April-June 2012

discussions! The issue of human rights might seem to be primarily one that belongs in the realm of politics and policy, but as the authors of the articles in this issue of ANS  so aptly demonstrate, human rights are invariably linked to health and well-being.  Falk-Rafael and Betker cite a report that says it best: “Social justice is a matter of life and death.”

The connection goes even further to encompass the matter of health and illness.  The article by Lee titled “Family Homelessness Viewed through the Lens of Health and Human Rights” makes this point very clear – their findings support the conclusion that being treated with dignity and respect is vital to health and well-being.

As nurses we face a fundamental challenge that requires honest reflection on what interests we serve not only in health care, but in the larger society.  Florence Nightingale laid a foundation for western nursing as fundamentally serving the best interests of society. By tending to the needs of those who are ill, at risk for illness, vulnerable, or whose well-being is challenged, we also tend to the needs of society.  But as nurses worldwide recognize, our social obligation goes beyond tending to individuals, to also taking bold steps to improve the social conditions under which people live and work and to shape public policy that creates those conditions.

In many countries around the world, the basic human needs and rights of the most vulnerable individuals have been undermined by the greed and desires of the few.  This is an issue that as nurses we cannot ignore if we take our social duty seriously.  It is time to step up to the challenge that faces our communities and nations, and to use our knowledge and our insights to advocate for social justice for all.  Take a look at the complete Table of Contents of this current issue of ANS.  This is the kind of evidence that nurses provide as a framework from which to build strong arguments that shape strong policies in favor of social justice.  Indeed, it is a matter of life and death, of health and illness.

Two articles appeared in the last couple of weeks that shed light on the persistent failure of dominant social systems to recognize the actual value of nurses and nursing, despite glaring evidence to the contrary.  The first of these articles, titled “Why Nurses Need More Authority” by John W. Rowe, MD, appeared in The Atlantic on May 7, 2012.  The second, titled “The Power of Nursing” by journalist David Bornstein, appeared on May 16, 2012 in the New York Times. Both articles provide ample evidence, which nurses have known for decades, of the effectiveness of a strong nursing influence and presence in health care.  They both make a strong case for nursing to have a much larger and prominent role in creating the changes that need to happen in health care in the United States.

At the risk of seeming to discount the importance of both of these article, what stood out for me as I read each of them were the many ways that each of these articles also reflected the dynamics that sustain the dominant imbalances of power in health care, and the fundamental issues that keep nursing on the periphery and yes, even in a relatively subservient role in the delivery of health care.  On the surface, it might seem that part of the problem has to do with the fact that both of the authors of these articles are not nurses and certainly that fact does shape the perspective that each author brings to the topic.  But we need strong allies, and each of these articles reflect the intention of both of these authors to come to the table as strong allies of nurses and of nursing.  The markers of sustained attitudes and assumptions that perpetuate the problem lie beneath the fact that the authors are not nurses, and in fact, are attitudes and assumptions that many nurses might also bring to the table.  They are part of the hegemonic climate within which health care in the United States and other western cultures exist.  I will only address a couple of the glaring issues that stood out for me as I read these articles.

In Rowe’s article “Why Nurses Need More Authority” he uses the recent Institute of Medicine (IOM) “Future of Nursing” report in part as a spring-board for making the case that advanced practice nurses should be “allowed” to have an expanded role in health care. He points to the opposition that organized medical groups have launched against the recommendations of the IOM report, and rightfully argues that this opposition makes no sense, and that state laws that restrict APRN practice need to be changed.  The concept of being “allowed” to practice to the full extent of our education (the first recommendation of the IOM report) is the first red flag.  It is true that laws and traditions do place restrictions on nursing practice, but the issue is not one of someone simply “allowing” nurses to practice .. it is an issue of making social change that removes restrictions, a process in which we as nurses are quite capable of being full and equal participants.  The other red flag that stands out for me is that the IOM report recommendations are not limited to advance practice only … the report calls for all nurses at all levels of education to practice at the level they are prepared, and it calls for improvements in the education system that give nurses from all levels of education and practice access to furthering their education.  Advanced practice nurses do have a critical role in providing quality health care in the United States, but so do general practice nurses who have earned associate degrees and baccalaureate degrees.  Yet, at each of these levels of practice, policies and traditions restrict what all nurses contribute.  These are barriers that need to be dismantled, not by having a benevolent “father” figure declaring that we are now “allowed” to practice in a certain way, but by social and political processes, in which nurses play a key role, to shape new policies, practices and laws.

