Yep, that is me and the esteemed and incredibly awesome, Dr. Jean Watson
(I was literally septic following dental surgery, but would I give this opportunity up? Not On Your Life!)
http://watsoncaringscience.org/
Tuesday, April 15, 2014
Monday, August 6, 2012
The Dynamic RN
Not being forced to write for class apparently means not writing at all! Now that I am back from my self-imposed hiatus, I hope to continue to share my journey to becoming a psychiatric mental health nurse practitioner. Many months ago, I wrote as a harried single mother, full-time student, part time soldier busily juggling (badly!) all the facets of my life. Today, I write as a dynamic person, no not Super Hero fabulous, but dynanmic, ever-changing, evolving towards my end self, the final product of this mess of ingredients that is to be me.
Since the class that created this blog, I have discovered Reiki and Therapeutic Touch. Every day, I add facets of each to my nursing practice convinced by the evidence of their efficacy. I have been blessed to see their benefit in my own life and in the lives of my patients, so much so that I am changing my dissertation. I am unsure where my path will take me, but am absolutely certain if I am doing what needs to be done for my health, both physical and emotional, my journey will end up exactly where it is supposed to be.
Since the class that created this blog, I have discovered Reiki and Therapeutic Touch. Every day, I add facets of each to my nursing practice convinced by the evidence of their efficacy. I have been blessed to see their benefit in my own life and in the lives of my patients, so much so that I am changing my dissertation. I am unsure where my path will take me, but am absolutely certain if I am doing what needs to be done for my health, both physical and emotional, my journey will end up exactly where it is supposed to be.
Thursday, May 3, 2012
To Feel or Not To Feel, That is the Question!
By the count above, I have 900 odd days to graduation. Translation? My dissertation project had better be completed by then! I'm having the hardest time creating a project. Some of the best ones are incredibly basic yet innovative. I admit it. I'm an over thinker. If there is a hard way to do something; I'll find it.
A good MD, PhD friend of mine told me, "You're not out to change the world. Graduate and then change the world," meaning stop over thinking my dissertation!!! I know that's true just as I know I don't want to waste two years on a project that doesn't mean anything to me. Therein lies the question - To feel or not to feel? Do I select a project I am passionate about or pick the easy A dissertation? Oh, who are we kidding? Anyone that knows me, knows I am ambiguous about NOTHING! I do have my shades of gray, but my black and white are exuberant.
A good MD, PhD friend of mine told me, "You're not out to change the world. Graduate and then change the world," meaning stop over thinking my dissertation!!! I know that's true just as I know I don't want to waste two years on a project that doesn't mean anything to me. Therein lies the question - To feel or not to feel? Do I select a project I am passionate about or pick the easy A dissertation? Oh, who are we kidding? Anyone that knows me, knows I am ambiguous about NOTHING! I do have my shades of gray, but my black and white are exuberant.
Wednesday, May 2, 2012
Evolutionary Psychiatry: Alzheimer's Pathology and the Dementia-Free Kitava...
Evolutionary Psychiatry: Alzheimer's Pathology and the Dementia-Free Kitava...: Over the last two posts I explored the theory that hyperglycemia might be one of the predisposing factors for developing Alzheimer's demen...
Awesome blog post by an evolutionary psychiatrist. Looks like I may take my practice in a new direction.
Awesome blog post by an evolutionary psychiatrist. Looks like I may take my practice in a new direction.
Saturday, April 21, 2012
Doctor Who
Pioneers, that's what we are, but then, when haven't nurses been at the forefront of innovation? The increasing complexity of the health care environment, the movement to doctoral entry for other health care professions like pharmacy and physical therapy, and the projected shortage of competent, qualified health care providers demands a terminal degree in nursing. For too long the pie-in-sky degree attainment for nursing was the Masters, the required degree for practice as an advanced practice nurse practitioner. Current health care needs demand a doctorally prepared nurse. Prior to this decade, terminal nursing degrees existed, the DN, doctorate of nursing and the PhD in nursing, but those are academically focused. The need for a practice doctorate exists. In 2006, the American Association of Colleges of Nursing (AACN) published The Essentials of Doctoral Education for Advanced Nursing Practice outlining the competencies required by practice doctoral programs. The AACN also called for the entry level nurse practitioner to by doctorally trained and this qualification be implemented U.S. wide by 2015. Read Me
Of course the backlash has been rough and steady. Many existing nurse pracs disagree with the suggested change citing discrepancies among pay and possible "second class citizenship". That is not a totally invalid argument. Ask any practicing certificate or associates of nursing (ASN) nurse how she feels working alongside BSNs and MSNs. We can all admit to a little degree-envy. The biggest backlash, however, originates from the physicians' medical associations. Many claim nurse practitioners want to replace medical doctors. Others think we'll all have to compete for a spot in the health care pool. Yes, health care resources are finite. Patients are not. Many specialties are sorely neglected such as primary care and OB. Primary care physicians refer to themselves as a "dying breed" yet worry publicly and voraciously against primary care nurse practitioners.
