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Posts from the ‘Editor’s Picks’ Category

Resisting Racism in Nursing


The current featured article in ANS offers critical insight into the dynamics of racism in nursing using narrative analysis. The article is by Nancy Clark, PhD, RN and Nasrin Saleh, RN, MPH, titled “Applying Critical Race Feminism and Intersectionality to Narrative Inquiry A Point of Resistance for Muslim Nurses Donning a Hijab”.  We invite you to download this article while it is featured, and share your comments and insights related to this important issue.  Here is a message sent by the authors for ANS readers:

Nancy Clark

Our article is based on the doctoral work of the second author who is a practicing Muslim nurse wearing a hijab. The article begins with a powerful quote by Nasrin Saleh stemming from her daily experiences and an encounter with one of her patients who accused her of being a terrorist based on her hijab. The article proposes a methodological approach that employs narrative inquiry framed within critical race feminism and the lens of intersectionality as a point of resistance for Muslim nurses donning to stand against their racialization.

We are very pleased to have our article published in ANS and in this special issue. Our article is timely and powerful, considering the dramatic and recent rise of islamophobia in the US, Canada, Europe and globally, and the current political climate, the heightened attention placed on Muslims by the media, the hypervisibility of Muslim women and nurses donning hijab, and the lack of knowledge on the experiences of Muslim nurses donning a hijab. Therefore, in our view, a main contribution of the article is in advocating for a collective antiracist social action in nursing by proposing a methodological approach to bring the voices of Muslim nurses donning hijab to the collective discourse

Nasrin Saleh

on racism in nursing, and to recognize and speak against the racialization of Muslim women/nurses. The article introduces religion as an axis of difference and the need for examining its intersections with gender and race in shaping the experiences of Muslim nurses donning hijab. This article is also a step forward in speaking against racism in nursing and to advance social justice.  

Promoting Culturally Safe Prenatal Care


The current featured article from ANS 42:2 is titled “Understanding Mi’kmaq Women‘s Experiences Accessing Prenatal Care in Rural Nova Scotia” authored by Laura Burns, BScN, RN; Joanne Whitty-Rogers, PhD, RN; and Cathy MacDonald, PhD, RN. Based on their study of Mi’kmaq women’s experiences accessing prenatal care, the authors reveal steps that are needed to improve culturally safe prenatal care for women at risk.  Here is a message providing the interesting background of this work from lead author Laura Burns:

Laura Burns being presented with the University Gold Medal in Nursing Award for the highest average in the final three years of study by StFX President, Dr. Kent MacDonald, and former StFX Chancellor, Dr. Susan Crocker.

I am so pleased to have this research study published in the ANS current issue: Culture, Race & Discrimination. I began this study as an undergraduate honours nursing student at St. Francis Xavier University. With the support and guidance of my previous supervisor, Dr. Joanne Whitty-Rogers, and second reader, Dr. Cathy MacDonald, I continued this work following graduation in 2017. I had the opportunity to attend the 44th Annual Conference of the Transcultural Nursing Society in San Antonio, Texas as a presenter. This international conference included over 260 participants from 48 cultures and more than 14 countries. Speakers and attendees included a diverse and global array of transcultural nursing and healthcare experts. The conference was an incredible experience for a novice researcher, as I engaged directly with theorists and providers from administrative, educational, practice, and research settings in a variety of panel discussions and breakout sessions.

Indigenous women experience a higher incidence of maternal complications compared with non-Indigenous women. Despite this, little is known about access to prenatal care for Mi’kmaq women in Nova Scotia. The purpose of this research study was to better understand the experiences of Mi’kmaq women accessing prenatal care in rural Nova Scotia. This was achieved using a Two-Eyed Seeing approach, by incorporating Indigenous and Participatory Action Research (PAR) principles to conduct research in a Mi’kmaq community. By using a feminist lens, Mi’kmaq women’s lived experiences were captured in a respectful manner, so as to legitimate their voices as sources of knowledge. Their experiences with access to prenatal care were used as a basis for building knowledge.

