A Nursing Journey

I am often asked, how did of chose to become a nurse? I have two major passions in my profession career, my love of nursing and my love of teaching. I have said for years, the only thing better than being a nurse, was marrying one and I’ve done both. Secondly, I have a great passion for teaching. In fact, I first wanted to be a high school teacher when I was in high school.

I went off to college (Lebanon Valley College in Pennsylvania) with all intentions of being a high school biology teacher. I loved the sciences, especially psychology, but in those days, psychology was not taught as a subject in high school, so I picked biology as a major. In New Jersey, you can be a substitute teacher after 60 college credits. As a way to get some experience teaching, I decided to do some substitute teaching during my college vacation breaks.  I substitute taught 3rd through 5th graders and as well as some high school science classes. I probably taught somewhere between 40-50 total class days over two years, but what I learned was . . . I did not really enjoy teaching in the secondary school system. Teaching in the secondary school system can be a big challenge and was so different from what I was used to as a college student. Even then I realized I wanted to work with motivated students, and to me (sorry to generalize) but about 1/3 of the students in high school were there because they really wanted to learn, 1/3 were just going through the motions, and the other 1/3 did not want to be there and wanted to make learning difficult for everyone else. As a substitute teacher, I felt I was spending more trying to manage the classroom rather than teaching. I know that substitute teachers often are treated differently, but still, the fit just not there for me. I decided, if I was ever going to teach, I wanted to teach at the university level.

Before I started my senior year of college as a biology major, I knew I had to make a career change. At first, I did not know what career to choose. My girlfriend at the time from high school was a nursing major. When we would go to the library to study, I became more interested in what she was learning and doing than what I was doing. Instead of spending hours dissecting pigs, cats, sharks and spending long hours in the chemistry lab mixing chemicals to learn about chemical reactions, she was out there making a difference in the real lives of people needing nursing care. I became fascinated as I listened to her experiences in clinical and reading her care plans.  I realized that as a nurse, I potentially could make a profound difference in the lives of other people. One day just before my senior year as a biology major during my visit to the campus health center I also saw a brochure describing a masters program in psychiatric mental health nursing from the University of Pennsylvania, and once I saw the course descriptions and remembering my love of psychology back in high school, I knew at that moment, that I was being “called” to the nursing profession, and my goal was to become a psychiatric clinical nurse specialist.

If I was to switch my major to nursing before I final year, it would take another 3 years of nursing course to graduate. Thus, in six years I would come out with one degree. Since I knew I wanted to go on to get a master’s degree, an associate degree in nursing program was not an option. But by doing some research I figured out that if I finished my final year of biology, then apply to a University nursing program that was a 2 + 2 curriculum design (meaning you have at least two years of college credit you enter as a junior nursing student and graduate in 2 years). So, instead of just one degree in six years, I would have 2 degrees in six years: a BS in Biology and a BSN. In retrospect, that biology degree came in handy. I was offered my first teaching position at Pacific Lutheran University because the faculty needed someone to teach pathophysiology, and so I was offered the position on the strength of my background in biology.

Since I grew up on military bases most of my life, when I chose nursing, I never even thought about the lack of men in nursing (less than 5 % at that time). I was unaware of stereotypical images of nursing. All through my childhood, most of the nurses or “medics” in the military I came in contact with, were men. It was also reassuring that in my class of 65 nursing students at Thomas Jefferson University in Philadelphia, 7 were male.

I’ve also have been asked many times, especially when I went back to graduate school, why I did not become a physician. I look at that question as an opportunity to educate the person asking the question the distinction between nursing and medicine.

For me, choosing nursing over medicine is a philosophical choice. I would rather work with people from a nursing perspective than from a medical perspective.  In other words, nursing’s values fit better with my own beliefs about the nature of people, health, and healing than the medical model. So, here are a few of those values that I share with those wondering how nursing is distinct from medicine.

Nursing is grounded in a holistic (bio-psych-social-spiritual-cultural) caring perspective of the person while medicine reduces the person to its biological parts with a focus on pathology and disease. Nursing sees the person as inseparable from their context (environment including the family), while medicine, because their focus is on disease, tends to view disease at the cellular level as pathology within its biological context, more often, isolating disease from its larger environmental context. Nurses, because they are informed by holism, realize the importance of family members on health and illness so we incorporate families into care as much as we can.