David Bornstein’s article focuses more on the provision of the Affordable Care Act that calls for Maternal, Infant and Early Childhood Home Visiting Programs, and the evidence of the effectiveness of a Nurse-Family Partnership (NFP) program established at the University of Colorado Health Sciences Center by David Olds, MD.  What is not acknowledged in Bornstein’s article is the vital interdisciplinary nature of the program, and the dominant role that nurses have played over the years in the conception, the research, program design and implementation.  Bornstein’s article is a brief opinion piece and is not designed as comprehensive report of the project, and I would not expect to see that kind of coverage in an opinion piece.  The red flag is not in the article itself, rather, it is the reminder of how dominant the realm of medicine is in being credited for an achievement like this, even those that are shaped in vital ways by nurses – nurse researchers, educators and practitioners (as was the Univeristy of Colorado NFP project).  This tradition of granting attribution to the dominant medical discipline is a huge factor that is shaped and sustained not only within the health care system and its practices, but also by the media and the public.  But it is not immutable .. it can change.

Nurses … it is time for us to mobilize the recognize these dynamics, and to claim the power, and the authority that is our!

Due to technical difficulties with my webinar last week I decided to make a recording of my presentation that is now available as a YouTube video. The length is just under 30 minutes. I hope you will join me for “lunch” or “tea” to experience the video, and share your thoughts and critique here or on the NurseManifest Project blog.

This presentation covers some of the ideas from my recent paper “The Integrality of Situated Caring in Nursing and the Environment” published in the current issue of Advances in Nursing Science. I sincerely look forward to the dialogue that I hope this presentation and paper will provoke. Don’t be shy, please share your thoughts.

“Lost Souls” by Richard Cowling ~ 2002 NurseManifest Research Study

I just watched the film “The Politics of Caring” featured on the nursemanifest.com website and oh, does it make some powerful statements about politics in nursing that are still relevant today! A core messages in the film is the importance of improving hospital working conditions, both for the nurses, and for the safety and health of patients. Growing out of my involvement in the NurseManifest Project, much of my current work directly focuses on research about the nursing work environment, including nurse staffing and management practices.

One of the defining moments of my nursing education was learning about the concept of “Upstream Thinking” in my senior year Community & Public Health Nursing course. We learned about John Snow’s classic work on the London Cholera epidemic of 1854 and read Patricia Butterfield’s seminal “Thinking Upstream” article (Adv Nurs Sci 1990;12(2):1-8) that challenged nurses to think beyond one-to-one caring relationships and embrace the social, environmental and political determinants of health. This was reinforced the following year in my graduate nursing theory course, with the addition of Butterfield’s then new paper, “Upstream Reflections on Environmental Health” (Adv Nurs Sci 2002;25(1):32-49). While nursing education programs are working to integrate new content in (epi)genetics, (epi)genomics and environmental health it is more important than ever to emphasize the interconnectedness (or integrality) of human beings (including nurses!) and the environment.

The macro-level and micro-level ways that human beings, including nurses, are interconnected with their environment and each other will be the main focus of a free webinar/seminar that I’m giving next week and hope you will be able to attend. The presentation is titled Redefining the Metalanguage of Nursing Science: Contemporary Underpinnings for Innovation in Research, Education and Practice and will be on Wednesday, Feb 8, 2012 (12-1:30 EST) at the University of Pennsylvania, Barbara Bates Center for the Study of Nursing History. This presentation will utilize images and narrative to explore the ideas presented in my new paper, The Integrality of Situated Caring in Nursing and the Environment, currently featured on the Advances in Nursing Science website.

To register for the webinar: https://www2.gotomeeting.com/register/210662026

The Impact Factor scoring system is managed and reported by Thomson-Reuters through their Web of Knowledge service.  While this is a valuable resource, the fact is that some very high quality and important journals will never be represented in this system.  Any journal that publishes work that has a very narrow audience – scientists and scholars working in a very focused field of study – will never attract others to their publication, and therefore their publications will not be widely cited.  This is actually a dynamic that effects scores for nursing journals, since our journals have not yet attracted widespread use by scholars outside of the field of nursing and some related health professions.  A journal such as the New England Journal of Medicine, for example, that many people both in and outside of the health professions use and cite, will carry a much higher impact factor score than any of our nursing journals (yet!).

