Launch of BILNOC Leaders Database

We are delighted to launch a database that provides information about Black, Indigenous, Latina/x and other Nurses of Color (BILNOCs) who are (or have been) leaders and scholars who have contributed to the development of the discipline. This will be a significant resource for scholars and students who seek to recognize and honor BILNOC leaders. This database will fill a huge gap that contributes to the underrecognition of the contributions of nurses of color to the discipline.

View the BILNOC Submission Form to review the information we are seeking. You can find a link to the this form from the website “Resources” menu anytime later.

Guest Post: Mid-Range Theory: In the Gap or In The Dark?

Contributor:
Teresa Tarnowski Goodell, PhD,RN,TCRN,CWCN

A recent post by Karen Foli presents a perennial nurse educators’ problem: students finding nursing theory irrelevant in practice. A commenter wrote, “If I have a patient crashing, I’m not going to stand there and theorize about how to treat the patient!.” The remark illustrates the theory-practice gap perfectly; the notion that there is little practical utility in nursing theory “at the bedside.”

Nursing theory describes and differentiates us from other professional disciplines, yet many practicing nurses struggle to integrate theory into their practice, perhaps because nursing theory is not recognized by most practice settings. (I certainly didn’t see much of it in my 30 years in intensive care.)

“the strange fish in water…” by Biscarotte is licensed with CC BY-SA 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-sa/2.0/

Practicing nurses swim in the water of the medical model. Just as the fish says, “Water? What water?” when asked “How’s the water?,” nurses don’t always realize that they are swimming in the water of the medical model in their practice setting. Nurses implement both nursing and medical models, yet only the latter holds sway in many practice settings.

The electronic health record serves as an indicator of the widening theory-practice gap. Filled with checkboxes for medications, procedures, and physical exams, the EHR leaves little room for documenting nursing theory-guided practice. Built on the medical model and optimized for billing and regulatory purposes, the EHR cannot capture self-efficacy, unmet needs, living with unpleasant symptoms or helping, all concepts informed by nursing mid-range theories.

The EHR is also poor at capturing individual characteristics, such as whether someone is a night shift worker who sleeps during the day. Even when mid-range theories are in the back of a nurse’s mind, quietly informing practice, they are not visible in documentation. Because they are not seen, they become less valued by nurses and other health professionals.

The theory-practice gap affects research as well. Evidence-based practice is inhibited by a lack of research guided by nursing theory. While our colleagues in medicine rarely cite a theoretical framework, one is expected, and useful, in nursing research. Nurses acknowledge that there are many ways of viewing health and illness. Still, the medical model predominates in practice settings, inhibiting broader research implementation. Individual nurses can’t implement research based on nursing theory; nursing practice must make sense to others and must be visible in the EHR. Thus, practicing nurses who decry the pointlessness of nursing theory can’t be blamed; they practice in an environment where, for example, documenting self-efficacy for breastfeeding is irrelevant to other users of the health record. There is no checkbox for it.

My cynical side says the medical model is linked to payment and regulatory oversight, and thus will continue to prevail in clinical settings. This calls upon us to ask: how then do we acknowledge, incorporate, and communicate nursing theory within our own profession, and also outside it? How do we implement evidence-based, theory-driven nursing practice when large parts of research and practice are driven by the medical model? Nurse educators have been doing this work, but we also need drivers of change in the clinical setting.

I envision a time when nurses study pharmacology, yes, but other health professionals also study Kolcaba’s Theory of Comfort (for example.) A time when the EHR captures more than medications, procedures and physical exams. When nurse informaticists play a key role in design of clinical information systems, incorporating nursing models, interventions and observations into the EHR. Improving the presence of nursing knowledge in the EHR will not only provide practicing nurses with more complete information about the person, but it will make nursing more visible to other professionals. Changing clinical settings entrenched in the medical model will be hard. How do we develop nurse change agents to get us there?

About Teresa Goodell

Gerontology, trauma, and skin/wound care clinical nurse specialist. Now retired from clinical setting, I serve on the board of a hospice and teach trauma continuing education. I’ve been an RN for 38 years and a clinical nurse specialist for 27 years. Nurse educator in academic and continuing education settings for 26 years.

