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Ethical Nursing Care


The current ANS featured article is titled “A Critical Analysis of the American Nurses Association Position Statement on Workplace Violence: Ethical Implications” authored by Darcy Copeland, PhD, RN. Please visit the ANS website over the coming 2 weeks to download this thought-provoking article at no cost. Dr. Darcy provided this message reflecting on this work:

Darcy Copeland

“I have been researching workplace violence in nursing for several years.  Increasingly, I hear nurses in many settings describe violence directed towards nurses in very polarized ways.  For example, some nurses contend that violence is an inherent risk associated with our work while others contend that violence ought not be part of our jobs.  Amidst these polarized views are workplace policies reinforcing a zero tolerance to violence stance.  The American Nurses Association adopted such a stance in their position statement on workplace violence.  Such a position, however, is not in alignment with our ethical framework. Zero tolerance policies are absolutely appropriate with respect to family/visitor or employee violence.  They are not appropriate in the context of patients, however. Zero tolerance policies have a punitive and moralist history; they are also ineffective at actually preventing violence.  Adherence to zero tolerance policies in the context of patient violence has the potential to negatively impact the RN-patient relationship, erode public trust, and criminalize illness behavior.  After a critical analysis of the ANA’s position statement it is recommended that the ANA draft separate position statements. One addressing patient violence and a separate document addressing employee and visitor/family violence.  Nurses have very different duties, obligations and power in RN-patient relationships than in relationships with coworkers and relationships with families/visitors.  Those duties, obligations and power dynamics ought to inform our response to patient violence.”  

Normalization of Deviance


The current ANS featured article is titled “Normalization of Deviance Concept Analysis” authored by M. Imelda Wright, PhD, RN, CNOR; Barbara Polivka, PhD, RN, FAAN;Jan Odom- Forren, PhD, RN, CPAN, FASPAN, FAAN and Becky J. Christian, PhD, RN, FAAN. The article is available at no cost while it is featured on the ANS website. Dr. Wright provided this video abstract of the article.

Secondary Traumatic Stress in Nursing


The current featured ANS article is titled “Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis,” authored by Marni B. Kellogg, PhD, RN, CPN, CNE, and it is available for download at no cost while it is featured. Here is a description of her work from Dr. Kellogg:

My primary research interest is secondary traumatic stress in nursing. As a pediatric nurse, my interest came about as I wondered if stress in nursing was different or more intense for pediatric nurses than nurses in other settings. As time has gone on, particularly with the pandemic, my research program has expanded to include stress and trauma in all nursing settings.

“Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis” resulted from my work overtime and was written to address a gap in the literature. Secondary traumatic stress is the stress a nurse faces when something upsetting happens to their patient. I propose a new definition in the article which explains what secondary traumatic stress is and what it is not. The phenomenon is frequently confused with the terms burnout, compassion fatigue, and vicarious traumatization; they are not all synonymous. Additionally, secondary traumatic stress has many of the same symptoms as Acute Stress Disorder and Post Traumatic Stress Disorder; therefore, nurses must be aware of this phenomenon to protect their mental health. A purer meaning of secondary traumatic stress in nurses is needed to distinguish it from each of the closely related terms. Clarity in the definition of secondary traumatic stress allows for the appropriate measurement and advancement of research related to its occurrence, treatment, and prevention in nursing.

It is vital to address traumatic stress in nurses as we emerge from the COVID-19 pandemic. Over the last year, I have completed some research with colleagues in psychology; nurses are suffering from traumatic stress. I am currently working with my team to explore the impact of the COVID-19 pandemic on nurses in the United States. We plan to develop appropriate interventions to help nurses. I worry about experienced nurses leaving their specialties or the profession because of the stress from the pandemic. Nurse educators must be aware of traumatic stress and work to build strong, resilient nurses who are mindful of the importance of self-care and mental health. Healthy nurses are effective nurses and will benefit our community.

I look forward to your feedback. Please take good care.

