Monday, June 12, 2017

Reach for the Stars: Harness Your Strengths and Embrace Your Weaknesses

To the 2017 graduates, let me say at the outset that you are graduating at the best time for nursing, the best time for us, as nurses, to make a positive impact on health care, quality of life and the well-being of populations globally. When the stars are aligned, you must seize that moment and reach for the stars.

Graduation ceremonies are a reminder of past graduations, so let me pause and share some events in my life that may provide you with some life lessons.

Fifty years ago I was sitting in your seats, receiving one of the first bachelor degrees in nursing in the Middle East, and a few years later, and a few more graduation speeches, I sat in the seats of those receiving graduate degrees. I remember I was dreaming about how I could make a difference and what that difference might be like, and for whom. Being among the first groups of nurses to graduate with a bachelor’s degree from the University of Alexandria, our dreams were modest. We simply wanted make a difference in the quality of care for Egyptian patients. We wanted to be able to provide equal and just care for the most vulnerable populations. None of my dreams at the time included the incredible potential progress that we eventually made many years later in providing the scientific evidence for quality care, nor the many leadership positions nurses now occupy, nor the powerful influence nurses now have in health care. We simply could not anticipate any of that. And none of my dreams included achieving any particular position; therefore, I did not dream to be the dean of one of the top schools of nursing in the world (University of Pennsylvania School of Nursing in Philadelphia).

So the question is, how did this happen for a person like me, who came from a humble and less privileged beginning? I am an immigrant from a developing country; I have an accent and I have maintained my accent; I am a nurse in a medicine dominated health care system; I am a women in a male dominated world; I am a social scientist in a world that places more value in physical and biological scientists; and I am a Muslim in a world that, more and more, views Muslims as terrorists.

So how did it happen that I was able to transcend these conditions and adjectives that are stigmatizing and that under the best of circumstances elicit prejudice and drive marginalization? In a nutshell, it was not easy! But, it was possible. It was possible because I used them as strengths to nurture my passion for making a difference, and it was possible because I abhorred inequities.

It was possible first and foremost because I believed with all my heart that I came to a country that was built on, and embodied, the best traditions for human rights and for equity traditions that are built on justice principles, traditions which appear to be under attack right now (in 2017). And we collectively must prevent that from happening.

Second, I am a nurse. Nursing is one of the most trusted professions with a long standing predisposition for equity and social justice. It is my nursing background, with its integration of caring and justice, which gave me my moral compass to care for all people, to insure that the most marginalized receive equal care, particularly at their most vulnerable moments. Nursing provided me, as it provides you as new graduates, with the ethos, the paradigm, the guidelines and the focus on inclusiveness and access in health care and in education. Nursing IS the health profession of choice to understand and act ethically and humanisticly, and to empower vulnerable individuals.

Third, I learnt early on that having and exercising my voice got me what I truly cared for. I really wanted to be a nurse and I really wanted to go to the first B.S. school for nursing in the Middle East, and I passed all of the hurdles except one. I was 15-years-old and entry into the school required students to be 16. Seeing my disappointment, my passion about nursing and my compassion about vulnerable women, my family encouraged me to make an appointment with the University of Alexandria President. Unbelievably, and the credit goes to him, he made time to meet with me. He came up with a creative solution. He calculated my age using the Muslim calendar instead of the Christian calendar. Bingo, I became 16-years-old overnight and I was admitted into the school. The lesson I learnt – do not take NO for an answer, and if there is a WILL, there is a way. However, it takes passion and using my voice.

Fourth, education and mentorship are the best weapons to make a difference. I was well educated (like all of the new graduates) and I received incredible mentorship. Recent graduates, like yourselves, have received the best education from top universities and top schools of nursing in the world; and with it came supportive and inspiring mentors.

Fifth, one voice alone does not do it, but collective voices help in making a difference. Therefore, I reached out, got connected, collaborated and surrounded myself with the best minds and voices that supported my strengths and complimented my weaknesses. I have been privileged to study, practice and work with the best of the best.

Sixth, I embraced my own heritage, the good, the bad and the indifferent. I learnt from my historical landscape, which paved the way for my passion for listening to the voices of others – many that were different than mine.