Guardian of the Discipline – “Lucie S. Kelly: A nurse’s nurse who held us all accountable for being better, doing better”

Contributor:
Marion Broome, PhD, RN, FAAN,
Editor Nursing Outlook, 2003-present

When I entered nursing in 1973, Lucie Kelly, PhD, RN, FAAN was already a well-respected scholar and leader in the field. Lucie obtained all 3 degrees from the University of Pittsburg: her BSN in 1947, a masters in nursing education in 1957 and a PhD in Higher Education in 1965. When she died on November 19, 2020 Dr. Kelly had left her impression on so many of us- nurses in practice, academe and in professional associations.  She held many leadership positions, such as Vice-President of Nursing, Chair and Professor, President of Sigma Theta Tau International,  as well as an academic dean in schools of nursing and public health. She was selected as a Living Legend in the American Academy of Nursing…. Such an apt and befitting title! Finally, her 6 (yes 6!) honorary doctorates speak volumes about her accomplishments as a scholar and leader in nursing. 

Lucie S. Kelly (source)

But here is what I remember about Dr. Lucie Kelly: she was a woman with ‘her own mind’ (not an exceptionally common thing said of most women in the mid-1900s). And she didn’t hesitate to share her ideas with others. Lucie Kelly spoke and wrote about everyday beliefs and practices of nurses across the profession- practice and education. Lucie was editor of Nursing Outlook for several years in the late 1980s.  As an assistant and associate professor I loved reading her editorials then. Lucie Kelly was always questioning existing myths and urban legends in the field. She would often ask readers ‘why’ AND ‘why not’?  For instance, in her editorial in the May-June Nursing Outlook issue of 1988 of Dr. Kelly shared her belief that nurse administrators ought to reach out to those young nurses who hold promise………. “who dare to bang on their doors with confidence and talent” and to groom them for leadership. To not turn them away as ‘too inexperienced, too young’.  She believed it was their mentoring and belief in these young nurses that would lead to the “biggest payoff for all: a stronger future for nursing in the image of the pioneers who dared”.

Source

On that same theme in another issue (Kelly, 1991), Dr. Kelly talked about “The Conundrum of Leadership” and shared her observation about the ‘recycling of the same leaders in nursing’ who were often invited to and assumed positions of influence and powers across many of the professional associations. Of course, she shared, these individuals were the experienced ones, the ‘proven’ ones who people knew and elected. Lucie asked readers to think about that as a viable strategy for leadership longer term or a way to infuse new thinking into the field at a time when it was so sorely needed.  

So many of the issues Lucie wrote about in her editorials are still very real today and deserve ongoing reflection and commentary by contemporary leaders.. That is, just how do we not just encourage but embrace young leaders! How do we make sure we sponsor our emerging leaders in key areas so they can expand their skills and spread their wings. Lucie Kelly’s written words reflected someone who was a wise sage in the field and yet still so ‘young at heart’ and still so willing to embrace those starting out and who stood out as future leaders and scholars.

And she didn’t just write about such. Many of her mentees have shared with me over the years how much faith she had in them and how that made all the difference in their career success.

What stuck me and so many others about Lucie Kelly was her smile and her sense of style which reflected her energy and timeliness, her laughter when with good colleagues and friends. So many of us who did have any opportunity to interact with, listen to, read about, and observe (as young leaders always do) will not just remember what Lucie Kelly said but how she made us feel….like we could spread our wings, could make a difference in our chosen field and maybe, just maybe ‘look and sound like’ Lucie Kelly one day.

Kelly, L. (1988). Calculated risk” Big Payoff.  Nursing Outlook, 36(3), 25.

Kelly, L. (1991).The conundrum of recycled leadership. Nursing Outlook, 39 (1), 5.

Is Medicine a Trade or a Discipline or Profession?

