PHILOSOPHY OF NURSING 1

Transcription

1 PHILOSOPHY OF NURSING 1 Philosophy of Nursing Jessica Caviness On Campus Submitted in partial fulfillment of the requirements in the course Nursing 431: Transition to Professional Nursing Practice Old Dominion University NORFOLK, VIRGINIA Spring, 2013

2 PHILOSOPHY OF NURSING 2 Philosophy of Nursing As a soon-to-be graduate nurse, I realize most of all, I am nervous for what the future holds for my nursing career. Having been through countless hours of clinical rotations and written numerous papers, I realize I still have an unbelievable amount of knowledge yet to obtain when I step out onto the nursing unit. I know now, in order to get through this upcoming transition, I must focus myself, thoughts, and abilities towards my ultimate goal: to provide professional, competent care to all patients utilizing a professional nursing philosophy which I intend to define in this paper. As a sophomore beginning nursing school, I envisioned my nursing philosophy to be about caring, specifically citing Kristen Swanson s Middle-Range Theory of Caring as my guide to practice. This theory incorporated caring in nursing as knowing, being with, doing for, enabling, and maintaining belief (as cited in Andershed & Olsson, 2009, p. 599) in the patient. While I continue to believe the theory is important to nursing, I do not still identify this as my ultimate guide to nursing practice. I believe there is much more to the profession of nursing than just caring. The rest of this paper is devoted to my updated philosophy and theories of nursing derived from multiple sources and experiences during clinical rotations. Definition of Nursing Nursing is most closely defined according to the Careful Nursing Philosophy and Professional Practice Model. The basic assumptions of this theory relate back to Florence Nightingale s statement that the purpose of true nursing is to put the patient in the best condition for nature to act upon him nature heals patients (as cited in Meehan, 2012, p. 2909). With these ideas in mind, nursing is defined as the ability to facilitate health and healing by viewing each person with dignity, respect, purpose, and inalienable rights (Meehan, 2012).

3 PHILOSOPHY OF NURSING 3 This is accomplished by providing a therapeutic environment where nurses practice with a high degree of competence, excellence, and professional authority amongst the interdisciplinary health care team (Meehan, 2012). Nurses should be in constant search for continuing education and broadening their knowledge base through research and evidence based practice. The ability to practice with competence and excellence encompasses attention to detail, having a watchful eye for changes in an individual s physical or mental status, engaging the patient to actively participate in self-care, assisting the patient whenever deficits are noted, working to overcome and work through potential deficits, fostering a safe environment, utilizing nursing assessments, diagnoses, and outcomes specific for each individual, and providing education for illnesses, injuries, health promotion, and growth and development (Meehan, 2012). Nursing has changed over the years from that of control to that of relation. Nursing has evolved from a hierarchal, physician dominated field where nurses treated illnesses and not the body (Wright & Brajtman, 2011). Present day nursing falls into a relational model which acknowledges the primacy of human relationships and directing the focus of our moral attention to relational qualities such as respect, compassion, and genuineness (Wright & Brajtman, 2011, p. 22). Nurses now focus on maintaining fundamental values to help others by providing holistic, all-encompassing care (Wright & Brajtman, 2011). Student s Purpose My essential purpose as a nurse is to help people. I do not have a religious influence or a calling to become a nurse. I simply wanted to be in the medical profession for as long as I can remember. It is the only career I have ever wanted, specifically focusing in labor and delivery. I want to help people; I want to help mothers and assist them through difficult and exhausting labor; I want to help bring babies into the world and assist them in taking their first breaths; I

4 PHILOSOPHY OF NURSING 4 want to help people recover from illnesses. It is joyous and rewarding to see patients stand up after an epidural or walk to the bathroom after having a Caesarian section. I enjoy teaching the mother how to breastfeed. I also want to help mothers and fathers in times of distress, death, and uncertainty. Labor and delivery is not all smiles and happiness. The death of a baby or the death of a mother both pose problems the labor and delivery nurse must deal with on this unit. To work through these situations, I will hold myself to the utmost of standards to provide nothing but compassionate, empathetic care to the mother, father, and family. I will function as a nurse according to the Nursing Code of Ethics, Provision 1.3: The Nature of Health Problems (American Nurses Association, 2001, p. 3), which states that the nurse respects the worth, dignity, and the rights of all human beings irrespective of the nature of the health problem. It is easy to provide competent, dignified care to the expectant mother married to a father with a financially stable background. It is more difficult to provide that same care to an expectant mother who abuses drugs, alcohol, or tobacco, who is not married, who does not know the father of the baby, or to teenagers. However, as a nurse, I will function professionally to provide the same competent and dignified care to all individuals, regardless of their specific social background. In situations that may not be appropriate in my own life, I will continue to provide the best care possible, and ensure that the baby comes into the world with the best beginning possible, starting with proper newborn care. Caring, compassion, and empathy are all characteristics that will guide my practice in delivering babies for even the individuals with the most complex and difficult family situations. Assumptions The Nurse and Client in a Culturally Diverse Setting The nurse-patient relationship is unique in which the patient must be viewed as a whole