One of the heaviest hitters is the Kentucky Medical Association (KMA). They have a bright, inviting website encouraging patients to seek qualified health care and declares, "Not everyone called "doc" is a medical doctor." The site further warns against receiving potentially unsafe, unqualified care from chiropractors, optometrists, midwives, nurse practitioners, pharmacists, psychologists, and any health care provider without an MD or DO behind their name. Hmmm...where are the physician's assistants? KMA Nastiness
Sadly, Kentucky is not alone. In most states, medical associations have successfully lobbied to limit the scope of practice of nurse practitioners. Most require agreements with collaborative physicians. Should your collaborator move, quit his practice, die, or lose her license, the NP is without a job immediately. Even though NPs are reimbursed at a lower rate than physicians (Medicare pays 85% of the doc's rate), many medical doctors continue to view NPs as a threat to their livelihood. The threat intensified with the advent of the DNP. PhDs in nursing are doctors. PhDs in anything are doctors! But the doctor of nursing practice conveyed upon nurse practitioner who look like medical doctors, diagnose like medical doctors, prescribe like medical doctors, the title "doctor". Suddenly became a hideous threat to the health care of our nation destined to fool unsuspecting patients into believing we are medical doctors.
Therein lies the most offensive part of the whole debate. If I wanted to be a medical doctor, I would have gone to medical school. I wanted to be a nurse. Nursing was an informed choice for me. With nursing, I can focus on the patient and how the disease, illness, or injury process affects the patient, his or her family, and community. Nursing is a holistic practice. We are rich with our own theories and concepts, evidenced-based practices and interventions. I can't even blame the era into which I was born. The 70s were ripe for feminism and equality. If I wanted to be a medical doctor, I would have. Instead, I wanted to be a nurse. And GI Joe....Wonder Woman....a television reporter....a hand model for Palmolive (yeah, I was a weird kid)...a writer...and a mom. I've accomplished five of those things. I still hold out hope Palmolive will call me yet.
Of course the backlash has been rough and steady. Many existing nurse pracs disagree with the suggested change citing discrepancies among pay and possible "second class citizenship". That is not a totally invalid argument. Ask any practicing certificate or associates of nursing (ASN) nurse how she feels working alongside BSNs and MSNs. We can all admit to a little degree-envy. The biggest backlash, however, originates from the physicians' medical associations. Many claim nurse practitioners want to replace medical doctors. Others think we'll all have to compete for a spot in the health care pool. Yes, health care resources are finite. Patients are not. Many specialties are sorely neglected such as primary care and OB. Primary care physicians refer to themselves as a "dying breed" yet worry publicly and voraciously against primary care nurse practitioners.
One of the heaviest hitters is the Kentucky Medical Association (KMA). They have a bright, inviting website encouraging patients to seek qualified health care and declares, "Not everyone called "doc" is a medical doctor." The site further warns against receiving potentially unsafe, unqualified care from chiropractors, optometrists, midwives, nurse practitioners, pharmacists, psychologists, and any health care provider without an MD or DO behind their name. Hmmm...where are the physician's assistants? KMA Nastiness
Sadly, Kentucky is not alone. In most states, medical associations have successfully lobbied to limit the scope of practice of nurse practitioners. Most require agreements with collaborative physicians. Should your collaborator move, quit his practice, die, or lose her license, the NP is without a job immediately. Even though NPs are reimbursed at a lower rate than physicians (Medicare pays 85% of the doc's rate), many medical doctors continue to view NPs as a threat to their livelihood. The threat intensified with the advent of the DNP. PhDs in nursing are doctors. PhDs in anything are doctors! But the doctor of nursing practice conveyed upon nurse practitioner who look like medical doctors, diagnose like medical doctors, prescribe like medical doctors, the title "doctor". Suddenly became a hideous threat to the health care of our nation destined to fool unsuspecting patients into believing we are medical doctors.
