Sociopolitical Knowing: Connecting with hearts, minds, guts, and groins

[Edited 8/6/16] At a time when many are celebrating the official nomination of Hillary Rodham Clinton I am also acutely aware that many are not. While there are many valid concerns that have been raised, what troubles me most is to hear the contempt and disbelief that anyone could support Trump. It concerns me because it reflects a de-humanizing and de-valuing of many in the white working class.

We expect that our students and coworkers will be sensitive to the values and personal goals our patients and their families. We expect nurses to be non-judgemental towards patients who are living in poverty, suffering from addictions, or making decisions that do not seem based in upper-middle class norms and values. Can we also expect nurses to develop an understanding of how to be respectful and understand what is important to people with different political views. 

Sociopolitical Knowing is a core strength of professional nursing. Conceptualized by Jill White in 1995, sociopolitical knowing occurs on two levels:

1) the sociopolitical context of the persons (nurse and patient), and 2) the sociopolitical context of nursing as a practice profession, including both society’s understanding of nursing and nursing’s understanding of society and its politics. [emphasis added]

To start the dialogue, I am circling back to the Spiral Dynamics model that was used to organize the sociopolitical context of nursing in the published Results from the Nurse Manifest 2003 Study: Nurses’ Perspectives on Nursing.


Basics principles of leadership and motivation according to Spiral Dynamics:

  1. identify the specific needs and capacities of individuals and groups, and
  2. calibrate the precise developmental messages that fit each unique situation.

Sociopolitical knowing requires an understanding of how to connect with and motivate people where they are. It means developing an understanding of what messages will be most effective in “pushing someone’s buttons” or eliciting a strong emotional response. The table below highlights the most prevalent value memes in modern society – defined through worldview, core values, and value-based reasons for violence and war. 

spiral dynamics.JPG

How Trump connects: From sexual innuendos and vulgar speech to stoking conspiracy theories and racist viewpoints, Trump often makes his connection with people’s minds, guts, and testicles. He has effectively tapped into pent-up frustrations and fears, justifying aggression and intolerance to make America “great again” (red and orange) and “safe again” (blue and green). 

How Clinton connects: From It Takes a Village to Hard Choices, Clinton has a long history of speaking to people’s hearts, minds, and ovaries. She has effectively tapped into national pride and hope, focusing on accomplishments that make America “great right now” (red and orange) and safer through unity and tolerance (blue and green). 

Both campaigns employ messaging that is strategically targeted at different audiences. The point of this blog entry was not to start a political debate — this is not the place for that. Rather, I am hoping to start a conversation about understanding how we might apply sociopolitical knowing to strengthen our ability to communicate with others. I hope that through application of sociopolitical knowing we can better connect with different communities about the work of nursing, and issues that impact the patient populations and communities we serve.

Please help build the dialogue around sociopolitical knowing, through comments here, and conversations with your coworkers, family, and friends. 

References for further reading:

Beck, D. E. Human Capacities in the Integral Age: How Value Systems Shape Organizational Productivity, National Prosperity and Global Transformation

Charen, M. What Hillbilly Elegy Reveals About Trump and America: A harrowing portrait of the plight of the white working class. National Review, July 28, 2016.

Harryman, W. Is Hillary Clinton the First Integral Politician? Integral Options Cafe, November 6, 2005.

Jarrín, O. F. Results from the Nurse Manifest 2003 Study: Nurses’ Perspectives on Nursing. Advances in Nursing Science, 29(2), E74-E85.

Pew Research Center. Few Clinton, Trump Supporters Have Close Friends on the Other Side. August 3, 2016.

Schwartzbach, S. M. Drowned: Nurses Under Water. The Nurse Sonja. July 27, 2016.

Vance, J. D. Hillbilly Elegy: A Memoir of a Family and Culture in Crisis. 2016; HarperCollins: New York, NY. 

White, J. Patterns of knowing: review, critique, and update. ANS Adv Nurs Sci. 1995 Jun;17(4):73-86.

