A Nursing Textbook Worthy of NurseManifest Endorsement

January 14, 2015November 29, 2015 / Peggy L Chinn / 2 Comments

Several months ago I had the honor of writing the Foreword to a new nursing textbook by Gweneth Hartrick Doane and Colleen Varcoe titled “How to Nurse: Relational Inquiry with Individuals and Families in Changing Health and Health Care Context.” In their Preface, they state the goal of the text very clearly – one that reflects elegantly the ideals of the NurseManifest vision:

“Our goal is to help readers engage in a thoughtful process of inquiry to more intentionally and consciously develop their knowledge and nursing practice, develop their confidence and ability to act in alignment with their nursing values, and to navigate the complexities of contemporary health care settings as they care for patients and families.” (p. x)

There are particular features of the book that are notable from “NurseManifest” perspective. One is that the book accomplishes something typically missing in textbooks – it fully engages the reader as a participant. In essence, the book “models” the title — it is relational. Throughout the book there are features that engage the reader in the content, for example encouraging the reader to “try it out” and providing guidelines for “this week in pracice.” The “Relational Inquiry Toolbox” features at the end of most of the chapters provide guidance for the reader in focusing on using the tools presented in the chapter in practice. For example, at the end of Chapter 2 – one of the tools is to “Enlist a critical feminist filter to see how gender dynamics are intersecting with other forms of oppression and affecting health and health care.”

In short, this is a marvelous book. Get your copy today .. even as a person who is not enrolled as a nursing student, I guarantee you will learn a lot and see vast possibilities for nursing that will amaze you!

Historic Wilma Scott Heide eBooks now available!

November 18, 2014November 18, 2014 / Peggy L Chinn / 1 Comment

Wilma Scott Heide

Two books of major significance to the modern women’s movement are now available as eBooks – “Feminism for the Health of It” by Wilma Scott Heide, and “A Feminist Legacy: The Ethics of Willma Scott Heide and Company” by Eleanor Humes Haney.

Wilma Scott Heide was bom on February 26, 1921 and died on May 8, 1985 of a heart attack. One of the most respected of feminist/human rights scholars/activists in the world, Dr. Heide was a nurse, sociologist, writer, activist and lecturer. During her lifetime she actively demonstrated intellectual force, caring and commitment in articulating the women’s movement imperatives for society. She served as visiting professor and scholar at several universities, consultant to various state education associations and innumerable colleges, churches and many branches of the government, education and social organizations. In 1984 Wilma described herself as: Behavioral Scientist at American Institutes for Research; Human Relations Commissioner in Pennsylvania; Chairone of Board and President of NOW (1970-1974); Professor of Women’s studies and Public Affairs at Sangamon State (would-be) University in Illinois; Feminist and Humorist-at-Large

These two books were originally published in 1985 by MargaretDaughters, a small independent feminist publishing company founded by Charlene Eldridge Wheeler and Peggy Chinn. They named their company after their mothers, both of whom were “Margaret.” They met Wilma on the occasion of an International Women’s Day celebration in Buffalo, New York where Wilma was featured as a guest speaker. Her dissertation, titled “Feminism for the Health of It” had never been published in book format, and the eager Margaretdaughters publishers were thrilled to have the opportunity to bring this important work into book form. Shortly after, they connected with Ellie Haney, who had been planning a biography of Wilma’s life that highlighted the amazing and inspiring feminist philosophy that grounded Wilma’s work.

Wilma challenged the patriarchal status quo with an inimitable humor, keen intellect, and a steadfast feminist commitment. She was the third President of NOW, during which she actively led the organization to turn away from the homophobic “lavender menace” messages of the earliest years of the organization. She led a number of actions of civil disobedience, several of which contributed significantly to moving the Equal Rights Amendment out of committee and into the nation-wide U.S. constitutional review process. She insisted that newspapers cease segregating the “help wanted’ columns by “male” and “female” – a change that is possibly one of the most influential in expanding economic opportunity for women.

