policy issues. The common themes from the examples are that nursologists need to have a seat at the table when all policies are developed, using a Health in All Policies approach, which includes policymaking across sectors, not only those policies directly related to health, and nursologists need to advocate for policies that have been shown to effectively advance health equity.
Black, Indigenous, and Hispanic people in this country are experiencing disproportionately high rates of illness and death from the COVID-19 pandemic. To address this syndemic (Poteat, Millett, Nelson, & Beyrer, 2020), we need to address the structural racism at the root cause of these disparities. Who better to forge the path forward, than this group of nursology leaders? It is time to move to action.
Inspire action on the environment and social determinants of health is the third approach. Another population-focused nursologists’ action from the conceptual framework posits that nursologists must build coalitions to be successful in this work. Others need to be inspired to join the effort. If nursologists are unsure of how to inspire, or lack inspiration themselves, they can read a few blog posts on nursology.net or nursesdrawdown.org for examples. Nursologists can also go to #nursetwitter where there are conversations about nursologists addressing the social determinants of health along with reflection and discussion on how to dismantle structural racism within nursology. Nursologists can also be inspired by leaders who advocate for nursology by serving on boards, writing op-eds, acting as expert sources for the media, reaching out to legislators, and/or running for office themselves. Inspiration comes in many forms. There is an energy and passion required to do this work and if you have the capacity, please help inspire others to join the movement.
We leave you with the call-to-action to reflect, act, and inspire. We look forward to continuing this conversation.
Freire, P. (1972). Pedagogy of the oppressed. Herder and Herder.
Poteat, T., Millett, G. A., Nelson, L. E., & Beyrer, C. (2020). Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics. Annals of Epidemiology, 47, 1–3. https://doi.org/10.1016/j.annepidem.2020.05.004
About the contributors;
The authors are writing as nursology colleagues who have worked together through the Environmental and Public Health Expert Panel at the American Academy of Nursing (AAN). Paul and Teddie are the past and current chair of the expert panel and fellows of AAN and Kelli worked with the expert panel through the AAN Jonas Policy Scholars Fellowship program.
Kelli DePriest, PhD, RN
Dr. DePriest is a health policy and research fellow at the Institute for Medicaid Innovation and adjunct faculty at the Johns Hopkins University School of Nursing. Her research mission is to investigate strategies to leverage innovation in the Medicaid program to improve and/or inform the development of interventions and policies designed to achieve health equity for children and families living in poverty. Twitter: @kellidepriest
Paul Kuehnert, DNP, RN, FAAN
Dr. Paul Kuehnert is President and CEO of the Public Health Accreditation Board, the national non-profit organization that sets standards for and accredits governmental public health departments in the United States. Dr. Kuehnert’s career spans nearly 30 years of providing executive leadership to private and governmental organizations to build and improve systems to address complex community health needs. Dr. Kuehnert is a pediatric nurse practitioner and holds the Doctor of Nursing Practice in executive leadership as well as the Master of Science in public health nursing degrees from University of Illinois at Chicago. He was named a Robert Wood Johnson Foundation Executive Nurse Fellow in 2004, a Fellow in the National Academies of Practice in 2010, and a Fellow in the American Academy of Nursing in 2015. Twitter: @PaulKuehnert
Teddie Potter PhD, RN, FAAN
Dr. Potter is Clinical Professor, specialty coordinator of the Doctor of Nursing Practice in Health Innovation and Leadership, and Director of Planetary Health for the University of Minnesota School of Nursing.
2020 was the year I applied trauma-informed approaches to my teaching. This was the year I learned being kind and compassionate were also good pedagogical practices. In previous years, I have been recognized as an “award-winning” teacher. I did all the things a good teacher in a research-intensive university was supposed to do: Incorporated students into research studies that also met course learning objectives, developed innovative teaching/learning methods, integrated solid student accountability into my syllabi, and so forth. And I wasn’t an uncaring teacher before 2020, but perhaps I wasn’t quite so compassionate. Perhaps I was fearful that by showing compassion, I would be less likely to hold students to a high standard of performance.
2020 was different. Many of my master’s students enrolled in the theory course became ill with COVID, or their family members did, or they endured significant traumas or confronted and processed past traumas. Several of the students were frontline workers, faced with COVID on a daily basis. This year, I used the resources on nursology.net by asking them to read two blogs and critique them in their discussion forum – many selected the blogs on issues the nation confronted this year, especially racism and racial disparities. This exercise brought theory to them in a way that no textbook ever could. These blog-writing nursologists were living narratives of those actively advocating for nursing knowledge and theory. As the students prepared their final papers, I saw this year’s learning was at a higher level than previous years and in the context of a virtual platform. Students, preparing for an advanced practice role, stated, “I think differently now.” Nursing knowledge and the distinction between nursing and medicine at the nurse practitioner level has never been more important for us as a discipline.
As a teacher, I learned that I didn’t have to diminish student accountability. But in order for them to take responsibility, I had to gain their trust by authentically showing compassion. Each week, I crafted an email to the class with reminders and updates, and this year, a bit more. I offered hope by reminding them the pandemic would be over at some point. I offered validation that what they were accomplishing wasn’t easy. And I offered them purposeful access to me through technology if they got “stuck.” When I would meet with students, they would thank me for these emails, describing how they would revisit them if they felt “down.” Several wrote me messages of gratitude and described how they looked forward to them every week. In a trauma-informed way, I created a transparent, safe space and established a connection as their teacher. I know now that listening, recognizing trauma, taking time to meet one-on-one, reaching out to “missing in action” students to inquire if they’re okay, giving grace on assignments, and still holding students to a high level can be compatible, and more than that, best practices in trauma-informed education.
2020 was the year that… “Be careful what you wish for,” once again became imprinted in my brain as truth.
In early 2019, the World Health Organization (WHO) announced that 2020 would be the “International Year of the Nurse and Nurse Midwife.” Among colleagues, there was lots of excitement about this. What would we do to recognize and celebrate this recognition? I heard many ideas—editorials, articles, museum displays, seminars, webinars—maybe we’d even get a stamp! The last time we had a commemorative nurse stamp in the US was 1961, almost 60 years ago. Seems like we were overdue for one.
And then, two months into our memorable year, COVID-19 hit. The world started locking down before the US, but for me, my unforgettable day was March 13 (a Friday, of course) when a symptomatic friend tested positive for the virus. Suddenly, everything changed. We all went into lockdown and remote work became the norm. I tried to figure out how to run a free clinic by phone and email (believe me, it’s not easy). I experienced two weeks of panic, followed by three months of bewilderment, and then settled in for the long haul, which is still ongoing.
Meanwhile, nurses were everywhere. The evening news was flooded with images of nurses in ICUs, EDs, nursing homes, and more. There were interviews with nurses crying, their faces bruised from their PPE googles, mourning their dying and dead patients, wondering if they could have done more. They worried about having enough PPE, their families, and their own health. At the same time, we were celebrated with impromptu parades, celebrations, signs on the street: “Heroes Work Here!”. I was offered a 50% discount at the car wash, but I declined. I figured that as a small business, they needed the money more than I needed a modest saving on washing my car.
