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!
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:
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.
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.
Our current featured article is titled “Embodying Caring Science as Islamic Philosophy of Care: Implications for Nursing Practice” authored by Salma Juma Almukhaini, MSN; Lisa Goldberg, PhD, RN; and Jean Watson, PhD, AHN-BC, FAAN. The article is available to download at no cost while it is featured, so we invite you to read the article and share your comments and responses in the “comment” section below! Here is a message about this work from the primary author, Salma Almukhaini:
The idea of writing this article started during my first semester, fall 2018, as a PhD student at the School of Nursing at Dalhousie University, Canada. I am an international student from Oman. I completed my Bachelor of Science in Nursing in Oman and my Master of Science in Nursing in the United States of America. During fall 2018, I was enrolled in the “Contemporary views of Nursing Science: philosophy, research, and practice” course, coordinated by Dr. Lisa Goldberg. The second class of the course was about understanding Caring Science. That was my first time to know about the Caring Science. That class was inspirational for me in so many ways. It inspired me to reflect on how I, as a nurse, provide care to my patients! What is the caring philosophy underpinning my nursing care! Despite the various caring theories that I have learned about in nursing schools, I knew that what guides my caring practice is my religion” Islam “ and the Islamic principles. I knew that Islam for other Muslims and me is not just a religion. It is a philosophy of life that guides every aspect of it. It guides how Muslim patients perceive their illnesses and how they act during such times. As a Muslim nurse, my love toward God ”Allah” is my main driver when I provide care to my patients, their families, others in my everyday life, and even when I provide care to myself.
The class inspired me to ask the question, “ what is the Islamic philosophy of care? And Is there any?. It inspired me to think more about the caring science, its philosophy, and the ten Caritas processes. I like Caring Science because it provides practical guides, through the ten Caritas processes, for nurses and teaches them how to provide genuine and authentic care and love to their patients. It asks nurses to transcend their egos to build a healing environment for their patients.
What was interesting is that I noticed many similarities between Caring Science and how I provide care based on Islam. At the same time, I realized that the God “Allah” who is central in Muslim patients’ lives is not well acknowledged in the Caring Science. The healing environment for Muslims can hardly be established without recognizing the importance of God “Allah” in Muslim patients’ lives, especially during illnesses and hard times.
I had a discussion with Dr. Goldberg about how Caring Science and Islam are similar in many ways and different in few. She encouraged me to read more about the Islamic philosophy of care and to compare it with the Caring Science. She further challenged me to go beyond that and think about how Caring Science could be aligned with the Islamic philosophy of care.
This topic was super interesting for me because Islam is now the most growing religion, and Muslims are all over the globe. Many questions came to my mind, such as how non-Muslim nurses could provide comprehensive care for Muslim patients if they are not aware of their unquie needs during illnesses, what illnesses and hardship mean to them and how these nurses could cultivate their Muslim patients’ self-care, and how they could build the healing environment for them?.
This article answers all the aforementioned questions. It thoroughly describes what Islamic philosophy of care is and what Caring Science is. It provides a holistic comparison, summarizing both similarities and differences, between the Islamic philosophy of care and the Caring Science (Table provided). In brief, both philosophies acknowledge the importance of self-care, human to human care, human to universe care, and verse versa. Unique to the Islamic philosophy of care is God “Allah” care. Additionally, both agreed that humans consist of physical, mental, and spiritual dimensions. According to the Islamic philosophy of care, in addition to these dimensions, Muslims have an ideological dimension. This dimension entitles that humans have duties toward God”Allah” and fulfilling that duties is the way to seek God’s care, which is fundamental for Muslims.
However, the article did not stop with the comparison; it goes beyond that to show how the two philosophies could be aligned. By embodying the Islamic philosophy of care in the ten Caritas processes of Caring Science, practical guides that could assist nurses, especially non-Muslims, to optimize their care for Muslim patients and provide care that meets their unique needs are summarized.
With the current influx of Muslim refugees and immigrants all over the globe, I could say that this article is timely and will advance nursing knowledge and practice toward Muslim patients. I want to conclude by saying that compassionate, non-judgmental, and patient-centered nursing care is a right for every patient regardless of their background, religion, color, race, or gender. Nursing is caring, and it is our responsibility as nurses to approve that it really is.
