Epilogue: Sustaining Nursing Science

The science of unitary human beings provides a comprehensive philosophical and theoretical foundation for nursing. Rogers' abstract system is grounded in numerous contemporary scientific theores ranging from relativity theory, quantum theory, quantum cosmology, systems theory, chaos theory, and evolutionary theory; all enveloped in a humanistic philosophy. The focus on unitary human beings as pandimensional, irreducible wholes in mutual process with their environment sets forth a conceptual systems that establishes nursing as a distinct discipline, which like all other disciples, has its own unique focus. The strength of a discipline is not how similar it is with other disciplines, but rather the value of its uniqueness.

Some nurses have suggested that since nurses will need to work more within a multidisciplinary perspective, nursing theory language limits interdisciplinary communication and collaboration and prevents the formation of interdisciplinary partnerships. However, collaboration depends on the ability of each discipline to clearly communicate their professional focus and the nature and extent of their contribution to the common shared goal. If the nurse is using only knowledge derived from other disciplines such as medicine or psychology, the nurse would have little to contribute to the care of the patient distinct from what physicians and psychologists contribute. If nurses use a nursing theory to guide assessment, the nurse would have information distinct from any other member of the team and therefore contribute to a new understanding of the patient’s situation that likely is not otherwise addressed. Clearly Rogers' nursing science provides nursing with knowledge about human beings and their health that is of great value in any [[#|nursing care]] situation.

What can assure that the science of unitary human beings becomes integral to the theoretical basis of nursing?

11.1 The End of Nursing Science?

A number of nursing scholars (Cody, 1997; Fawcett, 1999; Levine, 1995; Mitchell, 1997; Rawnsley, 1999; Reed, 1998) have pointed out a decreasing emphasis on the application of unique nursing knowledge in [[#|nursing education]] and practice. Interest in Rogerian science and nursing theory in general seemed to have reached its peak in the 1980s. Recently, DeKeyser and Medoff-Cooper (2002) commented that “over the decade of the 90s nursing theory seemed to take an increasingly smaller role in the content of schools of nursing” (p. 330) and “practicing nurses are continuing with their daily routines and are often unaware that the world of nursing theory is changing” (p. 329). The vast majority of published nursing research continues to be conceptualized from theories borrowed from other disciplines. More importantly, few nurses in practice use a nursing conceptual framework or nursing theory as the theoretical foundation for conceptualizing and guiding their work.

Of greatest concern is an entire generation of nursing students who are being educated with minimal exposure to the value of nursing-theory guided [[#|education]], research, and practice. Few students even learn about Rogers’ nursing science of unitary human beings, and worse, if nursing theory is taught at all, it is taught as having only historical value or taught in one isolated nursing theory course. In addition, confining nursing theory to graduate studies, which is the custom in many schools of nursing, conveys the false notion that theory is too esoteric and underestimates intelligence and abilities of undergraduate students in learning how to engage in theory-guided practice.

The lack of education grounded in nursing’s distinctive knowledge base may be a significant reason why there is a decreasing interest in Rogerian scholarship. With no tradition of educating the next generation of nurses in the traditions of nursing’s distinctive body of knowledge, the interest and flow of students into specific schools of nursing theory will become a mere trickle. There are strong indicators of decreasing Rogerian scholarship. There is evidence of declining submissions to Visions: The Journal of Rogerian Nursing Science, declining membership in the Society of Rogerian Scholars, fewer doctoral dissertations guided by Rogerian science, decreasing [[#|attendance]] at the national Rogerian conferences, and decreasing submissions to the Rogerian newsletter. Without catalysts to transform new energy into Rogerian scholarship, Rogerian science-based nursing is at risk of coming to an end.

How can we assure that in this world, the science of unitary human beings will continue.

11.2 Sustaining the Vision

Assuring the survival of Rogers’ vision requires a concerted effort of all Rogerian scholars toward living the values inherent in Rogerian science while making Rogers’ science and vision of nursing visible to all. Like the mass synchronization of fireflies and the sustaining energy of stars, it is incumbent on all Rogerians to make the science of unitary human being visible in all realms of nursing and in the public in general. The survival of Rogers’ vision requires effort directed toward creating fundamental change, transformation, and new direction.

