A Dynamic and Inclusive Approach

Abstract

After a year of transition to a new publisher, Creative Nursing 2024 will build on our legacy of nurturing novice authors with a Student Article of the Year initiative; presenting courageous discourse as reflected in our overarching theme for the year, The Impact of Social Forces on Nursing and Health; and publishing even more new knowledge in the form of research and discussion of nursing theories and models. This issue's theme, Activism, Advocacy, and Allyship, is exemplified by articles about paths to a nursing workforce that reflect the people we serve, and about concepts such as hygge, dialectical pluralism, acculturative stress, shared decision-making for breast health, nature immersion, iceberg demographics, and self-care in palliative care.

Creative Nursing 2023 was a year of transition and new experiences. We moved to a new publisher (Sage Publishing), published an open access issue (Vol. 29 (1), Inspiring, Recruiting, and Retaining the Health-Care Workforce), began publishing individual articles OnlineFirst (and then including them in the appropriate theme issues), and used our new capacity for publishing in languages other than English (to include content in Spanish, Arabic, Persian, and Chinese).

Building on Our Legacy

Creative Nursing 2024 will take our journal's legacy to new levels. Our historic mission to nurture novice authors now includes intentionally inviting submissions from students; we will select one published manuscript each year as Student Article of the Year. Our editorial board's dedication to presenting courageous discourse about topics many journals avoid is reflected in our overarching theme for the year, The Impact of Social Forces on Nursing and Health, with articles addressing racism in nursing, social violence, the ethical implications of artificial intelligence, and power imbalances in health care.

But the most visible expansion of our commitment to nursing scholarship will be publishing more articles about research and theories. This is a deepening, not a departure for us. We have been presenting theories and models and implications for knowledge translation since caring science pioneer Jean Watson's “Social Justice and Human Caring: A Model of Caring Science as a Hopeful Paradigm for Moral Justice for Humanity” (Watson, 2008). A complete reference list of all the articles would be longer than this editorial, but topics include using affective methods to address resistance, narrative learning in the virtual landscape, advocating for early-career nurse innovators, the Bridge Care Model for at-risk students, a Hawaiian model for aiding friends coping with dementia, an international profile of caring, and a sexual health model for older adults. Other articles have analyzed Dorothea Orem's Self-Care Theory, Margaret Newman's Theory of Health as Expanding Consciousness, four historical theories often applied in Communities of Color, and the use of the Neuman Systems Model to help a patient with preexisting mental health issues cope with COVID-19. Searching our journal website, https://journals.sagepub.com/home/cng/, using these terms will help you find these compelling articles and many others that refer to models and theories.

Frameworks of new knowledge that were presented first in our pages include the Nichols–Nelson Theoretical Model of Comfort (Nichols, 2018), the Houser Gear Conceptual Model for New Nurse Educators (Houser, 2020), and a Midrange Theory of Empowered Holistic Nursing Education (Love, 2014). And the title of this editorial is from “Exploring the Potential of Dialectical Pluralism for Nursing Knowledge Development” in this issue, by Shahzad Inayat and Graham McCaffrey of the University of Calgary. Dialectical pluralism appreciates divergent viewpoints, encouraging a more nuanced and inclusive understanding of complex nursing phenomena. Their actual verbatim quote is, “As nursing knowledge is pluralistic in nature, [dialectical pluralism] as a philosophical worldview has the potential to produce dynamic and diverse knowledge” (Inayat & McCaffrey, 2024, p. xx).

We offer new knowledge in this issue: a middle-range Theory of Nature Immersion as presented by Misako Nagata, a holistic nurse practitioner in Tokyo, and Patricia Liehr from the Christine E. Lynn College of Nursing at Florida Atlantic University. In Florence Nightingale's view, vital power, a health force that manifests in states of being while doing in nature to generate well-being, was an essential element of health. These authors’ content analysis of parental reflections on their children's experiences in nature reflected changes in the children's well-being. (Nagata & Liehr, 2024).

The concept of acculturative stress, which arises from the process of adapting to a new culture while balancing the realities of what was known and what is current, and its effect on the mental health of children of immigrants, is reviewed by Cassandre Horne, also of Christine E. Lynn College of Nursing at Florida Atlantic University. The author concludes that social support is necessary as these children and young adults work to reconcile different worldviews; a multifaceted approach to health care is needed that incorporates culturally appropriate responses to stressors (Horne, 2024).

Inclusivity

The inclusivity in this issue is reflected in our theme: Activism, Advocacy, and Allyship. Our Guest Editor, Ernest Grant, Past President of the American Nurses Association (ANA) and now Vice Dean for Diversity, Equity, Inclusion and Belonging at Duke University School of Nursing, outlines the history of racism within the nursing profession, including exclusionary policies within the ANA itself, and intentional actions that constitute a real revolution, to repudiate and reverse this history (Grant, 2024).

