My Personal Nursing Philosophy
Embrace the Past...Engage the Present...Envision the Future
Nursing is a practice discipline with multiple, interwoven theories sharing similar concepts, but lacking a singular defining nursing philosophy. Individual nurses develop personal philosophies to govern their own practices creating a philosophy of nursing rather than defining philosophy of nursing. Nursing philosophy can be understood as “an attitude towards life and reality that evolves from each nurses’ beliefs formed in three elements: conceptual analysis, assessment of argument, and concern with metaphysical and epistemological questions" (Edwards, 1996, p. 2).
The first step in identifying a personal nursing philosophy is defining nursing. Nursing as defined by the American Nurses Association is the “protection, promotion, and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2012). Understanding what nursing means to the individual nurse is a deeply personal journey. Defining nursing is relatively simple; embodying nursing is difficult.
Building upon the definition of nursing, the nurse explores her personal philosophy through recognition and refinement of her personal belief system, ethics, career goals, experiences, the experiences of other nurses, and nursing theories. The personal nursing philosophy becomes an articulation of these. The task of gathering theories used in practice, concepts of evidenced based practices, examples of instructors and respected peers, and personal beliefs to organize and record for others to read is daunting. I have identified the personal nursing philosophy that most closely aligns with my own to start. Virginia Henderson stated, “Nursing is rooted from the needs of humanity and is founded on the idea of service. The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother, and the mouthpiece for those to weak or withdrawn to speak” (Roberts, 2012, p. 1). In this philosophy, the nurse is essentially an advocate for all patients, significant others, and the community. Advocacy is a main element of my personal nursing philosophy. In addition to advocacy, my philosophy addresses five other concepts: knowledge, equality, economy, continuity, and unity.
Advocacy – Patient advocacy is any activity that benefits the patient from competent, compassionate, bedside care to actively legislating for improvements in health care systems or processes for patients. “Nurses act to change those aspects of social structures that detract from health and well being” (ANA, 2010, p. 2). Patient advocacy is not merely the defense of patient rights and the safeguarding of patient privacy. Advocacy stems from a philosophy in which nursing practice is the holistic sustainment of the patient, ill or well, to promote his or her total well-being as understood by that individual. Advocacy may take the form of finding reliable, timely information, financial aid, or appropriate referrals for patients. Advocacy includes protecting the patient from “incompetent, unethical, illegal, or impaired practice by any member of the health care team…or any action on the part of others that places the rights or best interest of the patient in jeopardy (ANA, 2010, p. 7). The nurse recognizes an ill and vulnerable patient cannot be a strong, self-advocate, is unfamiliar with the health care system, and unaware of his or her individual patient rights. Nursing advocacy is a continual process in the implementation of nursing care. Nursing advocacy requires critical thinking skills, appropriate assessment, and intervention, providing culturally sensitive information and education to the patient and significant others, ensuring equal access to care, and supporting the patient and family’s decision for care. At times, the nurse must have courage to be a voice for her patient within the interdisciplinary team maintain collegiality, but ensuring the responsibility to maintain the nurse-patient relationship above all else. In the past, advocacy consisted of ensuring the patient complied with the doctor’s orders. Today, nursing advocacy represents a new paradigm addressing issues not formally considered nursing concerns. I will listen to my patient and have the courage to advocate on his or her behalf.
Knowledge - The responsible, ethical nurse informs her patients about the issues, seeks new knowledge and best practices, and maintains credentials. Not only should the nurse actively seek new information, she should be excited to educate her colleagues and patients, offer solutions to identified problems, and to effect changes in practice to deliver better patient outcomes. The advancement of nursing practice relies on every nurse as an educator. I continually will seek knowledge whether formally or informally and share appropriate information with patients and colleagues.
Equality – Patients are human beings. Black patients, Jewish patients, and female patients are not inferior human beings by any genetic measure; only cultural biases place human beings on a scale of worth. As Virginia Henderson admonished in 1955 to “get inside the skin” of patients, I continue to do so today. In my practice, kind and quality of care is not determined by age, color, creed, religion, rank, or status. Triage determines treatment and urgency.
Economy – Resources are limited; wants and needs are unlimited. This is the economic law of scarcity. As it applies to health care, improved medical technology, the belief of entitlement to care, and the coming change in the age structure of the population has increased the demands for health care (Mariner, 1995). Health care resources are finite, a belief the American populace cannot accept. Many believe all individuals are morally entitled to unlimited longevity and good health at any cost and believe denials of services by providers or insurers are unfair or arbitrary. Unless a shortage occurs and rations are necessary as was the case with H1N1 vaccine, Americans do not appear likely to accept the fact of scarcity of health care resources. I will not order or cause to be ordered unnecessary tests or treatments and if uncertain will seek the opinions of collaborating health care providers to protect valuable health care resources.
Continuity – Continuity of care is “the process by which the patient” and provider “are cooperatively involved in ongoing health care management toward the goal of high quality, cost effective medical care” (AAFP, 1983, p. 1). Continuity of care is more than maintaining adequate nursing documentation and records. Continuity is more than collaboration with interdisciplinary professionals such as doctors, therapists, dieticians, social workers, chaplains, and case managers. Continuity of care involves ensuring the patient is able; mentally and physically to follow through with referrals and to provide self care upon release. Assessment of the patient’s needs and abilities allows the nurse to determine what interventions the patient needs to be successful. In my practice, this has meant signing up a chronically ill patient up for a free, guaranteed ride home program from work to calling a patient to remind him to schedule an appointment with the cardiologist. Not as an enabler, I will empower the patient to make necessary changes and seek follow-up care to grow and be well.
Unity – Nursing is not for the weak stomached or weak spirited. Nurses are strong, dedicated, flexible, and empathetic. Somewhere, perhaps to gloss over the bodily fluids and pounds of flesh, the idea of nurses as angels of mercy was popularized making nurses ethereal, otherworldly creatures. Satisfied patients hold to the nurse as angel ideal while nursing students may describe some seasoned nurses as openly hostile. Sadly, nurses eat their young is a common phrase used to characterize this relationship. “A major issue in nursing is our failure to achieve unity…From a feminist perspective; the real issue involves divisiveness and fragmentation that sustains oppressive relations in an industrialized, patriarchal medical system. Remaining divided from one another serves the interests of the dominant group. Rather than benefiting us, fragmentation in nursing serves to confuse us, to keep our minds and hearts focused on the dominant system for solutions that never materialize” (Edwards, 1996, p. 1).
First as a Registered Nurse, now as a doctoral student, and eventually as an Advanced Practice Nurse, I will strive to incorporate the concepts important to me: knowledge, equality, economy, continuity, and unity, in my life and in my practice and always remember:
The Army Nursing Creed
“My patients depend on me and trust me to provide compassionate and proficient care always. I nurture the most helpless and vulnerable and offer courage and hope to those in despair. It is a privilege to care for each of these individuals and I will always strive to be attentive and respectful of their needs and honor their uniquely divine human spirit.”
- LTC Leigh McGraw 2012
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Mariner, W. (1995). Rationing health care and the need for credible scarcity: why Americans can’t say no. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615628/
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