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Final Perspectives EssayStephanie MonroeFerris State UniversityAbstract Carper’s (2013) patterns for knowing in nursing outlines four important aspects of the nursing profession. The four patterns of knowing support nursing as being a diverse and unique profession. As unique as the profession, so is what guides our personal practice. I have found that what guided my practice in the beginning of my career changed as I developed as a nurse. I predict that what guides my practice will continue to change as I advance in my career and within the nursing profession. Final Perspectives EssayOver the years nursing has evolved into a diverse and unique profession. Scholars have developed numerous theories on different aspects of nursing such as caring, comfort, health promotion, and diversity. Each theory gives an in-depth look at the framework behind that area of nursing. The purpose of this paper is to identify what guides my nursing practice. I will also examine how nursing is unique in relation to Carper’s (2013) patterns of knowing in nursing. What Guides My PracticeAfter some deep thought about what it is that guides my practice, I came to the conclusion that it is impossible to pin point one thing. During the past four years of my nursing career my practice has changed significantly. As I thought about how much I have changed and grown as a nurse, I realized that these changes were a reflection of my development as an individual in the nursing profession. In the beginning of my nursing career I practiced the way I was told to by my nursing instructors, preceptors, and mentor. I was very task oriented. I wanted to know exactly what it was I needed to do and be shown how to do it. I quickly discovered that there are numerous ways to complete a task and many times these ways conflicted with what I had previously learned. I can remember my preceptors telling me that they were going to teach me the real way to do something rather than the book way. As a new nurse, who was just trying to do as told, this was very confusing. Allowing what I learned in school and in the clinical field to guide me early on helped to build a solid understanding of nursing fundamentals. After about the first year of being a nurse I started to come out of my shell; I was able to think more critically about situations and felt comfortable questioning orders. I adopted my own ways of doing things and my own style for caring for patients. It was after this first year that I began to develop my personal practice. What guided me in the beginning changed from doing what I was told to do to what I felt was right. What guides me in my current practice is a combination of evidence and nursing theory. Pipe (2013) supports this by stating “a professional work environment that engages and optimizes the empirical and?theoretical?foundations of nursing can advance patient health and safety" (p. 303).Utilizing evidence-based practice is important to me when caring for patients. I like to know that what I’m doing for a patient has strong evidence to support it. As a nurse I know that I have a responsibility to provide safe and quality care; evidence-based practice allows nurses to achieve this by identifying best practices and by eliminating worst practices. Though evidence-based practice is not specific to nursing, it holds value in that it is influential to the future of healthcare and to our profession. ?Today in nursing there has been a big shift towards incorporating evidenced-based practice into the profession. The downside to this is that by doing so many have forgotten the importance of nursing theory (Pipe, 2013). Nursing theory is what makes our profession unique. Nursing today would not be considered a profession if it was not for the theoretical foundations that nursing theorist have provided. Nursing theory provides nurses with a knowledge base that allows for a systematic approach to care and fosters critical thinking (Alligood, 2006). Kenney (2013) states “theory also contributes to more efficient and effective nursing practice and enhances nurses’ professional autonomy and accountability” (p. 334).?Nursing theories that I have identified as guides to my practice are Benner’s novice to expert theory, Swanson’s theory of caring, and Pender’s health promotion model. Benner’s novice to expert theory has not only helped me understand the developmental stages of a new nurse, but also my personal development as a nurse. Benner’s novice to expert theory is represented by the model of skill acquisition. This model is composed of five levels of clinical competency: novice, advanced beginner, competent, proficient, and expert (Levi, 2001). Awareness of competency levels of oneself as well as others is an important aspect of leadership. For example, it is beneficial to know that a nurse with two to three years of experience would be at the level of competent and would likely perform well as a preceptor. In my practice I’m able to apply Benner’s model when precepting new hires. Identification of the orientee’s