The nurse has seen many changes in nursing since starting in 1974. In the past, doctors led care and nurses followed orders without question. Patients had little say and were not fully informed. The nurse now sees their role as advocating for patients and facilitating their autonomy and decision making. The nurse believes Jean Watson's Theory of Human Caring fits their philosophy, seeing people as more than their illness and considering psychological/social factors. The nurse aims to care for the whole person within their communities and values putting patients first over schedules.

1. Personal Philosophy of Nursing<br />Elizabeth A. Libby RNC IBCLC<br /> Having been in nursing since 1974, I have seen and participated in many transformations in nursing. In the 1970’s and 1980’s the medical community had the upper hand and knew what was best for the patient. We wore white uniforms, nurse’s cap, school pin, name pin, white stockings and polished white shoes. We carried the air of authority. The patient was submissive and the family did not count in the process or ask too many questions. They were there to visit and take the patient home once the nurses had restored their health. Patients were at times not told of their diagnosis. Many of the hospitals where I have worked seemed only interested in caring for the sick patient, not the person. We would often refer to the “Gallbladder or fractured hip in room 409”. We would get them out the door so we could get the next patient admitted. Nursing at that time was still very controlled by the doctors and nurses did as they were told with few exceptions. Nurses charting was by omission. If you didn’t chart it, then you didn’t do it or were not involved in the incident and could not be held responsible. This behavior was encouraged at that time. Nurses were also not involved in policy making and followed the policies of others almost without question. No one asked a staff nurse her opinion about anything. You got your schedule and you came to work, took good care of your patients, charted and went home. Each department in the hospital worked in isolation. Even in today's fast food world, a quick turn around seems essential in everything including the hospital stay. Women with breast cancer are to take in the diagnosis, have surgery and out the door to have follow up radiation and /or chemo. The nurse must triage and treat, meet all the needs of patient and family with the DRG time frame. She does all this with safety, Quality Improvement, Joint Commission and very tight budgets in mind. Orem’s self care deficit model fills the need to administer care to the patient assisting them toward independence (George, 2002). The self care model was the focus of my thinking and behavior for many years. The nurse acts as the facilitator to the patient's decision-making process and respect is said to be emphasized by the important role the patient plays in her own care. Within this model, the patient moves through stages of dependence to independence, (McEwen & Wills 2007). I found respect and patient decision making to be given at best lip service, and they better move through the stages to independence pretty darn fast. I no longer play this game. Moving forward in my career and obtaining my BSN, I appreciate the difference in a occupation and a profession. I believe that to present nursing on a professional level that the BSN requirement is necessary. <br /> I have contemplated many of the nursing theories and believe that I incorporate many parts of several theories into my own practice. I feel I am continuing to evolve as time goes on. I think it is not only beneficial but essential to maintain growth in my nursing career whether it is formal education or experience. I grew up with a Quaker background and this in part molds my personal philosophy. Our belief is a commitment to non-violence and a being open and tolerant of other cultures. We believe that we must show outwardly what we attest to experience inwardly. Our lives are to be demonstrated in peace, equality, integrity and simplicity. <br /> The Theory of Human Caring as defined by Jean Watson fits well with my own nursing philosophy today. Her theory focuses on the human experience being not one truth, but many truths and thinking must be non-linear (George 2002). In this theory you will find three conceptual elements. These elements are described as Carative Factors, Transpersonal and a Caring Moment and the Caring Occasion/Moment (nursing.ucdenver). The Theory of Human Caring also includes not only the patient but the care giver as well (Cara 2003). At times, our critical thing skills tend to move in a linear direction and collide with this theory. It is a challenge but is easily over-come if one is creative. Often there is a need to look outside the limits of our scope of practice without stepping across the line. Both the client and nurse are well served when this occurs. The ability to meet these challenges rekindles the desire and belief that a nurse is instrumental in creating change and finds reward in being a significant figure in that clients outcome.<br /> Human beings are different from all other species on earth. We have unique personal values, beliefs and create our own past, present and future as well as have concern for others (George, 2002). Environmental forces act upon us and forge the individual we become. Our strengths and weaknesses are exposed but we are protected / nurtured by family and community throughout our life cycle. Our ultimate weakness may appear as illness. This person and extended family then enter the new community of medicine. This new medical community may have beliefs and practices that differ from those of the patient and family. As the nurse I must consider the whole patient, extended family and the community in which they reside. I have found that I am now more concerned with the patients’ comfort and understanding of the illness process than I am about schedules or others’ agendas. I fully believe that each patient should get first-rate medical care, but that is only part of the picture. I definitely have a reputation as the patient advocate of our unit and enjoy helping the patient move more easily through the system. At times this adds a tremendous amount of work to my day. It is not only the patient and family but social service, business office, public health, mental health, or even DYFS (Division of Youth and Family Services) in which I find myself involved. I believe in doing whatever it takes to get the individual the services they need. I am no longer timid about stepping up into a leadership roll and do not fearing failure. Somewhere I heard something that went, with failure comes knowledge and with knowledge comes wisdom, or at least I hope so.<br /> <br />References<br />Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal of Human Caring. Vol 7 (3) pp 51-57.<br />George, J. (2002). Nursing Theories: The Base for Professional Nurse Practice. (5th ed.) Upper Saddle River: Prentice Hall<br />McEwen, M., & Wills, E. (2007). Theoretical Basis for Nursing. (2nd ed.) New York: Lippincott Williams & Wilks.<br />http://www.ucdenver.edu/faculty/theory_caring.htm, University of Colorado at Denver. Caring. Retrieved September 9, 2010.<br />