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Mutuality in Caregiving

ANS is currently featuring the article titled “Family Caregiver-Receiver Mutuality: A Concept Analysis” authored by Brennan P. Streck, MSN, RN, CNE; Diane Wind Wardell, PhD, RN, WHNP-BC and Geri LoBiondo Wood, PhD, RN, FAAN. We invite you to download this article at no cost while it is featured, and share your comments here! Brennan Streck shared this background information about this work for ANS blog readers!

This concept analysis came to be after I dove into the literature on caregiver-patient (often called caregiver-receiver, as in this paper) dyads. I am an oncology/stem cell transplant nurse by training. Anecdotally, my nursing and medical colleagues noticed that our patients with positive reflections of their caregivers and those who seem to have stable, fruitful relationships tended to have better outcomes. This phenomenon is well documented in the literature; many studies have found that social support is an integral part of healing. Thus, caregiver research has become more popular over the last decade or so. Caregivers are being considered for their potential role in patient outcomes now more than ever. Studies are evaluating whether some characteristics (either those that make up the caregiver or patient as individuals, or those which are dyadic in nature) are associated with better health outcomes.

At the top of the list of characteristics that may prove important is the obvious: the dyadic relationship. As nurses, we often witness the nuances of our patients’ personal lives. We sometimes notice when patients seem to have strong support systems while others do not, and when some patients and their caregivers have healthy/bonded relationships while others’ are tumultuous. In the ideal case scenario, a sick patient would recruit a caregiver to help them get through an illness. The relationship between patient and caregiver should benefit both people; it should be mutualistic. When it isn’t mutualistic, the relationship suffers, which can ultimately affect the health of both involved individuals. There is a term that describes the mutualistic relationship between patients and caregivers. I came across this term a few times while researching the phenomenon of the patient-caregiver relationship. That term was mutuality.

I decided to perform a concept analysis on mutuality because it is, for lack of a better explanation, a rather “flowery” concept. Many people may not truly know what it means, because it is a rather altruistic term that lives in a metaphysical space. However, if mutuality could be clearly and succinctly defined, then the odds of inclusion in future studies would be improved, and we (the research community) would reap the benefits of understanding how mutuality impacts dyadic relationships.

I’m passionate about its inclusion in future research because I think it may be an important concept for dyadic frameworks, and despite having a psychometric scale already developed to measure it, it had never been properly defined. Thus, I performed a wide concept analysis by sifting through interdisciplinary literature, categorizing definitions and attributes, and ultimately arriving at an empirically-supported definition. In doing so, I hoped I could highlight mutuality as a concept for inclusion in caregiver-receiver studies.

Patient and Informal Caregiver Participation in Research (PAICPAIR) Part 1

The current featured ANS article is titled “Patient and Informal Caregiver Participation in Research (PAICPAIR) Part 1” The authors are PhD. candidate Katrine Staats, Professor Ellen Karine Grov, Professor Bettina Husebø, and Postdoctoral fellow Oscar Tranvåg. In this inventive article, the authors presents a framework for Patient and Informal Caregiver Participation In Research (PAICPAIR) — creating a stronger foundation for democracy, equality and research quality by promoting the active participation of vulnerable people with incurable life-threatening illness, as co-researchers. You can access this open access article anytime at no cost; we welcome your comments and responses!

Establishing research collaboration with vulnerable human beings implies ethical challenges and considerations. We do however believe it is unethically not to include patients and their informal caregivers as co-researchers solely based on vulnerability. Little attention is paid to how vulnerable people, living with incurable life-threatening illness, and their informal caregiver, actively can participate as co-researchers.

In this work, we present the first paper of two presenting the PAICPAIR framework for Patient and Informal Caregiver Participation in Research. The framework is founded on learnings from research collaboration with a patient and two informal caregivers experiencing incurable, life-threatening illness − participating as our co-researchers in the ‘Dying with dignity-project’. We describe and discuss crucial aspects of the first part of this research collaboration; how we constituted and developed a formal research collaboration, and how we supported and empowered the co-researchers during the initial stages while developing study aim, research questions, interview guides and letters of information.

From the early stages of the research process we have implemented a thorough collaboration with patients and informal caregivers – as partners of our research team. We acknowledge them as experts of the subject under investigation, making their contributions and unique competence of great value to all phases of the research process. These patient and informal caregivers,representing a large group of people experiencing incurable life-threatening illness, are seated in the projects’ advisory board as well as the steering group. Regularly scheduled planning sessions, plus systematic follow-up phone calls, helps ensure that the project receives adequate consideration from our co-researchers in all phases of the the research project. A strong working relationship of professional researchers and patient and informal caregiver co-researchers, has been a vital foundation throughout the PAICPAIR process thus far. And in this series of research actions a continous awareness of their potential vulnerability is highlighted while placing us as a team at the center of our methodolgical approach.

