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Nurses and Whistleblowing in Healthcare


Our current featured article is titled “Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health” authored by Amelie Perron, PhD, RN; Trudy Rudge, PhD, RMHN, RN; ´ Marilou Gagnon, PhD, RN. In this timely and important article, the authors examine whistleblowing and the failures it brings to light.  The article is available at no cost while it is featured on the ANS website.  Here is Dr. Perron’s message that provides background on this work:

This paper brings together two seldom discussed subject matters in nursing: whistleblowing and nonknowledge. Publishing this paper on whistleblowing turned out to be very timely in light of the numerous nurses and other healthcare professionals who have spoken up about serious covid-related concerns, in particular with regards to the prevention and management of coronavirus infections and the lack of personal protective equipment made available to care providers. Yet nurse whistleblowing is not limited to crisis and unprecedented situations such as the one we are currently experiencing. Whistleblowing is a constant in nurses’ worlds. Nurses regularly alert their organizations to unsafe, unethical or illegal practices, in the hopes that such situations will be corrected. However, while in some cases, positive reactions ensue, many nurses’ reports are instead met with indifference, suspicion or hostility.

There are many reasons for this. Managers can already feel overwhelmed with various pressures (e.g. budget cuts, staffing issues, patient turnover, the need to implement a new directive with minimal support, etc.) and have limited head space or time to take on additional concerns; they may feel their performance as manager is called into question and become defensive; they may agree with the reported concern but feel powerless to communicate it to their own superiors; their own reading of the situation may be different and they may feel they have a better or a more complete understanding of it. Whichever is the case, these reactions often lead to a lack of decisive action and therefore the perpetuation—and, in some cases, the worsening—of the original issue. Concerns can become lost and forgotten unless nurses persevere. Insistence often leads to nurses becoming overly and precariously visible in the organization: that is, they may be increasingly perceived as the ‘problem’ to be ‘fixed’, rather than the issue they are reporting. This is even more likely to occur if nurses decide to leak their concerns outside the organization (e.g. health ministry, patient safety office, integrity commissioner, health and safety agency, police, media, etc.) in the hope that something will be done to prevent or stop the wrongdoing.

Our paper delves into the reasons why nurses’ knowledge about critical situations or wrongdoing does not necessarily translate into organizational knowledge that can lead to corrective measures. Using the Sociology of ignorance as a framework to deepen this understanding is novel: it is the first time the (anti)epistemic underpinnings of whistleblowing are teased apart in any discipline. This perspective provides insights into the way “not knowing something” (for example through uncertainty, doubt, denial, censorship, forgetting, etc.) becomes a feature of organizational life; how it shapes the way people think and act; how it produces interests, meanings and priorities; and how it positions various individuals in the process.

The literature on whistleblowing emphasizes how the conscious or accidental interruption of critical knowledge is the main driver of critical events or wrongdoing in healthcare settings, and how lack of corrective measures is the main trigger of external whistleblowing.  Through mechanisms of ignorance, knowledge that could have prevented or stopped harmful events becomes unavailable, unusable or unconvincing. Pockets of ignorance form, that translate into organizational blind spots. Experts agree that whistleblowers are critical to the identification and elimination of these blind spots in order to safeguard patients’ and workers’ safety, the quality of care processes, the integrity and the reputation of the organization, and the public interest more broadly. Dissecting the organizational positioning of nurse whistleblowers through the Sociology of ignorance provides new insights into the phenomenon and allows us to reconsider the role of whistleblowing policies and legislation meant to protect whistleblowers.

This work follows a concept analysis on whistleblowing published previously (Gagnon, M. & Perron, A. (2019). Whistleblowing: A concept analysis. Nursing & Health Sciences, doi: 10.1111/nhs.12667). It is part of our work within the Nursing Observatory (https://nursingobs.com/), the first observatory of its kind in the world. It sets the stage for a federally funded study we are currently conducting on nurse whistleblowing in Canada.