Even though she did not practice nursing for most of her career, she never waivered in her identity as a nurse and her commitment to the deepest values of nursing that are today reflected in the Nursing Manifesto – caring, the right of all people to a high level of health and wellness, the essential element of peace in realizing health for all, and the imperatives of consciousness and action to bring about real change.

There are elements in both books that may seem limited or inadequate given the perspectives we have today, but both remain significant and current not only for their historic value, but for the light they shed on today’s persistent political and social challenges for women, for nursing, and for health care. I am thrilled to have brought these works forward into the present in accessible, affordable formats! I hope you will visit your preferred eBook provider now and consider making them part of your library!

The Light and Dark of Nursing: Our Shadow, Part II

September 8, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

I have heard from many folks that they enjoyed the Part I of this blog series, which looked at some of our deep, and most scary, shadow issues in nursing; namely how a serial killer nurse can work in a healthcare system for years before being brought to justice and how the system failed to protect patients.

While this was likely one of our most extreme cases of complex shadow issues (there are a few more serial killer nurses out there, though thankfully they are low in number) and certainly many healthcare systems and administrations are in need of reform, there are also some very serious “everyday” shadow issues that nursing needs to shine the light upon in order to transform the profession. As we shine the light on our dark side, our shadows, we can begin to move out of denial of our professional issues; hence we can also begin to look for creative solutions and transformational change opportunities.

We experience challenges with the transformation of nursing practice: why is it taking us so long to take back our practices; to be able to practice nursing as a caring, compassionate, and healing art; to practice nursing qua nursing; why does it feel like we are stuck in a dark night of the soul in nursing?. We, as a professional group, have yet to really look at our own shadow projections. Theoretically, it could be that once we recognize our own shadow, the hard work is done; then we can observe, acknowledge, witness, accept and integrate these issues. This would mean less doing and fixing for our profession; we could practice presence and being with where we are at right now during these challenging times, as we look toward where we would like to be and discover how we might get there.

Below are some shadows in the profession that may be worth examining, recognizing, and witnessing. Growing awareness, being with, and bringing our collective nursing consciousness toward recognition can help move us out of states of professional oppression. Please feel free to consider and share any nursing and healthcare shadows you experience in your workplace as well!

Cognitive stacking shadow: Boynton and Hall (2012) wrote an informative post about how complex and demanding nurses’ work is from the viewpoint of our complex duties and decision making processes. Nurse Overload: The Risks to Employees and Patients .

This is worth a read to get the basics around how our workplace environments overload us with information, data, and distractions at the risk of our own and our patients’ health and safety issues. The problem here is that while systems know that this sort of overload leads to job dissatisfaction, loss of nurses, and risks to patient safety, systems and nurses seem to be doing little to no research on how to change these issues. This is costly on many levels, and perhaps nurses need to also look into how we can create new workplace environments that support our own and our patients’ well being. Cognitive stacking leads to overload and initiates the stress response, which is our next shadow to shine some light upon.

Stress response shadow: Nurses are stressed out: we work in stressful environments and we often tend to put others’ needs in front of our own, somehow failing to recognize that a) our stress has a direct impact on the stress and healing capacity of those we care for, b) we can’t keep giving without taking time to recharge, rejuvenate, and care for ourselves and c) stress is impacting our own health and well being (Clark, 2014).

The stress shows up in obvious patterns that nurses have created. I have been asked many times why so many nurses are obese. Is this a shadow issue for us as nurses, the ones who know the damage obesity causes in our bodies? Despite knowing the health issues associated with obesity, up to 54% of nurses are overweight or obese (Miller, Alpert, & Cross, 2008). Most nurses in this particular study were not motivated to make changes in their lifestyle, despite knowing the health risks of obesity.

