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Posts from the ‘Editor’s Picks’ Category

Symptom Management for Adults with Cancer

The current ANS featured article is titled “Symptom management Theory: Analysis, Evaluation, and Implications for Caring for Adults with Cancer” by authors Asha Mathew, MBA, MSN, RN, RM; Ardith Z. Doorenbos, PhD, RN, FAAN; and Catherine Vincent, PhD, RN; College of Nursing, University of Illinois, Chicago. The PDF of the article is available for download at no cost while it is featured, and we encourage readers to share your responses here. Asha Mathew sent this summary of their work for ANS blog readers:

Asha Mathew Solomon

Theories of symptom management help nurse researchers organize the intricate relationships within the symptom experience. Our article presents a detailed analysis of the Symptom Management Theory (SMT) using Fawcett and De-Santo Madeya’s criteria for theory critique. To examine the application of SMT among adults with cancer, we performed a systematic review and identified 20 research studies that operationalized SMT concepts and propositions in adults with cancer. Further, using Silva’s evaluation criteria for empirical testing of a theory, we identified that only 35% of the studies had used the SMT to an adequate extent. We concluded that using SMT in longitudinal studies and comparing cancer-related outcomes with and without use of SMT are warranted.

Ethical Leadership and Moral Sensitivity

The current ANS featured article is titled “Effect of Ethical Leadership on Moral Sensitivity in Chinese Nurses: A Multilevel Structural Equation Model” by Na Zhang, PhD; Xing Bu, MBA; Zhen Xu, PhD; Zhenxing Gong, PhD and Faheem Gul Gilal, PhD. This article from researchers in China and Pakistan will be available for download while it is featured. We invite you to engage here with the authors and other ANS readers about this work! Here is a message from Dr. Zhang about this work:

This article aimed to explore the relationship between ethical leadership (a contextual factor at the higher organizational level) and nurses’ moral sensitivity (the individual outcome at a lower level), a cross-sectional quantitative study design was used. Participants were 525 nurses at 65 various departments in public tertiary hospitals. These results showed that ethical climate played a mediating role in the relationship between ethical leadership and nurses’ moral sensitivity. Moreover, nurses’ employment type moderated the mediating effect of ethical leadership on their moral sensitivity. Additionally, the link between ethical climate and moral sensitivity of contract nurses was stronger than that of nurses employed by the state.

Commonalities in Nursing Perspectives among Six Countries/Regions

Our current featured ANS article is titled “Commonalities in Nursing Perspectives Among 6 Countries/Regions” authored by Eun-Ok Im, PhD, MPH, RN, FAAN; Reiko Sakashita, PhD, RN; Chia Chin Lin, PhD, FAAN; Eui Geum Oh, PhD, RN, FAAN; Hsiu-Min Tsai, PhD, RN, FAAN; Wipada Kunaviktikul, PhD, RN, FAAN; Lian-Hua Huang, PhD, RN, FAAN; Hsiu-Hung Wang, PhD, RN, FAAN; and Linda McCauley, PhD, FAAN, FAAOHN. Dr. Im provided this description of the evolution of this work for ANS readers:

The idea of this manuscript started with a question from one of my PhD students who came from a different discipline (cannot remember exactly which discipline she came from). As I remember, the question was raised during a PhD class on how nursing is different from other health-related disciplines and what would be unique aspects of nursing research.  As a group, we had a discussion on many unique aspects of nursing research including our holistic approaches, our caring views, our unique contextual understanding, etc. At the end of the specific class, all of us agreed that nursing research would be different from other disciplines’ research because of these unique perspectives. Then, the specific student raised a question, “what is a nursing perspective?”  I remember that I talked about nursing scholars’ historical discussions on nursing perspectives (e.g., its foci on human beings as a whole, understanding human experience in different stages of health, a practice-oriented discipline, a health-oriented discipline, etc.). However, after the meeting, I felt a dire need for defining a nursing perspective in this interdisciplinary world and thought about what I could do about it.  I suggested the specific student to do an independent study with me so that we could define a nursing perspective together through a systematic literature review, and she agreed to work on it.  However, due to her busy life as a PhD student, she dropped off from the project. Then, I have tried to revive the idea of this paper with several different PhD students, but the efforts with PhD students did not work after all. Looking back on it, it would be a very difficult task for a PhD student to define a nursing perspective even through a systematic literature review.

