This article is based on a final project I wrote for my Bachelor’s of Nursing degree. I expect to be updating it over time. I have placed this at the top as a permanent tab, but I thought it would be nice to include it here as well.
During my final practicum of my career as a nursing student, my philosophy of nursing has begun to develop. Until this semester, I was more focused on the skills of nursing and did not pay particular attention to how I practiced. This final practicum has lent itself to the development of my personal philosophy of nursing and a resulting framework. This framework looks at the shared reality between patients and nurses, and expands it to suggest that this reality should be shared between an entire team of professionals and the patient. It also imagines healthcare professionals as acting together to create a barrier between patients and illness.
During a night shift at the beginning of the semester I had the opportunity to discuss a patient’s perception of his condition. I realized that he was speaking of his condition in emotions and relationships. He told me how he felt when he was originally diagnosed with prostate cancer and how this had affected his wife. Unlike a healthcare professional’s view of illness, which is very scientific and objective, his was subjective and fluid. In other words, he was creating a reality for his illness that was his own.
As a nurse, I realized that it was my duty to explore these realities so that I can understand a patient’s needs better. Because every patient’s reality will differ, no two will need the same care. All to often, as nurses, we get stuck in the routines of our jobs, acting as slaves to the clock, racing to complete tasks. I realized in this moment of epiphany what the true art of nursing is. To be an artistic nurse, you must work within the subjective realities of your patients, acting creatively to find a place in his or her story.
However, I realized that nurses also bring a certain subjective reality to their practice. Each of us has values and beliefs that are created throughout our lives and cannot be compared to anyone else’s. We also bring the concrete knowledge of nursing to our practice. Finally, nurses bring stories of patients who have been in similar situations and are able to discuss the similarities and differences with the patient. As a result, when we take care of a patient, we are not only on the receiving end of our patient’s information; we are also sending our own information.
In the end, the nurse and patient create a shared reality that is a combination of the patient’s own view of his or her illness and experience in the health care system, and the nurse’s knowledge, values, and beliefs. Together, they must negotiate the best way to improve the patient’s health. It is my belief that this relationship is created nearly subconsciously. However, if a nurse specifically focuses on this aspect of care, they could work toward creating a better experience for the patient.
Nurses are not the only people that interact with patients. Physicians, family members, and all other members of the health care team also individually talk with patients, bringing their own knowledge, values, and beliefs into the situation. Unfortunately, the shared realities between these persons and the patient may conflict with every other person’s. This creates a chaotic and confusing experience for the patient, making it difficult for everyone involved to create goals for the patient.
I decided to build my framework around this concept of “shared realities.” However, I also wanted to use a simplified version of Neuman’s (2002) model. Neuman’s model contains multiple layers of complex barriers between the patient and stressors that cause illness. In my simplified version, I simply see nurses as part of a health care team that, when properly used, creates a solid barrier around a patient. This barrier needs to follow the patient through primary, secondary, and tertiary care.
In figure 1 is a view of a model in which each health care professional is utilized to either a great extent, or not enough. The larger the circle, the better their skills were utilized. The lines show that most of the communication travels from the professionals to the nurse and then to the patient. In this model, it is the nurse who bears the majority of the stress of coordinating the team of professionals. It also makes it difficult for the professionals to work together as they do not understand each other’s subjective reality.
In Figure 2 is a view of what I believe a nursing framework (or more accurately, an interprofessional framework) should look like. It shows the members of a health care team working together to create a shared reality between the entire team and the patient. By creating this reality between the entire team rather than just each professional and the patient, it creates a unanimously agreed upon goal for the care of the patient. Having a shared goal would make it easier to share ideas and creative ideas on reaching this goal. The key to making this work is communication. Each member of the interdisciplinary team must feel comfortable talking with every other member of the team, and in turn must be approachable at all times for discussions regarding their patient.
I spent a lot of time trying to create a complex framework for nursing that would show the intricacies of our professions. However, in the end, I realized that by simplifying the model, it made it realistic and easy to follow. It simply states that a nurse must respect the differences between patients, and tailor his or her care to adequately care for their patients. On a bigger scale, a nurse must work, through communication, to create goals with the entire health care team. By working together, we create a stronger barrier around the patient that works to strengthen the barrier between health and illness.
References
Neuman, B., Fawcett, J. (2002). The Neuman Systems Model (4th ed.). Upper Saddle River, NJ: Pearson Education Inc.