Our current ANS featured article is titled “Keeping the Nurse in the Nurse Practitioner Returning to Our Disciplinary Roots of Knowing in Nursing” by Sylvia K. Wood, DNP, ANP-BC, AOCNP. In this article, Dr. Wood examines the factors that have shaped nurse practitioner education and provides the case for restoring nursing roots as central in the future. The article is available for download while it is featured – we welcome your comments and responses to this challenge! Here is a message from Dr. Wood about her work:
Attending the 50th Anniversary 2019 Case Western Reserve theory conference, I was deeply moved to listen to the wise voices of nurse theorists leading our profession, warning us of current threats in losing our disciplinary perspective. Having attended an open session for the Future of Nursing 2020-2030 just two days earlier, and journey as a Ph.D. candidate, created a confluence of events that compelled me to bring this article forward. It is my honor to present it in this issue of ANS. As a nurse practitioner and nurse educator, I have witnessed both the loss of nurse theory-driven practice and diminished presence in our curricula. This article provides a historical background for the context of the issue, existing challenges for academic educators are presented with an analysis of the current literature and recommendations are offered.
For many years in NP practice, these questions never left my mind, what is it that NPs know and do that make them so distinct from other providers and why is their care so valuable in its own right? Why is what they know not made visible? I often observed that NPs, including myself, could not find the words to explain our nursing, our nursing knowledge, how this nursing knowledge shaped what we did in practice, or trace that knowledge back to nursing theory and nursing science. Nevertheless, the result of our NP care significantly improved patients’ health outcomes, healing, wellness, wholeness, and quality of life.
As NP practice has become more sophisticated, there has been a necessary expansion of education from other sciences and health-related disciplines. However, there is a decreasing emphasis on the theoretical foundations of nursing and nursing science, unmooring practice from its anchor to nursing. The result obscures not only NPs’ identity, and the relevance of our practice compared to other providers, but the nurse-sensitive patient outcomes as a consequence of it. The theoretical basis of nursing knowledge (nursology) is what distinguishes nurse practitioners from other health care providers and drives the results associated with it.
2020 is the Year of the Nurse and Midwife. It is also a critical time when the demand for NPs is on the rise, and NPs are advocating for full practice authority. Therefore, in honoring our contract with society, we have an ethical and moral obligation to know, articulate and demonstrate the scientific foundation underpinning the distinction of our practice by returning to our disciplinary roots of knowing in nursing to keep the nurse in the nurse practitioner.
The autonomy of a profession rests more firmly on the uniqueness of its knowledge, knowledge gathered ever so slowly through the questioning of scientific inquiry. Nursing defined by power does not necessarily beget knowledge. But knowledge most often results in the ascription of power and is accompanied by autonomy (Fuller, 1978, p. 701).
Fuller, S. (1978). Holistic man and the science and practice of nursing. Nursing Outlook, 26, 700-704
The current ANS featured article is titled “Proposing Standards for Teaching Authentic Nursing Knowledge,” authored by Debra R. Hanna, PhD. This article appears at a time when many nursing faculty are realizing the importance of re-claiming and emphasizing nursing’s own body of knowledge and are discussing effective ways to do so. The article is available at no cost while it is featured; we invite you to consider Dr. Hanna’s ideas and return here to share your comments and reflections on her work. Dr. Hanna shared this message about her work followed by slides summarizing her main points:
This article is based on a speech I gave at the Case Western Reserve Nursing Theory conference on March 22, 2019 called Differentiated Standards for Teaching Nursing at Four Learner Levels. As I worked on the manuscript, I began to consider a wider scope of concerns that relate to how we teach authentic theoretical nursing knowledge.
Questions I’ve wondered about are: Which teaching standards might ensure that authentic nursing knowledge would be well taught at each learner level? When do nursing students learn to speak with the true words of authentic nursing knowledge? In fact, what is authentic nursing knowledge? What are nurses’ true words?
Authentic theoretical nursing knowledge has been incrementally set aside in official curricular documents for nearly two decades. Maybe one reason we’ve relinquished authentic nursing knowledge is that we never developed standards for how such knowledge should be taught at each learner level. In this article I present my thoughts about a simple structure of four learner levels that lead to four types of nursing practice.
The article has four sections. The history of our first curricular standards precedes a section on authentic nursing knowledge and ideas from Paolo Friere about true words. The next section shows that some teaching standards exist for prelicensure and graduate education. Yet, hardly any standards exist for teaching authentic nursing knowledge at each learner level. The final section differentiates curricular standards from teaching methods from teaching standards. This section is where proposals for new teaching standards are made.
From November 15, 2019 until January 15, 2020 the American Association of Colleges of Nursing called for a National Faculty meeting so that academic nurse educators could discuss proposed revisions to the AACN Essentials curricular documents. The next step will be regional meetings to collect feedback on the proposed AACN Essentials. This article offers timely ideas that might be useful for that important National Faculty discussion.