End-of-Life Care Terminology


Zahra Rahemi

Our current featured article is titled “End-of-Life Care Terminology: A Scoping Review” authored by Zahra Rahemi, PhD, RN andTracy Fasolino, PhD, FNP-BC, ACHPN. The article is available at no cost while it is featured, and we welcome your comments in response! Here is a message that Dr. Rahemi provided about their work:

End of life care research mostly focuses on end-of-life care options, cost of care, and advance care planning. However, the type of language and terminology that is used in end-of-life care literature and advance care planning forms is overlooked. The terminology used regarding end-of-life care options can convey positive, negative, or neutral meanings. For example, the term “intensive care” might convey a negative connotation compared to “comfort care”. Using these two terms in advance care planning forms and literature may influence individuals’ understanding and decisions about preferred end-of-life care options. Terminology and language are important in caring and nursing sciences, especially in the field of end-of-life care wherein the importance of culture and diversity is emphasized. The focus of this scoping review is to recommend healthcare professional, researchers, and policy makers to use neutral connotative language and terms when designing end-of-life care or advance care planning methods.

Addressing health disparities: the importance of culturally tailored interventions


Eun-Ok Im

The current featured article is titled “Components of Culturally Tailored Interventions: A Discussion Paper” authored by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN and Wonshik Chee, PhD. This article is available for 2.5 professional development credits, and is available for download at no cost while it is featured! Dr. Im has provided this background information that adds further to their article!

Throughout nursing history, we, nurses, have been on the frontline of the battles against health disparities, and have strived to provide culturally competent care for racial/ethnic minorities who are frequently discriminated and underserved in our health care systems.  Culturally tailored interventions are one of the products from the battles to have us equipped with necessary competence to provide better health care for all human beings regardless of their race/ethnicity. Considering the recent rise of racially motivated violence and discrimination against racial/ethnic minorities, it would be meaningful for us to reflect on culturally tailored interventions that have been our instruments in the battles against health disparities.

To start this blog, I am including a picture of a modern high-rise building with a Buddhist temple entrance. This is a typical scene of our daily life with a mixture of cultures that supports ourselves as cultural beings. As a researcher working on cross-cultural women’s health issues, from the beginning of my career as a nurse researcher/scientist, I have been frequently involved in the discussions on human beings as cultural beings, the complexity of culture, and culturally appropriate and sound approaches to culturally diverse populations. Many nurse researchers and scholars have talked about how to ensure cultural equivalence of wordings used in the questionnaires, how to ensure the accuracy of translations in research process, and if cultural matching would be needed, etc.  Also, nurse researchers and scholars have talked about inherent post-modern dilemmas in cross-cultural research (e.g., generalizability, etc.). However, it is very recent that our nursing community begins to talk about what makes an intervention be a “culturally tailored” intervention.In recent years, “cultural tailoring” became a buzz word among nurse researchers/scientists who are working with racial/ethnic minorities. With a recent high funding priority on health disparity research, an increasing number of nurse researchers/scientists began to develop and test culturally tailored interventions among specific cultural groups of racial/ethnic minorities.  Cultural tailoring sounds very simple in a way, but it requires researchers/scientists to give their special attention to many complex and various aspects of the interventions.  However, very little is still clearly known about the principles and processes of cultural tailoring although there have been some advances in the tailoring methods (e.g., surface tailoring, deep tailoring).

In this paper, we proposed suggestions for what would be essential in culturally tailored interventions based on our experience in multiple culturally tailored intervention studies, especially technology-based interventions.  Thus, the components that we are proposing might not be easily generalizable to the interventions that are not technology-based.  However, we made an assumption that cultural tailoring in both technology-based interventions and non-technology-based interventions would be similar in most aspects except the intervention medium.  Yet, technology-based interventions do not require physical transportation of the users and may not provide tangible in-person interactions.  Also, there are many unique characteristics of technology-based interventions that traditional interventions might not have (e.g., 24 hour access, required computer literacy, etc.). Thus, I hope that readers would be careful about the interpretation of the findings and suggestions.