However, back to the focus of this blog — what is the best way to find a “home” for your manuscript?  The first and most important task is to consider which journals reach the audience that you want your article to reach.  You can browse a comprehensive list of nursing journals, with links to their “Information for Authors,” on the Nurse Author-Editor web site.   Once you find journals that might reach your intended audience, the next challenge is to study the journal’s statement of purpose, recently published issues, and requirements for manuscript preparation and submission.

Like most other journals,  ANS has everything you need right at your fingertips on line!

• To determine if your manuscript is appropriate for the journal, check out the list of future issue topics in the right column of the home page. Since we are a topical journal you need to first determine if your manuscript has a good fit with our future topics.  You can find a description of each of the topics when you click on any of the listed topics.
• For detailed information about the purpose of ANS, go to the “For Authors” tab of the home page.  Here is the direct link to the “ANS Information for Authors.”
• On our home page, you can also browse the Table of Contents for each issue ever published in ANS, as well as abstracts of the articles.  All articles are available for online purchase if you do not have access through a library.

Questions?  Post them here in the comments for this post, and we will post the answers!

When Lippincott, Wolters & Kluwer assumed publication of the journal in 2002, they were open to making changes in the journal and we discussed several options.  Our Senior Publisher, Sandy Kasko, agreed that the cover design should remain the same because of the distinctive identification it brought to the journal.  We also agreed that the topical format should remain as a distinctive feature of the journal, and the Advisory Board members have remained committed to our topical format.

The primary reason remains this: our topics call forth scholarship that might otherwise be neglected in nursing’s literature.  It encourages prospective authors to focus their efforts and prepare their work for possible publication.  While excellent scholarship will usually find its way into print, but for work that challenges the status quo, or takes a path that is least traveled, getting into print can be a long and arduous journey.  ANS was founded with a purpose of challenging what is taken for granted, and bringing to the discipline cutting-edge thought.   Our issue topics have promoted the concept that this journal is open to addressing topics that may not be the most popular or prominent, but are vital areas that nursing can and should address.

The “down” side is that authors are required to submit manuscripts that can be viewed as a good fit with one of our issue topics.  When there is not a good “fit” withe an author’s current work, the author must turn to another journal.  Fortunately today, unlike the early days of the journal, there are a number of excellent nursing journals that are open to a wide range of scholarship.

Each year when the ANS Advisory Board meets, we spend time brain-storming the selection of future issue topics.  This is always a lively and interesting discussion!  It is also a sort of “crystal ball” experience of looking forward to plan topics that have appeal for the 18 or 24 months ahead.

Our journal web site shows a list of the planned future issue topics, along with brief descriptions of the kinds of manuscripts we are seeking.  Each topic is interpreted broadly, so if you see a “fit” with what you are planning, even if it is not a typical conceptual connection, craft your manuscript in a way that shows the connection you see.

Most of all, we welcome your suggestions!  We are always open to ideas and suggestions from readers as well!  If you would like to see us plan a particular issue topic, let us know!  You just might see it on the schedule coming up.

• The roles and responsibilities of publishers. The internet is making it possible for almost anyone to become a publisher, and is changing the ways that traditional publishers do business.  Publishers play a significant role in assuring certain standards of quality in their publications.  They cover the cost of getting the publication from manuscript to print and they manage the task of distribution of the product.  The internet provides an avenue for individuals to take up the role of publisher, but as many have discovered, the task is far from simple.  Nevertheless, watch for dramatic changes in how publishing is done in the future.
• Peer review and quality assurance.  The reliability and validity of what is published as “scholarly” literature is a prime concern for all.  The traditional approaches to peer review have recently come under scrutiny to determine how effective these practices are in assuring quality in scholarly literature.  The results are mixed, but no convincing case has yet been made to abandon traditional practices based on the level of quality that it produces compared to other practices.  However, the internet has given anyone access to critique through various forms of interactive services, enabling a wider participation the process of critique and comment on what is published.  Open access web resources, such as the “wiki” formats, have been demonstrated to provide almost instant revision and  correction of material published on the web.  This kind of access is likely to have a dramatic effect on how scholarly quality is monitored in the future.

