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Posts from the ‘Editor’s Picks’ Category

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”.

 

 

 

 

Caring Science Education to Promote Interprofessional Understanding


The current ANS featured article, available now to download at no cost, is titled

Kathleen Sitzman

Usefulness of Watson’s Caring Science for Online Educational Practices in Disciplines Outside of Nursing.” The authors, Kathleen Sitzman, PhD, RN, CNE, ANEF, FAAN and Dorothy H. Muller, PhD, report the results of a study to explore the perceptions of people from a wide range of disciplines of the usefulness of Watson’s Caring Science.  Here is a message from Dr.Sitzman about her ongoing work in this area:

I have been conducting research related to Watson’s Caring Science for many years. I teach online nursing courses and so a lot of my work explores caring in online settings. I also teach a Caring Science, Mindful Practice Massive Open Online Course where I regularly interact with people all over the world who are interested in learning about caring and sharing their own caring experiences. So far, almost 4000 people (and counting) have registered for this course, and about 25% of them are not in healthcare or (specifically) nursing. Despite not being nurses and knowing nothing about Watson’s Human Caring Theory when the signed up for the course, my non-nurse learners have responded with enthusiasm, wisdom, and deep understanding as they have progressed through the course. It became apparent to me that Watson’s Caring Science resonated with nurses and non-nurses alike, so I set out to conduct structured research to explore this more fully. This article is the result of my inquiry around this interesting observation.

Currently there is a paucity of research related to applicability of nursing theory outside of the nursing discipline. It is unknown from a formal, academic standpoint, whether Watson’s Caring Science would be considered applicable outside of the nursing discipline and I believe the results that appear in this article provide validation regarding applicability of caring science across disciplines. More research is certainly needed, but this is a good start.

This type of research is important because of the current focus in increasing interdisciplinarity in healthcare and beyond, and I believe that establishing/identifying a shared frame of reference (i.e. principles related to Caring Science) will help people create and maintain productive interdisciplinary collaborations and relationships. Exploration and recognition of basic shared core caring values (i.e. who we “are” as opposed to what we “do”), coupled with shared exploration of trim activities (i.e. varied tasks and job roles that all of us “do” every day), will create common ground upon which to build working relationships with a focus on caring rather than doing. And caring rather doing is a useful approach in nursing, healthcare, and beyond.

New Graduate Transition Programs: An Integrative Review


Our current featured article in ANS is titled “The Impact of New Graduate Nurse

Deborah E. Tyndall

Transition Programs on Competency Development and Patient Safety: An Integrative Review” by Deborah E. Tyndall, PhD, RN; Gina C. Firnhaber, PhD, RN, MLS, MPH and Elaine S. Scott, PhD, RN, NE-BC, FNAP. I had the pleasure of speaking with the authors about their work, and in the video below share our very interesting and informative conversation about how they came to do this work, insights about their method, and the implications of their work for future scholarship in this area.  Their article is available at no cost while it is featured – we welcome our comments and feedback below!

Dr.Tyndall sent this message about the background of her work:

My interest in New Graduate Nurse (NGN) transition stems from my experiences working with undergraduate nursing students and novice nurses in the first year of practice.  For many years, I taught professional development classes to NGN.  In one of these classes, Thriving in Your First Year of Nursing, I heard the successes and challenges that NGN face.  These stories deeply impacted my understanding of the many factors that influence NGN transition to practice.

After graduating with my PhD in 2016, I accepted a grant manager position to work

Elaine S. Scott

with a multidisciplinary team.  This team, led by Dr. Elaine Scott, was formed to advance nursing science by evaluating nurse’s contributions to: 1) patient safety, 2) organizational capacity-building, 3) organizational sustainability, and 4) economic benefit (POSE).  Dr. Scott had been my dissertation chair and I was familiar with her work related to NGN transition to practice.  Through her leadership, the team generated various grant projects.  This article features our scholarly work from of those projects.