Despite the limitations of the findings and suggestions that we made in this paper, most of our suggestions could be easily applicable to any culturally tailored interventions.  For instance, the suggestion to consider if their interventions specifically meet culturally unique needs of target populations could be applicable to any culturally tailored interventions using various different intervention media.  Cultural tailoring definitely needs to address culturally unique needs of the specific population. Otherwise, the intervention would not be easily accepted by the target group, and the intervention would be useless without the acceptance by the actual users. Also, the suggestion on the use of multiple languages and culturally matched bilingual research team members would be applicable to any culturally tailored interventions in a different medium.  For surface tailoring, the use of multiple languages and culturally matched bilingual research team members has been frequently emphasized in any culturally tailored interventions although it is new to find that they are essential even for non-face-to-face technology-based interventions.  Indeed, at the beginning era of the Internet usages, researchers thought that non-face-to-face interactions would eliminate the influences of race/ethnicity on human interactions. However, the findings reported in this paper support that culturally tailoring is necessary even for technology-based interventions, and the impact of race/ethnicity on human interactions still remain even in non-face-to-face interventions using computers and mobile devices.

All the suggestions, however, need researchers’ careful reflections on the benefits and costs involved.  For instance, we suggested researchers’ flexibility in intervention process (e.g., timing, intervention medium) to accommodate special and unique needs of their target populations. This flexibility will definitely increase the recruitment rate of potential research participants and will be helpful in retaining the participation throughout the intervention period.  However, at the same time, this could be a source of biases in determining the effects of the intervention on targeted outcomes of the research participants. Thus, researchers who are thinking of adopting flexible arrangements/strategies for their research participants need to consider possible biases that would be brought up by the arrangements/strategies and need to balance the losses and gains from adopting the arrangements/strategies.

We really appreciate this opportunity to discuss about the essential components in culturally tailored interventions, which would be pivotal for future nursing care and practice with racial/ethnic minority populations.  Hope that this article would urge nurses to further reflect on and discuss about future directions of culturally tailored interventions in nursing and contribute to advances in practical knowledge that is needed for development, implementation, evaluation, and refinement of culturally tailored interventions for racial/ethnic minority populations who are in great needs.  These efforts would definitely strengthen our instruments for future usages in our battles against health disparities.

Decolonizing the Language of Nursing


Daniel Suárez-Baquero

The current featured ANS article is titled “Critical Analysis of the Nursing Metaparadigm in Spanish-Speaking Countries Is the Nursing Metaparadigm Universal?” by Daniel F. M. Suárez-Baquero, MSN, RN;and Lorraine Olszewski Walker, EdD, MPH, RN. This article is available to download at no cost while it is featured, and we welcome your comments and questions here. Here is author Suárez-Baquero’s message for ANS readers about this work:

ENGLISH

This paper presents a critical analysis about the dominance of the English language as tool for colonization. We start from the use of the nursing metaparadigm – as the central component of Nursing knowledge – to elucidate the conceptual differences in Nursing foundations that exist due to social and linguistic differences.

For those nurses who learn Nursing in Spanish, the concept of Cuidado – amalgamation of the nuances of Care and Caring – is the cornerstone of the core disciplinary Nursing knowledge. However, this foundational perspective, rooted in most of the Nursing spoken in Romance languages, has been historically underrecognized. Several academic discussions about Nursing concepts and theories that I had with well-known nursing theorists during my doctoral studies brought up an overlooked issue: Meanings differences in the nuances and concepts from languages other than English.

Importantly, this issue has limited the expansion of disciplinary nursing knowledge. Therefore, in several instances, Nursing knowledge turns into a dogmatic believe that cannot be discussed; so that we, scholars who discuss the universality of Nursing knowledge, are seen as heretics in a seemingly homogenous and hegemonic vision of nursing.

This paper is an invitation to discuss, it is an awareness of the multiculturality that must be addressed for the growth of Nursing as a Science; it is a call to the nurses of color around the world, to let them know that the time has come to speak up and share our vision of Nursing. Nonetheless, the decolonization of disciplinary Nursing knowledge cannot be done without the support by the nursing community that dictates “what [Nursing] is, and what it is not.”

 

ESPAÑOL

Este artículo presenta un análisis crítico acerca del dominio de la lengua inglesa como herramienta de colonización. Partimos del uso del metaparadigma de Enfermería – como el componente central del conocimiento enfermero – para elucidar las diferencias conceptuales en los fundamentos de la Enfermería que existen debido a las diferencias sociales y lingüísticas.

