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Realizing the Focus of the Discipline

Facilitating Humanization in PhD Education

A Student Exemplar Integrating Nature and Health

Tehan, Tara M., MSN, MBA, RN; Cornine, Amanda E., MSN, RN; Amoah, Rita K., BEd, BSN, RN; Aung, Thin Zar, BSN, RN; Willis, Danny G., DNS, RN, PMHCNS-BC, FAAN; Grace, Pamela J., PhD, RN, FAAN; Roy, Callista, PhD, RN, FAAN; Averka, Kathleen A., BA; Perry, Donna J., PhD, RN

doi: 10.1097/ANS.0000000000000246
The Focus of the Discipline
Free

Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.

Massachusetts General Hospital, Boston (Ms Tehan); University of Massachusetts Medical School, Graduate School of Nursing, Worcester (Ms Tehan, Amoah, and Aung and Dr Perry); University of Massachusetts Medical School, Graduate School of Nursing, Worcester State University (Ms Cornine); University of Wisconsin-Madison, School of Nursing (Dr Willis); Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts (Drs Grace and Roy); Mount Saint Mary's University, Boston College, Los Angeles, (Dr Roy); Northbridge Elementary School, Whitinsville, Massachusetts (Ms Averka).

Correspondence: Tara M. Tehan, MSN, MBA, RN, University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Ave North, Worcester, MA 01655 (Tara.Tehan@umassmed.edu).

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

THE AMERICAN ASSOCIATION of Colleges of Nursing's position statement on the research-focused doctorate makes clear that nursing PhD graduates must be grounded in the foundational knowledge of the discipline as well as have the ability to work in interdisciplinary research teams that address complex health needs. The core of the PhD in nursing requires both “a strong scientific emphasis within the discipline” and “an understanding of the sciences of related disciplines.”1 (p1) It is critical that PhD education in nursing provides graduates with a strong disciplinary foundation that grounds interdisciplinary scientific endeavors. Thorne2 describes core disciplinary knowledge as “the historic and current understandings of the philosophical and theoretical grounding”(p1) that provides nursing with its unique lens. Furthermore, core knowledge of the discipline of nursing provides a “moral compass”2 (p1) and is the “essence of what keeps us on the course that is our collective disciplinary mandate.”2 (p2)

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Statements of Significance

What is known about this topic:

Education for the research-focused doctorate in nursing must prepare scholars with a solid foundation in disciplinary knowledge as well as the science of other disciplines to inform research on contemporary issues that affect human health. Numerous scholars have voiced concerns that nursing's unique disciplinary perspective, particularly theoretical knowledge, is being lost amidst the contemporary movement toward empirical interdisciplinary research. This creates challenges in preparing graduates who are able to both articulate the nursing domain and integrate that perspective with emerging science from other disciplines.

What this article adds:

This article provides a concrete application of the focus of the discipline as described by Willis, Grace, and Roy. It demonstrates how the unifying focus can be used in doctoral education to advance health education on issues relevant to multiple disciplines, preparing the next generation of nurse-scholars to lead the profession through the lens of a unified disciplinary focus.

For more than 40 years, Donaldson and Crowley3 emphasized the need to make nursing disciplinary knowledge explicit. Yet several nursing scholars have warned that nursing is at risk of losing the unique disciplinary identity so essential to meeting nursing's social obligations to advance the good of human health.2 , 4 Grace, Willis, Roy, and Jones emphasize that in order for nursing scholars to steward the discipline in meeting its societal obligations, there is a need for nursing inquiry in the dimensions of philosophical, theoretical, and empirical knowledge. However, contemporary academic trends such as funding pressures have shifted the emphasis toward empirical research and caused an imbalance in nursing knowledge development.4

A lack of emphasis on the formation of scholars who are steeped in the varied lenses of nursing philosophy, core knowledge of the discipline, including its conceptual models and theories (middle range and situation specific), mutes or silences nursing's voice and threatens the disciplinary perspective in the classroom and in collaborative endeavors.4 (p66)

Roy5 has proposed that to address contemporary health issues, the structure of nursing knowledge must integrate domain-derived knowledge with practice-shaped knowledge from basic sciences including behavioral, biomedical, and management. Such an approach can “bring nursing knowledge to every setting where it is needed.”5 (p90)

The purpose of this article is to provide an exemplar of 1 pedagogical approach to integrating core knowledge from the nursing domain with emerging research from other sciences. The article brings together different voices to provide a multifaceted lens on the project including perspectives of the faculty member, doctoral students, nursing authors, and an elementary school teacher. This provides a range of discussion from the theoretical level to practical application and personal experience.

