A. There are defining characteristics that determine nursing practice. Based on your clinical experience, explain the meaning of the following:
1. Nursing as a practice-oriented discipline – Nursing exists to provide nursing care for clients who experience illness, as well as for those who may experience potential health problems. When we say that nursing is a practice-oriented discipline, we simply mean that nursing has a primary mission related to practice. Its members seek knowledge of what nurses as professionals do, why they do it and when they do it. Basic understanding of various phenomena is essential for the subsequent development of applied knowledge. Applied knowledge is that which provides guidelines to maintain, develop, inhibit, support, change, advocate, clarify or suppress some of these basic phenomena.
The goal of knowledge development then, is to understand the nursing care needs of the people and to learn how to better care for them; therefore the caring activities that nurses are involved in on a daily basis maybe the focus for knowledge development. To put it in simpler terms, “knowledge is achieved not just for the sake of knowledge, but to provide better nursing care” (Meleis, 2012). To give a more palpable example of what nursing as a practice-oriented discipline is all about based solely on my own clinical experience, I would like to cite my institution’s striving mission to be granted accreditation for the Joint Commission International. Here, definitive guidelines are already set in place with regards to what is needed in order to comply with a standard that is being recognized globally for nursing care. In other words, in order for the institution to fulfill its nursing requirements specific rules and policies should be implemented.
2. Nursing as a health-oriented discipline – In earlier times, the responsibilities of nurses were centered on sanitation, hygiene and comfort, prevention of cross-infection and relief of prime symptoms of illnesses. Nurses functioned not only as nurses, but as housekeepers, dietitians and cleaners. Nursing since then has shifted from being primarily illness-oriented to being a profession that is health-oriented. Nurses practise in a growing variety of settings and nursing roles continue to expand as the focus of nursing care expands. Current nursing theoretical models reflect the trend to address the total person, in all dimensions, as an individual in interaction with the family and the community (Funnel, et al., 2009).
In my practice, we nurses participate in all sorts of interventions that maybe widely varied in its application but working under a unified premise: The client is the center of our care. Our client maybe the patient, the relatives or the entire community. All of our efforts are made to ensure our client’s safety and well-being. Part of our job as nurses is to employ our independent nursing interventions carefully amassed during our education and continuous training. However, a large part of what we do for our everyday work revolves around our constant interdisciplinary transactions with all the other members of the whole health team, more specifically our interactions with the doctors. Nursing becomes more health-oriented during these times primarily because of the nature of the medical officer’s duty: to alleviate, if not totally cure, the patient’s illnesses.
However, going beyond this, the nurses in my institution also engage in other areas of health-promotion. To cite an example just earlier this month our institution, spearheaded by the Department of Nephrology, joined in celebrating the “World Kidney Day”. Nurses participated in the campaign towards healthier lifestyle through information dissemination and volunteering by manning and running the various diagnostic booths being offered at the program though-out the day.
3. Nursing as a caring-discipline – Many questions have been raised about the concept of caring. In the older times, caring has been largely attributed with the feminine. It deals with moral virtues and at times, it even has philosophical or religious connotations. More recently, caring in the field of nursing has been introduced along with more structured concepts including skills, nursing interventions and policies. It has been given cultural and now even artistic connotations.
Nursing as an art is exemplified when the nurses are able to establish connections with their patients, skillfully perform nursing activities and morally conduct nursing practice to name a few (Meleis, 2012). Since 2011, a special program has been devised in my institution, focused on rendering good, quality service to our clients with the concept of care as the primary drive. Aptly titled, “The Asian Way”, Asian Hospital and Medical Center believes that what will set it apart from all other hospitals would not be the state-of-the-art diagnostic facilities nor the prime, well furbished rooms and hallways. It is the extra care and attention that the hospital staff would give to its clients that would make all the difference.
As soon as he enters the front lobby, he is graciously greeted and welcomed by the highly courteous security officers and guest service personnel. When he is transferred to his room, the patient is attended by the staff nurse with all smiles and hospitality. Even with the institution’s transactions among its internal customers, “The Asian Way” is highly encouraged. Basically, what the institution wants to achieve is to develop a whole culture of caring, pleasant and highly infectious, which in turn would be instantly felt when providing service with the clients most especially once it becomes second-nature to all of the hospital’s employees.
4. Nature of nursing as a human science. – The science underlying the discipline of nursing has shifted away from an emphasis on natural sciences, and nursing tends now to be described as a human science. Nursing as a human science is concerned with the life experiences of human beings and their meanings, with health and illness matters and their significance in their lives, as well as their experiences with dying (Meleis, 2012). Because these experiences are shaped by history, significant others, politics, social structures, gender and culture, nurses also are concerned with how these perspectives shape the actions and reactions of human beings. (Willis, Grace, Roy, 2008).
It is precisely because of this concern that makes nursing a practice discipline, which in turn helps to define its perspective. Taking everything that I have discussed since the beginning of this module into consideration, I honestly believe that all examples previously given readily support the nature of nursing a human science – it is practice, health and caring oriented, focusing on the human being in its entirety rather than subdividing it into smaller systems possibly independent from each other.
