Running head: PHILOSOPHY OF NURSING 1

Philosophy of Nursing

Jamie J. Borel

Bon Secours Memorial College of Nursing

Christine Turner, PhD, RN

Synthesis for Nursing Practice – NUR 4142

Oct 16, 2018

Honor Code “I have neither given nor received aid, other than acknowledged, on this assignment

or test, nor have I seen anyone else do so.”

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Definition of Nursing

Nursing in its simplest form is defined as the profession or practice of providing care for

the sick and infirm. However, throughout my three years in nursing school I have come to learn

that nursing is so much more than that. Guided by the Bon Secours College of Nursing’s

program philosophies I’ve come to realize that nursing is providing holistic care which not only

treats the ill and infirm; but preserves wellness, prevents illness, and provides comfort. This

goes beyond the patient’s physical wellness, too. According to the philosophy of health and

caring, nursing means working towards patient’s total health and wellness, which means unity

and harmony among the mind, body, and soul. With this in mind we, as nurses, must care for the

patient’s physical, mental and spiritual well-being in a holistic manner.

Nursing goes beyond what patients and their families see at the bedside. Nursing

education is a critical component to providing the highest quality care. I’ve learned that keeping

up with evidence-based practice in the ever-changing world of healthcare, could mean the

difference between a positive or a negative outcome for our patients. Continuing to practice in

the same way things have always been done does a disservice to our patients, when there is so

much research being done to update practice and procedures that give our patient’s the best

possible outcomes available. Finally, nursing above all is a service to our patients. It’s one thing

for a nurse to know policy and procedure and care for their patients in a very mechanical and

methodical way. However, what I’ve learned is that nursing is competent care partnered with

respect, compassion, integrity, and stewardship of the people and communities we serve. It’s

difficult to sum up one definition of nursing because so much goes into what we do, day in and

day out, for our patients, but if I had to sum it up in one sentence it would look something like

this. Nursing is a profession that uses evidence and research to guide compassionate, respectful,
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integrous care which restores and maintains the wellness of all people, throughout the lifespan,

birth to death.

Personal Philosophy

My personal philosophy from the beginning of nursing school has been to serve and care

for others as I would want to be cared for; with respect, compassion, and integrity. As someone

who has been in the hospital herself, and seen family members in the hospital as well, this

philosophy guides the way I practice in the clinical setting. When a patient is in the hospital they

are at one of the most vulnerable points in their lives. To know that their nurse cares for them,

respects them and will put their best interests at the forefront of their care, eases the anxiety and

fear that can build up during a hospital stay. As nurses we need to be advocates for our patients

and the best way to advocate and ensure the best care is being provided is to put yourself in their

position. How would you want your nurse to treat you? This is the way I practice when I am

with my patients, and how I will continue to work as a professional RN.

The philosophy of do to others as you would have them do to you, is not only prevalent

in the nurse-patient relationship, but also in the interprofessional relationships that nurses are in

as well. I’ve come to realize that nursing is a team sport and it takes integrity and respect for

your coworkers to create a positive and healing environment for your patients. For example, if

two nurses are relaying bedside shift report and they have a mutual respect for each other, the

patient will pick up on that and know that the continuity of their care is being properly managed.

In order to achieve this mutual respect, I need to treat my peers as I would like to be treated. This

philosophy applies to the nurse-provider relationship as well. As a patient, I want my nurse to

have a respectful relationship with my provider because as the nurse, they are the eyes and ears

relaying my health status to the physician. So as a nurse, I need to build strong relationships
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with the providers in order to ensure that they trust my judgement and recommendations

concerning patient care. In general, having a mutual respect among the nurse-patient, nurse-

nurse, and the nurse-provider relationship is important in ensuring that our patients are receiving

the best care possible, so I will continue to treat my patients and peers as I would want to be

treated; with integrity, compassion, and respect.