Students often tell me they are overweight because they don’t have the time to exercise, prepare meals, eat right, sleep well, drink water, etc. Somehow the healthcare system (12 hour shifts? lack of access to healthy foods? high cortisol levels related to stress?) creates a stressful environment for us, and somehow we fail to recognize the impact this stress has on our bodies, and that we need to manage this stress or suffer the consequences. The average nurse gets only about 6 hours of sleep before any given shift, and this has great impacts on health as well as ability to function as strong clinical decision maker hour after hour (Clark, 2014). This medscape article clearly delineates the issues we face around sleep and the impact it has upon us:A Wake up call for nurses: Sleep Loss, Safety, and Health.

Stress contributes as well to many of other shadow issues: lateral violence, the nursing shortage, and our own poor health states. Letvak, Ruhm, & Lane, (2011) found that nurses will work when they are sick, and unfortunately we have higher rates of eating poorly, smoking cigarettes, abusing drugs and alcohol… and we can tend to overwork or engage in workaholic type activities (Burke, 2000).

Time and again, I hear tales from ASN through PhD prepared nurses about how they suffered PTSD from the nursing school experience, and we know that PTSD is a hazard of being a nurse: up to 14% of all nurses meet the criteria for PTSD, while as many as 25%-33% of nurses in the critical care and emergency settings screened positive for symptoms of PTSD (Mealer et al, 2007; Laposa, Alden, & Fullerton, 2003).

We know about these issues and yet both nursing academia and the systems in which we work tend to turn a blind eye toward the reality of the nursing profession’s risks and deep challenges toward health and managing our professional stress. Every healthcare facility and every school that educates nurses should be striving to shine the light on these shadow issues, and look toward finding ways to help support the health and stress management capacity of nurses. This becomes an ethical issue when we consider how the stress of the nurse can impact the stress and healing process of patients; the nurse in stress response adds to the stress of the patient’s environments, potentially right down to the neurological stress response of the patient (Clark, 2014).

Shadow Side of Caring: Most nurses likely became nurses because they care about others, they want to support healing, and they want to make a difference in others’ lives. Unfortunately, nursing school in general does not prepare new graduate nurses for the challenge of creating caring-healing environments in the face of stressful workplace demands (Clark, 2014). Every nurse educator should be concerned about providing students the tools needed to manage stress in order that they make sound clinical decisions and maintain patient safety; and also that they might fulfill their life’s calling toward caring. This is an ethical obligation, and yet our academic environments tend to be initiation grounds for living through stress while students are not adapting adequate tools to manage stress.

There is also a lingering professional shadow that creating caring-healing environments takes time, we can’t possibly have time to care for and be with patients, when we have too much to do, too many demands, too many distractions, too much cognitive stacking, too little support, too few nurses, too much stress, etc. When we buy into the truth of this idea, there may no longer be a motivation to attempt to truly care for the patient. Additionally, many healthcare facilities, including magnet facilities, and systems may claim to support nurses in caring, and yet the reality of the workplace remains unchanged, even when changes have been claimed by administration. We may call this lack of support to realize our deepest call toward caring a form of oppression by the system (Clark, 2002, 2010). A concern I have is that oppression of nurses goes unrecognized by the profession in general, and as the largest number of healthcare providers, we seem to remain in the shadow of our own power, failing to recognize how we might begin to negotiate what is nurses do in systems and how we do it (Clark, 2002; 2010).

Shadow of Oppression

Oppression of the nursing profession may likely for many nurses have it’s shadow base in academia (Pope, 2008). As Pope (p. 21) so clearly defined oppression:

“Freire defined oppression as the imposition of one person’s (or group’s) choice upon another in order to transform an individual’s consciousness to bring it in line with the oppressor’s. Prescription of thoughts, values, and behaviors are the basic elements of oppression (Freire, 1970; Rather, 1994). A behavior that is symptomatic of oppression is horizontal violence. It is the exercise of power against people in the same oppressed group. It is overt and covert non-physical hostility, such as criticism, sabotage, undermining, infighting, scapegoating and bickering (Hamlin, 2000; Duffy, 1995)”. For many of us, these experiences of oppressive behaviors and horizontal violence began in nursing school, propelled by both faculty and students alike. Yet, most of us remain unaware that what we are experiencing, the bullying, the anger, the backstabbing, are clearly symptoms of oppression. Hence the cycles continue until we take the brave steps toward shining the light on these issues.