Nurses, because they are informed by holism, understand the inseparably of the mind and body, and so we address the psychosocial issues related to any illness condition. Nurses understand how body and mind are inter-related. Nurses understand the mind is a primary or co-equal factor in all illness. Nurses see the person as a dynamic system inseparable from the environment, and therefore, understand how the environment always plays a role in the cause and treatment of any health condition. In fact, nurses have the wisdom and are the only heath care professionals who have the intelligence to understand that people are biopychosocialspiritualcultural beings, and understand that illness is reflected in each of these equal interrelated parts, and therefore the healing directed by nurses is not just at the biological manifestations of the disease, but is each of these five dimensions. Therefore, nurses have a more complete and complex understanding of the nature health and illness, and it is this integrating-holistic-unitary perspective that patients, families, and communities need from nurses.

Nurses focus on the “relationship” level in their interactions with clients while medicine focuses on the cellular level.  All diseases are defined and conceptualized as changes at the cellular or physical level within a biomedical model. While nurses incorporate the biological (biomedical) component within their understanding of a person’s condition (medical diagnosis and care), but nurses know that people are more than their diseases and focus on the human responses to an illness or disease condition. Human responses (nursing diagnoses) are more specific than medical diagnoses and extend beyond physiology. Responses to a disease involves focusing on relationships; relationships within and between the bio-psych-social-spiritual-cultural components.

Because nurses value relationships, we are experts in communication. We, more than most, understand the importance of communication and know how to be with those who are seeking care. This is why many patients prefer a nurse practitioner over a physician.  Clients often feel listened to and cared for in a way that they don’t feel when with a physician. Nurses are experts in caring.  In fact, nursing can be viewed as a “caring science.” Nursing is the only health care profession that has developed models and theories that describe the nature of caring. If any profession wants to learn more about how to care they need only observe nurses in the act of caring and read the vast nursing literature describing what caring is. Medicine, however, is more focused on curing than caring.  Nurses have the wisdom to know, there can be no curing without caring.

Nursing focus on health while medicine focuses on disease. Because we focus on health by placing emphasis on illness prevention, patient teaching, health education, illness management, and health maintenance. While medicine is in the “fix it” business; nursing is in the “prevent it” business. While medicine needs to have a medical diagnosis to have a role, everyone needs and benefits from nursing care.  By this I mean, healthy people, even those without a medical condition or diagnosis benefit from nursing care because our health teaching can assist people stay healthy.

From my perspective, nursing is a distinct science that extends beyond the limitations of the biomedical model. Nursing is a human science because of its focus on the human experience of disease, subjectivity, holism, and on the human values of human dignity, compassion, and autonomy; while medicine is a natural science, not unlike other natural science such as physics, mathematics, chemistry, and biology. I’m grateful there are nurses, because what patients benefit most from is not another health care professional working within a biomedical model, but the holistic and integrating perspective nursing offers. So, I chose to become a nurse rather than a physician because I value holism, relationships, therapeutic communication, prevention, caring and healing, and a focus on health rather than the biomedical model’s focus on reductionism, disease, pathology, and curing.

Once I graduated from my BSN program, I worked for little more than a year in oncology. I chose to work on the research oncology unit because at the time, if you wanted to go into psych nursing, many recommended having some Med/Surgical experience first. I chose oncology because psychosocial issues are integral when helping cancer patients deal with issues of death and dying. There were two very important features of this particular unit that has had a lasting impression on me. First, when patients became critically ill, we did not transfer them to the ICU. Rather, we converted the room into a critical unit since we knew the patient and their treatment the best. So, as a nurse on that unit, we cared for patients during the entire trajectory of their illness: from their first cancer treatment to their last breath. Secondly, because patients came from all over the country to receive care on this particular unit, and treatments lasted up to two weeks, families were invited to stay with their loved one. This was an old hospital with huge private rooms and we stored many extra fold out beds so family members could stay with their loved one 24/7. Sometimes we would have three or four family members staying in the room at a time. What this experience taught me was how valuable it was to have family members present and involved in the care of their loved ones. Family members wanted to do as much as they could, so we taught the family members to do as much of the care they were willing to do and where legally able to do. Ever since, and in all my subsequent experiences as a staff nurse in ICU settings and as a clinical nurse specialist, I always tried to incorporate family members in the care of their loved ones as much as they were willing. For example, when I worked in the ICU, I never paid attention to the restricted visitation times. I allowed family members to be in the room much and whenever they wanted to be there.

