Regenerating Nursing’s Disciplinary Perspective

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

Marlaine Smith

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

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

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

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

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