My early education of the Mi’kmaq people of Nova Scotia was essentially through the lens of Caucasian, Euro-Canadian perspectives. The importance of gaining an understanding of Mi’kmaq people’s experiences from their own perspectives became important to me during my first year of nursing school, when I was introduced to the concept of cultural safety. I recognized that nurses have the responsibility to continuously learn, and by listening to the stories of Mi’kmaq women’s experiences I developed an understanding of what it is like to navigate the Canadian health care system from a perspective that is much different from my own.  I remained aware of potential perceived power imbalances, as a non-Indigenous undergraduate student, I asked participants to share details of their personal maternal experiences.  The participants’ willingness and eagerness to share their experiences and offer suggestions to combat issues with access to prenatal care confirmed the importance of establishing partnerships with Mi’kmaq women, as they know what they need to improve their own health and the health of their community.

The findings from this study highlight key implications for nursing practice such as promoting the nurse’s role in supporting and advocating for Mi’kmaq women’s health and for providing culturally safe care. Throughout this study, it was evident that mothers, sisters, grandmothers, and aunties are significantly relied on for support, especially in regard to seeking reassurance and information. Colonization did much to destroy women’s ways of knowing about motherhood, however, many of these traditions still carry on, highlighting Indigenous mother’s strength and resiliency over time. This research will highlight that access to prenatal care is a complex issue for some women. Through this research process, it became evident that inequities in the social determinants of health impact women in accessing adequate prenatal care. Although barriers were identified, it is important to mention that all the participants in this study felt that they received the best prenatal care possible and were pleased with the care they received. This was especially true for the care and education the women received from the Health Centre in their community.

In an otherwise affluent society, Canada’s Indigenous women experience a disproportionate burden of maternal complications due to negative social determinants of health. Nurses have the responsibility to recognize these health inequities in practice, and advocate for clients and families. Nurses must play a key role in recognizing and addressing power imbalances within the health care system, so that equitable care may be achieved for all Canadians.

Laura Burns presenting her research study titled “Understanding Mi’kmaq Women’s Experiences Accessing Prenatal Care in Rural Nova Scotia” at the 44th Annual Conference of the Transcultural Nursing Society in San Antonio, Texas, October 2018.

 

 

Health Care Experiences of Transgender Adults


We are now featuring the article titled “Health Care Experiences of Transgender Adults: An Integrated Mixed Research Literature Review” authored by Ethan C. Cicero, PhD, RN; Sari L. Reisner, ScD; Susan G. Silva, PhD; Elizabeth I. Merwin, PhD, RN, FAAN; and Janice C. Humphreys, PhD, RN, FAAN.  This review, guided by a gender-affirmation framework, reveals many barriers to healthcare access that could be eliminated.  The article is available for no-cost download while it is featured, and we welcome your comments here!  This is the message the Dr. Cicero provided about this work:

© 2019 Ethan Cicero

Throughout the United States there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from past and proposed anti-transgender legislation and governmental policies. Within healthcare, the Trump administration halted enforcement of the Affordable Care Act’s nondiscrimination protections for transgender people and most recently, a rule was issued that would allow healthcare institutions and clinical providers to deny healthcare to transgender individuals based on religious or moral reasons. These discriminatory and unjust actions oppose the medical guidelines of most professional medical and nursing associations, including the American Academy of Nursing, American Nurses Association, National Association of Pediatric Nurse Practitioners, and the National Association of School Nurses. Consequently, the decisions of this administration and the prejudice, stigma, and discrimination transgender people endure where they live, learn, work, and seek healthcare may contribute to the adverse health outcomes, social inequities, and barriers to equitable healthcare experienced by transgender individuals.

The transgender population is comprised of heterogeneous communities of individuals illustrating diversity of genders and gender expressions. In the United States, the transgender population is comprised of an estimated 1.4 million adults, which is more than the number of children and adults with type 1 diabetes. Transgender is an adjective used to describe individuals whose sex assigned at birth differs from their current gender or gender expression. This definition suggests a comprehensive approach to inclusion, but there are communities and individuals meeting its criteria who do not self-identify with the term (e.g., nonbinary, genderqueer, man or woman, gender expansive, etc.). In contrast, cisgender individuals have a gender that aligns with their sex assigned at birth.

