Role Paper
Role PaperMaribeth HollernFerris State UniversityAbstract The purpose of this paper is to gain awareness of my current nursing practice and how with attaining an advanced practice degree it will change. I will note throughout the paper my growth in knowledge and professional development utilizing varied resources. I will also discuss my transition from my current roles both as a bedside nurse and Adjunct clinical faculty to the Master’s prepared nurse.The purpose of this paper is clearly stated in the syllabus: “to explore the scope of your advanced practice specialty and identify how you will meet this new expectation” (Singleterry, 2014, p. 12). In order to transition into a new professional role it is important to know where your practice is centered at present in order to direct and forge a new path. According to Dr. Barbara Carper, “Personal knowledge is concerned with the knowing, encountering and actualizing of the concrete, individual self” (Carper, 1978, p. 18) and my professional journey both present and future will require examination and development. This paper will be a reflection of my journey. Nursing KnowledgeThe underlying theme of my teaching philosophy is to be a constant active learner. The constant active learner is an individual that is cognizant of their learning needs and actively seeks out the knowledge that is needed and required to be effective in their role. Carper describes nursing knowledge as four fundamental patterns of knowing: empirics, esthetics, personal knowledge of nursing and ethics (Carper, 1978). It is within these parameters of Carper’s nursing knowledge, and the discovery of the pattern’s meaning, that has validated my past practice and has newly shaped my future practice’s focus.At present my nursing practice is as a Surgical Intensive Care Unit (SICU) staff nurse at a Level One Trauma Center and also as Clinical Nursing Faculty (CNF) member of local universities. Both roles serve each other. The knowledge gained at the bedside over a twenty-eight year career serves me as clinical faculty. SICU nursing is a constant exercise in critical thinking and problem solving. It is in this venue I have fine-tuned my craft of nursing, the art of nursing. Carper identifies the art of nursing as esthetics and it is one of the fundamental patterns of knowing, “The art of nursing involves the active transformation of the patient’s behavior into a perception of what is significant in it-that is, what need is being expressed by the behavior” (Carper, 1978, p. 17). The art of nursing or esthetics is a difficult pattern to grasp and then to teach. It is a pattern of knowing that develops over time and with experience.Empirics is the science of nursing. Empirics is the fundamental pattern of knowing in nursing that according to Carper utilizes “empirical facts systematically organized into theoretical explanations regarding the phenomenon of health and illness” (Carper, 1978, p. 22). It is within this pattern of knowing that evidenced-based practice is revealed. “Evidenced based practice will improve the quality of patient care and enhance clinical judgment. Therefore, Practitioners must know how to obtain, interpret, and integrate the best available research evidence with patient data and clinical observations” (Rosswurm & Larrabee, 1999, p. 322). In the SICU an evidenced-based nursing protocol was enacted related to data obtained regarding a high incidence of Ventilator Acquired Pneumonia (VAP). ANA Standard 9: Evidence- based practice and research competency states, “the registered nurse utilizes evidence-based nursing knowledge, including research findings, to guide practice” (American Nurses Association [ANA], 2010, p. 51). Simply an around the clock scheduled oral care task was initiated by nursing on all ventilated patients to reduce the incidence of VAP in the SICU. Informal data gathering thus far in the SICU has supported the continuation of the oral care protocol and has revealed a significant decrease in VAP. This evidenced-based practice of VAP has been shared with students during their Critical Care clinical experience. Witnessing evidenced-based practice being utilized is empowering to students, nursing becomes real to them and impactful.Ethics as one of Carper’s fundamental patterns of knowing in nursing is the “knowledge of morality in nursing” (Carper, 1978, p.20). In the SICU moral challenges arise frequently related to quality of life, end of life and family issues. These issues are difficult for staff and student in this arena. Ethics are based in morality and ethical codes of conduct. Examining standards and codes and values assist the nurses in defining what is morally right. It is this awareness that assists the nurse in making and being responsible for moral choices (Carper, 1978).