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Analyzation of the Word Renew in Modern Nursing

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Analyzation of the Word Renew in Modern Nursing

The word renew has a strong spiritual connotation; in the Bible the word renew is often

used in the Old Testament to signify something being made new through God. For example, in

Lamentation 5:21 the Hebrew word for renew ḥāḏaš is used and shows Jerimiah asking for his

people to be made new again through God (Strong’s H2318, n.d.). In the New Testament the

meaning of the word renew continues to demonstrate a spiritual restoration specifically within a

person. For example, in Titus 3:5 the Greek work for renew anakainōsis is used and states that

the renewal of humanity is attained through the mercy of God (Strong’s G342, n.d.). The

definition of renew in the Merriam-Webster dictionary (n.d.) provides several meanings of the

word including a spiritual meaning: “1: To make like new: restore to freshness, vigor, or

perfection as we renew our strength in sleep. 2: to make new spiritualty: regenerate. 3a: to restore

to existence: revive. b: to make extensive changes in”.

The purpose of this paper is to analyze the concept of renewal in modern nursing

literature then integrate those concepts into the current nursing profession’s understanding of

renewal. In addition, the concept of renewal in the nursing profession will be contrasted with the

use of the concept throughout the Christian ages. Implications for advanced practice nursing will

be discussed from the analysis of the concept in nursing literature and through the Christian ages.

Finally, a personal application from the materials reviewed in this investigation will be

evaluated.

Concept of Renewal Analyzed in Modern Nursing Literature

In order to discuss the concept of renewal in nursing literature (starting with WWII) the

stages of the development of nursing theory will be referred to. The stages of nursing theory and

philosophical development begin with the silent knowledge stage (McEwen & Wills, 2019). This

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stage is marked by the “blind obedience to medical authority” (McEwen & Wills, 2019, p.29).

The silent knowledge stage refers to the time before WWII and therefore will not be referenced

in this analysis. The next five stages that will be referenced are the received knowledge stage,

subjective knowledge stage, procedural knowledge stage, constructed knowledge stage, and

finally the integrated knowledge stage (McEwen & Wills, 2019).

Received Knowledge Stage

The received knowledge stage attributes learning through listening from others as a

source of knowledge (McEwen & Wills, 2019). The development of nursing theory in the

received knowledge stage includes the borrowing of theories from other disciplines, nurses

obtaining non-nursing doctoral degrees for solutions in nursing problems, and research that was

primary focused on education and sociology (McEwen & Wills, 2019). During this stage the

model for nursing education began to shift from the apprenticeship system found in hospital

programs to nursing educational programs in universities (McEwen & Wills, 2019). Throughout

this period there was a restructure of nursing professional organizations and state testing for

nursing licensure began to take effect (McEwen & Wills, 2019).

A report by Dr. Esther Brown (1948) titled “Nursing for the Future” discusses the need to

enrich the current nursing curriculum “Current experiments should be multiplied many times.

Large numbers of the reasonably good hospital schools are so stereotyped in their program and

so lacking in any dynamic quality that such attempts are urgently needed if only to restore their

vitality”. Dr. Brown (1948) argued for a standardization of curricula in nursing education which

is a mark of the received knowledge stage where there was a push for uniformity of nursing

programs in universities. The word restore used by Brown (1948) is analogous to the concept of

renewal and therefore will be included in the analysis. Brown (1948) uses the word restore to

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assert that the curricula of nursing programs must be made new through increased dynamic

quality in order to restore their strength. The concept of restoration is used by Brown (1948)

devoid of spirituality, God, faith, or religion.

Subjective Knowledge Stage

The next stage in the development of nursing theory is the subjective knowledge stage

(McEwen & Wills, 2019). During this stage the source of knowledge in nursing shifted from

borrowed theories to theories developed by nurses intended for nursing practice (McEwen &

Wills, 2019). In this stage nurse scholars were preoccupied with defining nursing and nursing

research concentrated on the nurse specifically (McEwen & Wills, 2019). During the 1950s to

the 1960s a revolution in nursing gave rise to nurse theorists preoccupied with providing

conceptual frameworks for nurse education and practice (McEwen & Wills, 2019).

Ernestine Wiedenbach a nurse theorist developed a conceptual model The Helping Art of

Clinical Nursing in 1964 (McEwen & Wills, 2019). Wiedenbach’s model explains that nursing

practice identifies the patient’s need for help through nursing observations (Petiprin, 2020). The

goal of nursing in Wiedenbach’s model is to identify the patient's need for help (Petiprin, 2020).

