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Embracing Difference Between Theoretical and Practical Knowledge

The current featured article in ANS is titled “Learning in the Third Room—A Way to Develop Praxis by Embracing Differences Between Theoretical and Practical Knowledge” authored by Elisabeth Dahlborg, PhD. You can access the article at no charge while it is featured, and we would be delighted to know your comments and ideas about this article in the comments below! Here is the abstract for the article:

Contradictions between theory and practice are well known in nursing. To this end, this article discusses a learning strategy that might facilitate the capture of the dialectic between theory and practice, equally valid components of a nurse’s competence, giving the 2 forms of knowledge equal relevance. Using a virtual platform (ie, the “third room”) decreases the power order between different forms of knowledge. Nurses, students, and teachers all contribute to a seminar using nonhierarchical structures and concepts to capture the knowledge that enables to learn the praxis of nursing. Key words: discourses, nursing education, philosophy, power order, virtual seminar, work integrated learning.


Promoting Cancer Screening

The current ANS featured article is titled “A Critique of the Theory of Planned Behavior in the Cancer
Screening Domain” authored by Jinghua An, MSN, RN and Catherine Vincent, PhD, RN, both at the University of Illinois at Chicago College of Nursing. The article is available for download at no cost while it is featured. Here is a message that Jinghua An provided about this work.

Jinghua An

As a nurse, are you involved in promoting cancer screening participation in your community? Early cancer detection is key to improving patients’ chance of survival. The Theory of Planned Behavior (TPB), one of the most frequently applied behavioral theories, has been used to understand, predict, and change cancer screening–related behaviors. In this paper, we applied Fawcett and DeSanto-Madeya’s 2013 framework for analysis and evaluation of nursing theory to critique the TPB from a nursing perspective.

We systematically analyzed and evaluated the TPB to identify its contributions to and usefulness in cancer screening research and practice. The TPB is philosophically congruent with the nursing metaparadigm. The logical congruence between the TPB and the nursing discipline provides the basis for nurses to consider the TPB as a shared theory. The propositions of the TPB could provide information about the individual, interpersonal, social, and environmental determinants of health behavior. Thus, the TPB is applicable in diverse nursing practice situations and settings. It could have profound theoretical significance on nursing if researchers better integrated research findings within the nursing discipline.
The predictive validity of attitude, subjective norm, and perceived behavioral control for intention and behavior has generally been supported in empirical studies. Nevertheless, inconsistencies and gaps exist between empirical data and the theory, particularly with respect to the multiplicative combination rule, intention as a mediator of the effects of attitude and subjective norm on behavior, and the moderation effects of perceived behavioral control. Methodologically sound empirical studies are called for to test these theory propositions.

In addition, the TPB’s utility for developing interventions to promote behavioral change in the cancer screening domain requires further empirical testing. Specifically, future research should provide details of the mechanism of change, the intervention characteristics, and the corresponding theory elements (either from the current TPB or an expanded TPB that integrates other theories). Finally, we believe that translational studies are needed to evaluate the theory’s pragmatic adequacy for promoting cancer screening in nursing practice. 

The Collision of Caring and Carceral Institutions

Our current ANS featured article is titled “Gender Influences in the Intersection of Acute Care: Registered Nurses and Law Enforcement – The Collision of Caring and Carceral Institutions” authored by Danisha Jenkins, PhD, RN; Candace Burton, PhD, RN and Dave Holmes, PhD, RN, FAAN, FCAN. We invite you to download the article while it is featured, and share your comments here! Dr. Jenkins shared this information about this work:

Danisha Jenkins

Over a decade ago, when working as a nurse in a detention center for children and adolescents, I was first introduced to my position in the intersection of nursing and law enforcement. I saw the ways in which nursing practice and ethics were deformed and often made impossible, when working within carceral walls. My heart was broken. I committed at that point to study and make visible this terrifying phenomenon I was participating in; one in which nurses became tentacles of a system causing unfathomable harm. As I continued my work in trauma and critical care, I continued to witness the carceral influence that pervaded in the acute care setting, particularly in the care of some of our most marginalized and at-risk communities. Today, as legislation is introduced such as requiring nurses to report patients and families for seeking such medical services as gender affirming and reproductive care, nurses increasingly must grapple with their role and interactions with law enforcement and the prison industry. This manuscript is one in a series that reports on a study titled “Care Incarcerated: The Intersection of Nurses and Law Enforcement in the Acute Care Setting”. We hope to strengthen insight and understanding as to the complexities, challenges, and dangers inherent to the intersection of these “caring” and “carceral” institutions.