Nurse Patient Encounter

During my time on a Labor and Delivery unit I was caring for a patient who was 33

weeks pregnant with pre-eclampsia, who gave birth via emergency cesarean section, due to

rising blood pressures. Prior to delivery she had been in the hospital for three days. Because her

blood pressure readings were so high in those previous days, she had orders for continuous fetal

monitoring, which meant she hadn’t been able to shower since her admission. Of course, she

was able to clean up as best she could in bed, but she was just so miserable. Unfortunately,

during my shift her blood pressure shot up even higher than the readings had been, and she was

ordered to be put on magnesium sulfate and have a Foley catheter inserted. Her spirits were

diminished even further at this point because her baby was in the NICU and now she was bed

bound.

It was with this patient that I really got to exhibit the type of care that I would have

wanted, had I been in her position. She was very upset, not only for her situation, but because

she wasn’t able to go see her newborn baby. I sat with her and actively listened as she told me

she was exhausted, scared, and she mainly just wanted the medicines off and the catheter

removed so she could shower and go visit her baby. I assured her that as soon as her blood

pressures stabilized, and the doctor gave us the OK to stop the medications, that we would get

the catheter out and take her to see her baby in the NICU. The time was approaching shift
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change as we got the OK to stop the magnesium sulfate, so we discontinued the medication and

continued to monitor her condition. At this point it was 0630 and my nurse said that we could let

her wait until the shift change and the oncoming nurse could get her cleaned up, take the catheter

out, and get her to the NICU. At that point I stood up for my patient. I told the nurse that I’d

promised to remove the catheter as soon as I got permission and get her cleaned up to go visit her

baby. With that, my nurse happily obliged. We removed the catheter, got her up to the

bathroom to wash up, and we wheeled her to the NICU to see her baby for the first time. My

eyes swelled up as I watched her lay eyes on her 3.7lb baby girl for the first-time. It was a

beautiful moment and I’m so proud that I was able to show respect and compassion for her

situation and integrity by keeping my word. That is the type of nurse I’d want for myself and the

type of nurse I will strive to always be for my patients.

Values and Beliefs

As I looked at the Bon Secours College of Nursing philosophies to begin this paper, I

choose the values of respect, compassion and integrity to lead my philosophy of treating patients

the way that I would want to be treated. Interestingly enough, those were the exact values I

choose when I wrote my original Personal Philosophy of Nursing paper in NUR1100, so I can’t

say that my values and beliefs have changed at all. However, I can say that my appreciation for

these values and beliefs have grown exponentially since that first semester of nursing school.

In the beginning of nursing school, I couldn’t imagine how much a nurse could touch and

impact the lives of their patient’s. My experience was limited to bed baths, dressing changes,

and assisting in ambulating from the bed to the chair. As important as these components were, it

was hard to grasp the full extent of what nurses did because at this stage we weren’t fully

integrated into the day-to-day routine of a nurse’s work. However, after each clinical experience
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I was given a deeper insight into the impact we as nurses can have. As a future L&D nurse, I’ve

watched my preceptor challenge recommendations from a provider on whether it was time to

start pushing, or whether the patient needed more time to labor down on her own. In this

instance my preceptor’s intuition and recommendation likely saved this patient from ending up

in the OR with a cesarean section. With each clinical experience that passes I’m realizing that

it’s truly the job of the nurse to provide compassionate care in an integrous way that respects the

client and puts their best interests at the forefront of their care.

Patricia Benner’s Theory: From Novice to Expert

Patricia Benner’s theory, from novice to expert, comes from the idea that there is a

progression in skill acquisition, knowledge, and clinical judgement that develops as one moves

from being a student nurse to an experienced, practicing, clinical RN. As student nurses we

begin school as a novice, relying solely on what our textbooks and professors have taught us.

