As an associate degree practicing nurse, working on a cardiac unit, my scope of practice has been primarily focused on direct patient care. I have always been motivated to help my clients whenever possible to attain optimal level of restoration through different methods of therapeutic regimen and teaching. I assist my clients to meet their immediate needs, smiling, listening, using therapeutic touch where appropriate, and communicating effectively. I involve my clients and their families in their care by keeping them informed with medications, laboratory and diagnostic testing. I am a big advocate of the phrase ‘Knowledge gives power’ because it fosters nurse-client relationship and trust. I believe very much in engaging my clients with the knowledge of their disease process, the plan of care and the method of care delivery that will ensue. Knowing what to expect usually gives clients more control and they are more willing participants in an unfamiliar environment while coping with unfamiliar diagnosis and the challenges of being sick.
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However, transitioning to a baccalaureate program now, I realize that my approach to nursing is evolving and becoming more dynamic and inclusive to promote a more holistic method of care delivery. Primarily based on the body of knowledge that is emerging on my journey back to school and prior experience, I have come to understand what the philosophy of nursing means.
Nursing philosophy forms the framework for nursing practice and guides the application of nursing process to effectively manage the complexities of evolving nursing roles. “Developing a nursing philosophy requires that a nurse embarks on a journey of self-discovery”, Rew, 1994. It starts by recognizing and understanding the ‘interconnectedness of all things,’ how human beings relate with their environment and how it affects their health. Based on the body of knowledge and experience, nurses usually have a set of beliefs, values and ideologies that influence perceptions, thoughts and feelings, (Hood. pg. 60). These values are usually etched within the framework of ethical principles and they constitute a nursing philosophy. The profession of nursing primarily deals with human beings, health, nursing and environment and as such nurses need to examine and reflect on what each of these concepts mean and how they are related to one another in order to affect each positively.
Human beings are unique, holistic individuals characterized by genetics and biologic compositions. Human beings are defined by their understanding, perception, reasoning, life experiences, spirituality and cultural background. Human beings have intrinsic values and have ‘inalienable rights’, and the right to be treated with dignity and respect from conception to death.
Health is a state of well-being. Health is defined as the optimal functioning of all physical, psychological, social, sensing, feeling and communicating systems. A state of total shalom, nothing missing, nothing broken. A state of health is viewed as a point existing on a continuum, from wellness to death and it varies with individual perception of what wellness is. As defined by World Health Organization, Health is a “State of complete, physical, mental and social well-being, not merely the absence of disease or infirmity.”
Nursing is a helping profession, a synergy of arts and science. The science of nursing is based on the principles and theories of behavioral and natural sciences, the embodiment of scientific knowledge, skills and professional values and morals instilled in practice and care delivery. Nursing encompasses the collaboration and autonomous care of all individuals in all settings, it includes health promotion, awareness, prevention of diseases and a restoration from deviation of health.
Environment is not limited to physical space, but characterized by intrinsic and extrinsic factors, that defines a person. Internal factors that affect mood and wellness are considered environment and external environment includes families, social, spiritual, cultural factors that affect a man. Sill & Hall view human beings as an “interrelated, interdependent, interacting complex, organism, constantly influencing and being influenced by the environment.” (Sills & Hall, 1977, p.24).
Bearing in mind that the profession of nursing is centered on these four metaparadigms: Human beings, health, nursing and environment, it is imperative for nurses to approach care delivery to human beings in a holistic manner factoring in the interrelatedness of how one affects the other.
Environment co-exists with human beings in a reciprocal relationship and as such affects individuals positively or negatively. It may be a disruptive or peaceful relationship. Deviation from a state of well-being is a disruptive state that requires the helping compassionate care of nurse professionals. As individuals are constantly adapting to varying degrees of changes in their internal and external environment, nursing is a piece of healthcare delivery system that constantly strive to assist individuals to attain their optimal level of wellness. Utilizing the nursing process and accessing multi-disciplinary approach in a holistic goal directed manner, nurses assume multiple roles of professional caregivers, teachers, advocates and counselors to accomplish competent and compassionate care in different continuum of an individual state of health.
