708416 NSQXXX10.1177/0894318417708416Nursing Science QuarterlyBaumann / Global Perspectives research-article2017 Global Perspectives Graduate Students’ Reflections on Elder and End-of-Life Care for Prisoners Nursing Science Quarterly 2017, Vol. 30(3) 253–259 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/0894318417708416 DOI: 10.1177/0894318417708416 journals.sagepub.com/home/nsq Steven L. Baumann, RN; PhD,1 and Vidette Todaro-Franceschi, RN; PhD1 Abstract The focus of this report was graduate nursing students’ reflections on elder and end-of-life care for prisoners. The personal reflections of 21 graduate nursing students who attended a presentation by Susan J. Loeb on October 26, 2016 were included in this report. The title of the presentation was “Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community.” The student essays were synthesized to construct a summary essay, from which four themes were identified: aging in prison, dying in prison, ethical and professional issues in the elder and end-of-life care of prisoners, and ethical and professional issues in research involving elderly and end-of-life care of prisoners. These findings were interpreted from a global perspective in light of two different nursing perspectives: the humanbecoming tradition and the science of unitary human beings. Keywords eldercare, end-of-life, humanbecoming, prisoners, science of unitary human beings The worldwide demographic shift toward increased numbers of older adults is affecting all facets of contemporary life, including prisons. To better prepare nursing students for this phenomenon, Susan J. Loeb, RN, PhD, was invited speak on her program of research; the title of her presentation was “Enhancing End-of-Life (EOL) Care for Prisoners Through Partnering With the Prison Community.” The lecture was part of the annual Viola S. Shifrin Lecture in Palliative Care Nursing at Hunter-Bellevue School of Nursing. The purpose of this project was to explore the ethical and professional issues related to elder and end-of-life care in prisons. The text for this project was a summary of 21 essays written by graduate nursing students who attended the program. The students were asked to reflect on the ethical and professional issues raised in the presentation. The findings were considered from two different nursing perspectives, the humanbecoming tradition and the science of unitary human beings (SUHB). The problem of aging and dying in prison is seen here as a global issue. The Theoretical Perspectives One of the investigators of this project (S.L.B.) used the humanbecoming tradition (Parse, 2014, 2016) to consider the themes in the students’ essays, following the processes outlined in humanbecoming hermeneutic sciencing. This perspective holds that the humanuniverse process is an indivisible, unpredictable, everchanging cocreation. Hermeneutic inquiry from a humanbecoming perspective seeks to discover emergent meanings of humanuniverse experiences as captured in documents and artforms. One of the authors (S.L.B.) and his colleagues have completed two other humanbecoming hermeneutic projects involving graduate students’ personal reflections (Baumann & Ganzer, 2016; Baumann, Murphy, & Ganzer, 2015). The last of these two projects was on graduate nursing student essays on the documentary film The American Nurse, which included the story of Tonia Faust, RN, who works on a hospice unit in Louisiana State Penitentiary (Baumann & Ganzer, 2016). In addition, Parse (2007) conducted a humanbecoming hermeneutic inquiry on hope in Stephen King’s short story about a wrongly convicted prisoner, titled Rita Hayworth and Shawshank Redemption. The co-investigator (V.T.-F.) used the Rogerian SUHB perspective (Butcher, 2016; Rogers, 1992) to explore the text. Unitary nursing science is based in part on ideas from physical theories of the universe (Butcher, 2016) and was developed by Rogers (1992). Unitary nursing science postulates that humans and their environment are energy fields that are inseparable and not bound in space-time (Butcher, 2016; Rogers, 1992). Thus, all is essentially one and change is an inherent characteristic rather than a causal process 1 Professor, Hunter College of the City University of New York, USA Contributing Editor: Steven L. Baumann, RN, PhD, Professor, Hunter College of the City University of New York, 82 Sherman Ave, Williston Park, NY 11596, USA. Email: sbaumann@hunter.cuny.edu 254 Nursing Science Quarterly 30(3) (Todaro-Franceschi, 1999, 2001). Human beings, in mutual process with their environment, are always changing together, and change is innovative, unpredictable, and complex. Time is relative and nonlinear, so that being and becoming is pandimensional in nature. Wellness and illness are defined by individuals as they are living and experiencing change. Health and healing are not static things or concepts but rather are defined by the unique pattern manifestations of each person. The manifestations of pattern (unique to each person) can be discerned, and care providers assist people to actualize their potential to live well and die well as each person chooses. In so doing, the care providers and the person change, purposefully, creatively, and unpredictably together (Todaro-Franceschi, 1999, 2001). Humanbecoming Hermeneutic Sciencing Hermeneutics was initially developed to study sacred and classic texts. Humanbecoming hermeneutic sciencing (Parse, 2016) follows select tenants of humanbecoming existential hermeneutics. The assumptions of humanbecoming hermeneutic sciencing are as follows: 1. 