Six degrees of separation

Six-degrees-of-separation-model-Credit-WikipediaThe first news updates I received about the mass shooting at the Orlando nightclub Pulse came Sunday morning from a Catholic priest who is well connected to the communities of many of the victims. He put words to the intense emotions and outrage against terrorism, fundamentalist religions, and bigotry — as well as an outpouring of sorrow, love, and support for the victims and their families. In the hours that followed no less than a dozen people I know shared that they had been to the nightclub Pulse, or knew someone who was injured or killed during the shooting. This means that virtually everyone I know is, at most, 2 or 3 degrees of separation from the event. We are all connected, and this is highlighted when a mass-casualty event occurs in our own country or social network community. Having close network ties to victims and bystanders heightens our awareness of how interconnected we are to issues that we otherwise might not think about — in a different way than cumulative events like the 283 murders in the City of Chicago over the past 6 months.

What are the most important health problems in your neighborhood? What are people in your neighborhood most likely to die from? These were the questions I asked the inaugural classes of students at Hartford Public High School’s Nursing Academy eight years ago, during their summer orientation. The answers given by 14-year-olds were chilling – with gang violence, drugs, and AIDS ranked as the most important issues and leading causes of death.

During the first weeks of the school year we reflected back to the students their perceptions of health issues in their neighborhoods, while reviewing or introducing core concepts in math, statistics, epidemiology, and social network analysis. Together we explored data from the health department for their neighborhoods, city, and state to understand the top 10 causes of death, and why heart disease was at the top of every list. But it wasn’t all about the numbers.

Community violence prevention educators and gang mediators were engaged in the school, in addition to their work on the streets and through local media. We also introduced the students to basic social network analysis and the importance of their own social networks for their future career opportunities. We took time to talk about the concept of 6 degrees of separation, and how they were (at most) 5 degrees away from popular rap artist Wyclef Jean. They were curious to know how… and happy to watch his video The Ghosts of Soleil   The year before, Wycelf Jean had enlisted Cité Soleil gang leader Ti Blanc to participate in a music video project, and not long before that a nurse colleague of mine working in Haiti shared a letter (written by a physician priest that she worked with), describing the complex relationship between the delivery of health care and negotiating with gangs. After obtaining permission to share the letter, a local spoken word artist recorded the piece as a CD, to accompany the written letter (below).

Among the multiple layers of meaning, I hope that you will find some comfort and inspiration in the words of Father Rick Frechette, written 10 years ago.

Keeping Sabbath (A Summer Chronicle)

When June rolled around a few months ago, was I ever ready for it. I was so eager to have the saddle off my back for a while. I was absolutely going to drive my schedule down. June brought the feeling of old school days: waiting for the last bell to ring with its promise of three months of rest and fun. The promise was so real this year I could smell it- in the fresh coffee I would sip as I watched sunrise each morning, and in the scent of the red hibiscus lining the lane behind our hospital, where I would take a leisurely walk in first light. The months go fast. The years even faster. Already it would normally be time to answer the school bell again, with an essay, “What I did on my summer’s vacation.” At least for me, this was not a vacation but a string of Sabbaths. Not the “leave your bull in the pit until Monday” kind of Sabbath, but the kind where you help the paralytic pick up the mat and walk. My essay would be, “How I did my best to keep summer Sabbath.”

We had enjoyed four months of relative calm in Haiti, from February to June. The election of Preval had given a respite of hope. Ironically, in this period of calm and free from daily emergencies, we had our attention drawn again, shockingly, to the depth of the poverty that surrounds us. You don’t notice it as much when you are running to and from emergencies. Summertime would have a lot of difficult challenges in store for us, and would jolt us away from our poverty stare- and certainly had no idea of allowing us to rest.

Feast of Mary Magdalene

June saw a return to violence and to kidnapping. It was time once again to be aware of red zones, to be hyper-vigilant, to have at least one companion when on the road. Still with all of this they tried to kidnap our medical director right off our hospital doorstep at high noon. And when they didn’t manage to get her, they set her car on fire.

One day kidnappers took the whole airport road by storm. The chaos and frenzy had cars jumping curbsides, truck drivers jumping out of moving trucks, cars driving on the wrong side of the street and flipped upside down. The shooting was with heavy artillery. I know- I was there. We were helping the wounded.  A number of people died and a lot of people were kidnapped. There were two events that burned themselves into my memory that day, aside from the shock of seeing the airport road like a car cemetery. There was a family of three kidnapped, in front of the long-closed “Red Planet Market.” The father fought with the kidnappers, and was shot dead in front if his wife and young daughter and was lying on the road. The wife and daughter, numb with shock, were kidnapped. When Ti Blanc, the local “boss”, heard what had happened, he brought the mother and child out of kidnapping and to the main road where they could get away.

