Running Head: A GUIDE TO PROFESSIONAL PRACTICE

A Guide to Professional Practice: The Personal Philosophy of a Student Nurse Kayla Vadney Old Dominion Universality

A GUIDE TO PROFESSIONAL PRACTICE A Guide to Professional Practice: The Personal Philosophy of a Student Nurse As I began my journey as an undergraduate nursing student three years ago, I did not

fully understand all that nursing was or is, nor my beliefs or values related to it. At the end of my first semester and with very minimal healthcare experience, I was required to reflect on who I am as a student nurse and form a rudimentary personal nursing philosophy to guide my future practice. At this point, I did not have a thorough grasp on all of the responsibilities a nurse has to her patients. However, I decided at this moment that very little could be achieved in patient care if there was no nurse-patient partnership. My initial philosophy illustrated the necessity of partnership and described a metaphorical staircase as a means to achieve an overall goal of patient health. This goal could be anything that the nurse and patient decide it to be, however they both must agree. I defined nursing as assisting an individual patient in achieving optimum health as defined by that patient. The staircase consisted of four steps that must be climbed by the nurse and patient together. These steps included: individualized patient-centered care in which all interventions must be selected with the specific patient and goal in mind; competence and knowledge through the nurses initial and continued education; patience with the time necessary to achieve the goal; and dedication, even through any setbacks that may arise during the process of goal achievement. As a soon-to-be new graduate nurse, I still strive to work in a partnership with my patients and provide individualized nursing interventions. However, I have since built on clinical experiences and theoretical knowledge to alter my initial philosophy. The purpose of this paper is to rediscover my personal nursing philosophy as it exists at the end of my undergraduate education and to analyze the ways in which it has changed or remained the same with the incorporation of nursing theory and other resources.

A GUIDE TO PROFESSIONAL PRACTICE Definition of Nursing

For the most part, I continue to embody my initial definition of nursing in which I assert that nursing is to assist a patient in achieving optimum health as defined by that patient. I developed this definition for my original philosophy of nursing with inspiration from Hildegard Peplaus Theory of Interpersonal Relations, which emphasizes that nursing is an interpersonal process in which the nurse and patient interact with one another through a common goal (as cited in Johnson & Webber, 2010). I interpreted this goal as aimed to improve the patients health, quality of life, or some other aspect, which the nurse and the patient mutually identify. After several semesters of clinical experience and personal reflection, I have since refined this definition to expand on the identity of the patient. Originally I implied the patient in question is an ill or injured individual. However, according to Provision 2 of the American Nurses Association (ANA) Code of Ethics, the nurses primary commitment is to the patient, whether an individual, family, group, or community (2010). I also have clinical experience with varying definitions of the patient. In obstetrics, the patient is not experiencing a disease process, but is, in most cases, quite healthy. Also in obstetrics there is usually family present. Therefore, in this case the patient is the healthy and laboring mother and her family. In community health nursing, disease prevention is the overall goal and therefore the patient can be a healthy or recovering individual at home, a family, or a larger group in the community. Another evolution to my nursing definition includes a specification to how much and in what way the nurse assists the patient in goal attainment. After experiencing several types of nursing and a variety of patients, I have decided that there are varying degrees to which the nurse needs to intervene and that this degree of assistance should be individualized. For example, a bedridden patient may need more assistance in meeting goals than a mobile patient.

A GUIDE TO PROFESSIONAL PRACTICE Also through clinical experience, I have realized that in order for successful goal attainment, in many cases patient care is more of an interdisciplinary team effort and collaboration, rather than a nurse-patient partnership. Although some interventions can be

implemented just between the nurse and patient, other times physicians, therapists or pharmacists are required to meet the end goal. Lastly, I have learned with time that nurses are good caregivers because they base their care in evidenced-based practice. Although medicine and nursing was once only a trial and error effort, technology has come a long way and now we know what works and what does not so that we may maximize the success probability of goal attainment for patients. With all of this in mind, the definition that I choose to apply to my current practice and will carry with me after graduation is the following: Nursing is to assist the individual, family, or community to the degree necessary in achieving health and wellness as defined by the patient, through mutual goal setting and individualized, collaborative and evidence-based intervention. Purpose of Nursing Nursing is unique in that the purpose is to assist patients in improving their overall physical, mental and emotional wellbeing simultaneously. In other words, nurses help those in need with whatever they need. Nurses educate patients by offering health information and demonstrations. They promote rest and relaxation by manipulating the environment. They offer advice and sometimes peace of mind in difficult situations. Nurses also heal by administering medications and changing wound dressings and they fill the gaps of independence by helping a patient get dressed or use the restroom. The purpose of nursing is to make a difference, and I want to be a nurse because I love helping people and touching their lives. I am not a religious individual, however I am definitely a

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devout humanitarian and my love and concern for people is what influences my nursing practice. I receive a lot of satisfaction out of nursing because I really enjoy the appreciation I get from patients when they feel that I have helped them or improved their day in some way. Although the gratitude I have received from patients throughout my clinical rotations is few and far between, when I do receive it, it makes all of the hard work worth it. For the other times in which it may not have been said that my effort made a difference, I still feel that my purpose was served because although gratification is wonderful, the purpose of nursing is to help people, not necessarily to be appreciated. Assumptions Over the course of my theoretical education and practical clinical experience, I have developed a set of beliefs and values regarding the relationships that patients have with their patients, the community and other healthcare professionals. In the following sections, my beliefs regarding these relationships will be discussed with support from various nursing theories. The Nurse and the Client I highly value strong, therapeutic and mutually respectful nurse-patient relationships. I believe that they are the cornerstone of effective teamwork and goal achievement in the healthcare setting. This mutual respect is especially important in todays culturally diverse population. According to Madeleine Leiningers Culture Care Diversity and Universality Theory, everyone is part of a culture and has specific values and practices (as cited in Johnson & Webber, 2010). It is likely that at some point a patients values may be different from his or her nurses and therefore may significantly impact patient care. It is important for nurses to realize and accept this in order to provide culturally competent care for all patients. If nurses do not take the time to acknowledge and reasonably accommodate cultural considerations that are important to

