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Posts tagged ‘Adeline Falk-Rafael’

Nursing Models for the Future: Acknowledging the Political Nature of Nursing

Adeline Falk-Rafael, PhD, RN, FAAN in her guest editorial for the current issue of ANS makes a strong case for nursing models that ground practice in our own disciplinary knowledge, and makes nursing work visible and credible.  Dr. Falk-Rafael serves as a member of the ANS Advisory Board, and is a renowned nurse author/scholar whose work focuses on critical caring and social justice. She has shared these reflections on the message conveyed in her guest editorial (available here):

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Adeline Falk-Rafael

I first learned to be a nurse in a hospital “training” program in the early 1960s. During that time, I learned what nursing was in relation to medicine – what nursing care was in the context of specific medical diagnoses and treatments. Likewise, the relatively minimal attention to health promotion focused almost entirely on disease prevention. A substantial amount of the content of many of the program’s courses was delivered in the form of a physician’s lecture. Ethics was medical ethics and taught by the hospital’s priest. The nursing scope of practice was defined by employers as largely an ancillary medical service that also had some usefulness as a supplementary housekeeping service (cleaning linen and utility rooms and carbolizing the beds of discharged patients were required duties) as well as providing cheap labor in the guise of an educational experience through rotations that including several weeks of making and sterilizing infant formulas and filling individual dietary requests through short-order cooking. Little wonder that as a Registered Nurse, I had difficulty articulating what nursing was, let alone what nurses knew!

While much has changed, thankfully, in the education of nurses, I do not find that nurses practicing at point of service are much more proficient today in clearly articulating the valuable and often unique contribution they make to the health and healing of patients and populations. Because most nurses continue to be employees in bureaucratic organizations and/or large corporate structures, their scope of practice typically remains heavily influenced by prevailing medical and business models.

Nurses are still, in the words of Susan Reverby1, “ordered to care in a society that refuses to value caring.” For this reason, I am a strong apologist for nursing models. I believe they have a strong potential to strengthen nurses’ sense of identity as professionals who make a complimentary but unique contribution to health and health care. As such, nursing models can be tools of empowerment by grounding nurses solidly in disciplinary knowledge and naming aspects of nursing work, thus giving nurses language and credibility to make their work more visible. Grand theories help shape our values and belief systems about what caring for human beings means. Mid-range and micro theories provide more focused approaches to the provision of care that can and must be tested through research and linked to patient/health outcomes. To be useful, nursing models must be seen to be relevant and useful to nurses at point-of-practice, for example, as “apps” that can provide a quick resource when needed. But nursing models of the future must also have a critical perspective. They must serve as tools of resistance by assisting nurses to examine and challenge the larger societal and political forces that advantage a few while disadvantaging many others, whether those others are patients or nurses.

1Reverby S. Ordered to Care: The Dilemma of American Nursing, 1850-1945. New York, NY: Cambridge University Press: 1987.

Historical Nursing Documents Archived by City of Toronto

This update has been provided by Adeline Falk-Rafael to follow-up on the ANS article titled “Towards Justice in Health.”An Exemplar of Speaking Truth to Power.

Our article “Towards Justice in Health: An exemplar of speaking truth to power” is an analysis of 6 issues of the magazine (TJH) produced by Nurses for Social Responsibility (NSR) in Toronto, Canada, between 1992 and 1995. The article reported that the request of the magazine’s editors for archival of the magazine in the Library and Archives Canada had been denied.

A few days ago, Cathy Crowe, one of the magazine’s editors, notified us that the City of Toronto Archives has accepted both the 6 issues of the magazine and the NSR’s newsletters which predated the magazine and were alluded to in the article but were not part of the analysis. As Cathy Crowe noted, they will now be available “to aid and inspire future nurse and academic researchers on nursing and social justice.”

The vision and courage of these remarkable nurses for social responsibility is evident in some of the topics they wrote about and in which they actively sought change between 1985 and 1995. Their newsletter s and, in the later years, their magazine, covered many contentious issues that impacted health, including the environment, the sale of arms and war itself, women’s reproductive rights, health care policy, trade agreements, lesbian nurses, and needle-exchange programs, as well as issues that affected nurses in the workplace, such as working conditions and staffing mix. As we said in the article, they were exemplars in speaking truth to power and it is fortunate that the newsletters and magazines will now be available for aspiring historians and activists.

The images below of the newsletter and the magazine provide examples of the amazing topics that were addressed in this publication! Their placement in the City of Toronto archives provides a valuable resource and inspiration for nursing’s continuing social justice commitment.  For more information about Dr. Falk-Rafael’s and Dr. Bradley’s analysis of these important historical publications, see their blog message published here in August 2014.



Towards Justice in Health

Our current featured article is by one of nursing’s prominent scholars advocating for social justice in nursing and health care – Adeline Falk-Rafael, PhD, RN, FAAN.  For this article, she and her colleague Patricia A Bradley, PhD, MEd,RN report a critical contextual analysis of 6 issues of a magazine published by “Nurses for Social Responsibility” between 1992 and 1995.  In the article, titled “Towards Justice in Health.”An Exemplar of Speaking Truth to Power, Drs. Falk-Rafael and Bradley bear witness to a voice that has been largely absent in the nursing literature, as well as providing evidence of a significant grassroots effort to seek social justice in nursing and health care.  Visit the ANS web site today to download your no-cost copy of this article, and return here to add your comments, questions and responses to their article!

