Foreword by Jean Watson

Jean Watson, PhD, RN, AHN-BC, FAAN, LL (AAN)

From decade to decade, from one century to another, hospitals and healthcare systems have grappled with Nursing and Nurses. Now, each are faced with even greater upheavals with Post-COVID survival, as our industrialized healthcare institutions are turning upside down, and inside out.

Outdated industrial, economically dominated healthcare mindsets are now having to face loss of core values, meaning, and purpose; resulting in loss of nurses, dispirited nurses, shortage of nurses, turnover of nurses, retention of nurses, unhappy nurses, 'less resilient' nurses and on it goes. In their own way, each are grasping at short-term straws for any superficial 'fix it' tactic to solve this looming, but longstanding institutional human care, nursing quandary.

There is open critique from the public, worldwide, that continues from one decade, one century to another, that the so-called modern, healthcare industry is really a sick-care, body- physical, techno cure system - a system built upon an industrial, product model which differentiated diagnosis, technical treatments from patient/family personal meaning. A system that separated human from their humanity, their culture, spirituality, beliefs, and inner life world of subjectivity, in relation to outcomes. This dominant medicalized, institutional method of control over humanity has reigned over nurses and patients alike. It has been void of self-control, self-knowledge, self-care, self-choices for health and self-healing.

The result: Nursing being restricted from practicing its own profession. Nursing being restricted from its core values, philosophical moral, ethical covenant with humanity and human caring/healing/health for all. Such an industrial model, dominates, to this day, even while knowing other options. Without attention to the evolved, spirit-filled paradigm of health and human caring/healing that integrates nursing's foundational disciplinary philosophy and core values, the inevitable conclusion is that Nurses and hospitals, can no longer endure outdated, detached, medicalized, clinicalized, 'doing' models.

In mainstream organizations, there ironically remains, a proclivity for a dominant practice pattern, disconnecting one's theory and disciplinary grounding about the nature of nursing and nature of human experiences. Thus, there is reluctance to give voice, language, and informed reflection and critique to guide one's actions. Nurses at bedside often left with inability to articulate Nursing to self/system and the public.

To this day, the discourse from within nursing itself, including the American Academy of Nursing, and American Association of Colleges of Nursing continue to debate in despair how to address the 'nursing workforce shortage', the critical need for nurses (al la bodies) to serve a dysfunctional sick-care system of hospitals, in contrast to maturing professional nursing. Beyond hospital nursing culture and patterns. (Author, AAN program, 2022).

In spite of knowing better, mainstream nursing education and practices continue to have an affinity, almost a bias, towards focus on functional, concrete tasks institutional technical skills. This focused mentality is geared towards satisfying the technical accountability demands of a dysfunctional medical, institutional bureaucracy. In turn, restricting and limiting new patterns of professional practice to improve outdated systems, promoting hospital nurses to be directly accountable to the public for caring, healing, health. As such, nursing's caring ethos has been eclipsed from its natural prominence and place in the conventional medical-care system.

Moreover, the overriding culture of the patriarchal system, in spite of new societal awakenings for equity, diversity, and inclusivity, continues to further restrict nursing from its full development as a distinct discipline, within both practice and academic settings.

Ironically, in midst of these perennial institutional, historic and contemporary Nursing impasses, a timeless global model from the mid-eighties existed within our sight, but oddly overlooked, passed by, and out of sight. Christopher John's revised edition of the UK Burford Nursing Development, Professional Practice model, uncovers solutions to status quo institutional thinking.

It offers up a powerful mature Professional Nursing model of human caring/healing and health; grounded and informed by and from Nursing's own disciplinary solutions, overturning solidified institutional cultures. In this pre/postmodern world of medical science despair, and disorder of our human-environment healthcare/body physical, materialistic, technological 'sick care' system, there is overwhelming agreement that nursing education and healthcare are in a state of post-COVID disequilibrium. As a result, the institutional, scientific, and technological orientation of today's medical and nursing care systems cannot be sustained. Continuous inter/national studies and commissions, reports and research around the world indicate a growing consensus between and among the public and the nursing, medical and health community, search for dire measures to disrupt, repattern the prevailing institutionalized models. The first edition of John's book, in the eighties, demonstrated how Burford Nursing transcended the industrial depersonalized model. Even then during the eighties, the techno cure, bureaucratic hospital model was predicted as doomed, and deemed increasingly archaic and dysfunctional. The public continues to suffer the consequences. The Burford Model, in the eighties demonstrated how Nursing can offer professional caring/healing and health beyond medical/cure foci.

The original Burford model incorporated all the contemporary mandates for change; e.g. multi-disciplinary teams, broad based, integrated caring-healing practices, knowledge and skills; models that attend to praxis activities that seek to both integrate and transform the nurse's personal and professional values, beliefs, and reflective acts with clinical decision making in the concrete world of persons and individualize practices.

As John's clinical scholarship points out, 'all models of nursing are implicitly and explicitly underwritten by the assumptions of their authors concerning the nature of nursing'. It can be likewise acknowledged that all nursing practice is implicitly and explicitly influenced by the practising nurses' views and values concerning the nature of Nursing. And what it means to be human. In that nursing faces all the vicissitudes of humanity; nurses carry all the wounds of society - the joy, pain, celebrations, suffering, harms, hurts, loss, grief, death, dying, and before/beyond death/life - mystery, miracles, and unknowns. Nursing deals with paradox and ambiguity of human-universe existence.

One of the breakdowns in nursing practice is, and has been, the separation of the theories, philosophies, values, and worldview of the discipline of Nursing, from institutional professional nursing practice. The separation of one's calling, from reflective, critiquing of status quo, however, without reflective inquiry nurses has the tendency to conform and often complain, rather giving voice and informed moral action to sustain and actualize human caring-healing practices.

Without disciplinary grounding and informed reflection, critique and actions, nurses are left with inability to publicly and professionally ask new questions or constructively critique institutional care, towards generating new solutions. Solutions that overturn status quo assumptions about what matters? What counts as knowledge? Without informed disciplinary reflection nursing practice perpetuates separation of self from system; knowledge from voice; reflection from action. This non-reflective pattern tends to act without asking; tendency to conform and leap in, without stepping back, pausing, reflecting, questioning.

However, the good news is during the past four to five decades, nursing scholars and clinicians at multiple levels, behind-the-scene of conventional systems, have been questioning and revising nursing's very foundations for education, practice, and research. Such efforts have resulted in the critique of the dominant ideology of the patriarchal system; have led to the generation of multiple nursing theories, clinical nursing research, and theory-based practice models; have led to a revisiting of nursing ethics, basic philosophic beliefs, and ultimately to a re-examining of what is intended and needed for truly professional nursing practice.

For example, during the 1980s, with rise of doctoral nursing education, further important discourses emerged across developed countries about the nature of nursing science. These discourses critiqued nursing's 'modern' epistemological emphasis on empiricism, and critiqued the lack of ontological-philosophical-moral-ethical clarity and congruence among, and between ontology of 'being'; the nature of personhood, caring, health, illness and environment; and about the nature of nursing itself. This discourse brought new voice to nursing's place in healthcare; and has led to new perspectives about the nature of nursing's paradigm and the role of caring values and knowledge in theory and in practice.

Part of nursing's self-critique and revision of the profession is related to nursing coming of age, growing up as both a discipline and profession; is related to nursing gaining philosophical, moral, ontological, epistemological, and pragmatic clarity about its subject...