Para aquellas enfermeras y enfermeros que aprenden Enfermería en español, el concepto de Cuidado – amalgama del acto de enfermería y el acto de cuidar con amor o cariño – es la piedra angular del conocimiento central de la Enfermería. Sin embargo, esta perspectiva fundacional, arraigada en la mayor parte de la Enfermería hablada en lenguas romances, ha sido históricamente poco reconocida. Varias discusiones académicas sobre conceptos y teorías de enfermería que mantuve con conocidas teóricas de la enfermería durante mis estudios de doctorado sacaron a relucir una cuestión que se había pasado por alto: Las diferencias de significado en los matices y conceptos de otros idiomas distintos al inglés.

Es importante destacar que este problema ha limitado la expansión del conocimiento disciplinar de la Enfermería. Por lo tanto, en varios casos, el conocimiento de Enfermería se convierte en una creencia dogmática que no puede ser discutida; de modo que nosotros, los académicos que discutimos la universalidad del conocimiento enfermero, somos vistos como herejes en una visión aparentemente homogénea y hegemónica de la enfermería

Este artículo es una invitación a la discusión, es una toma de conciencia de la multiculturalidad que debe ser abordada para el crecimiento de la Enfermería como ciencia; es un llamado a las enfermeras y enfermeros de color de todo el mundo, para hacerles saber que ha llegado el momento de hablar y compartir nuestra visión de la Enfermería. Sin embargo, la descolonización del conocimiento disciplinar de Enfermería no puede hacerse sin el apoyo de la comunidad enfermera que dicta “qué es, y qué no es [Enfermería] “.

 

Database Integrity


The first ANS featured article in the newly released Volume 44:2 is titled “Integrity of Databases for Literature Searches in Nursing Avoiding Predatory Journals” authored by Marilyn H. Oermann, PhD, RN, ANEF, FAAN; Jordan Wrigley, MA, MSLS; Leslie H. Nicoll, PhD, MBA, RN, FAAN; Leila S. Ledbetter, MLIS, AHIP; Heather Carter-Templeton, PhD, RN-BC, FAAN; and Alison H. Edie, DNP, APRN, FNP-BC. The article is published open access, which means it is available at no cost from the date of publication going forward. Here is an informative explanation of this article by co-author and librarian Jordan Wrigley – followed by the transcript of her video.

Jordan’s narrative for the ANS Blog

Librarians and information professionals are valuable collaborators in data-based research where intimate understanding of the “behind the scenes” aspects of digital systems and human-information interaction are needed. This may include bibliometrics, metadata, meta-analyses, text mining, and content analysis among others. Librarians are also experts in understanding information-seeking behaviors and often facilitate research literacies including efficient literature searching and evaluation.

This project combined several of these aspects in the context of nursing publication. The goal of this project was to identify to what extent articles originating from potentially predatory and low-quality journals were penetrating databases commonly searched by nursing scholars and students. To achieve this, novel data collection strategies were required to create an original dataset. This included use of unique searching syntax across multiple databases and triangulation with authoritative sources to confirm data validation.

To create the dataset that would be the basis of this manuscript, I created a search algorithm based on journal metadata, such as International Standard Serial Number or ISSN, in one database. Then I translated it to the syntax of other databases. However, because low-quality journals do not consistently participate in processes such as ISSN registration, this dataset also required merging ISSN data with other metadata including journal titles, dates of publication, and publisher. Automated digital processes in databases are also imperfect, sometimes allowing low-quality articles to slip in through non-typical means such as being referenced in valid studies. This also needed to be accounted for in the dataset. The final dataset for this article allowed the team to make informed recommendations for nursing teaching faculty when facilitating research literacies as well as clinicians and researchers when considering where to search for literature.

Data- and digitally-intensive research is often more nuanced and complicated than it first seems. There is an endless amount of data to be used to inform research and teaching practices in nursing as well as other fields. Librarians and information professionals have intimate knowledge of the “behind the scenes” of data and human-information interaction. Please consider engaging a librarian or information professional as a collaborator in a research project to identify the potential unexplored areas of data-based research. Thank you for watching or listening to this video and, to learn more about our team’s findings based on this dataset, have a read of our “Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals” in Advances in Nursing Science.