We even got a TV show, creatively named NURSES with this tantalizing description: “The series follows five young nurses working on the frontlines of St. Mary’s hospital dedicating their lives to helping others, while figuring out how to help themselves.” Will those nurses be nursologists? Time will tell.
On the other side of the coin, the virus was taking its toll in multiple ways. As of the end of October 2020, the WHO presented an analysis that 1500 nurses worldwide had died of COVID-19, although they admitted that this figure was probably grossly underestimated. The White House put together a coronavirus task force in January that included (according to the New York Times) “internationally known AIDS experts; a former drug executive; infectious disease doctors; and the former attorney general of Virginia” but no nurses. President-elect Biden also put together a task force that seemed more diverse but once again, nurses are conspicuously absent from the membership. At a meeting of nurses in the Oval Office to commemorate National Nurses Day in May, Sophia Thomas, President of the American Association of Nurse Practitioners was rebuked by Donald Trump when she stated that there was sporadic access to PPE throughout the US. “Sporadic for you, but not sporadic for a lot of people,” Trump said. “Because I’ve heard the opposite. I have heard that they are loaded up with PPE now.” Thomas was bullied into politely agreeing and backing down from her original statement. This is not the first time I’ve seen this happen, and it makes me angry every time.
Where is the correct middle ground? Do we want to be “angels,” “heroes,” and members of the “most trusted profession” (according to Gallup, 15 years and running)? Or do we want to be nurses at the table, nurses setting policy, nurses seen as leaders, decision makers, and agents of transformation through research, practice, and education? In other words, nursologists? 2020, our “year” gave us lots of the former, not so much of the latter. And thus I say, “Be careful what you wish for.” I worry that our year of recognition will ultimately reinforce stereotypes and not result in meaningful change. To those in our ranks who have sacrificed their lives, and to others who are dealing with ongoing health issues from COVID-19, both direct and indirect, I hope that is not the case. Maybe with the spotlight off, we can get back to business and work to make incremental, but lasting change, which seems to be what nurses do best. That is my wish for 2021—but I’ll be honest—I would still like a stamp!
Anyone alive today (except the yet unborn!) will forever relate a memorable end to this sentence . “2020 was the year . . . “! For a handful of humans all over the globe, there will be those who end this sentence with “2020 was the year I was born, and I survived the great pandemic.” Some will also add that someone in their family did not survive , or someone was permanently affected by the ravages of the virus – a fact that will follow them in all the years to come. Of course how we each end that sentence (and the paragraphs that follow that sentence) will change with time, but our nursology.net team members pitched in to share how we are remembering this unprecedented year as it comes to a close in this and in the first few posts of 2021.
2020 was the year that my 5-year old Cuban/Chinese/Hawaiian/Haole grandson Dylan started kindergarten in daily zoom “classes” with his 24 classmates and fortunately with a very talented kindergarten teacher! His parents and I reflect mournfully on what he is missing by not going to his physical school – a school they selected because it is a public dual-language (Spanish/English) immersion school. The school is located in a zip code with one of the highest rates of COVID-19 cases and deaths in the city Oakland CA, and where racial tensions between police and the community have escalated. But they are both public school teachers, deeply committed to social equity and to ending social disparities, and are seeking to be part of the solutions to the many challenges faced in disadvantaged communities. So here we are at the end of 2020, in the midst of so much suffering that could have been prevented if the situation had been managed differently – suffering that is tragically amplified in disadvantaged communities. Like public school teachers and so many other public servants, as nursologists, we know so many ways in which the knowledge of our discipline could re-direct and re-shape the experience of the COVID-19 pandemic, and how our perspectives – our values and priorities as nursologists – could be mobilized to end health disparities. The growing response to Nursology.net over the course of the year suggests that 2020 may have been the year when widespread recognition and respect for the discipline took hold, when nurses all over the world began to see the significance of our disciplinary knowledge. Just as 5-year-old Dylan has learned the basics of reading and writing (in both Spanish and English) in the face of unprecedented circumstances, so too may it come to be recognized that nurses, in 2020, have learned anew the “reading and writing” fundamentals of our discipline.
2020 was originally destined to be the year of the nurse and midwife, but it really turned out to be a year of uprising. A year of change and adaptation. A year of learning and unlearning. It was a year of putting action behind our thoughts and words, questioning what we know, and standing up for what’s right — even in the most difficult and darkest of times. We protested, marched, wrote letters, and voted. We began to question our role as nurses in the oppression and marginalization of patients and each other. In 2020, I am proud to call myself a nurse but I know that I, and we, still have a lot of work to do. I hope that we never lose the awareness that 2020 has given us and that we can carry it on to the future to better ourselves, better each other, and better the world.
On a personal note, 2020 has catapulted my private and professional life in many directions. In July, my partner graduated from his emergency medicine residency program after spending the previous 4 months straight caring for COVID-19 patients on the frontline during Ohio’s first wave. I won’t lie that I was (and still am) worried about his health and well-being on the frontlines. Simultaneously, he was (and is!) worried about bringing home COVID-19, as I have underlying health conditions that place me at heightened risk. It is not phased on me that many nurses, physicians, and other healthcare providers have lost their lives during the pandemic working on the frontlines. I am grateful that so far we have both maintained our health, and I hope that with a vaccine around the corner that soon we will be able to provide better protection to our frontline workers and the patients they care for.
Since he graduated my partner accepted a job in Washington state as a physician in the emergency room. Because of this, we ended up moving from Ohio to Washington in July. Prior to us moving, I submitted my IRB application for my dissertation, and to my surprise as we crossed the state line into Washington my application was approved! Since then, we got married (outdoor Zoom wedding!), I have completed my data collection, and currently I am diligently working on my data analysis. I hope to defend my dissertation, (probably over Zoom, note the theme here) in the Spring of 2021. But with all of this, I think what I have taken to heart is the only constant is change… and while that change may not have been what you wanted it to be, if you are willing, open, and present, change can have a positive impact in your life – greater than you ever imagined. I can honestly say if you had asked me where I would be five years ago, I would have given you a completely different answer. I am grateful for where I have ended up, but I am excited to see where 2021 takes me (and us).
The year 2020 was my year of sustained close encounters o f the healthcare system kind. Although these encounters were not of the third kind, these were potential for encounters with those who could have been aliens to me. These encounters began on February 10th, when my husband, John, fell on ice outside our house in Maine. I was at UMass Boston at a lunchtime seminar when I received a phone call from a stranger – a woman who was driving by our house and saw John on the ground. She stopped, called 911, and then called me. The local ambulance crew took John to the local hospital about 15 miles away. An x-ray revealed he had a fracture of the proximal end of his left humerus. The orthopedic surgeon on call discussed options, and he and John decided on a closed reduction. So far, a seemingly reasonable decision, so to avoid surgery.
