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A New Perspective on Spiritual Care


The latest ANS featured article is titled “A New Perspective on Spiritual
Care: Collaborative Chaplaincy and Nursing Practice
” authored by DorAnne Donesky, PhD, ANP-BC, ACHPN; Emily Sprague, BSN, RN and Denah Joseph, MS, MFT, BCC. In this article the authors explore the domains of religion, spirituality, and culture as commonly conceptualized by chaplains and offer explanations of specialty-level chaplain interventions, primary spiritual interventions provided uniquely by nurses, and interventions that require the cooperation of both professions. Here is a message in which Dr. Donesky describes how this work evolved:

DorAnne Donesky and Denah Joseph

As a nursing professor fascinated by interprofessional education and practice, one day I had the opportunity to shadow palliative care chaplain Denah Joseph as she wen, t about her daily activities. I watched her provide hope and comfort to the patients and loved ones in each room using the language and rituals that were most familiar and reassuring to them. Her therapeutic interventions extended far beyond religious beliefs and addressed existential suffering, relational challenges, cultural misunderstandings, personal legacy and meaning, and psychosocial distress. Recognizing that spirituality is an important part of holistic nursing practice, I asked Denah how she thought we might share her clinical wisdom with the nursing community. In response, she shared with me a document where she listed spiritual interventions she was collecting and testing.

Emily Sprague

Meanwhile, an undergraduate nursing student contacted our graduate nursing school, asking if she might volunteer as a summer research assistant.  Emily Sprague attended a faith-based university and embraced the suggestion that we explore the application of Denah’s knowledge development to nursing practice. Together, Emily and I explored the best way to translate Denah’s knowledge and interventions, developed through the action/reflection methodology common to chaplaincy practice, for practical application to nursing practice.  We were surprised by the conflation of religion and spirituality in the nursing literature, and the recommendation by trusted advisors to focus on ethics rather than spirituality. These experiences reinforced our commitment to explore Denah’s interfaith spirituality interventions from a nursing perspective.

Given the ubiquity of the Religion, Spirituality, and Culture (RSC) model within interfaith chaplaincy practice, we decided to use the RSC model as a theoretical foundation for our paper (see figure in the article). We used exemplar stories based on composite patient experiences to illustrate the spiritual interventions that Denah had developed. Some of the interventions are appropriate for nurses to deliver as “primary spiritual care,” others are only appropriate for chaplains to deliver as “specialty spiritual care,” and we found that some complex spiritual interventions require nurses and chaplains to collaboratively contribute their expertise simultaneously (see table in the article).

The resulting paper has been embraced for interprofessional journal club conversations by nurses and chaplains who want to enhance their collaborative practice. It has been welcomed by chaplains who feel validated in their practice. And it provides a foundation for additional inquiry and interprofessional scholarship within the domains of primary and specialty spiritual care, and the intersection of nursing and chaplaincy collaborative practice.

Nursing in the Anthropocene


At this time of a global pandemic, the currently featured ANS article is especially relevant. In their article titled “We Have Never Been Nurses: Nursing in the Anthropocene, Undoing the Capitalocene,” Jessica Dillard-Wright, MA, MSN, RN, CNM; Jane Hopkins Walsh, MSN, PNP-BC, RN; and Brandon Blaine Brown, MSN, RN-BC, CNL advance a posthuman critique of the discipline and the future shape that is critical for the knowledge in the discipline.  You can download and read the article on the ANS website while it is featured.  The authors have prepared this short video in which they explain their perspective and why it is so important to understanding the experience of this pandemic, to the future of the earth, and to the development of nursing as a discipline.