For a Radical Renewal of Democracy in Hospitals


Contributor: Patrick Martin

Editors’ note: Thank you to author Patrick Martin for contributing this further reflection on his article co-authored with Louise Bouchard, that appeared in ANS 43:4, October/December 2020, p. 306-321 (doi: 10.1097/ANS.00000000000003220)

The staff nurses, who gave us an interview in the research project being discussed in the article “Constraints, Normative Ideal, and Actions to Foster Change in the Practice of Nursing: A Qualitative Study,” recently published in Advances in Nursing Science, have felt left out of decision-making processes that prevail in hospital centers, even if decisions arising from them have a direct impact on the way in which they work. It should be noted that staff nurses who practice in hospital centers represent most of the nursing workforce. The same observation emerges from one of our research projects that is still ongoing, conducted with nurses working in different sectors of specialty care (clinical nurse specialists, pivot nurses, specialized nurse practitioners [SNP], etc.).

This situation, which is eerily similar to the one experienced by the subordinate citizen, systemically left out of places associated with the exercise of power, appears consistent with the broad trends our contemporary oligarchic societies are taking under the aegis of world governance and market globalization. Our results suggest overall that the hospital democracy is increasingly confined to hospital boards of directors and to instances in which usually nurses do not have access. In the words of some participating nurses, these instances would themselves be submitted to a strict hierarchy of command, itself dependent on guidelines, particularly ministerial directives, which would considerably affect overall positions taken by hospital centers. It should be noted that our research is taking place in Canada; our health care system is certainly a public one, which connects, however, to an entrepreneurial-style governance model that leaves more and more room for the private sector and is advocated in all care settings, a clear separation between decision makers and “implementers”.

Based on our research results, the nurses who stand out for their commitment are thereby mostly confined to instances that only have the powers of recommendations, such as the hospital councils of nurses (CN). Participation in instances where access is “open” to nurses was otherwise associated by some participants with strategies put in place by the hospital authority to ensure nurses deploy their energy with no success to make any changes whatsoever happen in constraints they live in their daily practice. Even the parity committees[1] within which union representatives have the opportunity to talk with the employer are perceived as being marginally effective for eliciting to improve conditions under which nurses work.

Although these instances may appear a priori as great opportunities to promote nurses’ interests to the employer for concrete changes can be made in work organization, the perceptions of those interviewed with access to these committees as union representatives are no way going in this sense. These testimonies rather suggest that, even within these instances, numerous techniques would be deployed by the employer in a way to paralyze the dialogue with the union and to push dispute settlements, which we think has the effect of accentuating the separation between decision makers and implementers, already very much present in hospital centers. The fact of constantly changing interlocutors with which the union must find common ground would be leveraged in many backgrounds; this context among these techniques sometimes has the effect of significantly pushing some grievance settlements, the delays may spread out more than one year. If, according to some participating nurses, this is the constant turnover of managers, which would be the source of these delays, the fact remains that the current situation benefits the employer, even if the phenomenon is not necessarily a planned strategy.

When acting for change, the Slovene philosopher Slavoj Žižek(2008a), who is very interested in political action, states that it is important to question ourselves about the possibility of efforts deployed to cause the reproduction of dominant discourse, as it would be the case when nurses are investing time and energy in committees bringing very little outcomes, the hospital governance by far prefers seeing them running around in circles in some frivolous proceedings rather than noting they organize themselves concretely to resist the hospital authority. Žižek will specify in these situations that it is sometimes better to do nothing rather than try to act the wrong way to transform the status quo. Not cooperating in the functioning of the hospital framework by refusing participation in these proceedings – of what, from the point of view for a lot of nurses who participated in our research, in no way enable to improve their situation – would thus become, in itself, an act of resistance.

Results from the research project being discussed in the article “Constraints, Normative Ideal, and Actions to Foster Change in the Practice of Nursing: A Qualitative Study” revealed as well that decisions are usually made in accordance with decision-making processes in hospital centers, always consistent with interests of small influential groups. Participants on numerous occasions made reference to staff nurses in their discourse, but also to link nurses who, based on tacit knowledge, the one marginalized by the good governance doctrine, had warned institutions relative to decisions, many of which would achieve savings that have proven to be serious errors. Decisions even resulted in the death of many patients.

