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Personal Philosophy Paper

Sara Cable
NUR 4142: Nursing Synthesis
October 21, 2015
Instructor: Susan Massengill

Robin Williams, who played Patch in the movie Patch Adams, had an amazing
monologue that is meant to change the way one looks at medical treatment. During a hearing in
which Patch is questioned about performing medical treatment without a license, he explains his
philosophy of how all patients are not only patients but doctors as well. He goes on to state, [...]
you treat a disease, you win, you lose. You treat a person, I guarantee you, youll win, no matter
what the outcome (IMDB, n.d). What this quote means, to me, is that if you focus on a disease
and you look at a person as only a disease process you are less likely to bring them to wellness, a
term that isnt defined just by absence of disease. By neglecting the wellness of the whole person
you may physically heal someone but still leave them emotionally, mentally, and spiritually in
distress. But when you focus on the physical, mental, emotional, and spiritual aspects of a
person, the whole person, you will always have a positive outcome and you will always make a
positive impact no matter what happens. This quote, I strongly believe, is the perfect definition
of what nursing is. It also encompasses several of the tenets that define Bon Secours nursing
program, including caring, health, and service.
To care for a person is to not only focus on the physical, but to focus on the persons
whole self when they cannot do so alone. Health within nursing does not just center around the
curing of an illness. In fact, in nursing, health is more about prevention than curing. The quote
overall symbolizes the caring and health tenets by honing in on the total person in a way that
doesnt just focus on a disease process. Service, another tenet of the college, is very important in
the nursing profession. A nurse provides service to the person by not only providing medication
and helping with daily living tasks, but also by providing a quiet presence or a listening ear when
needed. The quote speaks about service in a very vague sense, but one can extrapolate that
treating the whole person is to provide a service for those in need.

I follow this philosophy every day in my nursing practice, sometimes directly and other
times indirectly. I understand that caring for a patient is not only to focus on physical needs. I
have to look at the total package. What are the dynamics within this family relationship? Does
the patient want religious practices done to help them in healing? Does the patient who has a
terminal illness want hospice services or do they want to fight till the end? Is the patient scared?
If a patient is angry, is it because they feel like they have not been heard or are there outside
forces causing it? These are all questions that are important to ask when focusing on the total
person. I also recognize that a patient usually needs help with caring for themselves, and as a
nurse I am of service to them and am there to care for them.
Though this example that I am about to share happened to me as a PCT, it could very well
have happened with a nurse. About a year ago we had a patient who was getting more and more
ill and constantly coming back to our unit for longer and longer stays. One evening this patient
was constantly hitting the call bell like he usually did. We had tried to redirect him many times,
but he still hit the call bell incessantly. When he realized that we were not answering his call bell
anymore he started yelling fire over and over instead. One nurse went into his room, said
something, and then slammed the door. Yet he still screamed and hit the call bell. Finally I went
in to see if I could talk to him, knowing that my chances of making things better were slim. I sat
down next to him and let him yell at me for a moment. Afterwards I asked him what he used to
do for a living, and found out that he used to work as an engineer for airplanes. I was able to
discuss with him the similarities in work ethic between both professions, and how difficult it was
to get work done with so many distractions.
This discussion seemed to calm him down a bit, but he still shared concerns that we were
not meeting his needs. To help him feel that his needs were being met, I discussed an agreement

that could be made with him. I would agree to come into his room every 45 minutes to check on
him, and in returned I asked him to trust that I would fulfill my promise and not hit the call bell
unless there was an emergency. He also had to agree that unless there was a real fire he was not
to yell out like he had been doing. I consistently showed up to his room every 45 minutes. I
wrote the time that I came in and when I would be back on the board, even when he was
sleeping, just so he could see that I had come in like I promised. For the rest of the night he was
quiet and friendly, two descriptions that I would never attribute to him usually.
Through this experience I demonstrated the concepts outlined above. By sitting down and
taking a moment to at least appear that I had the time to talk, it helped the patient to express their
feelings. Everyone was focusing on his physical symptoms, or lack thereof, and were becoming
frustrated with the fact that he physically was already being cared for. But for whatever reason,
no one was meeting his emotional needs. By consistently visiting like promised, I was able to be
of service to him in a more meaningful way. I was able to still complete my work, but without
the call bell constantly ringing. Of course it took more time to visit him every 45 minutes, but
most times he didnt need anything, so it was often a quick visit.
Since I first wrote this paper back in NUR 1100, my beliefs and values have changed
dramatically. When writing this paper before, I had a difficult time trying to even decide what I
believed nursing to be and it was hard for me to pinpoint a specific reason for why I wanted to be
a nurse. I looked at it as a way to pay bills and a steady job prospect. I felt very strongly that to
reference nursing as a calling was a way to diminish the complex skills that a person learns
and instead replaces that with a lofty idea of a person being chosen by something spiritually
bigger than ones self. I still dislike it, but I am more understanding of what a person means
when they state that nursing is their calling. It takes a certain kind of person to work within the

