Running head: PHILOSOPHY OF NURSING 1

Philosophy of Nursing

Deirdre Brown

Bon Secours Memorial College of Nursing

Dr. Christine Turner PhD, RN

Synthesis of Nursing Practice - NUR 4142

September 10, 2018

“I Pledge”
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Definition of Nursing

Nursing is a practice that allows those who have chosen the profession to participate in

ensuring the wellbeing of those for whom they care. Whether in the hospital, doctor’s offices or

clinics, nurses play significant roles in the lives of their patients by participating in the

coordination of care, administering medication, creating a safe environment or simply holding

the hand of a patient who is scared. Nurses are promoters of health, supervisors, teachers and

servant leaders in their communities.

Personal Philosophy

Being a nurse is about treating patients with compassion, care and dignity wherever they

may find themselves on their healthcare journey. Patients are often at their most vulnerable when

in the hospital or clinical setting and need to feel that they are in the care of someone that they

can trust. I’ve always enjoyed helping others in need and being of service so choosing to be a

nurse seemed like a natural fit when I decided to get my BSN. I knew I was in the right place

from the very beginning but it wasn’t until my first clinical experience that I understood the

importance of the nurses’ role as part of the health care team and just how important it is for

nurses to know best practice in order to serve at the highest level. I’m at the beginning of my

journey but feel that good communication skills are vital in being able to educate patients and

play a part in their journey to health or in providing care and direction at the end of their journey.

I implement or “work” my philosophy by doing my best to bring awareness to each patient

encounter with the intention of being present and connecting on a level that will allow me to

provide the best care of which I am capable. I know I have my own biases and work regularly to

recognize them in an effort to treat each patient with the dignity and respect I feel they deserve.

For example, in my current clinical experience on the behavioral health unit, I am learning as I
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go what is considered normal and abnormal and when to set limits with patients. I have a

tendency to trust and take people at their word when the most therapeutic response may be to

question or talk about appropriate boundaries instead of automatically accepting. I believe that

with this population, showing respect and building trust is essential to creating an environment

for healing.

Nurse Patient Encounter

I work on the behavioral health unit as a Patient Care Technician and I’m also there for

my student immersion experience. I have been fortunate to see experienced nurses play many

different roles with this population. When patients show up on that floor they are generally not

doing well and present many times with co-morbidities that need to be looked at and treated

alongside their current psychiatric issue. I have been impressed over and over with the patience

and attention that the nurses give their patients as well as the layers of knowledge from which

they seem to draw. I think it is a special type of nurse who can care for a person who is literally

not in their right mind while at the same time getting them to cooperate when they are

somewhere between sacred, angry, depressed and really sick, so that they can get the care they

need. There is one nurse who seems particularly adept at knowing the right tone of voice to use

depending on where the patient is mentally and what they are able to handle on their own. With

one patient, I watched her be stern, soft, attentive, serious and jovial over a five day stay,

depending on the level of stability and the care needed at that moment. When the patient first

arrived, they were feeling a high level of anxiety and benefitted from the nurse’s calm yet

focused demeanor. From her years of experience she seemed to intuit or know for what the

situation called. As the patient’s mood stabilized, I watched the nurse’s tone change and become

more conversational. This to me is a demonstration of what a nurse is and does; coupling the
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desire to serve with the knowledge gained from experience in an effort to best shepherd those in

their care towards health.

Values and Beliefs

My values and beliefs haven’t changed much since I wrote my personal philosophy paper

in NUR1100 but my understanding of what it takes to be an effective and empathetic nurse in an

often challenging environment is greater. For example, students are taught that communication is

important when caring for those who are ill but I didn’t have a sound grasp of what that meant

until I witnessed nurses ask questions of patients that didn’t come from a “to do” list of

questions but came from the nurse’s desire to understand what exactly was going on with the

patient or from their desire to be an advocate for a patient. What I saw was that their effective

communication skills may have saved the patients life or at the least, saved them a lot of pain.

On the behavioral health unit, patients can sometimes exhibit behavior that would test the

patience of the average person and I have watched nurses and doctors on that unit exhibit

immense patience and compassion for people who are sometimes at their worst behaviorally.