Nurses as Allies Against Racism and Discrimination


The first article in the latest issue of ANS is titled “The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time” authored by Jennifer Weitzel, MS, RN; Jeneile Luebke, MS, RN; Linda Wesp, PhD, RN, FNP-BC; Maria Del Carmen Graf, MSN, RN, CTN-A; Ashley Ruiz, BSN, RN; Anne Dressel, PhD, CFPH, MLIS, MA; and Lucy Mkandawire-Valhmu, PhD, RN. This important article is also available for continuing education credit, and it is available at no cost on the ANS website while it is featured.  The authors shared this background information about their work:

For this article, a group of ethnic and culturally diverse scholars joined in a collaborative effort to highlight and promote the role of nurses as allies against racism and discrimination. As a foreign-born Hispanic nurse, my contribution consisted in giving a voice and bringing awareness to the problematic suffered by undocumented immigrants living in the United States during times of openly exhibited xenophobia. Our manuscript is a call for all nurses to take action, become allies and promote a culture that fosters social justice and solidarity- Maria Del Carmen

As a second-generation multiracial Filipina American nurse scholar, whose interests focus on examining nurse-patient interactions following experiences of violence, I feel this manuscript speaks to the important role and responsibility that nurses hold in partnering with individuals and communities of which we serve. Particularly individuals and communities facing experiences of injustice. We hope this manuscript demonstrates the ways in which nurses hold a position of power capable of addressing health inequalities due to racism through establishing healthy partnerships as allies and maintaining solidarity with those we serve to change future health outcomes. – Ashley Ruiz

As a nurse scholar who is an enrolled member of the Bad River Band of Lake Superior Chippewa, I felt that my contribution to this manuscript was a crucial step as a leader in my academic and tribal community. This manuscript is an exemplar for how nurses can use their collective power and voices as allies and advocates to address issues of racial inequities and health disparities. This manuscript also highlights the key resistance movements of our time and how nurses have been in the field and on the frontlines of those movements, not just at the bedside. As advocates and allies, we acknowledge the role that historical trauma and structural violence plays in reproducing inequities that manifest as health disparities and poor health outcomes. – Jeneile Luebke

L-R: Jennifer Weitzel, Jeneile Luebke, Linda Wesp, Maria Del Carmen Graf, Ashley Ruiz, Anne Dressel, Lucy Mkandawire-Valhmu

Since 1965, UW-Milwaukee College of Nursing has developed a tradition of excellence. Dedicated to providing academic programs of the highest quality that are at the forefront of nursing, the college has been widely recognized for its innovation, leadership in the profession of nursing and extensive collaboration with diverse community agencies. U.S. News & World Report consistently ranks the college in the top 15 percent of nursing schools with graduate programs.

With our long-standing history of academic excellence, UW-Milwaukee is the ideal choice for students interested in a PhD in Nursing. The PhD in Nursing is a research-intensive program that prepares nurse scientists for roles in research, education, practice, health policy and leadership. Students work closely with faculty mentors to plan and conduct cutting-edge and innovative research using a variety of research methods.

Nurse Vulnerability


The current featured ANS article is titled “Vulnerability in Nurses: A Phenomenon That Cuts Across Professional and Private Spheres.” The authors, located in Denmark and Norway, are Sanne Angel, PhD, RN; Solfrid Vatne, PhD, RN; and Bente Martinsen, PhD, RN.  In this very timely article, the authors propose that organizational awareness and intervention could be a key to addressing nurses’ vulnerability – a message that clearly is needed now.  Dr. Angel provided the message below about their work and the insights from it.  You can access the article at no cost while it is featured; we welcome your comments and responses!

Sanne Angel

Nurses vulnerability has never been more present than now with the Corona Pandemic threating nurses’ health and lives as well as those of their kins.

The experience of vulnerability is never stronger than when life is at risk. Still, we know that whether aware or not, nurses are vulnerable because they are human and because they expose themselves in their role as a nurse, not least since they wish to do good.