The theoretical models and frameworks of various nurse theorists has emerged as a guide to nursing philosophy and care. They provide a body of knowledge used to support nursing practice. They each define their nursing philosophies placing human beings as the center of care but cognizant of the interconnectedness and relationship of health, environment and nursing interacting and affecting each other. Sister Callister Roy Adaptation model is one that has impressed on my heart and has influenced my practice.
Sister Callister Roy is a nurse theorist, professor and author, compelled by instructor, Dorothy Johnson, to write a conceptual model of nursing while studying for her Master’s degree at UCLA She proposed ‘The Roy Adaptation Model’ theory (RAM). Studying through this theory gives me a better understanding of man’s adaptive capacity in response to stimuli and also the intrinsic nature of man to adapt various modes to cope with life challenges especially relating to health.
In this mode, Human being is viewed as a holistic adaptive creature capable of adaptive systems. She describes the Environment consisting of internal and external stimuli that interacts directly with human beings. She sees Health as a sound unimpaired condition leading to wholeness and the Nursing goal as that which promotes modes of adaptation and that support overall health.
The four Modes of adaption of RAM promote integrity and they are: the physiologic-physical mode, the self-concept- identity mode, role function and interdependent mode.
Physiologic-Physical Mode identifies the intrinsic factors comprised of physical and chemical processes that occur in human beings that are responsible for the functions and activities of daily living. The underlying need is physiologic integrity evidenced in the degree of wholeness achieved through adaptation to change in needs.
Self-concept-Identity Mode focuses on the psychological and spiritual integrity and the sense of unity as humans search for the meaning and purpose of life
Role Function Mode deals with the individual roles that we occupy in society and how we aim to fulfill the need for social integrity. The knowledge of knowing oneself in relation to others.
Interdependent Mode looks at the interconnectedness and relationship of people, environment, structure and perception. Adaptation potentials individually and collectively.
Using RAM’s six- step nursing process, the nurse gathers a full assessment of a client including behavior, orientation, family dynamics, objective and subjective data. The second step is to recognize and determine the stimuli affecting the behaviors exhibited. The third step involves formulating a nursing diagnosis based on the presenting symptoms and the person’s adaptive state. The forth step is goal oriented and nursing planning to promote adaption and wellness which leads to the fifth step of nursing interventions. Utilizing several methods of therapeutic healing tailored to each individual crisis state with the ultimate goal of managing the stimuli to promote adaptation. The final and sixth step is the evaluation stage, using reflection and data to reassess the individual state of adaptation mode or lack of it. The ability of the nurse to manipulate the stimuli and not the patient enhances the person’s interaction with their environment, gives them a sense of control and promote health.
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Nursing, as stated earlier, is a synergy of science and art. Nursing is a learned profession and as such nurses are required to have a formal education, clinical practice and research in order to understand the biologic, physiologic, behavioral and social sciences to make decisions. The application of that body of knowledge in practice is built on the art of nursing. Delivery of care with wisdom, compassion, genuineness, empathy, respect for dignity and a sound commitment to do good at all times is the basis of the art of nursing.
Nursing is an experience that occurs between two individuals forming the nurse-patient interaction. Nursing is constructed around the centrality of nurse-client relationship and how they affect each other positively. When nurses use knowledge and personality to implement interventions in the nursing process to effect change in the ill, they alleviate stress and the relationship becomes therapeutic. It is through the establishment of therapeutic association that nurses are said to promote healing (Allen, 2000: 184).
In the early days, Nursing derived knowledge through intuition, tradition and experience or by borrowing from other disciplines (Kalisch &Kalisch, 2004). The knowledge of nursing has since then shifted to empirical knowledge discovered through research. Research is vital in nursing today because it expands nursing knowledge and integrates best evidence based practice into clinical practice. The systemic review of literature aspect of research makes it possible for quality improvement activities and to determine the effectiveness of nursing interventions and practice changes. Research allows clinical practice to evolve in knowledge and it gives confidence in practice based on satisfactory patient outcomes.
Therapeutic Nursing: Improving Patient Care through Self-Awareness and reflection … SAGE, Nov 4, 2002 –
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The Roy Adaptation Model was proposed by Sister Callista Roy and first published in 1970. The model has greatly influenced the profession of nursing. It is one of the most frequently used models to guide nursing research.
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