Theory and its philosophical applications

Philosophy of Nursing with an Emphasis on Labor & Delivery

Theory, Application, & My Philosophy

This paper is an insight into some philosophies of nursing with an emphasis on the process of Labor and Delivery. I believe the research was thorough and is well supported because I attempted to use relevant materials from several nursing theorists. I relied heavily on the Internet and other nursing journals and from other professional domains. The main objective of this report was to consider nursing, the future of nursing and the impact that I will have in the healthcare spectrum over the course of my career. I tried to identify my values and beliefs regarding the established metaparadigms and metatheories of nursing and the more succinct processes involved in regard to labor and delivery nursing. This assignment is a way for me to exercise the functions of clarification and organization about my own professional objectives. I have tried to incorporate some personal experiences through the use of conceptual materials and the 'patterns of knowing' which are: empirics, personal knowing, ethics and aesthetics.

With that being said, being a nurse is a very important aspect of my life and a report such as this is therefore an easy proposition. The report has distinct phases. I begin with a brief personal history of some of my experiences in the nursing field and why I became a nurse in the first place. I then try to identify, discuss, and document my ideas about the four basic metaparadigms within theory of the patient, nurse, health, and environment. Next I move to an identification, discussion, and documentation phase for two theories specific to Labor and Delivery with examples. Next is an example of how the patterns of knowing philosophies helped me get to where I am today. I conclude with a list of propositions or assumption statements which tie this work together and connect the concepts described throughout this piece.

Personal History

This part of the paper is about me and is a good picture of my personal history and experiences in nursing. In other words, it explains why I became a nurse. I hate to say it, but I believe that this profession was my destiny. I have to admit that I often wonder why anyone in their right mind would want to be a nurse considering the blood, vomit and other nasty things that go on in any typical day at the office. I am almost positive that it is not healthy to be around sick or dieing people on a daily basis.

For me, becoming a nurse was on the line of some inner calling that, in a sense, may be considered a destiny that is bit odd at best. I certainly never felt queasy at the sight of blood or any other types of accident scenes. As a child I always needed to bandage up my dolls and bears. Heck, I even added ketchup to make believe accidents and overturned strollers when I was little This gave a an effect of realness and it made me want to help those poor stuffed things even more as well as making my mom laugh. When I got those band aids on the dolls' knees I always felt a real sense of accomplishment.

Although the media says differently, the pay is not always what it is cracked up to be and the hours can be quite a challenge. I understand that my skill-level is a crucial component of my satisfaction and that any shortcomings or a lack of skill can entail dissatisfaction as a nurse. Sure I want to be paid because of my knowledge base. but, it is a serious myth that nurses are paid well and therefore satisfied because of the industry shortages and they are in such high demand. I love this job in spite of the income potential. I thrive on loyalty, trust and commitment. I have been lucky to work in environments in the healthcare community where it is understood that if the organization as whole is to provide a quality product or service, the organization requires employee commitment from top to bottom. My managerial teams have consistently provided me with the proper tools and climate to mesh my efforts into a complete team approach.

After learning of the true nature of nursing as an adult, I feel the insight that nursing is not all band aids has been an eye opening experience. Today I understand that I am not a normal person. That is because I still get that same sense of accomplishment that I felt as a child even when I am required to clean up another person's sick residue, stitch up a bloody gash or put my hands into any and all sorts of vile orifices. It is funny that I have personal experiences with some of the nasty and unpleasant substances emitted by our bodies. I can not believe some of the nursing tales that I have heard because of the fact that they were so disgusting that no one in their right mind would want to become a professional in this field. Yet, because it must have been my destiny, I am here and I love it.

Many people outside the field may be amazed that nurses get out of their beds and go to work each day. I have always felt a strong need to wake up in the morning and to make a difference throughout the day. Nursing as a profession offers me that opportunity. Besides, if nothing else, I get to wear scrubs to work and what is more comfortable than that? But all jokes aside, the work is challenging and it changes from day-to-day. There is no opportunity to get bored because as soon as you do another situation that needs one's full attention and therefore creates that sense of accomplishment that I needed from my childhood.