Nursology is regarded as a discipline and a profession, which means that nursology constitutes distinctive knowledge encompassing nursological philosophies, conceptual models, grand theories, middle-range theories, and situation-specific theories (see all content on https://nursology.net and also https://nursology.net/2018/09/24/our-name-why-nursology-why-net/).Medicine, in contrast, is a trade. This assertion is based on my search of literature for several years and pondering the difference between a discipline or a profession and a trade at least since the publication of Donaldson and Crowley’s now classic 1978 article, The Discipline of Nursing. .

I asserted that medicine is a trade in two 2014 publications (Fawcett, 2014a, 2014b) and in 2017, I wrote, under the heading, Medicine is a Trade:

I have never been able to locate any obvious or explicit knowledge that is distinctly medical. A September 18, 2016 search of the Cumulative Index of Nursing and Allied Health (CINAHL Complete) using the search term “medical model” yielded 816 publications. An admittedly quick review of a random sample of the retrieved publications revealed that the term medical model was not defined but rather used in a way suggesting that any reader would know what the term means. (Fawcett, 2017, p. 77)

I have continued to ponder whether medicine should be considered a trade and have wondered why no one has challenged my assertion, at least in any publications or blogs I have seen. Therefore, on January 4, 2021, I expanded my search to other sources–Taber’s Cyclopedic Dictionary, the Oxford English Dictionary, and Wikepedia.

The 22nd edition of Taber’s (Venes, 2013) includes no entry for medical model. Medicine is defined as “the act of maintenance of health, and prevention and treatment of disease and illness” (Venes, 2013, p. 1474). No reference to the knowledge needed to perform the act of medicine is evident. The Oxford English Dictionary also includes no entry for medical model, with only a mention of the term in quotations pertaining to two words, technologizing and miasmatist.

However, two definitions of medicine imply a knowledge base (although not necessarily distinctive knowledge). One definition is: “The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).” The other definition is: “The medical establishment or profession; professional medical practitioners collectively.”

A search of Wikipedia yielded this statement: “Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the “set of procedures in which all doctors are trained.” It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia). Noteworthy is that Laing did not mention the philosophic, conceptual, or theoretical knowledge that would guide the “set of procedures in which all doctors are trained.”

The content in Wikipedia also included an important negative consequence of adherence to the medical model. This consequence is “In the medical model, the physician was traditionally seen as the expert, and patients were expected to comply with the advice. The physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the medical model, it is necessary and to be expected. In the medical model, the physician may be viewed as the dominant health care professional, who is the professional trained in diagnosis and treatment.” (https:// en.wikipedia.org/wiki/Talk:Medical model – Wikipedia)

My concern with the very idea of “adherence to the medical model” (or adherence to or compliance with anything put forth by a nursologist or a physician) led me to ask “what [do] 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.” (Fawcett, 2020)

My concern regarding the physician as a professional person is grounded in my inability to identify any distinctive knowledge of medicine that is necessary for the designation of professional in both the OEDO definition of medicine and in the mention in Wikipedia of the professional being “trained,” a word associated with training for a trade.

Of course, I understand that physicians possess a great deal of scientific knowledge. However, that knowledge is of various disciplines, such as anatomy, physiology, histology, and chemistry, not of medicine per se (as there is no distinctive medical knowledge that I have been able to identify),

I have concluded that the so-called “medical model” is a fiction put forth at least since Laing’s (1971) publication by members of the healthcare team (including nursologists) and the general public to ascribe a particular status to a trade. .

Please note that I acknowledge the importance of trades in society. I certainly cannot survive without many tradespersons in my life. However, I maintain that it is important to be very clear about the words we bestow on the members of healthcare teams, words that clearly reflect whether those members belong to a discipline/profession or trade. If members of a discipline/profession, it is necessary to identify the distinctive knowledge that guides practice, and research and education, too..

What do you, a reader of this blog, think? Have you been able to identify distinctive philosophic, conceptual, and theoretical knowledge that would constitute the discipline of medicine? Please add your thoughts to the comments section of this blog. Thank you very much.

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Fawcett, J. (2014a). Thoughts about collaboration—or is it capitulation? Nursing Science Quarterly, 27, 260-261.

Fawcett, J. (2014b). Thoughts about interprofessional education.Nursing Science Quarterly, 27, 178-179.