Before making the transition to psychiatric nursing, I decided to get some critical care experience. After working on the oncology unit for about a year, I transferred to the ICU. When I was on the oncology unit caring for patients a ventilator and cardiac monitors and something came up that we did not understand or know how to do, we would ask for one of the ICU nurses to come down and help us out. I was always so impressed with the ICU nurses that I decided that I needed to work in the ICU to really reach my level of competency before transferring to psychiatry.

I then made a radical decision. In 1980, I decided to move to from Philadelphia to Toronto, Canada. After a couple of visits there, I just feel in love with Toronto and Canada. I never intended the move there to be permanent, but I just thought it would be a great experience, and it was. To make a major move was not unusual for me considering my experience as a “Army Brat.” As a child, we moved frequently as my father was transferred from Army Post to Army Post. I was born in San Francisco at Presidio at the head of the Golden Gate Bridge.  Then we moved to Ft. Polk in Louisiana for two years, then to an Army Post in Germany for five years before settling at Fort Dix, New Jersey.

My experience in Canada had a major influence in shaping my career. I lived in downtown Toronto on the 19thfloor of a 34 story building, walked across the street to work in the Cardiac Intensive Care Unit at Wellesley Hospital, and and would later ride my bike about a 1/2 mile to attend the graduate nursing program at the University of Toronto. It was in Canada that I came to understand the value of universal health care coverage. I discovered the role of the psychiatric consultation liaison clinical nurse specialist (PCLCNS), which was my major focus as an MScN student. The role combined my experience in medical/surgical nursing with my interest in psychiatric mental health. The PCLCNS works as a consultant to the nursing staff in the general hospital setting to assist nurses in meeting the psychosocial needs of clients who also have a medical problem.  The specialty really combines mind and body so is inherently holistic.

I also discovered nursing theory in my master’s program. Nothing has helped me understand the uniqueness of nursing and nothing more has helped shape my identity as a nurse than learning to conceptualize and practice nursing from a nursing-theory base. The chapter you will be reading that I wrote lays out why nursing theory is so important to the discipline. While in Canada, I meet and worked with most all of the major nurse theorists. I’ve worked with Martha Rogers, Orem, Roy, Newman, Neuman, Peplau, King, Henderson, and Watson. To have met and worked with these notable women nurse scholars was an incredible experience, by far, the most exhilarating experience in my nursing career. Writing about and teaching students and staff nurses the importance of practicing nursing guided by extant nursing theories continues to be a major focus of my teaching and scholarship.

I probably was not your typical graduate student. For example, when I was learning about Rogers’ science of unitary human beings, I would not just read all of Rogers’ writings, but also the writings of those she referenced so I could understand how she put her ideas together. I’ve never just limited my reading in a particular course to the required readings, but always sought to read more and different views of the content, especially reading the latest information about the topic the instructor usually was not even aware of.

After I graduated with my Masters degree in consultation liaison psychiatry, I worked or three years as a clinical specialist. It was in the role of a CNS that I discovered my love for teaching. Staff education was a major part of my role, so I would do inservices on units throughout the hospital. I would teach the staff on how to care for difficult patients, some patients who were in the medical setting and were depressed, hostile toward staff, very anxious. A also taught nurses in how to manage their own stress. I also gave inservices on how to use nursing diagnoses and how to apply particular nursing theories in practice. Hospitals in Toronto decided to implement nursing theory into the hospital setting, and because of my knowledge and ability to practice nursing from a variety of nursing theories, I became a leader in teaching nurse administrators and staff nurses how to implement a particular nursing theory on their unit. At the hospital I was employed, I implemented Orem’s conceptual framework on the psychiatric unit and on the long-term care unit.