After a few years passed, I became to get involved with leaders from several Asian countries. Through international workshops and conferences, we became to get engaged in discussions on many different issues/concerns related to nursing across the globe.  Then, I proposed this project on nursing perspectives to the leaders.  All of us naturally became interested in this topic because all actually experienced the same phenomenon with an increasing number of interdisciplinary collaborative projects and witnessed the struggles of nursing students from other disciplines. 

As soon as we began to work on this project on nursing perspectives, this article was written very quickly and smoothly with the inputs from the leaders. This topic was a timely topic for all of us across the globe. All of us have been thinking of this topic throughout our career. Eventually, the paper became a very interesting paper that could reflect nursing perspectives across six different countries/regions. This paper includes only the themes reflecting the commonalities in nursing perspectives across the countries/regions, but we had other themes reflecting differences in nursing perspectives across the countries/regions.  Yet, since the purpose of this paper was to find out the essence of nursing perspectives that could cross the countries/regions, we just focused on the commonalities in nursing perspectives.

As discussed in the paper, nursing perspectives are circumscribed by cultural and historical contexts of individual countries/regions; nursing perspectives are inclusive of philosophical pluralism; nursing perspectives are women-centered and care-oriented holistic views; nursing perspectives are ethical and humane perspectives; nursing perspectives respect human beings’(persons’), families’, and/or communities’ own views and experiences; and nursing perspectives assume diversity in nursing phenomena.  While some of these characteristics of nursing perspectives were expected and discussed from the beginning of the project, others were identified later at the end of the project.  Interestingly, all of us agreed that nursing perspectives had more similarities than differences across the countries/regions.

Based on the findings on commonalities in nursing perspectives across the countries/regions, we made several suggestions for future nursing researchers while acknowledging the limitations of this work.  With historical evolutions and revolutions of nursing, the characteristics of nursing perspectives could change, but some essential characteristics will not change. Actually, these essential characteristics need to be retained throughout different generations of nurses. This paper provides some of these essential characteristics of nursing perspectives that we should keep across different generations of nurse researchers throughout the world.

The characteristics of nursing perspectives that we found and reported in this paper, however, may not be applicable to nursing perspectives in different geographical areas.  Maybe, a nursing perspective in African or South American countries might have different characteristics that are not included in this article.  Maybe, after some time has passed from now, our future nurse researchers who will read our paper would say that they need to work on what a nursing perspective is because the characteristics of nursing perspectives that we wrote in this paper may not be applicable to future nursing.  As we did for this paper, they would feel like that a nursing perspective needs to be re-defined with all the changes that our next generation would meet.  Maybe, at that time, some nursing activities could be delegated to robots and nursing researchers may think some main tasks/responsibilities of nurses in our generation would be obsolete and not applicable to their nursing phenomena.  I think our efforts to define a nursing perspective is not only a difficult task, but also a continuous task that we should take across time points and across geographical areas.

I want to say thanks to Dr. Chinn for this great opportunity to open a dialogue with my respected colleagues across the globe. I hope this blog could continue our discussions on what a nursing perspective is, and it could initiate international dialogues on nursing as a discipline within current interdisciplinary environments.  To conclude this blog, I am attaching a picture of roses blooming on my front yard.  When we moved to our new home, we thought these would be weeds, so we planned to eliminate these. However, as the temperature got warmer, these turned out be roses.  Maybe, some characteristics of nursing perspectives that we are currently thinking as obsolete would turn out to be “roses” in our future generations, which is the reason that we should continue our dialogues on nursing perspectives. Indeed, we never expected this COVID19 pandemic. This pandemic has obviously brought nursing care for patients with infectious diseases back to the center of nursing care, and might be making some changes in nursing perspectives across the globe.  We never know.