level of clinical competency is used to guide the orientation process. One important aspect to Benner’s theory is that even when an experienced nurse starts a new position they start over at the level of novice, but advance quickly through the stages (Levi, 2001). Pender’s health promotion model has acted as a beneficial guide my practice. I currently work on a cardiothoracic unit where I care for and help people recover from open heart surgery. One aspect to recovery is assisting patients in making positive changes towards a healthier lifestyle. Pender’s health promotion model identifies the relationship and influences of individual characteristics, environment, past experiences, perceived barriers, benefits, and self-efficacy (Sakraida, 2006). An important component of Pender’s health promotion model is that a person’s environment and those in it influence behavioral outcomes (Sakraida, 2006). In the post-operative time it is vital that as the nurse, I create an environment that is beneficial to the patient’s health promotion plan. Another theory that guides my practice is Swanson’s theory of caring. Swanson defines caring as “a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (as cited in Wojnar, 2006, p. 764). Swanson’s structure of caring includes five concepts: maintaining belief, knowing, being with, doing for, and enabling (Wojnar, 2006). Together these concepts move towards the outcome of client well-being. Swanson’s theory of caring fits well into my practice because the five concepts are easily applied to the care of a post-operative patient. As a guide to my practice, the theory of caring reminds me to see my patients holistically, as mind, body, and soul. Boykin & Schoenhofer (2013) state “the intention to know and to nurture harmoniously opens a context in which caring is allowed to surface and flourish freely and creatively” (p. 98). Identifying what guides my practice has allowed me to reflect on how I have developed as a nurse. I believe that both evidence and theory are valuable to nursing practice. Pipe (2013) suggests that nursing practice is based on evidence but guided by theory. I predict that in time I will continue to change and so will the guides to my practice. I think that in the beginning all nurses are equal; it is what they choose to guide them in their practice that makes great nurses shine. Patterns of KnowingCarper’s (2013) patterns of knowing in nursing describe four elements of knowing that together create the foundation of knowledge in nursing. These four patterns are empirics, esthetics, personal knowledge, and ethics. “Each pattern may be conceived as necessary for achieving mastery in the discipline, but none of them alone should be considered sufficient” (Carper, 2013, p. 31). The four patterns of knowing in nursing exemplify how the nursing profession is unique and different from other professions. Carper (2013) describes empirics as the science of nursing. Furthermore, empirics is described as “publicly verifiable, factual descriptions, explanations, or predictions based on subjective or objective group data; the science of nursing” (Fawcett, Watson, Neuman, Walker, & Fitzpatrick, 2013, p. 313). Contemporary nursing is commonly referred to as a science. In the clinical setting empirics are the scientific facts behind disease and medicine. As nurses we have seen a big shift towards research and evidence-based practice. Healthcare in general is becoming more focused on the latest data, statistics, and outcomes. Fawcett et al. (2013) suggests that this pattern of knowing should be utilized as a guide to nurses’ work in evidence-based practice. The pattern of esthetics is referred to as the art of nursing (Carper, 2013). To be a nurse is more than understanding science, it is artful. The way in which each nurse cares for their patient is an artful gift and beyond what any science book could teach. Esthetics in nursing is the connection that nurses make with their patients; it is the ability to keen in to the needs of the patient and to identify important aspects of their behavior (Fawcett et al., 2013). An important component to esthetics is empathy (Carper, 2013). “The more skilled the nurse becomes in perceiving and empathizing with the lives of others, the more knowledge or understanding will be gained of alternate mode of perceiving reality” (Carper, 2013, p. 27). This pattern of knowing contributes to the uniqueness of the nursing profession and explains further to why nursing is separate from other healthcare professions. The component of personal knowledge is the process of building therapeutic relationships with others through the knowing on one’s self. Carper (2013) states “personal knowledge is concerned with the knowing, encountering, and actualizing of the concrete, individual self” (p. 28). I believe passion stems from personal knowledge. Patients can keen in on nurses who are passionate about what they do and as a result feel well cared for. Fawcett et al., (2013) explains personal knowledge as nurses’ ability to build authentic relationships with others; this