Uncommon journey

By Eileen T. Breslin | 12/02/2005

It is through awareness, taught servant-leader advocate Robert Greenleaf, that we discover destiny. Like all who seek purpose, the pursuit of destiny has taken Carol Picard, newly inaugurated president of the Honor Society of Nursing, Sigma Theta Tau International, on a unique journey.

As is true for all who successfully reach significant goals, Carol Leger Picard, RN, PhD, has been aided in her quest by five crucial attributes.

Sense of responsibility
A person develops a sense of responsibility, observed Greenleaf, by connecting to a wider community and becoming aware of the needs of others. “Responsibility,” he wrote, “requires that a person think, speak and act as if personally accountable to all who may be affected by his or her thoughts, words and deeds” (Frick & Spears, 1996, p. 41). She developed her sense of responsibility early in life.

Carol PicardPicard was born in Fitchburg, an industrial and ethnically diverse city in the center of the Commonwealth of Massachusetts, to parents of French-Canadian descent. Understanding relationships came naturally, as she is the oldest of seven children. Picard smiles when thinking about her childhood. “We had very little materially when we were young, but never felt poor,” she says. “We were rich in relationships in the family and in the neighborhood.”

She grew up in a Roman Catholic parish where service was a part of life. She raked leaves at the convent and helped her father sort collections after Sunday morning Mass. Even as an adolescent, she demonstrated leadership and responsibility, serving as vice president of her class at St. Bernard’s High School.

For Picard, reared in the 1960s with good relationships, energy and a big-picture view of possibilities, life was all about making a difference. “My mother remembers we sang ‘The Impossible Dream’ at our high school graduation,” she says. “When we sang it, we believed it. I still do. No matter how challenging a situation, I believe in the potential of people to respond and make a difference.”

Nursing seemed a logical career choice for a person whose family environment promoted caring for others. Her first work experience was in a neighborhood nursing home.

“Nursing provided me with a path for changing the world through service,” says Picard. “I think nursing and teaching probably were in my thoughts early. I had to provide postmortem care on my third day at work—alone. I remember thinking, there are better ways to help a person learn how to manage this difficult experience.” Later, it was nurse role models, such as nursing director Rita McCaffrey, who inspired her to consider nursing as a profession.

When Picard entered Fitchburg State College, she declared nursing as her major. Katherine Sehl, RN, EdD, nursing chairperson at the college, was a world traveler and, as a consultant for the World Health Organization, had helped establish nursing programs in Turkey and several African countries. Sehl inspired her to think globally about the profession and her personal potential.

It was Picard’s teachers, however—Kay O’Connor, Rita Driscoll and Lillian Bannon—who taught her to be a knowledgeable, competent and compassionate nurse. Early on, psychiatric nursing became her passion when she saw the potential of relationship-centered practice.

“Of course, our stories are always intertwined with our choices,” Picard notes. “Many of my relatives had bipolar disorder, and I tell my students that I think I got just 40 percent of the genetic loading, since I have always had a lot of energy.”

While at Fitchburg, she met Denis Picard, now her husband of 35 years. As young college students who shared similar family backgrounds and a love of music, literature, films and family, they recognized in each other a partner for life. A daughter, Alison, was born in 1980 and a son, Jeff, in 1984. Surrounded by extended family, the Picards loved raising their children and savored all the school and community activities in which the children participated.

Denis, vice president at DuPont Authentication Systems, is very supportive of his wife’s work, including her involvement in the honor society. Says Picard: “He has often helped the local chapter. For example, he set up a database system for us in the early ’80s. He is a real friend of nursing and the love of my life!”

After obtaining her BSN degree, Picard worked at the Gardner Mental Health Center in Massachusetts. Working with the most vulnerable of patients, people with persistent mental illness, she knew psychiatric nursing would be her life’s work. In 1974, another mentor and lifelong friend, Emily Chandler, encouraged her to begin lecturing and providing workshops for nurses on self-care strategies. Initially, the two women lectured together, and then Picard was on her own.

