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Posts from the ‘Journal Information’ Category

Reconceptualizing the Electronic Health Record for a new decade: A Caring Technology?

Our first featured article in ANS 42:3 is titled “Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?” authored by Catherine Robichaux, PhD, RN; Mari Tietze, PhD, RN-BC, FHIMSS; Felicia Stokes, JD,MA, RN; and Susan McBride, PhD, RN-BC, CPHIMS, FAAN. This article examines and critiques a 2009 article published exactly 10 years ago in ANS that focused on the electronic health record and propose a virtue ethics framework for the future (see Dilemmas, Tetralemmas, Reimagining the Electronic Health Record). It is available for free download while it is featured, and we welcome your comments related to this important topic!  Here is a message from Dr. Robichaux about this work:

L to R – Felicia (Liz) Stokes, Mari Tietze, Catherine Robichaux

We are very happy to have this article published in the Critique and Innovation issue of ANS. This is our second collaborative publication and we each bring different experiences and perspectives to the complicated issues inherent in the development and use of the electronic health record (EHR). Susan and Mari are nurse informaticists, researchers and educators, Catherine’s background is ethics and education, and Liz (Felicia) is a nurse ethicist, policy expert and attorney. As with our first article, this manuscript evolved from Susan and Mari’s research exploring nurses’ experiences with the EHR in which the participants described a wide range of advantages and disadvantages.  Recognizing that it had been ten years since passage of the HITECH act in 2009, we were interested in whether some of the problems

Susan McBride

described in their research were identified ten years ago. Through our literature review, we discovered the article by Petrovskaya, McIntyre, and McDonald, Dilemmas, tetralemmas, reimagining the electronic health record.  This article beautifully analyzes advanced technologies with the ethical and philosophical constructs of caring in nursing.  Rather than viewing the use of technology and caring practice as an either/or dilemma, they suggested application of the tetralemma, a Buddhist approach which expands the range of choices.

Although positive aspects of the EHR have been realized since 2009, many problems identified by Petrovskya et al. continue. We discuss these ongoing challenges to patient safety and nursing practice and suggest integration of polarity thinking with the tetralemma as a viable approach to resolution.  Petrovskya et al. also addressed the potential negative impact of the EHR on ethical nursing practice and we explore the relevance of virtue ethics and technomoral wisdom in revisioning the EHR as a caring technology.

We believe that the roles of nursing leadership, education, research and organizational accountability are all critical in addressing the issues identified in this article.  We hope this discussion is helpful to readers and we look forward to your comments.



New! ANS Vol 42 No 3 is now available!

This new issue of ANS features a number of articles that carry ou the tradition of articles that build on past content published in ANS – known as “Critique and Innovation” (also called replication in the past).  Browse the titles of all of the articles in this issue here and watch this blog for more information featuring each of the articles as they become available to download at no cost!

This issue opens with a commentary titled “Peer-Review Mentorship: What It Is and Why We Need It” by Kristen R. Haase, PhD, RN; Laura Dzurec, PhD, PMHCNS-BC, ANEF, FAAN.  Dr. Dzurec, who has served on the ANS review panel for many years, and Dr. Haase, who is early in her academic career,  worked together in to explore in depth the nature of peer review and how it is conducted for papers submitted to be considered for publication in ANS.  The plan we have for mentoring is proving to be highly successful, with mentees moving on to become peer reviewers for either ANS, or for other nursing journals.  If you are interested in participating in this program, take a look at the description of this plan (also accessed from a link in the sidebar of this blog) and let me know of your interest!

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.  

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.


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:



Remembering Margaret Newman

On December 18, 2018, Margaret Ann Newman, prolific nurse author, teacher and theorist, passed over to the great beyond. Margaret authored several notable articles in ANS, was frequently cited in ANS and other journals, and she was a dedicated supporter of ANS since the founding of the journal. Her writings expanded the nursology horizon over the past 40 years with her thought-provoking work. She advanced the knowledge of the discipline of nursing, and has been a key figure in the development of nursing theory.

Margaret was born on born on October 10, 1933 in Memphis. She received a BA degree from Baylor University. After college she returned to Memphis to care for her mother, who had Amyotrophic Lateral Sclerosis (Lou Gerig’s disease). Having learned from her mother that one can be healthy even in the face of disease, Margaret felt a call to nursing and entered nursing school at the University of Tennessee College of Nursing. After receiving her baccalaureate nursing degree, she entered graduate nursing studies at the University of California, San Francisco and received her master’s degree in 1964.

