Personal Framework: Family Nursing Practice - Essay Example

?Personal Framework: Family Nursing Practice Theory and practice are both essential in health care provision. Nursing theories provide “nurses tools to ensure that nursing assessments are comprehensive and systematic and that care is meaningful” (Frisch, 2009, p. 121). Whereas, nursing practice is “the acid test of the nursing theory” (Martin, Forchuck, Santopinto and Butcher, 1992, as cited in Wood & Alligood, 2006, p. 17). In my nursing practice, nursing theories have given me focus in my work, has made me more critical in understanding my patients and my work, and has given me the self-confidence to perform my nursing role. Whereas, my practice has demonstrated the efficacy and limitations of the nursing theories I have learned. This has enabled me to better grasp the theoretical knowledge I have gained which before have been too abstract to me. Both have strengthened my foundation, and have broadened and deepened my understanding of nursing. My nursing practice has demonstrated concretely that health care optimization largely depends on patients’ cooperation. The Roy Adaptation Model, a client-centered model, which promotes patient cooperation, as it focuses on enabling the patient to respond positively to environmental changes (Hargrove & Derstine, 2001, p. 15) has been my personal practice framework. With this framework, I learned lot of things as a bedside nurse. I learned to look for the specific factors and various nursing interventions that in any way may have an impact on my patients’ adaptation process. My assessment skills have greatly improved; I am able to identify the abnormal; and I have learned effective methods to evaluate my output, if it has been the product of my nursing care or not. Putting into practice Roy Adaptation Model has compelled me to spend more time with my patients, enabling me to focus on their problems/needs. Resultantly, I have developed mutually respectful relationship with them that they cooperate with me in their healing process. However, in the course of my practice, I came to realize that developing self-care in my patients would capacitate them to adapt more easily to their changing environments. Hence, Dorothea Orem Self-Care Model has supplemented my personal practice framework. Orem’s three central theories of self-care, self-care deficit and nursing systems are congruent with the Roy Adaptation Model. Self-care comprises those activities performed independently by an individual to promote and maintain his/her well-being. Self-care deficit happens when self-care is not possible. Nursing systems are ways by which nurses could help capacitate patients for self-care. These nursing systems could be (a) wholly compensatory system – the patient is dependent totally to nursing care, (b) partially compensatory system – patient can meet some needs but needs nursing assistance, and (c) supportive – educative system – patient can meet self-care requisites, but needs assistance with decision- making or knowledge (Hargrove & Derstine, 2001, p. 14-15). In Orem’s model, self-care is the focus of health provisions to reduce incidences of hospitalization, which is in all ways stressful to families (Crumbie, 1999, p. 246). As such, this has helped my practice focus in enabling my patients to self-care. Resultantly, I learned how partnership in care between the patient and the nurse can be developed naturally. More importantly, it has demonstrated that by enhancing self-care in patients, their sense of adaptability is further developed. Consistent with Bandura’s Self-Efficacy Theory, one’s belief in his/her ability determines his/her behavior (Clark, 2009, p. 80). Therefore, as the patient sees and believes he is capable of self-care, the lesser he/she requires nursing. Furthermore, my practice has consistently demonstrated the family’s vital role in effective nursing care. As Bowen’s Family Systems Theory argues, individuals should be understood as part of their family. To understand each family member, how each one relates to each other has to be considered, because a family is a system of interdependent and interconnected individuals who in their interrelationships affect each other and the family as a single unit. As such, a patient’s condition cannot be effectively assessed in isolation from his/her family. Therefore, in understanding the patient, all family events must be considered as these might have affected the patient. (Becvar & Becvar, 1999, p. 6) Four Concepts of Nursing: My Conceptualizations Over the course of my FNP educational experiences my conceptualization on the four nursing concepts (humans, environment, nursing, and health) which embody the nursing meta-paradigm (Reed, 2011, p. 7) has also developed, with their interrelationships further clarified. Environment. To provide effective nursing care, the environment should be appropriate to the patient. This means differently for every patient, who is unique in his/her own way. This is the challenge I came to understand and had to accept as a HCP. My patients have diverse cultural and socio-economic backgrounds, which largely determine their choice of treatment. Even if diagnosed of the same illness, they could not be given the same regimen, because their diverse backgrounds determine the different ways by which they deal with the problem. So appreciation of my patients’ diverse backgrounds, especially what they considered taboo, which I come to know in the course of my interview with the family, has helped me determine whether my intervention will be acceptable to them or not. Thus providing the appropriate environment for patient is not easy; it requires open-mindedness, patience, empathy, and