“Personal knowledge as a fundamental pattern of knowing in nursing… is the most difficult to master and teach” (Carper, 1978, p. 18). It is this pattern that encourages self –reflection and of taking into account what is known, what has been learned and what has been effective. Then these practices are shared with colleagues and students. The utilization of this pattern will be one of the most important aspects of knowing in nursing to transition my practice from bedside nursing to an advanced practice role of a Master’s prepared educator. As noted in M. Little’s workshop, “Of primary importance to a novice teachers’ development is taking the time to identify and appreciate the personal dimensions that are an integral part of the health educator role” (Little, 2007, p. 131). Incorporating all useful personal experiences into the teaching setting will only enhance the student’s learning experience.Integrating the patterns of knowing in nursing: empirics, esthetics, ethics and personal knowledge of nursing enables the nurse to provide care that is holistic, individualized, and patient-centered (Mantzorou & Mastrogiannis, 2011). This integration of knowing will assist the transition from bedside nurse to educator by allowing reflection of practice. The fundamental patterns identified by Carper provide a tangible meaning to nursing practice and what nurses know. Thereby, taking what is known and experienced and transferring or teaching these valuable bits of knowledge to future nurses.Significance of Unique KnowledgeJacqueline Fawcett, a nursing theorist, vocalized concern related to the nursing profession’s survivability if we did not distinguish ourselves as a “distinct discipline” (Butts, Rich, & Fawcett, 2012, p. 152). Fawcett’s metaparadigm four concepts of nursing assist in distinguishing nursing as a set discipline with a holistic patient focus. The metaparadigms four concepts are: human being or person; environment, health and nursing. “The four metaparadigm concepts are generally present and defined either implicitly or explicitly in each model and theory” (Butts et al., 2012, p. 151). The metaparadigm ensures that there is a holistic framework for all nursing theory and that our theories will be multi-focal. This will promote the highest of care quality and be beneficial to patient and nurse alike. PersonPerson within the health care area can mean many things. According to the Model of Quality of Nursing Care (Larrabee, 1996) the person or human aspect of care is that it is patient-centered and placed the greatest value and emphasis on the patient. Florence Nightingale describes a person in the health care environment as “the recipient of nursing care” (Masters, 2012, p. 29). In my current practice person includes the above mentioned as well as patient’s families and other support systems and communities.EnvironmentEnvironmental characteristics in the Larrabee theory take into account the responsibility of providing care that is economically observant thus decreasing waste both financially and fiscally (Larrabee, 1996). Environment can and should take into account the earthly environment and resources afforded to a patient and also their physical environment in the health care setting. Both of these areas can directly affect patient outcomes. “All conditions, circumstances and influences surrounding and affecting the development and behavior of persons and groups, with particular consideration of mutuality of person and earth resources” (Masters, 2012, p. 138) define environment.HealthThe concept of health has changed. It was once defined simply as the absence of disease (Pender, Murdaugh, & Parsons, 2006). Nursing itself was redefined when the focus of health care and the view of the definition of health changed. “The representation of health as more than the absence of disease is a crucial change; it permits health to be thought of as a dynamic state or process” (Carper, 1978, p. 14). According to Larrabee, Health is reflected in patient satisfaction of high quality, economically sound care (Larrabee, 1996). As health and its definition evolves so too does nursing along with it.Nurse The working definition of nursing is,” The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities, and population” (ANA, 2010, p. 66). The nurse’s role is to provide this necessary care to the patient and their families as needed. Quality nursing care can be accurately measured by patients and patient’s families, “Quality nursing care is characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor” (Izumi, Baggs, & Knaft, 2010, p. 299). The very “essence of nursing is caring” (ANA, 2010, p. 22) and it is this natural nurturing that drives my practice.Nursing TheoryWe are no longer handmaidens to physicians but are collaborative partners in practice. Nursing theory provides the “why” we approach our nursing practice in a certain manner. Our practice is not baseless or whimsical but it is driven by science, purpose, and theory. The rationale is to provide holistic care to our patients and families. Nursing theory and evidenced-based practice began with Florence Nightingale in the mid 1800’s and its importance continues to gain ground and is relevant to further development of theories today. “Research tested and expanded theories continue to define and elaborate the discipline of nursing” (ANA, 2010, p. 16) and as more evidence is gleaned nursing practice will become more and more exact. “Nursing is defined as both science and art, with science encompassing the theories and research related to the phenomena of concern and art as the creative application of that knowledge” (Smith & Liehr,2014, p. 5). Nursing theory essentially validates nursing practice.RoleWebster’s Dictionary defines a role as: “role /noun/ 1. Someone or something’s purpose in a particular situation (Webster, 2011). The functional definition gives value to my nursing professional journey. The realization is that although the role may change and develop into something new, the role, whatever it may be, by definition carries a purpose. “Registered nurses may pursue advanced academic studies to prepare for specialization in practice. New models for educational preparation are evolving in response to the