5 PHILOSOPHY OF NURSING 5 person; not individual parts (Wright & Brajtman, 2011). I find the following quote by de Raeve (as cited by Wright & Brajtman, 2011, p. 22) to be most fitting to describe the nurse-patient relationship: nurses invent nursing with each new patient they nurse, if they use their imagination. This is the framework that all nurses should use to view patient interactions. Each patient interacts with the world in ways specific to his or her gender, religion, past experiences, beliefs, and values. It is the nurse s responsibility to familiarize herself with the patient s ideals, values, and goals in order to provide culturally competent care and promote an environment conducive to healing and rest. Such care can be utilized by incorporating Madeleine Leininger s Culture Care Theory into practice. This theory assumes that in order to provide culturally competent care to all patients, one must recognize that within each culture, each person has variabilities, universal features, and factors influencing outcomes (Leininger, 2002). Nurses should have in-depth discussions and observations with the patients to determine any folk practices, health practices, and family dynamics (Leininger, 2002). To promote well-rounded, holistic care to each patient, it is imperative the nurse recognize different cultural practices, cultural maintenance, and proper accommodations for each and every patient (Leininger, 2002). In addition to determining the patient s culture and treating them as an individual regardless of their affiliation with any groups, the nurse must also understand his or her own beliefs and be able to set them aside when on the nursing floor. The Nurse in the Community Nurses in the community are responsible for educating the public on health concerns, ways to maximize health promotion, consume adequate nutrients, and to prevent injuries. To accomplish these tasks, community nursing involves entering the world of the other, and understanding and responding to the calls of that world (Wright & Brajtman, 2011, p. 23).

6 PHILOSOPHY OF NURSING 6 Nurses must immerse themselves within the population which the nurse is trying to educate in order to determine needs and potential obstacles to obtaining health care and living healthy lives. When doing this, the nurse should follow Pender s Health Promotion Model which groups health behaviors into individual characteristics and experiences, behavior specific cognitions and affects, and situational/interpersonal influences (Srof & Velsor-Friedrich, 2006, p. 367). By utilizing the Health Promotions Model for community nursing, the nurse will be better able to identify patient s beliefs about healthcare, patient s access to healthcare, interpersonal influences, situational influences, personal behavior, and locus of control (Srof & Velsor- Friedrich, 2006). With this information, the nurse is in a better position to assess the communities needs as a whole and act and plan accordingly. The Nurse and Other Health Care Professionals The profession of nursing is challenging the relationship between themselves and the physician in order to gain more autonomy and decrease the historical hierarchical physician dominance (Wright & Brajtman, 2011). In order to gain increased autonomy, nurses and physicians must work collaboratively together, along with other members of the healthcare team. All members must recognize that each team member brings a unique set of ideas and viewpoints to treat the full realm of patient s vulnerability (Wright & Brajtman, 2011). Imogene King s Theory of Goal Attainment is particularly applicable to this scenario. Goal attainment is achieved through complex interactions between the nurse, physician, and the healthcare team to include verbal and non-verbal communication which is exchanged and interpreted by transactions in which values, needs, and wants of each member of the dyad are shared (King, 1999, p. 293). The communication and interaction between team members collectively help to improve morale in the health care team, better patient and family satisfaction, improved patient

7 PHILOSOPHY OF NURSING 7 safety, increased efficiency of human and financial resources, and enhanced clinical care (Wright & Brajtman, 2011, p. 21). Principles Guiding Professional Practice The first principle guiding my nursing practice is that of advocacy. Advocating for a patient means looking out for the patient s best interest by means of speaking up, finding resources, asking questions, and making sure the patient s concerns have been addressed by the proper team members. Specific examples of advocating for my patient have occurred throughout my rehabilitation clinical. The clinical setting is sub-par in my perspective, and therefore, I have felt the need to notify my nurse of particular assessment findings that otherwise should have been picked up. For instance, my patient s blood urea nitrogen labs had risen three times the recorded level on admission and her creatinine had risen five times the recorded level on admission, only four days prior. I needed to make sure that the nurse and physician were aware of such drastic changes. I asked questions to my nurse such as, Have you noticed the changes to the patient s renal function lab values? What is the physician planning to do about this? When do we need to pursue dialysis options? Has the patient been informed about these lab results? Thankfully, the physician had just written an order for aggressive intravenous fluids to prevent further injury. The second principle I use to guide my practice is that of autonomy. Autonomy is the patient s ability to make decisions for himself and to act according to his or her beliefs without being pressured into making any type of unwanted decisions. Wright and Brajtman (2011, p. 24), define autonomy as lived, is a relational experience that involves both independence from others and dependence on others. Again, I chose specific examples to exemplify this quality from my rehabilitation clinical. The patient was nine days post-op and had not had a bowel