I changed my flight reservation (I typically fly on Cape Air between Maine and Boston) to that evening and saw John at the hospital at about 9 PM. He was in some pain controlled by opioids. He was discharged home the next day with referral for home PT and OT, which were helpful. I arranged for some grab bars to be installed in the house to ease John’s walking between our living quarters (we have a large house that also contains our toy museum) and the bathroom –excellent help from the across the road (we live on US Route !) hardware store staff. PT and OT continued until February 20th when John’s pain became intense. So, another call to 911, another trip to the local hospital, this time seen by a different orthopedic surgeon. X-ray revealed that the closed reduction had failed. Mutual decision to have surgery, especially when the MD told us that he “loves shoulders!” Surgery on February 24th followed by OT and PT while still in hospital, until March 1, when John woke up at about 2 AM with intense pain, soon discovered to be a massive hematoma. Off to surgery that day (even though it was a Sunday). Finally to a skilled nursing facility at a very nice life care community for rehab on March 3rd until John finally came home on April 9th with referrals to home nursing (John experienced a 3 cm dehiscence of the surgical site, so dressing changes were needed) and PT. I am very pleased to let you know that John has recovered almost completely now. The surgical site closed eventually, PT and home RN were not needed by about early May (the home health RN continued longer than I thought necessary, as I can change surgical dressings!), and his arm has almost full mobility. He was finally discharged from orthopedic follow-up visits in September, so no more trips to his office. John now walks very hesitantly so as not to fall, which is a good thing, although difficult for me to witness.
My close encounters with the healthcare team members were much more positive than I would have expected. I did not even have to advocate for John, as his medical and nursing care were efficient, effective, and caring. The second orthopedic surgeon (I had not met the first one) included me in all discussions about John’s condition without my asking for this information, even calling me once when I was at work at UMass Boston. The PT and OT persons included me in their plans of care for John. The hospital and skilled nursing facility staff nurses were caring, expressed their concerns about John, and were receptive to my talking with them about nursology – I gave each one of them our nursology.net card, of course!
The most difficult aspect of the healthcare system encounters came on March 12th, when Covid-19 came to Maine, and I was no longer allowed to visit John at the skilled nursing facility. We tearfully said good night that evening, and I promised to call him every day at 5 PM. John does not enjoy talking on the telephone, so I was surprised that he agreed to my calling him. Obviously, he needed contact with me. Indeed, when I occasionally called a few minutes after 5 PM, he expressed concern that I had had an accident. So, here we are in November 2020, with me at home in Maine all the time—UMass Boston has been doing remote teaching/learning since March 23rd (end of our spring break). Although occupied by teaching and lots and lots of zoom meetings with colleagues – I think we may have invented extra meetings to maintain contact while not on campus together—and my usual writing projects, the second half of spring semester and all of fall semester has seemed like a sabbatical – no commuting to work, more time for self-care, less worry about the possibility of John falling when I am not at home. 2020 is not a year I would like to repeat but it has not been too challenging for me, for which I am forever grateful.
Jane K. Dickinson
2020 was the year with no break.
I work in diabetes, and we often discuss how there is no break from diabetes. Even then, we find little ways to take “breaks” – have a family member help out; cut down on the number of daily fingersticks for a few days; carb out on a holiday; etc. I recently got an email from an organization that was announcing they are taking a break from December 19th to January 3rd. They are giving their entire staff this time to “rest and rejuvenate.” Reading this message really made me stop and think about how we all need a break. And how many nurses don’t get a break – from working on the front line exposed to health and human trauma, to literally not having time to eat a meal or go to the bathroom.
2020 was the year with no break from uncertainty. Often nurses work with people who are dealing with uncertainty and this year nurses had to deal with uncertainty in so many ways themselves – all the while helping their patients, students, staff, and family members handle the chaos that everyday life dealt us.
2020 was the year with no break from upheaval. Things were constantly changing – messages, scientific reports, numbers, job security – and yet we just kept going.
2020 was the year with no break from distraction and loss. The kids who are supposed to be at college came home. The kids who are supposed to be in elementary, middle, and high school, began homeschooling. Parents became teachers. Teachers became online instructors. People lost jobs and businesses and loved ones.
2020 was also the year with no break from accomplishment and innovation. Nonprofits and churches and schools got creative. Boards met virtually and made important decisions for their organizations. National and international conferences went online and delivered valuable content. Families and friends met through video conferencing – sometimes groups who hadn’t seen each other in a very long time! More and more nurses have become familiar with Nursology.net. They are accessing its abundant resources to further nursing knowledge to improve nursing education, research, and practice and ultimately the human health experience.
My wish for 2021 is that all nurses get some sort of break to rest and renew, and know that our work is vital to humankind. Happy New Year!
Do we allow or invite people to participate in research? Do we refer to people who volunteer to be in a study as subjects or respondents or informants or participants or people?
This blog is about the language we use when we present or publish our research. The impetus for this blog was a colleague’s recent declaration that people were “allowed” to share their experiences of a health related condition for a study. The blog is a follow up to a previous blog that addressed the implication of power when using words such as compliance and adherence and, perhaps, even concordance (Fawcett, 2020), as well as another previous blog focused on diverse meanings of power (Fawcett et al., 2020).
Upon hearing my colleague state that people were “allowed,” I immediately thought: What is meant by indicating that a researcher “allows” people who volunteer to be in a study so to provide answers to the researcher’s questions in an interview format or via a numeric survey? Does stating that the researcher “allows” the people who volunteer for the study to do whatever the researcher wants them to do mean that the researcher holds power over them? Is a “power over” relationship appropriate for what many nursologists claim as a core value and approach to people, that is, “relationship-centered care?” (See Wyer, Alves Silva, Post, & Quinlan, 2014). Does “allowing” people to share experiences for the purposes of research connote “paternalism, coercion, and acquiescence” (Hess, 1996, p. 19), Should we instead “invite” people to share their experiences or answer our survey questions or accept our experimental interventions?
Although most, if not all, nursologists who conduct research no longer refer to the people who volunteer to be in their studies as “subjects,” these people continue to be referred to as “respondents,” the term frequently used when people respond to a numeric survey, or they continue to be referred to as “informants,” when they answer open-ended interview questions. Perhaps most frequently, the people are referred to as a sample or population of “participants.” Until very recently, I was content with referring to people who volunteered for research projects as “participants.” However, I have begun to think that if we nursologists truly value and support relationship-centered care, we should personalize those who volunteer for our research projects. For example, many of the people who have volunteered for my Roy Adaptation Model-guided program of research (Clarke & Fawcett, 2014; Tulman & Fawcett, 2003).) are women during the childbearing phase of life. Should I refer to these people as women rather than participants?
I invite readers to offer their ideas for words that are most compatible with nursologists’ values about our relationships with people who volunteer for our research projects.
Clarke, P.N., & Fawcett, J. (2014). Life as a nurse researcher. Nursing Science Quarterly, 27, 37-41.
Hess, J. D. (1996). The ethics of compliance: A dialectic. Advances in Nursing Science, 19(1), 18-27.
Tulman, L., & Fawcett, J. (2003). Women’s health during and after pregnancy: A theory-guided study of adaptation to change. Springer.