Margaret returned to Memphis and served as UT Assistant Professor of Nursing and the UT Clinical Research Center Director of Nursing. Margaret spent the next 10 years at New York University—first in doctoral studies, receiving her PhD in 1971, and then as faculty. Dr. Newman assumed the position of Professor in charge of Graduate Studies in Nursing at Penn State in 1977, at which time she also organized an international nursing theory think tank. She introduced her theory of health as expanding consciousness in 1978 and published the earliest primer on developing nursing theory: Theory Development in Nursing (1979). In 1984, she assumed a position as nurse theorist and professor at the University of Minnesota, where she furthered the development and testing of her theory, working closely with doctoral students. In the 1980s, she served as a civilian consultant to the U.S. Surgeon General for Nursing Research. Dr. Newman retired from teaching in 1999, yet remained active for another 17 years advancing nursing theory, education, research, and practice through her presentations and publications, including her 7th book, Transforming Presence: the Difference that Nursing Makes (2008). Dr. Newman’s theory of health has been widely embraced around the world and her life will be commemorated in many countries.

For more information, visit these important resources resources:

A Tribute to Margaret Ann Newman by Margaret Pharris
Health as Expanding Consciousness (HEC) Theory Page
Go to 2016 Newman Scholars Dialogue Page

Memphis Funeral Home obituary

In lieu of flowers, contributions can be made to the fund for the Margaret Newman Endowed Chair

ANS Peer Review Mentoring Program

I am delighted to announce the launch of a peer review mentoring program for early-career scholars in nursing! The ANS Advisory Board has approved this plan in the interest of promoting the entry of new peer reviewers for scholarly publication in nursing, and to more fully enact our dedication to diversity and inclusion in the publishing process. We are encouraging current members of the review panel to participate in this process.  If you are an early-career scholar who is not yet involved in serving as a peer reviewer, let us know you would like to participate in this program and we will facilitate locating a mentor for you!  The full description of the program is available for download here.

To qualify as a mentee for this program, you need to meet the following criteria:

  • Completion of an earned doctoral degree, or in your candidacy anticipating final completion of the degree within the next 6 to 12 months;
  • At least one original published work as primary author that contributes to the development and application of nursing knowledge;
  • Expressed commitment to continued research, theory development, and other activities contributing to the development and application of nursing knowledge;
  • Willingness to complete reviews within approximately 3 weeks of being invited;
  • Ability and willingness to use the ANS Editorial Manager Peer Review Website;
  • Willingness to fulfill the responsibilities of the editorial review panel on a volunteer basis. (adapted from policies for serving on the ANS peer review panel)

Participating as a peer reviewer for scholarly publications is not merely a volunteer service — it is crucial to assure the credibility of published scholarship in any discipline. The main reason that this function must be voluntary is to avoid any possible appearance of conflict of interest, or vested interests influencing or controlling what appears in the literature of the discipline.  However, subtle bias can creep in to the peer review process, especially when reviewers tend to hold dominant points of view that might exclude less well known or accepted perspectives in the nursing literature.  So through this mentoring program, we hope to engage early-career scholars who have demonstrated excellence in scholarship while at the same time bringing to their work diverse perspectives that will be increasingly vital to the future of nursing.

Let us know you want to participate!


Featured topics coming up!

Here at ANS, we now publish “general topic” articles in most issues of the journal. These articles are consistent with the general purposes of the journal but not focused on a planned focus. But we still seek manuscripts for “featured topics” that continue our tradition of “calling forth” content that might not otherwise be addressed. Here is the plan for featured topics for the next 18 months, and a reminder of what we mean by “general topic” submissions:

General Topic Manuscripts are welcome any time ​

Manuscripts generally relevant to the purposes of the journal are welcome at any time. The purposes of ANS are to advance the development of nursing knowledge and to promote the integration of nursing philosophies, theories and research with practice. We expect high scholarly merit and encourage innovative, cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.​​