Kotter (1996) outlined processes for creating major changes. First is the establishment of a sense of urgency. The decreasing emphasis on nursing theory-based education and practice is beyond urgency. It is a crisis. The very survival of nursing as an independent academic discipline rests solely on the development and use of a distinctive knowledge base. Secondly, Kotter states that a coalition of persons acting together like a team needs to be created to lead the change. This column is a call to action, a call for synchronization of [[#|energy]] of those devoted to theory based practice and those devoted more specifically to advancing Rogerian science.

Third, Kotter explains one needs to develop a vision and strategy to guide and direct the change effort. Visions are about possibilities, about desired futures. Visions are ideals, standards of excellence, expressions of optimism and hope. Visions communicate what makes us singular and unequaled and ideal reveal our higher order value preferences. Visions give focus to human energy (Kouzes & Posner, 1997).

Kotter’s fourth process of creating change is communicating the change vision. Below are a number of visions or “luminescent beacons” to provide direction in sustaining and advancing Rogers’ vision of nursing. While a number of visions address nursing theory-based practice more generally, any vision that is designed to enhance the establishment of nursing theory-based practice as foundational to nursing will help actualize the vision of sustaining and advancing Rogerian nursing science. A beacon is usually a light used as a “signaling or guiding device” (American Heritage Dictionary, 2000, p. 155). Thus, each vision is offered as a beacon of light signaling a fundamental change, transformation, and new direction guiding the advancement of nursing theory-based practice more generally and in many instances, Rogerian science specifically.

11.3 Luminescent Beacons for Advancing Nursing and Rogerian Science

1) ANA standards of nursing practice accurately reflect the scope and diversity of nursing practice. We must make it clear to the standard writers at ANA that nursing practice is not only guided by the nursing process, but the nursing process is guided by extant conceptual framework. More importantly, the standard need to acknowledge that nursing practice is guided by specific practice methodologies other than the nursing process that are derived from conceptual frameworks. For example, the Rogerian practice methodology of pattern manifestation knowing/appreciation and voluntary mutual patterning is an established way of practicing nursing derived from Rogers science of unitary human beings that needs to be encompassed within any set of standards for nursing practice.

2) Accrediting organization of schools and colleges of nursing (AACN and NLN) make it clear that content on nursing philosophy, metaparadigm concepts, conceptual frameworks of both the simultaneity and totality paradigms, and practice methodologies derived from extant nursing theories are taught at all levels of the nursing curriculum. Most scholars agree that a unique body of knowledge is an essential quality of a profession (Styles, 1982). The use of nursing knowledge is a hallmark of nursing practice (Fawcett & Carino, 1989), distinguishes nursing as an autonomous health profession, and represents nursing’s unique contribution to the health care system (Parse, 1995). Nursing's distinctive knowledge base is expressed in nursing’s metaparadigm concepts, philosophy, patterns of knowing, paradigms, conceptual frameworks and theories specific to nursing, and practice models. A unique body of knowledge is a foundation for attaining the respect, recognition, and power granted by society to a fully developed profession and scientific discipline. Furthermore, the autonomy of a profession rests most firmly on the uniqueness, recognition, and recognized validity of the discipline’s theoretical knowledge.

Undergraduate nursing students expect to become knowledgeable, competent, ethical, and caring professionals who provide nursing care for promoting health and well-being. To meet this goal, it is essential that nurses acquire the knowledge, skills, values, meanings, and experience that are specific to nursing. Accrediting organizations have a tremendous impact on establishing what is considered "essential" content for the preparation of nurses. AACN and NLN need to explicitly identify nursing conceptual frameworks as the foundation of nursing education and make the integration of extant nursing frameworks a criterion for accreditation.

3) Extant nursing theories and their distinct practice and methods of inquiry form the core for organizing and structuring knowledge taught in nursing education at all levels. Nursing theory is integrated in all nursing courses. Specific nursing theories/models, including Rogers’ science of human beings, serves as a way of conceptualizing and organizing content in nursing courses. Nurse educators in the clinical setting need to teach, role model, and practice from a nursing theory base so that students can experience how nursing theory guides practice. Students are evaluated on their ability to conceptualize and base their practice on extant nursing theories/models.

4) Colleges of nursing recruit and retain faculty who are not only diverse in research interests but are diverse in terms of their paradigmatic and theoretical nursing perspectives. Balanced and healthy colleges of nursing not only have identified areas of excellence in scholarship but also have faculty with diverse educational, methodological, and theoretical expertise. In order for nurses to be educated within and across nursing paradigms, schools of nursing will need a faculty that embrace paradigmatic diversity as well as nurse scholars/educators/researchers who have expertise in a variety of nursing theories and research traditions, including the Science of Unitary Human Beings. Students have most to gain when they are exposed to multiple theoretical perspectives.

