WHAT GUIDES MY NURSING PRACTICE 1
What Guides My Nursing Practice
Michael D. Czechowskyj
Ferris State University
Abstract
This paper will discuss the events and experiences that have helped shape and guide my nursing practice. It will take into account the media, social stereotypes, personal experiences and patient experiences. This paper will also discuss how these things have effected me as a floor nurse. Then, as I transitioned into a nursing leadership role, all of these previous experiences along with my desire to be a transformational leader have guided my practice. The last influence that has guided my nursing practice is nursing theory. The second claim this paper will make is that the patterns of knowing for nursing are not unique to nursing but are relevant to other health care professions.
Keywords: patterns of knowing, transformational leader, nursing, nursing practice
What Guides My Nursing Practice
The purpose of this paper is to explore and understand the different experiences I have had in my nursing career that have helped guide my nursing practice. This will take into account personal experiences and patient experience which I have encountered over the past seven years. It will also look at how being a transformational leader has shaped my current leadership practice and how nursing theory plays a role as well. This paper will then look at the nursing patterns of knowing and make the case that professional nursing is not unique from other healthcare professions.
My practice
I knew that I wanted to work in the healthcare field at a young age, but did not know what avenue to pursue. My first introduction into the health care arena was watching my father work as a microbiologist in the hospital lab. When I was a kid I was able to spend hours with him in the lab watching him work; I doubt I could do that these days. To me that was interesting but I wanted a more hands on approach with patients. Watching television shows like ER and movies likeOutbreak I found myself wanting to give shots, draw blood, talk and relate to patients, and be very hands on, so I thought I would be a physician.I knew I needed experience in the healthcare field before I could apply to medical school so I got a job as a certified evaluated nurse’s assistant (CENA). This is when the real world hit me. I then found out that the things I thought the physicians were doing, based on media influence, the nurses actually did. Even though these are the things I wanted to do I struggled with changing my career path to nursing because of the gender stereotypes. I bring up this history to show that starting my career was not an easy decision for me. I had to get over the media and social influences that had shaped my perception of the healthcare field and nursing. I still on occasion face the gender stereotypes when I walk into patient rooms but I am long over this.
After I conquered the media and social influences that guided my career path and practice, I then learned from my patients how they could guide my practice. As a floor nurse I enjoyed meeting new patients and learning about them. I have cried with patients, laughed with them, prayed, and even held their hands as they were dying. All of these events have guided and shaped my nursing practice. Now, in my current position of nurse manager, I do the same things with my employees. What guides my leadership style in nursing revolves around being a transformational leader. A transformational leader is one who models the way, challenges the process, encourages the heart, inspires a shared vision, and enables others to act (Clavelle, Drenkard, Tullai-Guinness, & Fitzpatrick, 2012). These traits are what I strive for every day. I use these traits in meetings when I speaking up for my nursing staff and challenge the process. I also use them to help my staff to understand and see the big picture of how our unit and the organization as a whole fit into the ever changing healthcare field. These are just some examples of how trying to be a transformational leader has guided my nursing practice.
The last major influence that has effected my nursing practice is nursing theory. Nursing theory has effected my nursing career more than I had original realized. One thing I practice when making clinical decisions is called constructivist theory. I didn’t know I was practicing this until I had researched different nursing theories. Constructivist theory is when a person takes previous knowledge, expert colleague input, current evidence, and intuition to make a clinical decision (Ferrara, 2010). This type of theory makes sense to me. We use the knowledge we have and history along with a little art to treat our patients appropriately.
The other large theory that drives my nursing practice is one around a professional nursing practice model. The Magnet Recognition Program has recognized that health care organizations need to have a professional nursing practice model (McCrea, 2011). The professional nursing practice model we use in my organization is called Relationship-Based Care (RBC). This model was created by theorist Jean Watson using her caring and healing environment theory (Koloroutis, 2004). I teach this theory to my staff and help reinforce its benefits all the time. I was using a nursing theory without realizing it, and the benefits are evident in the care we provide.
Patterns of knowing
Now that I have discussed how different personal and patient experiences have guided my nursing practice I am going to discuss how the patterns of knowing are not unique to nursing alone and will compare this to the physician’s practice to defend this claim.