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PEDAGOGICAL APPROACH TO INTEGRATING CORE NURSING KNOWLEDGE

Students enter PhD programs in nursing via multiple pathways.1 Thus, students come to doctoral education with varying exposure to disciplinary specific knowledge, particularly theory. In some curricula, nursing's philosophical and theoretical heritage has been discounted and minimized in favor of other content.6 This creates a challenge for doctoral faculty in trying to provide students with the advanced scientific knowledge and skills they need as researchers while also trying to ensure core disciplinary knowledge that students may not have had in prior nursing education. This challenge is complicated by the need to make theoretical knowledge interesting and relevant for graduate nursing students who sometimes have preconceived beliefs about theory as having “no practical value.”7 (p23) In our PhD program, students are provided with a course in philosophy of science, followed by a theory course that focuses on critically analyzing and applying theories in research. As the faculty member teaching the theory course, I have sought to provide a disciplinary foundation through having the first few classes concentrate on the domain of nursing knowledge. In these classes, students read and discuss seminal works such as Donaldson and Crowley's3 article about the substance of nursing knowledge and Dickoff and James'8 explication of theory development in nursing as well as the rich historical explication of nursing theory provided by Meleis.9 Moreover, students read articles from the 2008 Advances in Nursing Science issue on the focus of the discipline of nursing. These and other writings provide students with fertile material for reflection, dialogue, and scholarly writing that help them better understand and articulate the domain of nursing knowledge.

Building on foundational disciplinary knowledge, the course also includes theoretical readings on broader issues that affect human health. Donaldson and Crowley emphasize that, “the discipline and profession must be continually reevaluated in terms of societal needs and scientific discoveries.”7 (p118) Nursing has a social contract to address emerging issues impacting health including socioeconomic and environmental factors.10 In this year's course readings, I added the book, The Nature Fix by Florence Williams.11 This work addresses contemporary research on the positive health impact of exposure to nature. The rationale for including this text in the class was 2-fold. First, the topic is important and relevant to health. An emerging body of research has provided robust evidence of the deleterious health effects of an increasingly indoor lifestyle as well as the positive physical and psychological benefits of exposure to nature11 , 12 or “nature contact.”13 (p45) This is particularly relevant for nursing science, given the professional mandate to promote the “good” of health and the metaparadigm of nursing, person, health, and environment.14 But the deeper reason that I chose this book is that it provided an engaging account of the author's quest to understand why she felt happier outdoors. Answering this question involved inquiry into emerging theory and science on the topic of nature and health. That quest led her to travel from outdoor settings in the Southwestern United States to forests in Japan and Korea in order to meet with scientists studying this topic. The book provides a firsthand account of how a personal experience inspired a path of inquiry and how different theoretical explanations could be explored and tested through science. My hope was that in reading about Williams' exploration, students could gain insight into how questions from their own experiences might generate theoretical explanations to be investigated through programs of research.

In her book, Williams11 cites Florence Nightingale's seminal work on environment and health. However, most of the research discussed is from other disciplines. Walker and Avant14 emphasize that concepts and theories derived from other disciplines must be reinterpreted from the context of the discipline of nursing. To creatively address the objective of integrating disciplinary knowledge with emerging science from other disciplines, I incorporated a student-led class assignment. Students were provided with the objective of developing an assignment in which they applied knowledge from the domain of nursing to the research on nature and health discussed in Williams' book. They were told that it could be an individual, team, or group assignment and that it could be in any medium of their choosing.