Wyer, P. C., Alves Silva, S., Post, S. G., & Quinlan, P. (2014). Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care. Journal of Evaluation in Clinical Practice, 20(6), 881–889. https://doi-org/10.1111/jep.12224
with Jane Flanagan (past SRS President) Marlaine Smith is current SRS President
The 33rd Annual Society of Rogerian Scholars (SRS) Conference, Celebrating our Past and Visioning our Future, was held on October 2, 2020 through a virtual format. The conference was a celebration of the 50th anniversary of the publication of Martha Rogers’ groundbreaking book An Introduction to the Theoretical Basis of Nursing. While many of Rogers’ ideas in this book changed significantly since 1970, this publication represents the birth of the Science of Unitary Human Beings (SUHB).
There were over 100 participants from across the world registered for the conference. The conference keynote, “The Contributions of Martha E. Rogers Over the Past 50 Years: A Conversation”, was presented by Dr. Violet Malinski and Dr. Anne-Marie Leveille. Dr. Leveille, a former student of Dr. Malinski, posed questions and comments to Dr. Malinski, and Dr. Malinski offered a detailed historical account of the evolution of the SUHB from the perspective of one of the founders of SRS and a student and mentee of Rogers. This presentation is an essential resource for anyone interested in the SUHB, a “must see” for all new and continuing students of Rogers’ science. This video is available here on the Nursology website.
Following the keynote, Drs. Dottie Jones, Howard Butcher and Marlaine Smith offered their perspectives in a panel discussion on “Re-envisioning Possibilities for the Science of Unitary Human Beings into Practice, Education and Research on Human Wellbecoming”. The panel was followed by the Martha E. Rogers Scholars Fund scholarship recipients, Drs. Kathryn Post and Philip Gimber, presenting their research findings and the impact on Rogerian Science, specifically Barrett’s work on Knowing Participation in Change. Each used the Knowing Participation in Change Short Form (KPCSF) or version III tool in their work.
Dr. Gimber used the KPCSF tool in a study exploring power and its correlation to quality of life and self-health patterning in persons with chronic illness. He found that there was a two way correlation between power and self-health patterning and power and quality of life. Dr. Post used the KPCSF to examine power and quality of life and patient activation in a nationwide sample of over 300 participants with breast cancer and found that quality of life and patient activation were strongly correlated with KPC.
Last but not least, Dr. Jane Flanagan presented “A Futurist Talk: Possibilities of Rogerian Science for Future Wellbecoming”. Dr. Flanagan’s keynote wove, photography, poetry and music into a tapestry of meaning to inspire us to realize the potentials embodied in unitary science. The presentations by Post, Gimber and a modified version of Flanagan’s talk are available on the SRS website at https://www.societyofrogerianscholars.org/conference-information.html.
The Society of Rogerian Scholars is nearly 35 years old. Its mission is to advance nursing science through an emphasis on Martha E. Rogers’ SUHB in the focus areas of nursing education, research and practice and in service to humankind. The organization convenes annual conferences, publishes the journal Visions, and provides mentorship, education and consultation to those interested in nursing research, practice and education from a unitary perspective. The Martha E. Rogers Scholars Fund, the independent development arm of the SRS, sponsors lectureships at the SRS conferences and provides scholarship support to students whose research focuses on unitary science. SRS welcome new members and is especially interested in recruiting a more diverse racial/ethnic membership.
Details of the program for the March 17-24 Virtual Nursology Theory Week are now available on the Nursology Theory Conference Website, including details of the “breakout sessions” for the week! Once you register, you will have access to any and all of the conference virtual events, as well as the digital Guidebook containing all of the conference program information, information about all speakers, and slides that will be included for many of the sessions.
The 3 General Sessions (Wednesday March 17, Monday March 22, and Wednesday March 24) will be Zoom Webinars (only the speakers and moderators will be visible; participants will interact using “chat”). The 30-minute Breakout sessions will also be Zoom Webinars with 3 “breakouts” in each webinar block, giving each presenter time to present and respond to questions and comments posted in the chat. Each day will end with “Daily Discussion” – Zoom regular meetings – open to all conference participants where you will be visible to one another and can have open discussion of the issues of the day.
The preliminary program schedule is subject change as the time for the conference nears. All who register will have access to the conference “Guidebook” which will show the final program schedule along with zoom login details for each session, and any slides used in the presentations that speakers want to share with participants.
If you registered for the 2020 conference and held over your registration for 2021, you are all set! If you registered for 2020 and asked for a refund, you will be able to now register for 2021 at a “renewal rate,” and will be contacted by Leslie Nicoll to work out the details. If you have not previously registered – you can do so now!! This promises to be a landmark event – so hope you can “be there!”
This blog is meant as a follow up to Christine Platt’s (2020) blog, “A Nurse Practitioner’s Perspectives on Theory in Practice.” Ms. Platt’s mention of primary care led us to recall primary nursing. Primary care refers to the type of care offered by nursologists, typically nursologists who hold graduate degrees and who are considered nursologist practitioners (NPs), such as adult and gerontological NPs, family NPs, and psychiatric-mental health NPs.
Primary nursing, which we call primary nursology, refers to the way in which nursologists offer care. It is a care delivery model that was introduced in the 1960s, and is characterized by “accountability, advocacy, assertiveness, authority, autonomy, collaboration, continuity, communication, commitment, and coordination” (Watts & O’Leary, 1980, p. 90). In particular, the primary nursologist is responsible for one or more patients for the entire duration of hospitalization or other clinical setting. Tiedeman and Lookinland (2004) explained:
Each patient is assigned a specific primary [nursologist] based on patient needs and the [nursologist’s] abilities. The primary [nursologist] assumes 24-hour responsibility and accountability for assigned patients for the duration of their hospital [or other clinical setting] stay and has the responsibility and authority to assess, plan, organize, implement, coordinate, and evaluate care in collaboration with the patients and their families. The primary [nursologist] decides how care should be administered and personally administers it whenever possible. When the primary [nursologist] is not available to provide care, responsibility is delegated to an associate [nursologist] who cares for the patients following the care plans developed by the primary [nursologist] (p. 295).
A mid-October 2020 search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete) revealed that discussions of primary nursing (the search term used) rarely mention any conceptual or theoretical basis. An exception is Webb and Pontin’s (1997) report, in which they described their use of the Roper-Logan-Tierney Model of Nursing Based on Activities of Living as the conceptual model on which they based development of a primary nursology care plan audit tool. The audit revealed that “although [nursologists] claim to use a [nursology] framework to structure their care, this is not evident in the documentation” (Webb & Poutin, 1997, p. 399). Another exception is at the Dana-Farber Cancer Institute in Boston, Massachusetts, where the Synergy Model is used as the conceptual basis for practice, coupled with primary nursing for delivery of nursing care (A. Gross, personal communication, October 30, 2020).