2. 3. 4. Scholar-text and scholar-artform dialogues coconstruct emergent meanings with the becoming visibleinvisible becoming of the emerging now. Interpretations of texts and artforms are perspectival, personal humanuniverse cocreations. Newknowings of living experiences arise with interpretations of texts and artforms. Newknowings transfigure the scholars’ living experiences. (Parse, 2014, pp. 77-78) Hermeneutics is well suited for sciencing living experiences in texts, such as the essays written by graduate nursing students on topics like aging and dying in prison. Humanbecoming hermeneutic sciencing involves the following: “discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging” (Parse, 2016, p. 273). Discoursing with penetrating engaging was used in this project to uncover the obvious and not-so-obvious in the experience of ethical and professional issues discussed in the graduate nursing students’ essays on “Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community” presentation. It is a rigorous attending to and reflecting on that which arises when reading the text to explore for new meaning. Interpreting with quiescent beholding in this project involved silent pondering and dwelling with the summary essay, as well as the students’ essays, which were read and reread. According to Parse (2007), this is “explicitly-tacitly immersing in the appropriating-disappropriating of the surfacing meanings” (p. 149). It is rigorous rational-intuitive considering of the meanings that arise in the scholar-text dialogue. Parse (2001, 2007, 2016) described it as a rhythmical expanding of understanding by reflectively attending to moments that arise in dialogue with artforms. According to Parse (2001), understanding with inspiring envisaging involves bringing forth new views from the dialogue between the researcher and texts. It is exploring with deep contemplation the meanings that arise while challenging the researcher’s previous understandings of the ethical and professional issues related to “Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community.” It is a reflective questioning of the researchertext dialogue that generates new questions, changing the researcher (Parse, 2001). The Hermeneutic Engagement The summary essay is the text that is engaged by the researchers from two horizons of interpretation. The researchers read and reread the text many times, searching for the meaning of the ethical and professional issues as discussed by the students. Notes were made from the presentation, from each participant’s essay, surfacing meanings that have global implications. In the process of penetrating engaging, quiescent beholding, and inspiring envisaging, the researchers, with the text, reflected upon the meaning of the words and images, particularly those that were relevant for global nursing. Understanding arose from consideration of two horizons of interpretation of the nurse’s reflective essays. Research Ethics The Hunter College IRB approved the project, and only the essays of graduate nursing students who gave consent were included. The Circumstance and Setting As a course assignment graduate nursing students, who were all RNs with at least 2 years’ experience as nurses, were asked to attend the annual Viola S. Shifrin Lecture in Palliative Care Nursing Studies at Hunter-Bellevue School of Nursing on October 26, 2016, where Susan J. Loeb presented “Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community.” The students were also asked to write a brief personal essay on the program. The essays of those who gave consent were included. Of the 43 students who gave consent, only the essays of the students who included reflections on their personal experiences related to the research question were included, 21 in total. The Presentation Dr. Loeb (personal communication, October 26, 2016) began her remarks by asking the question, “Why should we care?” She discussed her program of research as described in the 255 Baumann / Global Perspectives title of her presentation. She pointed out that there was a large and growing population of older prisoners, many of whom were in need of end-of-life care. She reported that Dostoyevsky (as quoted by Shapiro, 