Introduction
The nursing profession is based on the care accorded to patients to enable the achievement of health in an enabling environment. In my experience as a nurse, many theories on care have been learned and gained in the practice. There are many suggested theories in the approach to nursing care with most of them being developed in practice. Along with nursing theories, various concepts have also been fronted with different nurses at different levels of practice using them to dictate their approach and philosophies. In my practice, I have developed a philosophy that is consistent with that of others besides establishing concepts that aid in practicing nursing. The following essay focuses on the personal nursing philosophy through a brief autobiography in the practice besides presenting a discussion on the four major meta-paradigms, the practice of specific concepts, clinical examples, and a list of propositions. However, it will begin by presenting the nursing autobiography.
Nursing Autobiography
In the brief clinical experience gathered in nursing, a personal background in Medical-Surgical Nursing and Utilization Review Nursing has been developed. As the subspecialty of medical surgical nursing, I have been able to work in the inpatient care of many patients. In the care of these adult patients, most of their experience has been in the wards where knowledge on the running of in-patient clinics has been gathered. In these clinics, I have been able to take patients’ histories besides augmenting the functions of the medical team. In addition, I administered medication. The specialty has also given insight into the management of patients in the Emergency departments, outpatient centers, and surgical cases at the surgical center. Medical-surgical nursing has also given me adequate knowledge on the administration of HMOs and Home-based care. I have also gotten an opportunity to participate in humanitarian relief work in the same specialty. In the specialty of Utilization Review Nursing, I have been able to participate in the management of patients admitted to various institutions. In this specialty, I have been able to follow the management of patients, ensure that the right decisions in their management are made, and ensured they are discharged in a stable state. I have also dealt with insurance claims of the patients who have been in my care and ensured that they made the right decisions. This involved a close relationship with them, which has also had a significant influence on the outcome of their health and illnesses. This specialty has also given me experience in social work especially for patients under my care. The specialties have contributed towards the development of nursing skills and personal philosophy as will be discussed below.
The Four Meta-paradigms
The nursing profession is based on the care accorded to patients in the effort to improve their health and recovery in an environment that they can relate to. Fawcett states and defines the four basic meta-paradigms of nursing as being health, human beings, Nursing, and Environment (2005 p. 43). As he states, this needs to be integrated into any framework of nursing to achieve the most inpatient management. With the different nursing theories being fronted based on the divergent views globally, the meta-paradigm concepts provide a converging point. These concepts are therefore established as universal unifying and standardizing forces of the nursing profession.
Human Beings (Patients)
Florence nightingale recognized human beings as consisting of a spirit and an external physical body with the body only lasting until death and the spirit being eternal. The body is therefore the vehicle in which the spirit is carried as it serves its short purpose in the world (Macrae, 2001, p.34). In the concept of human beings in the meta-paradigms, the spiritual part is emphasized with recognition of improvement in health if taken into consideration during the nursing process. It is thought to be a link for all the spirits in the eventual destiny of life and an integral part of health. The body is also a connection between different human beings in social life and their ecology. The body can therefore not be separated from the spirit in management. The links are important to establish and maintain. The identity of human beings is influenced by their culture, their existing family history, and the position they hold in society. In the scientific understanding of the body, the genome and physical components are emphasized. However, there is also a scientific connection between people. This concept forms a central part of the meta-paradigms. Nursing has to consider it in almost all the theories that have been fronted in practice.
The Environment
Most nursing theories have established the environment as having a dynamic relationship with human beings. Theorists agree that the relationship is important to consider and that the health of an individual is dependent on the environment in which he or she lives and recovers. Nightingale is well known for her emphasis on the improvement of the physical surroundings of human beings in their management. In her explanation, she states, “We in vain labor at the moral progress of a population if we leave it festering in unhealthy dwellings…Probably there is no influence stronger than the buildings they live in, for bad or good, upon the inhabitants” (Vallée, 2003, p.24). Contemporary theories have also put the environment as an integral part of the nursing profession only changing the original definition and providing different views on how it should be manipulated in nursing practice. Some have suggested the environment as being the internal and external conditions of the patient with others claiming that it is a place where energies are exchanged (Rogers, 1970, p. 12). In the environment and client relationship defined, the nurse finds many positions based on each theorist. However, two basic positions of a nurse in the client’s environment emerge. In the first and more common position, the nurse is in the client’s environment. However, the second different view states that the nurse is the client’s surroundings. “In this perspective, the nurse turns toward her or his understanding of the ‘nurse-self’ as an energetic, vibration field, integral with the client’s environment” (Quinn, 1992, p. 30).
