I began my career in healthcare as a patient care technician (PCT) in a large hospital. Working throughout the hospital as a float PCT, I gained experience with a diverse group of patients on every unit in the hospital. I eventually took a position in the ICU and stayed there for 5 years.
I enjoyed caring for patients and began taking classes toward my nursing degree. After completing the LPN program, my career in nursing became earnest and more focused by the day. Starting in a long-term skilled care rehab facility and a dialysis unit, I returned to the same hospital I started in as a PCT and worked there for seven years as a staff nurse and later, an RN. Eventually I became team leader of the cardio unit, and simultaneously completed my BSN.
Once I completed my BSN, I began working in home healthcare as a case manager for a community hospice facility. I worked in case management at a hospice and then as an ICU nurse and unit supervisor in a long-term acute care (LTAC) facility. I remained PRN for hospice for another year, while I completed my orientation and training for my position in the LTAC facility.
I currently work for the LTAC facility caring for critically ill patients in the ICU and supervising staff nurses and PCTs as well. I am now working toward a MSN in education at South University and my goal is to teach new nurses in the cardiac setting, and preferably in coronary ICU . My nursing career reflects the importance of the Dreyfus Skill Acquisition Model. Since my humble beginnings as a PCT, I now serve in a position of leadership and look forward to reaching a higher level of expertise in my career.
The four metaparadigms of nursing undergird and underpin "the entire conceptual universe of the nursing profession," (Johnson, n.d., p. 1). Useful for providing a framework for all personal nursing philosophies, the four metaparadigms include patient, nurse/nursing, health, and environment. These metaparadigms are broad and flexible enough to allow for their application and understanding within several core nursing rubrics, including community nursing. As Schim, et al. (2007) point out, the metaparadigm model can also be expanded to include the "central concept of social justice," which is especially pertinent in urban nursing environments and similar settings requiring patient advocacy. The patient is reframed as a whole person, which is why the metaparadigm shifts the focus from "patient," suggesting that the person is viewed through the lens of his or her illness or precipitating conditions. By viewing the individual as a whole person, the nurse is better able to provide quality care. In fact, Johnson (n.d.) points out that the person metaparadigm takes into account personal background, family, and community.
Just as person broadens the concept of the patient, the metaparadigm of health expands the locus of healing. Health is not defined in narrow means, but always understood within the framework of the person's worldview, values, goals, and beliefs. The nurse does not need to project "absolute" concepts of health, and instead, works with the patient to cultivate a more personalized set of health-related goals and objectives that allow for cultural and personal specificity (Johnson, n.d.).
The metaparadigm of environment likewise expands the range of issues at stake in patient wellness. Everything from religion to addiction can be considered part of the person's environment (Johnson, n.d.). Taking into account a wide variety of variables that impact well-being, the nurse is in a better position to inspire change and healing. Finally, nursing itself is a core metaparadigm that is strongly linked to theories like caring. The provision of care via evidence-based practice but also compassionate attitudes and behaviors comprises the duties of the nurse.
Two Practice-Specific Concepts
Two practice-specific concepts I would like to focus on include diversity and health promotion. Diversity refers to cultural diversity, but also to a diversity of worldviews and especially those related to health and healing. However, diversity issues can be best understood in light of Leininger's Transcultural Nursing theory. The foundation of transcultural nursing is the universality of culture as the "broadest, most comprehensive,...
3). According to Leininger & McFarland (2006), the goal of transcultural nursing is to actively seek knowledge and information that can enhance the cultural relevance of healthcare. Until fairly recently, cultural knowledge remained "largely unknown" and discredited among healthcare workers (Leininger, 2002). However, ignorance of diversity detracts from patient care and can lead to unsafe incongruences between care delivery and patient needs, expectations, and goals. Leininger (1988) therefore recognized culture as the "missing link in nursing knowledge and practice," (p. 152). When working in a diverse setting, nurses can work with their colleagues to promote cultural competency. Transcultural Nursing theory can enhance the productivity and harmoniousness of the workplace environment, as well as improve patient outcomes (Leininger, 2002). Moreover, diversity in nursing promotes holistic care that converges with the four-pronged nursing metaparadigm in that it takes into account person, environment, health, and nursing care. The person is reconsidered in terms of culture, which also impacts environmental factors, attitudes toward health, and receptiveness to care.
