Nursing philosophy and professional values

Every nurse has a philosophy that guides her approach to care. Even if the nurse is not consciously aware of her personal philosophy, there is always some underlying construct in the nurse’s mind that helps her cope with split-second decisions or profound ethical quandaries. The philosophy is even necessary when making technical, everyday decisions. It is best for the nurse to be aware of her underlying assumptions, rather than unconscious of them, to ensure they are positive and serve patient needs.

According to Deliktas (et al. 2019), the classical nursing metaparadigm encompasses the person, environment, health, and nursing. For me, the person encompasses the patient, the patient’s caregivers, and also the patient’s community and the persons close to the patient. The environment encompasses all the influences on the patient. This can include access to healthcare itself, as well as the built environment (such as physical incentives to walk and exercise, as well as proximity to fast-food restaurants) (Sun et al. 2019). The environment can enable the patient to be healthy or unhealthy, sometimes in unavoidable ways (such as a child who grows up in a dusty, asthma-provoking household), or sometimes in ways where it is easier to make unhealthy versus healthy choices or vice versa. Although sometimes people insist everyone has a choice regarding health-related decisions, for people with the ability to afford healthy food and vigorous physical pursuits, it is far easier to be healthy.

Health is the individual’s personal definition of sickness and wellness, and how it intersects with evidence-based medicine’s definition of health. A patient may need to be encouraged to take into consideration evidence that he or she can lead a healthier life (for example, with a better diet or glucose regulation). But the nurse must be sensitive to the patient’s cultural beliefs regarding health, such as when planning a better diet, or engaging in a discussion of end-of-life care.

I define the process of nursing as health facilitation. The nurse steps in with technical assistance and knowledge when the patient cannot provide such self-care. This may be as simple as advice, or as complex as a major intervention when the patient is not fully conscious. The nurse is the patient advocate, bridging the gap between the patient’s beliefs and needs and the nature of modern medicine.

Nursing is the individualized face of medicine. Nurses must do their utmost to get to know their patients, and the persons who are close to the patient, such as caregivers and family members. Understanding the patient’s perspective does not mean that the nurse has to agree with the health beliefs of the patient, but the nurse must empathize with the patient and offer advice with knowledge of the patient’s worldview, faith, and needs. On a personal level, Dorothea Orem’s self-efficacy theory is one which appeals to me the most as a provider. Nurses can and must encourage patients to be independent and autonomous, when possible, but also be willing to step in with information, care, and hands-on interventions when this is simply not possible, given the patient’s condition (Khademian et al., 2020).

Jean Watson is the nursing theorist who has been most celebrated for incorporating the philosophy of caring into nursing. Nursing involves caring for the patient as an individual, appreciating the nurse’s perspective, and realizing what Watson’s caring factors, which includes showing love and kindness to the patient, maintaining faith and hope, and building trust (Wei & Watson, 2018). Nursing is based on reciprocity with the patient. Nurses must respect patient dignity and engage in compassionate care; perhaps most startling of all, Watson stresses the need for the nurse to believe in miracles (Wei & Watson, 2018). This means that the nurse must be open to possibilities for improvement, rather than closing a door on hope, although the nurse must also not encourage unrealistic beliefs. Caring also means working on an interprofessional level with physicians, therapists, and others who provide care (including spiritual advisers) to better integrate nursing care with other aspects of the nurse’s specialized care.

More than ever, I believe there is a need for the unique perspective of nursing in our society today. All too often, providers and administrators alike feel overwhelmed by the sheer volume of care they must manage at healthcare institutions. Institutions are attempting to provide too much standardized care at a high volume to too many patients, which often results in burned out providers and medical errors. Of course, given the current healthcare situation, this is sometimes unavoidable. But the social purpose of the nurse is ultimately always the provider which strives to see the world and human health from the patient’s perspective (Norman et al., 2016).

The nurse must strive to offer a holistic and non-institutionalized view of the patient. The nurse must care for the sick patient and also send the patient home with the tools to manage self-care, whether it is directions to the family to care for a patient with mobility issues or simply clarifying how to administer a complex prescription. However, healthcare institutions are increasingly trying to incorporate caring and compassion into care delivery systems, acknowledging their importance in contributing to the improvement of the health outcomes of patients. Nurses will always have a critical role in humanizing healthcare, and instilling a sense of optimism in patients.