The Nurse
Nightingale defined the role of a nurse as being to allow nature to heal the client by providing appropriate conditions and environment for this to take place (Vallée, 2003, p.42). To do this, the nurse needs to manipulate both the external and internal environments concerning the defined laws of nature. Nightingale’s theory has a significant influence on the theorists of our time. Therefore, this concept finds home in many nursing institutions. It has contributed to shaping the personal philosophies of many individual nurses and student nurses. It is also taught in many nursing schools as the basic introductory unit to nursing practice around the world. The nursing factors and characteristics provided to a client will dictate the speed and effectiveness of the services given to them and the outcome of their management. Several characteristics of an enabling nursing environment have been suggested as being important in the overall patient management. These are subjective to the individual nurse, only being influenced by training among other factors. They include empathy, authenticity, healing, human dignity and respect, personal relationship, caring intention, and the application of care-based knowledge. A nurse should also be good at touching, doing procedures, administering medication, and providing personalized care. All these factors about nursing are important in the eventual view of the outcome for patients. They dictate the client-nurse relationship.
Health
Various definitions of health have been formulated with wellness being in the definitions of almost all the theorists. The wellbeing of individuals under a nursing case is also an important concept in the nursing practice. Different individuals however have divergent views on the description of wellbeing. Most people claim that the absence of diseases is not an indicator of wellbeing and health. A nursing worker, therefore, needs to establish the exact position of clients and their needs besides working towards helping them to achieve their desired state of wellbeing. Aside from individual views on wellness, different societies have different views and descriptions of wellness. Some state and hold that an individual is in a state of complete health if they can perform their societal values as dictated by the society concerned. The contemporary definition in most cultures however is dictated by the level and standards of healthcare available. The nursing profession, therefore, becomes an important branch in setting the standards. A nurse should aim at providing care to the clients based on these expected standards.
Practice-Specific Concepts
In the personal nursing experience, there are many concepts in addition to the basic Meta paradigms that have influenced personal practice in nursing care. These concepts have aided in the learning and practice of nursing care. Personal concepts in addition to the basic concepts are evidence-based care and the concept of autonomy in nursing care. A discussion of these concepts in practice follows with definition and application in practice.
Evidence-Based Care
Evidence-Based Practice according to Melnyk and Fineout-Overholt (2005, p. 32) is a problem-solving approach that applies the best available and current evidence, the expertise available, and the patient preferences. It is from this definition that a personal concept of Evidence-based Nursing care developed. The application of evidence-based care in nursing practice involves the application of management criteria that have been tried, tested, and proven both in theory and in practice. Major theorists front this concept with Rodgers claiming that the care accorded to patients should not be based on the fixed work plans based on the experience gathered in practice in addition to theory (Rodgers, 1970, p.23). In the management of patients, care is dictated by the desired outcome, and if the available managements are not contributory to this, the adjustment has to be made to existing procedures to achieve patient recovery to health. Evidence-based care dictates that any service given to clients has to be proven either by practice or by scientific research to contribute towards health. In the personal application of this concept, I have developed standards of care for various patients with different needs. All patients have differing conditions. Those people with similar medical or surgical conditions have different needs according to this personal concept. The guide that forms a large percentage in the management of patients is the cumulative clinical knowledge gained in institutions that I have worked in placements. The standards set there have contributed to personal standards of care. Another important guide is the theory, which has origin in the lectures and practical knowledge in the nursing course.
Autonomy
The personal concept of autonomy has originated in the nursing practice experience and the knowledge gathered in class. Wade differentiated the professional nurse autonomy from the universally perceived personal autonomy. It is the belief by the nurse the centrality of the client in decision-making (1999, p. 1). He states that any decision made whether independently or interdependently by the client must be client informed and based on the proactive advocacy for clients (Wade, 1999, p. 1). In care for patients, most of the decisions made in practice have involved adequate counseling to the patients, provision of choices, and the right to choose between services. This has ensured personal accountability in the care of patients and job satisfaction. Wade reiterates that nursing autonomy has accountability as the primary consequence that leads to job satisfaction, commitment to the profession, and the professionalization of the nursing profession (Wade, 1999, p. 1). As defined by Batey and Lewis, Autonomy is “the freedom to make discretionary and blinding decisions consistent with one’s scope of practice and freedom to act on those decisions” (1982, p. 15). Nursing autonomy, therefore, is the ability to allow the patient to make informed decisions on their care, which has found a space in the personal concepts gathered throughout the practice and learning of nursing practice. As indicated above, the two concepts of evidence-based nursing care and autonomy have defined the care I have given to patients under my care. I am convinced that this has contributed to the recovery and adequate management of these patients, as it is to the other concepts I have employed in addition to the basic meta-paradigms. These have mostly been useful in the practice of Utilization Review Nursing where the patients’ decisions were based on the guidance I offered to them. In insurance claims, the concept of autonomy was more defined thus enabling correct, accurate, and independent patient decision-making. This step is necessary for any practice of nursing though not restricted to utilization review nursing. The following therefore are some of the clinical examples of the application of these concepts in the personal Nursing experience.