The need for help is defined by Wiedenbach as “any measure desired by the patient that has the

potential to restore or extend the ability to cope with various life situations that affect health and

wellness” (Petiprin, 2020). In this quote the concept of renewal is found in the analogous word

restore. Wiedenbach uses the word restore in reference to a patient’s coping ability. For

Wiedenbach it is the nurse’s role to help the patient find new strength to restore their coping

abilities. The word restore is used in this quote without any nod to spirituality, God, faith, or

religion. However, an argument can be made that patients can find renewed strength and

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restoration in coping abilities through spirituality, God, faith, or religion. But Wiedenbach

simply does not provide that argument for spirituality here.

Procedural Knowledge Stage

In the procedural knowledge stage of the development of nursing theory knowledge

attainment was attributed to objective analyzation for understanding and conducting procedures

to acquire knowledge (McEwen & Wills, 2019). The 1970s saw the nursing profession shifting

its view of itself “as a scientific discipline evolving toward a theoretically based practice

focusing on the client” (McEwen & Wills, 2019, p.31). In 1972 the National League for Nursing

required curricula in nursing educational programs to be grounded on conceptual frameworks

(McEwen & Wills, 2019). Beliefs on nursing and conceptual models on nursing were published

by numerous nursing theorists during this period (McEwen & Wills, 2019). Most notably during

this period there was a consensus among the nursing leaders of the common elements within the

science of nursing: person, health, environment, and nursing (McEwen & Wills, 2019). These

four concepts are otherwise referred to as the metaparadigm of nursing and many of the theories

developed in this time period discussed the relationships among these concepts (McEwen &

Wills, 2019).

Betty Neuman developed her nursing theory The Betty Neuman Health-Care Systems

Model: A Total Person Approach to Patient Problems in 1974 (McEwen & Wills, 2019). The

model “uses a systems approach that is focused on the human needs of protection or relief from

stress” (McEwen & Wills, 2019, p.150). One of the ten assumptions in Neuman’s model is

“Implicit within each client system are internal resistance factors known as lines of resistance,

which function to stabilize and realign the client to the usual wellness state” (McEwen & Wills,

2019, p. 154). The word concept realign is similar to the concepts of restoration and renewal

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and therefore will be analyzed. The word realign is used in reference to a person’s state of

wellness. Neuman asserts that each person has the ability within themselves to realign or restore

themselves to a former state which is one of wellness. The concept of realignment is used by

Neuman devoid of spirituality, God, faith, or religion.

Constructed Knowledge Stage

The constructed knowledge stage of the development of nursing theory attributes the

source of knowledge through reason, self-knowledge, and intuition (McEwen & Wills, 2019).

Nursing concepts and theories began to focus on the application of the theory in research and

practice (McEwen & Wills, 2019). Most notably the idea of evidence-based practice (EBP) was

introduced in this stage around the 1990s (McEwen & Wills, 2019). A terminal degree for

advanced practice nurses (APNs) was introduced as the Doctor of Nursing Practice (DNP)

because of the “recognition of the need for expanded competencies due to the increasing

complexity of clinical practice, enhanced knowledge to improve nursing practice and outcomes,

and promotion of leadership skills” (McEwen & Wills, 2019, p.32).

Brencick and Webster (1999) examined nursing philosophy that helped define the nature

of nursing. Brencick and Webster (1999) provided a holistic view towards nursing and the

concept of persons. The discussion of spiritual health is examined by Brencick and Webster

(1999).

Treatments that are impersonal and medications that merely blunt feelings cannot restore

health. From the foregoing I conclude that an environment that facilitates contemplation,

or at least does not interfere with it, and nurses who are able to maintain a high level of

spiritual health for themselves, are very important for promotion of the health of the

patient and of the nurse. (p.61)

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The concept of restoration is used in this quote in relation to the concept of health and

spiritualty. Brencick and Webster (1999) use the word restore, which is similar to the concept of

renewal, to argue that a nurse with a high level of spiritual health is vital for the of health of a

patient and the nurse. The concept of restoration is used to describe a person’s health being

returned to a state of wellness through spiritual strength.

Integrated Knowledge Stage

In the current stage of theory development in nursing, the integrated knowledge stage,

nursing theory frequently incorporates ideas from published literature and there is an emphasis

on clinical application theories (McEwen & Wills, 2019). Indeed, in the 21st century there has

been a shift towards nursing research that has clinical relevance and supports practice (McEwen

& Wills, 2019). It is anticipated that in this stage there will be ongoing interest in EBP, growth of

translational research, and interest to research that is centered on practical and clinical

application (McEwen & Wills, 2019).

