We Have Never Been Nurses: Nursing in the Anthropocene, Undoing the Capitalocene

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Heat

Extremely hot or humid days are anticipated to continue, occur more often, and intensify over time. School-age children are especially vulnerable to extreme heat. The primary acute health effects of heat on children can range from heat exhaustion to heatstroke. The purpose of this article is to raise awareness of the impact some acute heat-related illnesses have on school-age children's health and to provide school nurses with information on the signs and symptoms of heat-related illnesses as well as prevention tips to share with parents and school administrators. This is the fifth article in a series meant to inform school nurses about illnesses linked to the climate and provide them with the tools they need to safeguard children' health.

Do no harm: A call to action by nurses to dismantle structural violence against LGBTQ+ youth

This commentary addresses structural violence - an overlooked and unrecognized harm within nursing. Structural violence within nursing practice refers to the violent impacts of racism, classism, homophobia, and transphobia as well as other biases on vulnerable and underprivileged groups. As one of the largest and most trusted health professions, collectively nursing has the power to leverage their influence to mitigate the harmful effects of structural violence when caring for LGBTQ+ youth.

Decolonizing nursing knowledge: Challenging Eurocentrism centering Global South voices

BACKGROUND

Exploring decolonization in nursing knowledge, particularly through Latin American nursologists, is crucial. Initially focused on underrecognized thought schools in Latin America and the concept of "Cuidado" versus Eurocentric paradigms, this paper extends the discussion on decolonization as potentially colonizing.

PURPOSE

This paper examines the decolonization discourse in nursing reinforcing colonization, arguing that the nursing metaparadigm remains Eurocentric, neglecting Global South contributions.

METHODS

The article critically discusses emerging theoretical ideas and situational theories from Latin America relevant to decolonizing nursing knowledge, providing analysis and proposing decolonization paths in nursing.

DISCUSSION

The paper calls for genuine decolonization, urging Global North scholars to engage with indigenous, marginalized, and non-Western perspectives. It stresses the importance of acknowledging historical injustices, fostering cultural sensitivity, and revising nursing curricula for inclusivity and equity.

CONCLUSION

Ultimately, the paper advocates for a transformative approach to nursing knowledge that challenges colonial legacies, promoting a more inclusive and equitable field.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Air Quality

Climate change is having an unprecedented influence on human health. Children's allergies and respiratory problems are increasing because of rising pollen levels and air pollution. School nurses are well positioned to prevent and treat allergies, asthma, and other respiratory conditions. Due to their consistent presence with the school setting, nurses can promote health, wellness, and academic productivity by addressing poor indoor and outdoor air quality. The purpose of this article is to increase understanding of how air quality affects the health of school-age children and to provide school nurses with primary, secondary, and tertiary prevention strategies for ensuring clean and healthy learning environments. This is the second in a series of articles aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect students' health.

Sharing the space of the creature: Intersubjectivity as a lens toward mutual human-wildlife dignity

Human-wildlife coexistence is critical for sustainable and healthy ecosystems as well as to prevent human and wildlife suffering. In this paper, an intersubjective approach to human-wildlife interactions is proposed as a lens toward human decentering and emergent mutual evolution. The thesis is developed through a secondary data analysis of a research study on wildlife care and philosophical analysis using the work of Bernard Lonergan and Edmund Husserl. The study was conducted using the theory of transcendent pluralism, which is grounded in human and ecological dignity, including the dignity of beyond-human beings. Deeper interpretation of the original data suggests that human-wildlife interactions are mutually conscious, embodied, and hold spatial-temporal dimensions. The affective realm is an integral dimension of human-wildlife intersubjectivity. These findings inform an approach toward human-wildlife relations in which human persons and the beyond-human multitude can all flourish in dignity.

