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Intermodernism and Nursing Theory Development


The current featured article in ANS 42:1 is by Pamela G. Reed, PhD, RN, FAAN title “Intermodernism: A Philosophical Perspective for Development of Scientific Nursing Theory.” This article will also serve as a focus of discussion at a conference that will convene at Case Western Reserve University March 21-22 in Cleveland, OH, celebrating the 50th year since the first conferences focused on the disciplinary perspective of nursing, and the structure of nursing knowledge. Dr. Reed’s article will serve as a focus for discussion and debate for years to come, prompting advances in nursing knowledge development in the years ahead.  Her aritcle is available to download at no cost while it is featured, and we welcome your comments here!  Dr. Reed sent this message about her work.

Pamela Reed

I am SO pleased to have this paper published in Advances in Nursing Science! It was in this same journal where in 1995 I published a treatise that introduced some initial ideas about a philosophy of nursing science, which I then labeled neomodernism.  This current paper is the outcome of my continued work (and passion) in philosophy of science as it relates to knowledge and theory development in our discipline. In developing this philosophical perspective, I was particularly interested in bringing together the foundational focuses of nursing knowledge with the creative and scholarly ways that nurses practice their profession and science. I drew from philosophical worldviews within and outside of nursing, and from philosophies of science more formally.

I also thought it important to provide (for readers and me!)  some historical perspective on philosophies of science and theory structure, as background for a philosophical view I am  proposing for nursing’s present and future.  Whereas I initially called this view neomodernism, I came to the decision that intermodernism better represented the post-postmodern philosophy that it is – one that incorporates both modern and postmodern ideas. I wanted to articulate a philosophical view that is meaningful to nursing and is also pluralist yet internally consistent.  Accomplishing all of this will likely involve continued work and dialogue!  In the meantime, I hope it can be useful among nursing students as they hone their research questions, and among nursing scholars and maybe also other health science scholars as they formulate new directions for research and practice.

Mostly I am hoping that this article generates discussion among nurses about the role of theory in building nursing knowledge – about new strategies for theory development that integrate practice and science more deliberately, and about expanding perspectives of our familiar ‘nursing theory’ to make it the central cog in the wheel of nursing inquiry into processes or mechanisms underlying human health and well-being.

 

Regenerating Nursing’s Disciplinary Perspective


Our first featured article for ANS 42:1 is titled “Regenerating Nursing’s Disciplinary Perspective” by Marlaine C. Smith, PhD, RN, AHN-BC, HWNC-BC, FAAN.  This article will also serve as a focus of discussion at a conference that will convene at Case Western Reserve University March 21-22 in Cleveland, OH.  The conference will be celebrating the 50th year since the first conferences focused on the disciplinary perspective of nursing, and the structure of nursing knowledge. Dr. Smith’s article is available for download while it is featured, and we invite you to contribute to the discussion of the important challenges that the article raises.  Here is a message from Dr. Smith, with some background about this work:

Marlaine Smith

This paper addresses a topic that has generated debate within the discipline of nursing for at least 50 years, just a little longer than I’ve been a nurse.  Even when I was younger, or newer in my career, I was in search of the answer to the questions, “What differentiates nursing from other disciplines?” “What is unique about what we study and what we offer to society?” “I’ve tackled that question and have answered it for myself, by stating that it is the study of human-environment health and healing through caring, and that through a caring relationship nurses promote health and healing of whole persons within their relevant environment (physical, social, political, economic)”.  Some may argue that this question is settled, but I disagree.  There are many troubling signs, “existential threats”, that tell me that these questions and answers are as important as they were 50 years ago. I’ve described some of them in this paper.

In my experience nurse researchers, scholars and practitioners are not at all clear about the nature of the focus of the discipline. I’ve taught undergraduate and graduate nursing students for over 40 years.  In many of my classes I introduced the question, “What is the focus of the discipline of nursing?” The responses are often related to what nurses do in practice, or that “we coordinate the activities of all the health professions”.  As we dug deeper they discover how defining nursing by what nurses do has left us vulnerable to others who have carved out a practice grounded in specialized knowledge related to their phenomena of concern. By defining nursing as a verb (what we do) without considering nursing as a noun (what we know and study) has strengthened the claims that registered and advanced practice nurses are assistants, coordinators, team members, and technicians.  I can’t tell you how many “A-Ha” moments I’ve witnessed after this discussion as students come to the epiphany that being clear about the focus of our discipline matters.