Chandler also encouraged her to pursue a graduate degree in psychiatric mental health nursing at Boston College. There, Picard studied with Ann Wolbert Burgess, RN, DNSc, CS, FAAN, who, at the time, was researching rape trauma syndrome. By observing the impact of Burgess’ seminal research on the care of rape victims in emergency rooms, Picard developed an appreciation for the value of research and its implications for clinical practice.

As a clinical specialist, she continued working in mental health centers while furthering her education in family therapy. She led an after-care service program in Marlboro, Mass., for people with persistent mental illness and collaborated with a multidisciplinary team to improve the quality of life for these clients in the community.

After her daughter’s birth, Picard, reluctant to return to her 50-plus-hours-a-week position, began private practice in psychotherapy and consulting. Subsequently, she began teaching psychiatric nursing at Fitchburg State College. Her role as a clinician provided rich practical experiences to enhance her teaching, a combination that she maintains to this day.

While at Fitchburg, Picard was mentored by Kay O’Connor, the first president of Epsilon Beta Chapter, and she was inducted into the honor society as a community leader in 1982.

“Service to Sigma Theta Tau International is logical,” Picard says. “Leadership in this organization has been a way for me to give back for all the mentoring, opportunities and knowledge I have received from other leaders in the honor society.”

Picard takes her responsibility as a nurse educator seriously. I have observed firsthand her unconditional positive regard for graduate students. Under her tutelage, students blossom and accomplish far more than they ever dreamed possible. Her palpable passion for nursing instills in students a sense that all is possible, that the nursing care they deliver makes a difference in the quality of their patients’ lives.

“I see potential in students to lead and make a difference,” says Picard, and I tell them so, even if they can’t see it in themselves yet.”

Openness to knowledge
Openness to knowledge, asserts Greenleaf, allows one to be aware of a wide range of choices, to question what is known. It calls upon us to seek creative solutions in uncommon ways or rediscover what is known.

Picard believes that “knowledge comes from everywhere. I read widely, not only in nursing,” she says. “I try to read something from another field on every plane flight I take.”

Through cultivation of mindfulness and the practice of meditation, Picard’s self-awareness was developed. By deliberately choosing environments, such as travel, that create uncertainty, she has nurtured openness to people, ideas and ways of knowing. Her travels have taken her far from her small-town roots. She has been a keynote speaker at conferences in the United States, Scotland and England and has presented papers in Ireland, Canada, Taiwan, Denmark, Finland and Russia.

In her search for nursing knowledge, Picard experienced a real “nodal point,” as she calls it, while attending a 1990 conference sponsored by the International Association for Human Caring (IAHC), where she was also a speaker.

“It was a pivotal moment,” she recalls. “At one conference, Jean Watson, Madeleine Leininger, Marilyn Ray, Anne Boykin, Simone Roach, Gwen Sherwood and Sigridur Halldorsdottir all spoke on caring. I remember feeling that a door to a new area of nursing knowledge had opened for me. What they had to say spoke to the heart of my practice as a teacher and clinical specialist.”

The experience spurred her on to discover and understand more about relationships through alternative approaches. At age 38, Picard began taking classes in modern dance and experienced directly the impact of knowing and expressing oneself through movement.

What changes one personally also changes one’s practice, she says. Linda, a dear friend who died at age 39, once told Picard: “You’d better squeeze the juice out of every day you get. You don’t know how many years you’ll have, either.” That was Picard’s wake-up call to live each day fully, creatively and with gratitude.

She began reflecting on her inner life by cultivating mindfulness, reading the works of Hildegard of Bingen, the medieval mystic, and enjoying the arts—reading and writing poetry, perfecting her dance skills and performing with a small modern dance company. Drawing from the work of Robert Coles (1990), she began using stories to develop the moral imagination of her students. Together with an English professor, she taught a class on using literature and the arts to better understand illness and disability.

In 1995, Picard returned to Boston College to pursue a PhD degree. There she was privileged to be mentored by Dorothy Jones, RNC, EdD, ANP, FAAN. “She encouraged me to pursue my interest in creative movement as a mode of expression of meaning.”

Much of Picard’s work focuses on the meaning of health, experiences of parents who have children with bipolar disorder, and nurses who survive cancer. Through her writing and presentations, one gains an appreciation of the complexity of the human experience.