5) All nursing students graduate with knowledge grounded in extant nursing frameworks, including Rogers’ Science of Unitary Human Beings. Students who major in any discipline graduate with a wealth of knowledge about the application of using theories and conceptual frameworks specific to their discipline. For example, psychology students graduate with knowledge of psychological theories that describe the nature of the mind, development, and personality. Should not all nursing students be educated in the knowledge specific to nursing? Knowledgeable nursing students graduate grounded in the application extant nursing theories, practice methodologies, and modes of inquiry in both the totality and simultaneity paradigms. Nursing students are prepared for professional nursing practice when they are able to apply a variety of nursing theories to guide patient care in any given nursing situation.

6) NCLEX exams and certification exams for specialty and advanced nursing practice incorporate competency in the understanding and application of a variety of nursing theories. Its time that licensing exams accurately incorporate and make nurses and nurse educators accountable for learning and teaching knowledge that is specific to nursing, including extant nursing conceptual frameworks, which are the essence of all nursing knowledge. Nurses can no longer afford to ignore this unique scientific knowledge base. Only when nurses everywhere use knowledge specific to nursing will the nursing discipline achieve parity with other scholarly disciplines. Members of a discipline have the obligation to concern themselves with the knowledge base of their discipline, participate in its development, guide its use, and evaluate the work of their colleagues on the basis of the work’s relation to the extant theory base of the specific discipline (Cody, 1994). Once nurses base their practice, education, and research on nursing theory, nursing’s unique contribution to human well-being will become visible in the world of science, health care, and society. Incorporating nursing knowledge on licensing and certification exams would assure nursing content is taught and learned.

7) Major nursing textbooks integrate a variety of nursing theories. Major textbooks must move beyond including a chapter on nursing theories, which rarely addresses how the theory can be used in practice, toward integrating knowledge about the application of nursing theories. Just as frequently as nursing textbooks include knowledge about nursing diagnosis and the nursing process, alternative nursing practice methodologies need to be included and integrated throughout textbooks in order to present a more balanced perspective on the diversity of conceptualizing nursing phenomena.

8) JCAHO criteria for accrediting hospitals indicate the nursing practice must be guided by extant nursing theories. When hospitals realize quality care is grounded in theory-based practice, they will invest in implementing information systems, data collection tools, and documentation instruments that support nursing theory-based practice. All practicing nurses are expected to and are able to practice nursing from a nursing theory base. When interviewing for a position at a hospital, nurses are routinely asked what frameworks they use in practice and employee evaluation criteria include the ability to effectively use nursing theory-based practice.

9) National Institute of Nursing Research funds nurse researchers who conceptualize research within nursing’s extant theoretical frameworks. Currently, the mass majority of funded and published nursing research is conceptualized from theories borrowed from other disciplines. Having a unique body of knowledge is the very essence of a discipline. Donaldson and Crowley (1978) pointed out in their classic article, "a discipline is not global; it is characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry" (p. 113). Similarly, Meleis (1997) pointed out “a discipline provides a unique way of considering the phenomena that are of interest to its members” (p. 42). When conducting research there is nothing wrong with conceptualizing the research problem within a theory from another discipline. However, research conceptualized using non-nursing theories or borrowed theories from other disciplines does not advance nursing science nor does it advance the development of a unique body of disciplinary knowledge (Parse, 1994).

10) Independent nurse owned and managed centers abound and are places of excellence where nurses practice independently guided by extant nursing theories. Advanced practice nurses need to provide an alternative service promoting health and well-being that is complementary and not a substitute or surrogate for medical care. Extant conceptual frameworks provide the scientific foundation for providing unitary and holistic nursing care and are the foundation of independent advanced practice nursing.

11.4 A Call for Responsibility

John Wheeler, who along with Steven Hawking is one of the most eminent physicists of our time, believes that we are not simply bystanders on a cosmic scale; rather we are shapers and creators living in a participatory universe (Folger, 2002). In being informed of the work by Pierre Telihard de Chardin, Henri Bergson, and Alfred North Whitehead, it is not surprising Rogers’ nursing science is evolutionary, participatory, and process in nature. The notion of participation is integral to Rogers’ Science of Unitary Human Beings. Specifically, integrality, mutual process, and knowing participation in change all speak to Rogers’ participatory epistemology (Butcher, 1994, 1997). Participation is an implicit aspect of a unitary ontology. Skolimowski (1994) explains that one cannot truly conceive of the nature of wholeness unless one grants that the meaning of wholeness implies that one must participate in it. Participation is the core of life, the song of joy in experience, the source of meaningfulness, the profound catalyst of an evolving universe, and the vehicle of transforming visions into actualities. Furthermore, Skolimowski (1994) asserts meaningful knowing participation in change includes responsibility for change. Understanding integrality, or unity of the living and non-living, knowing that everything is inseparable, implies we must take responsibility.

