2018~philosophy of nursing

philosophy of nursing 1
Philosophy of Nursing
Tracee Pockett
Castleton University
Transitions to Baccalaureate Nursing
Prof. Kimberly Carey
30 September 2018

A nursing philosophy is an approach to nursing, usually created by individual nurses in their own
daily practice in the field. A nurse uses his or her philosophy of nursing to explain what he or she
believes nursing is, the role nursing plays in the health care field, and how he or she interacts with
patient. A philosophy also addresses a nurse's ethics as it relates to the practice of nursing.
(Nursing Theory, 2018) This paper will explore what defines a nursing philosophy as well as my
personal beliefs and attitudes towards nursing.
As a nurse advances from novice to proficient to expert, so too will her philosophy grow and mature. It
helps the nurse to understand how to navigate through the many demands made of them while they care
for their patients. Knowing what you believe to be the essence of what it means to be a nurse, knowing
what you hold sacred about yourself and your practice, gives you a constant in the quickly-changing
world of healthcare. Clinical knowledge is not enough;we must have the insight to understand the
why's, as much as the how's. This will come with time to the newly licensed nurse, who has learned
enough to begin, but now has the immense task before her of becoming a nurse. This means, in part,
knowing when to call upon her own judgment in a given situation rather than relying on that of her
preceptor, or other experienced nurses she is working with. Trusting oneself is a key piece in
developing the trust of your patients. As we grow in our practice, we gain confidence with our
judgments, through the discipline of repetition and attention to detail. Being open to new ideas,
techniques and methods is another important step in the journey. As new nurses become accustomed to
the flow of their days, they gain a certain amount of comfort from that. This can lead to a degree of
complacency, of being unwilling to embrace something different than the way they had originally
learned. I do not think that any nurse is immune to this, myself included. It can be difficult to accept a

change in the structure of our already busy shifts. But often, these changes are for the better. At RRMC,
we have instituted Interdisciplinary Rounds( IDR for short). These happen daily during the week, on
my unit beginning at 0945 and ending at1100. During this time, the nurses have the opportunity to
speak with the attending doctor, pharmacist, physical therapist, social worker, and case manager. We
are afforded the opportunity to bring forward our questions, concerns, and thoughts regarding the
patients in our care, additionally we are able to voice questions and concerns from our patients and
their families who know we have this time with their care team. This has proven to be a valuable
change in the flow of our days, decreasing pages to MD's, and creating improved communication.
For myself, I have struggled with change. I get into a comfort zone and it is a challenge to change it
even when I know it is unhealthy to remain where I am. In the last few years, I have found myself
slowly being less resistant to the changes occurring, and have accepted that change is a necessary and
healthy part of life. Changing my place of work, from a subacute rehabilitation/long-term care facility
that was my first nursing position, to a medical-oncology unit in an acute care hospital, was a nerve-
wracking experience. Although nurses change places of work often, I felt hampered by self-doubt.
Once I had made the change I felt an enormous weight had lifted from my shoulders. I felt as though I
was where I belonged. This is not to say that my floor is not challenging, but even on my worst day I
have felt that I was in my Place. RRMC has been a part of my life since I was born, volunteering there
in high school, having both my own children there, and many many trips to the Emergency Department
for things both mundane and life changing. My main thought on nursing, that I try to carry with me at
all times, is that I am never done learning. Whether I am in a program of study such as this, an
inservice done at the nurses station, speaking with my favorite doctor regarding something about our
patient, working with my LNAs to give a bedbath to our comfort measures patient, or helping a student
nurse understand why a particular medication is being given, these experiences help to hone my skills,
memory, compassion, and humility. I am of the opinion that nursing is both art and science, as has been

