Research Paper on "Personal Nursing Philosophy Conceptual"

Research Paper 5 pages (1524 words) Sources: 5

[EXCERPT] . . . .

Personal Nursing Philosophy

Conceptual Background of my Nursing Philosophy

The history of nursing includes foundational shifts of perspective that were, at least in the past, largely functions of the limitations of the discipline in the pre-scientific era of medicine. In fact, at the time that Florence Nightingale pioneered the practice of insisting on a hygienic carative environment, she was unaware of the clinical value of that approach in terms of antisepsis (Reid, 2009; Taylor, Lillis, & LeMone, 2005). Her motivational influence was simply to ensure that patients were treated with dignity. Until the age of modern medicine after the acceptance of Joseph Lister's Germ Theory of bacterial infection and disease, and later, antibiotics, nurses provided more in terms comfort, compassion, and dignity for their patients than they contributed to the clinical efficacy of their medical treatment (Reid, 2009; Taylor, Lillis, & LeMone, 2005). As medicine became more scientific and disciplined, nursing also developed into a scientific discipline that culminated in the late 20th century in the widespread appreciation for the value of empirical evidence-based nursing.

However, some nursing theorists came to the conclusion that the shift toward empirically-based scientific nursing was beneficial in many respects, but potentially detrimental to the overall purpose of nursing in others (Fawcett, 2005). Overemphasis of the scientific model had, in the minds of some, reduced nursing too much to a clinical exercise and removed the element of care that had been the hallmark of nursing in previous eras. In that regard, two theorists in particular outlined approaches to modern nursing that are entirely compatible with empirical evidence-based practice in a framework that simultaneously encompassed the underlying concepts of patient care and clinical practice in a manner that integrated the importance of the patient, the environment, and the professional nurse. Specifically, Jean Watson pioneered her Caring Theory of Nursing and Sister Callista Roy introduced her Adaptation Theory of Nursing designed to address the full range of four conceptual domains of nursing: (1) person, (2) environment, (3) health, and (4) the professional nurse (Fawcett, 2005; Taylor, Lillis, & LeMone, 2005). My personal philosophy of nursing is to practice the comprehensive integration of my scientific training in empirical evidence-based clinical nursing within a framework that applies clinical nursing to the four domains addressed by Roy and with an overall focus on the carative elements outlined by Watson.

Incorporation of Jean Watson Caring Theory of Nursing

Jean Watson expressed the fundamental belief that good nursing required a balance between scientific clinical knowledge and a broader spectrum of knowledge outside the realm of clinical medicine (Pipe, Kelly, LeBrun, et. al, 2008). For that reason, she promoted the importance of including a background of humanistic philosophies and of human value systems within the formal education of professional nurses. She was a firm believer that even the best clinical nursing care is less than optimally effective to the extent it is devoid of a more human-centered approach to caring for patients (Pipe, Kelly, LeBrun, et. al, 2008). Certainly, scientifically valid clinical nursing without caring is still much more medically effective than the converse that typified nursing in the pre-scientific age; however, optimal patient outcomes require the delivery of scientifically valid clinical nursing together with care.

Watson described seven essential components or assumptions of her carative nursing theory: interpersonal interactions, satisfaction of basic human needs, patient health and family growth, the future potential of every patient beyond his current state of being, balance between clinical necessity patient autonomy, a "healthogenic" multi-dimensional view of medicine, and the absolute mutual compatibility of the science of curing and the issue of caring (Pipe, Kelly, LeBrun, et. al, 2008). Watson also defined scientific medicine in terms of carative concerns outside the realm of strictly scientific criteria. Specifically, she promoted the importance of considering altruism and social value systems in human life, spirituality or religious faith, sensitivity to others, trust in human relationships, acknowledgment of both positive and negative emotions, scientific solutions to problems, teaching through interpersonal communication, a full range of environmental influences (i.e. socio-cultural, physical, spiritual, protective, and corrective), and what she referred to as "existential-phenomenological forces" (Pipe, Kelly, LeBrun, et. al, 2008).

In essence, Watson's view of nursing devotes as much attention and detail to the all-encompassing value of caring in a manner that is fully integrated within scientific clinical medicine. In my view, caring is the aspect of nursing that generates the greatest degree of personal reward and that sustains the professional nurse and her patients through the most difficult times and experiences. However, to maximize the value of caring in nursing, I also believe that it must be expressed with specific reference to the four domains outlined by Callista Roy's Adaptation Model of Nursing: person, environment, health and illness, and the professional nurse.

Incorporation of Sister Callista Roy's Adaptation Model of Nursing

The foundation of Roy's Adaptation Model of Nursing are the four domains of person, environment, health and illness, and nursing (Dobratz, 2008; Fawcett, 2005). According to Roy, human life entails a perpetual process of adaptation to change from internal (i.e. biological) and external (i.e. social and other environmental) influences on the individual. In that regard, Roy believed that human health encompassed the entire course of human life (literally) from the cradle to the grave and all points in between. Regardless of the stage of life, human health is determined largely by four "bio-psychosocial" considerations such as physiological factors, self-perception issues, role function, and the relationship or interdependence between the individual and myriad aspects of life among other individuals in society. To Roy, the view of human health that focuses exclusively on physiological functions and processes in myopic; to understand the state of health and welfare of the individual, it is necessary to understand how the individual is influenced by the full range of bio-psychosocial factors and considerations (Dobratz, 2008; Fawcett, 2005).

In my professional development, Roy's Adaptation Theory is most relevant and applicable in concrete terms by virtue of her six steps of nursing practice: behavior-based assessment, stimuli-based assessment, clinical diagnosis, setting of goals, intervention, and evaluation (Dobratz, 2008; Fawcett, 2005). Those steps are consistent with my training and applicable to my approach to practice, such as in connection with the importance of observation of the patient from the perspectives of physiology, psychology, and social influences of family environment and social culture (Dobratz, 2008; Fawcett, 2005).

Behaviorally, Roy described patients as either manifesting behavior that is fully functional or dysfunctional (or, more precisely, in her terminology, "adaptive" "ineffective"). Roy's psychological inquiry into patient assessment considers the stimuli that are relevant to the patient's behavior from the perspective of a clinical diagnosis based on identifying the causal interrelationships between those stimuli and dysfunctional (or "ineffective") behaviors. Realistic goal-setting is then based on the individual's potential given those influences rather than on any independent or general scale of goals. Likewise, intervention in Roy's model is also dictated by the information identified in the preceding steps. Roy emphasized that culmination of the value represented in the first four steps of her model realize their value to the patient in the intervention step, simply because that is the essential function of nursing. Finally, the process of evaluation allows nurses to consider whether and to what degree the first four steps have produced interventions that prove beneficial to the patient and, most importantly, to re-evaluate and adjust intervention plans based on that evaluation (Dobratz, 2008; Fawcett, 2005).

Conclusion

Having studied nursing only in the era of scientific medicine, my experience with various nursing theorists and their ideas and concepts has been substantially academic rather than practical. Given the technical challenges inherent in studying and applying scientific empirical evidence-based nursing methodology, it is somewhat easy to regard nursing "theories" as extraneous to the clinical practice of the modern nurse. However, Jean Watson's Caring Theory of Nursing has… READ MORE

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