I realized next to caring for patients, teaching was what I really enjoyed most in my role as a CNS. I also realized, that teaching nurses is what would the greatest impact on moving nursing closer toward the vision of nursing that began to take shape in my mind. I knew that the setting where I could have the greatest impact on leading change was to become a nurse educator at a College of Nursing and I also knew that I needed to further my knowledge and education if a wanted to teach future BSN and MSN students. There was only one PhD program in Nursing at the time in Canada, and I would not consider getting a PhD in medical science if I stayed in Toronto, which was the only option for nursing wanting a PhD in the late 1980s at the University of Toronto.

In 1989, I decided to return to the United States to pursue my PhD studies. Lived in DC for about 15 months while preparing to start studies at the University of South Carolina, and while there, I worked as a CNS at a Psychiatric Hospital in Georgetown. The highlight while we were in DC was my trip to present the findings from my master’s thesis at the International Council of Nurses Conference in Seoul, Korea. The ICN conferences occur only every 4 years and they are like the “Olympics” of nursing.  In the opening ceremony, nurses from countries all around the world march in under their nations flag. It was such an amazing experience I again presented the findings from my PhD dissertation at the ICN conference in Vancouver, Canada.

I decided to attend the University of South Carolina because I wanted to study under Dr. Richard Cowling and focus on Rogerian science. Richard is a Rogerian scholar and studied with Dr. Rogers when she was the Dean at NYU. In addition, South Carolina had 5 other faculty members who had a strong background in the Rogers’ science of unitary human beings. I had a wonderful time in my doctoral studies. I was able to focus on unitary science by taking a 5-credit course with Dr. Rogers, take a course on creative sciencing with Dr. Parse (another nurse theorist who developed a theory based on Rogers’ work), and consult with Dr. Margaret Newman. I focused on geropsychiatry, in particular, the experience of depression in later life and what I called “dispiritedness” in later life. For my dissertation work, I developed the first qualitative research methodology specific to Rogers science of unitary human beings and tested the methodology by examining the experience of dispiritedness in later life. All through my doctoral studies, I continued to work part time (about 20 hours a week) on a psychiatric unit at a local hospital. Dr. Cowling was my dissertation chair, advisor, remains a close friend and gerontology, especially depression in later life and family caregivers continues to be the major population and clinical focus of my practice and research.

I moved to Seattle in 1993 when I accepted a faculty position a Pacific Lutheran University. I taught a bunch of courses there including pathophysiology, nursing research, nursing fundamentals, undergraduate psychiatric nursing clinical, issues and trends, and the graduate courses in nursing theory and case management. Even though I had a PhD, I continued to work part-time (most on weekends and during semester breaks) as a staff nurse on the psychiatric units of two local hospitals. I point this out because, although I was now in academia, I continued to practice at the bedside. I continued to work as a staff nurse because: 1) I loved working with patients; 2) working in the clinical setting enabled me maintain clinical competence; 3) clinical practice enhanced my credibility with nursing students; and 4) enabled me to keep in touch with the massive changes that were going on in the health care system and hospitals at the time. Managed care was having a big impact on patient care and nursing throughout the 1990s in the Pacific Northwest.

While at Pacific Lutheran University (PLU), I had my second major leadership experience. I led the faculty in a total revision on the undergraduate curriculum. My idea was to implement a new curriculum model grounded in a caring philosophy and theories. Initially, I had thought I was going to be moving to South Florida and was well aware of the great program at FAU, and I came to FAU in 1992 and 1993 to explore future faculty positions. I knew about FAU strong focus on nursing theory and caring in nursing theory, but due to family reasons, I went to the Pacific Northwest. Since I could not be at FAU, I decided to bring FAU to PLU by implementing a caring curriculum inspired by the FAU model. I invited the former FAU Dean, Anne Boykin, to come out to PLU to work with the faculty. I also invited Jean Watson and Kristine Swanson, who gave workshops on caring in nursing to the PLU faculty. The implementation of the new caring curriculum took 4 years to complete, and since I was chair of the curriculum committee and the faculty member most knowledgeable about nursing theories based on a caring philosophy, I was viewed the leader of the curriculum revision. Two of the highlights in my teaching while at PLU was teaching a freshman writing seminar to non-nursing students and teaching a course on compassion in the PLU honors program. In 1997, I was recognized for my teaching by being awarded the Faculty Excellence Award. During my five years at Pacific Lutheran University I maintained a faculty practice as a nurse psychotherapist (10 hours a week) at a wellness center and WIC clinic that was operated by the school of nursing. I also continued to work past time at two hospitals as a staff nurse on their psychiatric units, mostly on weekends and during the times between semesters.