Zucker (2009) discusses the need for translation research for clinical practice “However,

interest in demonstrating the “translational” nature and the connections of research to tangible

beneficial goals has been reinvigorated by the explicit attention to “translational research” in the

NIH roadmap initiatives and its priority for funding these types of projects”. Currently,

translational research has been dubbed a priority initiative by the National Institute of Health

(NIH) (McEwen & Wills, 2019). Translational research is expected to bridge the gap between

research and practice by validating evidence in a practice setting (McEwen & Wills, 2019). In

the quote Zucker (2009) uses a similar word concept to renewal which is reinvigorated therefore

will be analyzed in this investigation. The argument Zucker (2009) makes echoes the current

focus of nurse research, translation research, which produces real beneficial goals intended for

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clinical practice. The word reinvigorated is used by Zucker (2009) in reference to research and

goals for clinical practice. No reference to spiritualty, God, faith, or religion is noted in the use of

the concept of reinvigoration. Zucker (2009) asserts that translational research has given new

strength in clinical research and goals for practice.

Renew Integrated into Current Nursing Profession & Contrasted with the Christian Ages

In the received knowledge stage of nursing theory development theory development was

heavily influenced by other disciplines and used to guide nursing practice (McEwen & Wills,

2019). During this period nurse education shifted from hospital-based apprenticeship programs

to university educational programs (McEwen & Wills, 2019). Dr. Brown (1948) used the concept

of restoration in reference to the curricula in nursing educational programs. Brown (1948)

argued that curricula in nursing programs needed to be restored or strengthened through

improved dynamic quality. The use of the concept of restore did not include spirituality, God,

faith, or religion. Brown’s (1948) argument for the need of improved dynamic quality of nurse

education integrates with the current understanding of the importance of lifelong learning for all

nurses (McEwen & Wills, 2019). Nurses are encouraged to continuously expand their knowledge

like through enhanced education and training (McEwen & Wills, 2019). The current focused

value for continuous education in nursing reflects those values seen in the Age of Reason and

Revival era. During the Age of Reason Era philosophers emphasized logic and science while

downplaying religion (History.com Editors, 2018). During this time knowledge was a source of

strength rather than spirituality or God. The current emphasis for continuous knowledge is seen

as vital for the growth of practicing nurses.

During the subjective knowledge stage of nursing theory development theories began to

be developed by nurse scholars intended for nursing practice (McEwen & Wills, 2019). Defining

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nursing through conceptual frameworks for nurse education and practice was the main theme

among theories in this period (McEwen & Wills, 2019). In this period the nurse theorist

Wiedenbach (Petiprin, 2020) argued that the role of the nurse was to help the patient in finding

new strength towards restoring their coping abilities. The use of the word restore in reference to

new strength and coping abilities integrates with the current concept of well-being achieved

through heathy coping mechanisms. The concept of restoration within oneself is a current value

applied in nursing practice (McEwen & Wills, 2019). An argument can be made that the concept

of renewal and restoration through new strength can be found all throughout the Christian ages

up to Modern Period. This is because throughout the ages between the Early Church Period to

the Modern period a person can find inner strength and renewal through their value of God or

knowledge. Presently, a person can find personal inner renewal through any combination of

knowledge, spirituality, God, faith, or religion.

In the procedural stage of nurse theory development nurse scholars began to produce

conceptual frameworks concerned with the concepts of person, health, environment, and nursing

(McEwen & Wills, 2019). These concepts dubbed as the metaparadigm of nursing heavily

influenced nursing theory, research, and practice (McEwen & Wills, 2019). In contrast, at

present nursing research and theory is concerned with EBP, translation research, and research

that bridges the gap to practical and clinical application (McEwen & Wills, 2019). The word

realign used by the nurse theorist Betty Neuman describes her notion that each individual has the

ability to restore themselves back to a state of well being (McEwen & Wills, 2019). The concept

of personal realignment used by Neuman can be integrated with the present nursing value of

autonomy. Neuman asserts that each person has the ability within themselves to go back to a

state of wellness which is relevant to the ethical value of autonomy. Autonomy “refers to

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freedom from external control” (Potter et al., 2017). Allowing patients to have autonomy, to have

an active role in their care, and make decisions based on informed consent enables the patient to

have restored strength. This contrasts to the concept of inner renewal and restoration in the early

Christian ages where spirituality, God, faith, and religion was the sole source of inner renewal.