 

Beliefs about personal weight


We are currently featuring the article titled “Refinement of the Beliefs About Personal Weight Survey” by Stephanie Pickett, PhD, RN; Rosalind M. Peters, PhD, RN, FAAN and Thomas Templin, PhD. You can download the article at no charge while it is featured!  Here is a message from Dr. Pickett about her work:

Dr. Stephanie Pickett

Culturally-related beliefs about personal weight are thought to contribute to behaviors leading to the high prevalence of overweight and obesity among African American women. However, no tools existed that measured beliefs about personal weight among young African American women. This gap in the literature was addressed with the initial development and testing of the Beliefs about Personal Weight Survey.

In our current study we report the revisions and psychometric evaluation of the revised Beliefs about Personal Weight Survey (BPWS-2) with a sample of young African American women.  Our goal was to reduce and refine the original items to make the Survey more useful in clinical and research settings.  Psychometric evaluation of the BPWS-2 showed that the four factors from the original BPWS reemerged (Weight Acceptance, Weight Concern, Conventional Weight Regulation, Circumstantial Weight Regulation) along with a fifth factor (Excess Weight Acknowledgement). This fifth factor represents a distinction between accepting personal weight as overweight verses acknowledging personal weight as excessive.  This distinction was associated with specific eating behaviors.

The five factors (subscales) were sensitive enough to determine unique eating behaviors and psychosocial factors that influence body mass index among young African American women. Findings from this study indicate that understanding beliefs about personal weight may be a critical component in developing effective weight management strategies.

The Experience of Dietary Culture and Cardiovascular Disease


The current ANS featured article is titled “Dietary Culture: A Concept Analysis” by Elise A. Mollohan, MSN, RN, CNE.  In this article Mollohan defines dietary culture as patterned group eating behaviors that are unconsciously influenced and socially organized, and explains how these patterns can increase the understanding of the links between diet, culture, and cardiovascular health. For more information, download your copy of the article at no cost while it is featured! Ms. Mollohand provided this message for ANS readers:

I am intimately familiar with cardiovascular disease, as many of us are. My personal and professional experiences with the devastating effects of heart disease prompted me to make significant dietary changes several years ago.  While I have reaped immense health benefits from modifying my diet, it was not an easy transition. My experience caused me to see diet change through a different lens, becoming acutely aware of the challenges individuals face from a cultural perspective.

While working on my doctoral studies, I began exploring diet change as a strategy to promote cardiovascular health. Much of my initial research left me pondering the connection between cultural influences and diet. I found myself using the words “dietary culture” often when describing obstacles to successful diet change.  However, this concept was not clearly defined in the literature.  I also received questions from others about how our culture could be a barrier to implementing a heart-healthy diet. My need for a clear definition and a more profound understanding of the concept lead me to conduct this analysis.

The analysis process was invaluable to clarifying my understanding of dietary culture in relation to cardiovascular health. The proposed definition will be used to inform my future work, exploring the plant-based diet transition among adults with cardiovascular disease. Also, I hope that this concept analysis will promote an acknowledgment and understanding of the relationship between diet, culture, and cardiovascular health among nurses and other health care providers.

Power & Resistance in Mental Health Practice


The current featured ANS article is titled “Power and Resistance: Nursing Students’ Experiences in Mental Health Practicums” by Allie Slemon, MSN, RN; Vicky Bungay, PhD, RN; Emily Jenkins, PhD, RN and Helen Brown, PhD, RN. As the authors state, this article adds to the need for interventions that respond to everyday power imbalances in mental health care settings, and I believe, in all health care settings. The article can be downloaded at no cost while it is featured, so we invite you to read this article and return here to share your comments.  Allie Siemon shared this background about her work:

Allie Siemon

This article presents findings from my Master’s thesis work on nursing students experiences of their mental health practicums.

My clinical background is in mental health nursing, and I previously worked as a Clinical Instructor supporting students through their mandatory mental health practicum in a general nursing program. Through this experience, I observed how many students struggled with many of the particular challenges this practicum: fear of violence, worrying about being unable to make a difference, and navigating new systems such as locked doors and seclusion rooms. Yet as much as students expressed difficulty in navigating these challenges, they also demonstrated a deep commitment to their patients’ safety and well-being.