The health promotion model was proposed by Nola Pender, and offers a nuanced and complex method of viewing health-related behaviors and decision-making. The model comprises three main areas: individual characteristics, cognitions, and behavioral outcomes. Health promotion is a holistic concept that coincides with all four of the nursing metaparadigms: person, health, environment, and nurse/nursing. One of the underlying assumptions of health promotion is that persons "seek to create conditions of living through which they can express their unique human health potential," (Pender, 2011, p. 5). Research on adolescent populations shows that as young people develop personal responsibility for health care, health promotion theory becomes especially relevant to understand the social and cognitive factors influencing health-related behaviors (Srof & Velsor-Friedrich, 2006). Families, peers, and health care providers become sources of influence in the adolescent's life, and these influences may "increase or decrease commitment to and engagement in health-promoting behavior," (Pender, 2011, p. 5).
Social learning takes place throughout adulthood, as well as childhood and adolescence. The nurse can play a critical role in inspiring patient self-efficacy, which is strongly correlated with positive health outcomes (Pender, 2011). Nursing actions can strongly influence health-seeking and health-promoting behaviors ("Health Promotion Model," 2012). Health promotion model has potential for long-term application and efficacy among patients, because the nurse and patient can work together to develop a comprehensive plan. Taking into account the person's background, beliefs, and prior behaviors, the plan can be constructed in ways that are meaningful to the patient and therefore more likely to inspire commitment. Pender (2011) finds that self-initiated commitment is "essential to behavior change," (p. 5).
List of Propositions
1. Cultural background includes a composite of beliefs, many of which the patient may be unaware of, but which nevertheless shape attitudes toward health and health-related behaviors.
Rooted in Leininger's Transcultural Nursing Theory, this proposition promotes the value of cultural competence. While cultural competence is not one of the major nursing metaparadigms, it does relate to all four of the metaparadigms: person, environment, health, and nursing. Culture provides the complex of values and beliefs that inform personal identity construction, thus influencing the individual's attitudes, self-concept, and behaviors. The person cannot be understood in isolation of culture, because culture has helped form that person and his or her current state of mind-body health. Moreover, culture is a major part of the person's environment, informs the person's attitudes toward health and health goals, and also the person's communication style with healthcare workers like the nurse. This proposition links Health Promotion Theory and Transcultural Nursing Theory.
2. Patients are more likely to commit to health-promoting behaviors when those behaviors are normative within their cultural framework, when peers or family models those behaviors, and when those behaviors deliver rewards that are personally valuable.
Health promoting behaviors stem from the person's value system. Basic behaviorism and cognitive-behavioral theories reveal the link between background beliefs and behaviors (Pender, 2011). Blended with Transcultural Nursing Theory, this proposition suggests that nurses better understand cultural norms that guide health-promoting behaviors. When cultural norms clash with health promotion, the nurse is challenged to come up with person-centered plans toward cognitive, emotional, and behavioral change.
3. Patient environments are complex, and the variables impacting health may shift on a regular -- even daily -- basis.
Variables impacting health range from the cluster of cultural variables to personal psychology. The patient's attitudes and behaviors may change rapidly. Viewing the person as a dynamic individual, rather than as a static patient, promotes quality of care and conjoins the metaparadigm of person with those of environment, health, and nursing.
4. Patient attitudes toward health and healing are malleable, but often rooted in metaphysical and spiritual beliefs.
The spiritual beliefs of patients fall under the general rubric of culture. Applying Transcultural Nursing Theory to…
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