Nurses and Whistleblowing in Healthcare


Our current featured article is titled “Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health” authored by Amelie Perron, PhD, RN; Trudy Rudge, PhD, RMHN, RN; ´ Marilou Gagnon, PhD, RN. In this timely and important article, the authors examine whistleblowing and the failures it brings to light.  The article is available at no cost while it is featured on the ANS website.  Here is Dr. Perron’s message that provides background on this work:

This paper brings together two seldom discussed subject matters in nursing: whistleblowing and nonknowledge. Publishing this paper on whistleblowing turned out to be very timely in light of the numerous nurses and other healthcare professionals who have spoken up about serious covid-related concerns, in particular with regards to the prevention and management of coronavirus infections and the lack of personal protective equipment made available to care providers. Yet nurse whistleblowing is not limited to crisis and unprecedented situations such as the one we are currently experiencing. Whistleblowing is a constant in nurses’ worlds. Nurses regularly alert their organizations to unsafe, unethical or illegal practices, in the hopes that such situations will be corrected. However, while in some cases, positive reactions ensue, many nurses’ reports are instead met with indifference, suspicion or hostility.

There are many reasons for this. Managers can already feel overwhelmed with various pressures (e.g. budget cuts, staffing issues, patient turnover, the need to implement a new directive with minimal support, etc.) and have limited head space or time to take on additional concerns; they may feel their performance as manager is called into question and become defensive; they may agree with the reported concern but feel powerless to communicate it to their own superiors; their own reading of the situation may be different and they may feel they have a better or a more complete understanding of it. Whichever is the case, these reactions often lead to a lack of decisive action and therefore the perpetuation—and, in some cases, the worsening—of the original issue. Concerns can become lost and forgotten unless nurses persevere. Insistence often leads to nurses becoming overly and precariously visible in the organization: that is, they may be increasingly perceived as the ‘problem’ to be ‘fixed’, rather than the issue they are reporting. This is even more likely to occur if nurses decide to leak their concerns outside the organization (e.g. health ministry, patient safety office, integrity commissioner, health and safety agency, police, media, etc.) in the hope that something will be done to prevent or stop the wrongdoing.

Our paper delves into the reasons why nurses’ knowledge about critical situations or wrongdoing does not necessarily translate into organizational knowledge that can lead to corrective measures. Using the Sociology of ignorance as a framework to deepen this understanding is novel: it is the first time the (anti)epistemic underpinnings of whistleblowing are teased apart in any discipline. This perspective provides insights into the way “not knowing something” (for example through uncertainty, doubt, denial, censorship, forgetting, etc.) becomes a feature of organizational life; how it shapes the way people think and act; how it produces interests, meanings and priorities; and how it positions various individuals in the process.

The literature on whistleblowing emphasizes how the conscious or accidental interruption of critical knowledge is the main driver of critical events or wrongdoing in healthcare settings, and how lack of corrective measures is the main trigger of external whistleblowing.  Through mechanisms of ignorance, knowledge that could have prevented or stopped harmful events becomes unavailable, unusable or unconvincing. Pockets of ignorance form, that translate into organizational blind spots. Experts agree that whistleblowers are critical to the identification and elimination of these blind spots in order to safeguard patients’ and workers’ safety, the quality of care processes, the integrity and the reputation of the organization, and the public interest more broadly. Dissecting the organizational positioning of nurse whistleblowers through the Sociology of ignorance provides new insights into the phenomenon and allows us to reconsider the role of whistleblowing policies and legislation meant to protect whistleblowers.

This work follows a concept analysis on whistleblowing published previously (Gagnon, M. & Perron, A. (2019). Whistleblowing: A concept analysis. Nursing & Health Sciences, doi: 10.1111/nhs.12667). It is part of our work within the Nursing Observatory (https://nursingobs.com/), the first observatory of its kind in the world. It sets the stage for a federally funded study we are currently conducting on nurse whistleblowing in Canada.

