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Posts from the ‘Editorial opinion’ Category

Maternal Role Attainment

The current ANS featured article is titled “The Evolution of Maternal Role Attainment: A Theory Analysis” authored by Bridget J. Frese, PhD, RN, CNM, CNL and My Hanh (Theresa) Nguyen, PhD, PMHNP-BC. This article is available to be downloaded at no cost while it is featured, and there are Continuing Education (Professional Development) units available if you complete the CE test! We also welcome your comments about this article here! The authors have provided the following background about their work, and a slide set presenting the main points of the article.

Brenda Frese
My Hanh (Theresa) Nguyen

I am a certified nurse-midwife and my co-author, My Hanh (Theresa) Nguyen, is a psychiatric mental health nurse practitioner.  Although in different nursing disciplines, our passion overlaps in supporting the mental health of new parents with a focus on maternal mental health.  Underlying this passion is the recognition and understanding of the joys and challenges that happen with the transition of becoming a mother.  Our article is a theory analysis of Reva Rubin’s theory of maternal role attainment (1967) which was updated by Ramona Mercer, who changed the name to the theory of becoming a mother (2004).  Using the theory analysis developed by Walker and Avant (2011), Dr. Nguyen and I highlight the strengths of this important theory as well as offer suggestions to update concepts and language that are inclusive of all people and families. In addition, we offer novel visualizations of Rubin’s and Mercer’s theories as they evolved over time.  The theory of maternal role attainment and becoming a mother is relevant to any nurse who works with patients or clients during this exciting time of growth, development, and transition for families.  This not only includes labor and delivery nurses and midwives, but also prenatal, postpartum, neonatal, pediatric, community health, and psychiatric nurses.  As we continue to learn more and grow our nursing profession, it is important to remember those nurses who have come before us, such as Rubin and Mercer, and continue to keep their work alive and relevant.

Caption: Mercer’s “Becoming a Mother”

  1. Pregnancy: commitment, attachment, and preparation
  2. Birth to 2-6 weeks postpartum: acquaintance, learning, and physical restoration
  3. 2 weeks to 4 months postpartum: moving toward a new normal
  4. Around 4 months: Achievement of the maternal identity
    The process of becoming a mother involves an initial four stages that overlap and move in a linear fashion. The four stages lay a foundation for the continual evolution that continues after the achievement of maternal identity. This process happens in the context of family and friends, who are situated in the larger community, which is situated in society.

Standing Up for Science

Advances in Nursing Science, along with a host of other scholarly journals world-wide, standing for the crucial activities of science that establish what we can rely on as fact, and based on that assurance, shape wise action. But there is a now a political and cultural wave of mis-information that serves to discredit science, and to sow seeds of doubt that undermines the value of scientific credibility. In my Editorial that appears in the current issue of ANS, I address this challenge and implore all ANS readers to engage in actions to do what is needed to stand for science in all aspects of your professional and personal life.

There are two levels that I address in this editorial – the first is the substantive practices of ANS that assure readers of the credibility and authenticity of the content we publish in the journal.  In particular, we provide clear descriptions of all of our editorial practices in the “Information for Authors,” we hold membership in COPE (Committee on Publication Ethics), and we adhere to these standards and practices.

The second issue concerns what each individual, particularly those of us who engage in scholarly activities, must do to stand for the credibility of both the products and the processes of science:

  • Be aware of the best editorial practices of nursing journals that ensure the integrity of their content.
  • Learn and practice “journal due diligence” when you are seeking a journal for publication of your work.
  • Be aware of the dangers of predatory publishers. (See articles published in Nurse and Editor)
  • Ensure that your practices as a scholar are well founded and maintain a record of your practices to ensure that your work is not compromised.
  • Educate others (your patients, students, and colleagues) about your own practices to ensure the integrity of your own work and why these practices are important.
  • Network with other scholars in your area of interest to ensure that you have a community of those who share your intent to maintain the integrity of the scholarship in your field, and who can speak with confidence about the foundation on which your work is based.

This editorial is available on the ANS website at no cost while this issue is the current issue!  Visit the website now to download your copy. Cut and paste or post the list of things to do where you can be reminded every day of how crucial our actions are in this time of challenge!


Unless you are preparing a manuscript all alone with absolutely no other person involved in any way, you are likely faced with the challenges involved in deciding who actually qualifies as an author, and once that decision is made, deciding whose name should be first, second, third and beyond.  The first and vitally important guideline for this process is this: early discussion and open negotiation among all parties involved.  This discussion can be initiated by any individual involved in a project – and hopefully that person is already familiar with the resources presented here as guidelines for the discussion.