Learning experiences from the second and conclusive part of the PAICPAIR process will be published in a later article (PAICPAIR framework part 2) − a description and critical discussion of the PAICPAIR process of data analysis, formulating and developing a plan for disseminating of study results – and how we as a research team implement it into practice.

About the Authors

Katrine Staats

Katrine Staats is MSc, oncology nurse, PhD candidate, Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Norway.



Ellen Karine Grov

Ellen Karine Grov is Professor, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Norway.





Bettina Husebø


is Professor, Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Norway.




Oscar Tranvåg

Oscar Tranvåg is Postdoctoral fellow, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway, and; Norwegian National Advisory Unit on Women’s Health, Oslo University Hospital, Rikshospitalet, Norway.


Weight Stigma in Pregnancy

Rachel Dieterich

The current ANS featured article is titled “Weight Stigma Related to
Pregnancy: A Concept Analysis
” by Rachel Dieterich, MSN, RN; Jill Demirci, PhD, RN, IBCLC and Cynthia Danford, PhD, RN, PNP-BC, CPNP-PC. While this is featured, we invite you to download it at no cost, and share your comments here. Here is a message that Ms. Dietrich has shared for our readers:

As a first year nursing PhD student at the University of Pittsburgh, I found myself knee-deep in the literature, investigating any and everything I could related to maternal body weight and breastfeeding outcomes, and how these two were related. I learned about the physiological relationship, such as the association between excess maternal adipose tissue and delayed lactogenesis II. As I delved more into this topic, I discovered that women with pre-pregnancy overweight or obesity have very poor breastfeeding outcomes compared to women without overweight or obesity. I had a feeling that these breastfeeding disparities may be attributed to more than just hormones and physiology.

Through my time sifting through the literature, I found numerous qualitative research studies detailing a wide range of psychosocial breastfeeding barriers experienced by women with higher body weight, including feeling uncomfortable and embarrassed breastfeeding around others or in public. I was in a rabbit hole – as they say. I then found several other qualitative studies interviewing obese women about their experiences interacting with their obstetric providers. The consensus was this: women with pre-pregnancy overweight or obesity often feel stigmatized, vulnerable, and judged when interacting with their obstetric healthcare professionals based her weight. In fact, one study found that midwives admitted to making negative judgments about a pregnant patient’s character or intelligence if she was obese. I was on to something. Has anyone examined this concept of weight stigma in relation to pregnancy before?

In my second semester of my PhD program, I took a course that challenged us to develop a concept analysis paper for our phenomenon of interest, the topic we would most likely conduct our dissertation research about. For me, the choice was easy. I chose to write a concept analysis on weight stigma related to pregnancy. I found that there was no definition or investigation into this concept and I felt the need to fill this gap to bring awareness to this ugly and unfortunate reality that some pregnant women are currently facing. It is my hope that through this article, nurses and other healthcare professionals will become more aware of the existence and consequences of weight stigma in the obstetric setting.

Currently, I am conducting my dissertation study, “The Relationship between Perinatal Weight Stigma and Breastfeeding Outcomes.” The development and publication of this concept analysis manuscript has been pivotal in the operationalization and development of my dissertation study data collection measures. In my future work, I aim to investigate how maternal race and ethnicity may influence the relationship between weight stigma and breastfeeding outcomes.

Beyond Resilience to Human Flourishing

The ANS article we are currently featuring is titled “Beyond Resilience: A Concept Analysis of Human Flourishing in Adolescents and Young Adults With Cancer” authored by Eunji Cho, MSN, RN and Sharron L. Docherty, PhD, PNP, FAAN. While the article is featured you can download and read it at no cost, and we invite you to return here to share your comments and questions. This is the message that Ms. Cho sent about this work:

This paper is a part of my doctoral dissertation about human flourishing in adolescents and young adults (AYAs) with cancer, exploring positive growth and the maximum potential of young cancer survivors who were diagnosed with cancer during adolescence. Being diagnosed with cancer during adolescence is a life-challenging experience. AYAs with cancer confront the unique developmental tasks of their age groups while dealing with a range of challenges related to cancer and its treatment. Despite the unexpected, challenging impact of cancer, a unique cohort of AYAs with cancer has shown exceptionally positive growth across the turbulent period of cancer treatment and entry into survivorship. This small group of AYAs shows the ability to move beyond the period of distress and suffering to emerge and live a high-quality life. They find meaning in their cancer experience, perceive the world positively, and use adversity as an opportunity to improve relationships with others and to aid others in suffering. Understanding these positive outliers may inform how healthcare professionals can provide adequate, age-appropriate care for this vulnerable population that is so full of potential.