Nurses as Allies Against Racism and Discrimination


The first article in the latest issue of ANS is titled “The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time” authored by Jennifer Weitzel, MS, RN; Jeneile Luebke, MS, RN; Linda Wesp, PhD, RN, FNP-BC; Maria Del Carmen Graf, MSN, RN, CTN-A; Ashley Ruiz, BSN, RN; Anne Dressel, PhD, CFPH, MLIS, MA; and Lucy Mkandawire-Valhmu, PhD, RN. This important article is also available for continuing education credit, and it is available at no cost on the ANS website while it is featured.  The authors shared this background information about their work:

For this article, a group of ethnic and culturally diverse scholars joined in a collaborative effort to highlight and promote the role of nurses as allies against racism and discrimination. As a foreign-born Hispanic nurse, my contribution consisted in giving a voice and bringing awareness to the problematic suffered by undocumented immigrants living in the United States during times of openly exhibited xenophobia. Our manuscript is a call for all nurses to take action, become allies and promote a culture that fosters social justice and solidarity- Maria Del Carmen

As a second-generation multiracial Filipina American nurse scholar, whose interests focus on examining nurse-patient interactions following experiences of violence, I feel this manuscript speaks to the important role and responsibility that nurses hold in partnering with individuals and communities of which we serve. Particularly individuals and communities facing experiences of injustice. We hope this manuscript demonstrates the ways in which nurses hold a position of power capable of addressing health inequalities due to racism through establishing healthy partnerships as allies and maintaining solidarity with those we serve to change future health outcomes. – Ashley Ruiz

As a nurse scholar who is an enrolled member of the Bad River Band of Lake Superior Chippewa, I felt that my contribution to this manuscript was a crucial step as a leader in my academic and tribal community. This manuscript is an exemplar for how nurses can use their collective power and voices as allies and advocates to address issues of racial inequities and health disparities. This manuscript also highlights the key resistance movements of our time and how nurses have been in the field and on the frontlines of those movements, not just at the bedside. As advocates and allies, we acknowledge the role that historical trauma and structural violence plays in reproducing inequities that manifest as health disparities and poor health outcomes. – Jeneile Luebke

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

Since 1965, UW-Milwaukee College of Nursing has developed a tradition of excellence. Dedicated to providing academic programs of the highest quality that are at the forefront of nursing, the college has been widely recognized for its innovation, leadership in the profession of nursing and extensive collaboration with diverse community agencies. U.S. News & World Report consistently ranks the college in the top 15 percent of nursing schools with graduate programs.

With our long-standing history of academic excellence, UW-Milwaukee is the ideal choice for students interested in a PhD in Nursing. The PhD in Nursing is a research-intensive program that prepares nurse scientists for roles in research, education, practice, health policy and leadership. Students work closely with faculty mentors to plan and conduct cutting-edge and innovative research using a variety of research methods.

Nurse Vulnerability


The current featured ANS article is titled “Vulnerability in Nurses: A Phenomenon That Cuts Across Professional and Private Spheres.” The authors, located in Denmark and Norway, are Sanne Angel, PhD, RN; Solfrid Vatne, PhD, RN; and Bente Martinsen, PhD, RN.  In this very timely article, the authors propose that organizational awareness and intervention could be a key to addressing nurses’ vulnerability – a message that clearly is needed now.  Dr. Angel provided the message below about their work and the insights from it.  You can access the article at no cost while it is featured; we welcome your comments and responses!

Sanne Angel

Nurses vulnerability has never been more present than now with the Corona Pandemic threating nurses’ health and lives as well as those of their kins.

The experience of vulnerability is never stronger than when life is at risk. Still, we know that whether aware or not, nurses are vulnerable because they are human and because they expose themselves in their role as a nurse, not least since they wish to do good.

In this work, we explored nurses’ vulnerability from their perspective which was possible because we used a phenomenological approach. We introduce the paper by saying “As patients’ vulnerability is a core concern in the nursing profession, nurses’ own vulnerability has received only scant scholarly attention”.

Nursing students who were attending a master’s course in advanced phenomenology were invited to be part of the study. This decision was based on the didactic assumption that when teaching students phenomenology, they benefit

Solfrid Vatne

from being exposed to the phenomenon because this makes them reflect upon it in relation to the conduct of a real study. One of the reviewers wrote: I loved seeing the link from teaching through to publication.