With our integrated mixed research literature review, we described the scope of literature pertaining to the experiences of transgender adults accessing and utilizing healthcare in the United States. Evidence from the 23 articles synthesized indicated that transgender adults experience numerous obstacles accessing healthcare, discrimination from healthcare professionals and clinicians, and barriers to medically necessary care, such as gender-affirming (cross-sex) hormones, as well as primary and preventative healthcare. In light of our findings, the impact from the current administration on health outcomes and healthcare access is yet to be determined. However, the knowledge gained from this review can help nurses provide the best care for the transgender population. In order to promote health and well-being for transgender individuals, improvements to healthcare access, healthcare environments, and the clinical care provided are paramount.

Nurses play a key role in creating a care environment that is welcoming and affirming where all transgender people can thrive. It has been my experience that nurses do want to help, but many might be uncomfortable or lack an understanding in how to deliver gender-affirming care to transgender people, especially given the dearth of nursing curriculums designed to address caring for transgender communities. Although this may be true, there are plenty of evidence-based resources, including top-notch research in nursing and academic journals (Advances in Nursing Science!), and free online CEU/CMEs dedicated to improving the knowledge base of nurses. (Be sure to check out the Fenway Institute’s National LGBT Health Education Center)

Nurses can also join professional organizations, such as the World Professional Association for Transgender Health and the Association for Transgender Health Nurses, as well as attend professional continuing education conferences dedicated to transgender health. This September in Washington, DC, the United States Professional Association for Transgender Health (USPATH) will host their biannual conference, which will feature the first USPATH Nursing pre-course (see registration and pre-course details here). I’ve had the privilege and honor to partner with other nurse leaders in transgender health to establish and design this evidence-based course that aims to empower nurses to advocate for inclusive and equitable healthcare policies and clinical environments as well as ways to deliver gender-affirming care to transgender people across the lifespan.

As nurses, we can become change champions to improve and facilitate the delivery of gender-affirming healthcare. As outlined by the Nursing Code of Ethics, we have an ethical responsibility to maintain a safe and healthy environment for all patients. In order to improve the health and well-being of the transgender population, the time is now for us to focus our collective power in transforming and improving the healthcare experiences and care provided to all transgender individuals.

 

© 2019 Ethan Cicero

Queer Phenomenology, the Disruption of Heteronormativity, and Structurally Responsive Care


Our current featured article is authored by Jennifer Searle, BSc, BScN, RN, titled “Queer Phenomenology, the Disruption of Heteronormativity, and Structurally Responsive Care.” In this article, the author reveals heteronormativity as a prevalent, but largely unacknowledged, source of structural harms for LGBTQ patients and discusses the importance of gaining an awareness of ongoing structural harms that are disproportionately experienced by vulnerable patient populations. She shared this background about her work for ANS readers, and we invite you to download the article while it is available for download and share your comments and insights related to this work:

Jennifer Searle

I wrote this prior to being accepted into the doctoral program early, while I was completing the coursework for the Master of Nursing program. The paper was a major writing assignment that was supposed to explore a practice issue or experience. We were directed to use a theoretical lens to develop a manuscript for publication. Queer phenomenology was the methodology I had planned on using as a graduate student, but I have since switched to grounded theory for a number of reasons. The decision to leave queer phenomenology behind was largely informed by a realization that I no longer wanted to use an interpretive framework that sought to understand how heteronormativity is experienced within health care because this routinely caused me to re-engage with my own experiences of heteronormative-related harm.