Notes on [post]human nursing: What It MIGHT Be, What it is Not

With this paper, we walk out some central ideas about posthumanisms and the ways in which nursing is already deeply entangled with them. At the same time, we point to ways in which nursing might benefit from further entanglement with other ideas emerging from posthumanisms. We first offer up a brief history of posthumanisms, following multiple roots to several points of formation. We then turn to key flavors of posthuman thought to differentiate between them and clarify our collective understanding and use of the terms. This includes considerations of the threads of transhumanism, critical posthumanism, feminist new materialism, and the speculative, affirmative ethics that arise from critical posthumanism and feminist new materialism. These ideas are fruitful for nursing, and already in action in many cases, which is the matter we occupy ourselves with in the final third of the paper. We consider the ways nursing is already posthuman-sometimes even critically so-and the speculative worldbuilding of nursing as praxis. We conclude with visions for a critical posthumanist nursing that attends to humans and other/more/nonhumans, situated and material and embodied and connected, in relation.

Just-relations and responsibility for planetary health: The global nurse agenda for climate justice

There is an urgent call for nurses to address climate change, especially in advocating for those most under threat to the impacts. Social justice is important to nurses in their relations with individuals and populations, including actions to address climate justice. The purpose of this article is to present a Global Nurse Agenda for Climate Justice to spark dialog, provide direction, and to promote nursing action for just-relations and responsibility for planetary health. Grounding ourselves within the Mi'kmaw concept of Etuaptmumk (two-eyed seeing), we suggest that climate justice is both call and response, moving nurses from silence to Ksaltultinej (love as action). We review the movement for climate justice in nursing, weaving between our own stories, our relations with Mi'kmaw ways of knowing, and the stories of the movement, with considerations for the (w)holistic perspectives foundational to nursing's metaparadigm of person, environment, and health. We provide a background to the work of the Global Nurse Agenda for Climate Justice steering committee including their role at the 26th United Nations Climate Change Conference in Glasgow, 2021, and share our own stories of action to frame this agenda. We accept our Responsibility for the challenges of climate justice with humility and invite others to join us.

Nursing as total institution

Healthcare under the auspices of late-stage capitalism is a total institution that mortifies nurses and patients alike, demanding conformity, obedience, perfection. This capture, which resembles Deleuze's enclosure, entangles nurses in carceral systems and gives way to a postenclosure society, an institution without walls. These societies of control constitute another sort of total institution, more covert and insidious for their invisibility (Deleuze, 1992). While Delezue (1992) named physical technologies like electronic identification badges as key to understanding these societies of control, the political economy of late-stage capitalism functions as a total institution with no cohesive, centralized, connected material apparatus required. In this manuscript, we outline the ways in which the healthcare industrial complex demands nurse conformity and how that, in turn, operationalizes nurses in service to the institution. This foundation leads to the assertion that nursing must foster a radical imagination for itself, unbound by reality as it presently exists, in order that we might conjure more just, equitable futures for caregivers and care receivers alike. To tease out what a radical imagination might look like, we dwell in paradox: getting folks the care they need in capitalist healthcare systems; engaging nursing's deep history to inspire alternative understandings for the future of the discipline; and how nursing might divest from extractive institutional structures. This paper is a jumping-off place to interrogate the ways institutions telescope and where nursing fits into the arrangement.

Toward an ontology of the mutant in the health sciences: Re/defining the person from Cronenberg's perspective

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the 'person' or 'patient' that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken-for-granted definitions and assumptions of the 'person' from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the 'person' in nursing and beyond. Cronenberg's work explores bodily transformation and mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of 'the person'. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming-mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals

The Vitruvian Man is a metaphor for the "ideal man" by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse" (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

Thinking through critical posthumanism: Nursing as political and affirmative becoming

As a rejection and continuous reframing of theoretical humanism, critical posthumanism questions and imagines the human condition in the current context, aligning it with nonhuman and more than human entities, past and future. While this philosophical approach has been referenced in many academic disciplines since the 1990s, it has been gradually garnering interest among nursing scholars, leading to questions such as what it means to be human and what it means to be a nurse in the here and now. As a deeply ethical and political project, posthumanism, which we associate with poststructuralist concepts of power and resistance, questions the formation of posthuman subjects who more accurately reflect complex times, characterized by capitalistic commodification of life-human and nonhuman. In this article, we aim to explore how the ontological and epistemological underpinnings of critical posthumanism, specifically through Rosi Braidotti's works, can be useful to understand a posthuman subjectivity that favors affirmative actions aimed at actualizing our world in becoming. Through examples in nursing practice, education, and research, we will explore not only how critical posthumanism allows us to frame transformations in the current situation that we are embedded in as nurses and more generally as beings but also how these examples allow us to move beyond critique to the actualization of affirmative actions that correspond to the creation of new worlds.