Fostering student creativity and insight is central to the pedagogy of our PhD program, which is based on the philosophy of Bernard Lonergan.15 , 16 Our faculty believe that graduates will best be able to steward the discipline through self-reflective inquiry and openness to new questions. Creative inquiry is critical in order to transcend current horizons and transform human living to meet contemporary health challenges.16 The assignment aimed at fostering student creativity through applying core nursing disciplinary knowledge to relevant findings from other health-related scientific disciplines. This approach is congruent with the American Association of Colleges of Nursing's position statement as well as Roy's call for nursing to integrate knowledge from the nursing domain with knowledge from other sciences.

We had a cohort of 4 students in this year's PhD class. The students discussed possible approaches over the early weeks of the semester and eventually decided to utilize the disciplinary focus provided in the work by Willis et al17 on facilitating humanization to write a children's storybook on the health benefits of being in nature. We then visited a local elementary school where the students read the book to a class of first-grade students. The students also created a PowerPoint for PhD class discussion in which they conveyed how the theoretical concepts of facilitating humanization were incorporated in their book.

This project was an opportunity for the PhD students to connect their work with the community. It was also a personally meaningful experience as it entailed working with my sister, a first-grade teacher, to bring together the students from each of our classes in a joint learning experience. In the next sections, the doctoral students describe how they carried out the project and how it helped them apply the disciplinary domain to interdisciplinary research findings on an important contemporary health issue. Following their discussion, reflections are provided by the elementary school teacher as well as the authors of the original facilitating humanization framework.

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A COHORT UNIFIED THROUGH DIVERSITY: THE STUDENTS' REFLECTION

We, the students in the cohort, are all nurses who chose nursing as a second career. There were many reasons that led each of us to choose this profession, and the span of experiences in nursing ranged from novice to expert and bedside to administrative. The similarities and differences in our backgrounds provided us with different perspectives in the discipline of nursing. The multitude of perspective lenses included acute care, critical care, rehabilitation, and academia. In the cohort, half of the authors entered the PhD program with a master's degree in nursing, and the other half undertook additional first-year master's-level coursework to bridge from a bachelor's degree to PhD. Prior to the theory class, our education in theory varied from minimal to master's level. The breadth of experience and multidimensional standpoint provided us with a unique angle to capture what we knew, what we did not know, and what we learned about an intangible subject and translated to a tangible project.

Among the professional differences, there were also similarities. The students were enrolled full time in the program, worked full time in their professional career, and had family responsibilities. The students had to balance their personal and professional responsibilities, and when offered the opportunity to work independently or as a team, we chose to creatively weave our personal and professional domains together. After spending 2 semesters as a cohort in the first year as PhD students, we became a cohesive group that appreciated one another's talents and what each person had to contribute.

For 2 of the authors, creative writing and art were hidden talents. The project allowed us to utilize our creative abilities and unified us like pieces of a puzzle in creating the children's book. In the early production of the project, we had a class discussion to brainstorm different methods of incorporating the theory and concepts that we had learned into an applicable and translatable result. Simultaneously, we were reading The Nature Fix, and it raised our awareness on the importance of environment and the correlation between nature and our health. With this new knowledge, we desired to share and expand further beyond the 4 walls of our classroom.

For some of the parents in the cohort, there was a struggle in finding the balance between exposing their children to technology and not letting it overcome their appreciation for the natural environment in its raw form. This discussion led to the story plot and title of the children's book (R. Amoah, T. Aung, A. Cornine, T. Tehan, Unpublished data, 2018). We based the premise of the book on how to create an opportunity for children to alternately choose utilizing their senses in nature and not let the influence of technology dull their senses. We decided to incorporate our children and make them the main characters in the book. The story started with the children watching television, and the power went out. As the power went out, a magical coyote appeared and the children followed the coyote on a nature walk. The children were asked to share their feelings and thoughts on the positive effects of nature on their mood and senses. The book was written in a classical rhyme, but the responses from the children were not scripted. The children were photographed in natural settings, and the photographs captured the children's experience in surrounding themselves in nature and the forest.