Fawcett, J. (2017). Thoughts about nursing conceptual models and the “medical model.” Nursing Science Quarterly, 30, 77-80. (Permission to provide a link to the PDF of this article was granted by the journal editor)
Fawcett, J. (2020, March 17). What is Reflected in a Label about Health? Non-Nursology and Nursology Perspectives. Blog.

Laing, R. D. (1971). The politics of the family and other essays. Routledge

Venes, D. (Ed.). (2013). Taber’s cyclopedic medical dictionary (22nd ed.). F. A. Davis.

Guest Post: I Thought all Nurses used Mirrors!

Contributor: Wyona M. Freysteinson, PhD, MN
Theory: Neurocognitive Model of Mirror-Viewing

Wyona Freysteinson

At the age of two, I decided I was going to be a nurse. My great grandmother, my first patient, taught me my colors while testing urine for ketones, how to give insulin, and that when I combed her hair, she looked in a mirror.

I thought all nurses used mirrors.

The quest to understand the mirror-viewing experience began in the 1970s-1980s when I practiced bedside nursing, with a small mirror my uniform pocket. I wondered why the mirror was soothing to so many of my patients (e.g., seeing how I had re-taped a nasogastric tube)? In some patients, I witnessed a look of terror (e.g., viewing a scalp incision)?

When I suggested a mirror-viewing study in my master’s program in 1990, the dean called me into her office. The dean said I could not study mirrors as sick people do not want to look in mirrors. Upon deep reflection, I realized that I had not caused severe psychological harm to thousands of patients with my pocket mirror. I turned to the philosophy department where a professor who had been a student of Paul Ricoeur joined me in my quest. The mirror research journey had begun.

This research trajectory continued with studies of the mirror-viewing experience after a terminal illness diagnosis, amputation, mastectomy, and military sexual trauma. This mirror knowledge base helped me understand the experience of mirroring.

This knowledge base, however, did not explain the mirror phenomenon. Why did some participants tell stories of severe mirror distress (e.g., I wanted to run out on the road screaming)? Why did other participants say they felt no emotions when seeing their bodies for the first time after disfigurement? Why did so many participants remember a terrifying mirror image that occurred several years earlier, and I struggled to remember my mirror image from this morning?

A deep dive into the literature unearthed MRI studies demonstrating self-recognition occurs in the pre-frontal cortex. Together with memory and the autonomic nervous system theories and my research, this information formed the foundation of the mid range nursing theory: Neurocognitive Model of Mirror-Viewing. Although mirrors have a tenuous historical and mythical past, and to some individuals are considered taboo, mirrors are simply tools. For example, mirrors are useful for self-assessment (e.g., diabetic foot care, skincare), self-incision and wound care, colostomy care, prosthetic alignment, and pushing during birth. Many individuals use a mirror to brush their teeth and other activities of daily living. Only in mirrors can we see our faces and whole bodies. However, Initial mirror-viewings in the aftermath of visible disfigurement, sexual trauma, or bullying may be distressing or traumatic. Ongoing mirror discomfort and mirror avoidance may occur.

Sensitive, supportive nursing mirror interventions are needed to mitigate mirror trauma. Since my visit to the dean, I cannot count the number of individuals who have considered my work absurd, frivolous, or inconsequential. Nor can I calculate the countless numbers of cheerleaders who have had traumatic mirror experiences and wished a nurse had been there for them. My hope is that my work expands nursing science to the extent that nurses do use mirrors.

Volume 2 of the Roy Academia Nursology Research Center (RANRC, Japan) now published!

The Roy Academia Nursology Research Center (RANRC) publishes a yearly Nursology Letter. Volume 2 has just been published! See information about volume 1 (2019) on our January 7, 2020 blog post celebrating the first known publication from a research center to use the word, nursology, in its title! The RANRC is a unit of the School of Nursing at St. Mary’s College in Kurume, Japan.

The RNARC is named for Callista Roy, the nursology theorist who developed the Roy Adaptation Model. Congratulations to our colleagues at St. Mary’s College for this notable achievement!

