Personal nursing philosophy and practice

Nursing - Nursing Philosophy

NURSING PHILOSOPHY and PROFESSIONAL PERSPECTIVE

Without a doubt, the first extraordinarily important new era of medicine began shortly after the close of the American Civil War, with Joseph Lister's introduction of the Germ Theory of disease, because it led directly to the understanding of the critical importance of asepsis in patient morbidity and mortality. However, increasingly aseptic hospital environments had already saved hundreds of thousands of lives in hospitals receiving battlefield casualties toward the end of the war, a full two years before Lister's historic announcement in 1867 (Starr, 1984).

Purely by coincidence, Florence Nightingale had stumbled into dramatically reducing the incidence of morbidity and mortality attributable to secondary infection - which on the scale experienced in battlefield injuries, almost invariably led to systemic collapse from septic infection and death - through one of history's best documented origins of holistic nursing in its purest form. In 1864, Florence Nightingale had absolutely no idea that the fundamental key to saving the lives of patients who survived their initial injuries in battle was to reduce their exposure to bacterial infection. She simply could not tolerate the squalor that characterized the hospital environment and the filthy conditions to which patients were exposed, even in the biggest hospitals in the post- war United States.

She implemented wide-scale hygienic improvements motivated exclusively by her conviction that the deplorable conditions in hospital wards of her era were undignified living conditions, especially from patients already ailing and in physical pain. Thanks to Nightingale's holistic approach to nursing, the protocols for cleanliness and improved hygiene, Union Army hospitals reduced their mortality rate among as many as one million casualties from approximately fifty percent to below ten percent before Joseph Lister ever established a scientific explanation for the mechanism through which Nightingale's holistic perspective saved so many lives. In her mind, she was doing nothing more than attending to the basic human dignity of her patients. The Personal Commitment to Quality Patient Care and Excellence in Holistic Nursing: Ironically, in some of the most modern medical institutions responsible for patients in the U.S., aseptic protocols are violated routinely by medical professional, including RNs, who allow lackadaisical loss of professional focus to jeopardize patient health and welfare. Specifically, it is widely acknowledged that clinical evidence suggests that the rate of morbidity and mortality caused by hospital acquired infections is unacceptably high and result in tens of thousands of deaths annually in the U.S. from hospital acquired infections unrelated to the initial hospitalization (Tong, 2007).

Anecdotal evidence, to a large extent, implicates hospital staff (including RNs as well as physicians) in breakdowns in basic hygienic protocols and common sense (Stanhope & Lancaster, 2004). In my view, this is unacceptable in modern medicine but resolution requires individuals within the field to take on unofficial patient advocacy responsibilities, in some respects, emulating the courage and concern for patient dignity exemplified by Florence Nightingale.

Specifically, that means addressing unacceptable situations and practices even in a professional environment where they have become incorporated into routine. Turkel (2004) describes the perspective of Magnet status nursing programs in particular, with respect to encouraging the voicing of constructive criticism and the training of nurse supervisors to respond to valid critical observations in a manner conducive to supporting such personal initiative. All too often, conditions that violate basic aseptic protocols such as the failure to change gloves in between patients or the needless increased risk to patients of exposure to harmful bacteria by virtue of dozens of other similar "shortcuts" become standard operating procedures and criticism discouraged, sometimes harshly.

Critics of holistic nursing have occasionally insinuated that holism is somehow incompatible with evidence-based practice such as that which underlies the Magnet standards. That is truly unfortunate. Holistic concerns in nursing are more than merely "compatible" with an evidence-based perspective; in fact, the holistic emphasis is an expansion of available treatment modalities that has been demonstrated empirically to bolster clinical success rather than competing with it or contradicting it (Stetler, 2001).

Holistic nursing is fundamentally, inclusive and a valuable adjunctive modality that does not shift focus away from the hard science components of modern nursing; holistic nursing complements clinical modalities.

Multiculturalism in Holistic Nursing:

Multiculturalism and the increasing age of the American population present two other fundamental components of the holistic approach to nursing that emphasizes treating the whole person in conjunction with clinical therapeutics. Patient outcomes have been clearly demonstrated to improve, both in studies of higher rates of symptom resolution attributed to social support focusing on cultural bridging (Steefle, 2002), as well as reduced reliance on medication for palliative relief attributable to cultural sensitivity on the part of treating staff (Miller & Chandler, 2002).

Furthermore, Spector (2000) demonstrated significant differences in patient compliance with medical instructions associated with specific efforts to include patient families in support networks. The fact that clinical studies establish those links is helpful, but the inclusion of families in patient-centered care is just another example of something that is (or should be) intuitively obvious even absent clinical studies disclosing formal research results. Patients whose families are directly involved in their medical care are less likely to suffer depression before and after discharge; they are also more likely to follow medical directions closely.