is accomplished through active listening and reflection. The last pattern of knowing in nursing is ethics. Ethics “includes all voluntary actions that are deliberate and subject to the judgment of right and wrong- including judgments of moral value in relation to motives, intentions, and traits of character” (Carper, 2013, p.29). In the profession of nursing ethics is dealt with on a daily basis. With every patient comes a different set of morals, values, and beliefs. Providing care that is ethically sound involves acknowledging, but separating, one’s personal morels, values, and beliefs in order to honor those of the patient. As nurses we must customize our approach to care to best fit the patient’s needs. As a unique profession we have our own body of knowledge, one being the American Nurses Association’s (ANA) nursing code of ethics. Provision one states “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (ANA, 2001, p. 4). The four patterns of knowing in nursing exemplify the complexity of the profession; yet it is the complexity of nursing that makes it so unique. Nursing is unique in that it covers a wide range of disciplines such as a bedside nurse, manager, administer, educator, and practitioner. The ANA (2004) describes the nursing profession as integration of art and science. “Registered nurses employ critical thinking to integrate objective data with knowledge gained from assessment of the subjective experiences of the patients and groups” (ANA, 2004, p. 10). The International Council of Nurses [ICN] (2010) describes nursing as encompassingautonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (p.1)The ANA’s and ICN’s definition of the nursing profession brings to light that nursing cannot be reduced to one job description. In my opinion, no other profession comes even close to being as diverse as nursing. During one day a nurse can take on many different roles within his or her job. Another unique aspect of nursing is that a nurse can take on completely different jobs within their career with the same degree. Carper’s (2013) patterns of knowing contribute to the diversity in nursing and to what makes nursing the unique profession that it is today. ConclusionAs I have grown and developed within the nursing profession I have learned that my personal practice is well defined by what I choose to guide it. Choosing a practice that is grounded by both evidence and theory allows me to deliver care that it safe, compassionate, authentic and supported by the nursing profession. As unique as the profession, so are the guides to our practice. The uniqueness of the nursing profession is expressed in nursing standards of practice, code of ethics, and various theoretical perspectives such as Carper’s (2013) patterns of knowing. The diversity and knowledge base that nursing brings to the healthcare industry is unique and cannot be replaced by any other profession. ReferencesAlligood, M. R. (2006). Introduction to nursing theory: Its history, significance, and analysis. In A. M. Tomey & M. R. Alligood (Eds.), Nursing Theorists and Their Work. (pp.3-15). St. Louis, MO: Mosby Elsevier. American Nurses Association [ANA]. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: AuthorAmerican Nurses Association [ANA]. (2004). Nursing: Scope and standards practice. Silver Spring, MD: Author. Boykin, A., & Schoenhofer, S. (2013). Reframing outcomes: Enhancing personhood. In W. K. Cody (Ed.),?Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (pp. 95-103).?Burlington, MA: Jones & Bartlett Learning. Carper, B. A. (2013). Fundamental patterns of knowing in nursing. In W. K. Cody (Ed.),?Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (pp. 23-33).?Burlington, MA: Jones & Bartlett Learning. Fawcett, J., Watson, J., Neuman, B., Walker, P., & Fitzpatrick, J. J. (2013). On nursing theories and evidence. In W. K. Cody (Ed.),?Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (pp. 311-319).?Burlington, MA: Jones & Bartlett Learning. International Council of Nurses [ICN]. (2010). Definition of nursing. Retrieved September 20, 2012, from , J. W. (2013). Theory-based advanced nursing practice. In W. K. Cody (Ed.),?Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (pp.333-352). Burlington, MA: Jones & Bartlett Learning.Levi, P. C. (2001). Role attainment: Novice to expert. In D. Robinson & C. Pope Kish (Eds.),?Core concepts in advanced nursing practice.?(pp. 325-330). St Louis, MO: Mosby.Pipe, T. B. (2013). Optimizing nursing care by integrating theory-driven evidence-based practice. In W. K. Cody (Ed.),?Philosophical and Theoretical Perspectives for Advanced Nursing Practice.?(pp.303-309). Burlington, MA: Jones & Bartlett Learning.Sakraida, T. J. (2006). Health promotion model. In A. M. Tomey & M. R. Alligood (Eds.), Nursing Theorists and Their Work. (pp.452-463). St. Louis, MO: Mosby Elsevier.Wojnar, D. M. (2006). Theory of caring. In A. M. Tomey & M. R. Alligood (Eds.), Nursing Theorists and Their Work. (pp.762 -773). St. Louis, MO: Mosby Elsevier. ................
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