Robert V. Piemonte, EdD, RN, CAE, FAAN (1934- April 21, 2020)

Guardian of the discipline

Contributors: Diane Mancino and Dorothy Jones

Robert V. Piemonte

Robert V. Piemonte, EdD, RN, CAE, FAAN, a highly esteemed professional leader and former Executive Director of the National Student Nurses Association, succumbed to the coronavirus on April 21, 2020. Dr. Piemonte, born in 1934 was one of 12 siblings and is survived by one sister, Adele Grossi, of Medford, NY and numerous nieces and nephews. His sister passed away in December 2020.

Bob graduated from Pilgrim State Hospital School of Nursing and earned the Bachelor of Science Degree at Long Island University. He later received a Master of Arts, a Master of Education and a Doctorate of Nursing Education from Teachers College, Columbia University. It was at Teachers College that Bob formed a lifetime friendship with other emerging AAN leaders including Dr. Margaret McClure, Dr Louise Fitzpatrick and Dr. Muriel Poulin (A Nursology 2020 Guardian of the Discipline) as well as Dr Joyce Clifford, Dr Lucille Joel and others. Each of these individual contributed significantly to the growth of nursing leadership in education, clinical practice and international organizations. To simply observe this group in action was to witness innovation, creativity, tolerance only for the best of wat nursing was and could be, and their joy in being with others they respected and valued.

Diane Mancino and Bob Piemonte

Bob Piemonte held many elected leadership positions in professional organizations including the presidency of: American Nurses Foundation, New York Society of Association Executives, Nurses Association of the Counties of Long Island (District 14), New York State Nurses Association; and Nurses House. He served as Assistant Director of Nursing at NYU Medical Center, Director of Nursing at NYC Health and Hospitals/Gouverneur Hospital and Chief Nurse, US Army 8th Medical Unit.

The major focus of Bob’s professional career was nursing organizations. In this capacity he served as the Executive Director of the New Jersey State Nurses Association; American Nurses Association as Director, Nursing Services Department; and as Director of House, Board and Cabinet Affairs.

Maggie McClure with Bob Piemonte

 In 1985 Dr. Piemonte was appointed as Executive Director of the National Student Nurses Association (NSNA), a position from which he retired in 1996. As the Executive Director of the NSNA Student Bob once said, “I saw the need for the pre-professional organization to prepare its members for leadership roles in the professional nursing organizations.”1 His dedication and commitment to student nurses across the United States promoted student leadership within SNA’s (Student Nurses Associations) at the local, state, and national level, fostered  professional commitment to addressing contemporary and national issues affecting the discipline and health care and enhanced socialization, mentoring and future collaborations for students as they advanced their professional career.  

Dr. Piemonte’s commitment to excellence in the profession, and tireless, pervasive professional leadership were recognized in such awards as: the Teachers College Nursing Education R. Louise McManus Medal; the National Student Nurses Association Honorary Member; the New York State Nurses Association Honorary Recognition Award; the Foundation of New York Nurses Driscoll Award; and the Nurses House Dolphin Award.  In 2008, Dr. Piemonte received the designation of Living Legend by the American Academy of Nursing and, in 2014, he was inducted into the American Nurses Association Hall of Fame, considered to be the highest honor in the nursing profession.  

Bob with Louise Fitzpatrick and Muriel Poulin (standing)

Dr. Piemonte was devoted to mentoring and encouraging nursing colleagues and students. His cousin, Phyllis Yezzo, DNP, RN, in thanking colleagues for their condolences, said, “He was the anchor of the family and a champion for the Nursing family.”2 Countless colleagues credit him with advancing their careers and professional development. He will be sorely missed but his legacy of extraordinary leadership will continue to advance his beloved profession.

A funeral mass and memorial service is planned in NYC at a later date.  Condolences may be made at the following website: http://www.folsomfuneral.com/?p=9085

The Foundation of the National Student Nurses Association has established the Dr. Robert V. Piemonte Memorial Scholarship for donations to honor him. Donations may be mailed to Foundation of NSNA, 45 Main St., Brooklyn, NY 11201 or made via the FNSNA website

1”Spotlight on Robert V. Piemonte,” NEAA Courier, spring, 2009, #97, pg.2.