Dr. Falk-Rafael and Dr. Bradley have shared their perspectives on this work, and have also invited two of the nurses responsible for the magazine to also speak here to ANS readers! 

From Adeline Falk-Rafael:

I had become aware of a group of nurses calling themselves the Nurses for Social Responsibility (NSR) in Toronto, Ontario in the mid-1990s while working on my doctoral dissertation. I had known some of the nurses both professionally and by reputation as their

Adeline Falk=Rafael

Adeline Falk=Rafael

advocacy activities for homeless persons often were reported in the media. Both Cathy Crowe

and Kathy Hardill have been guest speakers in my community health nursing course at York University and on one occasion several years ago, Cathy shared the 6 issues of the magazine this group had produced in the early 1990s, Toward Justice in Health (TJH). Her hope and mine was that they would serve as the focus for a textual or content analysis as a graduate student project. Although I was never able to interest a graduate student in this research, the opportunity finally presented itself for me to begin such an analysis. As I began the process, I realized that I needed a colleague with expertise first in selecting the most appropriate methodology for such a textual analysis and secondly in conducting the analysis. I am so grateful that Pat Bradley agreed to work on this project with me.

From the initial reading of the magazines, through the analysis and writing of the findings, I never cease to be amazed at the foresight and courage that a small group of nurses with a passion for social justice of which Florence Nightingale, Lillian Wald, Lavinia Dock, and other early nursing leaders would be proud. My hope is that this effort to make visible their efforts will inspire others similarly to advocate for transformative societal changes and reverse social injustices that result from public policies and social norms that privilege a few and disenfranchise so many.

From Patricia Bradley

I was not living in Ontario during the mid-1990s and was not aware of the Nurses for Social Responsibility (NSR). I was introduced to their history when Adeline Falk-Rafael graciously

Patricia Bradley

Patricia Bradley

invited me to be part of the analysis of the magazines. Through the process, and meaningful dialogue with Adeline, there was an opportunity to uncover the power and strength that resided in these nurses and to reveal the subsequent realm of possibilities when nurses gather together for a cause. The journey towards change is not always easy or easy to maintain. I wonder how many other silent nursing histories exist and what they can teach us about change and the momentum of change for social justice. These invisible nursing histories need to be brought into the light so we can all learn and be inspired.


We’ve invited 2 of the original founders of TJH –Cathy Crowe and Kathy Hardill – to reflect on their experiences more than 20 years ago and add their recollections of the challenges and successes of producing TJH:

From Cathy Crowe  

I’m so proud that a period of Canadian nursing feminism and activism is now recorded for

Cathy Crowe

Cathy Crowe

future generations to learn from. At the time, It seemed incongruous to have ‘peace, shelter, social justice, etc. as prerequisites for health’ drilled into us in nursing school (Ottawa Charter for Health Promotion, the Alma-Ata Declaration), while at the same time the same schools neglected to teach even a basic Economics 101 or Politics 101 to teach about the role globalization or militarization play in diverting resources away from healthy public policies such as daycare, affordable housing or decent welfare rates. I can only call it intentional neglect. So at NSR we taught ourselves, the whole while sharing our learnings with the public and other nurses in some of the most creative means I have ever seen.

"Justice In Health" (white cover)

“Justice In Health” (white cover)

This is a picture I took of our magazine on display with other prominent feminist publications in the window of the  ‘This Ain’t the Rosedale Library’ bookstore in Toronto.

From Kathy Hardill

Reading the analysis of “Towards Justice in Health” brought me back to a time that was “heady” with promise and potential for nurse activism. It was a tumultuous time on the planet

Kathy Hardill

Kathy Hardill

and, looking back, so much has changed. I find myself having to explain the nuclear arms race to younger people, not to mention the Cold War and the Berlin wall. I was recently reminded of a meeting I and others attended with representatives from the Registered Nurses Association of Ontario (RNAO) in about 1990 where we argued that organized nursing ought to speak out about homelessness. The nurses across the table from us blinked a few times and said “But what has homelessness got to do with nursing?”

For sure, times have changed! RNAO understands homelessness and many other upstream issues and has become outspoken on these issues within the parameters of its role. Although the language of TJH may at times have been “provocative, strident, and outrageous,” when I listen for the voices of progressive, radical nurses now, I strain to hear anything at all. The most progressive anti-poverty health care voices in Ontario at the moment are from medicine. Progressive nursing needs a radical rebirth in the 21st century!

Critical Caring Model update!

One of the best things about having a blog for ANS is the ability to update content along the way!  Adeline Falk-Rafael has provided an update on the model that she and Claire Betker used as the basis for their research reported in the article titled “The Primacy of Relationships: A Study of Public Health Nursing Practice from a Critical Caring Perspective.”  (See the recent blog post about this article).  Dr. Falk-Rafael explains this new depiction as follows:

This model of Critical Caring theory represents more of an evolution in the graphic depiction of the model than in the theory itself.  The color and artwork better depict the metaphor of the tree and are more suitable for the web than the previous black-and-white diagram and results, hopefully, in more legible text.  As in the previous model (published in ANS 35:4), the trunk of the tree, which supports the praxis branches, is comprised of the tenet of Critical Caring as a way of being, knowing, and choosing, along with 2 carative health promoting processes.  The shading  and positioning of each is helpful both in differentiating the carative processes from the tenet and in emphasizing the centrality of the latter.

I believe this model brings the elements of critical caring into focus, and helps to comprehend the whole of the process that the model represents.  Many thanks to Dr. Falk-Rafael for providing this update!

critical caring-DRAFT3

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