This is no simple challenge.  In fact, matters of authorship are the most common cases presented for discussion by COPE (Committee on Publication Ethics).  Their excellent discussion paper on Authorship should be at the top of your reading, and re-reading list every time you embark on a new project!  When you initiate an early discussion with your collaborators who might also become authors, if you start with a review of the widely accepted guidelines for authorship described here, you by-pass, or at least lessen the temptation to get involved in arguments and disagreements based purely on personal preferences and motivations.

For ANS, we subscribe to the guidelines for authorship provided by ICMJE (International Committee of Medical Journal Editors), which require that anyone who is included as an author on a manuscript must meet four essential criteria:

  1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
  2. Drafting the work or revising it critically for important intellectual content; AND
  3. Final approval of the version to be published; AND
  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

During the submission process for ANS, all authors must confirm that they meet these four criteria, and soon, you will also be required to include a statement for each author that describes the specific contributions that they have made to the work (criteria #1).  The fact remains that there are typically people who have made a contribution of some type to the conception or design of the work, but have not participated in all of criteria 2, 3 or 4; thus they do not qualify as an author, but they should be acknowledged as non-author contributors in the “acknowledgements” that are published with the article.

The matter of the order in which authors’ names appear is even more difficult to determine. The earlier you can settle this matter, the better for all concerned.  Further, whatever the decision, you will have a much more comfortable working relationship throughout the entire process if everyone involved is fully “on board” with the order in which authors’ names appear.  You can base this decision on the relative contributions of each person, or, if all contributions are roughly equal, you can use an alphabetical or reverse-alphabetical order.

There is a specific situation that many ANS authors face – that of the role of the dissertation or thesis committee members who have worked with a student who ultimately is expected to produce publishable manuscripts based on the scholarly project required for the degree.  The ANS editorial and publishing team concur with the recommendations that have emerged from ICMJE and COPE – faculty advisors do not qualify for authorship based on their advisory role alone. Even though it is typically the case that faculty advisors make significant contributions to the development of the dissertation project, and in turn the content that emerges in a publishable article, faculty advisors rarely meet all of the criteria 2, 3 and 4 above.  Therefore they should be acknowledged for their contribution as an advisor to the project required for the degree, but not as authors.  Of course, in the event that faculty advisors do actively participate and meet all four criteria, they should be authors. However, in my opinion, the student (or former student), as the sole author of the dissertation or thesis, would typically be named as the first author based on their relative investment in the project.

I welcome your comments and responses related to this important issue!  Leave your ideas below – I will respond!

Nursing Models for the Future: Acknowledging the Political Nature of Nursing

Adeline Falk-Rafael, PhD, RN, FAAN in her guest editorial for the current issue of ANS makes a strong case for nursing models that ground practice in our own disciplinary knowledge, and makes nursing work visible and credible.  Dr. Falk-Rafael serves as a member of the ANS Advisory Board, and is a renowned nurse author/scholar whose work focuses on critical caring and social justice. She has shared these reflections on the message conveyed in her guest editorial (available here):

Version 2

Adeline Falk-Rafael

I first learned to be a nurse in a hospital “training” program in the early 1960s. During that time, I learned what nursing was in relation to medicine – what nursing care was in the context of specific medical diagnoses and treatments. Likewise, the relatively minimal attention to health promotion focused almost entirely on disease prevention. A substantial amount of the content of many of the program’s courses was delivered in the form of a physician’s lecture. Ethics was medical ethics and taught by the hospital’s priest. The nursing scope of practice was defined by employers as largely an ancillary medical service that also had some usefulness as a supplementary housekeeping service (cleaning linen and utility rooms and carbolizing the beds of discharged patients were required duties) as well as providing cheap labor in the guise of an educational experience through rotations that including several weeks of making and sterilizing infant formulas and filling individual dietary requests through short-order cooking. Little wonder that as a Registered Nurse, I had difficulty articulating what nursing was, let alone what nurses knew!

While much has changed, thankfully, in the education of nurses, I do not find that nurses practicing at point of service are much more proficient today in clearly articulating the valuable and often unique contribution they make to the health and healing of patients and populations. Because most nurses continue to be employees in bureaucratic organizations and/or large corporate structures, their scope of practice typically remains heavily influenced by prevailing medical and business models.

