Philosophy of Nursing - Old Dominion University Portfolio



Philosophy of Nursing

Clarke Krugman

Old Dominion University

Career Pathway Assessment

NURS401

Spring, 2013

Philosophy of Nursing

Introduction

A philosophy of nursing is something that each nurse individually defines. Nursing s a very personal vocation; 'If there is a universal concept of nursing, it embodies the characteristics of a service that is intimate, constant and comforting' (Henderson, 2006, p. 21). It requires a giving of one's self to a degree far exceeding the mere performance of physical tasks and using application of practical knowledge to help ailing individuals. The truly professional nurse engages the patient and their family and loved ones on a physical level, an emotional level, and a spiritual level. In order to engage the patient, the family, loved ones and friends on these levels, the nurse must be grounded in his knowledge of self, which necessitates a foundation of beliefs – a philosophy of nursing – that works in concert with nursing best practices and standards of care. The purpose of this paper is to enable this author to identify his own philosophy of nursing, which will encompass the beliefs and values the author holds with respect to the profession of nursing, and his sense of moral responsibility as a nurse. The author will employ objective evidence to support the actions performed as a nurse which ultimately reflect the author’s philosophy.

Definition of Nursing

The journey to obtaining a bachelor's degree in nursing has acquainted the author with the written works of Virginia Henderson. For purposes of brevity, suffice it to say that Ms. Henderson is universally regarded, in this author's opinion, as among the most influential nurses of hers or any age. This author has chosen Ms. Henderson's definition of nursing function as the one which most closely reflects his own:

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible. (as cited in Blais., K., Hayes, J., 2006, p.100)

While the definition on the surface may appear simplistic, it is the, 'to do this in such a way as to help him gain independence as rapidly as possible' that comprises all the intangible workings of the nurse in a succinct statement. In it is housed the teaching, the therapeutic communication, the empathy, and all the other little and great things that a professional nurse does. In this author's opinion, Ms. Henderson has captured the essence of nursing function with her definition.

Purpose of Nursing from the Author's Perspective

There are four pillars that comprise the author's perspective regarding the purpose of nursing. They are, (1). To bring the patient to to his or her highest functioning level, (2). To educate the patient and family regarding all manner of treatment and successful life strategies, (3). To be a diligent and fervent patient advocate in the areas of proper treatment, pain management, and assuring the patient's rights and the family's rights are protected, and (4). To provide dignity at all times; in particular at time of decline and death.

These four pillars have been ingested into, and have become vital component parts of the author's philosophy. They are not original thoughts, they can be found in texts in other forms or combinations of words, but with the same meaning. They come from the schooling and the clinical experiences of the author. Additionally, they come from personal life experience.

It was roughly seven years ago that the author was stricken with a horrible infection which had escalated to acute liver failure, and nearly brought about renal failure and death. Against the odds, and with the expert care and attention of a healthcare team, the author survived. It was further teaching and care that the nursing staff provided during a protracted recovery period that helped the author reach a level of peak health. At one low point, the author was being considered as a candidate for a liver transplant. At time of this writing, health is fully restored, liver health, too. The purpose of nursing from the author's perspective as outlined in this paper emanates strongly from the personal experience of the author. The four pillars are the reasons behind his survival.

Values and Beliefs

Core values and beliefs for the field of nursing have been honed over time by various institutions. These institutions offer guidance and help shape the very nature of the profession of nursing. One such organization is the National League for Nursing (NLN). The NLN began in 1893, and since its inception has been a leading organization in the development and assessment of education programs throughout the United States ('About the NLN', 2011). A conscientious, professional nurse will craft their own core values out of the tried and true values that have endured and have been in use by such institutions as the NLN. The author adheres to, and promotes the core values of the NLN. They are, Caring: promoting health, healing, and hope in response to the human condition.

? Integrity: respecting the dignity and moral wholeness of every person without conditions or limitation.

? Diversity: affirming the uniqueness of and differences among persons, ideas, values, and ethnicities.

? Excellence: creating and implementing transformative strategies with daring ingenuity.

The values that the author has incorporated into his own practice have evolved from these values espoused by the NLN. They serve as the touchstone from which the author, as a new nurse with very little practical experience can begin to define himself and his role.

There is overlap when discussing values and principals and the purpose of nursing. They serve to support and define each other. The values of excellence and diversity are worthy inclusions to round out the author's philosophy. The value addressing the honoring of and respecting cultural diversity and inclusiveness resonates very clearly. The author hails from a family that has Native American and Japanese ancestry, and as such, has been brought up in a family culture which celebrates diversity. Also, the value of and belief in the pursuit of excellence is a core value that was heralded in the author's upbringing.

The two chief principles that guide this author's practice are veracity and beneficence.

Veracity: Being true to your word

Veracity occurs on an ongoing basis, and is most tested when there is difficult news. There was an incident early in the author's career when a patient at a skilled nursing facility suffered a major stroke, and had missed the window of opportunity to use the remedy, tPA. When communicating with the patient several days after the event, the author was asked by the patient if he would be able to recover use of his left arm. Having conferred with the physicians regarding the patient's condition, it was learned by the author that significant, if any, recovery was a remote outcome. With this evidence in hand, the author repeated what had been earlier stated to the patient by the physician; it was very unlikely that such a recovery would be the case, but that ongoing therapy would be a part of the nursing plan. Tears were shed, and the patient was consoled while the reality of the news sank in. At first blush, the aforementioned illustration appears simplistic. It was however a very significant breakthrough for this author in handling a situation of such a type. The natural inclination was to give the patient something he wanted to hear. To have placated the patient with false hope would have been bad nursing practice, and would have been in violation of the principle of veracity. Instead , the author made the tough choice which was to tell the patient the situation in a clear yet empathic manner. The author told the truth, and then assisted the patient through the grieving process and follow up with the plan of care. This break though moment has occasioned the continued practice of veracity. The author is known for his integrity as a result of this and finds himself in high demand for volunteering and other career-related projects. Thus, it is veracity that the author holds most dear as his first core principle guiding his professional practice.

