The responsiveness theory of nursing: A dialysis nurse's perspective

Personal Philosophy of Nursing

Philosophy of Nursing

The Responsiveness Theory of Nursing: Thoughts of a dialysis nurse

Providing effective nursing is not like following a rulebook or a recipe, although certain standard procedures and practices must be observed. Instead, a nurse must be continually responding to changes in the patient's immediate state of wellness, changes in the environment, and also to long-standing changes regarding how health and nursing is defined in the context of the patient and the nursing profession. Just as the patient responds to and changes with shifts in the environment and his or her internal state of health, the nurse must respond to and use his or her observations to define the belief structures that will underline a specific patient's treatment, and the nurse's subsequent interpretations, and practices. Nursing is creative and dynamic by necessity, and must be individualized in a responsive manner to facilitate the patient's health and well-being.

Person

The Responsiveness Theory of nursing ultimately defines nursing as choosing to perform specific roles. Nurses may act as advocates, teachers, advisors, supporters (even 'cheerleaders'), emotional punching bags, social workers, confidants, and/or friends. The one uniting factor of all of the roles a nurse may perform is the need to respond to the patient. A nurse approaches the patient first as a stranger, intruding into the patient's world yet implicitly asking the patient to entrust his or her life to the nurse. The nurse must learn about the patient and respond to the patient, learning about the patient and recognizing the patient's uniqueness. A nurse must recognize the 'situated' nature of the patient. The patient does not come to the nurse in a state of neutrality, but located in a personal, historic dynamic defined by his or race, culture, beliefs, and values. The patient's family and caregivers also have a 'situated' quality in regards to their own personal history and relationship to the patient. When the nurse communicates and treats the patient the nurse must respect and respond to such situational factors. Additionally, past experiences with the medical profession, the progression of the patient's illness or health, and stage in life will also affect the nurse's responsiveness to the person. The 'person' always exist as part of an integrated system of care, incorporating not only physical needs but also spiritual, psychological, and socio-cultural demands that define the patient as an individual, as a member of a family, and as part of community (Hagopian, 2009, Slide 5). Explaining what is going on to the patient and to their family, showing respect for their dignity in difficult situations, communicating in terms they can understand, and adjusting communication strategies as well as specific facets of the treatment process without compromising accuracy of information or quality of care are all part of Responsiveness Nursing.

Health

Health may be defined by the patient's state of relative physical, emotional, and sociological well-being (Hagopian, 2009, Slide 7). Questions that might arise when assessing the patient's health are: How functional is the patient? How positive is his or her mindset? What sort of social and financial resources does he or she have to improve his or her treatment? All of these factors affect one another. For example, someone without adequate health insurance may have a less positive attitude about his or her treatment than someone with the same medical condition. Patients may have different definitions of what constitutes a 'quality' life that will affect their response to and desire for treatment. A nurse must respond to these different health indicators in a holistic fashion. Additionally, familial perceptions of the patient's health will have an impact upon the patient. Health is individualized and culturally bound ideal as well as a medical concept. A former athlete might experience a more profound loss of identity and self upon being ill than someone who is sedentary and different cultures may have different concepts of when an elderly individual should relinquish some of the decision-making about their treatment at the end of life.

Nursing as a scientific discipline

A nurse is the ultimate 'first responder.' A nurse must observe the patient empirically and humanely, and different situations will call forth different aspects of nursing. The nurse must adapt, and help the patient adapt, to changes in the patient's environment, treatment, and help. This adaptation will be affected by the patient's past history, identity, and the patient's social environment of family and friends

Responsiveness in my own practice

As a dialysis nurse, I must constantly be aware of every element of my surroundings. A sudden drop in blood pressure on part of a patient requires an immediate response -- yet the discomfort of a first-time patient also requires an immediate response of an emotional, as opposed to a medical, nature. Responsiveness is also demanded of a nurse in terms of the patient's response to dialysis treatment -- a new patient may want everything carefully explained, so he or she knows what is going on, a more experienced patient may want the nurse to provide a distraction in the form of conversation. Also, the family dynamic may be such that the family is automatically integrated into the patient's decision-making and care, while other patients may need more distance and dignity in the context of the process.

Conclusion: Strengths and limitations

My theory is heavily influenced by one of the most inspiring and practical nursing theorists: Betty Neuman, who stresses the need to strive for a state of homeostasis on the part of the patient, in the context of his or her environment. Although my theory is flexible, which may be seen as a weakness, it is also resilient in the face of the diversity of needs and situations with which modern nurses must cope. Finally, although it is responsive, it is not merely reactive -- part of responsiveness is knowing when to be firm in the face of a patient's reluctance, shyness, or noncompliance.