2006, p. 210) had once said, “The degree of civilization in a society can be judged by entering its prisons.” Dostoyevsky himself had been exiled to do hard labor in a prison camp in Siberia, after being accused of reading and distributing works of literature, which were banned because they were seen as criticizing Russian politics and religion. Findings Aging in Prison A summary essay based on the essays of 21 graduate nursing students on Loeb’s presentation makes up the findings of this hermeneutic project. The first part of the story told by Loeb about her research, which surprised many, was that there were a large and growing number of older adults in prisons and that prisons were not designed to accommodate them. Even for the students who had taken care of incarcerated individuals, they never really thought about prisoners aging. The students appreciated that aging in prison must be difficult, in part because of the prison environment. They could imagine how hard it is for elder inmates to get into top bunk beds or navigate narrow hallways with a walker. Many said they knew that prisons were often overcrowded, and they had no problem understanding that incarceration accelerates aging and aggravates health problems. Many of the students could also appreciate that older inmates suffer because prisons are in general more about punishment, loss of freedom, and reduced choices than providing quality healthcare or rehabilitating individuals. In light of the long sentences in remote locations, prisons often end up the only family and home inmates have, even in the context of some inmates who remain predators of the weak and vulnerable. The students could appreciate that confined overcrowded institutions increase the exposure to infections, such as TB. Several students picked up on Loeb’s point that prisons have limited and fixed budgets for nutrition, recreation, and healthcare. One admitted that she had been under the impression that prisoners “did not have it so bad, and that most were in good condition because they worked out a lot.” Most of the students discussed the impact of misinformation, biases, and stigma on the quality of relationship between nurses and incarcerated persons. Several knew that prisoners disproportionately come from poor and disadvantaged backgrounds, as well as racial, religious, or political minority groups. Many admitted that they had previously held strong negative attitudes toward the incarcerated and that they had a difficult time trusting them and treating them like “law-abiding” persons. One said that prisoners who had “committed crimes against their family or acts considered especially heinous” were likely to have less family and community contacts. Another said, “Some of them were a product of their circumstances, such as economic status, environment, or just being at the wrong place at the wrong time and a significant proportion of the population suffered from mental illness.” A third said that a neighbor of hers had been imprisoned for a crime he may not have committed and that he had become psychotic in prison and that even after his release he was never the same. Another wrote that her father was a corrections officer and that he told her about how bad some corrections guards treat prisoners. One wrote, “What is needed is a better relationship of trust and caring between the inmates and prison staff.” One student said she had been a volunteer in a prison in the Philippines. She said, “In the Philippines the prisons are overcrowded and some prisoners are innocent, but they are in prison because of the Philippine government’s ‘no mercy’ policy on drugs. Prisoners there are treated inhumanely; they are subjected to abuse and brutality and placed in crowded cells, like cages for animals. One can assume that health and well-being of the incarcerated there is not a priority.” The students appreciated that providing healthcare for incarcerated persons requires specialized knowledge, commitment, and unique attitudes and skills that many nurses do not possess. Several were impressed with the Loeb’s achievements. One reported, “Efforts to transform the quality of life for aging inmates require selfless perseverance.” Many of the participants on this project admitted that before this event they had not been interested in learning about how to provide quality care to incarcerated persons in jail. Many said that they were grateful because the presentation “opened their eyes to the realities and suffering of aging prisoners,” and several felt moved by their plight and came to the conclusion that they, like the rest of the aging population, deserve respectful care and to be treated with dignity. Dying in Prison As with aging in prison, the students in this project were surprised to hear about prisoners dying there. Many noted that corrections officers, chaplains, volunteers, and other prisoners are often the