Critical ethnography and its others: Entanglement of matter/meaning/madness

Beginning with a critical examination of the humanist assumptions of critical ethnography, this article interrogates and surfaces problems with the ontological and epistemological orientations of this research methodology. In drawing on exemplar empirical data from an arts-based project, the article demonstrates the limitations in the humanist-based qualitative research approach and advances a postdualist, postrepresentationalist direction for critical ethnography called entangled ethnography. Using data from a larger study that examined the perspectives of racialized mad artists, what is demonstrated in this inquiry is that the entanglement of bodies, objects, and meaning-making practices is central to working with the ontologically excluded, such as those who find themselves in various states of disembodiment and/or corporeal and psychic distribution. We propose the redevelopment of critical ethnography, extended by entanglement theory (a critical posthuman theory), and suggest that for it to be an inclusive methodology, critical ethnography must be conceptualized as in the process of becoming and always in regeneration, open to critique, extension, and redevelopment.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Mental Well-being

Human health is being impacted by anthropogenic (human-made) climate change. This article describes four ways that climate change may affect mental well-being in school-age children. First, natural disasters-such as more frequent and intense tornadoes and flash floods-may have a direct influence on mental well-being by contributing to acute anxiety and distress. Second, indirect effects of severe weather-including changes in social support systems-may affect mental well-being by increasing isolation. Third, children may suffer feelings of anxiety or depression if they perceive a sense of powerlessness to solve the challenges of a changing climate. Finally, school nurses need to be aware of the emergence of correlations-such as data that suggest increases in temperature may influence the use of inpatient mental health services and suicidal ideations-that require further scientific exploration. This article aims to increase school nurses' understanding of how climate changes may impact the mental well-being of school-age children and to provide strategies for creating a safe, healthy learning environment. This article is the fourth in a series aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect school-age children's health.

Planetary health in nursing curricula: How one school transformed nursing curricula as they integrated planetary health concepts with the 2021 AACN essentials

BACKGROUND

Human health and the health of the planet are inextricably interconnected. The human impact on the environment and likewise the impact of the environment on human health is well documented across various areas of study. Climate change, air and water pollutants, land usage, vector borne illness, and other examples demonstrate this relationship. Nurse educators would be negligent if this knowledge was not integrated and aligned with AACN Essentials competencies to demonstrate acquisition of knowledge.

METHODS

The five domains of the Planetary Health Education Framework were mapped to the AACN Essentials competency based framework.

RESULTS

Crosswalks were developed for Level 1 and Level 2 Domains, Competencies, and Sub- Competencies with the Planetary Health Domains. Specific Planetary Health outcomes were identified with supporting resources. Exemplars demonstrate the application of the Planetary Health domains to classroom activities and learning objectives.

CONCLUSIONS

In order for graduates to be practice ready, practice to the full scope of their license, and practice from a holistic perspective, nursing education programs must address the reciprocal impacts of planetary health and human health as it is imperative for the health of all.

Communicative action, a path through the dissonance between nursing and corporate healthcare values

There is tension in the US healthcare system due to conflicting goals of maximizing the public's health and at the same time ensuring shareholder profit among the many private organizations that provide care to those in need. As a result, nurses (often the frontline workers in this mixed public/private and economized system) may experience dissonance between their professional values and the capitalistic values embodied in the healthcare system. Beyond the workplace, nurses are also committed to championing health and wellness, to advocating for social justice, and driving health policy. Yet, constrained by the conflicts between neoliberal values in an economized system and the values of care that inspire many to join the healthcare profession, nurses may lose the ability to live up to their moral ideals, to champion social justice, and to improve public health outcomes. In this paper, we use the critical theory of Juergen Habermas to explore these tensions and to suggest a path forward for nurses. We suggest that by engaging in dialog with each other and the public, and working for greater inclusivity, nurses can find ways to deconstruct ideologies inherent in our current healthcare system, to consider alternatives, and liberate healthcare from the dominance of market forces.

