Running head: Nursing Philosophy

Nursing Philosophy
Gil Anthony Rubia
Bon Secours Memorial College of Nursing
Synthesis for Nursing Practice - NUR 4142
Dr. Turner
October 12, 2016

Running head: Nursing Philosophy

Nursing is the art and science of caring with the proper license to maintain and promote
health while upholding values of respect, compassion, justice, integrity, quality, innovation,
stewardship and growth. This type of caring is expressed through critical thinking and creativity
when delivering care. Nurses focus on a patients unique mind, body and spirit so that patientcentered care is properly delivered. Nurses are ethically, legally and morally grounded and are
accountable for their actions. Nurses use evidence based practice to promote wellness, provide
comfort, restore health, and prevent diseases. Nurses must treat a patient as a whole, healing their
mind, body and spirit so that health is obtained and maintained. The patients environment must
also be addressed since there are many environmental factors that affect health such as
socioeconomic and cultural factors. Nurses reach out to other disciplines such as case
management for those struggling with access to healthcare. Nurses focus on collaboration with
multiple disciplines and applying new evidence based practice into the field, improving patient
outcomes. Nurses are both teacher and student, forever in the endless cycle of learning.
A nursing philosophy is what drives the nurse to do what needs to be done on a daily
basis. The philosophy impacts how the nurse can implement the best possible care he or she is
able to give. This can be affected by one's culture, beliefs, and values. In my case, I try my best
to have comradery within the work environment. I understand that tension may rise between
coworkers, but having the majority be a friendly relationship will make nursing more efficient.
Regarding the patients, I focus on patient centered care, tailoring the care plan to the patients
and families needs. A simple drink or an extra blanket can change the tension between the nurse
and family, especially during the initial meeting. Nursing may have set rules on how to care for
patients or how to use certain equipment, but theres so much room for independence and
creative thinking, which is why I find that nursing is an art form that is continuously affected by

Running head: Nursing Philosophy

our beliefs and values. Personal philosophies and nursing philosophies interact with each other
and determine the individuals professional behaviors. However, philosophies can change over
time as a nurse matures.
My nursing philosophy still holds great importance in education. It is the basis of our
character in that without it, we are not able to be open-minded about certain aspects of nursing
care. Education encompasses a lot more than just memorizing what the correct answers are. It
enables you to think outside the box, apply your own knowledge to different circumstances and it
improves the outcome of the task. Education gives an opportunity for higher knowledge for all
ages. Nursing is a learning experience from day one, and continues to be a learning experience as
we advance through the profession.
In my last day of critical care experience in Memorial Regional Medical Center, Critical
Care Unit, I had a challenging yet rewarding experience. I was able to communicate effectively
with my assigned nurse, report changes in vital signs, and was able to provide my
recommendation regarding the patients plan of care. I was also quizzed throughout the whole
day about sepsis and its relationship to the patients physiological changes. Coincidentally, we
were also learning about sepsis at that time. The use of concept maps aided me in answering his
questions since I have had a few patients who has had similar complications.
On that day, I was assigned to a patient who had a diagnosis of sepsis. The patient had
unstable vital signs, and was continuing to deteriorate throughout the day. I was able to answer
most of his questions, such as the relation of sepsis to acute renal failure, low blood pressure, and
increased heart rate. I told him that sepsis is the inflammation with the presence of infection. The
inflammation causes the vessels to become more permeable, causing vasodilation, then in turn
causes hypotension. Usually, the renal system tries to increase his cardiac output, however, in his

Running head: Nursing Philosophy

case, the decreased cardiac output caused an acute renal injury. His heart rate was increased due
to his low blood pressure. He also asked me why the patient was on CVVH, instead of just
normal dialysis. He said that he would be impressed if I actually come up of the answer. His
statement made me doubt my thought process, so I hesitantly answered by stating that normal
dialysis significantly lowers the patient's BP. This acutely ill patient would not have been able to
tolerate it due to his condition. From my experience, dialysis patients were usually diagnosed
with chronic kidney disease, instead of acute renal failure. I was able to answer this because of
previous patients that has had similar issues.
After taking the 1300 vitals, the patient was becoming more febrile, the blood pressure
dropped even lower, and presented with tachycardia. These were significant changes compared
to the previous vital signs, so I quickly told the nurse about the changes. He then asked me about
what I would do if I was the nurse. I suggested giving acetaminophen, increasing the fluid rate to
increase blood pressure, and to increase the dose of the Levophed. He agreed about the
acetaminophen and the Levophed, but did not agree with increasing the patients fluid rate. It
then made sense to me since the patient was having minimal urine output. I failed to assess his
indwelling urinary catheters output, and did not include it in my plan of care. For this patient,
fluid overload was a high possible risk. He also suggested giving Dilaudid to decrease the heart
rate which I didnt consider, because I was afraid that it may lower his blood pressure even more.
We performed the interventions and the patients heart rate decreased, and his temperature
somewhat decreased. However, increasing the Levophed from 30 mcg to 40 mcg did not
significantly increase the patients blood pressure. The nurse then called the physician, reported
the situation, and the physician suggested to temporarily increase it to 100 mcg. This improved
the patients blood pressure significantly. This experience emphasized the importance of