2 “Email Re: Sad News: Robert Piemonte,” April 22. 2020

Source:  Cathryne A. Welch, EdD, RN, Foundation of New York State Nurses, Retired.

  • Photos provided by Diane Mancino

Recruiting participants for Nursing Research Guided by Barrett’s Theory

The Influence of Nurse Coaching on Power as Knowing Participation in Change in the Process of Health Patterning

Researcher:
Shirley Conrad, MSN, RN, CCRN, AHN-BC, HWNC-BC
PhD Candidate
Christine E. Lynn College of Nursing
Florida Atlantic University

Are you a NURSE who has experienced stress related to providing nursing care during the Covid-19 Pandemic?

We are currently enrolling nurses in CT, MA, NH, MN, MD, TN, NJ, PA, KS, and CA to study the effects of nurse coaching on individuals’ power to participate in life changes like COVID-19.

If you decide to participate what is involved?

  • Four coaching sessions conducted remotely with an AHNCC certified nurse coach. Each will last about one hour. Scheduling is between you and the nurse coach.
  • Completion of short surveys and a phone interview after completion of the coaching. It should take no more than 5 minutes to complete the demographic survey, 10 minutes for pre assessment, 10 minutes for post assessment and 30 minutes for interview.
FOR MORE INFORMATION – please contact Shirley Conrad @ 407-314-3587 or Sconrad2009@health.fau.edu. Primary Investigator is Dr. Marlaine Smith @ 303-506-3450 or msmit230@health.fau.edu   IRB Number 1252160-1 Approved on: March 28, 2019 Expires on: Not Applicable      

New on Nursology.net – Aesthetic Knowing

We are delighted to announce an important new section on Nursology.net – Aesthetic Knowing in Nursing.

Aesthetic knowing in nursing is a way of knowing realities that are not empirically observable – the deep meanings in a situation. As nurses grasp these meanings, they can draw on their inner, creative resources to respond to the situation in ways move the situation from what is, to what is possible. Aesthetic knowing is called forth in the face of human experiences that are common for to all human experience such as grief, joy, anxiety, fear, love. Even though these experiences are common, they are expressed in ways that are unique to each and every individual experience. People recognize common expressions of such experiences as anxiety, or fear, or love. But each person’s experience is unique.

From Introduction to Aesthetic Knowing

This section features the works of nurse scholar/artists whose art expresses a dimension of caring in the human health experience. Our inaugural scholar/artists are:

View the Scholar/Artist Gallery

If you are a nurse/artist and have works you are willing to share, we welcome your submissions for this section of Nursology.net! Use our “Aesthetic Knowing in Nursing Submission Form“!

Guest Post: Allies and Advocates – Transforming Cultural Competence

Contributors: Jennifer Weitzel, Jeneile Luebke,
Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz,
Anne Dressel, & Lucy Mkandawire-Valhmu

The murder of George Floyd and Breonna Taylor has prompted a wake-up call to reflect on the pervasive issue of structural racism.  As a nation created through histories of colonization and slavery, these murders—among countless others—have acted as a catalyst for American society to recognize and act to disrupt continued legacies of racism embedded into the fabric of American society1.  As nurses, as a part of this society (and thus a reflection of society) it is incumbent upon the nursing profession to take a stark look at the ways in which the legacy of structural racism has continued to inform nursing practice, education, and research.  Doing so speaks towards the nursing professions commitment towards supporting best health outcomes for everyone.  As the most trusted profession, and largest healthcare profession, such allyship not only recognizes this issue, but acts to decolonize discourses, and provides explicit attention to the impact that racism holds on health outcomes.  Such measures call to realize the reality that racism is a health issue, that must no longer remain on the periphery of nursing education, research, and practice in the U.S. (see https://nursology.net/2020/01/14/decolonizing-nursing/ ) .

