The Role of the Nurse as an Advocate: A Reflectionon Learning and Spirituality - Essay Example

The Role of the Nurse as an Advocate: A Reflectionon Learning and Spirituality This paper is a reflection about a critical incident which involved asenior nurse who was charged to take care of a 37-year old, terminally ill cancer patient. I was asked to observe her interactions with the patient to be able to get more exposure with according care for these patient type. What I wanted to highlight in this paper was the strong spirituality which my mentor has practiced throughout the whole experience. From my point of view, this helped the patient and his loved ones cope with his condition more effectively. Religion and spirituality are arguably "among the most important factors which structure human experience, beliefs, values, and behavior, as well as illness patterns" (Moberg, 2002). Religion and spirituality significantly influence both mental and physical health in later life and relationship with God forms the foundation of their psychological well-being (Mackenzie et al, 2000). Personally, I feel that anyone who is involved in the provision of healthcare should be able to infuse a certain degree of spirituality into his practise. This is part of the holistic approach of treating patients. I realize that I must not only be concerned with addressing the physical needs or illnesses of the patient but must be able to expedite healing by delving into the spiritual aspect as well. From my experience in caring for critically ill patients, I realize that being able to lift them up through advise on spiritual consolation is important. It actually expedites physical recovery. Concretely, in healthcare practise, this means being able to give hope to both the patient and his loved ones, anchoring on the belief that there is a Higher Being that oversees everything that is happening to us and designs these for purpose. Formal religious involvement is related to general measures of personal adjustment and subjective health and life satisfaction (Koening, 1999). Spirituality is at the core of all human beings (Moberg, 2002). Religious and, or spiritual experience provides a sense of meaning and purpose in daily life and it is a primary source for inner peace, values and social harmony (Witmer & Sweeny, 1992), a greater sense of wholeness, connectedness, positive outlook. During the same experience, I remember one patient relating to me that he still feels happy despite being terminally ill. I realize then that religiously active people report higher levels of happiness. Upon reflection, I also acknowledged that a touch of spirituality is not only applicable for those who are suffering from illness; delving on the spiritual dimension also yields positive benefits even for those who are in perfect health. Based on my experience in caring for patients, they are given encouragement when they are reminded that a Higher Being is taking care of them. Just this thought helps substantially in healing them inside and out. It is the spiritual dimension which is an innate component of human functioning that acts to integrate the other components. I realize that spiritual wellness represents the spiritual dimension that permits the integration of one’s spirituality with the other dimensions of life, thus maximising the potential for growth and self- actualisation of a person. Mackenzie et al. (2000) reviewed over 250 studies examining the relationship between religious involvement and a wide variety of health conditions. It was found that as individuals aged, both formal and informal religious participation were associated with better health, happiness, and life satisfaction. Even when health was controlled, the strong link between religiosity and subjective well-being remained. Religion is related to good mental health and emotional health. For example, intrinsic religious orientation is inversely related to depression, anxiety, fear of death in older adults and they better cope with illness, loss, and grief (Mackenzie et al, 2000). I feel that onevery concrete application of spirituality in healthcare is in the area of geriatric care. According to Erickson (1963) and Liang-che (2001), from the stand point of developmental psychology, humanity passes through different stages stretching from birth to death. For example, a new sense of completion and ego during the final part of life (Erickson, 1963), increased wisdom and decreased use of immature defenses, a feeling of acceptance and contentment perhaps due to a positive life review (Butler & Lewis, 1973), ego transcendence (Peck, 1997), or increasing spirituality, or an integrated self (Jung, 1969). One other application area of spirituality is in the realm of counseling. As a nurse advocate, my mentor has been able to develop a close relationship with the cancer patient, I feel that nurses will be more effective if they try to address the needs of a patient holistically rather than just focus on curing his physical ills. I also feel that nurses and counselors interested in working well with clients committed to a particular spiritual view can best do so by affirming the importance of spirituality in the client’s life, using language and imagery in problem solving and treatment that is congruent with the client’s world view. Moreover, basing from experience, I feel that this process calls for cultural sensitivity and ethical practises of the highest standard. Regardless of the form spirituality takes, spiritual aspects of client’s lives can be enhanced through creating rituals or other ways for clients to focus on their lives that help them appreciate life rather than depreciate themselves. I feel that it is important for us nurses to address clients spiritual beliefs in counseling since they often influence the way individuals construct meaning of life events and the coping strategies individuals use to deal with challenges and problems in their lives. In many cases, nurses’ and counselors’ personal spirituality/religiousness may prove a value base for being attuned to clients’ spiritual and religious issues. I also realized from this experience as a nurse advocate that nursing is not just about curing an illness or disease – it is beyond that. It is about the nurse being able to center consciousness on the entire being of the other in order to detect his/her inner condition, and impart genuine concern through caring moments communicated through “movements, gestures, facial expressions, procedures, information, touch, sound, verbal expressions and other scientific, technical, aesthetic, and