B. There are assumptions shared by different theorists about nursing, health, client and environment. As you take care of patients (children, adult and older people) in your area of responsibility, how would you explain the following assumptions:
1. Health is a positive value – Beyond disease and its symptoms, health must be seen beyond physical capacities. According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment and the person’s physical characteristics and behaviors (WHO, 1986). In my experience as an Emergency Room nurse, I often deal with persons with acute conditions. In some instances, a potential patient walks into the ER only for us to find out (after careful interview and quick systems assessment) that the person doesn’t need emergency treatment but a check-up with a specialist at a clinic. Other times, some people just pass through on their way to the out-patient department.
A few others even end up in the ER just because they are lost. My point here is that the presence or the lack of acute illness or chief complaint does not deter us into giving the full service that all our customers (and potential customers) deserve. For the few who get lost in their way to wherever they need to be in, we still provide assistance and would even go as far as giving them health advices (within the scope of nursing fidelity of course) and promotions. For those who eventually end up as ER patients, health education doesn’t stop with the explanation of interventions. Health teaching is most often more critical during the termination phase of care – discharge planning and instructions. As nurses we have to make sure that the client, in this case the patient and/or the relatives, carry on with a sense of ownership with their well-being with the end goal of them not returning into the ER. Now it’s true that while it could be bad for the business it will, in the long run, beneficial for the general population.
2. Human beings do not exist in isolation. They are influenced by the individuals, families and environment. – The existing setup of our emergency department only allows for one companion at any given time for the whole duration of the patient’s stay. This usually brings about a lot of problems to the one who is in charge of the crowd control because patients and, even more so, relatives are simply having trouble abiding the rule. The need to belong is an inherent human trait that could be traced from way back from an evolutionary standpoint. Especially when a patient’s ability to work or move is compromised (as with the ER patients, usually weakened by illness or hampered by pain) the person’s instinct is to surround one’s self with as much support systems as possible whether they may or may not serve any particular purpose.
Phrases such as “security blanket” or “no man is an island” come to mind in these types of situations. Other times, it would be the relatives who are extremely insistent in crowding the room. This too has its origins that could be traced from way back. The need to protect or assist the weak is a common reason (oftentimes an excuse) for this kind of behavior. Nevertheless, in a broader point of view, according to Meleis, person-environment interactions are the focus of nursing care and that nursing care deals with the manipulation of this environment.
3. The health of human beings consists of more than their biological needs. – During my four years in the hospital practice, I got the chance to be rotated and exposed in different areas and units. One such area that I have been to is the medical-surgical intensive care unit. Here, I got to take care of the critically-ill; almost all of them unable to fend for themselves. Because of the nature of their bodies, these people heavily rely on the nurses to do everything for them. No, let me correct that. These people heavily rely on their nurses to perform and fulfill their basic biological needs for them. The need to rephrase and correct myself was done for a purpose. While we as nurses provide them with all the essential biological needs for their day to day survival, there is so much more than just achieving a person’s need to eat, or breathe, or clean themselves up, or protect themselves from possible harm like a fall or a bed sore. Realizing a state of optimal health needs realization of other functions as well.
4. Improved health is a goal of society, thus of nursing – To promote wellness and enhance productivity by partnering with motivated professionals in providing innovative and world-class healthcare services. That is the mission of Asian Hospital and Medical Center. It is a universal goal that all people, not just health-related institutions, strive for an improved health and an improved state of well-being. Since the early days of nursing, as envisioned by Florence Nightingale, the goal has always been constantly ever expanding, now broader in scope than ever. But the core has remained the same – to improve people’s lives.
C. One of the stages in the development of nursing discipline is the stage of practice, apprenticeship and service. What is your position about volunteerism (with pay), trainings and seminars before a nurse applicant can be hired to work in the hospital.
Volunteer is defined as: 1.) A person who willingly offers himself or herself for a service or undertaking. 2.) A person who performs willingly and without pay (dictionary.com, 2012). Based on the dictionary description alone, one will find the term “volunteerism with pay” highly problematic. Technically, if one is paying for the experience, then I believe that the proper term should be a post-graduate course (like the one I am doing right now). Trainings and seminars that are designed to support as an add-on or as a more in-depth discussion enhancing or enriching existing knowledge on topics previously tackled or not tackled in college are perfect examples. These courses are, by-and-far, widely considered, recommended and even encouraged as a way of furthering one’s education. Technicalities aside though, the influx of nursing graduates has provided means for health-care institutions to capitalize on the high-supply, low-demand frenzy.
Under stricter conditions, I do not see any problems with the acceptance of volunteers. However once patient safety is by any means compromised, that’s where I believe the appropriate government and even private regulating bodies should draw the line. With proper monitoring, I believe that volunteers can make a real impact in providing safe, efficient, quality nursing care. One example of volunteerism done right is the case of the Philippine Red Cross. Because the structure and the job description are well defined, these people turn out to be assets rather than liabilities for the institution.
Seeing the state of my own institution, where there is very high attrition rates resulting into fast turn-over of new inexperienced nurses, delegating tasks even to these registered nurses with accompanying licenses can already be daunting in itself. Delegating nurse-specific tasks on volunteers without respective licenses for them to practice on such as administration of medications would prove to be disastrous and very dangerous. Bottom-line: in order for volunteerism to work, proper set of rules, structures and restrictions should be implemented. Tasks being given to these types of workers should be well defined. Most importantly, implementation of all policies should be well regulated.