1. Chinn, Peggy L. RN, PhD, FAAN

Article Content

Over the weeks that I was reviewing manuscripts and preparing for this issue of Advances in Nursing Science (20:4), I was also preparing the new ANS World Wide Web site. [1] From the beginning, I wanted to provide full disclosure of all procedures and policies related to the journal. The editorial policies and procedures are designed to ensure quality in both process and outcome, and disclosure practices ensure our accountability to those we serve. Now all of this information could be accessible worldwide at the click of a mouse button. I was thrilled!


We live in a time when calls for quality and accountability dominate various discourses, and responding to these calls consumes a great deal of time and energy. A fundamental concern expressed in demands for both quality and accountability is the need to know. People on the receiving side of institutionalized interactions (receiving health care, for example) have grown weary of the institutional structures and practices that conceal important information and insights that could affect how they respond in the relationship.


Those of us who represent the institution in the interaction have acquired ways of acting, and of being, that sustain concealing practices. Many of these institutional practices have evolved in such a way that there is no identifiable accountable or responsible party, making the challenge of changing the practice extremely difficult.


Concealing practices include blatant practices that evolve as a structural component of the institution, such as billing and invoicing conventions that do not adequately itemize what is being charged. A concealing practice that directly affects nurses every day is the treatment of the medical record. The medical record historically has been treated as a document belonging to the institution, and not accessible to the person for whom it serves as a record, thereby serving to conceal the contents of the record from the person most invested in what it contains.


The most powerful concealing practices are those that are embedded in the language, expressed in such subtle ways that even those who would prefer not to conceal remain unaware of their complicity in concealing. The use of the grammatical passive voice and other phrasing conventions that convey passivity in both verbal and written communication are pervasive in academic circles, and in professional circles. The passive voice conceals agency, which is often central to quality and accountability. Consider an oversimplified nursing education example: "The class average on the exam was 82." This statement seems to convey information about the results of the examination, but in the absence of other statistical information the average actually conceals important information. The range of scores and standard deviation would disclose information about what the average means and the performance of all of the students who took the examination. Additional statistical information can disclose how adequately the examination itself served as a measure of knowledge; the examination itself is open to scrutiny and evaluation. Examinations sometimes adequately test the student's abilities; they more often reflect the quality of the educational process, indicating how well the teacher taught and how adequately the measure of success is conceived. Rarely, however, are examinations examined to disclose this type of information.


In many cultures, including the cultures of the professions, disclosure is difficult because concealing is a habitual, comfortable practice. Disclosure requires effort that is felt at a deep level, because disclosure exposes essential human experience, and opens the possibility of judgment, of criticism. It also calls upon the person disclosing to remain true to that which is stated.


If you have not yet seen the documents that disclose the practices we use in producing each issue of ANS, visit our web site. We welcome your response.


Peggy L. Chinn, RN, PhD, FAAN






1. Also see Aspen's web site at[Context Link]