most of all respect. Nursing. My concept of nursing, though did not change, has greatly improved. Working at the bedside has shown me a lot when it comes to treating patients. My actual encounters with patients have made me fully grasp what it means to provide care to varied patients. I came to appreciate many things, which before were only abstract to me. First, that nursing is not a mechanical job, because various factors could affect both the patient and the NP. Second, that there is no one single best remedy for the same illness, because each patient is unique. Third, that there are lots of implications on the health care that we provide, like legal, moral, financial, and even political implications. Lastly, that nursing has to be dynamic, because every single moment is important in saving lives. I have encountered patients on both sides: the sick side and the not sick side. My experiences on both cases have taught me one thing: That despite their differences, patients seek for the same thing – a provider who would listen and take time out with them. This somehow eases their suffering. Health. My understanding of health also broadened, that it is not a simple clinical matter and that it is contextual. Meaning to say health is perceived in different ways. What is unhealthy to one patient may not still be healthy for another patient depending on how grave the illness is. For example, a single day without pain would already be healthy for a very sick person, yet a simple headache may no longer healthy for the perfectly normal person. Yes, we need to keep patients healthy. This is what we have sworn to. However, keeping them healthy does not solely depend on our discretion. There is the wider context that we have to deal with. For example, with the new changes coming forth with the healthcare reform, I am afraid that we are going to start encountering more of the sick in the private setting due to the fact, that patients cannot afford the healthcare cost. Humans. Nursing is hard not only because of the nature of the job, but more so because nursing deals with humans – the most complicated specie in the world. Sometimes, there are those who knew better than HCP that extra-ordinary patience to help them understand the necessity of the intervention is needed. Though this has oftentimes tested my limitations, it has also made me better understand the patient and the intervention itself. Other times, there are those who would not want to divulge important information to protect their family’s reputation. It was during these times that I realized the importance of getting the confidence of the patient. Most of the times, patients decline the intervention for financial reasons. This is the most painful part for me, because I realize the limitations of my profession. Majority of my clinical rotation was done in a private office with lots of state aid patients. These were the patients, who I felt always rely on the office for assistance. They tried to select what medications to take and what regimen they would allow. When I was in the private setting with private insurance, the population was different. They followed whatever the provider prescribed. However, regardless of the situation, as a HCP, I want patients to understand that although they have rights, not all of them are correct. I would like to advocate for my patients, but for me to do it effectively, I will need their full cooperation. Other Constructs Relevant to Nursing: My Conceptualization Aside from the nursing meta-paradigm, my conceptualization of other constructs, such as spirituality, balance, self-care, autonomy, and family, relevant to nursing have been clarified and changed also in the course of my practice. Before, I view spirituality in nursing simply as respecting the religious belief of my patients. Now I came to understand that spirituality is more than this. It is actually giving them hope and easing their pain, and encouraging and empowering them to participate actively in the healing process. Balance may mean giving equal consideration between knowledge and humaneness or keeping your professional and personal life in equilibrium, which places us in a dilemma. Other than that, now I learned that between the two, the former is harder than the latter, perhaps because at stake is the patient. Balance between knowledge and humanness often occur in terms of the supposed intervention as against the patient’s right, specifically his/her right to decide. Even if the intervention is proven scientifically effective, yet the patient chooses to decline it, or if the intervention is scientifically proven futile, yet the family of the patient persists for it; which shall prevail? What I learned here was that, the concept of balance in nursing oftentimes fall into an ethical question. This means, what is scientifically correct may not be ethical and vice versa. And in this human world, ethical consideration is given prime importance over scientific truth. Self-care and autonomy are two other constructs in which spirituality and balance also come into play. Self-care applies not only to patients but also to nurses themselves. As nursing is undeniably a tough job, it is essential that nurses should also care for themselves, because nursing practice can be optimized if nurses are at their best to care for others. On the other hand, autonomy determines the boundary of my responsibility and authority as HCP. Sometimes, autonomy results to conflict between nurses and doctors, between nurses and patients, or between nurses and hospital administrators. To avoid this, clear rules and guidelines are important. However, there are times that a NP has to take the risk to go over the