While a faculty member at Pacific Lutheran University, I also became very involved with Sigma Theta Tau International and became President of Psi Chapter-at-Large, which included three Universities (Pacific Lutheran University, Seattle Pacific University, and the University of Washington). At the time, Melanie Dreher Dean at the University of Iowa, was the International President of Sigma Theta Tau. Dean Dreher knew of me because I was one of the Keynote speakers at a conference held at the University of Massachusetts when she was the Dean there. Ever since that first meeting, she became very interested in recruiting me to the University of Iowa.

The University of Iowa was the best place for me to build on my experience at a major teaching institution and shift my focus to building a program of research at a major R1 University. There were so many internationally recognized nursing scholars at the University of Iowa. I had a strong desire to be mentored by such renowned scholars as: Kathleen Buckwalter who I knew was one of the leading scholars on depression in later life; Toni Trip-Reimer, a well known expert in qualitative research methods; and the faculty scholars who developed NIC/NOC at the Iowa Nursing Classification Center. I can’t emphasize more how important it is to have great mentors to help advance your nursing career. Mentors are like gifts in our lives. They support, challenge, connect you to the right people and resources, and champion you to others. I surely have been blessed by having great mentors. I joined the faculty in August 1998 and served on faculty for 21 years.

At the University of Iowa, I taught the Professional Issues of Nursing Practice course in the undergraduate program, and three different courses in the psychiatric nursing ARNP/DNP program, theoretical foundations in the DNP and PhD programs, PhD course in qualitative research, and the research for evidence based practice course for DNP students. Between 2002-2004, I was a John A. Hartford Foundation Post-doctoral fellow. Being a post-doctoral scholar helped me establish a successful NIH funded program of nursing research focusing to testing the effect of journaling in reducing caregiver burden and stress in family Alzheimer Disease caregivers.

Ever since my master’s thesis testing guided imagery, I’ve been interested on the development and testing of nursing interventions. In 2003, I was asked by Joanne McCloskey if I was interested in joining the NIC team as an Editor, because Joanne was preparing to retire. I have always been interested in NIC, was an early adopter having using nursing standardized languages as a practicing nurse and nurse educator. The commonality of nursing theory and NANDA-NIC-NOC (NNN), is that nursing theory and NNN describe nursing’s unique body of knowledge. Nursing theory provides a disciple specific means for conceptualizing nursing standardized languages and thereby guiding nursing decision making.  I was the second editor of the 5th (2008) and 6th edition (2013) of NIC, and the first author of the 7th edition published in 2018. I also served as managing editor of the Evidence Based Practice Guidelines that are published by the Csomay Center for Gerontological Excellent at the University of Iowa College of Nursing. There are now over 27 EBP guidelines published under my leadership focusing on care of older adults I have edited available and downloaded from our ecommerce site at https://www.uiowacsomaygeroresources.com. While a faculty member at the University of Iowa, a received a national teaching award for excellence in teaching from New York University as well as the University of Iowa Excellence in Teaching.

In addition with my work with Rogerian Nursing Science, nursing interventions, and EBP guideline development, I have a strong interest and track record of scholarship, practice and research in the areas of: holistic nursing, narrative and constructivist models of psychotherapy, existentialism, treatment of depression and dispiritedness, alternative therapies, caring pedagogy, reflective nursing practice, nursing theory-based practice, the use of journaling as a meaning making intervention, gerontological mental health issues, nursing aesthetics, and phenomenological-hermeneutic research.