Then we had a phone call from some friends deeper inside the slum. There were two gunshot people badly hurt, but no one could reach them for the gunfire. I drove our truck near the entrance to the area, but it was obvious we could not go in. There was too much shooting.  So I thought we would sit and wait and think of what to do. Maybe they could bring the wounded to us in wheelbarrows. Suddenly, a truck full of heavily armed men, all in black, drove up to the intersection from inside the slum. They shot heavy artillery into the air. They were dressed like the special police force, but it was easy to see they were frauds. How? Because the special police eat well, and are strong from body building. These men were so thin, their clothes were hanging off of them. They were “chimeres” (ghosts) from the slums. I thought the were waging yet another attack, but Raphael understood at once that they were clearing the way for us to go in to get the wounded, which we did. I had never seen the like. We stabilized the wounded and raced them to the surgeons of Doctors Without Borders.

Seventeenth Sunday of Ordinary Time: Loaves and Fishes Multiplied

As usual, I started getting calls from people who had friends or family disappear into the hands of kidnappers. I write their names, their car license plate numbers, on small scraps of paper, and then make calls to people who scour the slums for a trace of them.

One was a missionary priest from El Salvador. One was a driver for an organization that provides food for poor children, called BND (Bureau of Nutrition and Development). I was able to find them but it was nearly impossible for me to get them free. I was doing my best but getting nowhere. For one thing, the gangs were getting tired of me making them lose money. Also, they were more arrogant now than they were four months ago. Before Preval became President, they were insecure with the interim government that opposed them. Also, at that time, the UN was a higher authority than the non-elected interim government, and the gangs were a bit more leery of them. Now, “their man” Preval was President, and as the legitimately elected leader, he had the upper hand over the UN. The gangs were arrogant and cocky. I decided to give up.

The next morning a few of us were talking and lamenting these changes that had weakened our hand in the slums. And of course the phone calls continued. We decided we could not give up. We even had the idea of borrowing a UN army tank and driving it ourselves to the kidnapped holding place and freeing the people. (I can still see the look of absolute disbelief on the face of the bishop when I suggested this idea to him.)  In the end, I decided to go to Cite Soleil myself and stay there until I got them out.

I was there until eleven o’clock at night, through black-outs and thunderstorms. I was able to force their hand for the liberation of Fr Cesar. I was brought to a dark alley to identify him before we brokered for his exchange. It was dark and he was far off, and I don’t see at a distance well without my glasses, which I did not have with me. So I wanted to get out and walk to his car to identify him, but I was not allowed. (Maybe they were afraid if it was not Fr Cesar, I would also want to free whoever it was!) When I protested that I could not see him, the kidnappers disappeared for a while and came back with a dozen pair of eyeglasses. (The took the glasses from everyone in the kidnapped holding place who wore them, and had me try them on, one after another, until I could see well enough to identify Fr Cesar.)

Then the price tag was mentioned.

What price? I don’t pay anything. There was bickering. They explained they had to pay the one who did the kidnapping, the motorcyclist who brought them at gunpoint into the slum, the owner of the house where they were holed up, the one who made them food everyday, the ones who made sure they didn’t run away, etc. This was a business.

No way would I pay! at least not what they were asking.

I went back to see one of the gang leaders I know in Cite Soleil, and asked him to call that other gang and badger them down, which he did. It did not make him popular with the other gang. It did not make me popular with either gang. But finally a modest sum was accepted. But then I had another problem. I did not have that money, nor could I get it at that late hour. So I asked the gang to loan me the money (which they did). I also asked them to come with me to get the priest, since it was very late and that other gang was surely angry with me, (which they did). And while I was at it, I told them I was nearly out of gas and asked them to fill by tank (which they did). So I was in the unusual situation of having a gang fill my tank, drive me to free Fr Cesar, and pay the ransom! And that was how we were able to liberate Fr Cesar and the seminarian who was kidnapped with him. (By the way, they had offered to give me the seminarian earlier, during the eyeglass incident, as a gesture of good faith. To my great admiration, the seminarian refused his freedom if Fr Cesar was not also being released.)