A Reflection on Primary “Nursology”
I (KR) was fortunate to begin my professional career, in the mid-1980s, as a primary nurse on a closed adult psychiatric unit. We were a group of hospital diploma and community college graduates, primarily, mentored by a trio of ultra-competent, assertive, and kind nursing leaders. Our practice was not modeled on any specific conceptual framework. Instead, it was modeled on a commitment to strong interdisciplinary leadership and excellent, compassionate care. Like the attending nurses described by Niemela and colleagues (1992) at the UCLA Neuropsychiatric Institute and Hospital, we coordinated and oversaw the care of our primary patients from admission to discharge. We were, in effect, their case managers; in an era when stays were measured in weeks and even months, we convened cross-disciplinary staff conferences and followed up with multidisciplinary treatment plans. We carved out time in every shift to sit and talk with our patients. Each patient was assigned both a primary nurse and an associate nurse. Both roles were filled by the full-time staff nurses.
Our practice model was, to echo Niemela et al. (1992), a “cost-effective, clinically productive, and professionally attractive role,” in our case for clinicians with entry-level nursing credentials (p. 5). The clinical specialist who headed our team eventually pursued her doctorate, though tragically she did not live to complete her degree. Inspired by her memory and by her enduring example, I’m now pursuing my own nursing doctorate.
The Attending Nursologist
After recalling primary nursology, we recalled the attending nurse, to whom we refer as the attending nursologist. The attending nursologist is a variant of primary nursology. A very special feature of the attending nursologist is the explicit link to Johnson’s Behavioral System Model.
The idea of the attending nursologist is a care delivery model developed and implemented at the University of California-Los Angeles (UCLA) Neuropsychiatric Institute and Hospital in the early 1990s (Dee & Poster, 1995; Moreau, Poster, & Niemela, 1993; Niemela, Poster, & Moreau, 1992; V. Dee, personal communication, October 17, 2020). Fawcett and DeSando-Medaya (2013) explained:
The major focus of [the attending nursologist’s] role is clinical case management. Role responsibilities include direct patient care; delegation and monitoring of selected aspects of [nursology] care; provision of leadership, consultation, and guidance to [nursologists]; and collaboration with [multiple discipline] team members. Moreau and colleagues (1993) reported that the [attending nursologist initiative] was well received by the [nursologists] and members of the [multidisciplinary] team. Moreover, attending [nursologists] reported an increase in job satisfaction and retention and a decrease in role conflict [Moreau et al. 1993]. Neimela and colleagues (1992) reported that the attending [nursologist initiative] increased general satisfaction and role clarity and decreased role tension for the [nursologists], and increased their communication with patients’ family members (p. 71).
Dr. Vivien Dee graciously replied to my (JF) query about her experiences with development and implementation of the attending nurse (nursologist) model of care delivery. She explained that the Dee and Poster (1995)
article was written to show the process taken by a chief nurse to bring about change in the workplace, moving from the Primary Nursing Model to the Attending Nurse Model for the delivery of nursing care. The attending nurse would be responsible for the nursing care of designated patients (from admission to discharge) 24/7, in contrast to the primary nurse (shift-based). The Attending Nurse must be a Clinical Nurse Specialist (Masters- prepared), responsible for self-scheduling, and has the authority to prescribe care based on the scope of practice for independent functions based on the California Nurse Practice Act. [The Dee and Poster] article addresses the phases of change using the Kanter’s Theory of Innovative Change, and the role of the executive nurse leader in creating the change. (V. Dee, personal communication, October 17, 2020)
Referring to the authors of the Niemela et al. (1992) and the Moreau et al. (1993) articles, Dr. Dee noted that Niemela “was the clinical nurse specialist – who assumed the role of the Attending Nurse, [and] Moreau was the nurse manager on the unit where the innovation took place. Poster was the Director of Education and Research”. (V. Dee, personal communication, October 17, 2020). Dee was the chief nurse (and the first PhD prepared nurse executive within the UC Hospital system of five hospitals) who implemented the attending nurse practice delivery model (V. Dee, personal communication, November 5, 2020).
Dr. Dee explained,
“The Attending [Nurse] Model was in place throughout my tenure at UCLA-Neuropsychiatric Institute and Hospital (NPI&H). I retired from UCLA-NPI&H [in] 2005. I have never looked back and have not kept up to date if the system is still in place. I think that the DNP today could very well serve as the Attending Nurse (similar to the Attending Physician role). But we need an executive nurse (CNE) with a DNP/PhD to fearlessly lead and create structures that allow for the full scope of practice for nurses with better patient outcomes.” (V. Dee, personal communication, October 17, 2020)
Ditomassi (2012) explained that the attending nurse practice delivery model also has been used by staff at the Massachusetts General Hospital (MGH) in Boston. “[A]ttending nurses function as clinical leaders, managing the care of patients on a single unit from admission to discharge. The attending nurse interacts with the inter-disciplinary team, the patient, and the family to foster continuity, responsiveness, quality, safety, effectiveness, and efficiency . . . And attending nurses make a commitment to work five eight-hour days to promote continuity and relationship-based care” (Ditomassi, 2012, p. 8). Specifically,
“The attending nurse: • facilitates care with the entire healthcare team. Is a consistent contact for patients, families, and the healthcare team throughout the patient’s care • identifies and resolves barriers to promote seamless hand-overs, inter-disciplinary collaboration, and efficient patient throughput • coordinates meetings for timely, clinical decision making and optimal hand-overs across the continuum of care • ensures that the team and process of care sustain continuous, caring relationships with patients and families that may begin before admission and continue after discharge • develops a comprehensive patient-care assessment and plan using the principles of relationship-based care • communicates with patients and families around the plan of care, answers questions, teaches and coaches • develops and revises patient-care goals with the clinical team daily • organizes team huddles that include the attending nurse and physician, staff nurses, house staff, and other disciplines • serves as a role model for inter-disciplinary problem-solving • meets with families on a continuous basis regarding the plan of care, disposition, goals of treatment, palliative care, and end-of-life issues” (Ditomassi, 2012, p. 8).
The conceptual and theoretical perspectives used in conjunction with the attending nurse practice delivery model at MGH include, as Ditomassi (2012) and D. Jones (personal communication, October 31, 2020), who is a faculty member at Boston College William F. Connell School of Nursing and director of the Yvonne L Munn Center for Nursing Research at MGH (Ives Erickson, Jones, & Ditomassi, 2013), indicated, relationship-based care, as well as Newman’s Theory of Health as Expanding Consciousness and Watson’s Human Caring Theory, as well as an instrument used to measure Barrett’s Theory of Power as Knowing Participation in Change (D. Jones, personal communication, October 31, 2020).
Ditomassi (2012) mentioned that the attending nurse practice delivery model also was being used at New York University and Baptist Hospital of Miami, Florida. An early November 2020 search of the CINAHL Complete database, however, yielded no relevant literature.
We welcome readers to add what they know about and/or have experienced within primary nursing and/or attending nurse practice delivery models and to refer us to other published and anecdotal accounts of these contemporary approaches to the delivery of nursologists’ practice delivery activities.
Dee, V., & Poster, E.C. (1995). Applying Kanter’s theory of innovative change: The transition from a primary to attending model of nursing care delivery. Journal of the American Psychiatric Nurses Association, 1(4), 112–119. http://doi.org/ 10.1177/107839039500100403
Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of conceptual models and theories (3rd ed.). F. A. Davis.
Ives Erickson, J., Jones, D., A., & Ditomassi, M. (2013). Fostering care at the bedside. Sigma Theta Tau.
