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What Do I Think I Know? – My View of the Ontological Dimension of NursingKelly Pittman Philosophical Foundations of NursingAthabasca UniversityOctober 8th, 2019AbstractIn this paper, an ontological stance is formed using two nursing values. The first value is the caring nature of nurses, and the second value is patient advocacy as a means to increase patient safety. The nursing metaparadigm four concepts (i.e. person, health, environment, and nursing) are used to influence the ontological stance of caring and patient advocacy. Bender’s (2018) critique on the nursing metaparadigm is used to inform the ontological stance.Word count: 1110Keywords: Ontology, Nursing Metaparadigm What Do I Think I Know? – My View of the Ontological Dimension of NursingOntology is described as “the study of being and meaning” (Thompson, 2016, p.1). This paper will discuss my ontological stance regarding my nursing practice and how the nursing metaparadigm influenced my ontological stance. The nursing metaparadigm is made up of a set of four nursing concepts that help describe the art and science that the nursing profession is (Thompson, 2016). The nursing metaparadigm also helps describes what nurses do (Thompson). I will then do into detail about the four nursing metaparadigm concepts which are person, health, environment and nursing. Lastly, I will reference Bender (2018) and the influence it had on my ontological stance.My Ontological Stance for my Nursing PracticeMy ontological stance is based on two nursing values which, are caring and advocacy. The first nursing value incorporated into my ontological stance is the caring essence that nurses portray towards their patients. As indicated by Andersson, Willman, Sjostrom-Strand, and Borglin (2015), caring is a core value of nursing practice. Andersson et al. discovered that nurses often look beyond the patient to integrate the patient's views and best interests in the nurse's daily care plan. As a result, the nurses are demonstrating the caring essence of the nursing practice. From my personal experience, the best person to obtain health information from to support their care plan is the patient. Listening to the patient about their perceptions of their illness enhances my care plan and, most times, the nurse obtains critical information that was not shared with any other health care professional as they have developed a trusting relationship with the nurse. The patients portrayed the nurse's actions as caring and, therefore, trusted the nurse enough to share this information with them (Dinc & Gastmans, 2013). Andersson et al. explain that nurses value person-centered care, which displays that the nursing profession values the options and beliefs of the patient. Therefore, this is why caring is incorporated into my ontological stance.Secondly, another value within the nursing practice that is incorporated into my ontological stance is patient advocacy as a means to increase patient safety. As seen in my practice, many vulnerable populations such (i.e., elderly) are often patient’s nurses care for. Especially with the aging population within Canada (Clemens & Parvani, 2017). Therefore, most of these patients do not have a support system that can speak for them; therefore, the nurses are the voice for these patients (Nsiah, Saikwa, & Ninnoni, 2017). As seen in Nsiah et al., most patients have little education surrounding their illness; thus, it is the nurse's duty to advocate for these patients. As a result, they receive the best care possible. As nurses advocate for their patient's optimal health status, it is shown to decreases the chance of patients having unanticipated medical outcomes (Nsiah et al.). Therefore, patient advocacy enhances the patient's safety within the hospital system (Nsiah et al.). Nsiah et al. found that nurses practicing patient advocacy increased the quality of care for their patients. Therefore this is why patient advocacy is incorporated into my ontological stance.My Ontological Stance and the Metaparadigm of NursingThe metaparadigm of nursing and the four core concepts which are person, health, environment, and nursing (Fawcett, 1984) has influenced my ontological stance. PersonThe concept of person is defined as the client, family, or environment the nurse is taking care of (Thompson, 2016). Providing patient-centered care demonstrates caring and patient advocacy. For example, the nurse often advocates for physicians to assess the patient and their wishes first before making any medical decisions about their care (Andersson et al., 2015). This example also demonstrates the caring nature of nurses by putting the patient’s best interest first (Andersson et al.).HealthThe concept of health is defined as nurses aiding in obtaining the patient's optimal health status and providing end of life care (Thompson, 2016). The concept of health has influenced my ontological stance by nurses to aim to obtain the patient's optimal healthcare outcomes by using patient advocacy (Nsiah et al., 2017). Nurses caring actions towards a patient can improve symptoms from their illness, and therefore the patient's overall health (Andersson et al., 2015). For example, nurse administrators the medication Zofran to a patient who is nauseated and is diagnosed with cancer. The nurse noted that the patient was uncomfortable and, therefore, improved their quality of life by completing a nursing intervention (Andersson et al.).Environment The concept environment has influenced my ontological stance as patients admitted into hospital are in an unfamiliar setting. The nursing metaparadigm concept of environment is described as where nurses provide care such as hospital or community settings (Thompson, 2016). Thus, the caring nature of nurses can ease the anxiety of being in an unfamiliar setting by providing nursing interventions (Andersson et al., 2015). Deguzman and Kulbok (2012) identified that nurses advocating for better neighborhood environments impacted patient health outcomes as well.Nursing Nursing is defined as “nursing actions” (Thompson, 2016, p. 7). Nursing views, such as social justice has influenced my ontological stance as many vulnerable populations are admitted into the health care system due to social issues. A caring and non-judgemental nurse can create a trusting relationship with the patient (Dinc & Gastmans, 2013) to help these patients receive the best possible care (Andersson et al., 2015).Bender (2018) and My Ontological StanceBender (2018) critics of the nursing metaparadigm and how the nursing profession requires a newer model of a nursing metaparadigm. Interpreting Bender’s article in relevance to my ontological stance, I concluded that my ontological stance could change over time as I evolve as a nurse. The more knowledge and experience, I obtain as a nurse; the need may appear to review my ontological stance (Bender). Bender reinforced my ontological stance by stating that caring is the foundation of nursing; therefore, stating that it should be included in a nursing metaparadigm.Nevertheless, Bender (2018) did not mention patient advocacy directly. However, it was mentioned (Bender) that nursing remains visible in multiple aspects of the health care system, such as with the patient (which could include patient advocacy) and with the interprofessional team (nurses advocating for their patient’s wishes at interdisciplinary rounds).Hence, patient advocacy remains valued within nursing practice and why it is in my ontological stance.ConclusionIn conclusion, my ontological stance incorporates the caring nature within nursing practice and the importance of advocating for patients to increase patient safety. The four concepts of the nursing metaparadigm have influenced my ontological stance by guiding my nursing practice. Lastly, Bender (2018) informed my ontological stance by reinforcing that my ideas in my ontological stance are valid.ReferencesAndersson, E. K., Willman, A., Sjostrom-Strand, A., & Borglin, Gunilla. (2015). Registered nurses’ descriptions of caring: A phenomenographic interview study. BMC Nursing, 14(16). doi: 10.1186/s12912-015-0067-9Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing inquiry, 25(3), 1-9. doi: 10.1111/nin.12243Clemens, J., & Parvani, S. (November 26, 2017) Canada must prepare for our aging population. Retrieved from: , P. B., & Kulbox, P. A. (2012). Changing health outcomes of vulnerable Populations Through Nursing’s Influence on Neighborhood Built Environment: A framework for Nursing Research. Journal of Nursing Scholarship, 44(4), 341-348.Dinc, L., & Gastmans, C. (2013). Trust in nurse-patient relationships: A literature review. Nursing Ethics, 20(5), 501-516.Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2017). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing Open, 6, 1124-1132.Thompson, C. J. (2016). Nursing Theory and Philosophy: Terms & Concepts Guide!. Retrieved from: Guide_ rev.pdf ................
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