Fr Cesar was very disturbed, even shocked, as I lead him out of Cite Soleil and to the road of his freedom. I remember saying to him, “I know this was hard and ugly. But all of life is like this in one way or another: some people try to enslave and degrade you, and others try to lift you up and set you free. You are free by the grace of God. Don’t stay a slave in your mind.”

I went back again into the dark slums, kerosene lamps lining the alleys, for the driver of the food program. He was easy to get at this point. The gangs wanted me out. It was late and they had also had it for one day.  I was able to leave with him. But I had to go back the next day to get his car.

Within three days, the director of the food program contacted me. His name is Rob Padberg, and he is also the honorary consul for the Netherlands in Haiti. He and the BND organization wanted to help the poor children in my programs and schools. Suddenly, we had 2500 meals a day for our summer programs, and a guarantee of 1600 meals a day for our schools for the new school year. And the promise of a water truck so we could resume water deliveries to the poor of Cite Soleil. We were astounded at how misfortune had produced food for so many hungry children. It’s an ill wind that doesn’t blow some good.

Feast of the Transfiguration

The summer was marked by frequent phone calls and travel, related to the sickness and death of the founder of our works for children in Haiti, Fr. Bill Wasson. He was the founder not only of our projects but of those in eight other countries. For fifty-four years he had worked tirelessly to establish homes for orphaned and abandoned children. As he diminished and weakened with age and sickness, he was given special graces evident to us all. Lifelong restlessness and driven-ness gave way to peace. He was very patient with his sufferings, which were enormous. (he was not able to eat anything or take a sip of water for the last two months of his life, and could not walk at all- in fact, he could hardly move.) He was not afraid to die, but put himself confidently in God’s hands. God gave him time to prepare for death. Many visits with cherished friends, short but strong conversations, occasional Mass at the bedside, followed occasionally by sing-a-longs and jokes. And always there was a blessing given.

For us it was also not easy. It was clear we were losing a longtime friend and a strong spirit and force for our life and work. We were trying to apply his living will to the delicate and changing issues of his health. It was clear to us immediately that the living will (advanced directive as to what to do in case of devastating illness) is not a cookie cutter. It was very much a dynamic involvement that was not without agony. But in the end, Fr Bill died a holy death: he was ready, he was reconciled, he was not afraid, he trusted in God, he was patient, he was kind, he gave blessings. His whole life had prepared him for his moment of death, when he was, as St Paul says, transformed at the twinkling of an eye, and given a body of light.

Feast of the Assumption

The unbelievable had happened. Sister Abha was shot. This was really surpassing all limits, that one of Mother Teresa’s sisters would be shot. How could they do this. The Sisters live with the poor, they live poorly themselves, they care for the worse of the poor. Especially Sister Abha, who opened their mission in Haiti, with Mother Teresa herself, twenty-eight years ago. She has worked tirelessness in Haiti for all these years. To add salt to the wound, the shooting was ordered and paid for by a young man she had

taken off the streets and raised from the time he was a small child. Fortunately, she had pushed the arm of the thief as he fired, and the bullet pulverized one of the bones of her forearm rather than piercing her chest. We were able to get her to Florida right away for surgery. Thank God for cell phones. Thank God even more for friends like Dr Keith Hussey. I called Sister a few days after her surgery and asked if she would return to Haiti. She told me that God’s goodness to her, especially following the shooting, obliged her to continue to care for the poor of Haiti wholeheartedly. “Besides, we will all die one day anyway. It does not matter how or when or where. It only matters how we have lived.”

As we were organizing for Sister’s emergency care, the phone kept ringing about other kidnapped people and other people shot in areas of conflict. We were back at the Red Planet Market again. This time the special police force was there. I told them I had to go into the slum for an old man who was shot in the abdomen and a young girl shot through the thigh. They told me they could not give me cover. I told them I didn’t need cover.