Together with other researchers, including nurses, she helped create the Newman Scholars Group in Boston, thereby furthering the development of nursing knowledge. By partnering with other artists, she displayed openness to understanding the human experience. Esthetics as a means of knowing became very real for her.

Openness to knowledge creation through partnerships is not new to Picard. Understanding intimately the power of personal knowledge, she published research on the process of cooperative inquiry that explored how each member of her family, 47 years earlier, had perceived and experienced the loss of her brother to sudden infant death syndrome (SIDS). It was a powerful, healing experience for Picard and her family. Recently, she and Jones co-authored a book, Giving Voice to What We Know, which explores Margaret Newman’s theory of health as expanding consciousness in practice, education and research (Picard & Jones, 2005).

The convergence of Picard’s love of dance, nursing and collaboration came together with an invitation to open the 1996 IAHC conference in Finland with choreography on suffering and healing. Together with another modern dancer, Caryl Sickul, and Shannon Natale, a nurse who is also a professional cellist, they used dance, music, dialogue, poetry and various symbols of suffering and healing to communicate care of patients in various stages of pain, suffering and healing.

Picard frequently has performed a piece of her own choreography to close a presentation she gives on “Energizing Nursing Practice: Keeping the Passion in Compassion.”

Entheos
Greenleaf defines entheos as being possessed by the spirit in a positive constructive sense. “Entheos,” he states, “is the essence, the power actualizing the person who is inspired. It is the spirit that sustains” (Frisk & Spear, 1996, p. 81). According to Greenleaf, two states of being, both paradoxical, indicate growth of entheos in a person. The first is being content, yet discontent, with the status quo. The second is sensing broadening responsibility while focusing more sharply on individual tasks.

Picard recognizes entheos with respect to her involvement with the honor society: “I find in Sigma Theta Tau International,” she says, “a home where I find colleagues with similar values and hopes for making a positive change to improve the lives of patients. But I also know that we need to continue to move the organization forward. In my presidential call to action, I tell members that we should never feel too comfortable. In any vital organization, there must be a balance between tradition and past success and the risk associated with change.”

Another example of entheos and personal growth involved Picard’s awareness of the need to heal racism. Some years ago, she and five others performed a modern dance, choreographed by a member of the Dance Theatre of Harlem, that addressed the influence of parents on racial attitudes of children and the need to heal this societal wound through development of relationships. The dance, which has since been performed numerous times in schools and before community groups, has given Picard a deep appreciation of the nature of racism and the need to understand it.

“I thought I understood racism until students of all ages told us about their experiences in daily life, and the energy it takes to deal with subtle as well as overt racially toned interactions. It changed me to dance this piece, and hearing from the audience changed me even more. Since then, I have routinely asked nursing students of color if their school is welcoming to them and how we might make it better. And they tell me.”

Picard also taught teenage students in an Upward Bound program to perform this choreography. “One of the teenagers I taught the piece to danced the role of the white mother. I asked her what it was like to perform the dance. She told me it was what she lived every day: ‘I look white, and people respond to me in a certain way. Then I start to talk and they hear my New York-Puerto Rican accent, and a veil comes over their eyes. They don’t see me the same way anymore.’” These dialogues informed Picard of the need to raise the issue as it relates to health and well-being at all levels, locally to globally.

From 1999 to 2003, Picard was associate director of the graduate nursing program at Massachusetts General Hospital (MGH) Institute of Health Professions in Boston. Since 2003, she has been employed by the University of Massachusetts, initially at Lowell and now at Amherst, where she is the graduate program director and director of the PhD program in the School of Nursing.

Picard continues to balance family life, teaching, honor society involvement, private practice and dancing. For 10 years, she performed with The Guild, a small repertory company. She found a way to combine her love for the arts and her profession by bringing the arts into the classroom for nursing students, sometimes taking the class to the college’s dance studio.

Focus on the future
Greenleaf challenges leaders to be involved with the preparation of future leaders because, as he states, “the future is now.” Throughout her career, Picard has been strongly influenced by exceptional nursing leaders who have assisted her, in Greenleaf’s words, in “painting the big dream.” She, in turn, is painting the big dream for the next generation of nursing leaders.