Moreau, D., Poster, E.C., & Niemela, K. (1993). Implementing and evaluating an attending nurse model. Nursing Management, 24(6); 56–58, 60, 64.
Niemela, K., Poster, E.C., & Moreau, D. (1992). The attending nurse: A new role for the advanced clinician—Adolescent inpatient unit. Journal of Child and Adolescent Psychiatric and Mental Health Nursing, 5(3), 5–12. http://doi.org/ /10.1111/j.1744-6171.1992.tb00123.x
Katherine is a first-year nursing PhD student at the University of Massachusetts Boston, focusing on health policy. She holds a BSN from the University of Illinois at Chicago and a PhD in theology from Boston College.
Contributors: Emma Crocker, DNP, RN Patrick McMurray, BSN, RN Shelley Mitchell, BA, BSN, MS, RN Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN, CNE, FAEN, PhD Candidate Timothy Joseph Sowicz, Ph.D., NP-C
Authors’ Disclosure: The authors would like to note that all members put in equal amounts of work in this project.
Nursing theory is the foundation of our practice, the way we differentiate nursing from other professions and disciplines. As readers of the Nursology blog, we assume that we do not need to discuss why nursing theory is essential to our practice. We would instead like to call your attention to a concerning trend – the lack of nursing theory in associate degree nursing programs. Please note that we are making generalizations based on our experience of graduating from and/or working in associate degree programs. There is a paucity of current research surrounding theory in associate degree programs.
According to the National Council of State Boards of Nursing (NCSBN), in 2019 50% licensure applicants were graduates from ADN and diploma schools of nursing; this number has historically been even higher. In other words, half of our newly practicing nurses may not have foundational knowledge of nursing theory to apply to their practice, further widening the theory practice gap. If theory content is not being integrated into the initial nursing education for half of our profession, how can we convince them it is important, let alone essential to their praxis?
We suspect that several factors contribute to the lack of theory in some ADN programs. Many nursing education programs are externally accredited by agencies such as the Accreditation Commission on Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Previous accreditation standards required nursing education programs to explicitly name the nursing theorists that guide the curriculum. This emphasis has been removed from current standards, allowing nursing education programs to use general educational theorists such as Knowles Adult Learning Theory.
Another critical point is that ADN programs do not usually require doctoral-level preparation for nurse faculty. According to the 2018-2019 National League of Nursing’s annual survey of nursing schools, 74% of schools replied that it was “somewhat difficult” or “challenging” to hire new faculty. The primary reasons cited were an inability to offer competitive salaries and a lack of qualified candidates. ADN programs usually have fewer financial resources and do not have research missions. Therefore, they have difficulty attracting and retaining faculty with research-focused doctorates and higher educational credentials. This may result in ADN faculty who do not have the knowledge and/or experience with integrating theory into pre-licensure education.
Without the requirements of accreditation and with faculty who are not supported and enabled to the inclusion of nursing theory, it is our anecdotal observation that many ADN programs have dropped the emphasis on nursing theory. We have personally worked in nursing education programs where theory is either given cursory attention or not included in the curriculum at all. This has resulted in removing or deemphasizing nursing theory from a large portion of the nursing professional population.
Nursing theory is currently situated in a place where it feels like it only belongs to some nurses, those embedded in academia or research, never practice. This has created a culture where most nurses and students cringe at the thought of theory-based content, with some complaining it has very little to do with “real-world” nursing practice. Nursing theory has not been made relevant to the modern nurse.
Many nurse scholars might use this conversation as yet another reason why the entry level of nursing practice should be raised. Students seeking nursing education in the U.S. encounter many barriers, such as socioeconomic status, geography, structural racism, and more. Many of these students choose to attend ADN programs rather than seek a BSN, especially as their entry to practice. If we want to continue to grow the practice of nursing in the US, we need to support and encourage ADN programs, especially in the integration of nursing theory in practice.
The authors of this blog post greatly value the contributions of ADN programs, ADN graduates, and ADN educators. We would like to challenge all educators, scholars, and researchers to consider how we might restore nursing theory to its rightful place in all levels of nursing education. Nursing theory belongs to all nurses – not just those in higher education.
Nursologists, what do you think?
About the contributors:
Emma Crocker, DNP, RN – CHIPS Health and Wellness Center, St, Louis, Missouri. Emma is a equity driven, population health quality improvement doctorate and advocate, devoted to ensuring the implementation of constituent-centered health policies, enabling communities to thrive located in St. Louis, Missouri. Twitter: @EmmaCrockerDNP.
Patrick McMurray, BSN, RN – Adjunct nursing faculty, Robeson Community College, Lumberton, North Carolina. Patrick is a Adjunct Nursing Faculty at Robeson Community College, in N.C. Patrick is patient about community college nursing education and championing social change via equitable access to nursing education. Twitter: @nursePatMacRN.
Shelley Mitchell, BA, BSN, MS, RN – Professor of Nursing, Austin Community College, Austin, Texas. Shelley contains multitudes. She teaches full-time in Austin Community College’s Professional Nursing Program, which has been voted as the best in the region for three years in a row, and she is deeply involved in the college’s equity and inclusion work. She has a BA in English from Oberlin College in addition to her nursing education, and she reads comics and writes queer romance in her spare time. Twitter: @ProfShelleyRN
Elizabeth Mizerek, MSN, RN, FN-CSA, CEN, CPEN, CNE, FAEN, PhD Candidate – Director of Nursing Education, Mercer County Community College, West Windsor, New Jersey. Elizabeth is the Director of Nursing Education at Mercer County Community College in New Jersey. She is currently a PhD candidate at Widener University in Chester, Pennsylvania pursuing a doctoral degree in Nursing Science. Her research interests include nursing education, patient safety, and emergency preparedness.
Timothy Joseph Sowicz, Ph.D., NP-C – Assistant Professor, UNC Greensboro, Greensboro, NC. Tim is an assistant professor at UNC Greensboro. His research is concerned with aspects of living with heroin and opioid use disorders, especially following an overdose.
As nursing professionals and women’s health advocates, we have watched in disbelief events unfolding in Barron County, Wisconsin. Embrace, a shelter serving survivors of sexual assault and domestic violence in Barron County, is facing backlash for displaying a Black Lives Matter (BLM) sign. Reacting to the sign, local officials stripped the organization of funding worth $25,000 and law enforcement are unwilling to continue collaborating with Embrace.
Embrace, located in Northern Wisconsin, serves a predominantly White populace, but also has a significant population of migrant farmworkers and Somali refugees. Migrant farmworker women face difficulties in accessing help following an experience of violence due to transportation and language barriers. Many refugee women also often have a history of sexual violence and trauma. Black women make up less than 2% of the population in Baron County yet constitute 10% of the population accessing help at Embrace’s shelter. Part of the St. Croix Chippewa tribe is also located in Embrace’s service area. Black women and American Indian (AI) women are disproportionately impacted by violence, but do not ordinarily seek help despite the potential for severe negative impacts such as injury or even loss of life.