Nursing With the People

The current featured ANS article is titled “Nursing With the People: Reimagining Futures for Nursing” authored by Jessica Dillard-Wright, PhD, MA, RN, CNM and Vanessa Shields-Haas, MSN, MA, RN, FNP-BC, SAFE-ME – available to download at no cost while it is featured! The authors describe what this article adds to the literature as being “. . . a robust discussion of nursing’s resistance to and complicity with structures of white supremacy and neoliberalism. This then serves as a platform to engage a radical imagination for the future of nursing.” The authors shared this message about their work:

L-R – Jess, Vanessa

Nursing is limited only by what we can imagine as possible. With “Nursing With the People: Reimagining Futures for Nursing,” we (Vanessa and Jess) are hoping to invite a broader dialogue in nursing around what is possible for our discipline, where we have been, where we are going, and what shapes the terrain we navigate. The circumstances of the ongoing COVID19 pandemic and the inequities laid bare in the wake of civil protests against police brutality demands our full attention. To this end, in our paper we recognize the deeply political nature of nursing work, attending to the ways our profession has, by turns, upheld oppression and fostered liberation. We sketch out a brief schema for thinking about change in nursing, outlining approaches including reform, whistleblowing, and radical resistance, recognizing the complexities and complicities of our disciplinary history. We use the tensions that arise when we complicate our history to invoke a radical imagination for nursing, a doorway to alternate possibilities for the future of health, wellbeing, nursing, and healthcare.

This paper is, in some ways, a culmination of sorts. We first “presented” what would eventually become this paper at Nursing Mutual Aid’s 2020 Twitter conference, a radical and unique event designed to connect nurses to one another in a time when sheltering in place led us to seek connection in new ways. We presented a more refined version of the topic at the 2021 Nursing Theory Conference, where ideas, engagement, and feedback from participants in that space propelled us forward. Our collaborative scholarship here was forged through our grassroots efforts with Radical Nurses Collective, a space for organizing and action. The kernel for Radical Nurses Collective was planted in another radical space, the 2018 NurseManifst Nurse Activism Think Tank organized by Peggy Chinn. “Nursing With the People” creates a tidy sort of symmetry that way.

In many other ways, it is a starting place – a foundation for dreaming up what is just, what is equitable, what is possible, if we choose to see it. We hope you read our paper. We hope you share your thoughts here. We want to know what you see for the future of nursing, for the care we provide. And we want to build that together. We invite you to contemplate nursing’s past to understand where we find ourselves now. We welcome you to activate your radical imagination. To paraphrase the inimitable Ursula Le Guin, we close with the reminder that, although the structures and systems that exist seem immutable, at points past “so did the divine right of kings. Any human power can be resisted and changed by human beings.” What it takes is imagination and collective will. We hope you will join us.

Biopower in the Dual Pandemics of COVID-19 and Racism

The current featured article of the latest issue of ANS is titled “‘I Can’t Breathe’: Biopower in
the Time of COVID-19: An Exploration of How Biopower Manifests in the Dual Pandemics of
COVID and Racism” authored by Christine R. Espina, DNP, MN, RN and Robin A. Narruhn, PhD, RN. This article is available at no cost while it is feature on the ANS website! Here is a message about this work from Dr. Espina:

Fissures, rupture, chaos, and change. These words describe the past 16 months of the COVID-19 pandemic. In an interview, Paul Farmer stated, “…pandemics reveal a lot about a society. They expose all the fissures and cracks of the ravages of history. And so looking back at previous epidemics…we’ve really seen again and again that social disparities shape not only the epidemics, but our responses to them” (Garcia-Navarro, 2020). Farmer ends his interview on a more optimistic note by saying that we, as a collective, can improve our response. In a similar vein, novelist Arundhati Roy writes, “historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next” (2020). The artist-activist Kill Joy visualized Roy’s quote as an erupting volcano as depicted here:

