What Do I Think I Know Now? My Personal Philosophy of Nursing
What Do I Think I Know Now? My Personal Philosophy of NursingAssignment #3Edna M. Grajalesfor Dr. R. KohrNURS 608Athabasca UniversityJuly 23, 2019AbstractThe personal meaning of nursing is discussed by addressing the metaparadigm of nursing aspects that include person, environment, health, and nursing followed by presenting my personal philosophy of nursing. How I use nursing knowledge in practice is discussed by exploring Carper’s (1978) ways of knowing. Lastly, I discuss how I can contribute to the development of nursing knowledge by participating in four scholarly activities suggested by Boyer (1990).Keywords: philosophy of nursing, meaning of nursing, ontology of nursing, nursing knowledge in practice, epistemology of nursing, contributing to nursing knowledgeWhat Do I Think I Know Now? My Personal Philosophy of NursingIn this paper, I aim to present my personal philosophy of nursing that has evolved since first entering the nursing profession and has expanded while taking the course, Theoretical Foundations of Nursing. To assist in presenting my personal philosophy of nursing, I will address what nursing means to me. I will also discuss how I use nursing knowledge in practice through ways of knowing, and how I can contribute to nursing knowledge by partaking in scholarly activities.Previous Meaning of NursingTo illustrate the evolution of my personal philosophy, I will share my previous perspective of nursing at entry to the profession that predominantly utilized an illness-based lens. Although it included compassionate and altruistic components, my perspective was formed mainly around working with ill patients, receiving treatment in a hospital or clinic setting, and as a nurse I was delivering medically based interventions. This encompassed head to toe assessments, vital signs, dispensing of medications, and other advanced skills. My focus and what I valued at the time to feel fulfilled in my work, as Benner (1982) describes was on “knowing how”. I recall accepting patients at face value. Meaning that because it was imperative for me to know and understand the disease process of the patient, I often focused mainly on their illness. There was minimal capacity to go beyond this superficial extent with such high learning curves and expectations on entry to the profession. The knowing of how to be a nurse incorporated a lot of skill building, which I equated to caring for my patients. At the time, I believed this was the essence of nursing. What Nursing Means to MeTo accomplish defining what nursing currently means to me, I will discuss my perspective in relation to the metaparadigm of nursing aspects that include person, environment, health and nursing (Fawcett, 1984), then present my philosophy of nursing that incorporate my personal values and beliefs. Metaparadigm of NursingThe person is whom the nurse interacts with during nursing care (Salem Press Encyclopedia of Health, 2018) and can be defined as individuals, families, communities, and populations (Canadian Nurses Association, 2019). In relation to my personal philosophy of nursing, I believe the person should be viewed in a holistic manner, which many nursing theorists describe as physiological, psychological, and social aspects. I also believe it is every person’s right to be treated with respect and dignity when receiving nursing care. I feel it is important to acknowledge and understand that each person comes with their own narrative and context when they intersect with nurses. In my practice area, the recognition of the client’s context enables nurses to deliver person and family-centred care by meeting the client where they are at and collaborating with the person on their care plan. Furthermore, acknowledging and attempting to understand the person’s context can assist the nurse to avoid making judgements about the person. The environment refers to internal and external factors that influence health and nursing care (Salem Press Encyclopedia of Health, 2019). These internal and external factors include facets of both the physical and psychosocial environment, political and economic factors (Schim et al., 2007), as well as the social determinants of health that are described as the conditions in which people are born, grow, live, work and age (World Health Organization, n.d.). In relation to my personal philosophy of nursing, I believe nurses need to foster a supportive environment while providing nursing care to positively influence the health status of a person. An example as a public health nurse requires considering ways of making breastfeeding clinics and programs welcoming and viewed as safe places. In home visiting, viewing the person in their home environment allows for understanding of the client’s life contexts, which is essential to the nurse-client relationship. Examples of these aspects may include but is not limited to a person’s social support system, family dynamics, living conditions, and accessibility to food. Health refers to the person’s physiological, psychological, emotional and spiritual aspects of well-being (Salem Press Encyclopedia of Health, 2019). Fawcett (1984) states that health is defined by the person and therefore, nurses should be guided in their care by what the person considers acceptable levels of health. This aspect also includes a person’s access to health care.In relation to my personal philosophy of nursing, health spans from pre-conception to end of life care. A person can intersect with a nurse any time along