Clinical Examples
In the use of evidence-based nursing care, the personal application that I found was in the care of chronically ill patients. In the nursing textbooks that are referenced in basic nursing courses, there is no particular method of analgesic administration in chronically ill patients especially for those with advanced cancers presenting with very painful symptoms. The analgesic used, the amount, as well as frequencies differ between these texts. This provides a barrier to their effective management. In my practice, the nursing journals available on the internet, which host literary works by various professionals and experts, as well as instructions from matrons and experienced nurses led to the development of a criterion I applied in the management of these patients. In the criterion, patients receive medication as per the presenting complaints and the route used is dictated by the quantity of pain. This has enabled me to contribute to the management of a chronically ill patient and augment the role of the medical team. In the concept of autonomy, most of the use and application has been in the specialty of Utilization Review Nursing. There are many legal implications for the decisions made by patients here. One of the main contributing factors is the quality of information given by the nurse in the process. With the use of autonomy, patients make their own decisions after I have guided them based on their experience and available options. In doing this, the first step is making the patient aware of the available options relevant to their interest such as insurance. The step that follows involves letting the patients choose from the available options and let them know the consequences of the decisions they are about to make. These two concepts have added to the effective personal management of patients under my care.
List of Propositions and Assumptions
In the integration of the aforementioned concepts, several assumptions and propositions result. These include:
- The universal goal of nursing is to provide care to patients and contribute towards achieving wellness and health, which is defined by the society they live in. the concept of care in this assumption is therefore universal
- The settings in which these nursing concepts are employed is the normal health environment, and with respect to the universal human rights
- An assumption that the nurses using the concepts have the same level of training or higher
- The concepts are applicable where the adequate number of nurses and medical staff is per the international requirement and there is no strain on the number
- Patients requirements are within the achievable levels and any nursing professional can achieve them in the same conditions and time
These assumptions enable the concepts mentioned above to be applied. If the right conditions and resources are provided, nurses should target manipulating them and achieving patient health.
Conclusion
In conclusion, based on the expositions made in the paper, it suffices to declare the nursing profession as an issue that has gotten shape from various theorists and pioneers in the practice. After Nightingales’ theories of nursing, many suggestions have been provided with the contemporary practice consisting of the four basic meta-paradigms of health, Environment, the nurse, and the patient. These issues have been discussed above. In conclusion, their integration is needed in each nursing approach to achieve maximum results. Also noted are the personal concepts of nursing autonomy and evidence-based nursing care, which have enabled the provision of care to patients in a satisfying and personal fulfilling manner. This has proven to be effective in my practice, as proven by the examples given above. Each nursing student and qualified nurse should strive towards the achievement of these concepts in addition to others suggested improving nursing care. This will go a long way in establishing and perfecting the profession and hence the future of nurses.
References
Batey, M., & Lewis, F. (1982). Clarifying autonomy and accountability in nursing Service: Part 1. Journal of Nursing Administration, 12(9), 13-18.
Fawcett, J. (2005). Contemporary nursing knowledge: Analysis of Evaluation of Nursing Models and Theories. Philadelphia: F. A. Davis.
Macrae, J. (2001). Nursing as a Spiritual Practice: A Contemporary Application of Florence Nightingale’s views. New York: Springer.
Melnyk, B., & Fineout-Overhholt, E. (2005). Evidence-Based Practice in Nursing and Health Care: A guide to Best Practice. Philadelphia, PA: Lippincott, Williams, & Wilkins.
Quinn, J. (1992). Holding sacred space: The Nurse as Healing Environment. Holistic Nursing Practice, 6(4), 26-36.
Rogers, M. (1970). An Introduction to the Theoretical Basis of Nursing. Philadelphia: F. A. Davis.
Vallée, G. (Ed.). (2003). Collected works of Florence Nightingale, vol. 4: Florence Nightingaleon mysticism and eastern religions. Waterloo, Ontario: Wilfrid Laurier.
Wade, G. (1999). Professional Nurse Autonomy: Concept Analysis and Application to Nursing Education. Journal of advanced Nursing 30(2), 310-318.