But, this isn’t about staking a claim for the discipline of nursing and defending it for our own sake.  It is about valuing nursing knowledge and the difference it makes to those we serve. Nursing knowledge is needed for the well-being of humankind.  When we conduct research contributing to the knowledge of medicine, psychology or sociology, or practice from the perspective of other disciplines, society suffers.  I do believe that nursing’s disciplinary perspective and the knowledge and practice that evolves from it is the “secret sauce” often missing in healthcare today. People need what we offer when nursing is studied and practiced from our disciplinary perspective.

I approached this article through analyzing the literature on the discipline of nursing to arrive at themes.  These themes could guide us in the differentiation of the professional discipline of nursing.  They might be a touchstone for those practitioners, educators and researchers as they ask, “How does my practice, curriculum or research align with the focus of the discipline of nursing?” I offer examples of areas of inquiry that would be aligned with the nursing knowledge.

I hope this article generates some lively discussion that regenerates the interest in and focus on nursing knowledge.  My hope is that while it may not be new, revisiting it may spark new understandings.  It reminds me of T.S. Eliot’s words, “We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time”.

 

 

 

 

Caring Science Education to Promote Interprofessional Understanding


The current ANS featured article, available now to download at no cost, is titled

Kathleen Sitzman

Usefulness of Watson’s Caring Science for Online Educational Practices in Disciplines Outside of Nursing.” The authors, Kathleen Sitzman, PhD, RN, CNE, ANEF, FAAN and Dorothy H. Muller, PhD, report the results of a study to explore the perceptions of people from a wide range of disciplines of the usefulness of Watson’s Caring Science.  Here is a message from Dr.Sitzman about her ongoing work in this area:

I have been conducting research related to Watson’s Caring Science for many years. I teach online nursing courses and so a lot of my work explores caring in online settings. I also teach a Caring Science, Mindful Practice Massive Open Online Course where I regularly interact with people all over the world who are interested in learning about caring and sharing their own caring experiences. So far, almost 4000 people (and counting) have registered for this course, and about 25% of them are not in healthcare or (specifically) nursing. Despite not being nurses and knowing nothing about Watson’s Human Caring Theory when the signed up for the course, my non-nurse learners have responded with enthusiasm, wisdom, and deep understanding as they have progressed through the course. It became apparent to me that Watson’s Caring Science resonated with nurses and non-nurses alike, so I set out to conduct structured research to explore this more fully. This article is the result of my inquiry around this interesting observation.

Currently there is a paucity of research related to applicability of nursing theory outside of the nursing discipline. It is unknown from a formal, academic standpoint, whether Watson’s Caring Science would be considered applicable outside of the nursing discipline and I believe the results that appear in this article provide validation regarding applicability of caring science across disciplines. More research is certainly needed, but this is a good start.

This type of research is important because of the current focus in increasing interdisciplinarity in healthcare and beyond, and I believe that establishing/identifying a shared frame of reference (i.e. principles related to Caring Science) will help people create and maintain productive interdisciplinary collaborations and relationships. Exploration and recognition of basic shared core caring values (i.e. who we “are” as opposed to what we “do”), coupled with shared exploration of trim activities (i.e. varied tasks and job roles that all of us “do” every day), will create common ground upon which to build working relationships with a focus on caring rather than doing. And caring rather doing is a useful approach in nursing, healthcare, and beyond.

New Graduate Transition Programs: An Integrative Review


Our current featured article in ANS is titled “The Impact of New Graduate Nurse

Deborah E. Tyndall

Transition Programs on Competency Development and Patient Safety: An Integrative Review” by Deborah E. Tyndall, PhD, RN; Gina C. Firnhaber, PhD, RN, MLS, MPH and Elaine S. Scott, PhD, RN, NE-BC, FNAP. I had the pleasure of speaking with the authors about their work, and in the video below share our very interesting and informative conversation about how they came to do this work, insights about their method, and the implications of their work for future scholarship in this area.  Their article is available at no cost while it is featured – we welcome our comments and feedback below!