Three other articles address course corrections needed to create a nursing workforce that reflects the people we serve. Mona Lee and Kim Cook of American Career College describe an innovative partnership between their institution's School of Nursing and AltaMed, a Federally Qualified Health Center in Los Angeles, California. The AltaMed Nurse Workforce Diversity Program supports Licensed Vocational Nurses on their staff, many of whom are Hispanic/Latino, in earning associate's degrees in nursing, passing the licensure exam, and entering positions as RNs (Lee & Cook, 2024).

To help health-care organizations succeed in talent acquisition and retention in a labor market that is both browning (becoming more racially and ethnically diverse) and graying (aging due to extended longevity and declining fertility), James H. Johnson Jr. and G. Rumay Alexander of the School of Nursing at the University of North Carolina at Chapel Hill present the concept of iceberg demographics—inherited and acquired traits that may not be visibly apparent—and highlight three such demographics that are particularly relevant in the nursing workforce: people with mixed-race identities, people experiencing menopause, and people with cognitive impairments, particularly young adults with long COVID (Johnson & Alexander, 2024).

Katie Boston-Leary of the ANA's Division of Nursing Practice and Work Environment and Olga Yakusheva of the School of Nursing and the School of Public Health at the University of Michigan outline structural issues within the current nursing reimbursement model. They emphasize that making the costs of direct nursing care visible and increasing the focus on nursing-sensitive patient outcomes metrics will strengthen the business case for investing in nurse staffing and work environments, lending opportunity and numerical stability to the nursing workforce (Boston-Leary & Yakusheva, 2024).

Dynamism

The dynamism in this issue is shown by the wide range of people nurses are helping, and the creativity of the tools and methods they are using to help.

Warm Comfort for People With Cystic Fibrosis

Hygge, a set of practices originating in Nordic countries to cope with winter's cold and long nights, is characterized by accepting conditions out of one's control, communal engagement, slowing down, finding balance, practicing mindfulness, and appreciating nature. Warmth and light are important elements of hygge. These practices can help people with chronic health conditions including cystic fibrosis (CF), a progressive condition with complex therapies and physical limitations. Leslie Pitts and colleagues Lynn Stover Nichols and Sigrid Ladores of The University of Alabama at Birmingham School of Nursing, Brittany Woods of the Oak Ridge Institute of Science and Education, and Morgan Polen, a CF community member and consultant who hosts the “Moms with Cystic Fibrosis” Facebook page, interviewed 15 people with CF who use hygge to promote wellness and cope with their disease. Results revealed that hygge practices influenced individuals’ aesthetics, attitudes, and activities, deeply impacting the physical and emotional experience of living with CF (Pitts et al., 2024).

Reflection on Giving and Receiving Palliative Care

In the field of palliative care, there is recognition of the importance of self-care, but the concept itself remains nebulous, and proactive implementation of self-care is lacking. Kalli Stilos of Lawrence Bloomberg Faculty of Nursing at the University of Toronto describes her interest and work in reflective writing, sharing a personal account that provides a source of happiness and an opportunity to better understand her own palliative care practice. Nurses need to explore ways of being with the dying that serve both the health-care provider and the dying person practically and spiritually, bearing witness, listening, and staying present as patients tell their stories (Stilos, 2024).

A Tool for Understanding Benefits and Risks of Breast Health Measures

Existing guidelines for breast cancer screening include assessing individual risk but contain no universally recommended risk assessment tool in the primary care setting. The balance between the benefits and adverse consequences of screening (improved outcomes versus false-positive tests, overdiagnosis, overtreatment, and cost) must be considered when providing breast health care. Louisa Krueger of the University of Minnesota Mankato School of Nursing presents a breast cancer risk assessment tool that provides an evidence-based foundation for shared decision-making conversations between patients and nurses/providers about risk reduction and screening. Nurses have a unique position in conducting risk assessment screenings, engaging in meaningful conversations with patients, taking into account their personal history, experiences, and expectations, and building trust (Krueger, 2024).

Insight into the Experience of Poverty

To address health-care disparities and promote social justice, educators need to prepare nursing students to care for diverse and vulnerable patient populations. Tamara Holland and colleagues Laurie Walter, Kerri Langevin, Adam Bourgoin, Michele McKelvey, and Christine Kirk from Central Connecticut State University, and Catherine Thomas from Worcester State University in Massachusetts report on a simulation experience, the Missouri Association for Community Action Poverty Simulation, in which participants role-play a typical month of living below the poverty line, navigating their community to meet basic needs with a minimal income and facing challenges related to employment, childcare, food security, and chronic illness. Participants reported a deep appreciation of the varied personal, societal, and structural barriers faced by individuals and/or their families, as well as their realizations of the tenuous nature of day-to-day survival (Holland et al., 2024).

Our remaining three themes for 2024 are Social Media and Artificial Intelligence, Social Violence, and Transforming Power Over to Power With. Some articles will be highlighted on the Sage Perspectives blog, and others will have video interviews with the authors posted on our website. Look for virtual abstracts in articles and expanded coverage of our virtual launch events celebrating the publication of each issue.