Crisis, Grief, and the Intentionality of Hope

Blog by Shawn M. Kneipp, Ph.D., RN, ANP, PHNA-BC, FAANP, Chair American Public Health Association Public Health Nursing Section

We have been living one health, social, or political crisis of historical significance after another in the United States for the past several years. The arrival of SARS-Cov-2 in early 2020 has pushed our public health and traditional healthcare (private, non-profit) systems into chaos given we were not at all prepared for a pandemic. Public health nurses, their colleagues, and a handful of thoughtful elected leaders at federal and state levels had been shouting our lack of preparedness from the rooftops for years, but to no avail. Leading us to this moment, lost in the political tunnel vision to rebuild our economy after the 2008 economic recession was the need for a public health system that was adequately funded, staffed, and functional.

We are paying the price for that neglect – heavily – now.

Other crises in the forms of social movements bent on reigniting and intensifying racist ideologies, and using unnecessary force (physical, political, or otherwise) to preserve power for already-advantaged groups have led to widespread social unrest. This past week, an insurrection on the U.S. Capitol nearly pushed our government into an abyss of anarchy. Through it all, in the midst of a pandemic that threatened their very lives, people took to the streets to protest the blatant injustices that have been fomented by our elected officials and embedded in our institutions through changes in policies, norms, and practices. Those of us in public health recognize each of these events as a distinct and real threat to population health.

With each new insult to our democracy and health, we have, collectively, experienced waves of new-onset grief before we could even fully work through the stages necessary to resolve our grief from the prior insult. An apt description for how many of us (myself included) have been feeling may be a perpetual state of grief.

Through the crises and grief, though, little pockets of hope have been, and continue to be, found. It may be that, as a nation, we needed to experience these challenges to arrive at a better place, where we care for each other on a fundamentally human, and genuine level. Former President Barack Obama’s recent book The Audacity of Hope:  Thoughts on Reclaiming the American Dream speaks to one aspect of hope – holding out for it as a bold idea in the midst of experiencing problems and setbacks of the magnitude we have been witnessing.

As I lead our PHN Section of APHA this year, I am borrowing from Barack Obama’s focus on hope, but am giving more attention to a different characteristic that can be applied to how we approach it – intentionality. Webster’s Dictionary defines intentionality as a thing “done by intention or design.” For me, this begs the question of how do we make hope actionable? How do we design our processes and practices with intention, to counter the actions put into play that have caused harm to others and eroded the health of our nation?

This year, the PHN Section members and leaders have worked on several fronts to do that. From a process point of view, we have restructured how our committee leaders are selected and function, with the intent of widening the field of who expresses interest in serving in these roles and making the process more democratic and participatory than it has been in the past. One specific outcome of this change is the hope of further diversifying the leadership roster in a number of ways. Another more recent intentional action includes reaching out to and recognizing our colleague and nurse whistleblower Dawn Wooten, who bravely stepped up to report the possibility that women held in migrant detention centers were having their reproductive rights violated through unwanted surgical procedures. Recognizing Ms. Wooten supports a future where nurses continue to speak out against such transgressions, despite personal risk. Our Racism Preconference Subcommittee spent over a year planning the Racism Preconference held at the 2020 APHA Annual Meeting – with a great deal of intention for attendees to walk away from the experience knowing where they can take specific action in their zone of influence to reduce maternal morbidity and mortality among Black women. In other arenas, we have realized our hope for a better funded and appreciated public health system – one where public health nurses take on central roles and their specialized areas of competence are recognized and valued. We have done this by working to ensure such recognition is both explicit and embedded in the language of guiding documents adopted by other public health and nursing organizations.

These are some examples of how we have put into practice our hope for a better, more just, and more equitable future for us all. As we move into 2021, let’s vow to be intentional – being thoughtful, reflective, and strategic – in our collective work together. As we manage our way through these crises and work through our grief, hope for something better is on the horizon, and public health nurses are a significant part of the solution.

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