The basic responsibilities inherent in the profession fulfill my need for a challenging work environment. I know that job needs me to be able to utilize my mind and that I need to be a detail oriented individual that can handle the routines of things like pharmaceutical distribution on one end of the spectrum and a complete meltdown in an emergency room setting at the other end of the spectrum. I am wired for this topsy-turvy roller coaster environment and I have chosen to fulfill my need to be a nurse that was apparent when I was quite young.

Four Metaparadigms

There are certain assumptions about nursing that underlie my philosophy and framework. Nursing encompasses both theoretical and practical knowledge. Nursing is a practice-oriented profession so the background theory recognizes the value of knowledge and judgment related skills that we must acquire daily through practice. My view is simply that information needs to be gathered before any goals are set which helps me with my approach to assessing each patient. I place a great deal of emphasis on the theory of the Cognator where I focus heavily on my self-concept, I understand my role or function which allows for me to work in an inter-dependent team setting.

I feel I have a very good understanding of the minute differences between a thorough patient interview or a quick chat to ask if there is anything I can do as I am checking vitals. Although this theory of nursing is often applied to psychiatric nursing, community nursing, or long-term care facilities I believe it can also be helpful in regard to Labor and Delivery. Determining the significance of any particular theory to nursing is important when considering the metaparadigms of nursing. For example, "Cultural competency is the ability to care for clients in a culturally sensitive and appropriate manner. The development of respect for others is vital for the improvement of cultural competency. Many models explain how cultural beliefs evolve and progress and we need to examine these to see how they fit with our own cultural development." (Royal College of Nursing, 2004) follow the philosophy that first and foremost must consider any impact on the patient, health and professional environment. The business world is very well aware of the paradigm, but only we nurse practitioners could carry it to the next level -- we have the Metaparadigm. A Metaparadigm is basically a series or group of paradigms that share certain common values or ways of looking at and interpreting, and at times distorting reality. They represent a picture of the purpose for our discipline. This purpose is what I try to incorporate into my life on a daily basis.

A define and employ the basic metaparadigms of nursing theory into my professional practice. The competency development and caring on an everyday basis constitutes my professional expectations in regard to the perspectives of the basic four nursing metaparadigms of theory as they relate to the patient, nurse, health and environment. There are other major concepts that I also incorporate and employ that are unique to my professional practice. For example, I am a firm believe in Florence Nightingales' approach to her life and her calling. She was almost radical in her approach to healthcare and healing.

By radical, I mean that she was the type of individual who aimed to solve matters by getting to the root of the problem. She was more interested in solving the problem and not the symptoms of an underlying issue. She used a systems thinking methodology that made her overall approach to healthcare a faith-based philosophy. Although she used God as a foundation, she was willing to make the effort to conduct scientific research to confirm a basic belief. Consider the fact that nursing focuses on the patient as an adaptive system while medicine on the other hand sees the patient from the perspective of a biological system or more importantly, the patient's disease.

Like Florence Nightingale understood, it is our objective as nurse practitioners to utilize the metaparadigms of nursing to help the patient move along a continuum that begins with health, moves to illness and eventually aims to return to health. The patient is most likely to get well if he or she is comfortable with him or herself, the nurse, to health situation and the environment. It is our goal as nurses to increase a patient's inert adaptation skills in cycles of physiological, self-concept, role function and inter-dependence. We nurses act as external regulatory forces that either modify or adjust any and all stimuli that affect a patient's ability to utilize his or her own adaptation system.

For example; rather than constantly utilizing a verbal analogue scale for assessing whether or not to continues with an I.V. morphine drip, it may be better to allow the patient to have more input from the patient which stimulates his own adaptation process. Does VAS of 4 sit right and is there a level of comfortable to a point where resting is possible or is the breathing good? Florence Nightingale understood that we must allow the patient to adapt to with the metaparadigms of nursing to allow for the adaptation process to promote healing.