only caregivers most prisoners have and that for many these relationships are long term. In addition, many inmates do not have advanced directives. Several students also picked up on special issues with narcotic medications in prison which can be barrier to quality palliative care for inmates. They also noted that there were a limited number of hospice beds in prisons. Hearing about the vulnerability of dying prisoners helped the students put aside biases and stereotypical attitudes about prisoners. They were moved by the presentation to acknowledge that dying prisoners deserve to be treated with dignity. One wrote, “I believe that through education, the majority of the prison staff will eventually develop more compassion for dying prisoners. This might encourage a better relationship of trust and caring between the inmates and prison staff.” 256 Another said, “I realized that my conception of how the prison system worked was wrong. I now know that there is an aging prison population that will require palliative care.” Another wondered how funeral rites of deceased inmates were done, and if their bodies were released to their families. Most of the students quoted Loeb’s remark that “every person’s life is meaningful to someone.” Another wrote, “They deserve our compassion. They deserve to be cared for just as any free man or woman is cared for as their death approaches.” One student wrote, “Caring for dying prisoners requires the entire prison staff. End-of-life care needs to be comprehensive and done in a holistic manner. The approach should be free of judgment.” They described the lecture as “an eye opener about a part of population that we very often pretend or forget that it exists.” Several participants added that they thought that nurses needed to be advocates for dying prisoners. Another wrote, “I was dismayed and astonished that our society could continue to allow this. My first thought was: What happened to humanity? We continue to discriminate against these individuals and treat them in such an inhumane and barbarous manner. Does anyone truly deserve such persecution?” Ethical and Professional Issues in the Eldercare and End-of-Life Care of Prisoners The students in this study were asked to reflect on the ethical and professional issues raised in the presentation. It is therefore understandable that most discussed ethical and professional dilemmas related to providing care to aging and dying prisoners. Many reflected on Loeb’s question “Why should we care?” A few added, “My thoughts exactly.” Some mentioned the cost of healthcare and end-of-life care to taxpayers and questioned why should prisoners receive quality aging and end-of-life care when many “law-abiding” people do not? Another said she had difficulty providing services to “those who committed atrocities, when many in our society don’t even have health insurance.” Another said, “I had not thought about inmates having access to technology. Honestly, in the past when I thought of prisoners, I did not think of them as people who add something positive to the world. My bias was that such people should be written off and isolated. The thought of them getting better care through technology never crossed my mind.” Several talked about others, who “find it difficult to provide compassionate care and kindness to persons who have committed violent crimes.” All of the students who wrote reflective essays wrestled with the incongruence of nurses being ethical and professionals and withholding or providing substandard care to a group of individuals. Many agreed with Dostoevsky’s remark that suggests the condition of the way a country treats its prisoners reflects something critical about that country. Another wrote, “I think Loeb’s work highlights the importance and beauty of the nursing profession that strives to the Nursing Science Quarterly 30(3) highest degree of integrity and ethical standards.” Several were moved by Loeb’s logic that each person is significant to someone and that by not providing care to prisoners, others suffered as well, continuing a cycle of pain and sorrow. Thus, prisoners came to be seen as human beings with the right to quality end-of-life care. Most of the students liked Loeb’s logo “respect-dignity-hope.” One said, “as a profession with compassionate care, we can forge ahead to redefine what health care should be about.” The student from the Philippines and a few others referred to national policies, incarceration inequity, and social injustice. One discussed a documentary she has seen on Netflix, titled Thirteenth. She said, “The theme of the documentary was that once you enter the prison system you are unofficially a slave.” Another who said she saw the film described prisons as big businesses “providing cheap labor comparable to a sweatshop, but worse.” Ethical and Professional Issues in Research Involving Elderly and End-of-Life Prisoners