The current ANS featured article is titled “Development of a Theory of Wisdom-in-Action for Clinical Nursing” authored by Susan A. Matney, PhD, RN; Kay Avant, PhD, RN; Lauren Clark, PhD, RN; and Nancy Staggers, PhD, RN. You can download this article at no cost while it is featured! Here is a message from Dr. Matney about this work:
The article presented in Advances in Nursing Science describes the emerging Theory of Wisdom-in-Action (WIA) for clinical nursing. The theory was developed in three phases, In Phase 1, a preliminary theory was developed deductively using derivation and synthesis, based on theories and models from psychology, education, and nursing. Pertinent concepts were identified and nursing-specific definitions created. In Phase 2, a constructivist grounded theory approach inductively captured the experience of wisdom in nursing practice, based on wisdom narratives from 30 emergency department nurses. The resulting grounded theory focused on two processes, technical and affective, juxtaposed on a foundation of expertise. In the final Phase 3, the two theories were synthesized into the Theory of WIA for Clinical Nursing. The theory describes two antecedent dimensions, person-related and setting-related factors, and two types of wisdom processes. General wisdom processes apply to patient care and describe the actions nurses take during a stressful or uncertain situation. Personal wisdom develops afterwards, as a feedback loop with reflection, discovery of meaning, and learning, followed by increased knowledge and confidence.
The theory illustrates how wise nurses practice using their head, their heart, and their gut. The following fictional story demonstrates WIA:
Jane Everywoman was practicing in the emergency room when she received a 42-year-old female patient into the trauma room with a head injury sustained during a bike accident. Jane has 10 years of experience and is the charge nurse for this patient. The patient was non-responsive and had been resuscitated. Jane called the trauma team and they began advanced trauma life support measures. Synchronously, Jane calls the family and notifies them that their wife and mother is in the hospital. The distraught family comes to the hospital and Jane puts them in a private room and visits them routinely to empathically give them updates. During the resuscitation, Jane gets the feeling that she should bring the family into the room, which she finally does. The family was only there for a short time when the doctor tells the nurse to remove them from the room. The patient ends up dying. Weeks later, the patient’s husband finds Jane in the emergency room and thanked her for doing everything they could to save his wife, communicating with him, and bringing the family into the trauma room. He said it was the hardest and best thing she could have ever done because it showed him that everything was being done to save his wife and helped him start the grief process.
The theory of WIA for clinical nursing general wisdom attributes include expertise, a technical nursing process, and affective processes, influenced by insight and intuition. Jane had expertise and was performing the technical skills needed to resuscitate the patient (head). At the same time, she used emotional intelligence to communicate with the family (heart). She also listened to her gut and brought the patient’s family into the trauma room during the resuscitation.
Wisdom is critical for all areas of nursing practice. The nascent Theory of Wisdom-in-Action for Clinical Nursing provides a working framework for translating wisdom in clinical nursing practice into theoretical and practical terms, depicting both the science and the art of nursing. This novel theory displays how nurses practice with wisdom during stressful and uncertain situation. The theory still needs refinement and testing but we feel it reveals that wisdom in action requires clinical skills, experience, knowledge, and affective proficiency.
The current ANS featured article is titled “Claiming the Narrative Wave With Story Theory” authored by Patricia Liehr, PhD, RN and Mary Jane Smith, PhD, RN, FAAN. The article is available for download at no cost while it is featured. In this article, the authors clarify the nature, the importance, and the benefits of narrative in both research and practice. Download the article now, and share your comments for discussion here! This is a message provided by Dr. Liehr for ANS blog readers:
Near the end of our STORY-WAVE paper, we say: “In order to attend to unique health challenges for those in our care, nurses must embrace the idea that listening to another’s story is as essential as any other vital sign.” Hardly any nursing action occurs without some understanding of the context that has supported an individual’s presenting health challenge. In fact, another’s story can tie together other pieces of clinical data in a way that makes sense; that enables human-centered precision care. Story is a vital sign; story theory proposes a way for nurses to think about, collect and analyze practice and research stories.
Just recently, while talking with a nurse who has spent the last 30 years working in the emergency room, the conversation turned to what energizes her and keeps her passion for nursing alive. In a move to South Florida about a decade ago, she was introduced to the population of Jewish patients who bear the history of the Holocaust, branded onto their wrists. She has invited these older adults to talk about the marking, thereby offering an opportunity to “make visible” what can easily be overlooked in an emergency room visit. “…sometimes they pause and I can see that they are considering what I have asked but almost all of them speak to me about the Holocaust. I LOVE caring for these older adults.” We believe that stories like these create a context for caring; in this case, infusing advanced ER knowledge and sophisticated skills with recognition of person that makes a difference in well-being.
In 2020, the Year of the Nurse and Midwife and the 200-year anniversary of the birth of Florence Nightingale, it is definitely time to claim the narrative wave. Why????….because story is central to our practice and our research. In the last line of our STORY-WAVE paper we say: “Story theory can help nurses raise recognition of stories from practice and research as valuable guiding evidence, thereby claiming the narrative wave as an integral facet of disciplinary knowledge development.”….that’s why.
