Fundamentals of Nursing - Essay Example

?Fundamentals of Nursing Article: “Fundamental patterns of knowing” by Barbara Carper. In relation to the four ‘patterns’ she presents, analyse how these relate (or not) to your own clinical nursing practice? Barbara Carper’s ‘Fundamental patterns of knowing’ is relevant to my nursing practice because all the four patterns she describes apply in my nursing practice in one way or the other. First, the ethical pattern of knowing is evident in practise especially as one attempts to follow written and unwritten codes of ethics to discern what ought to be done by differentiating right from wrong and taking responsibility of one’s actions. Secondly, personal knowing enhances my relationship with customers as it enables me to learn my own feelings about situations and enable me to respond appropriately. Thirdly, aesthetic knowing enables me to react to occurring phenomena even without conscious thought, such that I understand a situation in more ways than what is observable, or what a patient says. Finally, I express empirical knowledge through my ability to appreciate scientific facts, using senses to analyse situations and following the accepted standard operating procedures (Carper 1978, p. 13-24). Knowledge and Nursing 1. What is the difference between knowledge and belief? Knowledge and belief are similar notions of the same phenomenon, such that belief begets knowledge and not the other way round. If a person can prove that something exists or a certain procedure works, then that is knowledge, whereas belief is based on the premise that what the person believes is right but cannot be proved. For instance, it is common knowledge that the sun rises in the morning; a belief that has been proven repeatedly throughout the existence of the world. Therefore, everybody ‘knows’ that the sun rises in the morning based on recurrence of the phenomena regardless of other factors. On the other hand, a person might believe that a certain prescription is the cure for an ailment, a phenomenon that is used scientifically to prove that the drug does what it is purported to do. However, if research proves that the medication does not work, then the belief stops being knowledge and people are free to choose what to believe about the drug. This final example shows another difference between belief and knowledge, choice; a person can choose what to believe but has no choice over what to know (Edwards 2001, pp. 25-38). 2. What are the main differences between practical knowledge and propositional knowledge described by Edwards? Give an example of each of these from your nursing practice. The main differences between practical and propositional knowledge lie in the mode of expression of the knowledge, its extent, and limitations. Propositional knowledge is mainly expressed in speech whereby an individual uses statements that indicate his or her knowledge on the subject matter. On the other hand, practical knowledge is expressed in one’s work, where a person knows what to do now, or what one might do when posed with a problem of a certain nature. Propositional knowledge tends to be general, such that it does not major on one aspect of the subject whereas practical knowledge is job specific, and is useful in one job area and can be applied to solve problems in that field exclusively. While propositional knowledge comes mainly from literature that one reads, practical knowledge is acquired as one does his or her duties, and the latter incorporates more senses than the former. An example of practical knowledge is using a needle and syringe on a patient such that it inflicts minimal pain and damage. Books may give the procedures for use in a medical setting, but practise gives a person the practical knowledge of how to do the procedures right. Propositional knowledge is evident where a person knows the various disease cycles and patterns, but the knowledge is not applicable directly in practice (Edwards 2001, pp. 25-38). 3. Critically analyse the kinds of knowledge nurses use in practice. Support your answer with at least two additional references. There are five distinct kinds of knowledge as used by nurses in practice, all of which are geared towards improving the quality of care in the nursing profession. First, there is personal practice knowledge, which a nurse acquires in his or her line of duty. Personal practise knowledge is unique to every person since everyone views scenarios from different points of view. Therefore, this form of knowledge is more of a personal form of knowledge rather than being relevant for the whole professional, as personal practise knowledge is only relevant to the person possessing the knowledge. The second nursing knowledge is theoretical knowledge, where an individual knows something because he or she read it from a source. This is the basis of all other knowledge forms, as only after a person knows what has been scientifically proven can one apply the knowledge to acquire other kinds of knowledge. Thirdly, we have procedural knowledge, which is the knowledge used in performing routine tasks, whether written or unwritten. This knowledge gives a person the ability to follow standard operating procedures accurately to obtain quality and dependable results. Fourth, there is the ward cultural knowledge, which is knowledge that draws from many sources and guides nurses on things that they do in the ward. Ward cultural knowledge may be scientifically proven or may be based on beliefs that have not yet been proven. Finally, there is the reflexive nursing knowledge that is evident when a nurse reacts to a situation without consciously thinking about it. This knowledge can also be referred to as instinctive, and does not involve thinking about ones response to a situation. Reflexive knowledge is crucial, especially when dealing with patients that cannot express what they want (Edwards 2001, pp. 25-38). Conceptualising Nursing: Science, Art and Practice? 1. What is meant by the ‘ends’ of nursing? Ends of nursing are the results of giving nursing services to a patient, as opposed to means, which are the procedures, processes, and actions performed on or for a patient to aid in his or her recovery. While nursing means includes applying different forms of knowledge with scientifically proven results, the ends of nursing care for a patient depend on other factors for a patient to feel or get better. A nurse has to connect with a patient at a deeper level such that the former understands the needs of the latter even before the patient voices his or her needs. Therefore, the results, or ends, of a nursing exercise is the combined effect of a nurse working on a patient from a scientific, art, and practice approach to generate a combined effect on the wellbeing of the patient (Edwards 2001, p. 98). 