human means of communication.” The role of consciousness is deemed greatly important, because then the nurse exhibits commitment and sincere intention to connect with the patient at a deeper level, thus becoming an effective aid in nursing the patient back to health, physically, emotionally, and spiritually (Watson, 2006). On this aspect of personal and professional dimensions of the spiritual journey, Myers, Sweeny, and Witmer (2000) crafted an original model consisting of 16 dimensions later categorised into five major life tasks based on Adler’s theory of life tasks (Witmer & Sweeny, 1992): (a) spirituality, which is a profound appreciation for life; (b) self-regulation; (c) work, recreation, and leisure (ability to integrate a lifestyle); (d) friendship; and (e) love (recognition of social interdependence). When I was given the chance to be an advocate to my senior nurse who was taking care of a cancer patient, I realized the importance for the nurse to have the the necessary competencies to give effective care to patients who are terminally ill. Such competencies go beyond just clinical exposure. I agree that a competency sums up to more than a set of skills; it is a mix of aptitudes, attitudes and personal traits possessed by effective managers (Weightman, 1995). A competency is a relatively deep and lasting part of an individual’s personality and can predict behavior in a broad array of situations and job tasks. That it has a causal relationship indicates that a competency causes or predicts behavior and performance. Moreover, being criterion-referenced indicates that the competency is a predictor of doing a task effectively or poorly, as evaluated by a particular reference or standard. Why are competencies important in this particular incident? Somehow, the critical incident demonstrates that my mentor (i.e. the senior nurse) needed to be equipped with skills that will allow a holistic evaluation of the patient – not just clinical decision making skills but soft skills which are equally critical. One example would be her capability to counsel the client when he seems depressed or lonely. Again, this suggests more than clinical experience, but understanding a whole host of factors that may contribute to the patient’s condition, including his emotions and psychological well-being, in general. Given that this and similar critical incidents happen that may be attributed to the lack of soft skills, it may be worthwhile to draft a competency profile of the effective occupational therapist. This profile will specify all of the competencies that he ought to have considering her level and her role. Such a profiling exercise would prove beneficial because he may immediately be informed of both her strengths and weaknesses as a professional. Prescribing these competency requirements would also help in selecting competent health professionals in the future, effectively plan their careers, and constantly ensure external competitiveness and internal equity of their pay packages (Development Dimensions International, 2005). The National Institute for Clinical Excellence (NICE) defines clinical effectiveness as the “provision of high quality treatments or services in a way that allows the recipients to achieve the maximum health gain. This encompasses the provision of interventions/services that are acknowledged as effective (evidence-based practice), and according those services within a system that permits the recipient the most optimal benefit. This will cover environmental, time courtesy, safety (risk management) (The Chartered Society of Physiotherapy, 2005). Moreover, clinical effectiveness must also include offering care based on high-quality evidence-based clinical principles. In addition, this encompasses an assessment of practice or service through the utilization of clinical audit or outcome metrics, for quality enhancement. Based on these standards, I and other practitioners ought to do “the right thing (evidence-based practice), in the right way (skills and competence), at the right time (providing treatment/services when the patients need them), in the right place (location of treatment/services), and with the right result (clinical effectiveness/maximising health gain). I should be able to give the patient the full package of the patient experience, and contextualise this based on the ‘best available evidence’ (The Chartered Society of Physiotherapy, 2005). I have also realized It is imperative that health professionals’ people skills be given adequate attention. An effective health professional is someone who is a master at managing through ambiguity; inspires confidence and belief in the future; have a passion for results; are marked by unwavering integrity; set others up for success; have strong rather than big egos; and have the courage to make big decisions. Soft skills are as equally if not more important than technical skills, in the development of potential. These competencies must also be integrated into my success competency profile and adequately addressed through formal classroom or on-the-job training. The novice nurse acquires clinical judgment and skill over time. Knowledge is refined through actual clinical experience; this moves her from a rule-based, context-free stage to a more analytical, logical and intentional pattern of thinking (Benner, Tanner, & Chelsea, 1996). To effectively provide a conducive learning environment, new nurses need venues for examining and developing their problem solving and reasoning skills towards making clinical judgments (Miller, 1992). Such venues transpire through numerous learning experiences. The literature clearly suggests that the novice nurse, to acquire proficiency – develop self-mastery – and eventually lead and coach others, must expose herself to venues and learning opportunities that will allow her to exercise problem solving and reasoning skills. In particular, I am contemplating about being able to practice in a large urban-based hospital in my second to third years, to permit such comprehensive clinical exposure. I also realized that participating in varied learning experiences offers the chance to apply classroom theory in the clinical setting. These experiences can help them in developing the learner from the novice phase to advanced beginner. The advanced beginner has been exposed to choice real-life situations and therefore has more contextual rules. Advanced beginners, however, are in greater need for supervision and guidance. They are only starting to learn repetitive meaningful patterns in clinical practice. Clinical experiences enable