Source

Nursing as a science, has historically been constructed from a positivist and Eurocentric framework that serves to sustain the domination of “whiteness as a form of disciplinary power.”2(p.196)  Cultural competence is often the primary concept used to guide the nursing profession in addressing the needs of diverse populations locally and globally.3 The principles of cultural competence are heavily influenced by the social and political history of the U.S.4 Practicing with cultural competence is tainted with the effects of racial bias, as this concept fails to recognize how perceived “cultural differences” are code for modern-day racist ideologies dating back to colonialism.6 Therefore, what is often believed to be cultural knowledge is rooted in White, European worldviews and codified into healthcare practices based on faulty interpretations and observations of “Othering”. 

Calls have been put forth for nursing transform these harmful approaches to cultural competency using emancipatory knowledge development and critical theory. Although nursing has been heavily impacted by the hegemonic ideologies of the biomedical model, we have also pioneered ways of knowing that disrupt oppressive knowledge paradigms.   The very institutionalization of competence within the medical field was one way for healthcare providers to establish a standard of expertise. This was key to the professionalization of many disciplines informed by the biomedical model, which focuses primarily on biological factors of health and excludes psychological, environmental, and social influences.Because of the societal value placed on our education and our expertise (cultural competence), nurses enjoy a position of power in Western models of health care. Operating blindly within the hierarchies of power existent in the Western, biomedical model of health leads to running the risk of de-contextualizing the care we provide. For example, Ilowite, Cronin, Kang, and Mack found that parents of children with cancer, regardless of race and ethnicity, wanted detailed information regarding their child’s prognosis.7 However, the researchers also found that physicians provided less information to Black and Hispanic parents than to White parents. This is an example of how healthcare providers exert power by deciding what information to share with patients based on perceived cultural norms and implicit bias.

Most individuals entering the healthcare field espouse a belief that they need to deliver care with impartiality.  However, without a sufficient understanding of the machinations of racism in everyday society, the ways in which racism are perpetuated in the healthcare system will remain a blind spot.6 In attempting to provide care regardless of race or ethnic background, we might overcompensate (“I don’t see color”) and subsequently fail to see how social determinants of health, including racism, affect our patient’s opportunities to achieve and maintain optimal health. 6

Practicing with cultural competence is predicated on the nurse’s ability to learn and understand cultures other than their own  to predict health behaviors and ultimately health outcomes.7 When these predictions drive how care is delivered, the complexities of how individuals, families, and communities make decisions about life, illness, and death become reduced to single narratives and stereotypes.9 By many of our textbooks and NCLEX review materials still provide content based on assumptions and broad categorizations. These assumptions often boil down to ideas such as the belief that because of their race or ethnicity, people share static traits, values, and beliefs, racial categories are legitimized as objective truths, when in reality, these categories are social constructions shaped by history and politics.

It is fundamentally impossible for nurses to provide culturally competent care under the premise that knowledge is based on these singular narratives, beliefs, and stereotypes. We must be open to the use of new frameworks that underpin the delivery of nursing care to meet the needs of diverse populations.  These frameworks derive from epistemologies that challenge Western hegemonic knowledge, how it is produced and who produces it.  For example, cultural safety is a concept originating from indigenous Maori New Zealanders that calls on nurses to engage in ongoing self-reflection about issues of power and privilege. Intersectionality theory, rooted in Black feminist thought, requires an understanding that people identify in a myriad of ways that are fluid and interactive.  These identities, some of which are self-ascribed, and others are socially ascribed, form matrices that confer or deny power. Legal scholars introduced Critical Race Theory (CRT) drawing from critical legal and civil rights scholarship.  CRT is underpinned by the following assumptions:

1.  Race is a social construct with no basis in science.

2. White supremacy does not exist on the fringes of society but is embedded in the everyday order of U.S. life.

3.  The voices of those experiencing racism are essential to knowledge development.

4.  The notion of ‘colorblindness’ is a detour that allows White people to absolve themselves of racial biases and deny the oppressive realities of structural racism.