8 PHILOSOPHY OF NURSING 8 movement in eight days. While I was pushing to administer an enema and check for impaction, the patient had other scenarios in mind. Keeping with the idea that this is an inpatient rehabilitation setting, the patients are required to have physical, speech, and occupational therapy sessions for three hours per day in a common gym. I tried to put myself in her shoes and asked what her barriers were to having an enema since her regular bowel schedule is three times per day. She identified the fear of having an accident in a public place and not being fast or mobile enough to get to the bathroom in time. I understood the patient s concerns and let her choose a time for the enema to be administered. Allowing the patient to make her own decisions increases her sense of control over her body. She chose to have the enema in the evening so that she would be able to stay in her room undisturbed by the public. Some times what is best to do in a situation (i.e. having a bowel movement) is not always the choice the patient desires. As a nurse, I will keep this in the back of my head and always remember to search for reasons behind problems and allow patients the opportunity to choose their own options. Conclusion Utilizing the Careful Nursing Philosophy and Professional Practice Model, I will strive to provide the patients in my care the best opportunities for health and healing. While my original philosophy of caring has changed to a more broad and all-encompassing theory, I will not forget my roots as a nurse dedicated to caring, empathy, and sympathy in stressful situations. As I prepare to graduate nursing school and start my professional career, I am happy to know that I have given myself a solid philosophical beginning in which to draw upon during practice. I will strive to practice with a high degree of competence, excellence, authority, autonomy, caring, and compassion. I look forward to my future as a labor and delivery nurse and am excited to begin my nursing career.

9 PHILOSOPHY OF NURSING 9 References American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from eofethicsfornurses/code-of-ethics.pdf Andershed, B., & K. Olsson. (2009). Review of research related to Kristen Swanson s middle range theory of caring. Scandinavian Journal of Caring Science, 23, Doi: /j x King, I. M. (1999). A theory of goal attainment: Philosophical and ethical implications. Nursing Science Quarterly, 12, Doi: / Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13, Doi: / Meehan, T. C. (2012). The careful nursing philosophy and professional practice model. Journal of Clinical Nursing, 21, Doi: /j x Srof, B. J, & Velsor-Friedrich, B. (2006). Health promotion in adolescents: A review of Pender s health promotion model. Nursing Science Quarterly, 19, Doi: / Wright, D., & Bratjman, S. (2011). Relational and embodied knowing: Nursing ethics within the interprofessional team. Nursing Ethics, 18(1), Doi: /

10 PHILOSOPHY OF NURSING 10 Honor Code I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violators of the Honor Code. I will report to hearing if summoned. Signature: Jessica Caviness Date: February 10, 2013

11 PHILOSOPHY OF NURSING 11 PHILOSOPHY OF NURSING GRADE SHEET Grading Criteria Comments Points Appropriate introduction is included. Introduction includes a summary of the philosophy of nursing written in Nursing 300 (5%) The student s definition of nursing, whether borrowed or original, is described and explained. (15%) Great introduction! 5 15 The purpose of nursing from the student s perspective is clearly described. (10%) Assumptions about the relationships between the nurse and the client in a culturally diverse setting the nurse in the community the nurse with other health care professionals are discussed in relation to an appropriate theoretical model(s) (15%) TWO principles or rules that guide professional practice are identified; and specific examples specific of how these rules have been utilized or demonstrated in a clinical practice experience are described and analyzed. (15%) Conclusion summarizes main points of paper, describes how personal philosophy has changed, goal for future (10%) Three (3) or more references are cited in the paper and included on the reference list (10%) Correct grammar, spelling and punctuation (10%) Correct use of APA format, including adherence to page limit (10%) You very specifically described your own purpose of nursing. I loved reading this section. Great discussion and good job relating the assumptions to theoretical models

12 PHILOSOPHY OF NURSING 12 STUDENT S NAME Jessica Caviness GRADE 100 Jessica It was a pleasure to read about your philosophy of nursing. You have a very holistic approach and guiding principles that will serve you and your patients well. Ms Rose