said by many before me. Our way of interacting with our patients and their loved ones takes skill,
learning how to walk into a patient's room and be able to “break the ice” within the first few minutes,
explain to them in simple terms what their doctor has just said, advocate for them when they are unable
or unwilling to do so themselves, and help them to understand that they have to give themselves
permission to be sick, injured, afraid, sad. It is most difficult for many people to grasp this concept. Our
culture rewards achievements and productiveness. It looks disdainfully on those who are idle, even if
they are physically incapable of their usual activities. Healing is not always linear. Our patients need to
be reminded that if they experience a setback, it is not going to mean the undoing of all their progress.
One of the biggest challenges that nurses face today is the matter of having enough time to be with a
particular patient, as opposed to going from room to room, task to task. Sometimes, we need to sit and
listen to our patient, and be able to be totally present in that moment, without being distracted by the
litany of tasks and to-do's that fill our days. Patients can recognize a stressed and busy nurse, and may
not want to tell them something because they feel their nurse has enough to do. Being honest with
them, and making the time to listen to their concerns is a hurdle that takes creativity and patience to
overcome.
Jean Watson's theory, the science of caring, was first published in 1979. It consists of ten
carative factors that emphasize “the relationship of the nurse and the patient, drawing on philosophical
sources for a new approach that emphasized how the nurse and patient change together through trans
personal caring.” ( B.P. Black, 2011, p.309) The basis of the human experience is that of change; we as
nurses are changed by our time with the patient, they leave a part of themselves with us. Being task-
oriented is not enough, in order to grow as professionals we need to understand what our patients
experience;need to think about how we would want to be treated if it were us in an unfamiliar situation
over which we have very little control. The caring nurse is affected by each patient she cares for. This is
both blessing and curse; for too many negative experiences can cause her to become jaded, uncaring,

and to lose her faith in humanity. To maintain her balance is a daily work in progress. Nurses do not
practice their art uninfluenced by what is going on in their lives. To be able to manage strife outside of
the workplace, to put it aside for the duration of the next shift, is not always easy. As professionals, we
need to be able to give our patients the very best of ourselves;it can be the difference between life and
death. I feel that the relationship between the nurse and the patient is indeed often a reciprocal one,
changing the nurse as well as her patient. We cannot go through our days of being with people, often at
some of the darkest moments in their lives, and not come through unchanged ourselves. For myself,
being present as my patient transitions from life to death has had a profound effect. I have never shied
away from it, or felt uncomfortable in the presence of death. I feel honored to be a part of this journey,
and do all I can to ensure it is peaceful for both the patient and their loved ones, who often remain at
their side until the very end.
“While we adhere to health and curing/caring and healing as our primary mission in the health
care work”, writes nursing theorist Jean Watson of the transformative work of nursing, “we also now
have to acknowledge that we work within the great circle of life-death. This reality recognizes that we
all share this common task of facing our humanity at a deep level, both personally and professionally.
What we do is not without consequences, in that one way or another we are contributing to and co-
participating in the web of life.” (Cavanaugh, Maureen D bioethics, MS, MAHCM, RN, 2014) This
speaks to me in that as nurses, we must face the reality that we are agents of change, and this may mean
both working to best of our abilities to bring a patient back from the brink of death to a meaningful
life, to guiding them and their families to the end of their journey on this Earth. Jean Watson's theories
signify to me that there is grace in letting go, as well as not in giving up. This may seem a
contradiction. But I do not believe that it is, for in acceptance of what we may have formerly believed
concrete and absolute, we can find deep and meaningful growth, within ourselves and our patients. For
myself, I chose to believe that my primary goal is the care of my patients and their families, to facilitate

their understanding of both their choices and the consequences of those choices.
In many cases, my belief in regards to human health and illness is one of choice. Certainly not
in every case, but often in this society, the patients that come under my care are victims of their own
creation. An example can come from those close to my own heart; a patient that ignores warnings
about lifestyle choices, smokes two packs a day, drinking a six-pack of beer after their kids have gone
to bed, perhaps carrying an extra 15-20 pounds. Combined with a family and personal history of
hypertension, they have been warned they are at risk of stroke. This patient has the right and will to
choose to not take their medication, to continue to smoke and drink, not to monitor their blood
pressure. And unfortunately, suffer a stroke while still in their mid-forties. To be sure, a mild one, but a
significant event nonetheless. Persuading the public that making changes to their lifestyles, making
better, more informed choices, may seem a simple enough task. But it is the biggest hurdle that we face
as healthcare providers. Patients that choose to self-medicate with alcohol, and recreational drugs, are
putting themselves at high risk for hepatic and renal failure, endocarditis, familial dysfunction, and a
host of other medical and social problems that will plague them throughout their lives. Of course,
nurses cannot be expected to reinvent the wheel, so to speak. We are all human, with frailties and
failings in plenty. But when presented with clear choices from those whose business and responsibility
it is to know, to continue down a self destructive path must be accorded a measure of ownership. I
believe that all of us are responsible for our own choices, especially about our health. In addition, as
parents we are responsible for the health of our children, who cannot make those choices yet. Giving
them nutritious meals, limited on fat and sugar, keeping them from secondhand smoke, encouraging
activity and outdoor play, are the best ways to ensure a healthier next generation. To make excuses, to
play the victim, to blame others for our misfortunes, is so often an easier path to take, rather than taking
responsibility for ourselves. Being proactive, and preventative will have a much larger impact than can
be measured by surveys, statistics and case studies. As practitioners, we need to be open to new ways