A GUIDE TO PROFESSIONAL PRACTICE the patient, then the therapeutic relationship may weaken and mutual goal attainment will be unsuccessful. The Nurse in the Community Although strong relationships with patients at the bedside are very important, a therapeutic presence in the community may be more beneficial by promoting health and preventing the need for hospitalizations in some populations. The McGill Universalitys Practice-Derived Model argues that a persons health status is directly related to personal lifestyle and habits (as cited in Johnson & Webber, 2010). Therefore, it is extremely vital for health and longevity to develop and maintain an active and healthy lifestyle. I believe that if nurses establish a lasting therapeutic relationship with a community, they will have the opportunity to provide education and other preventative services, such as immunizations, in order to instill in that community the importance of healthy habits and will make a positive impact on the health status of the population. The Nurse and Other Healthcare Professionals It is incredibly vital for the nurse to establish and maintain therapeutic and culturally

sensitive relationships with patients, whether an individual or a community, in order to achieve health-related goals. However, positive interactions with other healthcare team members should be valued just as highly. Patricia Benner developed the Model of Skill Acquisition in which she theorized that nurses acquire knowledge and skill with work experience and that this experience is gained in phases (as cited in Johnson & Webber, 2010). This nursing theory is very important because it instills the idea that nursing students do not graduate all knowing. Therefore, it takes a lot of time to develop the ability to apply theoretical knowledge to real patients and situations. In order to initiate and maintain therapeutic and mutually respectful relationships between nurses

A GUIDE TO PROFESSIONAL PRACTICE

and other healthcare professionals, it is crucial that both nurses and the other staff remember this. If a new graduate nurse and her coworker both remember that skill is gained with time, then it may be less likely that the new graduate will get frustrated with her mistakes or that the coworker will get impatient. Both of these reactions may halt the development of positive interactions. The same can be applied to a nurse with a lot of experience. As skill comes with experience, according to Benner (as cited in Johnson & Webber, 2010), it is important for staff to respect and trust an experienced nurse. Principles Based on my assumption that if nurses do not acknowledge cultural differences in their patients, mutual goal attainment will be unsuccessful, I have come up with a moral and ethical principle to guide my practice. The principle I try to care by is that each patient deserves culturally sensitive and competent care and therefore it is the nurses responsibility to discover, acknowledge and reasonably accommodate any cultural beliefs or practices that a patient may have. I have personally utilized this principle in my clinical practice on many occasions. For example, during role transition on a labor and delivery unit, I had a patient who was a young adult Indian female laboring with her first child. I asked this woman if she had any specific cultural practices that she would like me to address and she replied she does not eat meat and would prefer that when she received meals in postpartum if they could be vegetarian. She then added that in her culture it is inappropriate for any man to see her exposed and preceded to ask if all of the staff could be female. I believe that I prevented offending and embarrassing this woman had she received a meat based meal or had a male doctor walked in since she did not have an assigned physician at that hospital.

A GUIDE TO PROFESSIONAL PRACTICE

Another principle that I utilize in practice is based off of my assumption that in order to build productive relationships with other team members, it is important to remember that skilled healthcare professionals are not born and that skill takes time to acquire. Therefore in practice I make use of the principle of respecting coworkers experience or lack thereof. In other words, it is important that one must have patience with new graduates and respect the experience of skilled professionals. I use this principle every time I participate in a clinical experience. For example, on my first day in role transition on a labor and delivery unit, I was so nervous to give my first sterile vaginal exam that my hands started to sweat and I could not even put on my sterile glove. I was so embarrassed, however I tried to relax and remember that I was there to learn and that I know I do not know what I am doing but so does my preceptor and that I am working with her because she is a skilled nurse and has a lot of experience. This realization allowed me to put my frustration behind me and begin the exam, taking guidance and cues from my preceptor as I went of what I should feel. We now have a very trusting and mutually respectful relationship in which she shows me a lot of patience. Conclusion In conclusion, through this paper I have rediscovered who I am as a soon-to-be nurse by reevaluating and enhancing my nursing philosophy. Through clinical experiences and theoretical education, I have learned that a patient can be any individual or group. I also realized the importance of interdisciplinary cooperation cultural competence and providing nursing care that is true to my core values. According to Bradshaw and Lowenstein (2010), creating a philosophy of nursing allows students to begin the socialization into the profession. Upon graduation, I intend to gain employment as a labor and delivery nurse, and I hope that my nursing philosophy

A GUIDE TO PROFESSIONAL PRACTICE will guide me in delivering unbiased, holistic and culturally tailored care so that I may build

trusting relationships with my patients and make a positive impact on their birthing experience.

A GUIDE TO PROFESSIONAL PRACTICE References American Nurses Association. (2010). Code of ethics for nurses. Retrieved from

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http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur ses/Code-of-Ethics.pdf Bradshaw, M J. & Lowenstein, A. J. (2010). Innovative teaching strategies in nursing and related health professions. (5th ed.). Sudbury, MA: Jones and Bartlett Publishers. Johnson, B. M. & Webber, P. B. (2010). An introduction to theory and reasoning in nursing. (3rd ed.). Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins.

A GUIDE TO PROFESSIONAL PRACTICE Honor Code

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I pledge to support the Honor System of Old Dominion Universality. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned. Electronic Signature: ____Kayla M. Vadney___ Date: _2/7/2014__