Kill Joy, Pandemic as Portal, 2020
Christine Espina

As academic-activists, we imagine centuries-old forces—the “ravages of history”—rumbling beneath the earth’s surface converging and erupting. The pandemics are further manifested in the extreme global climate change we are experiencing now. For BIPOC communities, the ground has always trembled with racism and health inequities. The virulence of COVID and structural racism expose the fragility of the protective factors of white privilege and other intersecting privileges. With these recent and public ruptures, a portal has opened more opportunities for some to choose an increased conscientization.

In early 2020, we were trying to make sense of the violent events converging publicly in our communities and across the nation: increased mainstream media attention to and public outrage at racist, state-sanctioned murders of George Floyd, Breonna Taylor, Daunte Wright, and countless others, police violence against Seattle and Portland protestors, the political downplay of this novel disease clearly and disproportionately impacting low-income BIPOC communities…just to name a few of the events troubling us.

Robin Narrhun

Agamben’s theory of biopower (2005) provides a useful framework to understand the eruption of the dual pandemics of COVID and racism. Biopower begets violence–whether acute acts of violence like police brutality and the murders of Black and Indigenous peoples or the chronic, slower violence of health inequities among BIPOC communities due to structural racism. We have been struck by Jane Georges’ work (2008; 2011; 2013) on Agamben’s theory of biopower and its relevance to nursing. It clicked for us: all these recent connected events were biopower at play before our very eyes.

In our paper, we connect Agamben’s theory of biopower with examples and illustrations from the dual pandemics, with the hope of showing how theory can provide a way to understand and name injustice. We also explore nurses’ ethical and moral responsibilities and introduce actions for nurses—particularly nurse educators—to respond to these dual pandemics. We look forward to the realization and praxis of a more just and equitable world.


Garcia-Navarro, L. (2020). Anthropologist Paul Farmer’s new book explores the failures of an Ebola epidemic. [Interview]. National Public Radio; Weekend Edition Sunday.

Georges, J. M. (2008). Bio-power, Agamben, and emerging nursing knowledge. Advances in Nursing Science, 31(1), 4–12.

Georges, Jane M. (2011). Evidence of the unspeakable: Biopower, compassion, and nursing. Advances in Nursing Science, 34(2), 130-135.

Georges, Jane M. (2013). An emancipatory theory of compassion for nursing. Advances in Nursing Science, 36(1), 2-9. https://doi/org/10.1097/ANS.0b013e31828077d2

Kill Joy. (2021). Justseeds Artist Cooperative. Non Commercial-No Derivs CC BY-NC-ND Creative Commons License. Retrieved on July 12, 2021:

Roy, A. (2020, April 3). The pandemic is a portal. Financial Times.

Ethical Nursing Care

The current ANS featured article is titled “A Critical Analysis of the American Nurses Association Position Statement on Workplace Violence: Ethical Implications” authored by Darcy Copeland, PhD, RN. Please visit the ANS website over the coming 2 weeks to download this thought-provoking article at no cost. Dr. Darcy provided this message reflecting on this work:

Darcy Copeland

“I have been researching workplace violence in nursing for several years.  Increasingly, I hear nurses in many settings describe violence directed towards nurses in very polarized ways.  For example, some nurses contend that violence is an inherent risk associated with our work while others contend that violence ought not be part of our jobs.  Amidst these polarized views are workplace policies reinforcing a zero tolerance to violence stance.  The American Nurses Association adopted such a stance in their position statement on workplace violence.  Such a position, however, is not in alignment with our ethical framework. Zero tolerance policies are absolutely appropriate with respect to family/visitor or employee violence.  They are not appropriate in the context of patients, however. Zero tolerance policies have a punitive and moralist history; they are also ineffective at actually preventing violence.  Adherence to zero tolerance policies in the context of patient violence has the potential to negatively impact the RN-patient relationship, erode public trust, and criminalize illness behavior.  After a critical analysis of the ANA’s position statement it is recommended that the ANA draft separate position statements. One addressing patient violence and a separate document addressing employee and visitor/family violence.  Nurses have very different duties, obligations and power in RN-patient relationships than in relationships with coworkers and relationships with families/visitors.  Those duties, obligations and power dynamics ought to inform our response to patient violence.”  

