key: cord-0011613-varlhnp5
authors: Thorne, Sally
title: Nursing in uncertain times
date: 2020-04-21
journal: Nurs Inq
DOI: 10.1111/nin.12352
sha: 5ab629d1b9cc5f8216a8527c402c9a734eada941
doc_id: 11613
cord_uid: varlhnp5

nan

As I write, the world is in the throes of the COVID-19 pandemic, and daily life as we know it has been unsettled across the planet.

There will be loss of life, a global economic disruption, and precipitous (perhaps even lasting) repercussions for how we conduct civil society. These are times that necessitate putting a pause on our long-established plans and expectations, and call upon all of us to act in ways that are a departure from our usual routines and comfort zones.

Where governments and policy-makers are showing effectiveness, it is because they are relying on judicious use of current best evidence, ensuring that their decisions and the guidance they provide to the populations they serve are informed by science, rather than political rhetoric, xenophobia, self-serving interests, or guesswork. In this context, as it has been throughout our profession's history, nurses find themselves in an ideal position to help the public interpret that guidance, and understand how it applies to them personally (Lusk, Keeling, & Lewenson, 2016) .

Despite our discipline's sometime theoretical debates about the evidence-based health care movement, including many that have appeared in this journal, the knowledge and practice of the nursing profession is strongly allied with the inherent value of good evidence. A major component of our job is to help patients and families understand the evidence-based reasoning that is being applied to understanding what ails them and the advice that is being offered in their plan of treatment and care. We guide them through the confusion of recommendations that are being made to help them protect themselves and their families, as compared with recommendations that are being made to restrict their choices and actions on behalf of protecting society.

Further, our professional obligation around protecting those we serve from harm requires that we be alert to what has now become ubiquitous 'disinformation', including both the misguided recommendations of those who have an affinity for 'alternative facts', and the malicious use of information created by what we now refer to as 'trolls'-a problem that has become especially pervasive online and in social media (Marwick & Lewis, 2017) . While information work has always been at the heart of what we do when we engage with every patient, family, or community we encounter (Loan et al., 2018) , much of that is no longer simply provision of information but rather helping people interpret the multiple kinds of information, often contradictory, to which they are exposed. And in a global pandemic, it also becomes evident in sharp relief across the public domain that the role of nurses in the health ecosystem is not simply carative; it is profoundly life-saving.

Building, enacting decisions upon, and interpreting evidence on behalf of populations is, however, only a part of the challenge.

The other brings us back to nursing's distinctive role in relation to care at the level of the individual. As a profession, we are acutely aware that population-based evidence addresses the average, the typical, the usual. And in their individuality, so many of the patients we encounter reflect various departures from those assumptions.

Further, we recognize that those who do not fit the dominant norms upon which population data are generated are often precisely those who are at greatest risk for being marginalized, left out, or rendered vulnerable by the standardized ways in which we approach things in health care, including our approaches to a global pandemic. We encounter these 'non-normative' individuals in a highly personal and relational manner. We come to know and understand their individual attributes and circumstances and appreciate the manner in which those factors may intersect to further complicate their health, safety, or well-being. And so, in the midst of this crisis, when we are busy interpreting evidence and enacting best practices, we are also in the business of reaching out to individuals, especially those most at risk, to try to understand them and work out how best to offer them protection and nurturance under such new and rapidly changing societal conditions.

approaches (what we are increasingly referring to as 'patient centred care') may not always be popular with those in decisional authority (O'Rourke, Thompson, & McMillan, 2019) . It can create apparent inefficiencies in care delivery processes, complicate their tidy reporting and accountability systems, and compromise their ability to report perfect compliance with evidence-based protocols. If nursing were to abdicate its individualized care mandate, and prioritize being an agent of the evidence-based machinery, it might serve the interests of institutions but not the social mandate we sign onto when we join this remarkable profession. And so nurses routinely continue to be a nuisance within their workplaces, speaking up for the voices that are silenced, figuring out workarounds on procedures where they believe their patients would be disserved, and ensuring that the human rights and dignity of all persons remain part of the equation. That is our commitment and our privilege-a covenant that we must always strive to preserve if we are to continue to earn the public trust we so cherish.

Uncertain times like these are often the times when nursing shines. Nurses who show up for work under increasingly complex and compromised conditions, demonstrate considerable self-sacrifice in serving while others are withdrawing from service in self-protection. And we continue, despite the chaos, to 'be there' for individuals, reaching out where and when we can to ensure that the spirit of caring is never lost. When this current 2 of 2 | EDITORIAL crisis is over, and we begin to return to a new normalcy across our health care systems, let's ensure that those who have decisional authority never forget why all of our health care systems need nursing. 

Call for action: Nurses must play a critical role to enhance health literacy

Using nursing history to inform decision-making: Infectious diseases at the turn of the 20th century

Ethical and moral considerations of (patient) centredness in nursing and health care: Navigating uncharted waters