Nursing in a posthuman era: Towards a technology-integrated ecosystem of care

The healthcare sector has undergone significant transformation due to the rapid advancements in artificial intelligence and biotechnologies, presenting both opportunities and threats to the nursing profession. Posthumanism, as a critical perspective challenging anthropocentrism and emphasizing the increasingly blurred boundaries between humans and nonhumans, provides a novel lens to comprehend these technological advancements. In this commentary paper, I draw on the posthuman discourse to argue that in light of these technological forces, we need to contemplate the core values and fundamental patterns of knowing within the nursing discipline, reconfigure nursing scope, redefine its relations with other agents, and embrace a technology-integrated ecosystem of care.

Nurses as Disciplinary Agents of the State: Ethical Practice and Mandatory Reporting in the United States

This article reviews legislative initiatives that mandate nurses to report patients, families, and clinicians to law enforcement. Most recently, these laws target transgender and gender diverse (TGD) youth and people seeking abortion. In this article, we examine the ethics of such laws through professional ethical codes. Furthermore, through a biopolitical lens, we critically analyze examples of nurses' participation in complying with laws that harm patients. Finally, we discuss the damage these laws have on the nursing profession and assert the necessity of a resituating of professional ethics that considers the complexity of nursing care amidst increasingly blatant state-sanctioned violence.

Nursing for the Chthulucene: Abolition, affirmation, antifascism

Critical posthumanism as a philosophical, antifascist nonhierarchical imagination for nursing offers a liberatory passageway forward amidst environmental collapse, an epic pandemic, global authoritarianism, extreme health and wealth disparities, over-reliance on technology and empirics, and unjust societal systems based in whiteness. Drawing upon philosophical and theoretical works from Black and Indigenous scholars, Haraway's idea of the Chthulucene, Deleuze and Guattari's rhizomatic thought, and Kaba's abolitionist organizing among others, we as activist nurse scholars continue the speculative discussion outlined in prior papers. Here we further imagine how we can engage a radical philosophical mission of care for all beings human and non, walking and working alongside the people and communities nurses accompany, connected as we are on this dystopian celestial orb. Discussion is centred on critical analyses of traditional justice framing in nursing, and on the praxis possibilities found within rhizomatic thought, making kin, and just episteme while knitting filaments of nursing theory and history, humming song lyrics from collective memory, and critically dismantling received wisdoms to stumble toward a more emancipatory present future.

Diversity regained: Precautionary approaches to COVID-19 as a phenomenon of the total environment

As COVID-19 emerged as a phenomenon of the total environment, and despite the intertwined and complex relationships that make humanity an organic part of the Bio- and Geospheres, the majority of our responses to it have been corrective in character, with few or no consideration for unintended consequences which bring about further vulnerability to unanticipated global events. Tackling COVID-19 entails a systemic and precautionary approach to human-nature relations, which we frame as regaining diversity in the Geo-, Bio-, and Anthropospheres. Its implementation requires nothing short of an overhaul in the way we interact with and build knowledge from natural and social environments. Hence, we discuss the urgency of shifting from current to precautionary approaches to COVID-19 and look, through the lens of diversity, at the anticipated benefits in four systems crucially affecting and affected by the pandemic: health, land, knowledge and innovation. Our reflections offer a glimpse of the sort of changes needed, from pursuing planetary health and creating more harmonious forms of land use to providing a multi-level platform for other ways of knowing/understanding and turning innovation into a source of global public goods. These exemplary initiatives introduce and solidify systemic thinking in policymaking and move priorities from reaction-based strategies to precautionary frameworks.

Patterns of Knowing and Being in the COVIDicene: An Epistemological and Ontological Reckoning for Posthumans

The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.

(Re)defining nursing leadership: On the importance of parrhèsia and subversion

AIM

Through a review of philosophical and theoretical constructs, this paper offers insight and guidance as to ways in which nurse leaders may operationalize advocacy and an adherence to nursing's core ethical values.

BACKGROUND

The US health care system works in opposition to core nursing values. Nurse leaders are obliged to advocate for the preservation of ethical care delivery.

EVALUATION

This paper draws upon the philosophies of Fromm, Foucault, and Deleuze and Guattari to critically review the functions of nurse leaders within a capitalist paradigm.