Dr.Tyndall sent this message about the background of her work:

My interest in New Graduate Nurse (NGN) transition stems from my experiences working with undergraduate nursing students and novice nurses in the first year of practice.  For many years, I taught professional development classes to NGN.  In one of these classes, Thriving in Your First Year of Nursing, I heard the successes and challenges that NGN face.  These stories deeply impacted my understanding of the many factors that influence NGN transition to practice.

After graduating with my PhD in 2016, I accepted a grant manager position to work

Elaine S. Scott

with a multidisciplinary team.  This team, led by Dr. Elaine Scott, was formed to advance nursing science by evaluating nurse’s contributions to: 1) patient safety, 2) organizational capacity-building, 3) organizational sustainability, and 4) economic benefit (POSE).  Dr. Scott had been my dissertation chair and I was familiar with her work related to NGN transition to practice.  Through her leadership, the team generated various grant projects.  This article features our scholarly work from of those projects.

 

Remembering Margaret Newman


On December 18, 2018, Margaret Ann Newman, prolific nurse author, teacher and theorist, passed over to the great beyond. Margaret authored several notable articles in ANS, was frequently cited in ANS and other journals, and she was a dedicated supporter of ANS since the founding of the journal. Her writings expanded the nursology horizon over the past 40 years with her thought-provoking work. She advanced the knowledge of the discipline of nursing, and has been a key figure in the development of nursing theory.

Margaret was born on born on October 10, 1933 in Memphis. She received a BA degree from Baylor University. After college she returned to Memphis to care for her mother, who had Amyotrophic Lateral Sclerosis (Lou Gerig’s disease). Having learned from her mother that one can be healthy even in the face of disease, Margaret felt a call to nursing and entered nursing school at the University of Tennessee College of Nursing. After receiving her baccalaureate nursing degree, she entered graduate nursing studies at the University of California, San Francisco and received her master’s degree in 1964.

Margaret returned to Memphis and served as UT Assistant Professor of Nursing and the UT Clinical Research Center Director of Nursing. Margaret spent the next 10 years at New York University—first in doctoral studies, receiving her PhD in 1971, and then as faculty. Dr. Newman assumed the position of Professor in charge of Graduate Studies in Nursing at Penn State in 1977, at which time she also organized an international nursing theory think tank. She introduced her theory of health as expanding consciousness in 1978 and published the earliest primer on developing nursing theory: Theory Development in Nursing (1979). In 1984, she assumed a position as nurse theorist and professor at the University of Minnesota, where she furthered the development and testing of her theory, working closely with doctoral students. In the 1980s, she served as a civilian consultant to the U.S. Surgeon General for Nursing Research. Dr. Newman retired from teaching in 1999, yet remained active for another 17 years advancing nursing theory, education, research, and practice through her presentations and publications, including her 7th book, Transforming Presence: the Difference that Nursing Makes (2008). Dr. Newman’s theory of health has been widely embraced around the world and her life will be commemorated in many countries.

For more information, visit these important resources

Nursology.net resources:

A Tribute to Margaret Ann Newman by Margaret Pharris
Health as Expanding Consciousness (HEC) Theory Page
Go to 2016 Newman Scholars Dialogue Page

Memphis Funeral Home obituary

In lieu of flowers, contributions can be made to the fund for the Margaret Newman Endowed Chair

Beliefs about personal weight


We are currently featuring the article titled “Refinement of the Beliefs About Personal Weight Survey” by Stephanie Pickett, PhD, RN; Rosalind M. Peters, PhD, RN, FAAN and Thomas Templin, PhD. You can download the article at no charge while it is featured!  Here is a message from Dr. Pickett about her work:

Dr. Stephanie Pickett

Culturally-related beliefs about personal weight are thought to contribute to behaviors leading to the high prevalence of overweight and obesity among African American women. However, no tools existed that measured beliefs about personal weight among young African American women. This gap in the literature was addressed with the initial development and testing of the Beliefs about Personal Weight Survey.

