Letter to the Editor by Fred Payne et al. to OJIN topic ”The New Millennium: Evolving and Emerging Nursing Roles”

Response by Fred Payne et al. to OJIN topic "The New Millennium: Evolving and Emerging Nursing Roles"

Dear Editor,

Underlying nursing and nursing education is an approach to evaluating patients and communities that is deficit-based. The deficit approach defines an individual through mapping out what is wrong with them, including health conditions, addictions, and social stressors. In this model, the nurse becomes a mechanic, trying to fix all that is wrong. In contrast, a strength-based approach shifts the focus to what is right with people, defining them by their strengths, skills, and resources. Strength-based approaches do not ignore what ails patients and communities but rather build a more holistic picture of each patient and community to address health conditions. If patients and communities are evaluated from a strengths approach, nurses become coaches, rather than mechanics, focused on empowering and motivating patients toward improved health.

Asset mapping has been applied to community level health interventions since it was introduced in 1993 by Kretzmann and McKnight (1993). Over the last decade, the Strength Based Nursing (SBN) framework has been described by Laura Gottlieb who proposes that this approach “reaffirms nursing’s goals of promoting health, facilitating healing, and alleviating suffering…bolster[ing] patients’ capacities for health and innate mechanisms of healing” (Gottlieb, 2014, p.24). SBN aligns with many core values of nursing, including patient-centered care that is critical for improving the quality and safety of healthcare. (Santana, 2018, p.429) SBN and person-centered care both center on empowering the people we care for, something that a deficits-based approach struggles to achieve. (Nanez, 2023, p. 277)

The following reasons for moving toward SBN were summarized by a group of nursing students into four points. First, this approach helps nursing return to its core value of seeing and caring for whole people (e.g. person-centered care). Second, SBN builds a skill set of identifying and using people’s strengths in their care plan, a skill that is currently not taught or practiced enough in nursing. As one of our student authors stated, “This shift requires nurses to go beyond simply treating symptoms or managing diseases. It means actively engaging with the patient's life, values, and strengths to create care plans that are not only medically sound but personally meaningful.” Third, SBN plays a role in maintaining the joy of being a nurse and addressing burnout by fostering deeper connections with patients and improving the experience of being a nurse. Finally, SBN is a critical tool for addressing health inequities, undoing racism, and decolonizing the care we provide. Inherent in our nursing education and practice are biases toward White, heterosexual, English-speaking people. One of the participating authors, an Indigenous nursing student, has seen the ways her people are deficit-mapped when receiving healthcare by people who take little interest in the person’s Indigenous culture. “It is essential to become educated on the traditions, values, customs, religion, and culture of the population being served, [allowing for] less-biased and more effective nursing care,” she commented.

Nursing education has a long way to go if we are to move from being mechanics to being coaches, moving toward SBN and strength-based approaches for our patients and communities. It starts with being curious to know what people are good at, where their resilience lies, how they have overcome obstacles. Develop your own strength-based questions and begin using them and documenting them in your notes. That leads nicely into teaching this approach, both with shadowing students at the bedside and in the classroom. Now is the time to move nursing education from training deficit-based mechanics to strength-based coaches.

Fred Payne III
University of New Mexico, Albuquerque, New Mexico.
Email: fpayne@salud.unm.edu

Sydnie M Pino
University of New Mexico, Taos, New Mexico.
Email: sydpino@unm.edu

Onamma A Edeh
University of New Mexico, Albuquerque, New Mexico.
Email: oaedeh@salud.unm.edu

Loren S Kelly, MSN, RN
University of New Mexico, Albuquerque, New Mexico.
Email: lskelly@salud.unm.edu

Anthony N Fleg, MD, MPH
University of New Mexico, Albuquerque, New Mexico.
Email: afleg@salud.unm.edu