We used a descriptive phenomenological approach informed by Giorgi’s theory, and the student conducted interviews with 14 Danish female nurses. The analysis revealed nurses’ experiences of vulnerability in relation to their work.

We found that vulnerability among nurses is a latent feeling that manifests itself by the body being out of control including feeling overwhelmed by feelings and struggling to avoid to be harmed.

Nurses’ experience of vulnerability is latent, and each nurse has a unique threshold of tolerable vulnerability the level of which cannot be predicted. She may reach her personal tolerability threshold when standing face-to-face with

Bente Martinsen

the basic terms of existence or when she experiences something unexpected or unclear or is challenged by an unintelligible tasks or experiences being treated unfairly. Vulnerability shows itself in feeling overwhelmed and losing bodily control. Vulnerability is closely related to professional insecurity, i.e. situations where nurses doubt their own knowledge and competences, or when they feel unable to treat a patient in the best way. This may happen when a nurse takes on a new job, works with seriously ill patients or is confronted with death, i.e. experiences that may exacerbate nurses’ own vulnerability. The experience of vulnerability is an existential feeling that makes the nurse struggle to avoid being harmed. The experience of vulnerability is not limited to the work sphere as it can spread from the professional to the private sphere. In that case, nurses cannot dissociate themselves from the feeling of vulnerability in their spare time, despite the situation provoking vulnerability being connected to their professional life. However, the experience of vulnerability may also be diminished through interaction with patients, relatives, colleagues, co-workers or managers.

Thus, the experience of vulnerability was evident in situations with patients and relatives. The inherent existential vulnerability was further exacerbated by the work conditions. What surprises was that nursing colleagues was also antecedents, transgressing the nurse’s personal boundaries.

One of the reviewers asked these questions and suggested:

“How might ‘we’ as a profession, as educators and/or practitioners support nurses to learn to navigate this aspect of practice and to recognize its impact on the nurse as ‘self’? This idea could be further explored & developed.

This is an important topic that we believe deserves to be a focus in itself.

In our discussion, we explored how to be sensitive and open without being harmed. Here we found support in Petterson’s theory on mature care that emphasizes that the nurse must take care of herself as well. This is not only allowed, but necessary in order to be able to provide authentic care for the patient.

In our search for recommendations on how to handle difficult situations, we found support in Chinn and Kramer’s theory on personal knowledge. According to this theory of personal development, the difficult situations may be experienced as a possibility to growth. Acknowledging that nurses from time to time experience situations that are more than she can handle will reduce the individual nurse’s vulnerability. However, admitting that something is difficult gives the nurse an opportunity to learn. Here, good colleagues are really needed and leaders play an important role in contributing to creating a learning environment.

 

Innovative Indigenous Research Methodology


The latest ANS featured article is titled “Symbiotic Allegory as Innovative Indigenous Research Methodology” by Barbara Charbonneau-Dahlen, PhD.  In this article Dr. Dahlen draws on her research focus describing the  experiences of Native American boarding school survivors who were victims and witnesses of abuse, with particular attention to the sustained impact of historical trauma. She provided this message for ANS readers about her background and her research focus:

Barbara Dahlen

I was born and raised in Olga, North Dakota and completed most of my childhood education in a mission boarding school in South Dakota and higher education in North Dakota. I am an enrolled member of the Pembina band of Indians. I earned my doctorate from Florida Atlantic University Christine E. Lynn College of Nursing located in Boca Raton, FL. In recognition of the scant literature that existed on the history of Native American nurses in the United States, I began a long journey of discovery in collecting data on historical trauma.  I came to focus on symbiotic allegory because I  wanted to tell  the indigenous stories in the participants own voices to allow the voice to be heard.  This methodology came with a desire to honor the story that was given to my through honoring the sacred tradition of story at the heart of the research.