They told me I would be killed if I went in. I told them I knew I would not be killed. They asked me why, was I a gangster too? Was I a friend of gangsters? Was I aiding and abetting gangsters? I told them I am a doctor and a priest, and unless they themselves shot me, I knew I would not be shot.

Four of us went in with two stretchers. Eight of us came out. (Aside from the two wounded, two young men offered to help carry the stretchers out.) Not a shot was fired by anyone from the minute we set foot into the slum until we left. When we came out unharmed, the special police gave us a full scale scathing and search.  They were sure we were criminals. We had to be, if we could circulate freely in the slum. They especially searched the two young men that helped us. The police took the pants off of these two to see if they had on women’s underwear. Unfortunately, one of them did. It is a sign of being in a gang. When you hide your gun between your pants and your hip, the extra elastic in women’s underwear holds the gun firmly, especially when you run. Wanting to give the benefit of the doubt, I was assuming that this young man must have gone to the wrong close-line when he got up and dressed before dawn.  I don’t know how it ended for this “Good Samaritan with a lot of explaining to do.” We had to rush the wounded, once more, to the emergency room of Doctors Without Borders.

The next day was my birthday. I worked hard all day caring for the destitute sick at the poorhouse of the Brothers. We rushed to finish early as we were going to play tennis as a foursome in the afternoon. Literally as we began our match, the darn cell phone rang again. It was Sister Marthe. She was frantic. Their jeep, driver, another worker and four of their psychotic patients that were heading to a doctor were kidnapped. I looked at my tennis racket and I heard myself say, “Now, now, Sister. I am sure they will be alright!” I really wanted to play tennis.

Cyrprien, the driver, had a cell phone. Since we have never been able to release kidnapped people immediately anyway, we decided to play out our set, calling the kidnappers on Cyrpriens cell phone whenever the serve changed. On my serve, I was often still on the phone and had to toss and serve with one hand as I roared into the phone. The conversations were complicated by the fact that the kidnappers did not know how to deal with four off-the-wall kidnapees. This was absolutely no way to play tennis. Of course, we lost.

By the time we had finished playing, we had put pressure on these kidnappers through the Cite Soleil gangs. These kidnappers were outside of Port Au Prince, in Croix-de-Bouquet. We had finally settled on a moderate sum. Raphael went to finish the arrangement. He called me an hour later. The deal was off. They insisted on a huge payoff. I could not understand what had happened. I went to the convent. It was already dark. No more phone contact was possible with the thugs. So five sisters and five of my teammates headed to the area. We knew more or less where they were and we would count on God to help us find them.

When we arrive in the dark and deserted place, we found a dead man on the road, head smashed by rocks and arms tied behind him. Not much further up the road was another.

We could not figure this out.

A gang of people appeared out of the dark. They told us they are against kidnapping and killed the people who had kidnapped Cyprien and company. There were their bodies on the road. They gave us Cyprien and Evelyn. The four psychotic patients were at another place and they would give them over the next day. What had happened? The gang leader got nervous by our involvement. He decided to change his spots, and pretend he was a rescuer, not a kidnapper. He killed his first assistant (the one who had agreed to the small payoff by phone.) Then he killed his second assistant (the one who demanded enormous pay). He was trying to save himself by lying, and betraying and murdering his own team. We have seen so many times, always dramatically, how those who serve darkness are devoured by it.

The next morning, as we celebrated the mass in honor of the Assumption of the body of Mary into heaven, the contrast was painfully clear. We are precious to God: heart, mind, body, and soul. Even our bodies are meant by God to be exalted and raised into splendor forever, as was Mary’s body. On the other hand, here was the fate of the one who served and was betrayed by darkness: he lay on a deserted road, with bloody and smashed skull and arms bound in slavery to sin, covered with ants, in disgrace. The reign of darkness degrades and destroys, the reign of light exalts and dignifies.

The Beheading of John the Baptist

The end of August brought no quiet. The kidnapping of Jonas (who was raised in our orphanage) and his companion, the kidnapping of the Dutch Father Wim Baksebelt and two companions, the shooting of Ronsard Fanfan.  Each is quite a story. The story of Fr. Wim is kind of a reverse kidnapping, I was already in the slums calling around and looking around for a man named Lucarne Caret and for a man from New York named Edouard Antoine. I could never find Antoine because no one had information about his car. You need to know the vehicle someone was kidnapped in, in order to find the person. Since he is Haitian American from New York, visiting Haiti with no contacts in Haiti, kidnappers used his cell to demand money from his family in New York. The New York family sought help from a local priest who knew me, and that’s how I got involved. The family in New York had no information about the car. So we never got him out, and the family in New York was required to pay, probably via Western Union.

