4-6 pages

Running head: CONCEPT SYNTHESIS PAPER ON PERSONAL NURSING

CONCEPT SYNTHESIS PAPER ON PERSONAL NURSING

The purpose of this paper is to identify, describe, and apply the concepts that underlie my personal nursing philosophy. I will give a brief overview of my nursing background, identify and describe the four metaparadigms of nursing, provide two other practice specific concepts that apply to my practice, and include a numbered list of five propositions that apply to those concepts.

Nursing Autobiography

When I was little, I dreamed of becoming a flight attendant, a lawyer, an architect, and a doctor. I never saw myself become a nurse someday. I must admit that my only motivation for pursuing a nursing degree in college was to get to the United States and make good money. But I didn't think that I would someday love the profession I never even imagined doing. It is for this reason that I believe that nursing is a calling. Being a nurse has its bittersweet moments and surely takes a lot of compassion, patience, empathy, and strength. While it's true that the long hour shifts can be physically exhausting, it's witnessing the most devastating situations in life that make this profession very challenging. On the contrary, our ability to heal, save lives, and make a difference in our patients' lives and their families, truly is very rewarding and incomparable to nothing. Being a nurse for almost five years has opened my eyes and changed my views about life and all other things. I first started working on a Telemetry/Neuro floor for about a year and a half before I decided to venture out and ended up working in an extremely busy ER in downtown Jacksonville, FL. I worked there for two years, and though it was a highly stressful environment, I enjoyed almost every minute of it. The ER has the kind of culture that is fast-paced, task-oriented, informative, and team driven. Having passed my certification in emergency nursing (CEN) recently, I can say that my knowledge base, assessment, and critical thinking skills, which I often use to guide me in my clinical decision making, have significantly improved since I became an ER nurse. It has molded me into a strong, hard-working, and competent nurse that I am today.

The Four Metaparadigms of Nursing

A metaparadigm is referred to as the global concepts and propositions that define a particular discipline and describes their distinction from other professions (Fawcett, 2000, p. 4). It consists of four stipulations: (1) a domain different from other disciplines, (2) all phenomena of interest to the discipline (3) a neutral perspective, and (4) a scope that’s international in nature

(Fawcett, 1996, p. 94). In nursing, there are four common interconnected basic concepts that include patient, nurse, health, and environment (Peterson, 2016). It is through these concepts that nurses can have a unified description of their job functions, limitations, purpose, and professional identity (Butts, 2015).

Patient

Patient refers to all individuals, families, communities, and other members of the society involved in nursing care (Fawcett, 2000, p. 5). It refers to all human beings as recipients and the primary focus of nursing care. In nursing practice, patients are viewed holistically as unique entities with biological, psychological, sociological, and spiritual needs (Masters, 2011). It is important that all these basic needs are met to achieve optimal health and well-being. 

Nurse

Nurse refers to the discipline that takes care of patients. The nurse’s role is to assess patient needs and assist patients in meeting those needs through supportive and therapeutic interventions (Masters, 2011). Nursing, as defined by the American Nursing Association (ANA, 2001), 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, groups, communities, and populations” (Massachusetts Department of Higher Education, 2010, p. 5).

Health

Health pertains to a patient’s state of well-being and lies anywhere on a broad spectrum of high-level wellness to terminal illness (Fawcett, 2000, p. 5). Health is a state of human wholeness and integration (Roy, 2009). The goal of nursing is to promote an optimal level of health and wellness and encourage positive behaviors that will help maintain an overall equilibrium and stability in patients (Masters, 2011).

Environment

Environment refers to a patient’s physical surroundings and includes all aspects of local, regional, national, cultural, social, political, and economic conditions (Fawcett, 2000, p. 5). It involves all internal and external factors, conditions, and circumstances that influence a patient’s health and behavior (Masters, 2011). Nurses improve patient health and comfort by implementing certain changes, whether physical or psychological, in a patient’s environment.

Practice Specific Concepts

As an ER nurse, the two most important concepts I value and apply in my nursing practice every day are clinical judgment and self-care. I believe that patients have a lot to contribute to the improvement of their health and well-being just as much as they need competent nurses to take care of them at the time of their illness or vulnerability. Successful patient outcomes require mutual, participatory, and collaborative process between the nurse and the patient  .