The last issue the students talked about in their essays was the importance of and ethical challenges of doing research involving aging and end-of-life prisoners. Several of the students said they admired Loeb for her tenacity and ability to get grants. One student wrote, “She reminded us that ethically, this is an extremely vulnerable population. Historically and still today, there are egregious violations to prisoners, including denial of necessary healthcare and human experimentation.” Another mentioned the Tuskegee Syphilis Study and said: This lecture opened my eyes to participant selection issues. Some prisoners sign up for research because of possible perceived benefits or out of boredom. Also informed consent must be at the forefront of the investigators obligation to the study and the participants. They must make sure that the patient understands what is going on and that promises are not made based on participation. Working at a cancer center I have seen some patients without any other treatment options looking for clinical trials. We have to make sure that patients are signing up with full understanding and informed consent. Health and general literacy was mentioned by several students as concerns for getting informed consent. Another alluded to the compounding vulnerability of both being elderly and a prisoner, because of the potential for “coercion of inmates in research studies such as the stories of chemical and medication studies on prisoners as test subjects with high risks and consequences.” A third reflected on “the legacy of mistrust with research” that many prisoners feel and how that makes recruitment more challenging. Another noted: these older populations within the prison face environmental challenges and have very limited availability to basic freedom and privileges. Her [Loeb] strategies involved establishing 257 Baumann / Global Perspectives credibility and trust. It is important to form the right team with the right tools and promote safety while conducting research in prisons. The Humanbecoming Hermeneutic Engagement With Students’ Reflections The above summary of the students’ essays on the ethical and professional issues related to aging and end-of-life care of prisoners represent the text explored in this humanbecoming hermeneutic engagement. One of the authors (S.L.B.) immersed himself in the text all-at-once penetrating engaging, quiescent beholding, and inspiring envisaging in the essays of the students, on the presentation described above. Immersion in the reflections suggested something about what was said and not said about the becoming visible-invisible becoming while arriving at new knowings. Kübler-Ross recognized the value of having hope, even if that hope was for a peaceful dying. Parse (2007) explored hope in the meaning moments in the Stephen King short story Rita Hayworth and the Shawshank Redemption. She said: The specific reference to hope arose explicitly and subtly many times in the story. The thread of hope–no-hope as a universal lived experience meandered throughout the narrative, surfacing with brief glimpses of moments of hope. For example, signs of keeping hope alive arose when the prisoners laid bets on certain things that surfaced in day-today living, setting expectations for winning. (Parse, 2007, p. 131) In this project, the students struggled to find meaning and hope, thinking about, for the first time for most, the juxtaposition of aging, death, and incarceration. The topic weaves together two key existential issues that all human beings face, freedom and awareness of mortality. Loeb’s presentation as reflected on by the students raises difficult questions about how we treat other human beings and suggests that the media often distorts uncomfortable truths. The essays reflect surprise that even in the face of advanced age and dying, many people are confined to an institution designed not for care or dignity but to remove persons from the general community and to some degree to punish. What bothered some of the students was that they had been okay with that. Contained in the student essays are hints of the forgiveness needed to restore the perception of the worth of dying criminals as still humans and of ourselves as guilty bystanders of incarceration inequality. Yet freedom and mystery as conceived by Parse (2014), remain even in the maximum security prisons. As demonstrated in the work of Tonia Faust in Louisiana State Penitentiary (Jones, 2014) and Lafeyette, one of her inmate caregivers, who create opportunities for family reunification and redemption as they bathe and clean the wounds of dying prisoners, which can also be seen as cotranscending with the possibles (Parse, 2014). In the language of the humanbecoming paradigm (Parse, 2014), the essays contain references to shifting rhythmical patterns in the “the revealing-concealing, enabling-limiting of