Running head: Nursing Philosophy

education and collaboration. Through rigorous studying and clinical experiences, I was able to
express my knowledge and care for a patient with the assistance of my preceptor.
Throughout my nursing school career, my values has remained unchanged. I still hold
great importance to education and perseverance. In the beginning, my reasons for going into the
field of nursing was somewhat selfish. I enjoyed providing great customer service, helping
people in need, but I also truly enjoyed the feeling of receiving the patients gratitude. As I have
progressed, their gratitude for the care I have given them started to have a less impact on my
self-satisfaction. What mattered more was the quality of care I was able to give, and the positive
outcomes that came from it. Seeing a patient recover, and hearing a patient understand the
teaching I provided was what mattered more. Even when faced with a negative outcome, I am
now also satisfied knowing that I tried my best to help my patients. The focus of feeling good
transitioned from receiving gratitude from my patient to giving quality care to my patients.
In Patiricia Benners theory, a nurse goes through multiple stages such as novice,
advanced beginner, competent, proficient, and expert. Over time, the nurse acquires skills to be
more independent and improve on critical thinking. They rely on past experiences, perception of
a particular situation changes and they become more holistically involved. From obtaining
interview answers of the same clinical incidents from new nursing students, senior nursing
students, new graduates, and expert level nurses, the researchers were able to differentiate levels
of proficiency. Their answers differed greatly in competency, which showed the difference
between the level of thinking between novices and experts. In this study, 21 pairs of expert and
new nurses are paired up, selected from three different hospitals and were interviewed separately
about certain patient care situations. Additionally, 51 other nurses with different levels of

Running head: Nursing Philosophy

experiences were also asked. Educational backgrounds was not a criteria for this research. Their
answers were taped and typed so that a textual analysis could be performed (Benner, 2001).
According to Benner, novices are without real situational experience, taught rules to on
how to perform tasks and applied universally. Their behaviors are somewhat inflexible and
limited, following the rules they have learned. The advanced beginner is able to demonstrate
adequate performance, use past experiences to recognize important components, and has gained
enough experience to help guide his or her actions. Competent nurses are those who have two or
three years of experience in the same area. To achieve efficiency, they are able to use abstract
and analytical thinking. The proficient nurse perceives situations holistically. They show better
decision making skills and through experience, they are able to modify patient care depending on
the situation. Expert nurses goes beyond the rules or guidelines regarding their actions. They
have highly proficient performance regarding patient care and has a more flexible, fluid and
intuitive grasp of a situation (Benner, 2001).
Currently, I feel that I am on the stage between an advanced beginner and competent.
Disregarding the years of experience described in the competent stage, I have been able to
demonstrate quality performance during my clinical rotations that would put me in the stage of
advanced beginner and competent. In the beginning, we were told by the nursing faculty rules
and time frames to perform each task. It would cause me distress when I would go past the time I
was supposed to give medications because of having only one nursing staff able to supervise and
give medications with us. Looking back, I believe that I probably would have been able to give
medications on time if I had better time management and completed my assessments on a timely
manner. I was also unfamiliar with some of the medications, and researching what the
medications purpose and mechanism of action consumed some of my time.

Running head: Nursing Philosophy

As I progressed through nursing, I had gradually transitioned to using my preceptor as

guidance, instead of reliance. I also believe that I have some of the qualities of a competent level
nurse in relation to patient prioritization. I believe that this skill has been improved because of
my time in the emergency department during triage and using quick decisions on which patient
to see and which orders to perform. I am able to familiarize myself with almost all nursing
actions, understand changes in patients vital signs and recognize deterioration of the patient.
According to Benner, nursing is not just doing tasks, but recognizing as to why the task is being
done. In order to move forward, I need to be able to rationalize all the tasks that I am doing
before doing it. I have caught myself questioning my own actions, unable to think as to why I am
doing a nursing intervention.
In order to achieve the proficient level of proficiency, I need to be able to perceive
situations based on experience and recent events to plan my care for patients. I believe that I
already apply my past experiences to my plan of care of a patient with a similar problem, but I
also recognize that each situation is different. Recognizing the difference between each situation
and analyzing the unexpected results is one of the important keys to progress. Another step is to
learn more knowledge by reading case studies. According to Benner, proficient nurses learn best
through case studies which have enough complexity and ambiguity to real clinical situations
(Benner, 2001). I plan on continuing the use of case studies in my learning and apply them to
real life situations. An estimated time to reach the proficient level is three to five years, so I need
to immerse myself in an area where I can gain experience, and be able to look at the bigger
picture on clinical situations that does not present itself as normal. I plan to gain these first few
years of experience in the emergency department and immerse myself in this clinical area so that
I will be able to reach the next level of competency.

Running head: Nursing Philosophy

References
Benner, P. E. (2001). From novice to expert: Excellence and power in clinical nursing practice.
Upper Saddle River, NJ: Prentice Hall.