KEY ISSUE

Key emergent issues in the paper include health care and capitalism and the nurse leader's obligations towards advocacy.

CONCLUSION

The nurse leader acts as parrhèsia in viewing truth telling as a duty critical to improving the lives of patients. Ramifications of the decisions by those in power have even greater impact in institutions that serve those with little to no political agency.

IMPLICATIONS FOR NURSING MANAGEMENT

The nurse leader has a freedom and platform that their patients do not and must take the courageous risk of choosing to speak. This paper serves as a call to action for nurse leaders to urgently address the current state of US health outcomes.

A radical imagination for nursing: Generative insurrection, creative resistance

In the crucible of the pandemic, it has never before been clearer that, to ensure the relevance and even the survival of the discipline, nursing must cultivate a radical imagination. In the paper that follows, I trace the imperative for conjuring a radical imagination for nursing. In this fever dream for nursing futures, built on speculative visions of what could be, I draw on anarchist, abolitionist, posthuman, Black feminist, new materialist and other big ideas to plant seeds of generative insurrection and creative resistance. In thinking through a radical imagination, I unpack the significance of reparatory history for nursing, a discipline founded on normative whiteness. From there, I consider what it would take to shift the capitalist frame of healthcare to one of mutual aid, which requires the deep work of abolition. With a radical imagination that breaks down the enclosures that contain us through reparatory history, mutual aid and abolition, kinship becomes urgently possible.

Mental health nursing and conscientious objection to forced pharmaceutical intervention

This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments.

Nursing With the People: Reimagining Futures for Nursing

We wish to advance a theory of nursing that intentionally engages in questions of politics and economics, centering equity and justice as a foundation for the provision of nursing care. As health care costs rise and health disparities widen, nurses have a clear imperative to develop alternative health care delivery models unmoored from the conventional employment and profit-driven structures that now disappoint us. This mandate arises from our disciplinary focus that emphasizes social justice as a social and moral good linked to the human services nurses provide. This kind of sociopolitical engagement is not auxiliary to nursing but rather central to our ethos. A health care environment that prioritizes profit over the well-being of people is an anathema to our disciplinary focus which, we believe, should center communities and people. The health care system that has forged nursing in the United States, transforms nursing into a commodity. This reinscribes inequality for those who are unable to access care, contributes to environmental harm through profligate hospital pollution and waste, and exploits nursing staff as workers. Nurses have a history of both upholding oppressive systems that disenfranchise segments of the public, usually poor, often People of Color, and engaging in innovative alternatives to the status quo. We wish to foster revolutionary alternative care delivery models that free us from the neoliberal confines of for-profit health care. Ultimately, we argue, nursing as a discipline and a science cannot neglect our role as whistleblowers and change agents. Nor can we presuppose that our dysfunctional and harmful health care structure in the United States is a foregone conclusion. Health care is constructed, which means it can be reconstructed. If we wish to realize our emancipatory potential as nurses, critically examining our role in upholding oppressive structures is a critical step toward a more robust future of nursing.

Harnessing the power to bridge different worlds: An introduction to posthumanism as a philosophical perspective for the discipline

Although it is argued that social justice is a core concern for the discipline, nursing has not generally played a leadership role in the responses to many of the greatest social problems of our time. These include the accelerated rate of climate change, pandemic threats, systemic racism, growing health and social inequities, and the regulation of new technologies to ensure an equitable future 'for all.' In nursing codes of ethics, administration, education, policies, and practice, social justice is often claimed to be a core value, yet it is rarely contextualized by philosophical or theoretical underpinnings. It appears that nurses' commitment to social justice may stem more from a penchant for 'doing good' than an attempt to explore, understand, and enact what is meant by social justice from an ontological, epistemological, and methodological perspective. We contend that the dominance of a human science perspective in nursing contributes to a narrow definition of health and relegates many issues central to social justice to the margins of nurses' care. In this article, we explore how the focus on 'the human' in the human science perspective may not only be limiting the capacity of nurses to develop strategies to adequately address social injustice, but in some instances, direct nurses to contribute to their very reproduction. We suggest that a critical interrogation of this human-centric hegemony can identify avenues of rupture and introduce posthumanism as an additional philosophical perspective for consideration to help bridge the human-social divide.