In this work, we explored nurses’ vulnerability from their perspective which was possible because we used a phenomenological approach. We introduce the paper by saying “As patients’ vulnerability is a core concern in the nursing profession, nurses’ own vulnerability has received only scant scholarly attention”.

Nursing students who were attending a master’s course in advanced phenomenology were invited to be part of the study. This decision was based on the didactic assumption that when teaching students phenomenology, they benefit

Solfrid Vatne

from being exposed to the phenomenon because this makes them reflect upon it in relation to the conduct of a real study. One of the reviewers wrote: I loved seeing the link from teaching through to publication.

We used a descriptive phenomenological approach informed by Giorgi’s theory, and the student conducted interviews with 14 Danish female nurses. The analysis revealed nurses’ experiences of vulnerability in relation to their work.

We found that vulnerability among nurses is a latent feeling that manifests itself by the body being out of control including feeling overwhelmed by feelings and struggling to avoid to be harmed.

Nurses’ experience of vulnerability is latent, and each nurse has a unique threshold of tolerable vulnerability the level of which cannot be predicted. She may reach her personal tolerability threshold when standing face-to-face with

Bente Martinsen

the basic terms of existence or when she experiences something unexpected or unclear or is challenged by an unintelligible tasks or experiences being treated unfairly. Vulnerability shows itself in feeling overwhelmed and losing bodily control. Vulnerability is closely related to professional insecurity, i.e. situations where nurses doubt their own knowledge and competences, or when they feel unable to treat a patient in the best way. This may happen when a nurse takes on a new job, works with seriously ill patients or is confronted with death, i.e. experiences that may exacerbate nurses’ own vulnerability. The experience of vulnerability is an existential feeling that makes the nurse struggle to avoid being harmed. The experience of vulnerability is not limited to the work sphere as it can spread from the professional to the private sphere. In that case, nurses cannot dissociate themselves from the feeling of vulnerability in their spare time, despite the situation provoking vulnerability being connected to their professional life. However, the experience of vulnerability may also be diminished through interaction with patients, relatives, colleagues, co-workers or managers.

Thus, the experience of vulnerability was evident in situations with patients and relatives. The inherent existential vulnerability was further exacerbated by the work conditions. What surprises was that nursing colleagues was also antecedents, transgressing the nurse’s personal boundaries.

One of the reviewers asked these questions and suggested:

“How might ‘we’ as a profession, as educators and/or practitioners support nurses to learn to navigate this aspect of practice and to recognize its impact on the nurse as ‘self’? This idea could be further explored & developed.

This is an important topic that we believe deserves to be a focus in itself.

In our discussion, we explored how to be sensitive and open without being harmed. Here we found support in Petterson’s theory on mature care that emphasizes that the nurse must take care of herself as well. This is not only allowed, but necessary in order to be able to provide authentic care for the patient.

In our search for recommendations on how to handle difficult situations, we found support in Chinn and Kramer’s theory on personal knowledge. According to this theory of personal development, the difficult situations may be experienced as a possibility to growth. Acknowledging that nurses from time to time experience situations that are more than she can handle will reduce the individual nurse’s vulnerability. However, admitting that something is difficult gives the nurse an opportunity to learn. Here, good colleagues are really needed and leaders play an important role in contributing to creating a learning environment.

 

Innovative Indigenous Research Methodology


The latest ANS featured article is titled “Symbiotic Allegory as Innovative Indigenous Research Methodology” by Barbara Charbonneau-Dahlen, PhD.  In this article Dr. Dahlen draws on her research focus describing the  experiences of Native American boarding school survivors who were victims and witnesses of abuse, with particular attention to the sustained impact of historical trauma. She provided this message for ANS readers about her background and her research focus:

Barbara Dahlen

I was born and raised in Olga, North Dakota and completed most of my childhood education in a mission boarding school in South Dakota and higher education in North Dakota. I am an enrolled member of the Pembina band of Indians. I earned my doctorate from Florida Atlantic University Christine E. Lynn College of Nursing located in Boca Raton, FL. In recognition of the scant literature that existed on the history of Native American nurses in the United States, I began a long journey of discovery in collecting data on historical trauma.  I came to focus on symbiotic allegory because I  wanted to tell  the indigenous stories in the participants own voices to allow the voice to be heard.  This methodology came with a desire to honor the story that was given to my through honoring the sacred tradition of story at the heart of the research.

