Nursing Autobiography
My nursing philosophy is informed by numerous and diverse experiences in this noble profession. In addition to the concepts learnt in class, I have had experiences in practice that have helped me perceive nursing in an entirely different perspective. While the concepts learnt in class are important, my experiences in practice have taught me that a lot more than then the knowledge of the nursing process is required to be a professional nurse. I have seen nurses driven by compassion make unimaginable sacrifices for well-being of the patient. For instance, I remember an incident where a nurse who had just handed in her shift remain behind to help stabilize accident victims before the on-call doctors came into the emergency room.
I have taken part in volunteer activities. My limited experience in nursing means that I was given tasks that I regarded as menial at the time. However, I remember the feeling of satisfaction when I successfully collaborated with nurses and other members of the health care team to help the patients. One specific experience of which I am fond is when I was called upon to carry out research on the best practices in the management of patients. Above other things, the fact that established professionals in the nursing profession relied on me was fulfilling. Even more fulfilling was the knowledge that my actions contributed to relieving a patient off discomfort. At this point, I felt that the passion and dedication I put into the tasks assigned were more important than the conceptual knowledge I had as student nurse. It is for this reason that I appreciate the sentiments by Carolyn Jarvis that, “The character of the nurse is as important as the knowledge she possesses,” as reported in (Shea, Wynyard & Lionis, 2014, p.26). The sentiments behind this quip are a big influence on my nursing philosophy.
The Four Metaparadigms
Metaparadigms play an important role in painting the universal perspective of the nursing profession while also helping to evaluate the various concepts that characterize the discipline of nursing. The four metaparadigms include health, person environment, and nursing (Doornbos, Groenhout, Hotz & Brandsen, 2005). The four concepts have been theorized different over time by different nursing theorists. Under the health promotion model, a person/patient is seen as a complex biopsychosocial individual. In this model, the person/patient is seen to contribute effectively to the promotion of health through lifestyle changes (Maville & Huerta, 2013). Under theory of goal attainment, a person is seen as an individual within a social system in which he functions through the interpersonal relationships he creates.
As argued by Imogene (1971) (cited in Maville & Huerta, 2013) these interpersonal relationships occur in the form of the perceptions of the individual that shaper his health and life. As person living within a social system, there are many needs that contribute to the well being of the person (Maville & Huerta, 2013). This is exemplified in Henderson’s theory of needs where she postulated that individuals are whole people with fundamental needs. The nursing profession is concerned with helping provided these needs to help bring a person/patient back to health (Maville & Huerta, 2013). For instance, the environmental theory of nursing by Florence Nightingale relates the physical, spiritual, intellectual and social needs of a patient (Maville & Huerta, 2013). In practice, nurses groom and feed the patients to meet their physical needs.
The environment describes the surroundings of a person. Many of the needs of the patients described in the paradigm above are found within the environment. The environmental theory of nursing describes the environment as a major source of diseases. This is an agreeable argument because the many pathogens which cause diseases are found in the environment. In the same respect, certain conditions within the environment such as lack of clean water are causes of diseases. The environment is not just limited to the external elements but also has some internal elements as argued by the theory of goal attainment by Imogene.
As people interact with the environment, they continually transform it to suit their needs. However, the health promotion model by Pander cautions that the environment transforms the people in return. This is illustrated in practice aptly by the actions of the nurses to manipulate the environment through the provision of warmth, food, hygiene and clean air, actions that contribute to the positive patient outcomes (Maville & Huerta, 2013). Even though Virginia Henderson in her needs theory does not place any significance on the environment, it is noteworthy that she delineates the impact that one’s friends and family can have on the health of an individual (Maville & Huerta, 2013). This is an acknowledgement of these elements of the social environment, and the contribution they have on the health outcomes of an individual.
Health as a metaparadigm is described by Imogene in her theory of goal attainment as dynamic state that results from the ability of an individual to adapt to stress (Maville & Huerta, 2013). The word dynamic in that definition is a choice word and has a big influence on the manner which this metaparadigm is understood. The fact that dynamic means ever changing means that one cannot achieve absolute health because it is a state that changes at all times (Maville & Huerta, 2013). More precisely, health is not static, and as such, complete health is unattainable. The dynamic state of this metaparadigm is also corroborated by Rosemarie Parse in her theory of human becoming. Her argument is that the concept of health changes constantly because it is a product of the human-universe experience, hence its fluidity.