As a lesbian, I experience harms that have been historically underrepresented, particularly in nursing literature. I often have to disclose personal experiences to illuminate the harms that heteronormative practices cause. I have found that those who do not experience such harms in their everyday realities often find it difficult to understand the risks of normativity to those who do not conform accordingly. This article does just that. I have taken an experience I had as a patient and used queer phenomenology to explain how being-in-the-world with heteronormativity causes harm to those who do not conform with the expectation of heterosexuality. I wanted to show both sides of a practice issue for this assignment and bring visibility to the intersection of my existence as both patient and healthcare provider. The systemic inequities that I experience are not unique to me as a lesbian or as a member of a historically marginalized group and like many others, I have come to anticipate being harmed. This informs my practice in ways that means I provide a level of care as a nurse that I have yet to receive as a patient. The risk of harm I was experiencing within my role as a graduate student became overwhelming and unsustainable. I felt as if I was always trying to convince others of the harm that characterizes my existence, which resulted in continued re-exposure to the trauma I experience in relation to discriminatory social structures. Some were easier to convince and I experienced most to be well-intended, but I came to realize that I must create distance between my harm and my work if I would be successful in finishing my graduate studies.

I believe this article reveals the necessity to provide care that has its intended impact and might even convey important insights into harm that resonates with members of dominant groups who have yet to gain an appreciation for the implications of professional education and training that inadvertently reinforces heteronormative assumptions. My understanding of harm has been expanded by queer phenomenology and it has provided me with a lens to make sense of a world that discriminates against me, but I did not feel as if my appreciation for how I might promote change within health care to address lesbian, gay, bisexual, transgender, and queer (LGBTQ) health disparities was furthered. Instead, I kept falling into a cycle of harm that has hindered my ability to focus on the purpose of my research. I want to know more about the process by which health services are delivered to LGBTQ patients by healthcare professionals who have received training that remains informed by a legacy of discrimination that once legitimized the stigmatization of non-heterosexuality via the pathologization of homosexuality. I no longer want to explore the ways in which people like me are harmed by a society that normalizes heterosexuality at our expense.

I believe the overall health system might be strengthened by narrowing the gap between health services provided by healthcare providers and those which are required to better meet the health needs of LGBTQ patients. Queer phenomenology will always shape my interpretation of the world around me and will likely inform the direction I take as a doctoral student, but its role in my work will be limited as such moving forward. Harm pulls focus on my ability to see a broader context and while I recognize that structural approaches can be overly deterministic and thus risk undermining the agentic possibilities available to individuals, this article reveals to me that agency will always be relative to structure. Those who are marginalized within broader society are likely to be constrained in their ability to re-act when they are re-exposed to structural harms. My experience as a patient as described in this article, demonstrates the role that healthcare professionals can take in understanding how a lack of reflexivity during the process of care delivery places patients at risk of being re-exposed to a lifetime of harmful assumptions, biases, and stereotypes. These subtler forms of harm often connect to personal, collective, and intergenerational traumas that are caused by social structures that discriminate, exclude, and marginalize individuals based on characteristics that they have no control over. As such, those who access health services are at an increased risk of being re-exposed to structurally-based forms of trauma.

As an educator, I recognize the ongoing gaps in nursing education in terms of perpetuating an assumption that marginalizing characteristics are visible and thus recognizable. I believe this sort of approach does us all a disservice. Members of equity seeking groups are not always recognizable; characteristics that relegate us to the margins are not always visible. Even if a person is visibly different, this does not mean that we, as healthcare professionals, can assume we know how a person’s lived reality is constructed alongside dominant cultures and normative expectations. Such an approach would surely reinforce stereotypes about groups rather than promote a layered understanding of individual circumstances in relation to structural conditions. This article is therefore offered as a means to explain that we, as healthcare professionals, must gain an appreciation for broader contexts of structural harm to situate individuals, understand their lived realities in safe and meaningful ways, provide what I describe as structurally responsive care, and minimize the risk of re-exposing patients to the traumas that characterize their existence.