How Nurses Come to Race


The current ANS featured article is titled “How Nurses Come to Race: Racialization in Public Health Breastfeeding Promotion” by Alysha McFadden, MSc, BSN, RN, CCHN(c); Susan L. Erikson, PhD. In thiis important article, the authors uncover ways in which nurses engage with racialized institutional practices, even when trying not to do so.  We invite you to download this article while it is featured and welcome your comments below.  Here is a message from Alysha McFadden, and a brief video she prepared about this work!

While people are gathering on their balconies at 7 pm every night to rightfully cheer on essential workers such as nurses, I questioned whether it was the right time to feature our research that critically examines nursing praxis. Yet, my newsfeed reminded me that no matter the circumstances, it is appropriate to draw attention to racializing, othering, and essentializing practices—even when its committers are our current day heroes.

“How nurses come to race” was based on my master’s research. As a second-year doctoral student, time has lapsed, and I am continuing to learn (and unlearn) how to conduct myself and my research in an anti-racist and decolonial way. For this blog post I decided to share a personal story of my decolonizing journey through visual storytelling. The video briefly describes what inspired my research on racialization and breastfeeding, while drawing attention to my privilege and complicity.

I hope that when you read our featured article, you will see that racializing, othering, and essentializing practices are ‘…not just occurring in rare situations by “racist” nurses.’ While our ethnographic account and its conclusions cannot be applied with broad brush strokes over every nursing practice area and setting, I hope our article will facilitate reflection—and then transformative action—when these insights resonate. Racialization, othering, and essentialization are pervasive, complex, and often structurally-arranged—but they are not inescapable.

This year, 2020, is the year of the nurse and midwife. Our profession is under considerable pressure and scrutiny. Let us ensure that nurses provide the best, equity-oriented care so that we can be a beacon of light in these uncertain times.

Traditional Masculinity and Men’s Health


The current ANS featured article is titled “Traditional Masculinity A Review of Toxicity Rooted in Social Norms and Gender Socialization” authored by Ashley Rivera, RN, MSN – and recently awarded PhD from Florida Atlantic University!  In this article (available at no cost while it is featured), Dr. Rivera explores the effect of traditional masculinity on health.  Here is a video that she prepared about her article – we welcome your comments and responses to her work!

Epistemic Injustice in Women’s Reproductive Healthcare


The latest ANS featured article is titled “Epistemic Injustice A Philosophical Analysis of Women’s Reproductive Health Care in a Somali-American Community”  authored by Robin Narruhn, PhD, MN, RN and Terri Clark, PhD, CNM, ARNP, RN, FACNM.  Visit the ANS website to download this article; we welcome your comments and responses to this work.  Here is a slideshow narrated by Dr. Narruhn that gives some background on this work:

Military to Civilian Reintegration


The latest ANS featured article is titled “Toward a System Theory of Stress, Resilience, and Reintegration” authored by Anna G. Etchin, PhD, RN; Jennifer R. Fonda, PhD; Regina E. McGlinchey, PhD; and Elizabeth P. Howard, PhD, RN, ACNP, ANP-BC, FAAN. In this article the authors address the need for a theoretical sturcture to understand and interpret complex phenomena.  Here is a message from Dr. Etchin about this work, along with  a link to her “Prezi” presentation that details the elements of this work.

Anna Etchin

In my Prezi.com presentation, my co-authors and I present our rationale for developing the System Theory of Stress, Resilience, and Reintegration, created with integrated concepts from Neuman’s Systems Model and the Transactional Model of Stress and Coping. Military to civilian reintegration, or the return to one’s civilian roles, is complex and demands a holistic perspective. Much like any medical or psychiatric diagnosis, considering other possible influencing aspects of one’s health is key to optimizing patient outcomes. With the help of simple metaphors, we demonstrated the abstract components of this theory, which we then applied to a research study (not presented in this paper).

As a nurse working with veterans for nearly a decade, I’ve seen the direct effects of successful and challenging reintegration experiences. These effects can spill into other areas of veterans’ lives, such as relationships, work stability, etc. By adopting a holistic lens, nurses can better facilitate veterans’ returns to their new normalcy.

 

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