What this means for a scholarly journal like ANS will continue to emerge over time – and “over time” has an increasingly short time frame!  This blog is one avenue that we have established to provide access for anyone to comment and challenge all things ANS.  Let us hear from you – you are part of shaping what emerges in the future!

Given that ANS articles are unsolicited, we can never predict the content profile of any single issue.  We publish issue topics well in advance of the date by which manuscripts must be submitted to considered for each issue, but we leave the interpretation of issue topics open.  But for this issue of ANS, I anticipated that authors might address two substantive areas – trauma and stress brought about by war, and that brought about by violence in the home.  Indeed, both of these areas of concern appeared in the articles we considered for publication, as well as those that were accepted for publication.

Predominantly, nurse authors represented in this issue addressed various aspects of trauma experienced by women and children.  Indeed, as I wrote in my editorial for this issue, war begins at home.  It is in the home, in the place that is supposed to be a safe haven, that is the very place where women and children are the most vulnerable.  Regardless of the physical location where nurses are in contact with patients and families, our work and the perspective that we bring to our work creates a window into what happens at home.  So it is incumbent upon us to have a strong base of knowledge about violence in the home, and effective ways to intervene and create healing.

This issue of ANS adds to the extensive evidence that underpins the imperative for all nurses to incorporate into their practice sensitivity to the possibility for trauma that is perpetrated against women and children in the home, and to incorporate into our practices effective approaches to care that address healing for those who are affected.  This issue is rich with content that enriches nursing knowledge of this phenomena, and with evidence to guide practice.  This is exactly the purpose of ANS to present substantive content that contributes to the development of nursing knowledge that serves to guide practice.  So browse this issue — you will not be disappointed!

There are two key points that I do want to comment on because I believe these points are important to notice, whether you have considerable familiarity with the idea of self-plagiarism, or are just learning about the concept:

• When your work is published in a journal or a book, and you have transferred copyright to your publisher, you need to treat your own work in the same manner as you would that of a work published by someone else.  The publisher now owns the copyright, not you!
• The basics of “fair use” of any work are not governed by strict rules.  Rather, there are guidelines that help to determine how much of a published work, yours or anyone else’s, can be legally (or even ethically) quoted and cited.  Many publishers have their own guidelines concerning how much of a published work can be cited without obtaining the copyright holder’s permission.  So become familiar with not only general “fair use” guidelines, but also the guidelines of your publisher.

The Copyright Clearance Center has an excellent 6-minute video that explains the basics of copyright, including the basics of fair use.  Watch it, and make sure everyone on your team knows that this resource is available.  

I had the honor of hosting the conference along with a dynamic team of other editors and publishers.  We had a record attendance of 135 people from all over the world.  This is a conference where everyone attends every session, despite the temptations that lie beyond the conference venue.  The reason?  Each and every attendee is deeply committed to one common goal — producing the best possible resources for nurses in every walk of nursing life.  Working side by side were the editors of journals such as Nursing Research, Nursing Outlook, American Journal of Nursing, Nursing 2011, Nurse Educator, and a host of specialty nursing journals.

Our focus for this conference was the use of social media to better serve our readers.  The opening session on the first day was led by Maureen (Shawn) Kennedy, Editor of the American Journal of Nursing.  She presented details on the use of Twitter to broadcast real-time news about what is available in the journal resources.  She was joined by Kim McAllister on Blogs, who writes a terrific blog, Emeribog: the Life and Times of an ER Nurse; and Leslie Nicoll on Facebook, who has established the INANE presence on Facebook and also administers the INANE blog.  Of course of the editors and publishers at the conference already were beginning to use these media resources for personal or “business” reasons, but most of us were only beginning to realize the potential, and the necessity, of these media for our journals.

You may have noticed, for example, that this blog only appeared less than one year ago.  ANS has had a Facebook page for a while, and also a presence on Twitter.  But until recently if you followed either of these, you only saw the automatic (although useful at times) posts about featured articles.  The INANE conference inspired all of us editors to step up to the challenges of this virtual world!  So watch what is happening in the social media world for not only ANS, but all of your favorite journals!