connecting-separating” (Parse, 2014, p. 36), as the graduate nursing students concede that dying prisoners are important to someone, and see that they after all are not so different from the rest of us, beings who will also get frail and die. This new knowing restores a degree of solidarity, and gives rise to compassion. Enabling-limiting of connecting-separating can be seen in the interdisciplinary team building needed for the end-of-life care and research involving prisoners. Included is team building with chaplains, corrections officers, inmate caregivers, and prison administrators, in the eldercare and end-of-life care, for individuals who more likely than not had been previously in adversarial and mistrustful relationships. Genuinely respectful teams who bear witness to fading and dying prisoners can also be seen as transforming the familiar-unfamiliar (Parse, 2014). Dempsey (2008) used the humanbecoming paradigm to guide her exploratory descriptive study of feeling confined. The participants in her study were 13 men on a locked psychiatric prison unit in the Midwest of the United States. She reported that feeling confined for these men “was an uneasy restricted seclusion arising with moments of reverie, as acknowledgement amid potential disregard emerges with shifting intimacies, while pondering possibles surfaces with endeavoring” (Dempsey, 2008, p. 140). In the words of her participants, one said, “I lost too much freedom being confined and I value freedom now more than anything,” and another said, “feeling confined is a time of loneliness where there’s no outside communication” (Dempsey, 2008, p. 143). This study suggested that confinement and freedom are parts of a rhythm, which includes feeling lonely and caged. This observation can be heard in the student who described life in prisons in the Philippines as being treated “like animals in a cage.” In the language of the humanbecoming paradigm, connecting-separating and enabling-limiting is lived as dying prisoners make efforts to reconcile with their families outside the prison as they live out the final days in the context of prison’s culture, relationships and services. A Rogerian Glance at Students’ Reflections Exploring student essays on Loeb’s presentation provides much food for thought from a SUHB perspective. Rogers (1992) said, “The purpose of nursing is to promote human betterment wherever people are” (p. 33). Her work reflects a consistent moral stance that nurses provide humanistic, compassionate care for all people. This is a notion that is prevalent in every nursing framework, and within the context of the SUHB, it is emphasized by the key postulates (human and environmental energy fields, pattern, and pandimensionality) and principles of homeodynamics (resonancy, helicy, and integrality). Humans and their environments are inseparable energy fields with distinct patterns that are unique to the individual, as well as group, community, society, world, and universe(s). 258 That everything is a form of energy and that it is all connected implies that all is one and that whatever I do or you do is not just reflected in the whole, it is the whole (TodaroFranceschi, 1999, 2013). Change is a continuous mutual process that involves everything, together (Rogers, 1992). Every act or change emerges in manifestations of pattern, which humans can often (but at times do not) discern. Through pattern appraisal, recognition and appreciation nurses identify ways to contribute to the actualizing of human potential and well-being (Cowling, 1997). Many of the students shared that prior to listening to Loeb’s presentation, they had thought that incarcerated individuals did not deserve much from society. Why should prisoners get quality healthcare when so many others who are good, law-abiding people lack it? Most of the students admitted to rarely, if ever, thinking about this vulnerable population at all (literally an invisible-visible paradox). Yet unequivocally Loeb’s presentation provided a reaffirmation of the most basic nursing premise—that all people deserve compassionate care and ultimately all of the students conceded that the question of “why care?” tugged at the communal meaning and purpose of who we as nurses serve and why we do it. The human-environmental field process evident in the compilation of essays reflects Rogers’ principles of homeodynamics (integrality, resonancy, and helicy). Not only does everything change all at once, all together (integrality), but change is continuous, innovative, and unpredictable (helicy) and occurs in wave patterns from lower to higher frequency (resonancy). These principles taken as a whole are said to reflect the nature of human-environmental field change. The students individually and collectively came to the conclusion that their initial thoughts were not reflective of who they are as nurses or how life should be for those aging or nearing