Art Making as Health Intervention

The current ANS featured article is titled “Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions” by Kyung Soo Kim, PhD, RN and Maichou Lor, PhD, RN. You can download this article at no cost while it is featured! Here is a message sent by D. Kim about this work:

Kyung Soo Kim

Hello, my name is Kyung Soo Kim, a junior nurse researcher at the University of Iowa, College of Nursing. My program of research focuses on chronic pain in older persons and chronic pain management using art making intervention. I am currently designing an art making intervention using visual art making activities for older persons with chronic pain. If you want to know more about and/or you are interested in my research, please contact me (! I am delighted to introduce my recent article entitled, “Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions”.

Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant’s approach. In this article, we reviewed 85 studies and found four defining attributes, four antecedents, and physical and psychological consequences. In addition to these findings, we provided several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making as a health intervention.

The Potential of Merging Intersectionality and Critical Ethnography for Advancing Refugee Women’s Health Research

The current ANS featured article is titled “The Potential of Merging Intersectionality and Critical
Ethnography for Advancing Refugee Women’s Health Research
” authored by Areej Al-Hamad, PhD, RN; Cheryl Forchuk, PhD, O Ont, RN, FCAHS; Abe Oudshoorn, PhD, RN; and Gerald Patrick McKinley, PhD. While this is featured you can download it at no cost. We welcome your comments and discussion of the article here! Here is a message from Dr. Al-Hamad about this work:

At a time of rapidly developing sciences and an enlarging research arena, this article highlights the paradigmatic moments of complexity, collaboration, and unrealized potential of merging critical ethnography and intersectionality. Exploring such theoretical complexity can inform knowledge development and knowledge-to-action for social justice through research. This merger allows scholars to embrace the best of both perspectives versus having to make a trade-off in choosing a single approach. Ultimately, knowledge of the intersection of theoretical perspectives and methodologies supports the advancement of scholarship and refugee women’s health research.

Areej Al-Hamad

We intersperse our considerations regarding critical ethnography blended with intersectionality and clarify the complexities and strengths of this combination. This article seeks to contribute to critical research methodology by detailing and providing insights into the strength and potential of merging critical ethnography and   intersectionality into a combined approach. To mapping the terrain of emancipation and empowerment, we align the philosophical underpinnings and methodology of critical ethnography with an intersectionality-based analysis to demonstrate a coherent fit between the two.

This blended approach is relevant across research with populations on the margins, such as refugee women, particularly research that seeks to effect enhancements in health equity. Ultimately, we should think about a theoretical approach for future nursing research by exploring the synergetic effect of merging critical ethnography and intersectionality.

Black Women’s Strength in Living with Chronic Pain

The current featured article for ANS is titled “’Be Strong My Sista’ – Sentiments of Strength From Black Women With Chronic Pain Living in the Deep South” authored by Lakeshia Cousin, PhD, APRN, AGPCNP-BC; Versie Johnson-Mallard, PhD, WHNP-BC, FAANP, FAAN; and Staja Q. Booker, PhD, RN. We welcome you to download this article at no cost while it is featured, and share your comments below in the ‘comments’ section. Here is a message that co-author Staja Booker shared about this work:

After meeting a Black woman on vacation who voluntarily shared her raw experience of living chronic
pain, it was clear that this conversation was a true representation of how many Black women feel living
with chronic pain. But more importantly, we were convinced that the story of aging Black women with
chronic pain had to be shared, but from a perspective that could (1) adequately explain the cultural
context of coping because of the gendered racial socialization that plagues us throughout our lives and
(2) realistically educate healthcare providers about Black women’s nuanced experience of living with
pain and seeking pain care in an unjust healthcare system.

The traditional connotation and expectations of “strength” have been associated with women who identify as Black for many decades. The Strong Black Woman (and its corollary The Superwoman Schema) is a unique cultural phenomenon with both paradoxically endearing positive and enduring negative characteristics. While evidence of the Strong Black Woman was robust in our sample, we also identified that women with a lived experience of chronic pain also submitted to God for strength and code-switched to counter the weaponization, misunderstanding, and implicit bias of being perceived as “strong” in healthcare encounters.