This is also an argument to the effect that health is the result of the interaction between the person and the environment. The transformation of the environment as argued by health promotion model by Pander affects the person/patient in ways that affect his health. Seeing that health is a fluid state, it changes in relation to the interaction between the environment and the person (Maville & Huerta, 2013). This argument is further advanced by Jean Watson in his theory of transpersonal caring where he argues that the harmony and unity within the body, mind and soul of an individual personifies the concept of health. This theorist further argues that health describes the extent to which there is congruence between the self as experienced and the self as perceived. Any incongruence between these two selves results in diseases.
Nursing as a metaparadigm describes the actions of a nurse in helping an individual meet their needs in the path towards the restoration of health. Dorothea Orem in her theory of Self-care theory gives a more nuanced description of this metaparadigm by arguing that the special concern for nursing is in the special need of an individual for self-care. In response to this need, nurses provide this care on a continual basis to help the individual sustain life, to help them restore their health, and to manage the effects of the injuries and disease that have affected their state of health.
It is noteworthy that even though the four metaparadigms are described in solitude, there are linkages connect these metaparadigms. Health as a concept plays a central role in the nursing profession (Maville & Huerta, 2013). All the actions of the nursing process are related to one aspect of health or another. Nurses perform their roles to restore the health of the patient. By extension, how the environment and the patient interact and the effects of these interactions are of concern to the nurse (Maville & Huerta, 2013). Thus, the metaparadigms of the patient/person and health become integral concepts in nursing.
Two Practice-Specific Concepts
In addition to the four metaparadigms, there are other concepts in nursing, some of which are practice specific. One of these concepts is that of dignity. This is a concept in nursing practice which is viewed with complexity. As Clark (2010) argues, various attempts at defining dignity in nursing practice have not yielded a standardized definition. However, Clark (2010) offered a more clear definition that is derived from the review of literature. In this definition, dignity is conceptualized as a human right. It is the feeling that one is regarded and treated with importance and value relative to others. This definition further recognizes the fact that dignity is subjective and multifaceted. Nonetheless, there is a universal shared meaning even if there are no standardized definitions (Clark, 2010). Despite these challenges in definition, dignity is a central concept in the delivery of care.
Nurses should use a dignified approach in the delivery of care irrespective of whether the recipients still possess the control over their surroundings or behavior. In practice, this means that people who have mental disabilities and may not have control over themselves still deserve the quality care other patients receive. It is my perspective that the knowledge of the importance of dignity inspires the integration of the concept in the delivery of care even in the absence of consensus on the width and breadth of the concept. It is agreeable that given the fact that the concept is abstract, it is challenging measure or enforce. However, the following concept and its integration into personal nursing philosophies motivate nurses to offer dignified care.
Altruism is yet another concept in nursing practice. Altruism is as important as the knowledge that is required in delivering care (Basford & Slevin, 2003). Altruism relates to the caring aspects of nurses. This concept is reminiscent to the illustration of the nurse who stayed in after a shift to assist the other nurses in stabilizing accident victims before the on-call doctors arrived. It is this aspect of care that made the difference in the emergency room. Without negating the importance of competence and knowledge, arguably all the knowledge and competence without altruism would not have made the same difference (Rhodes,M., Morris & Lazenby, 2011). Altruism is not completely unrelated to the concept of dignity. It is through altruism that nurses employ their knowledge and competence to deliver dignified care to their patients.
List of Propositions
The following propositions and assumptions delineate the connection between the concepts discussed above.
The environment has dramatic effect on the lifespan and optimum health of a persons
A person is not only self-directing but also has the ability to learn and implement the knowledge given.
A person has the capability to communicate their needs to enable the delivery of care to meet those needs towards the restoration of health.
A person has the capability to change on the basis of past experiences and acquired knowledge.
The environment can be manipulated to meet the needs of the individual.
References
Basford, L., & Slevin, O. (2003). Theory and practice of nursing: An integrated approach to patient care. Cheltenham, U.K: Nelson Thornes.
Clark, J. (2010). Defining the concept of dignity and developing a model to promote its use in practice. Nursing Times; 106: 20,
Doornbos, M. M., Groenhout, R. E., Hotz, K. G., & Brandsen, C. (2005). Transforming care: A Christian vision of nursing practice. Grand Rapids, Michigan: William E. Eerdmans Publishers.
Maville, J. A., & Huerta, C. G. (2013). Health promotion in nursing. New York. Cengage Learning.
Rhodes, M., Morris, A., Lazenby, R. (February 25, 2011) Nursing at its Best: Competent and Caring, OJIN: The Online Journal of Issues in Nursing 16, 2.
Shea, S. Wynyard, R. and Lionis, C. (2014). Providing Compassionate Healthcare: Challenges in Policy and Practice. London. Routledge.