Those invested in the endurance and advancement of Rogerian nursing science and all have a responsibility to participate in transforming visions into actualities. Laszlo (2001) reminds us that visions of “the future cannot be predicted; they must be created . . . the world we create in reality depends on us” (pp. 210-211). Responsibility is an intrinsic value in Rogerian-ethics (Butcher, 1999). Rogers frequently linked the science of human beings to the fulfillment of nursing’s social responsibility for enhancing well-being and human betterment. Knowing participation in change includes responsibility. Like the transformation of energy creating the light that emanates from fireflies and stars, nurses devoted to advancing nursing and Rogerian science have a responsibility to collectively direct their energy to make the vision real.

11.5 Being and Becoming a Beacon of Light

Each of us devoted to advancing Rogerian and nursing science has a part to play. We all have a part to play in the fire dance. We are all stars and each of us has the capacity and responsibility to burn brightly. Meaningful, deliberate, knowing participation in change is the way in which humans bring forth a new world (Butcher, 1997).

1) Live the values of Rogers’ Science. Sustaining the vision of Rogerian science involves living the values inherent in Rogers’ life and her work. In an earlier work, Butcher (1999) identified a constellation of values inherent in Rogers life and her works. Living the values of courage, commitment, transformation, responsibility, optimism, and wisdom have particular relevance in devoting energy toward advancing Rogerian science. Living the values of Rogerian science can be a continual source of inspiration and energy.

2) Attain positions of responsibility and facilitate transformation. Kotter (1996) explains that in order for change to occur, broad-based action is needed. Obstacles such as systems or structures that undermine the change vision need to be overcome. Becoming a dean of a college of nursing; chairing curriculum committees; sitting on the boards of hospitals, state boards of nursing, and nursing organizations; being a hospital administrator or unit administrator; or sitting on a NINR review board that funds “nursing research” are some examples where Rogerian scholars can work in assuring the voice and value of nursing theory based education, research, and practice is heard and advanced. In becoming members on boards of organizations such as ANA, NLN, AACN, NINR research review boards, State Boards of Nursing we can move nursing toward formally recognizing nursing’s distinctive knowledge base in educational and practice settings.

3) Nurse educators must create ways to incorporate nursing theory and specifically the science of unitary human beings in every course you teach. It is an educator’s ethical responsibility to teach nursing’s substantive knowledge. The survival of any theoretical system depends on the investment of this generation of nurse educators to pass on the ideas, values, concepts, principles, research findings, and practice methods of the discipline’s theoretical systems and research traditions to the next generation. Any aspect of teaching nursing knowledge can be connected to and integrated with postulates and principles in Rogerian science.

4) Nurse researchers must conceptualize their research in ways that serve to advance Rogerian science. Only a few Rogerian scholars have developed a program of research or a series of studies that build one on another. Until NINR becomes more receptive to Rogerian science, a couple of strategies can be used to further Rogerian research. For example, using theoretical triangulation, funded studies can be reconceptualized from a variety of theoretical perspectives. In addition, a Rogerian research study can “spin-off” of a larger, funded grant or use secondary analysis by taking some aspect of the data and re-examine it through the lens of Rogerian science. In addition, new concepts and tools need to be developed, old concepts reconceptualized, and Rogerian research methods tested and developed. Studies need to be replicated and expanded. Viable conceptual systems and research traditions need to have an active and growing community of scholars who are committed to advancing the science by conducting research and mentoring the next generation of research scientists.

5) Nurse administrators must lead their staff in implementing theory based nursing practice. Nurse administrators informed about Rogerian science can teach, role model, and formally implement the Rogerian practice methodology in their practice setting. There are numerous examples in the Rogerian science literature, and in the literature of other conceptual systems particularly Roy’s Adaptation Model, Parse’s theory of human becoming, Orem’s self-care deficit theory, and Neuman systems model, that describe successful implementations in various practice settings. The processes of implementation described in this literature can be useful in guiding the process of integration of Rogerian science in practice settings.