I was able to get Lucarne out after 15 days of kidnapping (it took me three days). I paid a very little bit of money, but even that I had to borrow again from the gang. After releasing him, the gang learned that Lucarne was an Arisitde protestor, and regretted they had loaned me to money to release him! Jonas was liberated after a day and a half. I had to do it myself. When I got him free he was surprised to see me there among the bandits. He even asked me, “ak fe ou kap la!” (what makes you able to be in this place?) I think he thought it was me that had kidnapped him!

It was while I was working on releasing the above people that I came across the case of Fr Wim. He has been 35 years in Haiti. In fact, the gang called ME and asked to come and get him. Fr Wim had put up such a resistance, it was incredible. He fought full stop, Imagine a small, white haired, 65 year old priest, boxing with the kidnappers. They did not know how to deal with him. Even when I had him safely in the truck, he was still eager to fight. He told me all the things they stole. I demanded everything back and got most of it- in particular, a gold cross his mother gave him when he was 25 years a priest. When the local “boss,” whose name is Yoyo Piment, brought the cross, Fr Wim took another full swing at him. I admired his resistance, but he didn’t know when to quit.

The case of Fanfan is extraordinary. He is a customs broker for us. He has gotten all the containers from Italy out of customs for us- all the equipment for our new hospital. Now we needed him to get out a few containers from Costa Rica, for our electrical installation at our new hospital. He had all the containers out but one. We were in hurry for the last one, since we already have 14 Costa Ricans on site, from the company, to do the electrical installation. A week ago, Fanfan borrowed a car to do this. He was kidnapped, along with the borrowed car. Twelve men who had one gun took him, they shot the gun into the air a number of times to scare him and force him out of the car. When he was out they shot in the air again, but ran out of bullets. Fanfan is a marathon runner and, realizing there was only one gun with no more bullets, he knew he could outrun the twelve, so he ran.

He ran nearly two miles, trying to reach a UN base at an intersection along National Road. The gang, who could not catch him, used the cell phone to call a gang further up the road to stop him. As he neared the UN, the other gang appeared out of the scrub lands and shot at him. He was hit in the jaw, his mandible was shattered, the bullet lodged in his throat. He kept running. He collapsed when he reached the UN, and they raced him to a hospital where immediate surgery saved him. We are not sure the surgery is right, in fact we are trying to get him to USA for reevaluation and surgery again if we can, but it did save him. From his recovery bed, with wired jaw and frequent need to spit bloody sputum, he used his cell phone and managed to get our last container out of customs. This is the stuff so many people in Haiti are made of.

A dialogue with Fanfan showed me something that I rarely have time to think about. We see the bullet wounds, the black and blue marks and bruises, but we never can see the damage the kidnapping and violence does to someone inside. To be the victim of violence, to be enslaved, to have your life in the hands of someone else, to be bartered for. It is sobering and sad to think of the depth of the wounds inflicted by violence, criminality and kidnapping. Fanfan told me he wakes up at night, scared and sweating, as he relives what happened to him. I reinforced the idea with him that when things that hit us hard in life, we have to see them again and again because they take time to really enter in and be integrated. But it is equally important to deliberately put a counterbalance. When he wakes up and relives the horror, he should also deliberately relive the blessings: his wise assessment of the situation that made him run, the strong legs and good health that delivered him to UN, the fact that UN raced to help him, the speed and skill of the surgeons, and the visits of friends like us and others who offer solidarity and will pay his hospital bill for him (which is otherwise an enormous burden.) If we don’t counterbalance our blows, we will become closed and cynical about life. Then we are really kidnapped and enslaved, inside where no one can get us.

The Birth of Mary

The birth of Mary is a concrete sign that the one who will save us is on the way. In fact, Mary is the way. The first light of dawn, called aurora, is the first sign that the sun is on the way. The feast of the birth of Mary, and the first rays of aurora, both promise that something wonderful will soon mark our journey. We just need to wait, and to prepare.