As the idea of a simple story plot transformed into a children's book, this became an outlet for our creative talents and allowed us to integrate the project into our personal lives. We shared the experience with the children in our lives and transformed the project into a lived experience for them. We spent a weekend afternoon with our children and shared the nature walk with them. The experience that Williams detailed in The Nature Fix made our own encounter come alive and reveal the same. In addition, the use of a mythical creature such as the coyote touched on the concept of humanization. The coyote was illustrated to show that the character was a wild animal. The coyote was drawn in an array of colors to symbolize it as a mythical creature. The idea of the coyote was dedicated to Dr Perry's personal experience with a coyote and her research involving human-animal interaction and society's perception of and attitude toward wild animals.

The project has surpassed our expectations that began as an assignment to incorporate our family into our scholarly inquiry. The project has been transformed into a message that can be shared with younger generations and other nursing professionals. We read the book to a group of elementary students and interacted with the students with a question and answer session at the end. Some of the PhD students later read the book to their own child's classroom as well. The children's responses and reactions to the book conveyed the conceptualization that we brought to life. The process of creating the book, spending time with our children, and reading to the young children and our own children's classroom was a meaningful experience for us all. As a collective whole, we translated and applied theory and knowledge in an understandable and graspable story that could be shared with the general population.

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A DIAMOND IN THE ROUGH: DOCTORAL STUDENTS APPLYING THE UNIFYING FOCUS

Willis, Grace, and Roy have proposed a central, unifying focus for nursing that identifies the “essential nature” of our discipline and transcends theoretical and conceptual frameworks. This focus is “facilitating humanization, meaning, choice, quality of life, and healing in living and dying.”17 (pE32) Willis et al17 describe the concepts of the unifying focus as facets of a diamond; each concept is connected to the others and reflects the whole. So are our practices as nurses and emerging nurse scientists; our practice informs our philosophical and theoretical beliefs and in turn the theory we come to understand informs our practice. Equally important is what we offer our nursing practice as humans. Willis et al17 explicitly identify humanization as the prescription for our discipline, but humanization applies to the self as well, as “it seems that nurturing human relationships and meaning are the 2 key aspects of living that we do not fully acknowledge and honor in our own lives as nurses and in contemporary health care.”(pE36) At the beginning of our project, we strived to guide the children in a process to mindfully engage in, appreciate, and benefit from the natural world, ultimately applying nursing's prescription for health. By the conclusion, we came to realize that as individuals, we had come to experience meaning, choice, humanization, and living, and that this assignment not only impacted us professionally but also helped us grow as humans. We applied, and describe later, each of the concepts separately; however, we acknowledge that these concepts are interwoven (see the Table).

Table

Table

Humanization recognizes that individuals are relational with the human-to-human, human-to-nature, and nature-to-human world. Nurses' commitment to facilitating humanization involves entering into a relationship with individuals that is open, intentional, without bias, and supports choice, growth, and health, even when healing is not possible. We intentionally chose to highlight human, nature, and animal interaction throughout the book. The backdrop for the story was a combination of photographs of our children in nature, as well as an illustration of a coyote. Not only did we want to include the nature-to-human interaction but chose to include human-animal interaction. This encounter was the first time our children had met; through this focused activity, they came to know each other and gained an understanding of the work their mothers engage in as graduate students in a concrete way that was meaningful to them.

One component of humanization is meeting individuals where they are and valuing their individual choices. At times, this may be difficult as nurses, especially when we know that one's choices may not facilitate health. In a simplistic way, this was experienced during our time taking photographs of the children. As a group, we had outlined the activities we wanted the children to engage in to ensure that our pictures explicitly demonstrated the concepts we were conveying. Our children ranged in age from 3 to 9 years, and while the older girls dutifully carried out the instructions, the 3-year-old boy had no intention of posing in the woods but instead chose to explore the nearby pond. This simple example drives home the individualistic component of humanization and how our role as nurses is to support individual choice, meaning, and values.