Normalization of Deviance

The current ANS featured article is titled “Normalization of Deviance Concept Analysis” authored by M. Imelda Wright, PhD, RN, CNOR; Barbara Polivka, PhD, RN, FAAN;Jan Odom- Forren, PhD, RN, CPAN, FASPAN, FAAN and Becky J. Christian, PhD, RN, FAAN. The article is available at no cost while it is featured on the ANS website. Dr. Wright provided this video abstract of the article.

Secondary Traumatic Stress in Nursing

The current featured ANS article is titled “Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis,” authored by Marni B. Kellogg, PhD, RN, CPN, CNE, and it is available for download at no cost while it is featured. Here is a description of her work from Dr. Kellogg:

My primary research interest is secondary traumatic stress in nursing. As a pediatric nurse, my interest came about as I wondered if stress in nursing was different or more intense for pediatric nurses than nurses in other settings. As time has gone on, particularly with the pandemic, my research program has expanded to include stress and trauma in all nursing settings.

“Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis” resulted from my work overtime and was written to address a gap in the literature. Secondary traumatic stress is the stress a nurse faces when something upsetting happens to their patient. I propose a new definition in the article which explains what secondary traumatic stress is and what it is not. The phenomenon is frequently confused with the terms burnout, compassion fatigue, and vicarious traumatization; they are not all synonymous. Additionally, secondary traumatic stress has many of the same symptoms as Acute Stress Disorder and Post Traumatic Stress Disorder; therefore, nurses must be aware of this phenomenon to protect their mental health. A purer meaning of secondary traumatic stress in nurses is needed to distinguish it from each of the closely related terms. Clarity in the definition of secondary traumatic stress allows for the appropriate measurement and advancement of research related to its occurrence, treatment, and prevention in nursing.

It is vital to address traumatic stress in nurses as we emerge from the COVID-19 pandemic. Over the last year, I have completed some research with colleagues in psychology; nurses are suffering from traumatic stress. I am currently working with my team to explore the impact of the COVID-19 pandemic on nurses in the United States. We plan to develop appropriate interventions to help nurses. I worry about experienced nurses leaving their specialties or the profession because of the stress from the pandemic. Nurse educators must be aware of traumatic stress and work to build strong, resilient nurses who are mindful of the importance of self-care and mental health. Healthy nurses are effective nurses and will benefit our community.

I look forward to your feedback. Please take good care.

End-of-Life Care Terminology

Zahra Rahemi

Our current featured article is titled “End-of-Life Care Terminology: A Scoping Review” authored by Zahra Rahemi, PhD, RN andTracy Fasolino, PhD, FNP-BC, ACHPN. The article is available at no cost while it is featured, and we welcome your comments in response! Here is a message that Dr. Rahemi provided about their work:

End of life care research mostly focuses on end-of-life care options, cost of care, and advance care planning. However, the type of language and terminology that is used in end-of-life care literature and advance care planning forms is overlooked. The terminology used regarding end-of-life care options can convey positive, negative, or neutral meanings. For example, the term “intensive care” might convey a negative connotation compared to “comfort care”. Using these two terms in advance care planning forms and literature may influence individuals’ understanding and decisions about preferred end-of-life care options. Terminology and language are important in caring and nursing sciences, especially in the field of end-of-life care wherein the importance of culture and diversity is emphasized. The focus of this scoping review is to recommend healthcare professional, researchers, and policy makers to use neutral connotative language and terms when designing end-of-life care or advance care planning methods.