2. Think about your current practice. Provide one example each of an aspect of your work which can be viewed as an art, science, and practice. Art is interacting with a patient in ways that do not have a scientific explanation, by establishing a rapport with a patient such that the patient trusts that whatever the nurse does, though painful, is for the best interest of the patient. For instance, getting a patient to relax and believe that everything is in order despite a painful illness is an art; whereby the nurse communicates with the patient at a level that words cannot express and science cannot explain. In addition, it is an art for a nurse to have the capacity to discern when a patient lies or withholds information about his or her illness. Science is the application of research proven knowledge when dealing with patients, regardless of if the knowledge succeeds in achieving the desired effect or otherwise. For instance, following a procedure described in theory, exactly as it is given in literature is an application of science in nursing. Science gives standards that act as a basis to other approaches, such that a nurse will always know if applying a certain approach, whether scientific or otherwise, adheres to the acceptable guidelines. Therefore, though science alone may not solve all the nursing problems, it is an integral part should be used together with other approaches to achieve the desired effect for the wellbeing of patients. Practise is the source of practical knowledge for a nurse, such that one may have scientific knowledge on how things should be done, but applying that and other forms of knowledge effectively is dependent on a person’s practical experience. For instance, there are accepted approaches to dealing with different types of patients; however, since every patient is unique, only practice can enable a nurse to know the modifications to make for the best results. Therefore, practice is essential if a nurse is to succeed in applying the artistic and the scientific nature of nursing for the benefit of his or her patients (Edwards 2001, pp. 186- 200). 3. Critically analyse why nursing might align itself with science? Nursing is both an art and a science, deriving its knowledge from biological sciences including physiology, and from social arts including psychology. While science enables a nurse to work on phenomena that can be analysed using the scientific method, arts enable a nurse to apply other factors of nursing duties that are not explainable or provable by any scientific means. Both scientific and artistic sources of nursing knowledge are crucial as they enable a nurse to increase effectiveness and efficiency of his or her service to a patient. However, the nursing fraternity is more likely to align itself toward science and distance its practices and methodologies away from art. This is due to real or perceived weaknesses or knowledge based on art, and the real or perceived strengths of scientific sources. For instance, society has made people believe that if a notion can be proven scientifically, it is knowledge but if it cannot be proven then it as a belief. Knowledge has a stable backing since people assume it is the truth until proven otherwise. On the other hand, people are always sceptical about beliefs, as they tend to vary with every person, making it hard to establish a standard. The above explains why nursing aligns itself with science. The alignment to science has resulted in questioning of many rituals associated with the nursing profession. For instance, there is the belief that a nurse should open a window when a person dies to enable the spirit to escape. The nursing fraternity was considering getting rid of this ritual due to lack of scientific backing; however, on scrutiny, the ritual has its merits. Opening windows lowers room temperature and reduces the rate of decomposition of the body, and works to comfort family members who are superstitious and believe in an afterlife. Therefore, the desire to have reasons for every activity that nurses participate in has caused the nursing fraternity to move towards nursing as it gives an assurance that they know what they are doing and not merely following traditions blindly. Evidence Based Practice 1. What does evidence-based practice mean in nursing and midwifery literature? Does this encompass the real meaning of evidence – explain? Evidence based practice is the approach in midwifery than bases all decisions, procedures, and processes on scientifically proven ideas. This means that all research material is assumed to be the truth and is suitable as a basis for the nursing profession, and any unproven approaches are assumed to be in applicable to the situation regardless of how valid they appear to the nurse. However, in nursing and midwifery practice, it is impossible to apply research findings due to the dynamic nature of the nursing profession and differences between the scenario where the research was done, and the one in which a nurse finds him or herself. This is because evidence based practice requires the use of selected research findings, of which not all may be relevant to the situation. Nursing and midwifery practice are research based, such that nurses apply other approaches including basing their activities on experience, theoretical knowledge, personal judgement, and modify the conclusions of research findings to fit the present situation (Pearson Field and Jordan 2007). 