end of life while incarcerated. In addition, they came to agree that without focusing on the whole (the human-environmental field), which in this case includes the inmates, correction officers, prison staff, and healthcare team, there could be no attentive care to the individuals who are aging or dying in prison. Prompted to ponder the limitations of caring for those who are aging and dying in the prison, students applauded the manner in which the entire community, inmates, and employees became engaged in a partnership to enhance the quality of elder and/or end-of-life care in prison. In her theory of accelerating evolution, Rogers (1992) noted changing manifestations of pattern that belie the idea that there is anything explicitly “normal” or “abnormal.” Instead, she suggested that human-environmental field changes occurring throughout our world are becoming increasingly diverse, innovative, and unpredictable, with new emergents arising all the time. Rogers (1992) viewed both aging and dying as dynamic processes in which is there is increasing diversity and creativity, along with limitless potential for growth. Aging is relative, as time is relative (we are not running down nor are we running out of energy—for Nursing Science Quarterly 30(3) we are manifestations of energy). Our bodies are not the whole of us as living entities; our energy fields in communal process with our environmental fields are increasingly diverse entities that continue to exist after death. In the student reflections, there was collective surprise over the apparent accelerated aging of individuals living in prison. From a unitary science perspective, we might be able to better understand the accelerating change in incarcerated individuals who are considered geriatric at the age of 50-55 as a new emergent or different “norm,” through pattern appraisal and appreciation. This could lead us to identify novel ways of assisting inmates to attain a better quality of life and death. Evident as well, in the cohort of student reflections, is the integrality of the human and environmental fields where changes are occurring in such a manner as to call out to those who are participating in the change process to do so more knowingly. Where one might have been unknowingly participating, for example not noticing that an inmate is no longer eating breakfast or is no longer able to climb down out of a bunk bed, through the intervention the community is participating more knowingly in change. Together there is a communal shift toward making known the unknown and acting upon it. Barrett’s (1989, 2010) power as knowing participation in change theory, based on the SUHB, aptly applies here. Through the use of the educational cards developed (GRIMMM), the entire community was able to participate more knowingly in changes that enhanced the well-being of the collective—both inmates and staff alike. From a research perspective, the acts combined to foster the further development of trust among the community members, which in turn paved the way for future research opportunities. Underfunding, lack of resources, and safety issues, along with stigmas associated with being incarcerated, make it challenging to care for this vulnerable population. Students noted how nice it was to have all of the staff and inmates on equal footing rather than identifying who was more expert. This approach, that everyone is important and contributes to the whole, sets a moral tone that we are all in this together, and we can overcome barriers to care. Rogers (1992) addressed this in her work as well, noting there is “a critical need for mutual respect between all health personnel; between nurses, between health fields, and between the fields of science” (p. 34). Engaging and educating all members of the prison community to enhance the quality of both living and dying is indeed very Rogerian. One student poignantly noted that by not treating prisoners with attentive care and compassion, we are not just hurting them but are also hurting those who care about them, “pushing hurt and negativity into society.” Unknowing participation where actions may seem dispassionate or inattentive eventually hurts everyone (Todaro-Franceschi, 2013). In closing, Butcher (1999) had noted, “knowing participation within Rogerian science is an ethic” (p. 116). Having explored the 259 Baumann / Global Perspectives student essays related to this complex subject through a Rogerian lens, this author heartily agrees. Conclusion French Canadian Jean Vanier (2015), philosopher and founder of communities of L’Arche, suggested that two worlds exist divided by a road. Located on one side are those seeking to advance themselves up the ladder of success, wealth, and power and, on the other side, are persons with mental handicaps, with whom he lives, those in prisons, and other persons unable to compete in such a way. Attending the presentation