Featured topics
Critique and Innovation
Vol 42:3 –  September 2019
Manuscript due date: January 15, 2019
Consistent with the journal’s tradition, we encourage nursing scholars to reflect on work previously published in ANS, and use critical insights to present innovations in nursing theory, research, practice and policy. We encourage cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.​
Artificial Intelligence & Robotics
Vol 42:4 –  December 2019
Manuscript due date: April 15, 2019
Artificial intelligence and robotics have been evolving in nursing for some time. We are planning to feature articles in this issue that address the relationship of artificial intelligence and robotics to patient outcomes and quality of care from a nursing perspective. We welcome philosophic analysis, including ethical implications, empiric research reports, and the development of innovative methodologies related to artificial intelligence. Articles must focus on the development of nursing knowledge that informs nursing practice, education and research.
Nursing Theory in 2020
Vol 43:1 –  March 2020
Manuscript due date: July 15, 2019 ​
The significance of nursing perspectives has gained renewed interest as social pressures to reform healthcare have created challenges for care that is more effective, more effective and more economically sound. In both theory and in practice, nursing offers possibilities that address each of these goals.  We are inviting articles that address the state of the art of nursing theory as we approach the third decade of the 21st century, revealing important contributions that nursing brings to create needed change. ​ We welcome articles addressing the full range of theoretic development: articles that report empiric research structured from existing nursing theories, philosophic analyses related to theory and knowledge of the discipline, critiques of existing theoretical approaches, and descriptions of new and evolving nursing theories.  
Best Evidence for Nursing Practice
Vol 43:2 –  June 2020
Manuscript due date: October 15, 2019 ​
Even though the ideal of practice based on evidence has flourished over several decades, the achievement of consistently sound practice, in nursing and in other disciplines as well, still eludes even the most well-intentioned practitioners.  For this issue of ANS we seek manuscripts that explore this dilema, examing questions such as ‘what constitutes evidence?” and “what constitutes the best evidence?” We also seek manuscripts that provide exemplars of best evidence and best practices. 
Methods for Nursing Knowledge Development
Vol 43:3 –  September 2020
Manuscript due date: January 15, 2020
We seek innovative approaches to knowledge development in relation to all patterns of knowing in nursing. We also welcome manuscripts that critique any methodologic approach, manuscripts that explore the philosophic, including ethical underpinnings related to the development of nursing knowledge, and manuscripts that address the critical connections between practice and knowledge development approaches. 
Humanizing Precision Science
Vol 43:4 –  December 2020
Manuscript due date: April 15, 2020
One of the trends of our time is the development of “precision science” – a trend that deserves careful consideration going forward. We seek manuscripts for this issue that provides assessment, explanation, evaluation and critique of this trend in light of the underlying foundations of nursology. This featured topic intentionally calls for both rigor and creativity that provides avenues for discussion and possible new directions in the development of our discipline. 

Structuring Nursing Knowledge

The current ANS featured article presents a new way of structuring nursing knowledge.  It is title “The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge” by Veronica B. Decker, DNP, PMHCNS-BC, MBA and Roger M. Hamilton, PhD.  This article is available to download at no cost while it is featured, and I join the authors in inviting you to post your comments here, and to join in a discussion of their work!  Dr. Decker shared this message about the evolution of this work:

Veronica Decker

The idea for the Nursing Knowledge Pyramid started in the fall of 2012 when I was in my first semester of a Doctor of Nursing Practice (DNP) program at Wayne State University. I was going to school full time and working full time. I was (and still am) living in Orlando Florida and I attended my courses synchronously on-line. The internal visual I maintain from this time includes seeing my cohort in their classroom seats in downtown Detroit, while I was in front of my lap top video cam in the den of my home, in sunny Florida. Most of the time, my fellow classmates would instant message me that they were a little jealous of the weather.

I was taking a course on foundations in nursing from doctors Nancy George and Rosalyn Peters when my work on knowledge development started. I was trying to get my head around integrating philosophical and theoretical perspectives of nursing to create a solid foundation for nursing practice and meet the requirements of an assignment for the course, which included a very detailed rubric. The paper I submitted to my professors was titled Toward a Theory of Cancer Coping. I titled it after Imogene King’s 1971 – Toward a Theory for Nursing: General Concepts of Human Behavior in mind. It made sense to me because I realized my ideas weren’t fully established yet, but I had made a solid start. This first document included a concept map that aligned King’s conceptual system with my own nursing system model, which included the Nursing Knowledge Pyramid. Over the next two years, nearly every assignment even remotely asking for use of theory, I would continue to enhance and better define this work.

As many of you know, DNPs are required to complete projects rather than the traditional PhD dissertation. To meet the requirements of my program, I completed two projects. A clinical performance improvement project (Decker, Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. 2016). and a theoretical application by developing a practice theory called Substructing a Cancer Coping Rule-base, which included the Nursing Knowledge Pyramid.