How Nurses Come to Race


The current ANS featured article is titled “How Nurses Come to Race: Racialization in Public Health Breastfeeding Promotion” by Alysha McFadden, MSc, BSN, RN, CCHN(c); Susan L. Erikson, PhD. In thiis important article, the authors uncover ways in which nurses engage with racialized institutional practices, even when trying not to do so.  We invite you to download this article while it is featured and welcome your comments below.  Here is a message from Alysha McFadden, and a brief video she prepared about this work!

While people are gathering on their balconies at 7 pm every night to rightfully cheer on essential workers such as nurses, I questioned whether it was the right time to feature our research that critically examines nursing praxis. Yet, my newsfeed reminded me that no matter the circumstances, it is appropriate to draw attention to racializing, othering, and essentializing practices—even when its committers are our current day heroes.

“How nurses come to race” was based on my master’s research. As a second-year doctoral student, time has lapsed, and I am continuing to learn (and unlearn) how to conduct myself and my research in an anti-racist and decolonial way. For this blog post I decided to share a personal story of my decolonizing journey through visual storytelling. The video briefly describes what inspired my research on racialization and breastfeeding, while drawing attention to my privilege and complicity.

I hope that when you read our featured article, you will see that racializing, othering, and essentializing practices are ‘…not just occurring in rare situations by “racist” nurses.’ While our ethnographic account and its conclusions cannot be applied with broad brush strokes over every nursing practice area and setting, I hope our article will facilitate reflection—and then transformative action—when these insights resonate. Racialization, othering, and essentialization are pervasive, complex, and often structurally-arranged—but they are not inescapable.

This year, 2020, is the year of the nurse and midwife. Our profession is under considerable pressure and scrutiny. Let us ensure that nurses provide the best, equity-oriented care so that we can be a beacon of light in these uncertain times.

Traditional Masculinity and Men’s Health


The current ANS featured article is titled “Traditional Masculinity A Review of Toxicity Rooted in Social Norms and Gender Socialization” authored by Ashley Rivera, RN, MSN – and recently awarded PhD from Florida Atlantic University!  In this article (available at no cost while it is featured), Dr. Rivera explores the effect of traditional masculinity on health.  Here is a video that she prepared about her article – we welcome your comments and responses to her work!

Epistemic Injustice in Women’s Reproductive Healthcare


The latest ANS featured article is titled “Epistemic Injustice A Philosophical Analysis of Women’s Reproductive Health Care in a Somali-American Community”  authored by Robin Narruhn, PhD, MN, RN and Terri Clark, PhD, CNM, ARNP, RN, FACNM.  Visit the ANS website to download this article; we welcome your comments and responses to this work.  Here is a slideshow narrated by Dr. Narruhn that gives some background on this work:

Military to Civilian Reintegration


The latest ANS featured article is titled “Toward a System Theory of Stress, Resilience, and Reintegration” authored by Anna G. Etchin, PhD, RN; Jennifer R. Fonda, PhD; Regina E. McGlinchey, PhD; and Elizabeth P. Howard, PhD, RN, ACNP, ANP-BC, FAAN. In this article the authors address the need for a theoretical sturcture to understand and interpret complex phenomena.  Here is a message from Dr. Etchin about this work, along with  a link to her “Prezi” presentation that details the elements of this work.

Anna Etchin

In my Prezi.com presentation, my co-authors and I present our rationale for developing the System Theory of Stress, Resilience, and Reintegration, created with integrated concepts from Neuman’s Systems Model and the Transactional Model of Stress and Coping. Military to civilian reintegration, or the return to one’s civilian roles, is complex and demands a holistic perspective. Much like any medical or psychiatric diagnosis, considering other possible influencing aspects of one’s health is key to optimizing patient outcomes. With the help of simple metaphors, we demonstrated the abstract components of this theory, which we then applied to a research study (not presented in this paper).