Our first featured article from the latest ANS issue (coming soon!) is titled “Reducing 30-Day Readmissions Through Nursing Science: An Application of Transitions Theory With Best Practice Guidelines” by Bridget Stixrood, MSN, RN, CNL. In this article, Ms. Stixrood provides an exemplar of theory-guided practice! While the article is featured, you can download it at no cost. We welcome your feedback and comments! Here is a message from the author about her work and her perspective:
I am honored to present my article outlining the Transition Management Model to this issue of ANS.
The Transition Management Model was completed as a part of my MSN program. The goal of the project was to improve care transitions for patients and reduce 30-day readmission rates for an Independent Health Network. At this unique healthcare setting nurse care coordination was utilized to manage care for complex Medicare and Medicaid covered individuals. Upon initial design of the project I quickly became inspired and energized by the application of nursing science to frame best practice guidelines. I found that nursing theory provides enough flexibility to adapt to the unpredictable nature of healthcare politics, policies and emerging best practice guidelines.
This project underscores the overwhelming importance of nursing practice to improved health outcomes and reduced 30-day readmission rates. I believe some project success could be attributed to the holistic nature of nursing practice. As nurses we look at an individual’s whole health story including spiritual, mental, physical and environmental.
Behavioral health was particularly difficult to address in the Transition Management Model. Those with mental illness have an added barrier to care when they are symptomatic and need a higher level of management. Applying the Transition Care Model to mental health transitions could be a next step for this project. Improving community partnerships and using nursing science to address the complexities of healthcare in the US is desperately needed. I am curious about what types of breaks in healthcare delivery are you seeing in your community? How can we build a practice that maintains integrity despite what political constructs we work within?
This article is meant to be read as a catalyst and an example of how nursing theory, in this case Transitions Theory by Meleis, can be a useful tool in navigating the complex health stories of our patients and the healthcare environment we function within.
I obtained my MSN from Pacific Lutheran University in 2018. I obtained my Clinical Nurse Leader certification soon after graduation. After working as a labor and delivery nurse for a year while also working at the Pierce County Jail, I fell in love with nursing in the jail setting. I am currently working as a nurse at the King County Correctional Facility. I am passionate about nursing science, mental health care and public health.
I look forward to reading your comments and strengthening our practice together.
Currently our featured ANS article is titled “Prodromal Myocardial Infarction Fatigue: A Concept Analysis” by John R. Blakeman, MSN, RN, PCCN-K. Please download the article at no cost while it is featured, and return here to share your comments and feedback! Here is John’s message about his work, including a presentation that he prepared featuring this work:
Symptom research is complicated. Because symptoms are, at their core, a human experience, each individual may perceive, attribute, and react to them in different ways. Because of the unique context in which they occur, symptoms cannot reliably be reduced to single, simple, objective pieces of data. Prodromal myocardial infarction (MI) fatigue is no different.
About six years ago, I began my adventure into the world of MI symptoms, especially MI symptoms experienced by women. I had heard about symptom differences between men and women, but, up to that point, I had not closely examined these symptoms in any comprehensive, systematic way. As I dove into the literature, one of the major themes that I identified was that fatigue was a particularly prevalent symptom experienced by women before an MI. However, fatigue was conceptualized in a variety of ways.
Symptom research is a messy business, partly because this research necessarily involves a considerable amount of self-report data. It is not uncommon to see multiple different descriptions of a given symptom. In the case of prodromal MI fatigue, I read a number of descriptions. Some research participants across studies had described this fatigue as “tiredness,” while others might have opted for the term “weakness.” Still others simply used the term “fatigue.” Study participants also provided an array of descriptions regarding the severity and intensity of this symptom. I recognized that this central, latent construct of prodromal MI fatigue was really made up of a number of other constructs, and I wanted to comprehensively review the literature to identify what exactly this latent construct of prodromal MI fatigue “looked like.” Out of this desire came the present concept analysis.
I learned that there was not a simple, neat definition that could be created, though I was able to identify several general commonalities across the many documents that I reviewed. I also recognized the need to further investigate prodromal MI fatigue, and I am now completing a qualitative study focused on women’s experiences of prodromal MI fatigue. This concept analysis helped frame my understanding of the symptom and guided me as I designed my study. Is there more work to do? Absolutely. I expect, and would hope, that this concept will be further refined and that researchers will be able to use this increased knowledge to improve care and patient outcomes. Indeed, if prodromal MI fatigue can be recognized early, morbidity and mortality can likely be reduced due to early intervention, prior to MI.