The Nursing Knowledge Pyramid (NKP) is a practical approach to support nursing practice. In my DNP program I was able to use the pyramid as a means of bridging the gap between theory and practice. As an experienced psychiatric mental health advanced practice nurse (APRN), I could operationalize the research project by methodically going from abstract knowledge (bottom of the NKP) to the concrete knowledge (top). The abstract level of the project was my knowledge as an APRN developed over my 30 years of experience. The middle tiers indicate the theoretical underpinnings and evidence-based practice. The most concrete knowledge at the top of the pyramid was the rule-base used to offer my patients coping strategies to handle their distress. Most recently we utilized the NKP to help develop the key conceptual relationships and theoretical foundation for a case study where the patient had an unrealistic fall risk appraisal. The patient was treated with a feedback strategy to reframe her perception of risk of falling. I’m interested in feedback from others who are considering using the NKP in their research.


Decker, V.B., Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. (2016). Effects of an Automated Distress Management Program in an Oncology Practice. Clinical Journal of Oncology Nursing, 20(1), e9-15.

King, I.M. (1971). Toward a Theory for Nursing: General Concepts of Human Behavior. New York, NY: Wiley.

Nursing Health Assessment Using Storytelling

The current ANS featured article reports a project that demonstrates how storytellng as a means of assessment has the potential to expose the complexities of health experiences that are not readily uncovered using standard assessment approaches.  The article is titled “Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications,” authored by by Amanda Marie Emerson, PhD (English), PhD (Nursing), RN.  Dr. Emerson shared this information about her work:

I had the enormous good fortune during my PhD program in nursing (2017,

“The Sexual Health Empowerment (SHE) for Cervical Health Literacy and Cancer Prevention study team, December 2017: (Back row) Katherine Gwynn, Amanda Emerson, Molly Allison, Brynne Musser. (Front row) Joi Wickliffe, Megha Ramaswamy (PI), Shelby Webb. Used by permission.

University of Missouri-Kansas City) to become part of an interprofessional team (RNs, public health professionals, health educators, medical residents, social workers, a sociologist, and even a historian!) doing cervical cancer prevention research led by Dr. Megha Ramaswamy (PI) at the University of Kansas Medical Center, and my mentor Dr. Patricia Kelly (Co-I) (UMKC). The Sexual Health Empowerment (SHE) study, funded by the National Cancer Institute, sought to learn whether a interactive, trauma-informed, small-group intervention centered on cervical health literacy and feminist principles would increase up-to-date Pap screenings among women detained in county jails. We implemented the program with successive cohorts of women over 2 years beginning in 2014 and have been following up for 3 years. In addition to my role in the intervention itself, I took part in an ethnographic sub-team that conducted interviews and participant observation with a group of volunteers in the community after their release.

The Advances in Nursing Science article reports on a series of particular interviews I conducted with those women. We were initially impressed by the variety of strategies women used in highly challenging circumstances (i.e., poverty, physical and emotional abuse, child separation, even during incarceration) to get and give social support to one another. In my analysis of the interviews—a course of coding, reiterative reading for themes, memoing, discussion with team members—a particular set of stories coalesced. Almost to a woman, the participants in our follow-up research struggled to find secure housing when they returned to the community. This basic need drove many of the stories they told, organizing how they perceived and interacted with others and impacted how they understood choices related to their health and safety. It bears noting that I have a background in literature as well (PhD, 2004) where I learned to recognize the power of stories to give form to versions of self and other, to shape feeling and motivate behavior. The stories about shelter-seeking told by women with histories of repeated incarcerations in this study were not long, but they were rich in implications for the women’s health. The analysis I present in this narrative inquiry maps a couple key trajectories the stories about shelter seeking take and serves as a call to nurses who work with women in the community who may have backgrounds involving incarceration. I urge nurses to listen up, to make stories part of the assessment. As my analysis illustrates, those narratives can carry otherwise unavailable information about threats to health and safety and open up valuable opportunities for nurse-led education and advocacy.


Planned featured topic: Nursing Theory for 2020

The significance of nursing perspectives has gained renewed interest as social pressures to reform healthcare have created challenges for care that is more effective, more effective and more economically sound. In both theory and in practice, nursing offers possibilities that address each of these goals.  We are inviting articles that address the state of the art of nursing theory as we approach the third decade of the 21st century, revealing important contributions that nursing brings to create needed change.  We welcome articles addressing the full range of theoretic development: articles that report empiric research structured from existing nursing theories, philosophic analyses related to theory and knowledge of the discipline, critiques of existing theoretical approaches, and descriptions of new and evolving nursing theories. Manuscripts are due by: July 15, 2019, but are welcomed any time!

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