In our current study we report the revisions and psychometric evaluation of the revised Beliefs about Personal Weight Survey (BPWS-2) with a sample of young African American women.  Our goal was to reduce and refine the original items to make the Survey more useful in clinical and research settings.  Psychometric evaluation of the BPWS-2 showed that the four factors from the original BPWS reemerged (Weight Acceptance, Weight Concern, Conventional Weight Regulation, Circumstantial Weight Regulation) along with a fifth factor (Excess Weight Acknowledgement). This fifth factor represents a distinction between accepting personal weight as overweight verses acknowledging personal weight as excessive.  This distinction was associated with specific eating behaviors.

The five factors (subscales) were sensitive enough to determine unique eating behaviors and psychosocial factors that influence body mass index among young African American women. Findings from this study indicate that understanding beliefs about personal weight may be a critical component in developing effective weight management strategies.

ANS Peer Review Mentoring Program


I am delighted to announce the launch of a peer review mentoring program for early-career scholars in nursing! The ANS Advisory Board has approved this plan in the interest of promoting the entry of new peer reviewers for scholarly publication in nursing, and to more fully enact our dedication to diversity and inclusion in the publishing process. We are encouraging current members of the review panel to participate in this process.  If you are an early-career scholar who is not yet involved in serving as a peer reviewer, let us know you would like to participate in this program and we will facilitate locating a mentor for you!  The full description of the program is available for download here.

To qualify as a mentee for this program, you need to meet the following criteria:

  • Completion of an earned doctoral degree, or in your candidacy anticipating final completion of the degree within the next 6 to 12 months;
  • At least one original published work as primary author that contributes to the development and application of nursing knowledge;
  • Expressed commitment to continued research, theory development, and other activities contributing to the development and application of nursing knowledge;
  • Willingness to complete reviews within approximately 3 weeks of being invited;
  • Ability and willingness to use the ANS Editorial Manager Peer Review Website;
  • Willingness to fulfill the responsibilities of the editorial review panel on a volunteer basis. (adapted from policies for serving on the ANS peer review panel)

Participating as a peer reviewer for scholarly publications is not merely a volunteer service — it is crucial to assure the credibility of published scholarship in any discipline. The main reason that this function must be voluntary is to avoid any possible appearance of conflict of interest, or vested interests influencing or controlling what appears in the literature of the discipline.  However, subtle bias can creep in to the peer review process, especially when reviewers tend to hold dominant points of view that might exclude less well known or accepted perspectives in the nursing literature.  So through this mentoring program, we hope to engage early-career scholars who have demonstrated excellence in scholarship while at the same time bringing to their work diverse perspectives that will be increasingly vital to the future of nursing.

Let us know you want to participate!

 

The Experience of Dietary Culture and Cardiovascular Disease


The current ANS featured article is titled “Dietary Culture: A Concept Analysis” by Elise A. Mollohan, MSN, RN, CNE.  In this article Mollohan defines dietary culture as patterned group eating behaviors that are unconsciously influenced and socially organized, and explains how these patterns can increase the understanding of the links between diet, culture, and cardiovascular health. For more information, download your copy of the article at no cost while it is featured! Ms. Mollohand provided this message for ANS readers:

I am intimately familiar with cardiovascular disease, as many of us are. My personal and professional experiences with the devastating effects of heart disease prompted me to make significant dietary changes several years ago.  While I have reaped immense health benefits from modifying my diet, it was not an easy transition. My experience caused me to see diet change through a different lens, becoming acutely aware of the challenges individuals face from a cultural perspective.

While working on my doctoral studies, I began exploring diet change as a strategy to promote cardiovascular health. Much of my initial research left me pondering the connection between cultural influences and diet. I found myself using the words “dietary culture” often when describing obstacles to successful diet change.  However, this concept was not clearly defined in the literature.  I also received questions from others about how our culture could be a barrier to implementing a heart-healthy diet. My need for a clear definition and a more profound understanding of the concept lead me to conduct this analysis.

The analysis process was invaluable to clarifying my understanding of dietary culture in relation to cardiovascular health. The proposed definition will be used to inform my future work, exploring the plant-based diet transition among adults with cardiovascular disease. Also, I hope that this concept analysis will promote an acknowledgment and understanding of the relationship between diet, culture, and cardiovascular health among nurses and other health care providers.