Our results suggest in addition that ideas from nurses are usually taken into account only when they are able to demonstrate they are in fact the partners “of those who play the game of the good governance” [free translation] (Deneault, 2013, p. 41). The nurse who sees herself complimented by a manager after having proposed, through a corporate website promoting innovation, that her colleagues bring their own toilet paper to workplaces for achieving savings, is a disconcerting example of this fact.

What Good is it?

A number of participating nurses encountered in studies and questioned relating to their commitment and the registry for political actions from nurses asked us if we really thought that it was possible to “change things”, with respect to the practice of the contemporary nursing profession in different backgrounds. The situations, described and criticized by them, have effectively come to our mind the most desperate throughout data collections, many participants indeed having openly admitted to us not believe in the possibility of making favorable changes happen to conditions for exercising the nursing profession, more particularly in the hospitals. As Žižek(2012) who, in a lecture given in Toronto, emphasized being regularly confronted with similar questions relating more specifically to pessimistic representations made of the state we find the world we are living in today, we responded to these participating nurses not being exactly sure it is possible to “change things”. And definitely we still have no certainty. Although many are likely to believe that things cannot change, paradoxically, however, we can only see the hectic pace at which, right now, they are changing radically, in both different care settings and our advanced capitalist society.

Not only in capitalist dynamics, but also in all spheres of life, things are in fact already changing automatically to a hectic pace. The very nature of sociability, of what constitutes a human being is as well shifting now and, if we let these changes be deployed passively – the same is true for the comparison to care –, it is expected that we will be heading towards an articulation of the society,[2] which is going to be characterized by a new form, permitted and perverse, of authoritarianism (Žižek, 2012). For Žižek, with whom we are in agreement on this, things are thus already changing to a hectic pace and that has to give us the motivation to act concretely to ensure these changes are getting a foothold in the sense of what we want, consistent with what nurses do. If Žižek postulates we are living the end of the world as we knew it, we also believe that we are witnessing here the end of care settings as we understood them, and sort of – to the end of the nursing professional practice as we knew it. Thereby drastic changes occurred, are happening and will continue to occur and it is expected that these are going to happen in a way even more authoritarian, arbitrary and perverse, because everything seems now okay in the name of the triumphant economy, and these ways of doing things in our societies necessarily affect care settings.

It is not a matter for staff nurses to foolishly accept these changes that will continue to occur quickly, but for them to reflect on what they can do to direct/influence these as well, certainly in a sense which would be salutary to them, but more particularly so we have some humanity. Nurses could also refuse categorically these changes – or some of them –, just as they can propose new ways of looking at the nursing professional practice – and they do so increasingly. And to those who believe that no change is possible because small groups disallow any transformation to the social order, Žižek(2012) unequivocally responded it is wrong to think there is only one social class governing and manipulating what is going on. According to Žižek(2012), reality is in fact more complex, certainly disconcerting, but with no way out – because those who are standing at the top of hierarchies are as well constantly destabilized by this ever-changing world and have enormous difficulties adapting to it. They are thus always improvising, definitely with a lot of means, to promote the maintenance of their hegemonies – hegemonies which, in all of this improvisation are necessarily much more fragile than we would like us to believe. As nurses, as a group, it is extremely important to become aware of this fact, which in regard to what we experienced as a society with the COVID-19 pandemic in the last year, looks absolutely undeniable.

In accordance with the writings of philosopher Rancière (1991, 1999), we refuse, however, to position ourselves in the expert role – a posture which remains anti-emancipatory – or in the Sartre’s trend of the intellectual, by dictating to nurses how they should act to cause the desired transformations to the nursing professional practice. But we feel strongly, consistent with what Gene Sharp (2012)[3] wrote, the power exercised in a hostile way, particularly by the governance of major hospital institutions, must be thwarted by an equal or greater nurses’ collective strength, without which the policies associated with it will continue to be imposed on them. To direct in the sense which is salutary to them, but also so we have some humanity, the societal changes affecting the nursing practice, we believe as well that there is no point for nurses to set off on a crusade against capitalism even if as a group, they and patients to whom they are giving care suffer enormously from collateral effects of this socio-political way of organizing we have. As Žižek (2008b) reminds it, this reflex obsessing the “old left” (p. 29) is not conducive, especially in the way in which the reality of today’s capitalism is structured, namely from a globalized manner where it becomes, for all practical purposes, impossible to have a grip on the ongoing transformations this ideology imposes to our existences.

