Nursing Theory as a Guide for Knowledge - Article Example

This paper is a study on nursing as a guide for nursing knowledge and how it applies to a nursing setting such as in emergency departments where stress and trauma are a daily occurrence. The paper addresses the metaparadigm of nursing, how it links to the emergency department structure of operations, and how it affects the philosophy of nursing in a practice setting. Having a structure of knowing and theoretical infrastructure in place is a great assistance in conducting operations quickly and efficiently in the emergency department. Introduction Since the latter half of the previous century, nursing theories have been developed to provide methods of thinking which provide direction in constructive diagnosis and solving problems in working with patients. While patient cases will have similarities, each case is also uniquely different and may require a different process of determining solutions. A patient is inherently individualistic, based on social and economic factors as well as the type of illness involved. What may work for one patient, may not work for another patient, due to differing circumstances of age, eating habits, social structure and economic environment such as working status or for those who are unemployed. Nursing morals and ethics will also come into play when confronted with issues of insurance coverage and what solutions are available as defined by the coverage, if there is any coverage. Consequently, right answers in one case may not be right in another, based on principles which are not always absolute (Nourreddine, 2001). Nursing Theory as a Guide for Knowledge When evaluating nursing knowledge, nurses will ask themselves what they know; what the extent of that knowledge is, based on how that knowledge is attained through various methods, and whether it is appropriate. Epistemology is the term used for the study in the theory of knowledge which has several basic types. Empiric knowledge is developed through scientific observations, suitable testing and ability to replicate and validate the information. Personal (priori) knowledge is attained from thought processes alone. Intuitive knowledge comes from feelings and hunches that come from unconscious recognition of experiences or patterns as known from previous experiences or by some type of educational process. Somatic knowledge is experience attained from a physical experience which becomes a learned process through conducting physical tasks. Ballet dancers and gymnasts are great examples of those with somatic knowledge. Metaphysical knowledge which is a spiritual precept of knowledge gained by acknowledging a higher power other than ourselves through religious practices, miracles, extrasensory perceptions, near-death experiences, and other conventions which are not scientifically proven, at least not currently. Esthetics is the knowledge of beauty and harmony, expression through creativity and art, and development of values which sustains these. Finally, moral and ethical knowledge is based on the concepts of what is considered right and wrong, based on social values and surrounding environment (McEwen & Wills, 2010). In nursing knowledge, it is not based simply on the scientific proof, but also on the social and behavioral sciences as well and, therefore, nurses rely on multiple genres of knowing. Carper (1978) presented four fundamental basic concepts which applied to nursing knowledge: empirics as the scientific form of knowledge, esthetics, personal knowledge and ethics. Empirical knowledge is gained through laws and theories which describe, explain and predict various phenomena, based on factual evidence (Carper, 1978; Carper, 1992; McEwen & Wills, 2010). This would be most evident in clinical practice conducted within the environment of the emergency department because split-second decisions must be made and they can only happen when there is enough knowledge from structural theory and from experience gained through other case experiences of trauma and sudden illnesses. Personal knowledge is gained through interactions, developed relationships and transactions between the nurse and the patient. While this is certainly applicable when the nurse is gathering information and then designing the methods towards a wellness of being for the patient, it is also about how the nurse understands his or her own self in conjunction with the nursing field and with patients. Ethics, as the fourth component, concerns the elements of right and wrong, which sometimes can be questioned under certain circumstances where the consequences of one’s actions are not easily seen ahead of time. Nurses provide a social service which is to enhance conserving life, alleviating suffering and ultimately, provide the guidelines or series of steps towards achieving a goal of wellness for the patient. This also requires the nurse to know different philosophical positions, different ethical frameworks that address complex moral judgments and to understand nursing obligations within those contexts. A nurse takes on a great deal of responsibility in assimilating these concepts and deciding which way to go to provide the outcome desired (Carper, 1978). Patterns of Knowing in Nursing by Carper Fig. 1 (McEwen & Wills, 2010) In the context of nursing in emergency departments, decisions must be made quickly and efficiently to stabilize a patient in stress from sudden injuries from sudden accidents and in crime situations. In a high stress situation like this, where nearly every patient is in need