1. Carroll, Susan V. MS RN CNE

Each 2008 issue of the Journal of Neuroscience Nursing includes an anniversary feature in which we celebrate the vision, determination, and challenges that have marked 4 decades of neuroscience nursing practice and publishing excellence. We will highlight our past and begin to envision our future as we examine the changes we have witnessed.


Article Content

Forty years ago, many of us were emerging political and social activists, budding feminists, counterculture converts, and nurses. During the mid-1960s, social norms and mores were undergoing a paradigm shift that would ultimately change not only our larger world view, but our professional perspectives as well. Societal changes occurred in tandem with phenomenal changes in technology; biomedical engineering and communication and information technology grew out of the space race and the conflict in Vietnam. As baccalaureate education gained momentum, nursing education began its transformation from hospital schools to more formal academic programs housed in colleges and universities. Healthcare institutions began their own transformation to reflect technologic change, exponential growth in pharmaceutical availability and diagnostics, and changes in specialty medical practices.


Neuroscience nursing grew up in this shifting healthcare universe. Like other groups of "specialty" nurses, we began defining a unique professional identity in the 1960s. This included a defined patient population, an expanded scope of practice, specific educational needs, technologic expertise, and a willingness to define ourselves as "special." Building on the values, beliefs, and ethics of the nursing profession itself, neuroscience nurses built a professional organization that paved the way for practitioners to meet the enormous challenges of that time as well as those of the future. The American Association of Neuroscience Nurses (AANN) brought together nurses with common clinical, research, and educational interests and provided a forum for professional growth. As AANN grew, so did the scope and influence of the Journal of Neuroscience Nursing (JNN).


AANN and JNN's efforts during the past 4 decades reflect and support five overarching themes in nursing: caring, critical thinking, change, complexity, and chaos. The concept of caring emerges again and again as a core motif in nursing-we are compassionate, concerned, committed, and aware of common human bonds and experiences. As professionals, we expand this concept by applying our expert knowledge, skills, art, and theory to our practice. Caring is a basic intervention, and in our specialty practice, we have long recognized that we can always care, even when there is no cure. Our bedside expertise and our specialty literature provide proof.


One foundation of professional practice is the ability to think critically. Critical thinking is rational, conceptual, reflective, and creative. It requires us to use domain-specific knowledge, experience, standards, and competencies in making decisions. Critical thinking also requires intellectual courage, intellectual integrity, and intellectual perseverance. As we look at our growth over the course of the past 40 years, neuroscience nurses have repeatedly demonstrated these skills, and again, our literature reflects this. Neuroscience nurses write about issues and clarify new concepts and ideas. They willingly examine both assumptions and empirical data, draw inferences from them, and develop implications for our practice and patients.


Change is omnipresent and the nature of change transforms us. As nurses, we confront change daily. Neuroscience nurses have witnessed changes in technology, pharmacology, and basic and behavioral sciences that were unimaginable in the 1960s. The queen in Through the Looking-Glass and What Alice Found There says it best, "Sometimes I've believed as many as six impossible things before breakfast." (Carroll, 1965b, p. 76). We have dramatically changed our care of stroke and brain-injured patients and patients with seizures and movement disorders. In October 2007, the National Academy of Science reported findings from a British study of patients diagnosed as "vegetative" who demonstrated the same functional magnetic resonance imaging (fMRI) responses to ambiguous sentences, which were read to them, as nonvegetative volunteers (Davis et al., 2007). The report underscores a fundamental change in how we think about our neuroscience patients, focusing not on what is wrong with an individual's brain, but instead, on what is working. A new field, educational neuroscience (or "brain-based" pedagogy), is generating hypotheses that children develop their concept of numbers linearly and that spelling requires both soundprocessing and memory-meaning encoding; both hypotheses might ultimately change how we teach young children.


Despite our very human desire to tie cause to effect and make assumptions about the predictability of events, research has revealed that absolute predictability and control may not be achievable. Dynamic systems like the human brain can generate random, unpredictable behavior. The human nervous system has proven to be far more complex than what we believed it to be 40 years ago. The human brain is sensitive to evolving conditions elsewhere in the body so that small changes can be magnified many times over; small errors in function or response may not stay small. With these changes, chaos can appear when given the right push.


Chaos is the unstable behavior that emerges when a system responds in unpredictable ways during a crisis or hinge point. As neuroscience nurses, we see chaos in electroencephalograms (EEGs), aphasias, apraxias, intracranial pressure changes, and compulsions. Dynamic systems are resilient, however, and demonstrate the ability to maintain order despite the disorder that also is present. Complexity theory tells us that we may never completely understand the vulnerable points within a system-a human body, a healthcare institution, a professional organization-but with caring and critical thinking, we can cope with complexity and change and preempt the chaos.


Forty years of specialty practice and the literature that supports it is remarkable. We have developed a broad body of knowledge and expertise. We have become independent, critical thinkers who confront a complex, rapidly changing healthcare world with strength and confidence. We write about our research, patients, unique specialty practice, and experiences. We may even feel like Alice as she reflects on her adventures through the looking glass-chaotic, complex, wildly changeable-and tries to evaluate the experience, telling herself "[horizontal ellipsis]it's no use going back to yesterday, because I was a different person then" (Carroll, 1965a, p.122).




Carroll, L. (1965a). Alice's adventures in wonderland. New York: Random House. [Context Link]


Carroll, L. (1965b). Through the looking-glass and what Alice found there. New York: Random House. [Context Link]


Davis, M. H., Coleman, M. R., Absalom, A. R., Rodd, J. M., Johnsrude, I. S., Matta, B. F., et al. (2007). Dissociating speech perception and comprehension at reduced levels of awareness. Proceedings of the National Academy of Sciences of the United States of America, 104(41), 16032-16037. [Context Link]