by Loeb and reflecting on her story about nurses partnering with the staff and those who live, age, and die in prison represents a visit to the other world for the students and the authors of this paper. As Vanier found in his 50 years of living with persons with mental handicaps, students got a glimpse of the human community as a whole, that prisoners are in the big picture not so different, that we all face becoming frail and death, and as Loeb said, “every person’s life is meaningful to someone.” This insight gives rise to compassion for all human beings. They not only crossed the road but encountered persons on the other side and began the work of mutual transformation. It has been just over 50 years that the United Nations Human Rights Office of the High Commissioner published the Human Rights Covenants, which included the recommendation to protect the right to not be imprisoned without proper reason, the right to be treated with humanity and respect while in detention, and also suggested limitations of imprisonment. But these documents made no mention of aging or dying in prison. Solzhenitsyn (1971/1975), who, like Dostoyevsky, understood firsthand the pernicious nature of incarceration, wrote “in our camps, as nowhere else, in detail and on a large scale, the special process of narrowing the intellectual and spiritual horizons of a human being, the reduction of the human being to an animal and the process of dying alive” (p. 208). Within such circumstances as aging and dying, persons struggle to hold on to their cherished values and beliefs, and nurses when working with their community partnering knowingly participate in creating change and in the human-environmental fields to give rise to illuminating meaning, shifting views of what is, and cotranscending with the possible. While humanbecoming and the Rogerian science are different in many respects, both views convergence on their commitment to human betterment for all persons, which remains in the authors’ views the essence of nursing. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this review. Funding The authors received no financial support for the authorship and/or publication of this review. References Barrett, E. A. M. (1989). A nursing theory of power for nursing practice: Derivation from Rogers’ paradigm. In J. Riehl (Ed.), Conceptual models for nursing practice (3rd ed., pp. 207-217). Norwalk, CT: Appleton & Lange. Barrett, E. A. M. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23, 47-54. Baumann, S. L., & Ganzer, C. A. (2016). Being dedicated in the film The American Nurse. Nursing Science Quarterly, 29, 71-77. Baumann, S. L., Murphy, D. C., & Ganzer, C. A. (2015). A study of graduate nursing students reflections on the art of Tibetan medicine. Nursing Science Quarterly, 28, 156-161. Butcher, H. K. (1999). Rogerian ethics: An ethical inquiry into Rogers’s life and science. Nursing Science Quarterly, 22, 111-118. Butcher, H. K. (Ed.). (2016). The science of unitary human beings: Theoretical basis for nursing. Retrieved from http://rogeriannursingscience.wikispaces.com/ Cowling, W. R., III. (1997). Pattern appreciation: The unitary science/practice of reaching for essence. In M. Madrid (Ed.), Patterns of Rogerian knowing (pp. 129-142). New York, NY: National League for Nursing. Dempsey, L. F. (2008). A qualitative descriptive exploratory study of feeling confined using Parse’s humanbecoming school of thought. Nursing Science Quarterly, 21, 140-149. doi:10.1177/0894318408314692 Jones, C. (Producer & Director) (2014). The American nurse [Motion picture]. Fresenius Kabi, USA. Parse, R. R. (2001). Qualitative inquiry: The path of sciencing. Sudbury, MA: Jones and Bartlett. Parse, R. R. (2007). Hope in “Rita Hayworth and Shawshank Redemption”: A human becoming hermeneutic study. Nursing Science Quarterly, 20, 148-154. Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh, PA: Discovery International Publications. Parse, R. R. (2016). Parsesciencing: A basic science mode of inquiry. Nursing Science Quarterly, 29, 271-274. Rogers, M. E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5, 27-34. Shapiro, F. R. (2006). The Yale book of quotations. New Haven, CT: Yale University Press. Solzhenitsyn, A. I. (1971/1975). The Gulag Archipelago, 19181956: An experiment in literary investigation (III-IV) (Trans., Thomas P. Whitney). New York, NY: Harper & Row. Todaro-Franceschi, V. (1999). The enigma of energy: Where science and religion converge. New York, NY: Crossroad. Todaro-Franceschi, V. (2001). Energy: A bridging concept for nursing science. Nursing Science Quarterly, 14, 132-140. Todaro-Franceschi, V. (2013). Compassion fatigue and burnout in nursing: Enhancing professional quality of life. New York, NY: Springer. Vanier, J. (2015). Why the strong need the weak: Jean Vanier at the House of Lords. Retrieved from https://www.youtube.com/ watch?v=0NOX_UPSyJw