Confronting Institutionalized Racism


Our first featured article in ANS 42:2 is titled “Words Matter: An Integrative Review of Institutionalized Racism in Nursing Literature” authored by Whitney Thurman, PhD, RN; Karen Johnson, PhD, RN, FSAHM; and Danica F. Sumpter, PhD, RN. This article, which provides insights that can guide dismantling racism in nursing, is available for download on the ANS website while it is featured.  Dr. Thurman shared this background about this work:

(l-r) Karen Johnson, Danica Sumpter, and Whitney Thurman

In 1999, the Institute of Medicine released the groundbreaking report, “To Err is Human.” One of the main conclusions of this report was that the majority of medical errors do not result from individual recklessness. Instead, errors are more commonly caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. Within this integrative review of the nursing literature, we hope our readers can see a parallel between focusing on institutionalized racism as a combination of systems and structures created in a culture that privileges whiteness and therefore requires systems-level solutions, just as medication errors require systems-level solutions. To be sure, similar to individual medication errors, individual acts of racism exist and must be quickly addressed. However, our purpose in conducting this review was to move the conversation past racism as merely interpersonal in order to challenge the nursing profession to understand and accept that racism is woven into the very fabric of this country and all of its institutions, including healthcare. After all, when it was written and signed, the Constitution of the United States did not consider African Americans to be fully human, and the ramifications of centuries of legalized discrimination and segregation did not vanish with the signing of the Civil Rights Act.

As nurses, we pride ourselves in serving our patient populations without judgement. The reality is, however, that all of us hold biases that have been formed– often without our awareness– by the larger culture and systems in which we operate. Similarly, patients bring with them a lifetime of experiences that influence their health beliefs and behaviors as well as their opportunities to be healthy and productive. As nurses with collective expertise and experience in public health, NICU, and pediatric nursing across teaching, research, and practice settings, we suggest that it is time for the nursing profession to reconsider our commitment to non-judgment. We challenge our readers to recognize and confront the systems that perpetuate health inequities, provider-level implicit biases, and individual-level overt and microaggressions. However, the challenge must be done in without re-centering the conversation on individual-level definitions and solutions to addressing racism. With greater intention to institutionalized racism across educational, research, and practice settings, nurses will be better equipped to dismantle systems and structures that perpetuate racial inequities in health.

Our hope with this integrated review is three-fold. First, this is a call to action to our nursing colleagues and students across practice, education, and research settings to engage in continuous self-reflection and dialogue about racism. Second, we challenge our peers to join us in owning our collective responsibility to recognize and challenge institutional policies that perpetuate racism and health inequities. Finally, we hope to amplify the voices– particularly those from communities of color who have been doing this work for ages– calling for us to address racism in our ongoing dialogue about health inequities. Specifically, we hope that the organizations and road maps that guide decision making for nursing and healthcare overall, such as the upcoming Healthy People 2030 and the Future of Nursing 2030 reports, will heed the recommendations of organizations such as the Black Mamas Matter Alliance and provide strong, evidence-based recommendations for nursing’s role in dismantling systems that have perpetuated racial inequities in favor of more equitable systems.

Health Care Experiences of Lesbian Women


Our current ANS featured article is titled Health Care Experiences of Lesbian Women: A Metasynthesis authored by Marianne Snyder PhD, MSN, RN. Her metasynthesis offers insights that can assist nurses in providing sensitive and appropriate care for lesbian women.  This article is also our current continuing education offering, providing nurses in all area of practice an opportunity to explore the important issues raised here, and demonstrate understanding of these issues.

Dr. Snyder provided this message for ANS readers about her work:

Marianne Snyder ’17 Ph.D. on May 10, 2018. (Peter Morenus/UConn Photo)

Despite the increasing awareness about the health disparities among lesbian women, many in this population continue to  encounter discrimination in healthcare settings. We know from the literature that many lesbian women delay seeking preventative healthcare service based on previous negative encounters with a healthcare provider. This metasynthesis addresses the healthcare experiences of lesbian women as explicated across 14 qualitative studies. This study resulted in four overarching themes about lesbian women’s perceptions that emerge during a healthcare encounter. Lesbians cautiously navigate a healthcare visit by listening to the provider for statements based on heteronormative assumptions, responses to the women who voluntarily disclose their sexual orientation or have a partner who accompanies them to the visit.  A broader understanding of the factors that contribute to positive and negative experiences among these women can benefit current and future healthcare providers who strive to provide more culturally sensitive and affirming care. Lesbian women perceive providers who demonstrate a welcoming and affirming presence when communicating and caring more positively.