Nurses are still, in the words of Susan Reverby1, “ordered to care in a society that refuses to value caring.” For this reason, I am a strong apologist for nursing models. I believe they have a strong potential to strengthen nurses’ sense of identity as professionals who make a complimentary but unique contribution to health and health care. As such, nursing models can be tools of empowerment by grounding nurses solidly in disciplinary knowledge and naming aspects of nursing work, thus giving nurses language and credibility to make their work more visible. Grand theories help shape our values and belief systems about what caring for human beings means. Mid-range and micro theories provide more focused approaches to the provision of care that can and must be tested through research and linked to patient/health outcomes. To be useful, nursing models must be seen to be relevant and useful to nurses at point-of-practice, for example, as “apps” that can provide a quick resource when needed. But nursing models of the future must also have a critical perspective. They must serve as tools of resistance by assisting nurses to examine and challenge the larger societal and political forces that advantage a few while disadvantaging many others, whether those others are patients or nurses.

1Reverby S. Ordered to Care: The Dilemma of American Nursing, 1850-1945. New York, NY: Cambridge University Press: 1987.

Overcoming “status quo bias” – a call for innovative action

The first featured article from the latest ANS issue focusing on “Innovations in Health Care Delivery” is the guest Editorial by Paula N. Kagan, PhD, RN.  Dr. Kagan’s scholarship is grounded in critical/emancipatory feminist perspectives, and she is the primary Editor of the forthcoming (2014) text  Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis. Routledge Publishers. Dr. Kagan shared this message about her work, concluding with a call for action:

I have been interested in the idea of innovation for many years. I am attracted to radical change in areas such as the arts as well as nursing practice, in pedagogy, in ethics and policy approaches, and at various other points of social thought and practices. However, there is a horizon of embracing radicalism, a threshold at which there can be comfort in ambiguity and in difference and in creating drastic change. Think resistance. We do not have to stay attracted and attached to the status quo to the exclusion of real change. But how often that occurs.

Paula N Kagan, PhD,RN

Paula N Kagan, PhD,RN

During this election week, the astute Chris Hayes on MSNBC spoke about status quo bias, the human behavior characteristic that moves people to, at times irrationally, chose the status quo over options of change, some of which may be better choices than what constitutes the present circumstance. He was referring to status quo bias in decision-making, an effect demonstrated by Samuelson and Zeckhauser (1988) and applied to many fields of study.

I am perplexed at organizations that chronically spend time on improvement measures but in the end stay within the boundaries of tradition. I am perplexed at our unrelenting focus on acute care and hospital nursing. And, I am perplexed at nurse educators who prepare students to uncritically meet the status quo. We are not serving our students or the public.

Perhaps nurses can begin meetings, at any level of organization, with a consideration of the phenomena of status quo bias, resistance, and the practice of radicalism and make sure these concepts are included as ‘essential’ in the content of study for students (as well as in the practice of faculty and professional leaders) in nursing. Would that make a difference in our criticality, in our ideas of what constitutes innovation and progression?

You can read the full text of Dr. Kagan’s Editorial and download your copy on the ANS web site.  We would be delighted to engage with you here on this blog!  Leave your comments, ideas and questions here, and we will respond.

Nursing, politics, and the economy

The month of May typically prompts some attention to nursing in most Euro-centric countries, given that May 12th was Florence Nightingale’s birthday, and the second week of the month has been designated as Nurses’ Week in the United States. May is also the month of Mother’s Day in the U.S. — a parallel fact that I see as not altogether accidental.  All too often the attention drawn to mothers and to nurses comes in the form of gratuitous and token recognition of nurses in the “Hallmark card” tradition .. flowers, cards and small gifts that convey appreciation.  I certainly do not question the sincerity of these expressions of appreciation, and in fact believe that such messages are notably absent in places and at times when they could make a huge difference in a relationship.  However, when a culture depends on a designated yearly “day” or “week” to prompt recognition of contributions that are as vital as those of nurses and mothers, and at the same time fails to endow those vital contributes with social and cultural markers of  significant value, something is terribly awry.

Two articles appeared in the last couple of weeks that shed light on the persistent failure of dominant social systems to recognize the actual value of nurses and nursing, despite glaring evidence to the contrary.  The first of these articles, titled “Why Nurses Need More Authority” by John W. Rowe, MD, appeared in The Atlantic on May 7, 2012.  The second, titled “The Power of Nursing” by journalist David Bornstein, appeared on May 16, 2012 in the New York Times. Both articles provide ample evidence, which nurses have known for decades, of the effectiveness of a strong nursing influence and presence in health care.  They both make a strong case for nursing to have a much larger and prominent role in creating the changes that need to happen in health care in the United States.

