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

/ Olga F. Jarrín / 3 Comments

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,

Olga

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 http://www.cervantesvirtual.com/portales/concepcion_arenal/autora_biografia/

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

Nursing as Practical Magic

/ Wendy Marks, DNS, ANP-BC / 4 Comments

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Nursing is a practical magic that creates internal and external environments to promote health or a peaceful death through acts that generate transformation. Ancient wisdoms and civilizations create rituals to honor life’s milestones and seasonal changes.

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Samhain (pronounced sow-een) is known as the ancient Celtic festival of the dead. Celebrated on the 1st day of November, Samhain is a time of introspection, and remembrance of the ancestors.

How do you remember and honor your ancestors?

Wise women throughout the ages, healers, and witches honor the turning of the wheel of life, the seasons, and the rhythms of the natural universe.

Connecting with the moon, stars, plants, animals, self and spirit they give thanks and set intentions to create healing and the life they dream of.

Consider the symbols and talisman of Halloween. One may see that the Broom symbolizes clearing of the old to make way for new; the Owl for wisdom; the Cat for mystery of the unknown; Ghosts for notions of the other world; and Bats for transformation.

As nurses, we inherently make connections with and for our patients and families. We tap into the power of the universe, as we embrace it we realize there’s a little witch in all of us.

Magic isn’t just spells and potions; its symbols and talisman that have whatever meaning you assign to them. What are the symbols and rituals that hold meaning for you?

Healers use their powers to conjure and create by setting intentions and connecting with the inherent energies of their environments.

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The nursing metaparadigm (nurse, person, health, environment) viewed through the Unitary Transformative paradigm conjures an integration of multiple ways of knowing, being and becoming.

As we honor our nursing ancestor Florence Nightengale, we hear her say:

“All disease is a reparative process…an effort to remedy a process of poisoning or decay…I use the word nursing for want of a better. It has been limited to the administration of medicines and applications of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and diet…”

How do you conjure your environment for healing? How do you create the environment for your patients to heal? What ritual, symbols and talismans and intentions do you use in your self healing and work?

As we connect to our ancestors today, let us begin to reclaim our providence and power as nurse healers.

Listen to you heart, hear the beat of the drum, the drum of your heart as it connects with the hearts of the others and the universe; conjuring, gathering and sending out powers of healing and love to self and universe.

On this day we honor the ancestors, the ancient wisdoms, where we have been and the gifts we have been given.

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See the vibrant colors of the Autumn; red, yellow, orange, and brown. Smell the earthly aromas of patchouli, sandalwood, musk, spice and copal. Hear the rustle of leaves as they fall and fly.

Let your nursing be a practical magic. Conjure a spell and send your intentions off on the winds, allowing the vibrant leaves of red, orange and yellow carry your wishes of health and healing to the earth, animals and humans.

Reference

Nightingale, F. (1859). Notes of Nursing; What is it and What it is not. Barnes & Noble (2003): New York, NY (pp 1-2).

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Gun violence: A nursing concern?

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

Once again we find ourselves reeling from a mass shooting, this time in a small community college in Oregon. One of the most disturbing reports of the Umpqua Community College incident was that the dead victims’ cell phones were ringing when police and rescue workers arrived on the scene, as their families and friends tried to make contact with them. The heartbreak for this community is palpable; for nursing educators, the concern of wondering if this could happen in our classrooms, in our schools, is unsettling. Some of us might recall the 2002 Arizona nursing faculty mass shooting, where 3 nursing professors were gunned down and killed by a student who had failed a pediatric class and decided that he had the shooting authority and was angry enough, I suppose, I don’t understand really, why.

What has changed since those 2002 shootings? If you scroll through your facebook feed today, it is likely you will find many postings about the statistics of mass shootings, thoughts about how nothing has changed, and debates over stricter gun control. Meanwhile, I feel that nursing should be viewing the gun violence issue as a public health issue, and we could be the ones helping to lead the way in preventing future mass shootings. We have a strong voice, as we recently proved with the “#Drsstethoscope ” and “#nursesunite ” movements; and now perhaps we could unite over some issues that deeply impact the health of all beings on this planet.

The American Public Health Association (APHA) has made clear statements that gun violence is preventable (https://www.apha.org/~/media/files/pdf/factsheets/gun_violence_prevention.ashx). APHA recognizes that gun violence is contagious and has become an epidemic in the United States. APHA recommends that we:

  • Use surveillance techniques to track- gun related deaths and injurious shootings.
  • Focus on identifying the many risk factors for gun violence.
  • Create, implement, and evaluate interventions that reduce these risk factors and support resilience for those who are suffering.
  • Institutionalize prevention strategies.

We also clearly need more research in this area; we need to examine what common sense gun policies might look like, what have other countries implemented; what worked for them, and what has not worked for them.

Nurses and educators can begin in their work places, looking at their own risks within the workplace, and working toward implementing prevention strategies and trainings around what to do should an issue of gun violence begin to emerge.

We need to also reach out to communities, particularly school settings, and develop and support education around gun safety, bullying, mental health issues, and how to ask for help. We need to have mental health services in place that can truly identify and properly intervene with those who are at risk for gun violence.