line, when at stake is the life of the patient. To take this however, the NP must be sure of what she does. How to strike the balance between self-care and call of duty is a practical question that we always encounter. Here, spirituality becomes important, because always the deciding factor for me my disposition to provide nursing care. On the other hand, how to strike the balance between autonomy and need is a question that requires courage and wisdom on the part of the NP. Before, I only perceive family as that which composes it. When it comes to health care, I only see it as the patient support. But my nursing practice has taught me that the family is a system of relationships within and beyond it. And these systems may have influenced the condition of the patient. Thus involving the family from assessment to intervention is essential. Family Theory and My APN Framework as an FNP There are different family theories that can be applied to family health care. But despite their differences, they all emphasize one thing important: All individuals originate from families that have somehow shaped them. The important implication of this to health care is that “families are an inherent and inevitable participant in the prevention and treatment of diseases and health problems” (Doherty, 1991, p. 2423). As such, consistent with my personal framework, these family theories have influenced my APN framework as an FNP in such a way that I came to understand patient not simply as the individual but as a family unit. Thus my nursing care has not been limited to the recovery of the individual patient but also extends to help enable the family to arrive at the best decision and to adapt to the stress they are undergoing. Hence to ensure an integrated family approach in my student FNP, I have consistently enacted family history in my clinical assessment of patients. I do this by conducting formal and informal interviews among available family members. Once I perform my assessment and exam on the patients, if family members are in the room I also ask if they have any questions or concerns in what the patient and I have discussed. I have encountered on numerous times when my elderly patients bring their children to help remember if any changes are needed or done.  Both interviews are important; though in the informal interview important inside information not usually divulge in formal interviews are unconsciously provided, for example the relationship of family members, the internal dynamics of the family, the values of the family, and others. I usually substantiate these with keen observation. The Nurse Practitioner Role within the Office Setting: My Understanding My understanding of NP’s role within the office setting is that my responsibilities will be as challenging as any other nurse caring settings demand because as always nursing care is to help ensure the efficient provision of our patients’ health needs. Hence nursing procedure, educating patients, and medication management remain my essential role. Although, I also understand that this will give me a unique opportunity to learn new skills, for example billing and coding, phone management, patient flow, practical knowledge of technology and software programs, supply management, and dealing with pharmaceuticals, and probably more. As Richmeier (2010) clarifies, medical offices often require nurses “to work closely with the providers and therefore require knowledge of these various roles (p. 65).” This to me is an exciting anticipation. As such, my essential task as a medical office APN is patient management and office administration. The Relationship between My Practice Framework, the Nursing Process and the Clinical Decision Making Processes: An Analysis My practice framework had always instilled in me the primary importance of my patient, that I had consistently conducted my assessment, diagnosis, planning, implementation and evaluation, putting my patients at the center. I had always reminded myself that what I am doing is always intended to provide my patients the best possible care they needed and agreed to have and at the same time help develop in them resilience to their changing environment. Furthermore, since “clinical decision making is at the heart of clinical encounters” (Sque, Chipulu & McGonigle, p. 235) and since the recipient of whatever clinical action arrived at is the patient, I always regard the opinion of my patients and their families with high esteem, that any intervention remains a proposal not until the patient and their families agreed to it. Added to this, I find it part of my nursing role to help them understand both the positive and negative implications of the proposed action, emphasizing in them that their health is actually their decision. This patient-centered and family integrated approach in my NP has made me appreciate the nobility of my profession, and it has made me a proud NP. References Becvar, D. S. & Becvar, R. 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Crawford Shearer (Eds.), Nursing knowledge and theory innovation (pp. 1-36). New York, NY: Springer Publishing. Richmeier, S. (2010). Fast facts for the medical office nurse: What you really need to know in a nutshell. New York, NY: Springer Publishing. Sque, M., Chpulu, M., & McGonile, D. (2009). Clinical decision making. In M. Hall, A. Noble & S. Smith (Eds.), A foundation for neonatal care: A multi-disciplinary guide (pp. 235-252). Southampton, UK: Radcliffe Publishing. Wood, A. F. & Alligood, M. R. (2006). Nursing Models: Normal science for nursing practice. In M.R. Alligood & A. Marriner-Tomey (Eds.), Nursing theory: Utilization & application (3rd edition, pp. 17-42). Missouri: Mosby. Read More