Pope (2008) goes on to illuminate how in the shadow of oppression, the oppressed become the oppressors; she suggested it is only through a recognition of the world of oppression, reflecting and acknowledging the reality of our socio-cultrual and political worlds, that we can begin to take action against the oppressive elements of reality and also recognize our own role in our own oppression.

The problem is that failing to address this in academia, we send nurses out into the workplace who have come to either deny oppression or conversely accept it as the norm; we may have new and seasoned nurses who lack the capacity to reflect upon these issues and their origin, rather generally accepting them “as the way things are”. As Marks (2013) found in her work with nurses at a Magnet hospital, while the nurses felt empowered with their work with patients, they knew they were experiencing a lack of empowerment within the healthcare system, but they were not aware of this as a form oppression.

Conclusion

This blog is simply the tip of the iceberg; the challenge remains for us in nursing to begin to examine our shadow issues, to be open and reflective toward our own roles in oppression, despite the discomfort this brings. We need to have scholars, researchers, theorists, and bedside nurses reflecting upon oppression. How did oppression in nursing begin, how has it evolved over the years, what are our next steps toward freedom through integrating the shadow? Are we ready to free ourselves from this oppression, choosing to not be like the oppressors, and transforming the oppressive nursing professional role toward one of nursing qua nursing: namely caring, holism, and healing?

References:

Boyton, B. & Hall, D. (2012). Nurse overload: The risks to employee and patients. Retrieved from http://www.confidentvoices.com/2012/10/23/nurse-overload-the-risks-to-employee-and-patient/

Burke, R. (2000). Workaholism in organizations: Psychological and physical well-being consequences. Stress and Health, 16(1), 11-16.

Clark, C. S. (2002). The nursing shortage as a community transformational opportunity. Advances in Nursing Science, 25(1), 18-31.

Clark, C.S. (2010). The nursing shortage as a community transformational opportunity: An update. Advances in Nursing Science, 33(10), 35-52.

Clark, C.S. (2014). Stress, psychoneuroimmunology, and self-care: What every nurse needs to know. Journal of Nursing and Care, 3, 146.

Laposa, J. M., Alden, L. E., & Fullerton, L. M. (2003). Work stress and post-traumatic stress disorder in ED nurses/personnel. Journal of Emergency Nursing, 29(1), 23-28.

Letvak, S., Ruhm, C. & Lane, S. (2011). The impact of nurses’ health on productivity and quality of care. Journal of Nursing Administration, 41(4), 162-7.

Marks, L.W. (2013). The emancipatory praxis of integral nursing: The impact of human caring theory guided practice upon nursing qua nursing in an American Nurses Credentialing Center Magnet Re-designated healthcare system. Retrieved from http://media.proquest.com/media/pq/classic/doc/3073838521/fmt/ai/rep/NPDF?_s=HaGBMdTxvziM7lbtbb%2FHTWouZWo%3D

Mealer, M., et al. (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine, 175(7), 685-7.

Miller, S.K., Alpert, P.T., & Cross, C.L.. (2008). Overweight and obesity in nurses, advanced practice nurses, and nurse educators. Journal of the American Academy of Nursing Practice, 20(5), 259-65.

Pope, B. D. (2008). Transforming oppression in nursing education: Towards a liberation pedagogy. Retrieved from http://libres.uncg.edu/ir/uncg/f/umi-uncg-1639.pdf
8.