Nurses could also bond together, #nursesunite, and create a clear voice around stricter gun control. We could do our own research around what has worked in other countries and what that might look like here, and then bring these ideas forward to our lawmakers. At the very least, we could be calling for better access to mental health services for those in need, and early identification of those who might be at risk for perpetuating gun violence. Childhood traumas likely play a role in this issue as well, and supporting the creation of trauma informed schools should be a nursing advocacy issue.

We have power in our numbers; let’s put it to great use. #nursesunite

Humor in Health Care

/ Jane K. Dickinson / 1 Comment

There has been plenty of discussion about Kelley Johnson’s monologue and comments from The View. I just took a look at the response from the President of the American Nurses Association, who said, “Nurses don’t wear costumes; they save lives.” and its true, you won’t ever see a nurse wearing joker teeth welcoming a patient.

I am grateful to all the people who have stood up for nurses by responding, supporting, and making us feel like the honorable, trusted, and caring profession that we are. I am also thankful to Pamela Cipriano for her quote above, because that has encouraged me to take a lighter approach in this blog article. Everything doesn’t always have to be heavy or philosophical or serious, right?

While I understand what Pamela meant by “Nurses don’t wear costumes,” I will share that I did wear a costume once, when I was a staff nurse on an adolescent unit. It was Halloween and most of the nurses dressed in costumes that day. I was taking care of a particular 14-year-old boy who needed a new IV placed. In all my costumed glory, I went in and put an IV in this adolescent’s arm. His dad sat by the bedside as I did so. And his dad was a VP of the hospital. I never knew if that patient’s father was amused by my costume or annoyed thinking I wasn’t taking my job seriously. He didn’t say anything to me about it.

I sometimes think back to that experience, especially around Halloween, and wonder when it’s ok to infuse humor into health care. I sometimes use humor with patients I see for diabetes education, but then again those visits are not life or death situations. Hospital staff where I work still dress up every year, but I have never worn a costume to work again.

Personally, I like and appreciate humor. But when I’m the patient I do expect health care professionals to use it appropriately. I remember when I was a patient in room # e111, a joke that I didn’t “get” was sort of an issue I didn’t want on my mind. I’ve noticed in the Diabetes Online Community that people often discuss with frustration the jokes that are told about diabetes. Sometimes funny things happen to nurses at work, and those times (and memories) can help us get through tough jobs. In fact, humor can be one way nurses take care of themselves. Are there ways we can use humor to help people heal?

How do you use humor in health care? Or what funny thing that has happened while you were working in a health care setting? What did you learn from the experience?

American Academy of Nursing Calls for Collective Action to Include Social and Behavioral Determinants of Health in the Electronic Health Record

/ Peggy L Chinn / 1 Comment

This is a major policy position that all NurseManifesters should know about!!

From: American Academy of Nursing <aan>

Subject: News Release: American Academy of Nursing Calls for Collective Action to Include Social and Behavioral Determinants of Health in the Electronic Health Record

Date: September 14, 2015 at 4:18:28 AM PDT

To: peggy.chinn

Reply-To: elyse_petroni

American Academy of Nursing Calls for Collective Action to Include Social and Behavioral Determinants of Health in the Electronic Health Record

Academy Releases Policy Brief Identifying Action Items for Health Care Industry

Washington, D.C. (September 14, 2015) –The American Academy of Nursing has released a policy brief that endorses the capturing of social and behavioral determinants of health in the electronic health record (EHR). The policy brief identifies several recommendations for health care industry leaders to foster standardization and promote interoperability.

The policy brief is published in the September/October issue of the Academy’s journal, Nursing Outlook.

“There is strong evidence that social and behavioral factors influence health; however, they may not be addressed in clinical care for shared decision-making. It is imperative that all stakeholders in health care collaborate to include this information in electronic records, including EHR vendors, health systems, providers and funders,” said Academy CEO, Cheryl Sullivan.

The policy brief states the Academy’s support for recommendations put forth by the Institute of Medicine (IOM) in a 2014 report, “Capturing Social and Behavioral Domains and Measures in Electronic Health Records (Phase 1 and Phase 2).” Identified barriers to the implementation of IOM’s phase 2 recommendations include:

  1. Lack of commitment to standardization of clinical practice, documentation and data.
  2. Lack of consistency and ease-of-use of clinical workflow within EHR technology.
  3. Need for increased patient empowerment and culture of trust.

These barriers prohibit the adoption of a standardized assessment panel of approximately 20 questions put forth by the IOM addressing: Alcohol use; Race/Ethnicity; Residential address; Tobacco use; Median household income; Depression; Educational attainment; Financial resource strain; Intimate partner violence for women of reproductive age; Physical activity; Social isolation; and Stress.

The policy brief states:

“…The recommended action steps of multi-stakeholders will begin to address the global changes that must be made in clinical practice to assure EHRs capture and permit sharing of contextual patient information, promote shared decision-making, enhance appropriate inter-professional planning/providing of health care services and facilitate monitoring of patterns of health and outcomes of care for entire populations.”

Read the full policy brief.

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About the American Academy of Nursing

The American Academy of Nursing (http://www.AANnet.org) serves the public and the nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. The Academy’s more than 2,300 fellows are nursing’s most accomplished leaders in education, management, practice, and research. They have been recognized for their extraordinary contributions to nursing and health care

CONTACT: Elyse Petroni

202-777-1174

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