Beneficence

Beneficence is, 'doing good for the benefit of others' (Bastable, 2008, p. 34). A specific event in the author's life illustrates the exercise of beneficence. It was a very unique episode in which an individual, a homeless man, was treated and released from an emergency center where the author was completing a clinical rotation. The man had advanced liver disease and end stage renal disease. He was intent on walking forty miles from Cottonwood, Arizona over Mingus mountain (altitude 7,100 feet) to a homeless shelter in Prescott. This was a task that could not be completed by a person in peak physical condition, and certainly not by this individual. The police, the fire department, and the hospital had neither the authority nor the resources to take him to the shelter, and the attempt to make the trek would certainly have resulted in a return to the emergency room.. This author, guided by beneficence, took the homeless man in his car over the mountain, to safely deliver him to the shelter. In doing so, the homeless man, the hospital, the fire and police departments all received a benefit.

In a daily setting, beneficence is being exercised at every turn, whether lending a hand stocking supplies, or covering another nurse's patients while they run to the bathroom. It is beneficence - mindfully doing that little bit extra, and being aware of the needs of others, whether it be a kind word, or an action - that is this author's second hallmark principle that guides his professional practice.

Greatest challenge

In the context of working as a nurse, a consistent commitment to veracity can be a tough test. Veracity means telling the truth. The truth is the truth, there is no shade of gray. The difficulty is not that dishonesty and lying are innate, nor is lying the preferred choice for a nurse. The difficulty is that it is human nature for persons to explain themselves or speak of events in such a way that it places them in a positive light regardless of actual circumstance. This can strain the exercising of veracity on occasion. There are times, particularly when mistakes are made, that a person will be tempted to massage the facts in order to justify his actions. The author witnessed a clear example of this while on a shift during a clinical rotation on a medical surgical floor. The nurse of the prior shift had failed to plug a patient's nasal cannula into the oxygen on the wall. The patient had a respiratory issue and was prescribed six liters of oxygen per minute and was receiving nothing for an entire shift, putting the patient at great risk. Upon being informed the following day of the situation as it was observed, the nurse on whose shift the error occurred responded with denial, finger-pointing, and defensiveness. A convoluted story told by the nurse about a nursing assistant's involvement ensued, which was unintelligible. Simply telling the truth of the matter and additionally taking accountability (another great principle) would have provided an opportunity for learning, for clarifying protocols, and bringing about a greater awareness of safety. It is the internal decision to always tell the truth that stands as a challenge for any nurse.

An analysis of the ethical dilemmas facing nursing students serves as an appropriate proof that veracity is indeed a major challenge in nursing. When asked about primary challenges facing them, 'Those most frequently experienced were ‘family giving up on a patient because he or she could not be cured’, and ‘not telling the truth to the patient’.' (Han, S., and Ahn, S., 2000). In this author's opinion, once a nurse practices veracity faithfully -incorporating it as a habit – a momentous shift takes place whereby the nurse will experience an enhanced image of self, an increased pride in his professionalism, and will be viewed as forthright and dependable by his peers.

Conclusion

A philosophy of nursing is an aggregate of personal experience, formal education, environment, and culture. It evolves over time and matures, as does the individual nurse. The author is a newly minted RN, having just obtained his license within a few weeks of this writing. With very little nursing experience and a two-year associates degree, the author has had to draw from the collective experiences and published philosophies of renowned leaders of nursing and organizations, whose purpose is guidance and oversight of the roles of the nursing profession, in order to construct a foundational philosophy of his own.

The core beliefs and values and principles of a recent graduate RN will closely mirror those of established leaders and organizations at the outset of his or her career, and then become more refined as experience and maturity lend their insights. The philosophy of nursing that the author has described as his own in this paper will undoubtedly go through revisions from the beginning of the baccalaureate education through its completion.

As this author contemplates potential career choices in healthcare, whether they be in administration, teaching, advanced practice, or doctorate of nursing practice, the path that will ultimately be chosen will be guided by the core ideas that comprise the philosophy of nursing that has been defined in this paper.

References

1. Henderson, V. (2006). The concept of nursing. Journal of Advanced Nursing, 53(1), 21-34.

2. Blais, K., & Hayes, J. S. (2011). Professional nursing practice, concepts and perspectives. (Sixth ed.). Upper Saddle River, NJ: Prentice Hall.

3. About the NLN. (2011). Retrieved from

4. Bastable, S. B. (2008). Nurse as educator: Principles of teaching and learning for nursing practice. (Third ed.). Wyoming: Jones and Bartlett Pubishers.

5. Han, S., & Ahn, S. (2000). An analysis and evaluation of student nurses' participation in ethical decision making.Nursing Ethics, 7(2), 113-123.

Honor Code

"We, the students of Old Dominion University, aspire to be honest and forthright in our academic endeavors. Therefore, we will practice honesty and integrity and be guided by the tenets of the Monarch Creed. We will meet the challenge to be beyond reproach in our actions and our words. We will conduct ourselves in a manner that commands the dignity and respect that we also give to others."

Honor Pledge

"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 a hearing if summoned."

Clarke Krugman – 3/28/13

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