Realizing the focus of the discipline of nursing


The final featured article for this important issue of ANS (Vol 42:1) relates the perspective of doctoral students who share the experience of discovering the vital importance of nursing’s underlying perspective as an underpinning for practice.  The title of the article is “Realizing the Focus of the Discipline: Facilitating Humanization in PhD Education A Student Exemplar Integrating Nature and Health” by Tara M. Tehan, MSN, MBA, RN; Amanda E. Cornine, MSN, RN; Rita K. Amoah, BEd, BSN, RN; Thin Zar Aung, BSN, RN; Danny G. Willis, DNS, RN, PMHCNS-BC, FAAN; Pamela J. Grace, PhD, RN, FAAN; Callista Roy, PhD, RN, FAAN; Kathleen A. Averka, BA; Donna J. Perry, PhD, RN. The four doctoral student authors of this article shared this description of their experience:

Our article, “Realizing the Focus of the Discipline: Facilitating Humanization in PhD Education” began as an assignment in our nursing theory class. When Dr. Perry asked our cohort of four to “apply a nursing theoretical lens to nature and health” never in our wildest dreams could we anticipate that the assignment would lead to this article. Each of us was still learning what it meant to be a doctoral student, all while balancing careers and families.

Dr. Perry encouraged us from the onset to be creative and to consider untraditional products for this assignment. This license to think beyond the boundaries of papers and presentations spurred reflection and thought from the beginning and allowed us the opportunity to integrate the various roles we lived. In hindsight a children’s book seemed an obvious choice. Our classmate, Rita, recently reflected on what this assignment meant to her as a mother:

 Being in a graduate school as a wife and a mother of three young children is very challenging and stressful in all possible senses – physically, emotionally, and psychologically. The guilt of not being there for my children and countless occasions of delegating parent conferences and my kids’ games and performances to my husband become overwhelming sometimes. Studies evince a significant negative relationship between work-family conflict and life satisfaction, work satisfaction, and family satisfaction. As interpersonal support from family increases, perceived stress in graduate education decreases as noted by Iniki (2018).

This scholarly work undertaken with my colleagues that yielded this publication brought the assertions above into reality for me as a beneficiary with my first-grade daughter as the supporting agent to mitigate stress. The choice of including my child in this project was pricelessly meaningful to both of us. I remember how my daughter’s eyes widened with gleam and excitement the day I invited her to help my classmates and me do a project. Her anthem to siblings and friends through the week was, “I’m helping my mom and friends in their school project!” My personal interpretation of those words of hers is, “My mom’s schooling is not depriving me of her after all; I could still have fun with her even when she’s doing schoolwork!” To this day, Yiedie and I still reminisce on our experience on the trip to take pictures for this project. The lovely memories of the day are etched in our hearts.

As we worked together creating the book, we realized how transformative this assignment had been. By applying nursing theory in general, and the unifying focus specifically, we came to understand nursing theory and knowledge not as a static framework but as a reciprocal guide that is generated from experience and in turn guides practice. More importantly, we experienced humanization and improved quality of life. It is quite possible the renewal that came from this assignment carried us through the remainder of the year!

We hope this article spurs faculty and students to consider ways to apply nursing theory in a way that is meaningful to them.  We truly believe that theory guided practice comes from knowing and embracing theory in a practical and personally relevant way. Finally, we applied the principles of the unifying focus to public health. In the future we plan to further disseminate the  book to encourage children to enjoy the wonders of nature.  We hope that nurses in all role groups and settings can consider how they can apply the concepts of humanization, meaning, choice, quality of life and health to their practices; for it is through these concepts that we differentiate our practice from those of other health disciplines.