the formation of meaningful related information on the basis of what the nurse has learned in the classroom. There is an expectation that with more experience, this novice can move from the level of advanced beginner to the level of competence by programme completion (Carnaveli & Thomas, 1993). Clinical judgment is defined as nursing decisions about which areas to assess, analyzing health data, prioritizing which task to do, and who should carry it out (Carnaveli & Thomas, 1993). For clinical judgment to be assessed as sound, it should be arrived at using critical thinking and logical reasoning, that will enable the deduction of valid conclusions, and the decisions that may be borne from these. To make the most of my clinical exposure, I hope to establish a strong mentoring relationship with a senior nurse and/or a doctor who will be able to coach me on increasing competence in my clinical practice. Coaching and mentoring is a very effective way of developing my leadership potential because it does not only develop me in terms of technical expertise, but it will also allow me to actually experience how these experts undergo the coaching and mentoring exercise. Skill acquisition acknowledges that proficiency and expertise are a function of the exposure to a variety of situations. These circumstances become experiences for the learner to elicit apt responses. I also realize that most learning transpires by observing and modeling behaviors. This information is then stored and coded cognitively and utilized as guide for action. It may be further noted that the development of a realiztic learning setting incorporating environment, behavior, and thought promotes the acquisition of complex clinical skills. Moreover, simulation can help in providing this realiztic exposure for new graduates (Bandura, 1977). This experience has also taught me the importance of critical thinking, a cognitive process of dexterously undertaking analysis, synthesis, and evaluation of data gathered from observation, experience, reflection, or communication as a guide to belief or action (Paul, 1993). Several researchers have presented critical thinking as a reflective, reasoned thinking process (Ennis, 1985; Halpern, 1989). It is utilized to allow clinical judgments to act based on the information analysed or processed (Ennis, 1985; Halpern, 1989).Clinical reasoning is a cognitive process of progressing from what one already knows to more knowledge (Anderson, 1990). Reasoning is used to make a clinical judgment. Reasoning entails a capacity to remember facts, organize them in a meaningful whole, and then apply the information in a clinical patient care situation. Individuals can make use of reasoning to help in formulating principles or guidelines as a basis for their practice judgment decisions. This demonstrates that occupational therapists ought to have critical thinking skills to enable them to make sound judgment in a wide array of clinical situations. Moreover, care should be taken so that no conclusions are made unless all protocol have been carried out; this helps in avoiding the errors that occurred during the critical incident. Other factors which may have influenced the client’s perspective was the need for the client to rationally realize and understand his situation. That is, he should be able to comprehend all the factors that may have caused his condition, and systematically address each one of them. The fact that she has been able to abstain from alcohol intake indicates some sense of control over the situation, which he could leverage on to totally ‘cure’ herself of alchohol abuse. It was also helpful to have referred to the various literature on acohol misuse; this has siginificantly helped me come up with a better evaluation of the client’s circumstance. Finally, I had to reconsider my commitment to occupational therapy values that advocates client-centered care; that is, the well-being of my client comes before anything else. As concrete outcomes of reflecting on this critical incident, I intend to discuss my experiences and feelings with my senior nurse. This exercise on sharing and exchange of ideas may lead to more profound insights about the incident. Moreover, I also plan to keep a reflective diary to make the reflective exercise an integral part of my learning; I would be able to reflect on critical incidents on a more regular basis, improving my critical thinking skills and holistic view about client experiences. I like the idea of a learning journal because I am able to document my thoughts in black and white, which is what I know I need. I do agree that learning journals are a powerful tool in helping students become more effective learners through reflective thinking and analysis of their learning experiences. Perhaps, this action plan may be difficult to undertake at first because I would feel I am being forced to write. However, I know that as time passes by and I see the benefits of reflection, the change in attutude would come with it. Keeping a reflective journal would help me become a more effective learner through critical reflective thinking about my learning experience with my role as an advocate. I have also realized through this experience that reflective learning journals are significant tools in translating theory into viable action, that is, praxis. Reflective learning journals have been utilized for quite some time now, specifically in the nursing and teacher education disciplines, to improve individual learning effectiveness, encompassing critical and creative thinking (Kobert, 1995; McCrindle & Christensen, 1995; Meyers & Jones, 1993). In an early application, Hahnemann (1986) had nursing undergraduates spend 10-15 minutes in class time doing their journal entries over the semester. She reported that: … journal writing has been a valuable tool that encourages clearer thinking and better learning (Hahneman, 1986, p. 215). Recently, Lyons (1999, p. 33) described how journal writing promoted the development of reflective skills among healthcare students. She concluded that developing reflective skills made students more confident in their learning, fostered responsibility and accountability and assisted in integration of theory and practice. Conclusion Having realized the dire need for nurses to be adept at addressing this aspect of care, I would like to hone my skills along this line. It would be ideal to have a mentor who could walk me through the necessary steps in using both technical and soft skills to expedite the full healing of a person. 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