These are a few of the concepts and frameworks that could inform nursing science and ultimately our practice. Why are we interested in theories from other disciplines? How might we develop nursology discipline specific knowledge that addresses the issues?  In the midst of the world witnessing the murder of George Floyd by police officers, the COVID-19 pandemic continues unabated with its current epicenter in the U.S.  In urban metropolitan areas, we have watched how centuries of disinvestment in Black and Brown communities and systematic oppression has led to health disparities that are also manifesting clearly in this pandemic in disproportionate morbidity and mortality of Black and Brown peoples.  Ethnic minority populations are at greater risk for contracting Covid-19, or experiencing severe COVID related illnesses.10  According to the CDC’s report on COVID-19 in the Racial and Ethnic Minority Groups, cases of COVID-19 are highest among American Indian persons, and hospitalization rates for COVID-19 related illness are highest among Latinos, American Indians, followed by Black persons.10  Since Covid-19 was first reported on the Navajo Nation in mid-March, infection rates per capita have soared to the highest in the country compared with any individual state.11   The COVID-19 pandemic thus only exacerbates the challenges that ethnic minority communities already face, particularly American Indians who already experience disproportionate disparities in health outcomes.

The time for nurses to act is now, not just in the care of people and communities that are most marginalized, but to address the very root of marginalization and oppression through a practice of critical reflection on our own profession: which of our theories need to be contested because they are rooted in colonist and white supremacist ideologies?  How can we embrace of innovative ways of theorizing, through meaningful and intentional care that results from a critical and reflective analysis of the realities going on around us and our role as a profession in fostering lasting change? We leave you with these questions and call upon you as fellow allies and advocates on the path towards health equity and social justice.  When we discuss racism, should we not include all races and ethnicities?

Sources

  1. Paradies Y. Colonisation, racism and indigenous health. J.Popul. Res. 2016; 33(1):83-96.
  2. Puzan E. The unbearable whiteness of being (in nursing). Nurs Inq. 2003; 10(3):193-200.
  3. Rajaram SS. Bockrath S. Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. J Health Dispar Res Prac. 2014; 7(5):82-89.
  4. Kirmayer LJ. Rethinking cultural competence. Transcult Psychiatry. 2012; 49(2). 149-164. doi.org/10.1177/1363461512444673
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Note: this post is based on the ANS article published in the spring of 2020 – Weitzel, J., Luebke, J., Wesp, L., Graf, M. D. C., Ruiz, A., Dressel, A., & Mkandawire-Valhmu, L. (2020). The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time. ANS. Advances in Nursing Science, 43(2), 102–113. https://doi.org/10.1097/ANS.0000000000000290

L-R: Jennifer Weitzel, Jeneile Luebke, Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz, Anne Dressel, Lucy Mkandawire-Valhmu

Jennifer Weitzel, MS, RN is a doctoral student and public health nurse with Public Health Madison & Dane County. Her research examines the use of cultural safety in the delivery of humanitarian nursing in Haiti

Jeneile Luebke, PhD, RN is a post-doctoral nurse research fellow at University of Wisconsin-Madison. Her area of research and expertise include violence in the lives of American Indian women and girls, and utilization and application of postcolonial and indigenous feminist methodologies.

Linda Wesp, PhD, FNP, APNP, RN is a Clinical Assistant Professor at University of Wisconsin-Milwaukee in the College of Nursing and Zilber School of Public Health, with a focus on health equity, participatory research, and critical theories. She also works as a family nurse practitioner and HIV Specialist at Health Connections, Inc. in Glendale, WI

Maria del Carmen Graf, MSN, RN, CTN-A, is a PhD candidate at UW-Milwaukee. Her research area includes studying the mental health needs within vulnerable populations with an emphasis on the Latina population and women of color in the US using a Postcolonial Feminist approach.

Ashley Ruiz RN, BSN, is a doctoral nursing student and clinical instructor at the University of Wisconsin-Milwaukee, as well as a Sexual Assault Nurse Examiner (SANE). Her current work focuses on advancing feminist theory in nursing science for the purposes of providing a theoretical foundation for addressing the problem of violence against women. Such advances inform Ashley’s research, which seeks to identify and develop nursing interventions that are tailored towards the unique needs of Black women that disclose sexual assault and seek healthcare services

Anne Dressel, PhD, CFPH, MLIS, MA, is an Assistant Professor in the College of Nursing at the University of Wisconsin-Milwaukee, where she also serves as Director of the Center for Global Health Equity

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.