My worldview, beliefs, and assumptions have undergone a tremendous change over the past five years changing my self-image, my self-concept, and perception of nursing.
My Nursing practice aligns with the interpretive paradigm. The interpretivists believe that we co-create reality through our experiences. Interpretivists through a perceived view recognize human values as real and important, connected to historical and social settings. The truth is dynamic, bound by human interactions. The empiricist paradigm on the other hand, have a received view, which is the belief that reality is independent of who we are historically or socially. The Empiricist paradigm holds value to scientific facts. It is disconnected from the interactive process and seeks theoretical knowledge of truth.
The profession of Nursing cannot function separated from human interactions. Nurses interact with patients, families, interprofessional disciplines to provide holistic care. Working in the emergency department for example, I cannot rely on just the empiricist idea to provide care for my patients; where I know the signs of respiratory distress in a child and know the treatment that is needed to care for that child but, it does not help in situations where I have an elderly female with Alzheimers and the family does not want to take the patient because they are no longer able to take care of the patient at home. In this situation there are issues much deeper than Alzheimers at play involving caregiver burnout, coping issues, and financial stress that will impact the situation. In this scenario it is recognizing that this family needs more than medical help.
Nursing knowledge since the time of Florence Nightingale has seen the introduction of multifaceted paradigms, philosophical perspectives and nursing theories. These perspectives and theories explain the different ways nursing science is developed and approached. In the interpretivist paradigm, knowledge is co-constructed, with the focus on subjectivity, giving voice to concerns and practices of participants. I believe nursing knowledge is a combination of our explicit knowledge and our tacit knowledge. Explicit knowledge is factual, technical, and scientific knowledge. Tacit (‘know-how’) knowledge develops from personal experiences combined with intuition and common sense. Sharing of tacit knowledge among workers is crucial to the process of knowledge creation.
Nursing knowledge has come ways from the time of nightingale. We have countless theories and guidelines to guide our practice and improve patient care outcomes. For instance, my nursing knowledge originated from what I learned in academia and through my clinical experiences in university. It wasn’t until I began working as a nurse however, that I learnt what I know today. A majority of this information came from my colleagues – nurses, doctors, social workers; as well as from the interactions with the patient, observation, and reflection. Socialization, the process of sharing of information between members, is essential for the process of knowledge creation. Experiential knowledge is essential to the application of nursing. As Nurses I feel we are still seen as carriers of physician orders, diminishing our creativity and autonomy. Nurses are reservoirs of tacit knowledge, and nursing needs to have a distinct focus independent of other professions for practice or research. Even though as a nurse, we have our set of skills and knowledge, it is not given as much respect as other professions because nursing hasn’t evolved as researchers want it to be. As a nurse I contribute to knowledge creation by continually improving myself at work through professional development courses, attending workshops, participating in department care councils and contributing my opinions to increase efficiency in my organization. I mentor students and new hires, sharing not only technical skills but also experiential knowledge. Patient education is a big component of Emergency Department, and one of my nursing roles is to ensure that the knowledge I have is mobilized to my patients in a manner they understand.
I situate my nursing praxis with Jean Watson’s Human Caring Science. In Watson’s theory, humans are seen as interactive being and health are illness are manifestations of the human pattern. I practice principles of the Human Caring theory from the first point of contact with patients. Ensuring that I create a therapeutic environment where they feel cared for. Working with marginalized clients who face issues such as substance abuse, mental health disorders, adults and children I maintain to provide patient centered care by creating a therapeutic relationship with them. Watson’s 10 Caritive processes which focus on practicing with a caring consciousness, being present, cultivating transpersonal self, beyond the ego-self, being supportive to true feelings, participating in teaching and learning, creating healing environment, assisting with basic, and being open to life and death and self care.
Working in a busy Emergency Department, where everyone comes to the hospital feeling unwell, there is the challenge of making everyone feel cared for, at the same time prioritizing care. I ensure that I make all patients know that their feelings are valid, be supportive, and communicate in a therapeutic manner. In the beginning, I struggled and felt powerless on how I could provide care for everybody, while ensuring that I cared for myself. Nurses taking proper breaks is one of the challenges nurses in our department face because of the busyness of the department. This took extensive self-reflection and recognizing what was important for me as a nurse – treating patients as I would want to be treated as a patient, and above all the realization that patients are very vulnerable because they are putting their care in another person’s hands. This lead to changing the way breaks were organized in the department so nurses could take the allotted breaks in a shift.
Watson’s Human Caring Science framework aligns with my current institution. My organization’s values are Compassion, Professionalism, and Respect. The goal being patient-centered care. To ensure this our organization relies on technology to help make things faster and easier for patients – such as computer charting, computerized order entry, we also have screens for patient where patients can see when their results are completed, and staff have portable phones for easier reachability. The organization has also added additional resources such as increasing number of doctors, nurses on shift, even adding housekeeping staff to ensure patients can be seen in a timely manner, to prevent staff burnout, and ensure patients get the best clean environment to promote healing. Our manager performs weekly huddles and rounding on staff monthly to developing a trusting relationship. Our organization provides professional development opportunities – such as recertification opportunities and education sessions. My organization while facing its challenges does try its best to address the needs of the patient, staff and facilitating staff growth learning.
Nursing is a profession embedded in caring, compassion, collaboration, presence, empathy and acceptance. Through the combination of scientific knowledge, evidence- based practice, and experiential knowledge, I care for patients through all stages of illness into wellness and at times death. I consider the human as a valued person who deserves respect, assistance, and understanding regardless of age, gender, sexual orientation, or social status. I engage in open-dialogue with my patients to create a therapeutic relationship. I am held by a series of ethical and professional codes of practice as set out by the College of Nurses of Ontario (CNO) that sets out codes of conduct, practice guidelines and practice standards. I am responsible for ensuring my professional development through continuing education and graduate studies so that I can contribute to social justice and health policies. I practice self-reflection to learn about my weaknesses and strengths and gain insight.
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