Published Nov 25, 2000
I am writing a paper on my philosophy of nursing as it applies to my nursing practice and must support with at least three articles. I would be interested in hearing what you the real working RN's feel about your philosophy of nursing as it applies to your practice in today's marketplace.
The debate over the utility of theory in nursing is still as hot today as ever! Many nurses who consider themselves 'bedside' nurses fail to understand the utility of theory in nursing practice [even though they don't realize that they use it every day and with practically every nursing intervention]. Theory is usually considered the work of nurse academians with Ph.D.'s. Actually it is for everyone. Theory forms the basis for a responsible scientific practice of nursing. Without it, we cannot justify the importance of our interventions. Nursing theory has helped us to explain why we intervene in one way versus another.
This has implications for today's marketplace. If we can adequately use theoyr to demonstrate the cost effectiveness of one particular intervention over another, we can demonstrate our contributions to healthcare in this time of 'managed care crunch.' Others will probably disagree, but this is the reality of today's healthcare marketplace.
I suggest the book "Analysis and Evaluation of Conceptual Models of Nursing" by Jacqueline Fawcett, as a good place to start. It gives a good sample of nursing theories and what they entail. Happy paper writing!
Everyone of the aforementioned interventions are founded in a nursing theory. You mentioned elements found in Watson's Caring Theory, Roy's adaptation model, Wiedenbach's Need for Help theory, and even Neuman's Systems model. Additionally, you used some interventions whose utility has been demonstrated by some of the other behavioral sciences...Bravo!!! We know that the interventions you have proposed are effective in terms of enhancing the quality of care and quality of life for our patients. We know that these interventions are defined as 'good patient practices' yet we overlook the fact that nursing theory underpins them all.
Also, the original posting asked about nursing theories, not managerial/ adminstrative theories. There is an important distinction that should be made here. Nursing theory has helped define nursing practice as we know it today. Granted it helps those with Ph.D.'s to synthesize new knowledge, but it helps nursing to have a unique identity of it's own, instead of allowing nurses to remain 'the doctor's handmaiden.'
In terms of administration and management.... who knows what theories they use. In the healthcare marketplace, nurses are more often than not, the victims of the managerial bull----. I acknowledge this and continue to use my nursing science to care for my clients. I guess it is all just a matter of having a positive outlook.
Originally posted by Linda Jackson:I am writing a paper on my philosophy of nursing as it applies to my nursing practice and must support with at least three articles. I would be interested in hearing what you the real working RN's feel about your philosophy of nursing as it applies to your practice in today's marketplace.
Sorry, I am not an advanced practice nurse nor am I in the nurse management field. Just a humble staff nurse with a BSN. I work in an acute care hospital and have worked in med-surg, telemetry, and the units. To us staff nurses nursing theory is the stuff of PHD's and doctorial thesis presentations...sorry to say it has no place in the everyday work environment. Every couple of years we are forced by management to update or manufacture so called "care plans" in an effort to apply the window dressing needed to pass the JACHO inspections. It might actually be nice to see someone like Florance Nightengale be put into practice. ....Just imagine the patients are put to sleep at 10 pm sharp (no 2400 hour meds, no early morning phlebotomy attacks, no EKG tech at the bedside at 5am; all of the confused, disoriented, sometimes violent--placed in soundproof rooms, each with their own personal sitter to watch over them and ensure no injuries in a restraint-(both chemical and physical)free environment. How about a clock in every room, a calander on the wall that each patient can see. How about food that is individually prepared with the patients likes and dislikes in mind as opposed to some 5 basic item cookie-cutter, cost saving meal plan. How about a staff the changes bed linens every day instead of the MWF routine so many hospitals have adopted lately. How about individual temperature controls for each patient.... need I go on.
Sorry to say, it ain't going to happen. Hospitals are BIG BUSINESS. They can say they are community service minded, but they are only so as long as it does not effect the bottom line.