Vicky Bungay

In my Master’s degree, I began to examine the evidence on mental health practicums in nursing programs and found a small yet powerful body of literature illustrating that students in mental health practicums across many countries experience the types of challenges I had observed in my educator role. I also found that these experiences that students were having in their practicums negatively impacted students’ overall preparedness to work with individuals experiencing mental health challenges. Supporting students in navigating difficult mental health placements is a gap in our nursing education programs, and extends to gaps in mental health care delivery. To date, there have been relatively few qualitative studies that have contributed nuance and depth to our understandings of how students experience these practicums and navigate these challenges that have been illuminated largely through quantitative and survey-based research.

Emily Jenkins

I hope that this article can support nursing educators like myself in supporting students through the challenges of the mental health practicum, and can inspire nurses and nursing managers to shift practices in the mental health inpatient setting that are difficult for students and, importantly, patients. I also hope that thinking about mental health practicums as a space where resistance to power is possible can give students a new language and perspective on navigating complex environments and challenging experiences in the mental health practicum. I believe when students feel empowered and supported, they can demonstrate compassion, engagement, and commitment, and make an incredible difference in the experiences of their patients.

Helen Brown

Throughout the process of my Master’s research, I was supported by my committee: Vicky Bungay, Emily Jenkins, and Helen Brown. Each of them has contributed immeasurably to the research and to this article.

Reflective Action for Social Change


The latest featured article in ANS is titled “Cultivating Praxis Through Chinn and Kramer’s Emancipatory Knowing” authored by Jessica Peart, BSN, BA, RN and Karen MacKinnon, PhD, RN. In this article the authors explain how emancipatory knowing provides nurses a formal structure to recognize the sociopolitical factors affecting wellness, while making evident the ethical imperative and central role of taking reflective action toward social change—the praxis of nursing. The article is available for download at no cost while it is featured, and we welcome your comments and ideas!  Here is a message from Jessica Peart about this work:

What do we value as nurses?  What is important to know in order to practise safely, competently, and ethically? These questions took on a new meaning when I started my Masters of Nursing program last year as I study to become a Nurse Practitioner.

Jessica Peart

  My background—prior to my nursing career—as a community organizer laid the groundwork for seeing nursing through the lens of social justice.  The perspective, skills, and knowledge I garnered through my community work is threaded throughout my daily nursing practice.  In fact, they are integral to my “nursing toolbox” as a client and community advocate, in the critical empathy that I display supporting clients “on the margins”, and in my comfortability in the “grey” areas of our practice where nursing isn’t well represented by tick boxes or flow sheets.

But how do nurses, especially those pursuing advanced practice roles, develop competencies that forward the social justice lens that foregrounds our ethical practice when they came into their nursing role without a background in social justice work?  Following this path of inquiry in my MN coursework led me to Peggy Chinn and Maeona Kraemer’s exploration of emancipatory knowing as a means through which nurses can better understand the socio-political forces affecting our clients and take action towards more equitable social relations.  The mandate for nursing as social justice is clear, but the path we take to get there might not always be.  I found that Chinn and Kramer’s emancipatory knowing can help nurses to shed a light in the directions we might take towards cultivating the reflective practice that we have come to know as nursing praxis.

 

 

Emancipatory nursing, the environment, and anti-oppressive practice


Our featured article for the coming two weeks is titled “A Theoretical Framework for

Elisabeth Dahlborg- Lyckhage

Emancipatory Nursing With a Focus on Environment and Persons’ Own and Shared Lifeworld” by Elisabeth Dahlborg Lyckhage, PhD; Eva Brink, PhD and Berit Lindahl, PhD. In this article, the authors conceptualize “rooms” that re-focus understanding of the central phenomenon of the person’s experience of health, along with the central influence of the environment in shaping that experience (see model below). The theoretical framework leads to understanding and action in the form of anti-oppressive practice (AOP). They state: “Knowing

Eva Brink

the complexity involved in defining health is basic to understanding a person’s experiences of health. But, in contemporary nursing, definitions of health need to be complemented by more explicit critical and environmental aspects, the aim being increased equality and social justice.” (page 344).  Dr. Dahlborg-Lyckhage shared this message about their work:

Due to a growing inequity, regarding both health and received care among different groups we propose an emancipatory theoretical framework for nursing care practice. The focus on environment is a way of connecting to Nightingale’s work, although in the

Berit Lindahl

Western world of today there are other problems in the environment that affect nursing care. By using the metaphor room, we scrutinize our environment, from the philosophical level to the interactions between care seeking persons and the professionals. We hope that the paper will contribute to the existing literature on equality in nursing.