Thin Zar Aung, BSN, RN
Rita K. Amoah, BSN, RN
Amanda E. Cornine, MSN, RN
Tara M. Tehan, MSN, MBA, RN

References

Iniki, F. 2018),”My Life’s in Shambles: Examining Interpersonal Relationships as a Moderating Factor in Reducing Post-Graduate Stress” (Electronic Theses & Dissertations Collection for Atlanta University & Clark Atlanta University. 131. http://digitalcommons.auctr.edu/cauetds/131

Willis DG, Grace PK, Roy, C. A central unifying focus for the discipline: facilitating humanization, meaning, choice, quality of life, and healing in living and dying. ANS Advances in Nursing Science. 2008; 31 (1) :E28-E40. Doi:10.1097/01.ANS.000311534.0459.d9

Spiritual Knowing


Danny G. Willis

The current featured article from the current issue of ANS is titled “Spiritual Knowing Another Pattern of Knowing in the Discipline” by Danny G. Willis, DNS, RN, PMHCNS-BC, FAAN; Danielle M. Leone-Sheehan, MS, RN. In this article, the authors call for “stunning clarity” about the focus of the discipline. We are featuring this article during the time that a large number of nursing scholars will be gathered at Case Western Reserve University (Cleveland, Ohio, USA) toe.  examine the focus of the discipline, and chart the course forward in the development of nursing knowledge.  This article, and the other articles in this issue of ANS focusing on this topic, will be available on the ANS website at no cost for the next few weeks.  Dr. Willis sent this background about the work on which this article is based:

When Danielle Leone-Sheehan and I wrote this paper, it came from our collaborative engagement in living nursing theory and caring. Our experiences as n: urses and human beings compelled us to write about that which was special to us within the unitary field. As nurses grounded in nursing disciplinary knowledge and deeply appreciative of the view of life’s unfoldment afforded from within nursing’s unitary-transformative paradigm, we felt it important to explicate spiritual knowing as another pattern of knowing in nursing.  In a sense, we wanted to act as ‘illuminators of spiritual knowing’ drawing upon wisdom deep within ourselves that reflected our experiences as healers and teachers oriented towards all that is good, wholesome, and healing in being human. In our collective experiences across multiple dimensions of our lives as private citizens as well as in our nursing research, clinical nursing experiences, and teaching-learning-mentoring work with students, we’ve experienced the value of being the recipient of and holding-for-others this expanded spiritual consciousness  of compassion, peace, patience, kindness, and gentleness. We’ve known the power of spiritual knowing when discerning meaning or finding strength within difficult situations. We’ve felt compelled to claim and lift up that which is spiritual and central in the work of healing, caring, and humanization in its fullest sense.

This journey into the land of spiritual knowing has been inspiring. We look forward to the evolution of our expanded unitary spiritual knowing as the years unfold ahead. As we were planning this paper, our common insight was that spiritual knowing is real; yet, spiritual knowing has not been named, lifted up, privileged, and talked about within the wide world of nursing. This insight energized us to change this unfortunate reality. We named spiritual knowing as a unitary-transformative pattern of knowing the world. And, as we often reflect, once you’ve experienced spiritual knowing there’s nothing quite like it. There is a feeling of  alignment with a universal world of goodness without boundaries. Spiritual knowing is pan-dimensional and healing. It uplifts one’s consciousness into a more expansive unitary thought model than is possible without it. Spiritual knowing is important to human wellbeing such that nurses need to engage in further research/study about this pattern of knowing particularly with relevance to how nursing and caring grounded in spiritual consciousness influences nursing-sensitive caring outcomes and human wellbeing.

We wrote this paper to strongly advocate for spiritual knowing and to  intentionally focus our work as caring healers on spiritual qualities that uplift humankind. It has been our experience that human beings typically do well with lovingkindness, compassion, forgiveness, peacefulness, and experiencing self-other and living-dying within a larger framework of meaning and purpose. We are pleased that we have named and claimed spiritual knowing as a pattern of knowing for the discipline and profession of nursing on behalf of those we serve. We hope other nurses will find our writings valuable contributions to the ongoing evolution of nursing. Opening and Welcoming All – Come walk with us on this inspiring and expanding unitary-transformative journey.