So my feeling is that nursing theory in the nursing trenches is that "pie in the sky" stuff that administration does not give you the time or the latitude to implement. You are too busy wondering if pt 1's cardiologist knows about his ST elevations, or if pt 2 gave you a complete list of all his medications for your admission assessemnt, or if you will get a chance to take a break, or if they are going to enforce manditory overtime, and make you work into the next shift.
My philosopy of nursing is to provide to best care that I can, and provide as much emotional and supportive care that I can in an environment that can be humiliating and downright mean to todays patient.
Hi Tim-GNP. I agree with your assessments. However, your post indicates you probably chose nursing as a career as opposed to a job.
Most nurses I know sought nursing as a field that offered job security. When I attended nursing school years ago, there was no mention of nursing as a career. Nursing schools may have changed now in terms of how they brainwash students.
Nursing has a generational identity crises when it comes to its professional status. I don't anticipate this to change in my lifetime.
I agree that theory should be applied to practice. All well-established professions that I know of actively utilize applicable models in their practice. Unfortunately, when I was in school, there was not a consistent and intense follow through by the instructors on the application of theory to practice. Also, it doesn't play well to employers and physicians who eagerly max their exploits of nurses and exert dominion over nursing-particularly in nonunionized states.
There is such an overriding problem with high nurse-patient ratios, poor working environments, and compressed wages that I think that most bedside nurses, at this point, place philosophy low on the priority list. Again, I don't see this changing anytime in my lifetime.
buckboomer, BSN, RN
My philosophy is to keep my license, then help my colleague's license keep their's, then worry about patient care delivery. Nursing is under attack. The stress or near crisis, affects all nurses at the bedside. How each of these health care workers respond to this challenge is important. Do we respond by political means, new laws? How about a grass roots approach? Or use powerful TV time to illustrate some of the issues in health care, like staffing, patient expectations, or even patient care rights. The US is NOT the only country with nursing shortages. Scare tactics, industry demanding changes in health care delivery to protect their workers is now happening. Computer aided pharmacies, Mds changing their prescribing of medications legiblely or entered by the person ordering in the computer. Health care in this country has been called a disgrace! Accidental deaths, happen too often. So does mandatory overtime. What will it take, to make changes? As bedside nurses, we need to assist each other during this crisis. Nuturing the unfortunate newer nurses, surviving this cycle is important. Expanding our perspectives, hope for the future, while we sacrifice today. Or quit, and find a better profession, and hope you stay healthy. Lower your expectations, so you won't be continually disappointed. Find your spot under the big umbrella of nursing and survive. I think I can.. I think I can...
The philosophy of Nursing..................
Nursing has a history that literally goes back ten's of thousands of years. How so?
When one human being sacrifices their time and energy to care for another. It's really quite simple. In our modern times it is easy to lose sight of the significance of our chosen profession (I use this word loosely, not to get into the "what is professional" argument) , because if we listen to the people who stop focusing on the sick and needy instead of listening to the spirit inside that guides you to heal, then you will be pulled down to the street level where dollars, and professional status, and rules and regulations and backbiting crap is going on. These things that take you away from the healing arena, do not have anything to do with the philosophy of Nursing. Additionally, change is inevitable and always necessary in the process of system evolution. The "good old days" never existed. We must be able to find a way individually to work from a position of inner peace and thereby be connected to our clients in a healing, helping fashion, or just go find another job doing something else.
Don't dwell on the past, you can't determine the future, but every day you show up for work you can do your absolute best for the poor sucker laying in that bed.
Good luck with your paper,
Hi. I have 2 cents more to add to this topic. Earlier I addressed why I feel nursing has not been able to focus on the philosophy that I had went I entered it. Philosophy, like patient care, is very subjective and open-ended, so there are alot of good responses to be had in this area.