Power & Resistance in Mental Health Practice


The current featured ANS article is titled “Power and Resistance: Nursing Students’ Experiences in Mental Health Practicums” by Allie Slemon, MSN, RN; Vicky Bungay, PhD, RN; Emily Jenkins, PhD, RN and Helen Brown, PhD, RN. As the authors state, this article adds to the need for interventions that respond to everyday power imbalances in mental health care settings, and I believe, in all health care settings. The article can be downloaded at no cost while it is featured, so we invite you to read this article and return here to share your comments.  Allie Siemon shared this background about her work:

Allie Siemon

This article presents findings from my Master’s thesis work on nursing students experiences of their mental health practicums.

My clinical background is in mental health nursing, and I previously worked as a Clinical Instructor supporting students through their mandatory mental health practicum in a general nursing program. Through this experience, I observed how many students struggled with many of the particular challenges this practicum: fear of violence, worrying about being unable to make a difference, and navigating new systems such as locked doors and seclusion rooms. Yet as much as students expressed difficulty in navigating these challenges, they also demonstrated a deep commitment to their patients’ safety and well-being.

Vicky Bungay

In my Master’s degree, I began to examine the evidence on mental health practicums in nursing programs and found a small yet powerful body of literature illustrating that students in mental health practicums across many countries experience the types of challenges I had observed in my educator role. I also found that these experiences that students were having in their practicums negatively impacted students’ overall preparedness to work with individuals experiencing mental health challenges. Supporting students in navigating difficult mental health placements is a gap in our nursing education programs, and extends to gaps in mental health care delivery. To date, there have been relatively few qualitative studies that have contributed nuance and depth to our understandings of how students experience these practicums and navigate these challenges that have been illuminated largely through quantitative and survey-based research.

Emily Jenkins

I hope that this article can support nursing educators like myself in supporting students through the challenges of the mental health practicum, and can inspire nurses and nursing managers to shift practices in the mental health inpatient setting that are difficult for students and, importantly, patients. I also hope that thinking about mental health practicums as a space where resistance to power is possible can give students a new language and perspective on navigating complex environments and challenging experiences in the mental health practicum. I believe when students feel empowered and supported, they can demonstrate compassion, engagement, and commitment, and make an incredible difference in the experiences of their patients.

Helen Brown

Throughout the process of my Master’s research, I was supported by my committee: Vicky Bungay, Emily Jenkins, and Helen Brown. Each of them has contributed immeasurably to the research and to this article.

Reflective Action for Social Change


The latest featured article in ANS is titled “Cultivating Praxis Through Chinn and Kramer’s Emancipatory Knowing” authored by Jessica Peart, BSN, BA, RN and Karen MacKinnon, PhD, RN. In this article the authors explain how emancipatory knowing provides nurses a formal structure to recognize the sociopolitical factors affecting wellness, while making evident the ethical imperative and central role of taking reflective action toward social change—the praxis of nursing. The article is available for download at no cost while it is featured, and we welcome your comments and ideas!  Here is a message from Jessica Peart about this work:

What do we value as nurses?  What is important to know in order to practise safely, competently, and ethically? These questions took on a new meaning when I started my Masters of Nursing program last year as I study to become a Nurse Practitioner.

Jessica Peart

  My background—prior to my nursing career—as a community organizer laid the groundwork for seeing nursing through the lens of social justice.  The perspective, skills, and knowledge I garnered through my community work is threaded throughout my daily nursing practice.  In fact, they are integral to my “nursing toolbox” as a client and community advocate, in the critical empathy that I display supporting clients “on the margins”, and in my comfortability in the “grey” areas of our practice where nursing isn’t well represented by tick boxes or flow sheets.

But how do nurses, especially those pursuing advanced practice roles, develop competencies that forward the social justice lens that foregrounds our ethical practice when they came into their nursing role without a background in social justice work?  Following this path of inquiry in my MN coursework led me to Peggy Chinn and Maeona Kraemer’s exploration of emancipatory knowing as a means through which nurses can better understand the socio-political forces affecting our clients and take action towards more equitable social relations.  The mandate for nursing as social justice is clear, but the path we take to get there might not always be.  I found that Chinn and Kramer’s emancipatory knowing can help nurses to shed a light in the directions we might take towards cultivating the reflective practice that we have come to know as nursing praxis.

 

 

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