of emergency care, nurses face a constant barrage of on-the-spot decision-making processes to determine what to do for the patient first in order to perhaps save that patient’s life or to stabilize severe pain and provide some semblance of comfort. Compassion is needed from the nurse towards the patient in order to make the patient feel safe and to begin the process of healing, both physically and mentally (Chase, 2005). In cases of assault and rape along with other sustained injuries, women are particularly in a position of fear and pain and may prefer to be with a female nurse instead of a male doctor. A great deal of understanding must be provided by a female nurse who can provide emotional comfort and relate on some level to what the victim experienced and to also explain what will be needed in terms of tests and the next steps to take in recovery (SANE, 2012). Over time, nursing and other medical staff members can encounter an overload of trauma-based burnout or compassion fatigue, making it difficult to relate to incoming patients, all of whom need immediate help. This is rather similar to post traumatic stress syndrome (PTSS) or even disorder (PTSD) which military members experience in war zones. An emergency room on a busy night may very well seem like being out on the battlefield under fire on a continuous basis. While not incurring physical pain, unless exhaustion qualifies, the mental bombardment of seeing people coming in from terrible car wrecks, shooting victims and other life-threatening emergencies, can take a toll on just about anyone. In order to survive this, medical staff members must learn coping mechanisms that work for them and help them to stay strong in the face of overwhelming negative situations (Chase, 2005). In my practice, I usually calm myself down whenever I get into a high-stress situation by focusing on the steps I need to make to provide solutions. I look at the case as a problem-solving issue rather than letting the stress of a life-threatening issue take over. It is a certain detachment and I project the vision of the patient being better after I’ve provided the help. Seeing the goal ahead of me makes me push forward with what I need to do to make it happen. The Metaparadigm of Nursing in Emergency Department Practice In nursing theory, the metaparadigm that is commonly used in all circumstances refers to the Person, which can also mean a group of people, Health, Environment and Nursing. The person is the focal point from which all information is gathered, processed and evaluated in order to make a final prediction and solution. How a nurse presents his or her attitude to that person, can make a difference in the success of returning that person to a state of wellness. It is in the discovery of individualism of that person as regards health status, and the social/economic environment around that person, that determines the theoretical framework that must be used to achieve success in returning that person to wellness again (NLN, 2012). The metaparadigm in nursing is a global composite of information on nursing concepts that identifies phenomena pertinent to the knowledge of nursing and explains how to deal with these phenomena. This is comprised of philosophical directives, conceptual models and theories for research studies and scholarly reports, and the infrastructures that guide actions in creating solutions. The four points of requirements for a paradigm are presented below. Fig.2 (McEwen & Wills, 2010) Relationships exist between the four metaparadigm concepts of Person, Health, Environment and Nursing in that they are related to each other and cannot be separated. The following must be addressed at some level within first interactions and information review. There is the relationship between person and health, person and environment, health and nursing, and finally, person, environment and health. Fawcett and Malinski (1996) determined that these four concepts met the metaparadigm criteria because they are neutral in view, do not represent any one paradigm or model structure, and also do not represent one country’s culture over another (Fawcett & Malinski, 1996; McEwen & Wills, 2010, p.40). In receiving a patient into the emergency department, using the metaparadigm and its four concepts above, the person and health status is evaluated first, particularly in emergency procedures. My nursing concept, as relates to health and environment, is to stabilize the patient first by stopping the bleeding from severe wounds, then cleanse and suture them, and finally to protect the wounds from further injury. In other cases, such as drug overdoses, blood tests must be made for verification and appropriate life-saving measures conducted such as emptying the stomach when possible. Depending on the environment of where the patient was taken from, additional measures may be needed to cleanse the body of other toxins. In emergency situations, all concepts must be addressed within a very short amount of time. Impact of Nursing Philosophy on Emergency Department Practice Nursing philosophy and developed theories have a great impact on how nursing is conducted within the practice setting, whether a clinic or at a hospital, and most important of all, within the emergency department which sees daily trauma on a continuous basis. I see that philosophy and theory of nursing must be learned well to be applied appropriately for any given circumstance that a nurse might encounter, most particularly in a crisis center dealing with accident and crime victims. I must be able to