this spectrum, either when they are healthy and attempting to prevent illness or when they are already ill and seeking treatment. Every person is entitled to good health; therefore, health care should be accessible and equitable for all people. The last aspect is nursing. Nursing refers to the actions that the nurse takes by applying nursing knowledge and skills to their practice and refers to indirect and direct patient care (Salem Press Encyclopedia of Health, 2019).In relation to my personal philosophy of nursing, I feel the above definition is limited by scope and should reflect and incorporate fundamental qualities of a nurse that includes but is not limited to being genuinely interested in caring for other people. Not only by performing competent skill-based interventions as I did when I entered the profession but by being concerned about all aspects of the person’s well-being. Nurses are knowledgeable, skilled, and in some instances specialized to address or meet a person’s health needs. Personal Philosophy of NursingConsidering all of the aspects encompassed by the metaparadigm of nursing, I will now discuss my philosophy of nursing and what nursing means to me. Family-centred care is foundational to nursing and the basis for development of therapeutic relationships. In building a therapeutic relationship and through effective assessment, the nurse uses a holistic perspective of the person to learn about and genuinely understand the client's life context. Nursing incorporates collaborative care with the client and other disciplines. Nursing calls for compassionate, respectful and dignified care of the person. When nurses recognize the internal and external factors impacting a person’s life, this can lead to more effective interventions that improve health. Nurses are highly educated, knowledgeable, critical thinkers, and competently skilled in delivering evidence-based care. Nurses are compassionate, caring, ethical and committed to their clients and profession. I believe my philosophy of nursing has evolved from when I first entered the profession viewing clients in relation to their illness and focusing on the completion of tasks, compared to now, which I feel reflects a more holistic perspective. The change in my philosophy can be attributed to being a nurse for over twenty years and in part due to taking the course Theoretical Foundations of Nursing, which I feel has my enhanced my perspective. How Do I Use Nursing Knowledge in my Practice?I will now discuss how I use nursing knowledge in my practice. Nursing knowledge encompasses what is unique to the profession of nursing and shares elements of other discipline knowledge used within the scope of nursing practice. Nursing knowledge is the type of knowledge that is necessary to unify the nursing discipline (Kim, 2015). Within the nursing discipline, the different types of nursing knowledge have been organized through Carper's (1978) framework of four fundamental ways of knowing. This framework allows for the recognition and understanding of knowledge within the nursing discipline (Johns, 1995). These ways of knowing include empirical knowledge, esthetic knowledge, personal knowledge, and ethical knowledge.The emphasis of empirical knowledge is on "the generation of theory and of research that is systematic and controllable by factual evidence" (Munhall, 2012, p. 73). It is described as the ‘science’ of nursing. Knowledge is organized in general laws and theories that help to describe, explain, and predict different events in nursing.I use empirical knowledge by integrating theory and research into my practice. In community health nursing, Nola J. Pender's (2006) Health Promotion Model is a nursing theory that guides my practice by application of the theory’s assumptions. Research is used often in my practice area in program planning, implementation of interventions, and evaluation of these interventions.The emphasis of esthetic knowledge is on expressiveness, subjective interactions, individual perceptions, and empathy (Carper, 1978). Each person has their own interpretation of reality; therefore, nurses may have a unique approach in forming and delivering their nursing care. This way of knowing encompasses the art of nursing, which includes but is not limited to caring and intuition.I use esthetic knowledge in my practice in tandem with delivering person and family-centred care. When completing similar assessments on a regular basis and interacting with clients that present with similar issues, it is easy to generalize these issues and conclude that the solution would be the same as the previous client seen. However, I attempt to view each client as being unique with their own context despite similarities in their issues and concerns to other clients.Personal knowledge focuses on the importance of the interpersonal process of knowing the self and knowing another (Carper, 1978). Personal knowing is required in the nursing profession for interpersonal processes and interactions with clients. It blends the art and science of nursing into practice and demands for the nurse to dismiss any preconceived notions and commit to remaining open-minded (Moch, 1990). My personal knowledge has been formed through informal and formal learning, experience, and knowing myself as a person and my capabilities within the scope of nursing practice. I integrate this type of knowledge into my nursing practice by drawing on what I have learned, have experienced in the past and what I currently understand in relation to working with clients. I