Research now and in the future must leverage the inner strength of the “sisterhood” and spirituality as cultural assets to empower Black communities to effectively manage chronic pain. We hope this work will lead to a greater appreciation of narrative inquiry of underrepresented individuals as rigorous scientific evidence that can lead to innovative and equitable health solutions that transform lives. “There is a kind of strength that is almost frightening in Black women. It’s as if a steel rod runs right through the head
down to the feet” (Dr. Maya Angelou).

HOPE Women’s Group (author Staja Booker in the green/blue sweater in the center)

ANS 45:2 opens with an analysis of the social meanings of the COVID-19 mask

Today the ANS Volume 45, issue 2 is published! The opening featured article for this issue is titled “The COVID-19 Mask: Toward an Understanding of Social Meanings and Responses” authored by Oona St-Amant, PhD, RN; J. Anneke Rummens, PhD; Henry Parada, PhD, MSW; and Karline Wilson-Mitchell, DrNP, RM, RN, CNM, FACNM. This article is available to download at no cost while it is featured, and we are offering continuing education credits for this timely article! Here is the abstract :

The COVID-19 pandemic has imposed unprecedented restrictions on everyday life. Unlike lockdown or shelter-in-place measures, the facemask has emerged as an empowering response to the public spread of the virus, permitting some degree of return to prepandemic life—such as school or work—by disrupting transmission that would otherwise occur. And yet, this utilitarian tool has attracted considerable controversy and polarized opinions. This article uses Blumer’s adaptation of symbolic interactionism as a theoretical roadmap to examine the various meanings ascribed to the facemask and its usage. We discuss how it is socially perceived and consider implications for health care providers within the Canadian social context.

Japan’s tragedy (or is it all of us??)

This just appeared out of nowhere just now and I had totally forgotten writing it – but it would have been so appropriate 2 years ago – not that it will not continue to be appropriate going forward because the earthquake/hurricane/tsunami is still ahead of us.

Peggy L Chinn

Yesterday Thomas Cox sent around a terrific commentary on what is happening in Japan, and with his permission, I am posting it here.  If you want to see the actual post on the Nurse-Philosophy list, go to this link:

But this is so important, I am posting it here in its entirety:

Risk – The Real Butterfly Effect

by Thomas Cox, PhD, RN, author of  the soon to be available book: Standard Errors: Life, Health & Death When Hospitals, Long Term Care Facilities, Home Health Agencies, Physicians & Nurses Are Insurers.

I have resisted the impulse to comment on Japan. But there are only a few “Teachable moments” as profound as this one.

45+ years ago somebody thought it would be a great idea to build a nuclear reactor along the pacific ocean coastline in a country with high seismic activity and high risks of tsunamis.

That day, a butterfly emerged…

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Rethinking How We Design Written Exams

The current featured ANS article is titled “Revisioning Assessment and Evaluation in Nursing Education Through Critical Caring Pedagogy: Using Authentic Examinations to Promote Critical Consciousness” authored by Laura A. Killam, MScN, RN and Pilar Camargo-Plazas, PhD, RN. We invite you to download this article at no cost while it is featured, and contribute to a discussion in the comments below! Below is a brief message from the authors, and a video abstract that can also be accessed from the article PDF.

As nurse educators, we believe that written exams are an important part of how we help students learn to think critically and be empowered to speak-up against oppression in society. Since the beginning of the pandemic, we noticed increasing debate in our professional circles around testing practices. This article provides an overview of historical sources of oppression and injustice that educators may unknowingly propagate during traditional exam design. It also addresses the unintended consequences of encouraging surface learning, uncaring practices, oppression, inequity, and cheating when traditional testing is overused or used poorly in nursing education. In the context of critical caring pedagogy and universal design for learning we advocate for authentic assessment, more specifically exams that mirror the real-world context of nurses such as open-book open-web written exams.