Most sin is the perversion of something good. Hatred is a perversion of love. Jealousy is a perversion of appreciation of differences. Revenge is a perversion of justice. That is why there is hope for a sinner. The basic stuff for something very right is still there, it has just gone very wrong. But it is still there and can be reworked with God’s grace. In the end everything comes down to this: when the heart is perverted there is suffering and death. When the heart is healthy and free there is life, even forever. But how to rework the heart!

Gangs are perversions of families. It is evident that gangs give a feeling of belonging and a feeling of power, to the lost and disconnected and powerless. Many of the people that I know in gangs can be led to do the right thing, even at financial loss. What is right in their hearts needs to be recovered. This is hard to do when bitterness and vengeance have built up over the many unspeakable assaults and crimes. Archbishop Desmond Tutu is leading the national reconciliation of South Africa based on this idea. We need to stop, to forgive, and to recover the best of the human heart in everyone.

When I spoke with the five main gang leaders over the past weeks, asking what they thought about Preval’s statement that he would kill any bandits that did not disarm, their answer was surprising. They said they agree, Preval should kill the bandits.

They do not see themselves as bandits, but as revolutionaries, trying to better the life of the poor.

Maybe good people always underestimate their goodness, and bad people always underestimate their badness. In the end, everyone has a good measure of both, and we all need ongoing redemption through our lifelong journey with the living God.

Ghandi’s nonviolent way to change the world was born a hundred years ago today. Terrorists attacked the United States five years ago today, and do so around the world daily. The idea of God gives rise to both good and brutal forces. Tomorrow is once again slated for disarmament in the slums of Haiti. Let’s pray it is a dream that comes true.

Then I can return to being a priest and physician, and abandon my stint as kidnapper-whisperer.

Fr Rick Frechette CP

September 11, 2006




Call to Action for 2016 NurseManifest Study: Request for Co-Creators


a quote from The Lorax by Dr. Seuss

You are invited to comment, collaborate, and co-create a global NurseManifest research project, to be carried out later this year.

Previously in 2002 and 2003 we asked nurses what it was like to practice nursing, and what changes they envision to create the conditions for ideal practice, using emancipatory methods.

For 2016 I propose we explore the topic of excellence in nursing care, from the perspective of patients and caregivers, using Appreciative Inquiry.

With a blog readership of over 7,500 people, we now have the capacity to carry out the international study envisioned by the NurseManifest Project founders over a decade ago, and make a global impact through our collective action.

Some critical questions we might ask include:

  • What is like to be the recipient of excellent nursing care?
  • What specifically about your nursing care experience made it excellent?
  • How would healthcare be different if every nursing interaction was excellent?
  • What would it take to create a healthcare system where excellent nursing care is the norm?

Some opportunities to participate include:

  • Host a conversation group with patients and family members who have received care from a single health care organization or network of providers.
  • Host a conversation group with patients and family members who have received care related to a specific condition or life event.
  • Host a conversation with a community group, with co-workers, or even with your own family.

Some ideas for dissemination:

  • Present at national and international conferences in 2017
  • Develop a series of manuscripts for peer-reviewed journals
  • Turn the findings into a book
  • Use the findings to inform a public service campaign about nursing and policies impacting nurses

Please add your ideas in the comments section below this blog entry or write to Olga Jarrín at by June 1, 2016 – in time to have a shared protocol and IRB approval in place for interviews and focus groups to begin in September, 2016.

For more information about Appreciative Inquiry see the website: Appreciative Inquiry Commons. Case Western Reserve University, Weatherhead School of Management. April 18, 2016. *Note: This repository of information Includes Appreciative Inquiry resource materials in 22 languages.



Lessons from the history of nursing… Who was Concepción Arenal?


I recently returned from a conference in Spain about the economic value of nursing where I spoke about many promising international models of community nursing, including some that were not so new. What sparked the most conversation later was the final image of my presentation with the words of the Spanish feminist writer and activist Concepción Arenal: How many centuries will it take for reason to arrive at the conclusion on [social] justice that the heart instantly understands.