apply this knowledge and can adapt how to respond in each unique interaction with clients. The last type of knowledge is ethical knowledge. This way of knowing focuses on the nurse's obligation to what should be done (Carper, 1978). "Knowledge within this domain requires an understanding of ethical theories, conditions of society, conflicts between different value systems, and ethical principles" (Munhall, 2012, p. 74).I feel ethical knowledge is essential to all nursing practice and relates to the knowledge of what I "should" do when interacting with clients. This includes providing nursing care that is respectful and dignified for each client. It also includes providing equitable care for a client while considering the impacts of the social determinants of health on a client's life. Ethical knowledge guides me in being accountable to my clients and the nursing profession. Different types of knowledge are used in various ways within my practice. I integrate science, art, personal ways of knowing, and ethical knowledge into my practice. The different types of knowledge contribute to my ability to practice competently, intuitively, holistically, and in a principled manner. How Can I Contribute to the Development of Nursing Knowledge?Lastly, I will discuss how I think I can contribute to the development of nursing knowledge. Boyer (1990) suggested four types of scholarly activity that can guide my contributions. These activities include discovery, teaching, application, and integration. Discovery is described as knowledge that is newly generated such as research and theory development (Boyer, 1990). I feel that pursuing higher nursing education and taking a course like Theoretical Foundations of Nursing has led to discovery of new knowledge such as the ontology and epistemology of nursing. This course has provided the opportunity for reflection and expansion of thinking around my perspective of nursing. This discovery was often facilitated by completing required assignments and sharing between colleagues in course forums. The second activity, teaching, is described as a method to link a nurse’s understanding of knowledge and a students’ learning (Boyer, 1990). Precepting is a way in which I can contribute to the development of a student’s nursing knowledge by incorporating nursing theory, current research, and evidence-based information related to practice into my teaching. The third activity, application, refers to the use of new knowledge to address client issues or concerns (Boyer, 1990). Application of nursing knowledge leads to evidence-based practice. By implementing an evidence-based approach, evaluating it, and sharing findings is another way in which I can contribute to nursing knowledge. The last activity, integration, refers to establishment of collaborative relationships among disciplines (Boyer, 1990). Every year, a learning event is organized in my practice area where nurses can share knowledge with other disciplines within the organization. I have also had the opportunity to share nursing knowledge by co-authoring a presentation for a Community Health conference where other disciplines attended. Aside from the four scholarly activities mentioned above, I am confident that there are numerous ways in which I can contribute to the development of nursing knowledge within my practice area, especially while in the pursuit of higher education. I look forward to this opportunity as I continue to develop my academic knowledge and skills.ConclusionI have explored the metaparadigm of nursing to help define what nursing means to me and I have presented a philosophy of nursing that has evolved in values and beliefs. In attempting to define my philosophy of nursing, I have had the opportunity to reflect on what is important to me as a nurse. I then discussed how I use nursing knowledge in my practice by elaborating on ways of knowing. This presented an opportunity to explore the types of nursing knowledge and how it is applicable to my practice. Lastly, I shared how I feel I can contribute to the development of nursing knowledge through identified scholarly activities, which has inspired me to further pursue nursing knowledge.ReferencesBenner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.Boyer, E. (1990). Scholarship reconsidered: Priorities for the professoriate, Princeton, NJ: Carnegie Foundation for the Advancement of Teaching, University of Princeton.Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-munity Health Nurses of Canada (2019). Canadian community health nursing professional practice model & standards of practice. Midland, ON: AuthorFawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. The Journal of Nursing Scholarship, 16(3), 84-88.Johns, C. (2005). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22, 226-234.Kim, H.S. (2015). The essence of nursing practice: Philosophy and perspective. New York, NY: Springer Publishing Company, LLCMoch, S.D (1990). Personal knowing: Evolving research and practice. Scholarly Inquiry for Nursing Practice: An International Journal, 4(2), 155-165.Munhall, P.L. (2012). Nursing research. Mississauga, ON: Jones & Bartlett Learning Canada Pender, N.J. (2011). Health Promotion Model Manual. Retrieved from Press Encyclopedia of Health (2018). Metaparadigm?concepts in?nursing. Retrieved from , S., Benkert, R., Bell, S., Walker, D., & Danford, C. (2007). Social justice: Added metaparadigm concept for urban health nursing. Public Health Nursing, 24(1), 73-80. ................
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