Like Rancière (2014) and Žižek(2012), we think it is in the radical renewal of democracy in our societies and institutions as citizens, we must deploy our energies and concrete actions, actions that will do harm to the powers-that-be and destabilize oligarchs who have literally appropriated our democracies. It is in this sense, without telling nurses what to do, but we believe it is relevant to move towards a radically renewed hospital democracy[4] as the ultimate central purpose to which their collective actions must be structured, but also their individual ones, because it is always preferable to act on several fronts. Maybe that, starting from these concerted collective and individual actions in the thoroughness of everyday living, nurses will cause the establishment of a new balance of power and they finally have the opportunity to debate on the direction that must take the nursing practice – which, need we remind is essential to life.

Deneault, A. (2013). Gouvernance : le management totalitaire. Montréal : Lux Éditeur.

Rancière, J. (1991). The Ignorant Schoolmaster: Five Lessons in Intellectual Emancipation. Stanford : Standford University Press.

Rancière, J. (1999). Disagreement : Politics and philosophy. Minneapolis : University  of Minnesota Press.

Rancière, J. (2014). Hatred of Democracy. Brooklyn : Verso.

Sharp, G. (2012). Sharp’s dictionary of power and struggle : language of civil resistance in conflicts. New York : Oxford University press.

Žižek, S. (2008a, January). Violence. Paper presented at: the London Review Bookshop, London, United Kingdom.  

Žižek, S. (2008b). Violence : Six Sideways Reflections. New York : Picador.

Žižek, S. (2012, September). Until the end of the world. Paper presented at: Toronto’s Nuit Blanche Symposium, Toronto, Canada.


[1]Given our results, the grievances of nurses can be expressed and tolerated only when they – through their representatives – are invited expressly to do so by their superiors, particularly during these parity committees.

[2] By describing this new entity of new perverse permissively authoritarian society, which will be most rigid but, in a new way, Žižek(2012) prefers not to make reference to what some people are calling a new form of fascism, because he considers that those who use this term do it because they are too cowardly to think what is really new in these ways of doing things. The term “management totalitaire”, used by Deneault (2013), appears to us, however, as a key concept to describe this new articulation of our societies.

[3] Note that these writings of Sharp (2012) do not specifically refer to the nursing reality.

[4] We think at the same time nursing actions must also be directed so we have some radical renewal of democracy in our societies because it appears unlikely that a renewal so radical of the hospital democracy is done without much larger reflections, at the societal level, isn’t it put forward in this sense?

Theory Development Process of Situation-Specific Theories


The current ANS featured article is titled “Theory Development Process of Situation-Specific Theories” authored by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN. In this article, Dr. Im described the development processes used in fifteen situation-specific theories published in refereed journals. This article is available at no cost whiled it is featured, and we encourage you to take advantage of its availability! Dr. Im shared her reflections about her work in this message:

Since my first article on situation-specific theories was published in Advances in Nursing Science in 1999, my thoughts on situation specific theories have grown. I have started this year with an unusual excitement because of the upcoming first book on situation-specific theories from Springer Nature that I have worked on with Dr. Afaf Meleis. The book is a collection of the works by many theorists who gave their thoughts on and have developed and used their own situation-specific theories. On this blog, I am including a picture of little red fruits on a tree that I found in Atlanta, GA this winter (American Holly tree?) in order to illustrate my feelings about all the theoretical works related to situation specific theories that we have done. A collection of our little pretty fruits that we produced despite all the challenges!!!

While working on the first book on situation specific theories, I became to wonder what theoretical development process had been used in the actual development of situation-specific theories. During the same time period, I was invited to several international conferences/workshops/seminars related to theory development, and many of them asked me to give presentations on theory development process of situation-specific theories. Also, over the past several years, I have been asked by PhD students on how they could develop their own situation specific theories through their PhD dissertation works.  When I published the article on the integrative approach to situation-specific theories in 2005, I thought I gave clear guidance for theory development process of situation specific theories. However, many junior and senior scholars were wondering how situation-specific theories had been actually developed during the past two decades.  Because of these inquiries by many nursing scholars and PhD students, this paper was initiated.