The patterns of knowing for nursing are empirics, esthetics, personal knowledge, and ethics (Carper, 2013). I will be looking into each of the four patterns and comparing them to the physician profession. First I will start off with empirics. Empirics is the science of nursing (Carper, 2013). This is nursing knowledge that is learned in nursing school. The general principles of taking care of patients and the theory of why nurses are doing what they are for the patients. This knowledge is learned in nursing schools, and in apprentice programs before that. I would equal this to any formal education that physicians also obtain in medical school. Physicians learn the science of why and how to take care of patients using the medical model.
Now let us look at the esthetics of nursing. Esthetics of nursing, sometimes referred to as the “art” of nursing is most recognizable to me as how well the nurse can show or feel empathy (Carper, 2013). Empathy is the capacity of a person to feel or experience another person’s feelings (Carper, 2013). This is something that is very difficult to teach another nurse. I know from personal experience. I can describe how I am feeling and teach how to react to a patient in order to show them empathy. Unless that person truly feels empathy towards that patient I cannot force them to have feelings they do not have. This is also true in physician practice. Empathy is so important to a physicians practice that a scale was created to measure this skill in physicians. The scale is called the Jefferson Scale of Patient Perceptions of Physician Empathy (Kane, Gotto, Mangione, Wesr, & Hojat, 2007). It is widely believed patient’s perception of their caregivers demonstrating empathy is linked to positive patient outcomes (Kane, et al., 2007). The Jefferson scale was created to test this because of how important empathy is to the physician profession.
The third pattern of knowing is personal knowledge. Personal knowledge is the nurse’s ability to know one’s self and by knowing one’s self they can build relationships with their patients (Carper, 2013). This once again is hard to teach. I found a similar need for knowing one’s self in the physicians Hippocratic Oath. It talks about the need to know one’s self and limitations and that warmth and sympathy might be better than the surgeon’s knife (Hippocratic Oath, 2011). I believe this speaks to the same relationship that needs to be established between a nurse and their patients.
The final pattern of knowing is ethics. Ethics for nursing in this age of complex patient care revolves around what is right and wrong in the treatment of an illness and promotion of health (Carper, 2013). Ethics in healthcare can be very complicated. I have sat on many ethics meetings to discuss the best course of treatment for a particular patient. I have sat in these meetings with nurses and physicians alike to help come up with the best plan. This is how I know that physicians are also governed by the same ethics foundation as nursing. Once again the Hippocratic Oath discusses ethics in the classic version. It states that the physician will not dispense any deadly drug or abortive remedy to their patients (Hippocratic Oath, 2011). These are two ethical issues that face both physicians and nurses alike.
Conclusion
Life experience and education have all effected my nursing practice, from social influences to nursing theory. Without all of these, I would not be the nurse I am today. Knowing how events and knowledge effects my practice is important to understand and realize so I can look for new opportunities to help me grow as a nurse in the future.
After doing a deep dive into the patterns of knowing for nursing and looking into the literature for similarities to other healthcare professions I feel I was able to demonstrate that the patterns of knowing for nursing was not unique to the nursing profession. Physicians are governed and judged by similar patterns. The patterns of knowing were just compared to physicians but this still does not make them unique to nursing. This should not take anything away from the patterns of knowing, but may add to the validity of their importance to nursing and healthcare.
References
Carper, B. A. (2013).Fundamental patterns of knowing in nursing. In Cody, W. K. (Ed.), Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (pp. 23-33). Burlington, MA: Jones & Bartlett Learning.
Clavelle, J. T., Drenkard, K., Tullai-Guinness, S., & Fitzpatrick, J. J. (2012). Transformational leadership practices of chief nursing officers in magnet organizations. Journal of Nursing Administration, 42(4), 195-201.
Ferrara, L. R. (2010). Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: Bridging the theory practice gap. Research and Theory for Nursing Practice, 24(4), 213-216.
Kane, G. C., Gotto, J. L., Mangione, S., West, S., & Hojat, M. (2007). Jefferson scale of patient’s perceptions of physician empathy: preliminary psychometric data. Croatian Medical Journal, 48(1), 81-86.
Koloroutis, M. (2004) Relationship-based care: A model for transforming practice. Minneapolis, Minnesota: Creative Health Care Management.
Hippocratic Oath. (2011). In Medicine Net.com, Retrieved from
McCrea, N. (2011). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care. Journal of Advanced Nursing, 68(1), 222-229.