Meaning is the understanding individuals gain from the dynamic interplay between the human-natural world; through insight and integration, one is able to make choices.17 Meaning was experienced on 3 levels during this project. As a student-driven project, this assignment allowed us to develop a project that was meaningful to us. Through this project, we came to understand the relevance and application of nursing theory. This assignment was due in the middle of the semester in a cold New England March. To fully apply the concepts in The Nature Fix, we spent the afternoon outdoors, experiencing the principles in The Nature Fix. As we walked back from the park, we commented how we would never have taken the time to spend the day outside if not for the assignment but how just a few hours outdoors rejuvenated and renewed us.

Most importantly, through this project, we were able to apply interdisciplinary scientific evidence through a nursing lens. At the end of the book, discussion questions were provided to facilitate a conversation with children on nature and health: What does being healthy mean to you? What is your favorite thing about nature? How does being outside make you feel? (Figure). During the class presentation, we were able to ask the children these questions and engage them in a discussion on nature and health. The questions spurred the children to articulate the meaning of nature to them and by incorporating principles of health, we hope to encourage future choices that support a healthy lifestyle.

Figure

Figure

Willis et al17 describe 3 modes through which nurses construct meaning: by facilitating meaning related to health and healing concerns at the individual level; by influencing the broader health care and sociopolitical environment on issues related to humanization, meaning, choice, quality of life, and healing; and third by reflecting “on nursing concepts, ways of knowing, and practice knowledge; the relational use of self and natural world in forming effective healing relationships; and other healing modalities.”(pE35) During this project, we were able to experience 2 modes: the opportunity to reflect on nursing knowledge and practice and, by attending to the individual, through teaching the students about the benefits of the environment and supporting them in gaining personal meaning.

Choices reflect the decisions that are made by individuals and arrive from experiences, perceptions, and meanings. As a student-driven project, this assignment had choice embedded in it. Choice was also modeled in the book. For example, at one point in the book, the mother tells the children to “go outdoors, have fun, and explore.” Once the characters arrive outside, they meet a fantastical coyote who guides them on their outdoor adventure. The coyote poses a question to them, “Look all around, take it all in. Do you prefer the houses or trees? Which one will win?” The children chose the trees and respond, “We don't care for houses all lined up in rows.”

Willis et al17 define quality of life as “the value and significance ascribed by individual human beings to their lives, given their changing unitary human-natural world situation.”(pE35) To know quality of life for an individual, we must know them as human beings, including personal values. The students experienced being known by their faculty throughout this course and by empowering the cohort to determine the assignment, the faculty member facilitated the students' expression of their own values, thereby promoting quality of life.

Yet to facilitate human flourishing, we must also support individuals in making informed decisions; patient education has always been a core nursing activity, but in today's increasingly complex world, the nursing imperative requires us to translate this complex knowledge for patients to make informed decisions. The book The Day the Power Went Out is an example of nursing's translation of sophisticated information in a way that is accessible and understandable. The children in the book respond to a changing situation of loss of electricity through embracing and valuing an outdoor adventure. While this project was written for children, nurses interpret and translate sophisticated information for their clients across specialties, roles, and environments every day.

Choice is also embedded in the philosophy supporting our doctoral program. The graduate school of nursing program is “guided by the belief that we will best meet the needs of the future by helping students advance a scholarly path of inquiry that is driven by the questions emerging from their own practice and experience.”14 (p81) In this assignment, we experienced choice and meaning through selection of a unifying focus from various perspectives in the nursing literature and then applying that disciplinary lens within the context of nature and health.

The concept of health was the premise for the book. As a component of the unifying focus for nursing, health is defined as “the embodiment of wholeness and integrity in living and dying.”17 (pE35) Willis, Grace, and Roy call out health as an integration of the human-natural world, recognizing that we live through our body with continuous interaction with the natural world. Nature was the backdrop for our story and through the story line, we were able to convey principles of the positive impact of nature on health.

The unifying focus provided a conceptual map from which to consider applying interdisciplinary research findings. The assignment required us to incorporate the research described in The Nature Fix, but by starting with Willis, Grace, and Roy's central unifying focus for nursing, we were able to articulate concepts that we wanted to convey and provide the lens through which to view the science on health and the environment.