Concepts Specific to Labor & Delivery

There has been a debate about the value of looking at culture as a way of understanding aspects of health, for example differences in the health status of ethnic groups." (Royal College of Nursing, 2004) in regard to Labor & Delivery, various cultural beliefs exist. There are various considerations in regard to nursing and cultural labor and delivery philosophies.

The concepts and propositions associated with the Trans-cultural Nursing theory for example opens us up to many shortcomings. Nursing and each individual nurse specifically must be aware of subtle differences in the way people do things. Consider Bennett's Intercultural Sensitivity Model as presented by the Royal College of Nursing:

Denial of Cultural Differences

Defense of One's Own Culture

Minimization of Other Cultures in Order to Protect One's Own Cultural Identity

Cultural Acceptance

Adaptation to Cultural Differences

Integration of Full Cultural Awareness Into Everyday Interactions

Nurses must be cognizant of a woman's cultural differences when it comes to Labor & Delivery. "However, Bennett's model does at least provide a framework for examining our own attitudes towards our culture, how we came to understand our culture and how this fits with our thinking about other cultures. Where each individual nurse lies on the continuum depends on life experiences and the overall aim of the model is to move the nurse towards higher levels of cultural competency through the presentation of specific content and exposure to different cultural experiences." (Royal College of Nursing, 2004)

From the initial stages of the model, it shows how a new or inexperienced nurse practitioner may be unaware that any cultural differences even exist in our society or they may be in a state of denial. We nurses more than many other professions need to understand and promote that there are cultural differences in our environment. A black woman and a white woman may have completely different expectations of the post delivery care for example.

We nurses must also take into consideration our own culture's expectations. "The holistic health perspective of nursing, which integrates all aspects of the health and well-being of individuals and families, can provide especially valuable insight to the assessment, planning, and service delivery processes. Nurses need to not only participate in the planning process during the interdisciplinary planning meetings, but also to contribute their own assessment and recommendations from a nursing perspective." (Mattson Bryan & Wirth, 1995, p. 73)

Life is a bunch of habits that we present as our personality. If our habits are not taken into consideration when we deal with others we tend to risk alienation. "At this stage Bennett suggests that cultural difference is not perceived. During the first stage the individual is unable to see cultural difference, but once awareness is recognized the individual may feel threatened. 'Defense' arises when the individual is only able to perceive their own cultural existence as the norm; anything outside of this is viewed negatively." (Royal College of Nursing, 2004) We nurses are required to promote similarities and appreciate differences.

By minimization of other cultures in order to protect our own, we may inadvertently create expectations or not recognize subtle language and cultural differences. The fact that a Jewish newborn is not circumcised may be a huge problem for a one family and in other Middle Eastern nations other than Israel the concept to circumcise may be thought of as a desecration of the body.

Our own believe patterns may see one, both or neither as unreasonable criticize anyone person for having those beliefs. There are often dynamic and many times very controversial situations affect nursing and health care because of diversity such as the cultural beliefs on birth which also includes prenatal care, pregnancy, labor, delivery, and post-partum care. In case of death there may rites of passage rituals that must be followed in regard to death and dying. Some other considerations include:

Definitions of Illness

Family Roles and Responsibilities for Ill Clients

Nutrition and Diet

Culturally Appropriate Communication,

Culturally Appropriate Diagnoses,

Culturally Appropriate Interventions

Culturally Appropriate Standards of Care

Cultural acceptance and adaptation to cultural differences is where I as a nurse would like to consider myself. I feel as though I have made substantial advances in cultural differences where I may not have had an awareness and understanding of the different meanings of behavior in regard to Labor and Delivery across diverse cultures. Integration of full cultural awareness into everyday interactions is how life should work. "During this stage the individual is able to move between different cultures competently; they are able to draw on their knowledge of different cultural perspectives and frameworks." second nursing theorist that I wish to mention in regard to idea of Labor and Delivery is some of Ernestine Wiedenbach's works. "Wiedenbach believed that there were 4 main elements to clinical nursing. They included: a philosophy, a purpose, a practice and the art. Wiedenbach also believed that there were 3 essential components associated with a nursing philosophy: Reverence for life, Respect for the dignity, worth, autonomy and individuality of each human being and resolution to act on personally and professionally held beliefs." (Wright, 2004) nurse's purpose based on Wiedenbach's works should revolve around what the nurse wants to accomplish as demonstrated by her actions but all of those activities need to focus on achieving results for the patient. Whether the function is Labor and Delivery or any other nursing requirement, nursing actions must be fueled by inert beliefs or feelings about the ability to meet the patient's needs. In order to accomplish this, a nurse like me must therefore have an understanding of a patient's needs and concerns in order for me to develop any viable goals which should be the blueprint for my actions. "The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns." (Wright, 2004) Wiedenbach clearly created terms in her theories for nursing which were not intended to fully define the profession, but were mere attempts to clarify her understanding of many nursing misconceptions and to try to clear up and present clarity.

In the Labor and delivery process, this can be translated into identifying a patient's need for help and if necessary, providing the needed intervention such as implementation of a medical plan of care. For example, the nurse and entire medical team are responsible to be aware of Labor and Delivery issues that may stem from the likes of a premature labor, drug dependent mother or a premature rupture of the membranes. "Providing care, a nurse exercises sound judgment through deliberative, practiced, and educated recognition of symptoms. The patient's perception of the situation is an important consideration to the nurse when providing competent care." (Wright, 2004)

Brief Clinical Example

As a first year nurse I was diligently exploring the nurse's role for meeting the basic and usually more complex physiological needs in various health care settings. Although I touched upon acute care, long-term care and mental health facilities, my biggest eye opening experience in regard to cultural expectations came in an inner city delivery room. My entire perspective of leadership and culture changed as was required to apply the roles I had learned to promote adaptive responses in the child and family during the child's illness, pregnancy, labor and delivery, and post-partum and neonatal phases of reproductive processes.

It did not take me long to learn of the many inherent and of course common discomforts women suffer during pregnancy and how the various communities and cultures they live in dictate the severity of those discomforts. Symptoms of discomfort due to pregnancy should vary from person-to-person but I imagined seeing patterns of common discomforts based on ethnicity and social setting. The poor always had it worst and they seemed to complain less. Hormonal changes may be the cause of headaches during pregnancy but living in an unsafe environment is just as guilty no mater which trimester. It is hard to recommend proper rest and nutrition, or adequate fluid intake if the person can not afford to do any of those things.

Some of the lessons I learned then seem are more than obvious now like the fact that about half of all pregnant women experience some form of nausea and sometimes vomiting in the first trimester. I assumed when growing up that morning sickness was a myth. Today I am able to contend with the diversity issues of Labor and Delivery.

I am more aware of the facts. For example, since I am aware that morning sickness may be aggravated by stress, traveling, and certain foods high in protein and fat I am better able to question mother's to be on their habits and diets. I can then explain in a holistic sense that to lessen the symptoms of morning sickness that the person should be eating smaller meals throughout the day and curtailing my talks to diversity sensitive areas that may have diets that are not ideal.

From my experiences in life and work I am now prepared to be a nursing professional. "Wiedenbach conceptualizes nursing as the practice of identification of a patient's need for help through observation of presenting behaviors and symptoms, exploration of the meaning of those symptoms with the patient, determining the cause(s) of discomfort, and determining the patient's ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals." (Wright, 2004) My only question is, how do you tell a pregnant drug addicted mother living in a ghetto to eat a high in complex carbohydrates meal which includes whole wheat bread, pasta, bananas, and green, leafy vegetables? "A clinical nurse specialist from the University of Michigan, School of Nursing, conducts prenatal classes on-site. Each pregnant inmate attends six classes on topics involving body changes during pregnancy, labor and delivery, natural childbirth, parenting skills, personal hygiene and other birth-control issues the women choose to discuss. Pregnant inmates are encouraged to have job assignments and attend school." (Epp, 1996)