The Light and The Dark of Nursing: Our Shadow, Part I

August 13, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I love nursing and I love being a nurse. That is what makes this post so challenging to write, admitting that the profession where my heart sings, where I have grown and evolved over the last twenty years, has a dark side. But if we take the advice of Jung, we come to realize, perhaps, that the shadow, the dark parts that we may try to hide or deny, needs to be acknowledged and integrated. We can learn to be loving and kind toward that which was previously denied or rejected. By shining a light on the dark places, we can invite those hidden areas to come out fully, to open up to our secrets and our darkness. While we usually think of shadow work as an individual challenge, the profession of nursing could grow and evolve from examining our shadow, from shining a light upon our darker sides.

The Shadow: Nursing in the Media

I recently read the book “The Good Nurse”by Charles Graeber. I remember listening to NPR and hearing about the book when it was released and being very upset that a book about a nurse serial killer was given such a title. To listen to what I heard on the radio in April 2013, visit this link:

The Good Nurse, NPR

It took me a year to work up to the challenge of reading the book, as I was so upset about the title alone, let alone the interview. Who was this outside journalist who came to investigate these horrendous acts, surely he did not understand nursing if he named the book in this manner. My own anger at the title of the book and the horrific situation should have been clue to me right there that I had something to face here, at least according to shadow theory. Still, I thought a book called the Good Nurse should be all about the good nursing does, not about this outlier who murdered perhaps dozens of patients. Why not call this book, “The Worst Nurse EVER”? or “The Abhorrent Nurse?”

What I didn’t realize at the time was that this book has an important message to deliver, an important message not just about Charlie Cullen, the RN who killed many, many patients, but about the whole healthcare system, about the dark side of medicine for money and the need to protect hospitals’ revenue stream dominating over the need for patient safety. I finally purchased the book and settled into reading it over spring break 2014. About half way through reading the book, I contacted the author, Charles Graeber through email and began a dialogue about the book and his choice of the title. And I was surprised to find that Graeber was beyond generous in his responses to me, helping me to shine the light, expanding it further into this dark tale.

The story is about flaws in our reporting systems, about flaws in how nurses respond, report, react to concerns for patient safety, and about flaws in quality assurance. The book is about a call for justice, for action to be taken against the healthcare systems and the specific individuals who perpetuated Cullen’s killing spree by failing to act. There is no statute of limitations with murder charges, and healthcare administrators who knowingly supported the continuing practice of a murdering nurse may perhaps be found liable on some level for the many murders that occurred after knowledge of, or even suspicions of. multiple murders were not adequately addressed. You can read my full review of the book here:

http://www.amazon.com/review/R38G2SH63CBCVG/ref=cm_cr_pr_perm?ie=UTF8&ASIN=B004QX078C

Although we can clearly see Cullen carried a deep shadow with him into nursing, that he suffered from some sort of mental illness to have had these deep killing compulsions, that he was a manipulator or sorts who could put up a front as a hard working hero nurse, we have the obligation to also see what worked in the system, and identify the shadows that need to be addressed.

What worked, where was the light? The hero-nurse who helped to indict Cullen, the investigators who did not give up or turn a blind eye, and the penal system were the lights in this issue.This book itself also becomes a beacon to shed some light on the issue.

What did the light reveal about this looming shadow in nursing, what can we learn from this media portrayal of a nurse carrying a gigantic shadow? Perhaps we can consider if academia may have some issues with screening students; that some nurses may consider a nurse who works a lot/takes the hard patients/ and makes the coffee to be a “good” nurse; that QA/QI/surveillance issues around safety as related to nursing practice and competence is apparent; that nurses may have not been empowered to take action when their suspicions arose; and that systems failed in protecting patients through monitoring and reporting.

By increasing our awareness of shadow, dark side incidents such as this obvious one, we can begin to create change and perhaps prevent future devastation. While this is an extreme example of a shadow in our beloved profession, the next entry or Part II will examine some less extreme shadow issues and Part III will focus on actions we can all take to shine the light into darkness and further support our autonomy and evolution as a caring- healing profession.