“Opportunity is not a lengthy visitor” is one of Picard’s favorite proverbs. In 1990, Barbara Stanley, president of the Massachusetts Nurses Association, called Picard and asked her to help escort a visiting Russian nurse. She immediately agreed. As a result of that simple response, a wonderful friendship and collaboration developed between Galina Perfiljeva of the I.M. Sechenov Medical Academy in Moscow and Epsilon Beta Chapter at Fitchburg State College.

Connie Vance, RN, EdD, FAAN, professor at The College of New Rochelle School of Nursing in New Rochelle, N.Y., a mentor by phone to Picard for years, helped her craft a grant proposal to fund this international work. Many honor society nurses remember the Russian lacquer pins sold at conventions during the 1990s by Epsilon Beta Chapter. That effort raised more than $100,000 to support nursing education, exchanges, materials and technology at the first university-level baccalaureate and master’s programs in Russia. The chapter won the Ethel Palmer Clarke Award for its many collaborative programs and projects, the largest of which was the Russia project.

Another inspiration to Picard during this time was Joan Riley, former Region 5 coordinator who also served on the executive committee of Sigma Theta Tau International. “She was a champion and mentor to many people in the honor society, and I am grateful for the enthusiasm and joy she shared with us.”

Picard has subsequently traveled many times to Russia, taking American, Canadian and British nurses with her to promote collaboration and long-term relationships. Her Epsilon Beta colleagues, Sharon DiVitto and Rachel DiFazio, continue this important work.

Laughter
Purpose and laughter, states Greenleaf, are “the twins that must not separate. Each is empty without the other. Together they are the impregnable fortress of strength, as that word is used here: the ability, in the face of the practical issues of life, to choose the right aim and to pursue that aim responsibly over a long period of time.”

In every position she has held with the honor society, Picard has found ways to bring joy and laughter to the work. “I have always thought that the best sound in a hallway while at work is laughter,” she says. “It means that people are taking pleasure in their work and in the company of their colleagues. Supporting such relationship building leads to creative strategies and solutions to challenges.”

For 23 years, the honor society has been part of Picard’s professional life. She has served as president of her first chapter, Epsilon Beta; regional coordinator for New England and New York; chair of the Regional Chapters Coordinating Committee; and vice president, president-elect and now president of the national organization. In the past biennium, she chaired the Futures Advisory Council, which worked on strategic directions for the honor society. She also has served on a number of other committees and task forces. She has been very active in the International Association for Human Caring, serving on its board and as president from 2002-04.

Picard believes Sigma Theta Tau International provides great opportunity for people to demonstrate leadership and find others with whom to collaborate in producing and using knowledge to improve health. “Every member has the chance to find a global linkage and to contribute to the mission and vision with their unique talents,” she says. One of the best ways to accomplish this, she points out, is through collaboration, an essential element in her presidential call to action. For Picard, collaboration is vision toward a common goal and relationship bound together.

In the busyness of her everyday life, Picard values solitude. She treasures the time she has spent in silent retreats, regarding them as opportunities to reflect on what is most meaningful in life. She has a favorite saying from the Buddhist tradition: “Movement creates life. Stillness creates love. To be still, and still moving, this is everything.” 

Eileen T. Breslin, RN, PhD, is professor and dean, School of Nursing, University of Massachusetts Amherst.

Author's Note
“I have been privileged,” writes Dean Breslin, “to work closely with Carol Picard in her role as graduate program director of the School of Nursing at the University of Massachusetts Amherst. Her energy and global view, combined with her deep understanding of the nurse-patient relationship and the primacy of caring and compassion, will enhance her tenure as president of Sigma Theta Tau International. Her understanding of relationships informs her call for collaboration and partnership for evidence-based knowledge transfer, both locally and globally.” 

References:
Coles, R. (1990). The call of stories: Teaching and the moral imagination. New York: Marriner.

Frick, D., & Spears, L. (1996). The private writings of Robert K. Greenleaf on becoming a servant-leader. San Francisco: Jossey-Bass.

Picard, C., & Jones, D. (2005). Giving voice to what we know: Margaret Newman’s theory of health as expanding consciousness in nursing practice, research and education. Boston: Jones and Barlett.

Photo: Robert Tobey

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