We have no situational knowledge to base decision making on and no experience to guide our

processes. Everything is task oriented without the use of clinical judgement. From novice we

move to advanced beginner. This transition occurs after several years of clinical experience in

the student setting. We have limited experience to fall back on and have gained minimal

proficiency in tasks, but still function under evidence-based guidelines to lead our nursing care.

Upon graduation, after a couple years, the RN may begin to feel competent in their nursing care.

The nursing care at this stage is organized and critical thinking is being used to assess what the

priority actions are that need to be taken at any given moment. After competence, comes

proficiency. At this stage the nurse is able to perceive situations as a whole and are able to look

at long-term goals for patients. The focus is no longer on individual tasks, but rather what

general care is needed to get the patient to the next level of wellness. Finally, the nurse reaches
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the level of expert. The expert nurse has so much experience and knowledge of the clinical

situation that they can act intuitively and hone in on only what is important to each patient’s

needs without falling back on the rules and guidelines. According to “From Novice to Expert:

Excellence and Power in Clinical Nursing Practice” written by Patricia Benner (2001) “The

expert nurse perceives the situation as a whole, uses past concrete situations as paradigms, and

moves to the accurate region of the problem without wasteful consideration of a large number of

irrelevant options. In contrast, the competent or proficient nurse in a novel situation must rely on

conscious, deliberate, analytical problem solving of an elemental nature” (p. 3).

Skill Acquisition

As a senior nursing student, ready to graduate and begin my first RN position as a Labor

& Delivery RN, I feel that I am in the advanced beginner stage. I had experience in L&D last

semester where I played more the role of observer and felt very novice in that setting. It was all

new and I had no clinical experience to draw on with those patients. However, this semester, I

am on L&D as an immersion student and I have gotten so many great opportunities to perform

RN duties and skills. I have been in enough situations where I can recognize if fetal status is

changing or I can recognize if a mother is progressing in her labor and anticipate what

interventions may be necessary for the patient. Although I am feeling much more prepared for

my role as an RN, there is still so much more to learn and so much more critical thinking that

needs to evolve before I truly feel competent in this role.

As an advanced beginner I notice my preceptor is helping me to formulate guidelines

about actions to take and about what a patient’s situation and outcome may look like based on

assessments throughout the shift. I believe this is the core of what an advanced beginner is

developing. It’s about learning to recognize reoccurring situations, what the main priority is for
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those patient’s, and determining what the long-term picture looks like for their care. My hope is

that with each shift I grow and learn something new that will help develop me into a competent,

proficient, and eventually, expert L&D RN in the future.

Action Plan for Moving Forward

I believe that to move forward from an advanced beginner to a competent RN there are

three actions that need to occur. The first action is reflection. You can’t move forward without

knowing where you’ve come from, which means learning from past successes and mistakes. As

a student nurse about to graduate, it’s important to reflect on situations where you made a

mistake, figure out what went wrong, and learn what could have been done to avoid that mistake

so you don’t do it again in the future. Reflection is the perfect way to manage these events and

learn from them. The second action I will take is to continue to ask questions. When my

preceptor does something that I don’t understand, I will continue to ask her how she came to that

conclusion, or to that action. Like Benner mentions, once you’re at the proficient and expert

level, things become second nature and the thought process isn’t always clear to others who are

lower in the skill acquisition stages. With that said, it’s important to speak up and learn from

these nurses, to try to train my brain to think through situations like they do. Finally, I will

continue to learn, whether it be through formal education or just looking through recent research

being conducted in my area of nursing. By keeping up to date on new studies and new evidence

that comes forward, I will be setting myself up to practice in the best and most efficient way

possible. It is through education that we gain new ideas and new processes, so in order to move

to the level of competence, I’ll need to continue learning. Through reflection, questioning, and

education I will set myself up to become a competent nurse who will provide compassionate,

integrous, and respectful care to all of my patients.

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References

Benner, P. E. (2001). From novice to expert: Excellence and power in clinical nursing practice.

Upper Saddle River, NJ: Prentice Hall.