think quickly, work within a set of preordained precepts but also be able to make changes to a structure of nursing frameworks when the occasion arises, which can happen often. Economics may also play a factor in today’s world of healthcare when it means whether certain steps can be taken because insurance will pay for that, or not, when there is no insurance coverage for a victim who is brought in with severe trauma and wounds. The difference could very well be in giving Motrin as opposed to a methadone drip (Chase, 2005). Of many suitable theories provided within the nursing field, Jean Watson’s Theory of Human Caring (1985) presents one that works well for me within the emergency department nursing field. Watson’s concepts for nursing interventions are applicable for the high-stress environment within the emergency room and promote the following factors: utilizing a humanistic-altruistic value system, providing a faith and hope attitude, maintaining sensitivity to patients as well as one’s person, providing a relationship of help and trust with a patient, allowing for naturally occurring expressions of positive and negative feelings, utilizing a creative problem-solving process, providing a teacher-learning environment, providing the sense of protection and support to a patient’s mind as well as the body within the patient’s socio-cultural and spiritual environment, gratifying human needs, and allowing for the spiritual-phenomenological-existential forces to be expressed however needed (Watson, 1985; Chase, 2010, p.8). As I see it, I make myself a guiding presence by communication with the patient, if possible, and I work to provide a sense of security and safety where the patient begins to feel relaxed. This helps everyone as doctors and nurses will not have to struggle with the patient when he or she is at ease. The patient is also more open and informative and able to think more clearly in giving information about any allergies to medications and to state whether there are internal injuries that should be noted and addressed. I also encourage the patient to begin controlling the breathing process as part of the calming down process and like to think of it as putting the patient into a rhythm, maybe even a state of light hypnosis. Nursing as a profession is unique and has its own body of knowledge unlike any other profession. Theories encompass all parts of a patient and how to provide the best care for a patient. Doctors may not have this kind of insight because of their specialties in surgery and specific areas of the body. Nurses and nursing theory and knowledge do encompass all parts as well as the mind of the patient. Final Thoughts Having this infrastructure of theory, particularly in utilizing Watson’s Theory of Human Caring (1985), is a big help in making on-the-spot decisions of what steps must come first when dealing with each case as it arrives into the emergency department. I have learned that every day and every case is different and it requires split-second determinations from looking at the immediate injury to analyzing other parts of the body for symptoms which indicate an underlying issue is at cause. When a patient is conscious, my caring abilities are the first steps I make towards the patient which help all of us who are attending to the patient. When the patient is not conscious, then I assist in making observations, talking with relatives who may be there, and I also do any quick research needed if it is needed for the attending doctor who is busy trying to save a life. Knowing that I provide a very valuable service to patients and doctors alike is very satisfying to me. While providing many challenges in having to work fast, knowing the theories is the key to thinking quickly on one’s feet and hands to provide quick life-saving techniques and giving someone a renewed chance at life. Nursing theory and structure as a guide for what I do, is essential to my success and feeling competent. References Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), pp. 13-24. Retrieved from: http://samples.jbpub.com/9780763765705/65705_CH03_V1xx.pdf Carper, B.A. (1992). Philosophical inquiry in nursing: An application. In J.F. Kikuchi & H. Simmons (Eds.), Philosophic inquiry in nursing. pp. 71-80. Newbury Park, CA: Sage. Chase, M.M. (2005). Emergency Department Nurses’ Lived Experience with Compassion Fatigue. Thesis for The Florida State University School of Nursing. Retrieved from: http://etd.lib.fsu.edu/theses/available/etd-11082005-54529/unrestricted/mmc_thesis.pdf Fawcett, J. & Malinski, V.M. (1996). On the requirements for a metaparadigm: An invitation to dialogue. Nursing Science Quarterly, 9(3), pp. 94-97, 100-101. http://www.ncbi.nlm.nih.gov/pubmed/8850982 McEwen, M. & Wills, E.M. (2010). Theoretical Basis for Nursing, 3rd ed., North American Edition: Lippincott Williams & Wilkins. NLN. (2012). Why the Metaparadigm is Necessary to Nurse Theory Construction? NurseGroups Online, NLN Associate. http://www.nursegroups.com/why-metaparadigm-necessary-nurse-theory-construction Noureddine, S. (2001). Development of the ethical dimension in nursing theory, International Journal of Nursing Practice, 7, pp.2-7, Available at http://deepblue.lib.umich.edu/bitstream/2027.42/73773/1/j.1440-172x.2001.00253.x.pdf SANE. (2012). Sexual Assault Nurse Examiner (SANE) Program. Crime Solutions.gov. Office of Justice Programs. http://www.crimesolutions.gov/ProgramDetails.aspx?ID=219 Watson, J. (1985). Nursing: The philosophy and science of caring. Colorado: University Press of Colorado. Read More