6) Support the advancement of Rogerian science by being actively involved in the Society of Rogerian Scholars. In laying the foundations for nursing, Nightingale (1893) declared, “no system can endure that does not march” (p. 198). Rogerian science has endured so far; however, the march toward the fulfillment of Rogers’ vision remains unfulfilled. A major catalyst in the movement of any science toward achieving wider recognition is the collective participation of its members in professional organizations. Freidson (1986) points out that the professional association is the major “formal means by which the interests of its members are pressed collectively and focused politically” (p. 185). Professional organizations are the vehicle that serves to create a collective identity, political entity, and a voice for the profession (Beletz, 1990). A major limitation in moving Rogerian science forward is the low participation of nurses in the Society of Rogerian Scholars. Without the active involvement of each member in the professional society, Rogerian science may languish in the shadows. The Society of Rogerian Scholars is a major vehicle educating others about the science and promoting the advancement of Rogerian scholarship. The Rogerian Society acts as a resource for emerging Rogerian scholars. To march also means “proceed directly and purposely . . . to walk steadily and rhythmically forward in step with others” (American Heritage Dictionary, 2000, p. 1068). Through collective actions of its members, the Rogerian Society needs to expand recruitment and energize its membership to actively participate in the organization. The only limit to the force of collective action is the number of members working together to effect change.

7) Support the Society of Rogerian Scholars Newsletter and Visions: The Journal of Rogerian Nursing Science by submitting work for publication. As the common statement in academia goes, “publish or perish;” the same can be said about the survival of a scientific system. Unless new work is being generated and published, the science will perish. Rogerians have two excellent vehicles for disseminating their work: the newsletter and the journal. Yet, as of late, both have struggled with not having enough submissions for publication. At the same time, Rogerian scholars need to publish work in other prestigious, referred journals so that a wider audience can become familiar with Rogerian science.

8) Seize opportunities to tell stories to the public, health care professionals, and other nurses of how nursing is distinct from medical science when guided by extant nursing conceptual frameworks. Buresh and Gordon (2000) explain in some detail how nurses can inform the public about the true nature of nursing by telling stories that illuminate the value of nursing’s contribution to health and human betterment. Similarly, Rogerian nurses can engage with and educate the public by telling stories that illuminate how Rogerian science makes a difference in everyday health situations.

9) Rogerians must devote serious scholarship and effort toward making sure Rogers’ original work remains easily accessible to educators, students, researchers, administrators, other health care professionals, and the public. New in-print or on-line primary sources are needed and must be made accessible to the next generation of Rogerian scholars. Most of the primary sources of Rogers’ work are no longer in print. Those teaching and those students interested in learning about Rogerian science are finding it increasingly difficult to access the classic and current Rogerian literature. In addition, a new comprehensive text based on Rogers’ post 1970 revisions that explicate Rogerian research and practice methodologies is needed. Every three to four years, Roy, Orem, Neuman, Leininger, and Parse publish new editions of their theories/models assuring that their science remains accessible and endures. In addition, a number of classic nursing theory texts have been reprinted in their original form. For example, Peplau and Henderson’s original books have both been reprinted and made accessible for students.

11.6 Finding Energy in the Apparent Void

The summer night thunderstorm rattles all from their sleep, reminding us that we are enveloped in creative energy. Torrents of lightening shatter the apparent void. The Midwest nighttime thunderstorms strike with sudden force and then recede quickly, revealing a night sky inky black. Crickets are chirping and fireflies flashing again. Stars are blazing overhead.

Between December 18-25, the Hubble telescope’s keepers focused on an area of “least activity,” an apparently empty quadrant in the vicinity of Ursa Major’s tail no larger than a dime seen at 75 feet (Benson, 2002, p. 105). The sampled image, the deepest image at the time ever taken of the heavens, collected beams of light from this tiny speck of sky for 10 consecutive days using 342 exposures. When the exposures were cleaned up, processed, and digitally fused this area of apparent darkness and emptiness housed about 1,500 pinwheel galaxies and other galactic forms. Since that deep field image was assembled 7 years ago, astronomers have concluded that no matter what seemingly empty speck of space deep cameras focus on, there are an abundance of glinting powerhouses (Benson, 2002). Even where there is apparent darkness, there is light. Even where there is apparent emptiness, there is a fullness of energy.

Now is the time for all to rise up; burn brightly, and illuminate the void in nursing. Now is the time to make Rogerian science visible to all.

11.7 References

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