Because they are not met with resistance or judgement, a space seems to open up for them to

calm down and receive the care they need. I have witnessed this same calm during my rotation in

the emergency department where so many come in agitated and scared or close to death and can

benefit from a nurse who can act quickly yet remain calm in their efforts to save lives. I’ve

learned that not only is communication a way of speaking to find answers but also a way that a

nurse can present themselves that may not be as much about verbal communication but that lets

the patient know that the nurse is there to deliver the best care that they can.
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I also have a greater understanding of the attention to detail that is required of nurses.

From assessment skills to medication administration, it is vital that nurses ask the right questions,

look in the right places, notice subtle changes in a patient’s condition, speak to others who may

help complete an assessment as well as research what a patient may possibly have going on.

Nurses are expected to be quick thinkers and quick on their feet and be able to respond to many

different types of patient situations. All of this is important while maintaining the interpersonal

skills that are needed to work with other staff members and to be the friendly face on which the

patients are often depending. Watching experienced nurses in action has at times left me both

highly impressed as well as wondering how long it will take before I feel myself to be as

competent a caregiver.

Benner’s Theory

In Patricia Benner’s book, From Novice to Expert, she speaks to the theory that the level

of skill acquisition, related to the practical knowledge gained over time from actual nursing

practice and direct care, can be interpreted through a model and classified into five stages of

nursing. The fives stages include: Novice, Advanced Beginner, Competent, Proficient and

Expert.

Skill Acquisition

Benner described the novice as, “having no experience of the situations in which they

are expected to perform” (Benner, 20). The nurse in the novice stage performs based on

measurable data that does not depend on experience. The “advanced beginner” is defined by

Benner as, “ones who can demonstrate marginally acceptable performance, ones who have coped

with enough real situations to note (or to have pointed out to them by a mentor) the recurring
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meaningful situational components that are termed ‘aspects of the situation’ in the Dreyfus

model” (Benner, 22). My skill acquisition level as a student nurse would be considered

somewhere between “novice” and “advanced beginner” as I have what would be considered

some experience in the clinical setting but not enough to consistently be able to draw conclusions

from my previous experience. At this level I rely heavily on the general rules I have learned in

nursing school but I’m beginning to recognize signs and symptoms in patients that indicate

improvements as well as declines. I have been fortunate to have teachers around me who have

been willing to point out changes that are significant and answer my questions and so allowing

me to gain a better understanding of each patient’s status. One of the jobs my preceptor has given

me is doing care plans and one of the questions that presents is whether or not the patient is

progressing. In order to answer the question I have to know how the patient presented when they

arrived as well as how they are currently. I read notes, ask questions and talk with the patients to

gain an understanding of their progression. This has been immensely helpful in knowing where

they are currently but also in seeing the bigger picture of what is considered progression in this

population. Being able to draw conclusions from previous experience is a quality of an

Advanced Beginner nurse.

Action Plan Moving Forward

The third stage of skill acquisition is termed “Competent’ and is when the nurse has been

learning in the same or similar environment for 2-3 years. Benner describes this stage as, “when

the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she

is consciously aware. The plan dictates which attributes and aspects of the current and

contemplated future situation are to be considered most important and those which can be

ignored” (Benner, 22). The next stage for me would be to be solidly in the Advanced Beginner
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stage and moving toward competent. I would like to think that in many cases I demonstrate

acceptable performance but know that I have much to learn in my field. I look forward to having

enough experience that I can consistently draw from prior experience to draw conclusions to

guide my assessments and nursing plans. To do this I will continue to rely on those around me

for guidance. Nursing is taught and learned through an apprenticeship type system and as a new

graduate I have every intention of learning from those who are willing to share their experience

and expertise. I also feel that to become a solid Advanced Beginner, it will be important to have

an open mind in order to move from a task oriented, short term goals view to seeing the patient

with more long term range goals in mind. I feel this will come naturally with experience. I also

feel it is important as a new nurse to be willing to learn a lot in a short period of time without

letting myself be overwhelmed. I want to learn as much as I can and provide great patient care

and plan to do that by applying my acquired skills in a safe manor so that I can begin to trust

what I’ve learned and apply that knowledge in recurring situations. In an effort to feel and be

considered competent, I will pay attention to the bigger picture of each patient’s care and try to

decipher what is truly important to their long term health.

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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.