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WIDENING OUR VIEWS: INCORPORATING INTERDISCIPLINARY RESEARCH GEMS

If the elements of the nursing discipline are facets of a diamond,17 incorporating research from many disciplines might be seen as harvesting other unique diamonds from a mine. Beyond a brief mention of Florence Nightingale, The Nature Fix is not nursing-specific.11 This project allowed us to mine “gems” from other fields, including physics, forestry, forest medicine, microbiology, psychology, and ecopsychology.11 For example, the scent of the compound pinosylvin in evergreens has been linked to relaxation.11 , 18 Making this information understandable to an audience of 6- and 7-year-old students was a challenge. This drew on our nursing skills of interacting with clients across the life span and our abilities to translate science into practice, an important element of interest in the nursing profession.19 To illustrate this information from microbiology, the coyote character smells a pine branch, which prompts the children to ask whether he is foraging for food. When the coyote reveals that this scent helps him feel “swell,” the children smell a branch and agree that it helps their mood. We hoped that providing information in this way would make the multidisciplinary findings accessible to our audience.

Incorporating such a lens that looks beyond the nursing profession is not only in keeping with the American Association of Colleges of Nursing's position statement on PhD education1 but it also fits with nursing's rich history of collaborating with other disciplines in research endeavors.20 Yet, this interdisciplinary information was interpreted through the lens of quality of life as a central concept to the discipline of nursing.17 Not only did we understand the relaxation benefits of pinosylvin through our identification as nurses but we were able to personally experience the disciplinary concept of quality of life as we went outdoors and smelled the evergreen branches ourselves. As all of us integrate indoor jobs, full-time doctoral study, and other responsibilities, this opportunity to attend to our own quality of life while still completing a course requirement was welcome. By challenging us to incorporate knowledge from outside nursing within a nursing lens, this project allowed us to think about and fully experience this information as nurses.

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REFLECTION FROM ELEMENTARY SCHOOL TEACHER

My students thoroughly enjoyed their visit from the graduate nursing students from UMass. Having real photographs was a wonderful way to present the story. The coyote helped make the tale a fun adventure as well as connect the children to nature through wildlife. Also, the story began with the children planning to enjoy a day of television—until the power went off. I loved that the children were then told to go outside and explore. This is a common subject in my classroom as we often discuss the pros and cons of technology and how important it is to go outside and just play! My students were able to relate to the story and had many connections to the characters as well. The nursing students took turns reading the book to my children, which made it very enjoyable to listen to. The nurses also left one book as a gift to my class, which was displayed for free-read in May and my students have been rereading it and enjoying it each day!

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REFLECTION FROM AUTHORS OF FACILITATING HUMANIZATION

Reflection by Danny Willis

The nursing professor and PhD students' generative process and product of a children's book (The Day the Power Went Out) showcases the creative integration of central unifying concepts of the nursing discipline (ie, humanization, meaning, choice, quality of life, and healing) with lived experience. The inquiry process illuminated the value of human-to-human, human-to-nature, nature-to-human, and animal-to-human relations, reflecting back the integral nature of person-environment and health. These relations are seen as integral with processes of facilitating humanization as posited by Willis et al.17

Given the participatory inquiry processes, the PhD nursing students engaged in, the concepts came “alive,” in a sense. The concepts (as-lived-through in experience) certainly go beyond mere words on a page within a textbook, classroom discussions, or journal articles. As a result of lived embodied experience, the concepts carry a different gravity and energy now—they have resonated in one's very being and the learning experience incorporated multiple ways of knowing self, other, universe. The concepts and their meanings are unlikely to be forgotten and will likely guide these emerging scholars' future theoretical thinking in the discipline and within interdisciplinary contexts where nursing's voice needs to be amplified. Extending beyond a PhD graduate seminar on philosophy of science, theory, and nursing perspectives, the human-animal-natural world provided context and situatedness for enhanced learning and deeper understanding. The PhD students, educators, and the children all became closely acquainted with nursing and extradisciplinary concepts through this innovative project. The project was very creative and illuminating of how nursing conceptualizations, including processes/patterns of promoting humanization and other scientific perspectives (nature science), are needed in the assurance of individual, community, and societal good. Furthermore, this project clearly indicates that multidimensional nursing perspectives can be translated, experienced, and understood in the world by nonnurses. Many nursing perspectives, such as the one identified here on humanization, meaning, choice, quality of life, and health, provide the foundation for expanding human beings' meanings of health and healing. This innovative pedagogy facilitates integration and unity in coming to understand one another as human and nonhuman and within the larger context of the environment in which one lives.

