As Madeleine Leininger noted, nursing is built on the element of caring; nurses are caregivers and thus their interaction with the patient is a necessity rather than an option. Any role that falls within nursing and seeks to cut off the link with the patient cannot in any way find its basis in nursing. My philosophy is built on Linenger’s description of the role of nursing as a process that affords a patient in need the chance to meet and interact with a caregiver who cannot only give them access to resources but can help them cope within the demands at the time (Park, Kjervik, Crandell & Oermann, 2012). In my view, the nursing process is continuous and cannot be limited to social, spiritual, cultural, economic or geographic aspects. It is a process that even if afforded by different individuals should be seen to achieve the same objective. I believe therefore that a nurse should be a curious person; simply, there is that need to afford care that is appropriate and necessary because in any case, the patient has placed hope in you to help them meet their health needs (Purtilo & Doherty, 2011).
As a nurse, I am guided by the values of doing what is right. I know the patient expects the best from me and in that case, I have to work within their demands. That is not just confined to the nursing process; I actually believe that beyond the clinical point I have a role of advocating for the rights of the patients and utilizing all available resources to meet the patients’ needs. I consider myself as the first level of security in safeguarding the patient and ensuring that all other aspects of care conform to the patient’s needs. It is within this perspective that I consider that if at all I have to defend the patient then close interaction with the patient is a necessity. I thus seek to nurture my relationship with the patient as the first element of quality care. Further, my perspective of ethical care is much wider; if I have to afford my patient quality holistic care, it is important that I also seek to determine how well their beliefs align with those of self. Thus to me, doing right at the point of care implies doing what is acceptable to me and the patient equally. I value the role of negotiation with my patient and it is within this cope that I always believe that building a reliable and effective communication platform with the patient holds the key to successfully care planning and better outcomes. I always seek to afford the patient the type of care that I am comfortable with; whereby I do not feel limited by my own beliefs. I base my philosophical view of nursing within the knowledge that when the receiver and the giver of care can manage to speak and reason within a common wavelength then a common ground will always be found and everyone will have to do their part to the fullest.
Patients, at all times expect the nurse to provide a solution no matter how unique their problem may be. I therefore feel that nurses as solution seekers should and do not deserve to be limited in their practice especially in the context that the caregiver is entitled to make holistic restoration of the patient they serve. While the current setting affords nurses such an environment, nurses still have challenges that go beyond that; most of these challenges are directly influenced by the perceptions of the patients on what entails holistic or patient-centered care (Cribb, 2011). Patients today are educated and well informed; they do recognize that nurses have a role to prioritize their needs, preferences and beliefs and subsequently have them reflected in their care plan. Patients thus will present their spiritual, social and cultural beliefs as essential elements that need be augmented in the care plan.
In this case, the nurse is presented with the ethical dilemma of constricting themselves to the patients’ beliefs, overlooking the existing policies or even overlooking their personal beliefs which also cannot be assumed. In my view, nurses have their beliefs; social, cultural or spiritual which play a key role on how they deliver care to the patients (Park, Kjervik, Crandell & Oermann, 2012). Within my experience, I find it hard for a nurse to overlook their beliefs in order to accurately put into context the needs of the patient. It is important to recognize that as much as the patient feels bound by their beliefs, the nurse equally feels so at a professional and personal level. I believe that nursing is a liberal profession where beliefs of the nurse and the patient all have equal magnitude and it is at this point that I regard negotiation as a key element that would drive this liberalism (Purtilo & Doherty, 2011).
When nurses are subjected to fulfilling the beliefs of the patient in their entirety, while also ignoring their own beliefs, there is likelihood that the nurse will by intention to safeguard their beliefs ignore some aspects of care. Notably, when policies are written and adopted at the clinical level, the expectation is that they must be observed. However, there is an assumption that these policies will physically monitor how the nurses perform their roles. This is not true because on one hand, nurses have the authority to drive the nursing process without necessarily relying on the guidance of any other authority that acts horizontally or diagonally (Purtilo & Doherty, 2011). In that case, it is true that the nurse can make a personal decision based on their unlimited authority at the point of care to fulfill their personal beliefs even when they act contrary to the aspects of patient-centered care. Such an aspect actually implies that the nurse in their professional conduct works contrary to the existing code of ethics of the nurses and further contravenes the moral authority that they gold in respect to the nursing process (Park, Kjervik, Crandell & Oermann, 2012).
However, in my view blame cannot be squarely be put on the nurse rather the policy that separates or sidelines that nurses beliefs so that the nurse is bound by the policy and the beliefs of the patients. In such cases, the nurses are forced to act on the basis of policy and patient beliefs even when they do not hold similar beliefs. The importance of nursing process is basically to create a platform for the patient and the nurse to interact and negotiate the care plan. This platform is only possible when the nurse and the patient or the family can communicate and share openly without feeling bound by internal issues (Huffman & Rittenmeyer, 2012). The nurse has a role to understand the preferences of the patient but the patient has also to put into context the beliefs of the nurse. While is odd that the patient has to be made to understand the beliefs of the nurse and the fact that they would influence the nursing process, the nurse managers and the supervisors have a role of protecting the nurse so that they do not feel subjected to actions within the nursing process that do not respect of recognize their beliefs.
In my view, there needs to be a system that allows for consultation within the nursing care teams so that the patient’s are serve within the context of their beliefs while also considering that the nurse even at a personal level; have their respective beliefs that if not managed and negotiated can negatively affect the outcomes of the nursing process (Huffman & Rittenmeyer, 2012). I believe that when nurses are allowed to work within an environment that recognizes their beliefs as critical in the nursing process, the nurse is less likely to ignore those aspects that they regard as not conforming to their beliefs. In such instances they would willingly seek the collaboration of colleague nurses who can continue the nursing process and in instances where the nurse does not abide or agree with the respective beliefs of the patient in regard to care planning. It is important the healthcare sector or each facility develops a policy that will eliminate the possibility of such dilemmas and that implies allowing collaboration to rule as the workplace culture. In a workplace that is characterized by collaboration, these issues of ethical and moral dilemma that the nurse may be subjected are managed within the diversity of the care teams (Cribb, 2011).
References
Cribb, A. (2011). Integrity at work: managing routine moral stress in professional roles. Nursing Philosophy, 12(2), 119-127.
Huffman, D. M., & Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: a systematic review. Critical care nursing clinics of North America, 24(1), 91-100.
Park, M., Kjervik, D., Crandell, J., & Oermann, M. H. (2012). The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nursing ethics, 19(4), 568-580.
Purtilo, R. B., & Doherty, R. F. (2011). Ethical dimensions in the health professions. St. Louis, MO: Elsevier.