Surprisingly little has been written in English about this remarkable woman, whose work in social reform and the development of nursing was simultaneous with, and comparable to, that of Florence Nightingale. Born in 1820 (the same year as Nightingale), she was the first woman to attend a university in Spain (auditing law school classes dressed in men’s clothing). An early and influential advocate for women’s rights, she wrote extensively about issues affecting marginalized populations including those living in poverty and in jails.

I am just beginning to read Arenal’s original writings in Spanish, and am struck by the parallels between her writing and current conversations in nursing about social justice and cultural humility. For example, her manual for visiting (nursing) the poor begins with the philosophical questions: What is pain? (Ch. 1), What are we? (Ch. 2), and What is poverty? (Ch. 3)  Before moving on to the central chapters on the theory and practice of visiting (nursing) the poor and how to approach and handle different situations with humility, respect, and empathy, while empowering the poor to improve their condition and lives. The book ends with chapters on the importance of having respect for the pain [of the poor] (Ch. 14), and the spirit of the sick (Ch. 15).

Please join me in reading and reflecting (here in the comments on this NurseManifest blog) on the writings of Concepción Arenal. We hope to build connections with colleagues in Spanish speaking countries and bilingual academic settings around the world. Looking forward to learning more about your thoughts inspired by Arenal’s writings (comments welcome in English or Spanish).

Un cordial saludo,


P.S. Please also reach out if you are interested in working on a Spanish version of the NurseManifest Manifesto.

References and Further reading:

  1. Josep Bernabeu Mestre – Encarna Gascón Pérez (Univ Alicante). Historia de la Enfermería de Salud Pública en España (1860-1977). [The History of Public Health Nursing in Spain] Capitulo 2. Full text pdf (162 pages)
  2. Miguel de Cervantes Virtual Library Collection for Concepción Arenal, including her collected works in digital format

Direct links to a few of Arenal’s books that I’ll be reading and would love to discuss with others:

We Need More Nurses: Working Together

Filmed nearly 40 years ago, the “Politics of Caring” film provides history of the grassroots support groups and activities that we continue to build on. One of my favorite parts of the film is about 5 minutes in, when a group of nurses are discussing their frustration with hospital working conditions: “We don’t have enough staff, we don’t have enough time…” They talk about wanting to improve their working conditions, by moving to a different hospital, or unit, or leaving the hospital to work in the community described as “mecca”.

When I graduated nursing school it was not uncommon for nurses to regularly care for 8 or even 10 patients on a cardiac surgery step-down or transitional care unit. I knew this was not the way I wanted to practice nursing, and found my passion in community and home health nursing. The 2003 NurseManifest Study provided an opportunity to talk with my co-workers and colleagues locally and nationally, to better understand what changes were needed and desired by nurses to create their ideal working conditions. Some of the major findings were that nurses felt a lack of respect, a lack of voice, and a lack of unity. Now, over a decade later, my work is dedicated to research that tells the story of what it is like to practice nursing today, and that shows the value of nursing for patients and society as a whole.

Why everyone should care about nurses’ working conditions and staffing ratios was the subject of a recent New York Times Op-Ed “We Need More Nurses” by Alexandra Robbins. The op-ed piece mentions dozens of research studies providing the evidence that patients’ risk of death, infections, complications, falls, hospital and hospital readmission are greater when nurses are caring for more than 4 or 5 medical or surgical patients. Hundreds of readers’ comments brought personal stories and richness to the conversation from the views of nurses, patients, family members, physicians, administrators, and more.

Working conditions and labor force issues for nurses is an international priority, and one source of current information is the RN4CAST Consortium, consisting of nursing workforce research groups in 17 countries, including the United States. Currently the United States group, based at the University of Pennsylvania, is surveying over 250,00 registered nurses and advanced practice nurses about nursing care, patient outcomes, and general working conditions for nurses. You can learn more about their work, and the study director Dr. Linda Aiken here.

Another source of information and place for collaboration is National Forum of State Nursing Workforce Centers, comprised of nursing workforce centers in 33 states. The National Forum of Nursing Workforce Centers is a resource for finding information specific to your state, as well as about nursing workforce issues nationally. Their annual conference will be held next week in Denver, Colorado and you can download the conference brochure and registration information from their website.