A Middle-Range Theory of Nurses’ Psychological Trauma

The current ANS featured article is titled “A Middle-Range Theory of Nurses’ Psychological Trauma” by
Karen J. Foli, PhD, RN, FAAN. We are offering continuing education credit for this article, so you can also access the CE test and apply for credit! And, you can download this article at no cost while it is featured! Here is a message from Dr. Foli about her work:

Many years ago, I became a registered nurse. Despite the decades that have passed, I still recall my active clinical days and, most often, the satisfaction that came from either direct patient care or supervising others in rendering care. I practiced in psychiatric nursing, long-term care (direct care provider, nurse manager, and consultant), hospital-based rehabilitation, and as a clinical instructor. But there are also distinct memories that were born from traumatic experiences as a nurse, ones that I believe are specific and essential to being a nurse. Some examples of what I remember…

  • My visceral reaction to knowing the added workload from a peer who called off sick and wondering how I would get “it” all done. (Insufficient resource trauma – personnel)
  • Being completely unprepared as a baby was delivered in the hallway of an operating room suite while the mother awaited an unnecessary C-section. I can feel the newborn’s soft head as I frantically tried to suction her nose. (Insufficient resource trauma – knowledge).
  • Being verbally abused by patients, especially an older adult, Agnes, a patient confined to a wheelchair because of advanced rheumatoid arthritis. (Workplace violence)
  • Grieving from the passing of a patient with advanced metastatic breast cancer, Carol, who had resided on my long-term care unit for months. The tears that suddenly appeared and that I couldn’t seem to control as I walked down the hallway outside her room. (Secondary traumatic stress)
  • Witnessing the toll of patient suffering that medical intervention caused and contributed to patient suffering. One of my patients was a Vietnam veteran and had received electroconvulsive therapy for major depression; suddenly, he couldn’t remember my name. (System-induced trauma)
  • Recalling a medication error I made and, then another one, on the rehab unit where I worked because I was so rattled and distracted about whether I had harmed the patient. (Second-victim trauma)
  • Training in the operating room by a nurse who expressed impatience at my slow uptake of information and wondering if I would ever be competent as a nurse (Historical trauma)

Above I have described six of the seven nurse-specific traumas that I present in my middle-range theory, which are described in detail in my article. The seventh is nurse-specific trauma from disasters, experienced by so many nurses today due to the pandemic: deciding who receives what treatment and being exposed to and endangered by the virus as frontline workers. Although I have offered personal examples, I believe these traumas are universal phenomenon in the practice of nursing.

This paper expands on my theory as outlined in my book, The Influence of Psychological Trauma in Nursing (Foli & Thompson, 2019). As a nursologist and active researcher, I uncovered the concept of “insufficient resource trauma” after the book was published in data I had collected (see Foli et al., 2020). Nurses related the lack of time, personnel, and knowledge prevented them from carrying out their moral responsibilities as professional nurses.

I will close with two additional points that also directs us toward praxis: some traumas in nursing practice are avoidable and others are not. Secondary trauma, for example, may be unavoidable as we connect with patients in their most vulnerable moments. Insufficient resource trauma, I assert, is avoidable, which brings me to my second point. While resiliency in nurses should be encouraged and is a good thing, the environment provided to nurses has to be committed to allowing nurses to become resilient. In a chronically, insufficiently, resourced environment, nurses will struggle to become and maintain resiliency. Nursing care isn’t provided in a vacuum; the organizational context must be considered.

About a month ago, I was asked to present my theory to senior, public health nursing students in post-clinical debriefing sessions. It was an honor to listen to their narratives and hear them speak about what had happened to them. Even with this focus to my work, I was amazed at the traumatic events these young adults had witnessed and endured. I could see them trying to make sense of it; some students were vocal, one sobbed, and some seem paralyzed. Their primary clinical instructor was masterful and demonstrated a safe, compassionate space for them. She followed up with several to ensure they were all right. The experience was a gift to me, albeit bittersweet, in validating my work and understanding the responsibility of how fragile nurses are as we recall past traumas. Although nurse-specific traumas have surged with the COVID-19 pandemic, these traumas are old acquaintances.


Foli, K. J., Reddick, B., Zhang, L., & Krcelich, K. (2020). Nurses’ psychological trauma: “They leave me lying awake at night.” Archives of Psychiatric Nursing, 34(3), 86-95.

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Sigma Theta Tau International Publishing.

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