Our study examines the unique attributes of those special AYAs with cancer and their maximum favorable growth and development by applying a developing concept, human flourishing. Human flourishing, a life-long process to achieve “uniqueness, dignity, diversity, freedom, happiness, and holistic well-being of the individual” (National League for Nursing, 2014, p. 1), can work as an excellent target for healthcare that addresses the unique needs of this population. However, the concept of human flourishing has received scant attention in the field of pediatric and young adult oncology, and has been applied in a very limited fashion to AYAs with cancer. The primary aim of this study is to conduct an evolutionary concept analysis to describe the history and current usage of human flourishing in various disciplines, and analyze human flourishing and its related concepts in the AYA oncology literature.
We present three antecedents (i.e., the situational conditions that precede the concept); seven attributes (i.e., the critical characteristics of the concept); and three consequences (i.e., the outcomes, conditions, or situations that follow the concept). The figure below  shows a metaphor of an apple tree, describing the characteristics of human flourishing in this population.

In this study, we can describe human flourishing in AYAs with cancer as the highest positive state that AYAs can attain, and also a continuous, life-long, self-driven process and methods for reaching this heightened state. As human flourishing is a process that continues throughout life, the consequences can become antecedents as well as attributes of human flourishing in the ongoing process. The individual characteristics and resources that have been fortified during an AYA’s past encounter triggering events such as cancer diagnosis. The direct and indirect experiences associated with cancer diagnosis and treatment during the unique developmental period create a strong foundation and new opportunities for growth. By achieving positive intrapersonal changes and interacting and engaging with others or with the external environment, a flourishing AYA positively influences others (and even trigger flourishing in others), lives a truly owned life, and achieves ongoing harmonious development with their environment.

National League for Nursing (2014) claimed that nurses can guide individuals’ journey of self-actualization and fulfillment and help them to recover or develop pathways to human flourishing by providing individualized, holistic, culturally tailored, relationship-focused care. It is evident that this concept can be applied as a health care goal for a range of populations with health care challenges, including AYAs with cancer. Our next studies will focus on further exploration of human flourishing in this population and develop various methods to apply this concept to nursing practice, education, and policy.

Living with End-State Renal Disease

The current ANS featured article is titled “Existential Contradictions in
Living With End-Stage Renal Disease: A Qualitative Metasynthesis
” authored by Ingrid Villadsen Kristensen, MScN; Jette Henriksen, PhD, MScN;
Regner Birkelund, PhD, Dr Phil, MScN; Annelise Norlyk, PhD, MScN. Here is a message the Ms. Kristensen sent about this work!

This article presents a study, which is a part of a phd study, that encompasses the entity of investigating the existential experiences of living with end-stage renal disease and undergoing a kidney transplantation with a living donor.

Ingrid Villadsen Kristensen

The title of the phd dissertation is “Living with ambivalence while facing the future: The existential experiences of patients living with end-stage renal disease before and after a kidney transplantation with a living donor”. Besides the qualitative metasynthesis, the phd study includes two empirical studies conducted in the tradition of Ricoeur’s theory of narration and interpretation. The dissertation has been accepted for defense by the Faculty of Health at Aarhus University, Denmark, and defended May 27, 2020.

My supervisors during my phd studies are co-authors in this article: Main supervisor Annelise Norlyk, RN, Associate professor, Study Director, PhD, MScN, Research Unit for Nursing and Health Care, Department of Public Health, Aarhus University; Co-supervisor Regner Birkelund, RN, Professor, PhD, dr. Phil, MScN, Lillebaelt Hospital, Vejle & Institute of Regional Health Research, University of Southern Denmark and Co-supervisor Jette Henriksen, RN, Senior lecturer, PhD, MScN, VIA Nursing, VIA University College.

The qualitative metasynthesis conducted in this article follows parts of ‘Handbook for Synthesizing Qualitative Research’, where qualitative metasynthesis is amplified by two American nursing researchers, Margarete Sandelowski & Julie Barroso. Living with end-stage renal disease is anchored in complexity, and to reach profound knowledge concerning the experiences of living with end-stage renal disease, we conducted this qualitative metasynthesis.

Kidney transplantation is a well-established treatment for end-stage renal disease. Simultaneously, kidney transplantations with a living donor are increasing in number. However, patients experience challenging existential aspects concerning kidney transplantation. Furthermore, some patients have the possibility to undergo transplantation with a living donor, while others may have to wait for a deceased donor for several years. As not all patients living with end-stage renal disease are eligible for a kidney transplantation, some patients will be in need of dialysis. This qualitative metasynthesis following Sandelowski and Barroso’s method, therefore investigates the existential experiences of living with end-stage renal diasease.