I went into nursing as a calling. My sole intent was to administer to and provide for the patient, now client to me, in spite of low wages, poor working conditions, little respect, recognition, and external rewards.
I believe that there was once a "good ole day" when nursing practice was not subjected to all the rules and regs of the hospital, government, accrediting agencies, and insurors. Hospitals were also mostly nonprofit then and not wholly engaged in employing consulting firms, developers, insurors, and the like. It's akin to being married not only to your spouse, but the spouse's family, your family, and any extended family. I was able to experience the times in which I worked my behind off, but I did not have to worry about the overly stressful and chaotic challenges faced by nurses today. I want to clarify, I don't object to change. In fact, I welcome it as I have practiced in different patient care settings and cities. I also have continued to engage in continuing and formal education. I welcome change when it is done thoughtfully and not chaotically as is typically the case. The problem is that materalism and focus on profit has taken front and center. It's all about "show me the money." A positive and balanced attitude, for nurses, is vitally important in being able to dodge bullets, darts, and knives from entities who don't have the same vision for our clients as we do. It is difficult for nurses to help patients (clients) maintain the status quo today in light of the profit focus. We must educate and train our patients (clients) to forge ahead with us and not against us. We need to discuss alternatives with our patients (clients) to consider in managing their own health without fear of repercussion from others. The model of care applied in most settings, the medical model, is essentially outdated in terms of its adaptiveness. A mindset change is needed. This will take time, but if nursing changes from within, we will have greater success from without.
I agree with all the above posts and was SSSOOO impressed that Tim-GNP pointed out the correlation between the thought process that zings through a nurse's mind and the theory that we use AT the bedside. And just for the record because I want every nurse to know who hasn't seen or experienced it...there WAS "a good time" for me, 1978 till approx 1985 or so I actually got to experience taking care of patients in the optimal setting with a nurse manager who protected us like a mother lion-no joke! I know where my nursing practice came from...I just don't know where I'm headed.I went to a conference this year for triage-Taming of the Beast and one of the nurse, who is STILL in the trenches spoke about practicing nursing with mercy....mercy.. 5 little lettered word...Bo Ball, he will make me think for a long time.
Originally posted by Tim-GNP:Everyone of the aforementioned interventions are founded in a nursing theory. You mentioned elements found in Watson's Caring Theory, Roy's adaptation model, Wiedenbach's Need for Help theory, and even Neuman's Systems model. Additionally, you used some interventions whose utility has been demonstrated by some of the other behavioral sciences...Bravo!!! We know that the interventions you have proposed are effective in terms of enhancing the quality of care and quality of life for our patients. We know that these interventions are defined as 'good patient practices' yet we overlook the fact that nursing theory underpins them all. Also, the original posting asked about nursing theories, not managerial/ adminstrative theories. There is an important distinction that should be made here. Nursing theory has helped define nursing practice as we know it today. Granted it helps those with Ph.D.'s to synthesize new knowledge, but it helps nursing to have a unique identity of it's own, instead of allowing nurses to remain 'the doctor's handmaiden.' In terms of administration and management.... who knows what theories they use. In the healthcare marketplace, nurses are more often than not, the victims of the managerial bull----. I acknowledge this and continue to use my nursing science to care for my clients. I guess it is all just a matter of having a positive outlook.
By the way, where'd you go to school? I'm from Taylor--small world!! and the earlier
poster, Jp279 in Mountaintop!
Thank you maikranz. I received my B.S. in Nursing from Wilkes University, and my M.S. in Gerontological Nursing and my G.N.P. diploma from State University of New York at Binghamton. I attended Marywood University for my Nursing Home Administrator program.
I think that this topic is important to nurses. I hope that all nurses understand that our science is not founded in 'mindless' traditions as much of nursing once was-- but are based in real and tangent principles that will lead to good patient outcomes, and will always make us ask "why are we doing what we are doing?" and "is there a better way?" As long as we keep doing this... we are stuck with theory- like it or not!
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