I will never forget my early traumas and what they taught me. My best friend and playmate, Sadia, who was the doorman’s daughter, went to her grandparent’s home in Upper Egypt every summer and came back to Alexandria where we lived at the beginning of every new school year. One summer, at the age of 12, she went and never returned. I found out she was married to her cousin! I was devastated about losing my best friend, but it was not until years later that I fully understood the gravity of young girls being forced into marriage. This realization prompted the impetus for my passion about girls, women and their health.

Other traumatic memories are of the oppressive regime of the British colonialists in Egypt who deprived us local Egyptians of valuing our own culture and heritage, but provided me with the opportunity to learn second and third languages. The diversity that resulted in marginalization made me a reflective citizen and a passionate nurse about diversity and about speaking up for minorities.

Another painful memory is seeing my loving and caring grandmother with her lack of schooling condoning and promoting in her own village “cliterectomy purification” for girls (as she emphatically called it), which gave my mother the midwife, and myself, a pause. We loved and adored my grandmother, yet we absolutely hated her stand and perception of cliterectomy. But it made us understand different perspectives, and gave us the courage to develop more culturally appropriate and respectful ways to deal with well-meaning and misinformed grandmothers without condemning them.

So I was and I still am a minority of minorities. I was and I still am burdened and enriched by being a women, an immigrant with an accent, a nurse, a social scientist and a Muslim. Yet these are the strengths that ignited and informed my passion to make a difference. They provided me with the courage to uncover marginalized voices and with the platform to empower girls and women to have a voice and to be inclusive.

It was that understanding that nurtured my passion to make a difference. It gave me the drive to mentor hundreds of nurses around the world, to support their education, their positions, and more importantly, their voices. It was that passion that helped me to uncover unjust practices, and to use whatever tools I gained over the years of speaking, writing and advocating to raise awareness and to push for changes.

What I do is but a minute drop in an ocean of injustices and inequities. What I do is for all the Sadia’s in the world who are trafficked, and for all the grandmothers who are misinformed with their traditions. My minority statuses helped me to transcend my comfort zones, and gave me such incredible privileges such as becoming a commencement speaker.

The new generation of graduates received the best education, the devoted mentorship from world class inspiring faculty, and they have been supported by incredible families and friends who join together in admiring their achievements and celebrating their dreams about the future. New graduating classes may not be able to fully articulate their dreams yet, but dreams they must always have - dreams for themselves, for our profession and for our nation. As a nation, we are currently facing many issues that challenge the core of the values that we uphold so dearly. We must be aware of these issues and engage in insuring that justice is always at the core of our actions.

So new graduates, you must never forget your civic duty. You must always uphold and preserve the tried and true traditions and values upon which our democracy is built. It is what many in the world gravitate to, and these values are what made me stay and become a proud American citizen. You must always anchor your dreams on the core values and moral compass you hold as citizens and as nurses.

After graduation you will hold many positions and many roles. You will become clinicians, researchers, administrators, friends, mothers, fathers, presidents, among many others. In any or in all - be a voice for the marginalized, open doors instead of building walls, honor, cherish and celebrate our diversity, respect people’s physical and mental challenges rather than mock them and always nurture a passion to make a difference and a compassion for those who are suffering.

There are over 3 million nurses in our country. There are 20 million of us nurses in the world. Imagine what our collective voices can do for the rights of people for quality health care, for social justice and for inclusiveness. Use your education, use your knowledge of people and their needs, and use your voice.

Honor and harness your best capacities, and you have many of them, and know your weaknesses and embrace them. When you see injustice – call it out; when you see disparities in care – denounce them; and when you see discrimination – do not tolerate it and condemn it. Inequity is inhumane, it is unjustified, and it should never be tolerated. Do not put up with any of it. Do not put up with bullying, incivility or harassment toward you or others. Because it is the best time for nurses to make a difference, so go on, dream big and always reach for the stars. And remember, the stars are aligned and the moment is ours. The moment is yours. Congratulations graduates of today. And the stars of tomorrow

Based on my commencement speech for the University of Illinois School of Nursing on May 4, 2017

Photo: Afaf I. Meleis, PhD, FAAN, LL and Terri E. Weaver, PhD, RN, FAAN 

Friday, September 23, 2016

Reflections on NINR Symposium and 30th Anniversary Celebration

I was privileged to participate as the director of ceremonies at the National Institute of Nursing Research’s (NINR) closing symposium, which celebrated their 30th Anniversary. The symposium brought together presentations and dialogues, top eminent scientists in sleep research and findings that were supported by NINR. The event, which attracted more than 500 attendees (and was closed to more registrants), had two sleep research panels, a symptom science panel and a precision health omic science panel.