Exploring the Knowledge Base of Nursing


The current featured article is authored by Mary Jane Smith, PhD, RN, FAAN and Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, titled “Perspectives on the Unitary Transformative PersonEnvironment-Health Process for the Knowledge Base of Nursing” . This article, along with others in the current ANS issue, will form a basis for discussion at a conference to be held March 20-21st at Case Western Reserve University Frances Payne Bolton School of Nursing.  The conference will be focused on exploring the knowledge base for nursing, and will commemorate the first nursing theory conferences held in 1967, 68 and 69.  The theme of the conference is “Nursing Theory: A 50 Year Perspective, Past and Future”  At the conference, participants will be doing exactly what the title of this post calls for – exploring the knowledge base of nursing. In this current featured article, the authors focus on a unitary-transformative perspective – one of a number of perspectives that contribute to the development of knowledge that informs and shapes nursing practice.  Download your copy of this article while it is featured – and come back here to share your comments and reflections!

The Future of Nursing


The current ANS featured article is titled “Nursing Knowledge in the 21st Century: Domain-Derived and Basic Science Practice-Shaped” authored by one of nursing’s best known scholars – Callista Roy, PhD, RN, FAAN. In this article Dr. Roy proposes a path forward for nursing that is clear, well-defined and vital to the future of nursing and healthcare. We invite you to download this article while it is featured and share your comments here – let us know your vision for the future!  Dr. Roy sent this message for ANS readers about her work:

Callista Roy

As I look back on the last 50 years of progress in nursing knowledge (Roy, 2018) I feel a great sense of pride in accomplishments of setting a firm foundation for the discipline of nursing and the practice of nursing as a profession.  Still, I feel challenged by a call to nurses to move forward in building on the advances in defining nursing to create a structure for knowledge for practice that accounts for our developments and those of all the sciences. This structure gives a central place to all levels of nursing theory. In this article, I present a full picture of nursing knowledge development as domain-derived and practice shaped. The figure (Figure 1 below) includes philosophical beliefs and values and has at the center, the goal of nursing. I really feel, as did Dorothy Johnson 50 years ago (Johnson, 1968) that a clear goal for nursing is the basis for developing knowledge. I selected the goals of facilitating humanization, meaning, choice, quality of Life, healing in living and dying from a publication on a central unifying focus for the discipline (Willis, et al. 2008) that has received attention in the literature in the years since. The right side of the figure proposes that nurses use all other scientific developments, including genomics by shaping them for practice. Nurses will contribute to this knowledge in other disciplines by asking practice relevant questions. However, the major efforts of nurse scholars will be to focus on domain-derived knowledge using all forms of inquiry.

In my view, the contribution of this article is the domain-nursing knowledge tree (see Figure 2 below). I am proposing that based on the over-all goals of nursing, each nursing grand theory has a way of contributing to these goals.  Each grand theory then is the basis for a number of model range theories that give rise to practice theories. This approach is open to controversy. I ask PhD students to consider the advantages of all theories aimed at common goals of nursing. Secondly, what do they think might be barriers to all theories aimed at common goals?  Every reader will have opinions on these and other questions. Still at this stage of my work, I feel called to put forth this possibility. I would love to see how this approach might turn out. I will also enjoy whatever happens by just putting the ideas forward.

References

Johnson, D. E. (1968). Theory in nursing: Borrowed and unique. Nursing Research, 17, 206-209.

Roy, S. C. (2018). Key issues in nursing theory: Historical developments and future directions. Nursing Research. Special Focus Issue on Theory and theorizing in nursing science. 67 (2). 81-92.

Willis, D., Grace, P., & Roy, C. (2008). A Central Unifying Focus for the Discipline: Facilitating Humanization, Meaning, Choice, Quality of Life and Healing in Living and Dying. Advances in Nursing Science. 31(1).  available online only: http://www.advancesinnursingscience.com

 

 

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