As a nurse working with veterans for nearly a decade, I’ve seen the direct effects of successful and challenging reintegration experiences. These effects can spill into other areas of veterans’ lives, such as relationships, work stability, etc. By adopting a holistic lens, nurses can better facilitate veterans’ returns to their new normalcy.

 

Caring Science and Islamic Philosophy of Care


Our current featured article is titled “Embodying Caring Science as Islamic Philosophy of Care: Implications for Nursing Practice” authored by Salma Juma Almukhaini, MSN; Lisa Goldberg, PhD, RN; and Jean Watson, PhD, AHN-BC, FAAN.  The article is available to download at no cost while it is featured, so we invite you to read the article and share your comments and responses in the “comment” section below!  Here is a message about this work from the primary author, Salma Almukhaini:

Salma Juma Almukhaini

The idea of writing this article started during my first semester, fall 2018, as a PhD student at the School of Nursing at Dalhousie University, Canada. I am an international student from Oman. I completed my Bachelor of Science in Nursing in Oman and my Master of Science in Nursing in the United States of America. During fall 2018, I was enrolled in the “Contemporary views of Nursing Science: philosophy, research, and practice” course, coordinated by Dr. Lisa Goldberg. The second class of the course was about understanding Caring Science. That was my first time to know about the Caring Science. That class was inspirational for me in so many ways. It inspired me to reflect on how I, as a nurse, provide care to my patients! What is the caring philosophy underpinning my nursing care! Despite the various caring theories that I have learned about in nursing schools, I knew that what guides my caring practice is my religion” Islam “ and the Islamic principles. I knew that Islam for other Muslims and me is not just a religion. It is a philosophy of life that guides every aspect of it. It guides how Muslim patients perceive their illnesses and how they act during such times. As a Muslim nurse, my love toward God ”Allah” is my main driver when I provide care to my patients, their families, others in my everyday life, and even when I provide care to myself.

The class inspired me to ask the question, “ what is the Islamic philosophy of care? And Is there any?. It inspired me to think more about the caring science, its philosophy, and the ten Caritas processes. I like Caring Science because it provides practical guides, through the ten Caritas processes, for nurses and teaches them how to provide genuine and authentic care and love to their patients. It asks nurses to transcend their egos to build a healing environment for their patients.

What was interesting is that I noticed many similarities between Caring Science and how I provide care based on Islam. At the same time, I realized that the God “Allah” who is central in Muslim patients’ lives is not well acknowledged in the Caring Science. The healing environment for Muslims can hardly be established without recognizing the importance of God “Allah” in Muslim patients’ lives, especially during illnesses and hard times.

I had a discussion with Dr. Goldberg about how Caring Science and Islam are similar in many ways and different in few. She encouraged me to read more about the Islamic philosophy of care and to compare it with the Caring Science. She further challenged me to go beyond that and think about how Caring Science could be aligned with the Islamic philosophy of care.

This topic was super interesting for me because Islam is now the most growing religion, and Muslims are all over the globe. Many questions came to my mind, such as how non-Muslim nurses could provide comprehensive care for Muslim patients if they are not aware of their unquie needs during illnesses, what illnesses and hardship mean to them and how these nurses could cultivate their Muslim patients’ self-care, and how they could build the healing environment for them?.

This article answers all the aforementioned questions. It thoroughly describes what Islamic philosophy of care is and what Caring Science is. It provides a holistic comparison, summarizing both similarities and differences, between the Islamic philosophy of care and the Caring Science (Table provided). In brief, both philosophies acknowledge the importance of self-care, human to human care, human to universe care, and verse versa. Unique to the Islamic philosophy of care is God “Allah” care. Additionally, both agreed that humans consist of physical, mental, and spiritual dimensions. According to the Islamic philosophy of care, in addition to these dimensions, Muslims have an ideological dimension. This dimension entitles that humans have duties toward God”Allah” and fulfilling that duties is the way to seek God’s care, which is fundamental for Muslims.