The panelists, who were moderated by Dr. David Dinges and Dr. Yvette Conley, discussed their scholarly trajectories and major findings from their research programs, their vision of progress in sleep research and their specific goals for advancing knowledge related to symptom and omic sciences. They also discussed how sleep influences, and is influenced by, health and wellbeing for individuals and populations, and ways by which sleep science reflects, and is congruent with, the overall mission of NINR, which is to promote and improve health and quality of life of individuals, families and communities through basic and clinical research that provides the scientific base for practice. The mission also includes the training of nurse scientists and preparing them for a life of scientific discoveries for the purpose of advancing nursing knowledge. Therefore, the panelists asserted also that it is imperative to give attention to translating sleep science to practice through developing best practices.

The symposium certainly exemplified the importance of this mission by highlighting how nursing science discoveries made a difference in people’s quality of life. It also demonstrated, rather effectively, through modeling, how NINR strategic goals foster and nurture the development of interdisciplinary teams. The panel members’ presentations, individually and collectively, reflected the richness of knowledge advanced by scientists who represented different fields and disciplines.

Moving forward in advancing sleep science, it is imperative to give attention to translating the evidence produced through their work. Research findings and recommendations should bridge the research and practice gaps. Best practices for management of sleep by professionals, as well as practices for self-management of sleep by people, should be developed by scientists and clinicians. Continued research is also needed to establish the benchmarks for healthy sleep quantitatively (7 hours?) and qualitatively? Research translated and reflected in policies is imperative as well, such as policies that affect working hours, school/education hours and care giving hours. Considering knowledge that emanates from the many sleep research findings about circadian rhythms and sleep-wake cycles, and what are the best and most congruent start times for shift workers and for schools, are just a couple of questions with answers that should lead to policy changes.

The panelists also spoke about the need for research focusing on outcomes of disturbed and insufficient sleep, particularly on special populations such as adolescents and the elderly, on management of chronic diseases, on developing and testing cognitive, behavioral and pharmaceutical interventions, and on developing tool boxes that include neurological, biological, cultural and social determinants. The panelists also advocated for advancing community and population based research and interventions. The expanse of technology, such as apps, wearable sleep trackers and watches, computer programs and other innovations to record, monitor or induce sleep, should drive future research. Technology and its use should drive research as determinants of healthy habits and outcomes, and as tools of communication between health professionals.

It was also suggested that these extraordinary sleep specialists, as well as others, may insure that the science produced reflects the diversity in this country and the different lifestyles imposed by race, culture, heritage, education and socioeconomic backgrounds.

With the agreement between 72 countries in confirming the United Nations 17 Sustainable Development Goals (SDGs) which encompass 169 targets, it behooves all scientists to be aware of these 2015-2030 goals, to value them, to critically consider connecting their work with them, and to consider ways by which they contribute to achieving them through their science. Sleep is vital for human health, and if the SDGs attainment by 2030 is mandated for the developed and developing countries, then it is imperative for every scientist and every professional organization to monitor and ensure progress toward attaining these goals.

Furthermore, sleep scientists are urged to consider how their science is being driven by competing or integrated theories that reflect determinants of health which include biological, genetic and sociocultural factors. I challenge sleep researchers to take responsibility for integrating findings by developing middle-range theories of sleep determinants and best practices for managing healthy sleep. Situation-specific theories may be a vehicle to better represent specific populations (underrepresented minorities and economic, cultural, gender and age differences) and more limited sets of variables.

A very stimulating and inspiring symposium about sleep symptom science, omic science and precision health in celebration of the 30th Anniversary of NINR.