The key findings of the study show that living with end-stage renal disease challenges patients existentially; as the lives of patients consist of existential contradictions characterized by different types of oscillations. ‘Oscillation’ symbolises moving back and forth without getting anywhere, passing from one condition to another. Hereby, being in a state of oscillation is challenging for patients, and it highlights the existential characteristics of living with end-stage renal disease:

The findings in the qualitative metasynthesis show that technology plays a major part in the lives of patients living with end-stage renal disease. Time is an important issue. Besides, we found that dialysis treatment is an uncertain condition and a long-lasting reminder that life is time-limited. The metasynthesis contributes with new knowledge about how these oscillations are experienced by patients, and illustrates the need to move beyond providing only treatment by prioritizing the existential dimensions experienced by patients.

A New Perspective on Spiritual Care

The latest ANS featured article is titled “A New Perspective on Spiritual
Care: Collaborative Chaplaincy and Nursing Practice
” authored by DorAnne Donesky, PhD, ANP-BC, ACHPN; Emily Sprague, BSN, RN and Denah Joseph, MS, MFT, BCC. In this article the authors explore the domains of religion, spirituality, and culture as commonly conceptualized by chaplains and offer explanations of specialty-level chaplain interventions, primary spiritual interventions provided uniquely by nurses, and interventions that require the cooperation of both professions. Here is a message in which Dr. Donesky describes how this work evolved:

DorAnne Donesky and Denah Joseph

As a nursing professor fascinated by interprofessional education and practice, one day I had the opportunity to shadow palliative care chaplain Denah Joseph as she wen, t about her daily activities. I watched her provide hope and comfort to the patients and loved ones in each room using the language and rituals that were most familiar and reassuring to them. Her therapeutic interventions extended far beyond religious beliefs and addressed existential suffering, relational challenges, cultural misunderstandings, personal legacy and meaning, and psychosocial distress. Recognizing that spirituality is an important part of holistic nursing practice, I asked Denah how she thought we might share her clinical wisdom with the nursing community. In response, she shared with me a document where she listed spiritual interventions she was collecting and testing.

Emily Sprague

Meanwhile, an undergraduate nursing student contacted our graduate nursing school, asking if she might volunteer as a summer research assistant.  Emily Sprague attended a faith-based university and embraced the suggestion that we explore the application of Denah’s knowledge development to nursing practice. Together, Emily and I explored the best way to translate Denah’s knowledge and interventions, developed through the action/reflection methodology common to chaplaincy practice, for practical application to nursing practice.  We were surprised by the conflation of religion and spirituality in the nursing literature, and the recommendation by trusted advisors to focus on ethics rather than spirituality. These experiences reinforced our commitment to explore Denah’s interfaith spirituality interventions from a nursing perspective.

Given the ubiquity of the Religion, Spirituality, and Culture (RSC) model within interfaith chaplaincy practice, we decided to use the RSC model as a theoretical foundation for our paper (see figure in the article). We used exemplar stories based on composite patient experiences to illustrate the spiritual interventions that Denah had developed. Some of the interventions are appropriate for nurses to deliver as “primary spiritual care,” others are only appropriate for chaplains to deliver as “specialty spiritual care,” and we found that some complex spiritual interventions require nurses and chaplains to collaboratively contribute their expertise simultaneously (see table in the article).

The resulting paper has been embraced for interprofessional journal club conversations by nurses and chaplains who want to enhance their collaborative practice. It has been welcomed by chaplains who feel validated in their practice. And it provides a foundation for additional inquiry and interprofessional scholarship within the domains of primary and specialty spiritual care, and the intersection of nursing and chaplaincy collaborative practice.

Nursing in the Anthropocene

At this time of a global pandemic, the currently featured ANS article is especially relevant. In their article titled “We Have Never Been Nurses: Nursing in the Anthropocene, Undoing the Capitalocene,” Jessica Dillard-Wright, MA, MSN, RN, CNM; Jane Hopkins Walsh, MSN, PNP-BC, RN; and Brandon Blaine Brown, MSN, RN-BC, CNL advance a posthuman critique of the discipline and the future shape that is critical for the knowledge in the discipline.  You can download and read the article on the ANS website while it is featured.  The authors have prepared this short video in which they explain their perspective and why it is so important to understanding the experience of this pandemic, to the future of the earth, and to the development of nursing as a discipline.

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 (, 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.


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