While working on the paper, I was very glad to find that I was right about the theory development process of situation specific theories that I proposed in 2005.  For instance, all the situation-specific theories that were reviewed were developed through various combinations of induction and deduction using unique theory development strategies. The situation-specific theories were developed using multiple sources of theorizing (including multiple theories and multiple research studies) in various, but no homogenous steps.  I thought these findings were reasonable and natural considering the high specificity and diversity that situation-specific theories are supposed to provide and respect. 

I also had an interesting finding that situation-specific theories were developed from all types of theories including grand theories, middle-range theories, and situation-specific theories.  Considering the lowest level of abstraction in situation-specific theories, the derivation of situation-specific theories from grand theories and middle-range theories was recommended by many scholars, but situation-specific theories were actually developed based on all types of theories/theoretical works. Considering the characteristics of situation-specific theories (e.g., respecting diversity and contextuality, direct linkages to research and practice), it would be understandable to see the derivation of situation-specific theories from all types of theories and theoretical works.

Based on the expected and unexpected findings on theory development process of situation-specific theories, I made several suggestions for future theoretical development of situation-specific theories in this paper.  Especially, I thought it would be essential and important for future theorists to be creative and innovative in their theoretical efforts to develop situation-specific theories. All situation-specific theories were developed in their own unique ways that would fit with the specific populations and particular nursing situations that they aimed to describe, explain and predict. Without openness to new and creative methods, it would be difficult for theorists to develop situation-specific theories that could exactly fit with their unique populations and nursing situations.  

Especially when considering all the evolutions and revolutions that nursing discipline might need to go through with new changes in nursing environments (e.g., COVID19 pandemic), the openness would be a key to success in our future theoretical journeys. Indeed, with the start of COVID19, health care systems went through drastic changes including the rapid adoption of telemedicine and telehealth. With the changes, nursing situations became to involve telenursing procedures in many aspects of practice, and nurses have been on the frontline of health systems to take care of COVID19 patients through both in-person and non-in-person encounters. Are we ready to provide theoretical lenses that could support all these changes in nursing practice and care?  What if robots began to replace some components of nursing care? Maybe, these would not be necessary worries and concerns at this moment, but we never expected the COVID19 as well. 

Again, many thanks to Dr. Chinn to provide me with this great opportunity to dialogue with my respected colleagues; I missed our dialogues during this pandemic while staying at my little place. Hope this blog could initiate some fruitful discussion on situation-specific theories.  Also, to conclude this blog, I want to mention that this is the year of Golden Cow, White Ox, or Metal Bull in Asian culture, which will bring good fortune to all of us.  With the new good luck, I hope the COVID19 pandemic would disappear and we could get together soon.  

Best wishes for all of us.

Eun-Ok Im

Discrimination-fueled mistrust of hospice care


The current ANS featured article is titled “Mistrust Reported by US Mexicans With Cancer at End of Life and Hospice Enrollment” authored by Margaret L. Rising, PhD, JD, RN; Dena Hassouneh, PhD, RN, FAAN; Patricia Berry, PhD, CNP, GNP-BC, ACHPN, FPCN, FAAN; and Kristin Lutz, PhD, RN. The article is available to download at no cost while it is featured! Here is the abstract giving a summary of the outcome of the grounded theory approach used in this work:

Margaret L. Rising

Hospice research with Hispanics mostly focuses on cultural barriers. Mindful of social justice
and structural violence, we used critical grounded theory in a postcolonial theory framework
to develop a grounded theory of hospice decision making in US Mexicans with terminal cancer. Findings suggest that hospice avoidance is predicted by mistrust, rather than culture,
whereas hospice enrollers felt a sense of belonging. Cultural accommodation may do little
to mitigate hospice avoidance rooted in discrimination-fueled mistrust. Future research with
nondominant populations should employ research designs mitigating Eurocentric biases. Policy makers should consider concurrent therapy for nondominant populations with low trust
in the health care system (p. E14)

Rising, M. L., Hassouneh, D., Berry, P., & Lutz, K. (2021). Mistrust Reported by US Mexicans With Cancer at End of Life and Hospice Enrollment. ANS. Advances in Nursing Science, 44(1), E14–E31. https://doi.org/10.1097/ANS.0000000000000344
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