2. Consider the critics of this movement, are their criticisms justified, particularly in relation to nursing practice? Provide at least two references to support your point. According to Holmes et al. (2006, pp. 180-186), evidence based practice is a form of fascism in the 21st century that forces people into one line of thinking without room for choice or freedom to pursue other lines of thought. Cochrane Group together with other bodies, formulated evidence based practice that many academic institutions accepted for use in all scientific service delivery professionals. This approach uses random research results and recommends them for use as standards in all service professionals including nursing. While basing practise on a standard is suitable for quality assurance purposes, limiting a profession with so many varied scenarios to a limited number of research results is irrational. Evidence based nursing only encourages the use of empirical knowledge in, undermining the significance of other forms and sources of knowledge. This does not allow nurses to choose what to do with patients since every action must have a basis on specified researches. The results of the research may have relevant only at the time of research, or for a certain population, generalising the results without allowing nurses to modify them to suit the current situation results in conflicts; especially if applying the recommendations of the research does not replicate the finding of the study. Evidence based practice limits the freedom of thoughts for nurses, since they are supposed to use research findings as they are without questioning the rationality or effectiveness of using them. It also portrays other thinking approaches and other research findings as inferior by promoting the exclusive use of select research findings. These critics are justified since nursing is a versatile field with numerous possibilities, and should be free to adapt to situations as they occur without entirely depending on previous research findings (Pearson Field and Jordan 2007, p. 13). 3. Consider a recent interaction you have had with your patient/client. Briefly account for the sources of information, which constituted ‘evidence’ in this situation. Recently, a patient was showing signs of new infection despite being in the hospital ward for two weeks. According to the patient, there was severe pain in the infected region, accompanied by an itchy feeling. On closer observation, I discovered that the infection was spreading, indicating an increase in the number of the organism causing the infection. According to recent research, there are some bacteria that are resistant to antibiotics, especially those found in the hospital environment. According to Rycroft-Malone et al (2004, p. 81-90), there are four main sources of information basing on the clarity, indicative, informative, and pointer characteristics. In the scenario described above, there are four sources of information for use by the nurse including the patient, research, clinical experience, and the environment. The patient complained of a discomfort that led me to investigate; my clinical experience led me to believe that this was a case of infection; and research shows that according to the environment in which my patient was staying, an infection could only result when the causative agent was resistant to drugs. Summary of learning: Critical analysis in relation to knowledge and nursing Nursing professionals possess knowledge in its various forms, which they should use in their line of duty such that it is for the benefit of a patient. However, a nurse must have all levels of knowing including personal, empirical, ethical, and aesthetic. This enables not only effective care of patients, but assures quality and adherence to acceptable levels of standards and ethics. Consequently, a nurse becomes more effective and efficient in his or her work, which in turn increases the ability of the nurse to be more effective due to a high self-esteem and a feeling of achievement (Carper 1978). A nurse should be capable of differentiating between knowledge and belief, only then can one apply these two aspects in practice for optimal results. For instance, in situations where results may mean life or death, it is advisable to use knowledge, whose outcomes are predictable and scientifically proven. On the other hand, a belief can only become part of knowledge through being proven; therefore, a nurse should use intuition to know situations where beliefs could be applied and result in minimum or no harm. There are five principal types of knowledge available for use in the nursing practice. Nursing professionals should use a carefully balanced amalgamation of these knowledge types to ensure that their patients get the best service the profession has to offer (Edwards 2001). Depending on the approach a person takes, nursing can be an art, a science or both; the latter being the most valid description since nursing is derived from both arts and sciences, and knowledge from both sources is used simultaneously in practise. There are raging debates whereby the nursing fraternity is attempting to ensure that all its practises are based on science alone, such that every routine or tradition has a scientific basis. However, it does not matter where the knowledge comes from as long as professionals perform their duty effectively to patients. If those in the nursing profession want it to be classified as a science and not an art then maybe it is high time they ignored those labels and existed as a unique art-and-science blend (Edwards 2001). An aspect of the nursing profession facing stiff criticism is evidence-based practice, which aims to ensure that all decisions and actions by nurses use chosen studies as a basis. This does not auger well with critics, who purport that evidence based practice is limiting and denies nurses and other scientists from having a different opinion from the given ones. In this regard, evidence based practice hinders innovation and prevents nurses from reaching their full potential in their profession (Rycroft-Malone et al. 2004; Holmes et al. 2006). Though standards should be used for quality assurance purposes, they should be flexible enough to allow for personal choice and innovation. References Carper, BA 1978, ‘Fundamental Patterns of Knowing in Nursing’, Advances in Nursing Science, vol. 1no. 1, pp. 13–24. Edwards, SD 2001, Philosophy of nursing: An introduction, London, Palgrave. Holmes, DR, Murray, SJ, Perron, AR and Rail, G 2006, ‘Deconstructing the evidence-based discourse in health sciences: truth, power and fascism’, International Journal of Evidence-based Healthcare, vol.4, pp. 180-186. Pearson, A, Field, J and Jordan, Z 2007, Evidence-based clinical practice in nursing and health care: Assimilating research, experience and expertise, New York, John Wiley & Sons Rycroft-Malone, J, Seers, K, Titchen, A, Harvey, G, Kitson, A and McCormack, B 2004, ‘What counts as evidence in evidence-based practice’? Journal of Advanced Nursing, vol. 47, no. 1, pp. 81–90. Read More