The National Intimate Partner and Sexual Violence Survey (NISVS) report shows that 84.3% of AI women have experienced lifetime violence (Rosay, 2016). The NISVS shows 41% of Black women have experienced physical IPV in their lifetime with homicide being one of the leading causes of death for women aged 44 and younger. It is in this context thatEmbrace seeks to serve the most vulnerable populations of women in a four-county area where they are the only available domestic violence shelter.
We are in unprecedented times with an ongoing COVID-19 pandemic that not only disproportionately affects the lives of Black and Brown women and their communities, but also increases their risk of violence and homicide. A recent US study showed a surge in the incidence of severe intimate partner violence (IPV) during the Covid-19 pandemic compared to the previous 3 years, and a decrease in the number of people seeking hospital care (Gosangi et al., 2020). It is important to be clear that this supports the idea that the stressors of Covid-19 including the economic fallout may exacerbate existing IPV but probably does not start IPV that has not existed before. Consistent with what has been seen in some other countries, IPV and sexual assault advocates across the state began to report an increase in self and police referrals to their agencies after the pandemic began (Luthern, 2020).
Domestic violence related homicides have been on the increase in Wisconsin even before the pandemic. According to End Abuse Wisconsin’s Domestic Violence Homicide Report (2020), there were 47 domestic violence related homicide deaths in 2018, and 72 in 2019. And frighteningly, as of September 29, 2020, domestic violence homicide has taken 69 Wisconsin lives this year. If that pattern continues, it is estimated that 93 lives will be lost this year. Also concerning is that 22% of the victims, so far in 2020, were age 18 or under.
Black communities in urban metropolitan areas like Milwaukee are disproportionately impacted by violence in general while also experiencing tensions with law enforcement. Recent acts of police brutality captured on video and circulated widely on social media have implications for community relations with law enforcement. The fear that community members have about police officers potentially using excessive and unjustified force in the policing of Black bodies (Frazer, Mitchell, Nesbitt, et al., 2018) can impact women’s help-seeking following an experience of violence. Black women may want to call the police if they feel like they are in danger from their partner’s abuse but they do not want that partner to be harmed and they usually do not want him to go to jail. They, like most abused women, just want the violence to stop. At the same time, there needs to be a non-racist police response available to abused women who are in fear for their and their children’s lives. There needs to be carefully informed triage (a concept well known to nursing) for 911 calls for IPV so that police are not brought in when not needed but can be brought to homes where there is a high risk for homicide.
Our state has also been the site of civil unrest in the past few months. In Kenosha, the police shooting of Jacob Blake in August resulted in protests requiring the declaration of a state of emergency. Clashes have also ensued between law enforcement and community members in Wauwatosa in the last few weeks as a result of protests for the February, 2020 shooting and killing of Alvin Cole by a police officer. Apart from these incidents that have created not only unrest but also continued mistrust between Black and Brown communities and law enforcement, there have also been concerns about the prevalence of the trafficking and sexual violation of young Black and Brown women. In Kenosha, Chrystul Kizer, a 19-year-old African American woman, was released this year after being charged for killing a man who sexually abused her as a child in what her defense team argued was self-defense (Fortin, 2020). Her defense team spoke of how the criminal justice system fails to protect Black and Brown women and girls and yet also holds them disproportionately ‘accountable’ for crimes that would not be charged in cases of White women and girls. This is eloquently detailed by Beth Richie in Arrested Justice.
Within the past few months, Wisconsin has had a number of Indigenous women murdered and missing. Kozee Medicinetop Decorah (Ho-Chunk Nation) was found deceased on May 16, 2020, a victim of domestic violence related homicide (Volpenheln, 2020). Stephanie Greenspon was found deceased on August 19, 2020. It is suspected that she was also a victim of violence related homicide. Her case is still being investigated by the FBI (Menominee Nation, 2020). Kaitlyn Kelly has been missing since June 17th (Conklin, 2020). There has been little mention of the missing and murdered Indigenous women in local or national media, particularly taking into account the extent of national and even global media attention drawn to the missing of Jamie Closs; Closs went missing in the area where Embrace is located, but she was eventually located.
Given all this, dialogue from law enforcement and local officials indicating willingness and commitment to community safety and wellbeing would be helpful. Instead, the response of law enforcement to Embrace’s display of a Black Lives Matter sign intensifies tensions and mistrust between the police and the communities they serve. It also seriously undermines the vital work of the only shelter in a four-county area, further endangering the most vulnerable populations Embrace serves.
Employing relevant theories to our practice as nurses and liaising with our colleagues across disciplines has now become urgent. Together with colleagues across disciplines, nurses need to support and advocate for survivors of violence. Screening and identification of resources for women is of utmost importance, and shelters like Embrace both ensure the provision of shelter and connect women with urgently needed health and social services. As nurse scholars, we wrote this blog post in collaboration with our colleagues at Women’s and Gender Studies at University of Wisconsin-Milwaukee as part of building coalitions. But we also did so for the purposes of deepening our understanding of the urgent healthcare challenges experienced by the most vulnerable across our state, in the context of the rising tensions and mistrust among various institutions and agencies that exist to enhance the health, wellbeing and safety of all Wisconsin communities.
Violence is central and even essential to the sustaining of social hierarchies that inform the oppression of some groups while enhancing the privilege of others (Collins, 2017). Patricia Hill Collins (2017) points out how without human agency and resistance, institutions can engage in bureaucracies that replicate power dynamics, and even perpetuate normalized violence that maintains dominance and inequities. Law enforcement is one institution, and healthcare, of which nurses are a part, is another.
Robin Walter’s theory of Emancipatory Nursing Praxis comes to mind as one that guides us towards allyship in advancing a social justice agenda in pursuit of health equity, which is central to ensuring the health and wellbeing of the most marginalized in our communities during this time. In order to advance a social justice agenda, there is need for nursing as a profession to partner closely with domestic violence advocates and shelters like Embraceas well as law enforcement officers, who play an important role in enhancing the safety and wellbeing of our communities. We must engage in research and dialogue that would help us reimagine a criminal justice response that acknowledges the context of racism in which Black and Brown women experience violence.
As professionals, we need to respond and to meet their urgent needs for health and safety. It has never been more urgent to engage in the learning processes that Walter outlines, critically reflecting on our social location in relation to those we serve, shifting our worldview and experiencing transformation by expanding our consciousness (Walter, 2017).
Campbell, J. C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, … & Laughon, K. (2003). Risk factors for femicide in abusive relationships: results from a multisite case control study. American journal of public health, 93(7), 1089–1097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447915/
Frazer, Eva et al. “The Violence Epidemic in the African American Community: A Call by the National Medical Association for Comprehensive Reform.” Journal of the National Medical Association vol. 110,1 (2018): 4-15. doi:10.1016/j.jnma.2017.08.009 https://pubmed.ncbi.nlm.nih.gov/29510842/
Gosangi B., Park H., Thomas R., Gujrathi R., Bay C. P., Raja A. S., … Khurana, B. (2020). Exacerbation of Physical Intimate Partner Violence during COVID-19 Lockdown. Radiology, 202866, Epub ahead of print. https://pubs.rsna.org/doi/10.1148/radiol.2020202866
U.S. Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis (2017). Sex, Race, and Ethnic Diversity of U.S, Health Occupations (2011-2015), Rockville, Maryland.