In the constructed knowledge stage Brencick and Webster (1999) developed a holistic

view towards the concept of person. The idea that nursing care should be holistic, and patients

should be seen as a whole integrates directly with the current nursing practice. For example, the

current motto for Loma Linda Medical Center is “To Make Man Whole” and is a nod to holistic

patient care (Loma Linda University Health, n.d.). The idea of holistic care is a relatively new

concept in nursing seen first with Martha Rodgers Theory of Unitary Man (1961) (McEwen &

Wills, 2019). Therefore, the concept of restoration used by Brencick and Webster (1999) for the

holistic care of the patient was not observed through the Christian Ages.

In the assessment of the current stage of nursing theory development, the integrated

stage, the word reinvigoration was analyzed. Zucker (2009) used the concept of reinvigoration

to state that translational research has given new strength in nursing. Nurse research, knowledge,

and science is a dominating theme at present in the practice much like how knowledge and

science was a dominating theme in the Age of Reason and Revival (History.com Editors, 2018).

Implications for APNs from the Literature and Historical Analysis

Implications for APNs from the nursing literature reviewed are that nurses can find

renewal or new strength from a combination of knowledge, education, faith, God, spirituality, or

religion. This is especially true because patient care is largely moving towards the notion of

holistic care. As nurses if we are expected to treat patients holistically then it would make sense

that our own spiritual health is pertinent. Implications for APNs from the historical analysis of

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the concept of renewal is similar. Historically, inner strength was found in spirituality, God,

faith, religion, knowledge, science, logic, and reason. A combination of these values

incorporated into nursing practice would strengthen nursing as a whole. Prayer and reading the

Scripture are some examples of how a nurse can incorporate spirituality into practice in order to

enhance spiritual renewal. Nursing research should be conducted to develop a personal

measurement questionnaire for the concept of spiritual renewal. Such a questionnaire can be used

in patient care to guide spiritual interventions that increase spiritual renewal.

In conclusion, the concept of renewal throughout nursing literature has connotations to

both spirituality and knowledge as was seen in the use of the concept throughout the Christian

ages. My personal application from the investigation is that there does not have to be choice

between either spirituality or knowledge. The two concepts can exist in my nursing practice

harmoniously and can strengthen me.

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References

Brencick, J. M., & Webster, G. A. (1999). Philosophy of nursing: A new vision for health care

(1st ed.). State University of New York Press.

Brown, E. L. (1948). Nursing for the future. Russell Sage Foundation.

https://www.russellsage.org/sites/default/files/Nursing-Future.pdf

History.com Editors. (2018, March 7). Great awakening. History.com. Retrieved November 6,

2022, from https://www.history.com/topics/british-history/great-

awakening#:~:text=In%20the%201700s%2C%20a%20European,the%20world%2C%20

while%20downplaying%20religion.

Loma Linda University Health. (n.d.). Mission and values. Loma Linda University. Retrieved

November 22, 2022, from https://home.llu.edu/about-llu/mission-and-values

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.

Merriam-Webster (n.d.). renew. In The Merriam-Webster.com Dictionary. Retrieved September

29, 2022, from https://www.merriam-

webster.com/dictionary/renew#:%7E:text=Definition%20of%20renew,to%20restore%20t

o%20existence%20%3A%20revive

Petiprin, A. (2020). Ernestine Wiedenbach. Nursing Theory. Retrieved November 21, 2022, from

https://nursing-theory.org/nursing-theorists/Ernestine-Wiedenbach.php

Potter, P., Perry, A., Stockert, P., Hall, A. (2017). Fundamentals of nursing. 9th ed. Elsevier.

Strong’s G342. (n.d.). Blue Letter Bible- anakainōsis - Strong’s Greek Lexicon (kjv). Retrieved

September 30, 2022, from https://www.blueletterbible.org/lexicon/g342/kjv/tr/0-1/

Strong’s H2318. (n.d.). Blue Letter Bible- ḥāḏaš - Strong’s Hebrew Lexicon (kjv). Retrieved

September 29, 2022, from https://www.blueletterbible.org/lexicon/h2318/kjv/wlc/0-1/

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Zucker, D. R. (2009). What is needed to promote translational research and how do we get it?

Journal of Investigative Medicine, 57(2), 468–470.

https://doi.org/10.2310/jim.0b013e31819824d8