nursing field and not everything can be learned. Emotional aspects of the job can not be taught. A
person must already possess the emotional intelligence to survive in such a difficult industry. I
never really understood that at the beginning of my nursing school career like I do now.
The Dreyfus Model of Skill Acquisition in relation to nursing, which focuses on the idea
that in the acquisition and development of a skill, a student passes through five levels of
proficiency: novice, advanced beginner, competent, proficient, and expert (Benner, 2001, p. 13).
Each stage has a different goal in teaching and learning.
Stage 1, or what is referred to as novice, relates to those who have no experience. This
would apply to a nursing student who has just started within a clinical rotation. They are taught
ideas that do not correlate with context, but instead are inflexible in definition so the concept can
be better understood (p.20-21). They learn about attributes which include things like weight,
blood pressure, height, and heart rate. Situations provided to students are presented in a way that
is void of any variables that might complicate the situation. A nurse would also be considered a
novice if they have developed skills in caring for one type of patient population and then
transfers to an area that handles a very different patient population (p. 22).
An advanced beginner, who is at stage 2, is considered a person who is able to perform
skills at a marginally acceptable level (p. 22). While the focus for the beginner may be
centered around attributes, the focus within stage 2 are attributes and aspects, or the recognition
of characteristics that one only learns through experience (p. 22). This group is able to recognize
certain situations through previous experience, though they only have minimal amounts of
encountered experiences to apply within these situations. With this knowledge, they are able to
process theoretical knowledge with the current experience to form a plan of action. They,
however, treat aspects and attributes as equally important (p. 23).

Those who graduate to stage 3, or are considered competent, have had two to three years
of experience. They are able to see actions in terms of long term goals and are able to create a
plan of care to follow when determining what is considered important to notice (p. 25-26). The
skills that are lacking in this group include speed and flexibility, however they are able to display
some mastery of the tasks performed. The proficient nurse, who is at stage 4, is able to see
situations in terms of a whole instead of as bits and pieces like competent nurse views situations.
This nurse is able to perceive cues of importance as they appear; it is not necessary for the nurse
to think it through to come to a conclusion.
Lastly, an expert nurse, who is at stage 5, no longer needs to rely on preset rules and
guidelines to process a complex situation and the necessary action that applies to that situation
(p. 31). This nurse relies on gut instincts because of their abundant previous experience with the
same situation. They have an appropriate amount of confidence in regards to the actions that
need to be taken. They may make mistakes, but overall they properly assess a situation and
perform the correct action.
Within my practice, I believe that I function as an advance beginner nurse. I have many
hours of clinical experience, have watched nurses handle situations while at work, and have
encountered issues myself during work. Because of this, I am able to understand that nothing is
usually as defined in the text book. I understand that even though I should report all
abnormalities in vital signs, I am able to determine when the results are critical or inadvertently
due to something else.
To move from an advanced beginner to a competent nurse I will have to first gain
experience. Without experience I will not be able to notice the effect that certain variables may
cause within certain situations. This can be accomplished by gaining employment in an area of

nursing that interests me. Secondly I will need to be watchful of other nurses and how they
process situations. You can learn a lot just by watching someone. Without even asking questions
you may be able to process the reasoning behind your cohorts actions. You can also see ways in
which they handle something differently that helps speed up the process without affecting overall
patient care. Lastly, I will be sure to ask questions of other nurses and get their view on a
situation when I may not feel confident in what action I should consider. I will ask management
questions about types of continuing education I can do to further my skills. I will also ask
management as well as other nurses about what areas of improvement they see in my work.

Reference
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing
practice (commemorative ed.). Upper Saddle River, NJ: Prentice-Hall.
IMDB. (n.d.) Patch Adams. Retrieved from: http://www.imdb.com/title/tt0129290/quotes.