I do have a broad methodological background in nursing research. My master’s thesis was a quantitative pretest-posttest control-experimental design looking at the effect of guided imagery on time experience. My dissertation research involved the rigorous process of developing and testing a methodology that I developed derived from a specific nursing theory (Rogers’ Science of Unitary Human Beings). This is a qualitative theory driven hermeneutic phenomenological method. My program of funded research from NIH uses a clinical trials design (pre-posttest; experimental-control), like my masters thesis. The focus of this program of research is on testing the health benefits of a journaling intervention in promoting health in family caregivers of persons with dementia and late stage cancer. The journaling intervention, though, could be used in any healthy or stressed population. I have two current on-going studies, one is testing the journaling intervention on the internet with a population of family caregivers of persons with memory loss and the other is non internet version testing the journaling with cancer caregivers. I also have completed 4 other studies that have pure qualitative designs. These studies used a variety of phenonmenological approaches including van Kaam’s, van Manen, and Colaizzi. These studies focused either on the lived experience of depression in later life or the experience of being a caregiver with a family member with Alzheimer’s disease.  I’m a methodological purist, which means that I believe that these methods need to be used as they were designed by the creator of the method, and if one adapts or alters the procedures of the method, there needs to be a scientific rationale for the change. I’ve also completed a hermeneutic phenomenological study guided by Heidegger’s phenomenological perspective and worked with a student who used Ricoeur to study the ethical decision-making process of family members and health processionals at the end of life.  So, I have experience with both quantitative and qualitative methods.

After 21 years at the University of Iowa, I finally decided to join the faculty at Florida Atlantic University. I have known about FAU since 1987 when I met a graduate student, Gail Mitchell, who had just graduated from FAUs new BSN program. I first visited here in 1993, and fell in love with FAU, met many of the faculty, who I have remained connected to for all these years. I could not even consider moving until my daughter graduated from High School, because I did not want her to lose her friends, school, church and all that was her world in Iowa City. She graduated from HS this past June 2019, so I was able to consider relocating. I joined the faculty at FAU in the summer of 2019 where I plan to advance my work with the Science of Unitary Human Beings, Unitary Caring Science, and my research with family caregivers and persons with memory loss. I have shifted my research interest toward working with persons with mild cognitive impairment testing interventions such as meditation in enhancing telomere activity and cognitive function. In 2020 I became the director of the PhD Program. More details of my background, research interests, and publications can be found here https://nursing.fau.edu/directory/butcher/index.php on the FAU website.

On a personal note, in 2017, I married Rita de Cassia Gengo e Silva, a nurse and Professor of Nursing at the University of Sao Paulo in Brazil. We met at a nursing conference in 2015 in Bern, Switzerland, and we lived in Iowa City, Iowa, before moving to Boynton Beach, Florida. She is now also on faculty at the Christine E. Lynn College of Nursing at Florida Atlantic University.

My daughter is now 22 and is out on her own living in San Francisco. I am really into cycling, travel, and I am a “foodie.”  We have a beautiful Siberian cat named Sasha and a Cavalier King Charles Spaniel named Pingo..

Updated: October 2023

Butcher, H. K. (1998). Crystallizing the phases of the unitary field pattern portrait research method.  Visions: The Journal of Rogerian Nursing Science, 6, 13-26.

Butcher, H. K. (2005). The unitary field pattern portrait research method: Facets, processes and findings. Nursing Science Quarterly, 18,293-297.

Butcher, H.K. (2006). Unitary pattern-based praxis: A nexus of Rogerian cosmology, philosophy, and science. Visions: The Journal of Rogerian Nursing Science, 14(2), 8-33.

Butcher, H.K., & Malinski, V. (2010).Martha E. Rogers’ Science of Unitary Human Beings. In M. E. Parker and M. C. Smith (Eds). Nursing theories and nursing practice (Third edition) (pp. 253-276; Bonus Content; Chapter 15, pp. 1-10). Philadelphia: F.A. Davis.

Butcher, H.K. & Malinski, V. (2015). Martha E. Rogers’ Science of Unitary Human Beings. In M.C. Smith and In M. E. Parker (Eds). Nursing theories and nursing practice (Fourth Edition), (pp. 237-261). Philadelphia: F.A. Davis.

Butcher, H.K. & Malinski, V. (in press). Martha E. Rogers’ Science of Unitary Human Beings. In M.C. Smith and In M. E. Parker (Eds). Nursing theories and nursing practice (Fifth Edition), Philadelphia: F.A. Davis.