of not only helping our patients to heal, but to prevent new new illnesses and complications with their
health from arising. I do understand that life and the human condition is not so simplistic; not
everything can be attributed to lifestyle choice. So many things happen that are beyond what we have
control over, car accidents, medication reactions, surgical complications, heartbreak, devastating
diagnoses, loss of loved ones, betrayal. These things can cause acute emotional as well as physical
reactions in us that cannot be explained away by modern medicine. I have seen my patients die of a
broken heart, succumb to their battle with cancer after re-staging, and I have seen amazing courage in
the face of imminent death, grace in the face of adversity, and peaceful acceptance that they were ready
for what lie ahead of them, that they had lived a good life and were ready to be with their lost loved
ones. That they believed they would be reunited with them I doubt not. I cannot image having such
grace in the face of the unknown. I have never been able to have the faith that I have seen so fiercely in
some of my patients, the absolute belief that their god had an eternal reward for them. I have wondered
what that would be like. I was not brought up with the tenets of doctrine, although I am familiar with
many, often finding my way there through simple curiosity, or a desire to please others. But I have seen
the comfort it brings to so many of my patients, and I have deep respect for it. I believe that I am
finding my way towards my own unshakable faiths and beliefs, though they may seem unorthodox to
most people I know. But the deepest belief that I have, that guides my life, is that we must in the end,
be kind, and be willing to stand firm for what we believe to be right and just.
“As I realized the value of interconnectedness, it became apparent that my responsibility to the
patient expands to a broader perspective as well. As a professional nurse, I'm responsible to society as a
whole. I'm responsible for acknowledging how my nursing practice influences how the public views
the nursing profession.” ( McCutcheon, K.A., 2017) This quote from Kimberly McCutcheon, a
perioperative nurse practicing in Dayton, Ohio, echos my feelings in regards to the responsibility that I
feel, not only to my patients, but in a much broader sense as well. We represent not only ourselves and

our place of work, but every nurse that has come before and will come after us. We are held to a higher
standard by society, and although we are all human, with the failings and frailties that come along with
that, we need to accept that we represent something that is greater than the sum of its parts. As
professionals we spend a good deal of time collaborating with our team members for the best outcomes
for our patient. We also spend considerable effort in working with our colleagues to keep our policies
current, to encourage the use of new technology and information, ensure safe staffing, and empowering
nurses to use their collective voice to ensure the best possible outcomes for patients and for each other.
Being willing to precept newly graduated nurses, to orient nurses coming from differing units and/or
shifts, taking the time to show a new technique to a fellow nurse, empowering those that look to you
for guidance and leadership to stand firm in the face of adversity, to set an example for those around
you ( especially at the end of a long shift!), are all qualities that define what it means to be a nurse.
These things cannot be taught in school, they are a part of oneself that develops as your practice does.
The longer one works as a nurse, the more it teaches you about yourself and your role in shaping the
future. There is no way of knowing how far-reaching the influence of one person can be, and those who
have the biggest influences in our lives may not even know their contribution. That we may be that
person to someone else is part of the wonderful experience that is nursing. I cannot imagine being
anything else.

References
Nursing Theory (2018) Nursing Theories and a philosophy of Nursing. (retrieved from: http://nursing-
theory.org/articles/nursing-theories-and-a-philosophy-of-nursing.php)
McCutcheon, Kimberly A (2017). Discovering my nursing philosophy. Nursing 2017, vol. 47 number
5
Cavanaugh, Maureen D (2014). A Transformational Journey Through Birth and Death. American
Journal of Nursing:October 2014-volume 114-issue 10-p 66-70
Chitty, K & Black, B. (2011) Professional Nursing concepts and challenges 6 th edition Saunders
Elsevier, Maryland Heights, Missouri

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