Clinical judgment, as defined by Hardin (2016), is the clinical reasoning utilized by a health care provider; and consists of critical thinking and nursing skills acquired through the integration of formal and experiential knowledge. (p. 295). It is an important skill that every nurse needs to possess and develop. In a fast-paced environment where lives are often at stake, critical judgment is a must in almost every situation. Some aspects include prioritization, anticipation, and time management. Prioritization is always utilized both individually and systemically. The triage nurse assigns the level of acuity based on the patient’s appearance, the severity of presenting symptoms, and the patient's risk factors. The sickest patients are always given the utmost priority and attention so life-saving measures may be initiated as soon as possible. In any trauma patient, prioritization starts with assessing the airway, breathing, circulation, disability, and environment; followed by the secondary and tertiary survey. As in any given situation, an anticipation of the worst case scenario is the key to prompt and efficient treatment. It is a skill that can be honed over time. It’s the ability to form preconceived diagnoses based on the patient’s signs and symptoms and proactively intervening. As with any adult complaining of chest pain, EKG and serum troponin are the definitive tests to rule out myocardial infarction and thus, need to be initiated even prior to the physician’s orders. Mastery of this skill doesn’t only help to improve patient outcomes but also helps with time management. In an environment where time is of the essence, organization and task delegation are imperative for effectively managing one’s time. As the saying goes, “Work smarter, not harder.” Excellent time management skills don't only prevent the nurse from being too overwhelmed. But through a timely disposition of patients, patient overcrowding in the ER may also be avoided. 

Self-care, according to Shah (2015), refers to practices performed by mature and maturing individuals to maintain life, health and well-being (p. 39). It’s based on the belief that human beings have an acquired ability and need to care for themselves (Orem, 2001). Self-care doesn’t only mean eating a healthy diet and maintaining a healthy lifestyle. It also means compliance with the prescribed treatments and medications, keeping up with annual physicals and screenings, staying well-informed, being proactive and taking control. Evidently speaking, patient outcomes are increased when they can independently care for themselves. The theory suggests that “nursing is required in case of inability to perform self-care as a result of limitations” (Masters, 2011, p. 57)  One of our roles as nurses is health promotion, and the way to achieve this is to reinforce self-care and independence in our patients. Our job is to assess for any factors that might be affecting a patient’s ability to care for him or herself. Some of these factors include socioeconomic factors, cultural beliefs, health conditions, and other environmental factors (Orem, 2001). In the ER, we try to figure out why an alcoholic patient can’t maintain their sobriety; why a patient with diabetes is noncompliant with his medications; or why a patient diagnosed with a chronic condition in the ER doesn’t have a primary care provider or has never been to a doctor. We, then, consult case manager if necessary, refer them to other healthcare providers or organizations, provide them with a list of resources, and educate them. Only through the identification of these barriers can we guide, direct and provide our patients with the resources they need to help them get back on their feet (Masters, 2011). 

List of Propositions

According to Meleis (2004):

“Human beings have capabilities to provide their own self-care or care for dependents to meet universal, developmental, and health deviation self-care requisites.These capabilities are learned and recalled” (as cited in Masters, 2011, p. 59).

“Therapeutic self-care includes actions of nurses, patients, and others that regulate self-care capabilities and meet self-care needs” (as cited in Masters, 2011, p.59).

According to the American Association of Critical Nurses (AACN, 2006):

“The needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses” (p. 1).

“Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies” (p. 1).

According to Hardin (2016):

“The core of nursing is clinical judgment, which is grounded in the nursing process of assessment, planning, intervention, and evaluation” (p. 300).

The concepts and propositions I’ve gathered, evidently, are a combination of AACN’s synergy model and Dorothea Orem’s self-care model. As mentioned earlier, I strongly believe in the importance of good clinical judgment in nurses and self-care or care participation in patients, families, or caregivers. Mature and maturing human beings are capable of caring for themselves to meet their basic, developmental, and health needs imperative for their well-being, quality of life, and survival (Masters, 2011). Even some disabled individuals are capable of self-care. It is innate for us human beings to be independent. However, self-care is another thing and it's a trait that needs to be reinforced even at a very early age. The theory of self-care suggests that nurses play a role in helping patients who are unable to take care of themselves as a result of limitations (Masters, 2011). Therapeutic self-care is best achieved when nurses, patients, and everyone else involved in the patient’s care, such as family or caregiver, work together to meet the patient’s self-care needs (Meleis, 2004).

Nursing practice, though a care-driven profession, is also based on clinical judgment through the integration of critical thinking, knowledge and experience (Hardin, 2016). Through problem solving and critical thinking, nurses are able to identify problem areas and come up with an intervention that would be beneficial for the patient. It only makes sense that a patient with a very complicated condition will have very complex needs and in turn requires a proficient nurse to address and solve those issues (AACN, 2006). Optimal outcomes are achieved when a nurse's competency is able to complement a patient's needs (AACN, 2006). 

Conclusion

Adaptability is an innate quality in us humans. We adapt to survive and improve our quality of life but also need the help of others to adapt. Needless to say, both the nurse and the patient have significant roles in enforcing effective adaptive measures. The nurse-patient relationship is a kind of relationship that is based on coalition and partnership that requires the skills of a nurse and a patient or family’s cooperation to meet relatively optimal goals. 

As nurses, it is our job to use our best clinical judgment when caring for our patients. But it is also important that we sincerely empathize and genuinely care for our patients. After all, trust is the key to establishing any kind of harmonious relationship. And through these harmonious relationships, we’re able to make a huge impact in our patients’ lives. This is what nursing is all about. And I couldn’t be prouder that this profession has chosen me to fulfill such an influential and special role in our society.

References