Decolonizing the Language of Nursing

Daniel Suárez-Baquero

The current featured ANS article is titled “Critical Analysis of the Nursing Metaparadigm in Spanish-Speaking Countries Is the Nursing Metaparadigm Universal?” by Daniel F. M. Suárez-Baquero, MSN, RN;and Lorraine Olszewski Walker, EdD, MPH, RN. This article is available to download at no cost while it is featured, and we welcome your comments and questions here. Here is author Suárez-Baquero’s message for ANS readers about this work:


This paper presents a critical analysis about the dominance of the English language as tool for colonization. We start from the use of the nursing metaparadigm – as the central component of Nursing knowledge – to elucidate the conceptual differences in Nursing foundations that exist due to social and linguistic differences.

For those nurses who learn Nursing in Spanish, the concept of Cuidado – amalgamation of the nuances of Care and Caring – is the cornerstone of the core disciplinary Nursing knowledge. However, this foundational perspective, rooted in most of the Nursing spoken in Romance languages, has been historically underrecognized. Several academic discussions about Nursing concepts and theories that I had with well-known nursing theorists during my doctoral studies brought up an overlooked issue: Meanings differences in the nuances and concepts from languages other than English.

Importantly, this issue has limited the expansion of disciplinary nursing knowledge. Therefore, in several instances, Nursing knowledge turns into a dogmatic believe that cannot be discussed; so that we, scholars who discuss the universality of Nursing knowledge, are seen as heretics in a seemingly homogenous and hegemonic vision of nursing.

This paper is an invitation to discuss, it is an awareness of the multiculturality that must be addressed for the growth of Nursing as a Science; it is a call to the nurses of color around the world, to let them know that the time has come to speak up and share our vision of Nursing. Nonetheless, the decolonization of disciplinary Nursing knowledge cannot be done without the support by the nursing community that dictates “what [Nursing] is, and what it is not.”



Este artículo presenta un análisis crítico acerca del dominio de la lengua inglesa como herramienta de colonización. Partimos del uso del metaparadigma de Enfermería – como el componente central del conocimiento enfermero – para elucidar las diferencias conceptuales en los fundamentos de la Enfermería que existen debido a las diferencias sociales y lingüísticas.

Para aquellas enfermeras y enfermeros que aprenden Enfermería en español, el concepto de Cuidado – amalgama del acto de enfermería y el acto de cuidar con amor o cariño – es la piedra angular del conocimiento central de la Enfermería. Sin embargo, esta perspectiva fundacional, arraigada en la mayor parte de la Enfermería hablada en lenguas romances, ha sido históricamente poco reconocida. Varias discusiones académicas sobre conceptos y teorías de enfermería que mantuve con conocidas teóricas de la enfermería durante mis estudios de doctorado sacaron a relucir una cuestión que se había pasado por alto: Las diferencias de significado en los matices y conceptos de otros idiomas distintos al inglés.

Es importante destacar que este problema ha limitado la expansión del conocimiento disciplinar de la Enfermería. Por lo tanto, en varios casos, el conocimiento de Enfermería se convierte en una creencia dogmática que no puede ser discutida; de modo que nosotros, los académicos que discutimos la universalidad del conocimiento enfermero, somos vistos como herejes en una visión aparentemente homogénea y hegemónica de la enfermería

Este artículo es una invitación a la discusión, es una toma de conciencia de la multiculturalidad que debe ser abordada para el crecimiento de la Enfermería como ciencia; es un llamado a las enfermeras y enfermeros de color de todo el mundo, para hacerles saber que ha llegado el momento de hablar y compartir nuestra visión de la Enfermería. Sin embargo, la descolonización del conocimiento disciplinar de Enfermería no puede hacerse sin el apoyo de la comunidad enfermera que dicta “qué es, y qué no es [Enfermería] “.


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