 

Promoting Mental Health of Female Veterans


Our current featured article, which also provides 1.5 Continuing Education contact hours, is titled “Clearing Away Past Wreckage: A Constructivist Grounded Theory of Identity and Mental Health Access by Female Veterans,” authored by Lindsay Williams, PhD, MS, RN, PHN, PMP; Carol Pavlish, PhD, RN, FAAN;Sally Maliski, PhD, RN, FAAN; Donna Washington, MD, MPH. This article provides important insight to understand how women Veterans make health care–related choices and process traumatic events (such as military sexual trauma). This article is available at no cost while it is featured, and I hope you will share your thoughts about this work!  Here is a message that Dr. Williams has provided giving some background to this article:

This is a culmination of work from my dissertation that recognizes the service of women Veterans and their experiences before, during, and after their military service that ultimately lead to the use of mental health outpatient services.

Lindsay Williams

My interest in this work stemmed from my professional and personal passion to advocate for vulnerable women and amplify their voices. Women Veterans face tremendous obstacles from the pressures of military service, but I wanted to delve deeper into their lives before and after service and explore what led them to the military, and what happened to them once they left. Not being a Veteran personally, I was concerned about my placement as a researcher, and that participants would perceive as someone seeking to exploit their stories. Fortunately, I had the support of my advisors: Drs. Carol Pavlish, Sally Maliski, and Donna Washington in exploring this topic by preparing me with the tools to respectfully approach, and interview this group of women. I used Constructivist Grounded Theory methodology, as articulated by Charmaz (2014), to inform the development of the interview questionnaire with a focus on decision-making for outpatient mental health services. Using that as a starting point enabled me to maneuver backward and forward in how I approached the interview and the questions I asked.

In the course of completing this study, I was honored to interview these women and hear their powerful stories, which were undoubtedly marked by trauma throughout their lives, which became one of the major categories of my model. Another incredible part of their stories were the ways they renegotiated the place, and inherently the value, that trauma had in their lives. They were able to see the positive aspects of their service and see themselves as survivors.

I believe this study has policy and practice implications within and outside of nursing practice. As more women serve and leave the armed forces we have a responsibility to anticipate their needs, advocate for their care, and have timely, trauma-informed, gender-informed care at the ready at all points along this trajectory.

Reference:

Charmaz K. Constructing Grounded Theory. 2nd ed. Thousand Oaks, CA: Sage Publications; 2014.

 

Emancipatory Cultural Competency in Nursing


We are delighted to introduce the current ANS featured article, titled “An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories” authored by Linda M. Wesp, MSN, RN, FNP-BC; Victoria Scheer, BSN, RN; Ashley Ruiz, BSN, RN; Kimberly Walker, MSN, RN, CHPN; Jennifer Weitzel, MS, RN; Leslie Shaw, MSN, RN, ACNP-BC; Peninnah M. Kako, PhD, RN, FNP-BC; and Lucy Mkandawire-Valhmu, PhD, RN. In this article the authors address the critical need for approaches in nursing education, research and practice that uphold the core nursing value of commitment to social justice.  Download a copy of this article at no cost while it is featured, and share you comments and ideas about these ideas on this blog!  Here is more information about this work from the authors:

Linda M. Wesp

Emancipatory \ i-​ˈman(t)-​sə-​pə-​ˌtȯr-​ē\ (adjective): freeing from any controlling influence1

As peers pursuing a PhD in nursing at University of Wisconsin-Milwaukee, we have found common ground with our professors Dr. Lucy Mkandawire-Valhmu and Dr. Peninnah Kako in a passion for learning about and using critical and feminist theory to shape our thinking and our work, especially intersectionality, critical race theory, and postcolonial feminisms.  The idea of this paper was originally born from several brainstorming sessions between Linda Wesp and Victoria Scheer. As we sat and talked and thought, we kept coming back to our common frustration that the theories we were finding so helpful

Victoria Scheer

and informative in our research were not being talked about in nursing or health care at all, outside of a few PhD level classes.