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Reflection by Pamela Grace

This very creative project exemplifies in practice the spirit of the central unifying focus of the nursing discipline. In our article, we were concerned to provide nurses with a way to articulate the unique nature and perspective of nursing that both distinguishes it from the perspectives of other disciplines and also highlights its complementarity with the knowledge from, and viewpoints of, other disciplines related to human health. In the increasingly complex and technologically saturated contemporary environment we inhabit, it is more important than ever that we try to humanize/rehumanize life for all those in potential or actual need of nursing services. In a sense, this project epitomizes the health-promoting work of nursing. Recent research in the cognitive sciences has suggested that the incessant use of technology is subtly changing the way we interact and relate21 , 22 and for the most part not in a positive or healthy way. Given the lasting nature and effects that modern technology can have on developing brains, this project to connect children with the “natural” environment and their part in it is absolutely aligned with the goals of nursing knowledge development and its relationship to the profession's moral goals of furthering health and well-being.

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Reflection by Sister Callista Roy

I am convinced that facilitating humanization as a central unifying focus of nursing is imperative for the discipline. We can use this focus to create a structure of knowledge with a central role for nursing theories and multiple ways of knowing for domain-derived knowledge. With this strong nursing focus, we can integrate our knowledge with practice-shaped knowledge from other disciplines. Every application of this central unifying focus brings us closer to the consensus needed to facilitate knowledge development. This team of graduate students provides a creative application of the central unifying focus. Their project is an authentic application of the concepts and at the same time extends the understanding by including person-to-nature knowledge in a significant way.

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CONCLUSION

Nursing is a multifaceted discipline that mediates and facilitates positive human-to-human and human-to-environment relations for the betterment of health. Development and application of such a multidimensional discipline demand inventive integration of nursing and nonnursing concepts and theories. As nurses engage with other disciplines, it is important that they maintain a solid grounding in the unique body of nursing knowledge. The focus of the discipline articulated in the facilitating humanization framework provides a unifying lens for broad application.

Nurse researchers must extend their horizons to investigate areas that are not traditionally nursing but yet believed to yield positive public health outcomes. For instance, exploring contributions of human-to-nature relations toward quality of life, an important component of facilitating humanization, could bring a unique nursing focus to the emerging science of nature contact.

Flexibility for innovation in the research-focused graduate nursing curricula allows students to creatively explore a wide range of insights in order to contribute meaningfully to the development of nursing knowledge. As graduate students and future nursing scientists, we recommend that graduate nursing education should foster creativity (a virtue pertinent to successful careers in nursing research) among learning. Engaging in creative activities allows scholars to view knowledge from nursing and science in a new dimension, fostering the generation of new questions and answers; for practicing nurses, creativity supports the translation of knowledge to meet the needs of diverse clients.

In this article, we have described how we employed an integrative approach and incorporated interdisciplinary knowledge in applying Willis, Grace, and Roy's facilitating humanization conceptualization into a children's book project. The book became well embraced by a population of young students. Our experience supports that nursing disciplinary knowledge can successfully be integrated with emerging science from other fields to broadly advance human health with diverse populations and age groups. Moreover, such approaches can be applied to enhance theory application in nursing doctoral education. By encouraging doctoral students to have the lived experience of the unifying focus, the concepts become fully integrated into the student's knowledge, professional philosophy, and practice, fostering a generation of nursing scholars that can steward the unique nursing perspective.

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Keywords:

choice; disciplinary focus; exemplar; health; humanization; interdisciplinary; nature; nursing knowledge; pedagogical approach; quality of life

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