Walter, R. (2017). Emancipatory nursing praxis. A theory of social justice in nursing. Advances in Nursing Science, 40(3), 225-243. Also see Walter’s Theory on Nursology.net
We are grateful for the support and input of the following colleagues from Women’s and Gender Studies: Anna Mansson McGinty, PhD, Xin Huang, PhD, Kristin Pitt, PhD, Gwynne Kennedy, PhD, Melinda Brennan, PhD, & Jeremiah Favarah, PhD
About the contributors
Lucy Mkandawire-Valhmu, PhD, RN is Associate Professor in the College of Nursing at University of Wisconsin-Milwaukee (UWM). Her research focuses on violence in the lives of Black and American Indian women. As a feminist scholar, she seeks to creatively identify interdisciplinary interventions and to inform policy that centers the voices of women in addressing gender-based violence. Dr. Mkandawire-Valhmu also seeks to contribute to the development of feminist theory that would help to advance nursing science.
Jeneile Luebke, PhD, RN is a post-doctoral nurse research associate at University of Wisconsin-Madison. She in an enrolled member of Bad River Band of Lake Superior Chippewa Indians. She received her early nursing degrees (LPN and ADN) in Bemidji, MN, and her BS and MS Nursing from the University of Wisconsin- Madison, and her PhD at UW-Milwaukee. Her area of research and expertise include intimate partner violence in the lives of American Indian women, community health nursing and utilization and application of postcolonial and indigenous feminist methodologies. She is a survivor of intimate partner violence and is passionate about sharing her knowledge and personal experiences to help to support and empower other women to transition to survivorhood.
Carolyn J. Eichner is Associate Professor of History and Women’s & Gender Studies at the University of Wisconsin, Milwaukee. She was a Member at the Institute for Advanced Study in Princeton, New Jersey, in 2015-2016. Eichner is the author of Surmounting the Barricades: Women in the Paris Commune (Indiana University Press); published in French as Franchir les barricades: les femmes dans la Commune de Paris (Editions de la Sorbonne). She has two forthcoming books: Feminism’s Empire, which traces the roots of nineteenth-century French anti-imperialism in the race, gender, and class politics of the era’s first French feminists to engage with empire; and A Brief History of the Paris Commune for the 2021 sesquicentennial of the 1871 revolution (Rutgers University Press). Eichner he is currently writing The Name: Legitimacy, Identity, and Gendered Citizenship. She has published in journals including Feminist Studies, Signs: Journal of Women in Culture & Society, French Historical Studies, and Journal of Women’s History
Kaboni Gondwe, PhD, RN is an assistant professor at University of Wisconsin-Milwaukee College of Nursing. Her research interests are on maternal and child health and she is focused on studying effects on how chronic life stressors moderates the effects of perinatal stress on preterm biomarkers in African American /Black mothers and Malawian Black mothers. She completed her PhD in Nursing from Duke University in 2018 where her research focused on relationship between preterm birth with postpartum stress and mother-infant relationship. She received her undergraduate degree and midwifery training from University of Malawi, Kamuzu College of Nursing and her Master in Nursing Education and Nursing Administration from Ohio University.
Diane Schadewald, DNP, MSN, RNC, WHNP-BC, FNP-BC joined the faculty of the University of Wisconsin-Milwaukee, College of Nursing in 2013 and is currently a Clinical Professor. I have been certified as a Family Nurse Practitioner and a Women’s Health Nurse Practitioner since 1993. As a board-certified Women’s Health Nurse Practitioner, I have experience providing care for Black women as well as AI women who are at risk for or who have experienced IPV. Since working in academia, I have practiced in primary care and am currently working for an online nurse practitioner service. Prior to working in academia, I practiced in an OB/GYN clinic setting. I’m a co-author of Women’s Health: A Primary Care Clinical Guide which is in its 5th edition. I have also lectured on care of women who have experienced female genital cutting and IPV. I’m currently working on an educational research project about female genital cutting.
Peninnah Kako, PhD, RN, FNP-BC, APNP is an Associate Professor at the University of Wisconsin-Milwaukee (UWM) College of Nursing. Dr. Kako’s research focus includes improving health care access for underserved populations, issues affecting women living with HIV in sub-Saharan Africa. Her research also focuses on violence in the lives of women. Her research aims to contribute to efforts that meet primary and secondary HIV prevention needs in sub-Saharan Africa; and build sustainable, timely, and effective interventions to assist African women and their families in accessing treatment and managing chronic HIV illness. Clinically, Dr, Kako has served in underserved populations including corrections as a family nurse practitioner.
Jacqueline Callari-Robinson, BSN, RN is a Doctoral student at the University of Wisconsin, Milwaukee, School of Nursing, Research Assistant for Tracking our Truth, and an on-call SANE Nurse for United Concierge TELESAFE Program. Previously, Jacqueline was the Director of Sexual Assault Prevention and Statewide SANE Coordinator for the Wisconsin Coalition Against Sexual Assault and the Wisconsin Department of Justice. In that role, she developed the Wisconsin adult, adolescent, and pediatric SANE training courses. Jacqueline was also instrumental in the facilitation and creation of the Wisconsin Attorney General Sexual Assault Response Team (SART). Working collaboratively with SANE programs, law enforcement communities, and the Wisconsin Crime Lab, the AG SART addressed patient access to advocacy driven medical forensic care and the composition, handling, and processing of sexual assault kits.
Brittany Ochoa-Nordstrum is set to graduate with a Bachelor’s degree in Sociology in the spring of 2021. As a recipient of a SURF (support for undergraduate research fellow) award, Brittany is working under the mentorship of Dr. Lucy Mkandawire-Valhmu on various projects pertaining to advocacy for marginalized communities of color. Brittany’s area of study is medical racism and its impacts on maternal mortality amongst African American women in Milwaukee. She is applying to Ph.D. programs across the country in Sociology and African Diaspora studies. As a third generation Mexican American, her life experiences often inform her passion for these areas of study. When Brittany is not researching, she is often involved in planning and organizing community grassroots demonstrations and fundraisers to benefit marginalized groups around the city of Milwaukee.
Nicole Weiss is a current graduate student at the University of Wisconsin-Milwaukee pursing a Masters of Sustainable Peacebuilding. Nicole is the project coordinator for the Department of Justice funded project: Tracking our Truth, Providing Access to Advocacy Driven Medical Forensic Care. She received her BA in International Studies at the University of Wisconsin-Milwaukee. Her areas of focus include undertaking a holistic, systems approach to complex issues within our community through facilitation and conflict resolution strategies.
Jacqueline Campbell, PhD, RN, FAAN is a national leader in research and advocacy in the field of domestic and intimate partner violence (IPV). She has authored or co-authored more than 230 publications and seven books on violence and health outcomes. Her studies paved the way for a growing body of interdisciplinary investigations by researchers in the disciplines of nursing, medicine, and public health. Her expertise is frequently sought by national and international policy makers in exploring IPV and its health effects on families and communities.