Early in 2018, Dr. Mkandawire-Valhmu encouraged the group of us using critical theories in our research to join forces with one another and challenged us to think about how we could take these theories and apply them.  The special ANS issue on emancipatory nursing seemed like the perfect fit for the ideas we were already tossing around about various areas of the nursing profession that would benefit from a more critical approach.  Each of us brought a specific working knowledge about the various

Ashley Ruiz

theories we used for this paper, whether intersectionality theory, critical race theory, or postcolonial feminist theory.  One of the main goals of our project was to intentionally and carefully distill the main ideas of these theories and make them understandable and applicable for nurses who may be unfamiliar with them (see Figure).

As we considered our experiences as clinicians, educators, and scholars, we decided that the way nursing approaches “cultural competency” could benefit greatly from the tenets outlined in the various critical theories.  As it is currently conceptualized, “cultural competency” in nursing (and across all health care settings) does not

Kimberly Walker

provide nurses with the tools to identify and disrupt the major structural processes and oppressive ideologies that create marginalization and inequity.  These ideologies are a controlling influence on our profession and health care as a whole. And so, we thought, what if we could outline specific ways to bring an emancipatory approach to our current understanding of cultural competency?  We began in our knowledge of the theories that seek to disrupt oppression and hegemonic thinking that create health inequities, and used this to come up with tools to equip nurses with new ways of thinking about and caring for populations that are different from them (even, and especially, for nurses who are well intentioned and think they are being “culturally competent”).

Jennifer Weitzel

Diving deeply into the theories as we prepared this paper meant we had to do our own personal work about how power and privilege works in our own lives, and think about our own approach to caring for people who are different than us. We also thought a lot about the ways that power and privilege play out in the academy and in our health care institutions, and what that means for us as nurses occupying positions that are generally considered “less powerful.”  These are not always easy realizations,

Leslie Shaw

especially for people who benefit from having more power and privilege because of the color of our skin, or our gender identity, or the country where we were born, or the letters behind our name.

We do not take lightly the magnitude of the emancipatory approach we are proposing here, and yet we feel deeply that we must continue to push for change.  We as nurses must continue to understand how power and privilege work to create and maintain difference and inequality in our

Peninnah M. Kako

world.  Continuing to approach difference in the ways we always have will mean that we completely misunderstand and erase certain populations (e.g. people of transgender experience) and/or that we continue to create unintentional and implicit bias for other populations (e.g. people who experience racialization and are therefore considered “racial or ethnic minorities” in the U.S.).

We hope that this paper is just the beginning of a larger conversation within our profession that can create much needed dialogue and change.  Also, we have so many more ideas to talk about!  We hope to spark ongoing

Lucy Mkandawire-Valhmu

ideas, that might begin with questions like: Where else have nurses already been applying an emancipatory approach to cultural competency, as we suggested here, in our educational and clinical programs?  What does it look like for nurses to remain self-reflexive about our own biases?  How does implicit bias contribute to inequitable patient outcomes?  What would it look like for the nursing profession to shift from the phrase “cultural competency” to the concept of cultural safety2, which more accurately represents the emancipatory approach we suggest here?

What have you already been doing or thinking about in this area? We would love to hear from you. As the largest health profession in the U.S., we can create a slow and steady shift that leads to lasting change and health equity for all people.  Please share your thoughts, publish your experiences, and let’s keep the conversation going!

References

  1. Merriam-Webster Dictionary. Available at: https://www.merriam-webster.com/dictionary/emancipate. Accessed October 31, 2018.
  2. Mkandawire-Valhmu L. Cultural Safety, Healthcare and Vulnerable Populations: A Critical Theoretical Perspective: Routledge; 2018.

 

 

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