However, the article did not stop with the comparison; it goes beyond that to show how the two philosophies could be aligned. By embodying the Islamic philosophy of care in the ten Caritas processes of Caring Science, practical guides that could assist nurses, especially non-Muslims, to optimize their care for Muslim patients and provide care that meets their unique needs are summarized.

With the current influx of Muslim refugees and immigrants all over the globe, I could say that this article is timely and will advance nursing knowledge and practice toward Muslim patients. I want to conclude by saying that compassionate, non-judgmental, and patient-centered nursing care is a right for every patient regardless of their background, religion, color, race, or gender. Nursing is caring, and it is our responsibility as nurses to approve that it really is.

Keeping the Nurse in the Nurse Practitioner


Editor’s note:
See information about the 2nd Annual Nursing

Theory Conference and future conferences here

Our current ANS featured article is titled “Keeping the Nurse in the Nurse Practitioner Returning to Our Disciplinary Roots of Knowing in Nursing” by Sylvia K. Wood, DNP, ANP-BC, AOCNP. In this article, Dr. Wood examines the factors that have shaped nurse practitioner education and provides the case for restoring nursing roots as central in the future.  The article is available for download while it is featured – we welcome your comments and responses to this challenge!  Here is a message from Dr. Wood about her work:

Sylvia Wood

Attending the 50th Anniversary 2019 Case Western Reserve theory conference, I was deeply moved to listen to the wise voices of nurse theorists leading our profession, warning us of current threats in losing our disciplinary perspective. Having attended an open session for the Future of Nursing 2020-2030 just two days earlier, and journey as a Ph.D. candidate, created a confluence of events that compelled me to bring this article forward. It is my honor to present it in this issue of ANS. As a nurse practitioner and nurse educator, I have witnessed both the loss of nurse theory-driven practice and diminished presence in our curricula. This article provides a historical background for the context of the issue, existing challenges for academic educators are presented with an analysis of the current literature and recommendations are offered.

For many years in NP practice, these questions never left my mind, what is it that NPs know and do that make them so distinct from other providers and why is their care so valuable in its own right? Why is what they know not made visible? I often observed that NPs, including myself, could not find the words to explain our nursing, our nursing knowledge, how this nursing knowledge shaped what we did in practice, or trace that knowledge back to nursing theory and nursing science. Nevertheless, the result of our NP care significantly improved patients’ health outcomes, healing, wellness, wholeness, and quality of life.

As NP practice has become more sophisticated, there has been a necessary expansion of education from other sciences and health-related disciplines. However, there is a decreasing emphasis on the theoretical foundations of nursing and nursing science, unmooring practice from its anchor to nursing. The result obscures not only NPs’ identity, and the relevance of our practice compared to other providers, but the nurse-sensitive patient outcomes as a consequence of it. The theoretical basis of nursing knowledge (nursology) is what distinguishes nurse practitioners from other health care providers and drives the results associated with it.

2020 is the Year of the Nurse and Midwife. It is also a critical time when the demand for NPs is on the rise, and NPs are advocating for full practice authority. Therefore, in honoring our contract with society, we have an ethical and moral obligation to know, articulate and demonstrate the scientific foundation underpinning the distinction of our practice by returning to our disciplinary roots of knowing in nursing to keep the nurse in the nurse practitioner.

 

Reprinted with permission: Baldwin, M. (2009). Tree of Life~Hope. [Web Image of Oil Painting]. EBSQ Self Representing Artists.

The autonomy of a profession rests more firmly on the uniqueness of its knowledge, knowledge gathered ever so slowly through the questioning of scientific inquiry. Nursing defined by power does not necessarily beget knowledge. But knowledge most often results in the ascription of power and is accompanied by autonomy (Fuller, 1978, p. 701).

Source:

Fuller, S. (1978). Holistic man and the science and practice of nursing. Nursing Outlook, 26, 700-704

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