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The Disciplinary Perspective of Nursing

Commentary From Nursing Education

Lindell, Deborah F., DNP, MSN, RN, CNE, ANEF, FAAN

doi: 10.1097/ANS.0000000000000254
Discussion Commentary
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Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Correspondence: Deborah F. Lindell, DNP, MSN, RN, CNE, ANEF, FAAN, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106 (Deborah.Lindell@case.edu).

The author acknowledge the mentorship and guidance of Dr Joyce Fitzpatrick.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

THIS ARTICLE is a call to action to address the critical need to prepare nurses who understand and value our unique disciplinary perspective and integrate throughout their practice. This article was stimulated by the Nursing Theory Think Tank (NTTT) convened by the Frances Payne Bolton School of Nursing, Case Western Reserve University, in October 2017. Eminent nurse scholars-theorists-philosophers reflected on the state of philosophical and theoretical knowledge in nursing, developed a consensus disciplinary perspective of nursing, and recommended actions to promote viability and relevance of the disciplinary perspective.

The expansion and structuring of nursing knowledge and efforts to articulate our disciplinary perspective have been regularly accompanied by concerns about the “theory-practice gap” and descriptions of nursing as “a profession at the crossroads.”1 (p61) With an ever-increasing emphasis on goals such as the Triple (or Quadruple) Aim, nursing must, to ensure its survival, consistently articulate and demonstrate unique value as member of the health care team. Willis and colleagues declared: “We believe that nurses must lead the discipline forward by knowing what our central unifying focus for practice is, developing it, teaching it, and speaking it, thereby transforming self, other, and the larger healthcare environment.”2 (pE37)

Nursing education is essential to making this happen! Students, across educational programs, should be expected to understand and value the disciplinary perspective of nursing and be guided and held accountable to incorporate it in their work: clinical practice, education, research, or other scholarly activities.

This is not a new idea. Recently, Roy observed that, in 1959, “Johnson challenged nurse educators that ‘certainly no profession can long exist without making explicit its theoretical bases for practice so that this knowledge can be communicated, tested, and expanded.’”3 (p82) Sadly, almost 60 years later, the same calls continue, while the need and risks are more urgent than ever.2 Yet, anecdotally, nurses often struggle to recall the conceptual framework of their educational program(s), question the relevance of theory to practice, are not familiar with mid-range theory, and describe a perspective of nursing that combines a holistic view of persons with a strong biomedical element.

What is to be done? How do we begin? First, consensus on the disciplinary perspective of nursing will facilitate its inclusion across nursing education programs. Students are open to philosophical ideas and want to appreciate nursing in its full breadth but may become frustrated when exposed to several versions of a similar construct. They comment, “Why can't nursing ever agree on what we are about?” Second, let us not reinvent the wheel. Rather, build on opportunities, challenges, and action plans proposed by Roy,3 and others, and utilize established models such as the think tank and process improvement to promote nimble, timely change. Stakeholders from education, practice, and policy development can review and make recommendations regarding integration of the disciplinary perspective of nursing in education programs, practice settings, accreditation criteria, and licensure and certification test plans.

Third, the QSEN Institute4 provides a model for effective diffusion of innovation in nursing education. Examples of its approaches include prelicensure and graduate competencies; publications; conferences; Web site of peer-reviewed, teaching-strategies; and faculty development workshops.

It will be important to identify level-appropriate outcomes and curricula as well as teaching strategies that go beyond a traditional course on nursing theory to integrate the disciplinary perspective throughout the educational program, particularly clinical practice and simulation. One example of a clinical outcome is that a nurse is able to articulate nursing's unique value and contributions to peers, patients, and when collaborating on the interprofessional team.5 To support learning and application of the disciplinary perspective as well as appreciation for nursing as a unique discipline, students can be introduced to Nursology; that practice can, and should, be theory- and evidence-based; and encouraged to use all patterns of knowing, including emancipatory, to fully implement the disciplinary perspective.6–8

In summary, the critical need for nurses to practice through the lens of a unique disciplinary perspective is clear and associated challenges are well documented. However, as illustrated in articles from the 2017 NTTT and other authors, there are opportunities as well to ensure ongoing viability and relevance of our disciplinary perspective in nursing. Nursing education is a cornerstone of this endeavor.

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REFERENCES

1. Grace PJ, Willis DG, Roy C, Jones DA. Profession at the crossroads: a dialog concerning the preparation of nursing scholars and leaders. Nurs Outlook. 2016;64(1):61–70. doi:10.1016/j.outlook.2015.10.002.
2. Willis DG, Grace PJ, Roy C. A central unifying focus for the discipline: facilitating humanization, meaning, choice, quality of life, and healing in living and dying. ANS Adv Nurs Sci. 2008;31(1):E28–E40. doi:10.1097/01.ANS.0000311534.04059.d9.
3. Roy C. Key issues in nursing theory developments, challenges, and future directions. Nurs Res. 2018;67(2):81–92. doi:10.1097/NNR.0000000000000266.
4. QSEN Institute. http://www.qsen.org. Accessed November 28, 2018.
5. Fawcett J. Thoughts about collaboration—or is it capitulation? Nurs Sci Q. 2014;27(3):260–261. doi:10.1177/0894318414534493.
6. Nursology. https://nursology.net. Accessed November 28, 2018.
7. Fawcett J, Watson J, Neuman B, Walker P, Fitzpatrick J. On nursing theories and evidence. J Nurs Scholarsh. 2001;33(2):115–119.
8. Chinn P. Critical theory and emancipatory knowing. In: Butts J, Rich K, eds. Philosophies and Theories for Advanced Nursing Practice. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2018:143–161.
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