At the risk of seeming to discount the importance of both of these article, what stood out for me as I read each of them were the many ways that each of these articles also reflected the dynamics that sustain the dominant imbalances of power in health care, and the fundamental issues that keep nursing on the periphery and yes, even in a relatively subservient role in the delivery of health care.  On the surface, it might seem that part of the problem has to do with the fact that both of the authors of these articles are not nurses and certainly that fact does shape the perspective that each author brings to the topic.  But we need strong allies, and each of these articles reflect the intention of both of these authors to come to the table as strong allies of nurses and of nursing.  The markers of sustained attitudes and assumptions that perpetuate the problem lie beneath the fact that the authors are not nurses, and in fact, are attitudes and assumptions that many nurses might also bring to the table.  They are part of the hegemonic climate within which health care in the United States and other western cultures exist.  I will only address a couple of the glaring issues that stood out for me as I read these articles.

In Rowe’s article “Why Nurses Need More Authority” he uses the recent Institute of Medicine (IOM) “Future of Nursing” report in part as a spring-board for making the case that advanced practice nurses should be “allowed” to have an expanded role in health care. He points to the opposition that organized medical groups have launched against the recommendations of the IOM report, and rightfully argues that this opposition makes no sense, and that state laws that restrict APRN practice need to be changed.  The concept of being “allowed” to practice to the full extent of our education (the first recommendation of the IOM report) is the first red flag.  It is true that laws and traditions do place restrictions on nursing practice, but the issue is not one of someone simply “allowing” nurses to practice .. it is an issue of making social change that removes restrictions, a process in which we as nurses are quite capable of being full and equal participants.  The other red flag that stands out for me is that the IOM report recommendations are not limited to advance practice only … the report calls for all nurses at all levels of education to practice at the level they are prepared, and it calls for improvements in the education system that give nurses from all levels of education and practice access to furthering their education.  Advanced practice nurses do have a critical role in providing quality health care in the United States, but so do general practice nurses who have earned associate degrees and baccalaureate degrees.  Yet, at each of these levels of practice, policies and traditions restrict what all nurses contribute.  These are barriers that need to be dismantled, not by having a benevolent “father” figure declaring that we are now “allowed” to practice in a certain way, but by social and political processes, in which nurses play a key role, to shape new policies, practices and laws.

David Bornstein’s article focuses more on the provision of the Affordable Care Act that calls for Maternal, Infant and Early Childhood Home Visiting Programs, and the evidence of the effectiveness of a Nurse-Family Partnership (NFP) program established at the University of Colorado Health Sciences Center by David Olds, MD.  What is not acknowledged in Bornstein’s article is the vital interdisciplinary nature of the program, and the dominant role that nurses have played over the years in the conception, the research, program design and implementation.  Bornstein’s article is a brief opinion piece and is not designed as comprehensive report of the project, and I would not expect to see that kind of coverage in an opinion piece.  The red flag is not in the article itself, rather, it is the reminder of how dominant the realm of medicine is in being credited for an achievement like this, even those that are shaped in vital ways by nurses – nurse researchers, educators and practitioners (as was the Univeristy of Colorado NFP project).  This tradition of granting attribution to the dominant medical discipline is a huge factor that is shaped and sustained not only within the health care system and its practices, but also by the media and the public.  But it is not immutable .. it can change.

Nurses … it is time for us to mobilize the recognize these dynamics, and to claim the power, and the authority that is our!

How to list your credentials and title when you publish

Updated resource (Sept. 12, 2019)
APA “Misuse of the PhD(c)

Here is a topic that is not often discussed, but remains a persistent issue for many!  “What is the proper way to list my credentials?  Which should come first, RN, PhD, MS?”  Most folks have very strong opinions about this and will most certainly object if you list their credentials in an order other than what they prefer.  TheyDiploma and notebook will typically give you very good reasons for why they feel one credential or another should be first.  Therefore, as an Editor, my guideline for this is that each person’s credentials should be listed exactly as they prefer them to be listed!

However, there is one “credential” that is frequently indicated that we will not use — the non-credential “PhD(c).”  I am not sure how this convention started, but it is one of my particular pet peeves.  And in many formal and informal polls of other editors, by far the majority agree — this is not an acceptable credential.  Yes, the little (c) does indicate that a person has passed Read more

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