changing healthcare, education, and regulatory practice environments” (ANA, 2010, p. 15). The evolution of nurses and career goals is essential in assisting the nursing profession to advance. As Fawcett shared increasing the educational expectation of nurses and encouraging the further development of nurses into advanced practice degrees ultimately brings the most benefit to the person who counts the most, the patient (Butts et al., 2012).Role DevelopmentIt is not enough to be in a certain profession for a moderate amount of time to be qualified to teach within that profession, “many novice nurse faculty are not educationally prepared for the faculty role” (Halstead, 2007, p. 170). Throughout this course and others this realization has come to fruition. In order to be competitive in the global arena as well as competent at the bedside, the nursing profession acknowledged the need to elevate the requirement of nursing educators. “Registered nurses must continually reassess their competencies and identify needs for additional knowledge, skills, personal growth, and integrative learning experiences” (ANA, 2010, p. 13) thus my journey to seek out an advanced practice degree with an educational tract. Acknowledging this requirement was not the only motivation to obtain a Master’s of Science in Nursing (MSN) degree. Primarily, I love being a nurse, every aspect of nursing, and I consider it my vocation. It is the core of who I am. The likelihood of being able to physically continue bedside nursing in an adult SICU, for an extended period of time, was that it was not going to continue indefinitely. This fact, along with my underlying sense of responsibility to share my personal nursing knowledge with future nurses, has led me to my new path towards an MSN degree.The responsibility to help shape and even better the nursing force is my impetus. The level of accountability I have for my students and meeting their educational outcomes is my greatest priority. It is not enough anymore to just draw from my past experiences as a bedside nurse. I know as I continue to develop and grow as an educated educator I will only serve them better. “Nurse educators who are well prepared for the role will influence undergraduate and graduate curriculum and program development to produce strong graduates prepared to engage in clinical practice, pursue advanced education, and engage in scholarship that builds upon the existing body of nursing knowledge”(Halstead, 2007, p. 13). My purpose, my role as a nurse, has always been patient-centered and knowing that students have an educationally prepared teacher will conversely provide patients with excellent nursing care. The new nursing force will be improved versions of our former selves because as we grow and learn in our profession so too will they.I have grown in my nursing professional journey. I will always be proud of what I have given and received as a bedside SICU nurse. However my purpose or role may change in functionality, it will not change in focus. I will remain a patient-centered care advocate but now it will be expressed in a different manner, as an educationally prepared advanced practice nursing educator. My greatest revelation in this process is a new realization: Obtaining an MSN degree is not something I have to do because of new requirements and regulatory expectations. The path set before me is one of my own choosing.ReferencesAmerican Nurses Association. (2010). Nursing: Scope and standards of practice (2 ed.). Silver Spring, Maryland: .Butts, J. B., Rich, K. L., & Fawcett, J. (2012). The future of nursing: How important is discipline-specific knowledge? A conversation with Jacqueline Fawcett. Nursing Science Quarterly, 25(2), 151-154. , B. A. (1978). Fundamental patterns of knowing in nursing []. Advances in Nursing Science, 1(1), 13-24. Retrieved from Patterns of Knowing in Nursing.4.aspxHalstead, J. (Ed.). (2007). Nurse educators competencies: Creating an evidence-based practice for nurse educators. New York, NY: National League for Nursing.Izumi, S., Baggs, J., & Knaft, K. (2010). Quality nursing care for hospitalized patients with advanced illness: Concept development []. Research in Nursing & Health, 33, 299-315.Larrabee, J. H. (1996). Emerging model of quality []. Image: Journal of Nursing Scholarship, 28(4), 353-358.Little, M. (2007). Preparing nursing students to be health educators: personal knowing through performance and feedback workshops []. Journal of Nursing Education, 45(3), 131-135.Mantzorou, M., & Mastrogiannis, D. (2011, October). The value and significance of knowing the patient for professional practice according to the Carper’s patterns of knowing. Health Science Journal, 5(4), 251-261.Masters, K. (2012). Nursing theories: A framework for professional practice. Sudley, MA: Jones & Bartlett Learning.Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2006). Health promotion in nursing practice (5 ed.). New Jersey: Pearson Prentice Hall.Rosswurm, M., & Larrabee, J. (1999). A model for change to evidenced-based practice. Image-the Journal of Nursing Scholarship, 31(4), 317-322.Singleterry, L. (2014). N501 Introduction to advanced nursing roles. Unpublished manuscript, School of Nursing, Ferris State University, Big Rapids, MI.Smith, M. J., & Liehr, P. R. (2014). Middle range theory for nursing (3 ed.). New York: Springer Publishing Company.role. (2011). In Merriam-. Retrieved Aril 14, 2014, from http:/dictionary/role. ................
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