Therein lies the most offensive part of the whole debate. If I wanted to be a medical doctor, I would have gone to medical school. I wanted to be a nurse. Nursing was an informed choice for me. With nursing, I can focus on the patient and how the disease, illness, or injury process affects the patient, his or her family, and community. Nursing is a holistic practice. We are rich with our own theories and concepts, evidenced-based practices and interventions. I can't even blame the era into which I was born. The 70s were ripe for feminism and equality. If I wanted to be a medical doctor, I would have. Instead, I wanted to be a nurse. And GI Joe....Wonder Woman....a television reporter....a hand model for Palmolive (yeah, I was a weird kid)...a writer...and a mom. I've accomplished five of those things. I still hold out hope Palmolive will call me yet.
Tuesday, April 10, 2012
My Personal Nursing Philosophy
Two weeks ago, we were assigned a paper describing our personal nursing philosophies. The paper was limited to three to five pages and the final draft I turned in was short some of the better 'stuff'. I'm posting my philosophy here for other nursing students to find when they frantically Google "personal nursing philosophy" for their own assignments. It's not a masterpiece, but it is personal and meaningful to me. So here it is....
Bartholomew, K. (2008). Why nurses eat their young: A look at nurse-to-nurse hostility and why it occurs. Retrieved from http://www.realityrn.com/more-articles/nurse-relationships/why-nurses-eat-their-young%e2%80%a6/542/
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/
My Personal Nursing Philosophy
Brandman University
March 2012
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
References
American Academy of Family Physicians. (2010). Definition of continuity of care. Retrieved from http://www.aafp.org/online/en/home/policy/policies/c/continuityofcaredefinition.html
American Nursing Association (2001). Code of ethics. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
American Nursing Association. (2012). What is nursing? Retrieved from http://nursingworld.org/EspeciallyForYou/StudentNurses/WhatisNursing.aspx
Bartholomew, K. (2008). Why nurses eat their young: A look at nurse-to-nurse hostility and why it occurs. Retrieved from http://www.realityrn.com/more-articles/nurse-relationships/why-nurses-eat-their-young%e2%80%a6/542/
Edwards, S. (1996). What is philosophy of nursing? Retrieved from http://www.ruth-s-coleman-college-of-nursing.com/What_is_a_philosophy_Edwards_Art.pdf
.
Jarrin, O. (2007). An integral philosophy and definition of nursing. Retrieved from http://digitalcommons.uconn.edu/cgi/viewcontent.cgi?article=1049&context=son_articles&sei-redir=1&referer=http%3A%2F%2Fsearch.yahoo.com%2Fsearch%3B_ylt%3DA0PDoX29vIRPZBEAEiuJzbkF%3Fp%3DJarrin%252C%2BO.%2B%25282007%2529.%2B%2BAn%2Bintegral%2Bphilosophy%2Band%2Bdefinition%2Bof%2Bnursing.#search=%22Jarrin%2C%20O.%20%282007%29.%20An%20integral%20philosophy%20definition%20nursing.%22 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/
McGraw, L. (2012). Army nursing team creed. Retrieved from http://armynursecorps.amedd.army.mil/assets/home/NursingCreed.pdf
Roberts, K. (2012). Virginia Henderson: A contemporary nurse 1897-1996. Retrieved from http://www.contemporarynurse.com/archives/vol/5/issue/3/article/3027/virginia-henderson-a-contemporary-nurse-18971996Thursday, April 5, 2012
Foreign Nurses
"My philosophy in life is that any human being, however unpleasant, yields to the honest, caring hands of another. I believe this is the essence of nursing—to heal not only the ailing physical body, but also to mend bruised feelings and self-esteem."
Anyone who listens to the news, not just medical professionals, has heard of the nursing shortage in this country and the shortfall is expected to rise. To supplement the shortage, many organizations particulary long term care facilities recruit foreign nurses. Here in my area there are many Filipino, Caribbean, and African nurses to fill the gaps. I've heard some of the prejudices, but thankfully never encountered that kind of behavior at a facility where I've worked. The more I learn of the barriers nurse practitioners face "breaking in" to the primary practice world dominated by medical doctors, the more I understand what they must face.
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