Abstract
Philosophies and Conceptual models are essential in Advance Nursing Practice. Many theorists have created their own conceptual models and theories to be used as guidelines for healthcare workers. Despite the healthcare systems best effort , some patients aren’t willing to follow instructions at times due to many obstacles in health care itself.Some patients also experience many barriers to healthcare in which it is our duty to develop a patient-nurse relationship that is goal oriented to overcome these barriers. In this paper I will describe my personal philosophy of Advanced Practice Nursing. With this philosophy I will incorporate other Nursing Philosophers into my plan and describe how philosophy has evolved throughout the years. Developing philosophies are extremely important to guide, collaborate, and thoroughly care for our patients.
When caring for patients it is important to discuss perceptions, cultural influences, experiences and beliefs that our patients may have. The mind is a powerful place, and if our patients are not ready to accept certain healthcare behaviors we will not be successful in health promotion. As a future Nurse Practitioner who is Hispanic I want to ensure that I give proper care to all patients that I manage and take their culture into consideration. To aid a patient properly one must consider all factors including psychosocial. As a Practitioner one must be mindful of the patient’s culture as that will affect the compliance of their care. For example many Hispanics may tend to believe that mental illness comes from a supernatural force. How will I be able to develop a plan of care for these certain individuals? The foundation of my personal philosophy will be based on a culture of care and healthy behavior changes to develop a plan to guide health promotion.
My philosophy in Advanced Practice Nursing is that we will have the responsibility to develop a healthy,positive, and safe plan of care influenced by healthy behavior habits, goal setting, education and being culturally congruent. Mutual goal-setting between the nurse practitioner and the patient is key in attaining a state of health; this is one concept in my philosophy. UImogene King developed a philosophy called Conceptual Model and Theory of Attainment. This theory provides a holistic approach to organize the complex factors of health care systems. She believed that the patient had three fundamental needs such as the need for health information, the need for care that seeks to prevent illness, and the need for care when the patient is unable to care for themselves (“Imogene King-Nursing Theorist”,2016). Upon assessing the patient and gathering the patient history it is important to develop goals between
you and the patient. Having good listening skills and communication will preserve and restore health to an individual. Providing health promotion and disease prevention can positively impact a patients outcomes. Assessing the patients education level, goals, and what self management skills they have access to and are willing to be consistent with. The transactions between the patient and the health care provider can only occur if the expectations and performance are clarified by the patient (King, 2007).
Being culturally sensitive and aware is another concept in my philosophy. In order for Advance Practice Nurses to provide culturally competent care they must be aware of and discuss belief systems, expectations of treatments, social, and clinical factors. Culture is essential because this allows us to understand how individuals may respond to illness. In my Transcultural Class Nursing 700 I learned a lot about Madeleine Leininger’s Transcultural Nursing Theory. She emphasized many key components of the need for structure and resources that are necessary to evaluate and meet the cultural needs of the many diverse patients we care for. She discussed that as practitioners it is crucial to educate patients about their health status and by doing this NP’s need to perform cultural assessments (McFarland ; Wehbe-Alamah,p.348). It is my duty to advocate for vulnerable populations and reduce health disparities . Treating patients as unique as possible will allow me to provide quality care. As cultural competence in our healthcare system continues to develop , our patients will be able to overcome barriers that may prevent them from trusting the healthcare system.
The last concept to my philosophy is promoting education to have positive behavioral changes by the patients. According to Dr. J.O Proschaska who mentioned in his article “The Transtheoretical Model of Health Behavior Change”, (1997), “behavior change unfolds through a series of stages” (p. 39). The stages of change are precontemplation, contemplation, preparation, action, maintenance, and termination. To enhance positive responses, information should be given according to which stage the patient is experiencing, otherwise resulting in negative outcomes. He stressed that what you input into your patient will affect the outcomes. For example if you want to promote smoking cessation to your patient , your patient will have to be ready to accept that behavior change or it will never happen. Education is key to preventing illnesses. Promoting health screening , discussion of diet, exercise; not just telling the patient that they must do it but actually taking the time to educate the advantages to each behavior will have a positive impact on the patient.
Plans to Integrate Philosophy into Practice
First of foremost when working as an Advance Practice Nurse I will make sure first impressions are imperative. Setting the tone and the welcoming of patients is crucial. How polite, humble and caring you are will set the tone for the patient-practitioner relationship. The NP looks at patients on a holistic basis, body, mind, and spirit. Developing a relationship with your patient will influence how they trust you as a practitioner.
Developing a goal-setting vision board with my patients is a tactic I will like to incorporate. It might seem time consuming but by actually taking the extra minutes to develop a goal will influence patients to want to be more involved in their own care. In my clinical setting I had a patient whose hemoglobin A1c was 6.4 , I took the extra 10 minutes to write a diet plan on a piece of paper with her so that we can prevent complications that come with Diabetes Mellitus. I asked her questions regarding who prepares her meals, who does the food shopping, the salt content in canned foods. The goal was to follow up in 1 month and to decrease her hemoglobin A1c to at least a 6.0. The goal was a success because I educated and developed a goal with the patient’s input.
Developing a questionnaire that incorporates pt fears, education, accomplishment of goals, religion and spiritual needs they may follow that will influence their health care decisions. The experience of fear in patients can prevent the achievement of health promotion and disease prevention. According to Caplan et al. (2018)”fatalistic beliefs are cited as a cultural barrier to preventative care and help seeking behaviors” (p.69). Writing a strategic goal plan that outlines clear goals to provide culturally appropriate service will provide health promotion.
Evolution of Philosophy
As I reflect on my Advance Practice studies I definitely have had different beliefs and areas of enlightenment. Prior to my Transcultural of Nursing class I never really took ownership to how much I didn’t incorporate culture in taking care of my patients. With that course I began to become more culturally aware. I began to analyze how the organization I worked for represented diversity. I remember not being able to find pictures or posters of diverse team members. That was about 4 years ago and now my organization holds a required cultural awareness course to all members of the team. I then joined the cultural mentoring program at Staten Island University Hospital. Creating approaches to mentoring that take culture into account will allow more productive and empowering partnerships.
As the years went by I have grown and have become more aware of what factors affect patient’s compliance and involvement in their own care . At the beginning stages of my philosophy culture was not essential as I see it now to be. In my organization as an NP I would like to join the strategic planning team to encourage the organization to develop an action plan to educate their members on being culturally competent and culturally sensitive in order to provide safe quality care. In my practice I will provide evidence based practice written resources no higher than 6th grade level and in patients preferred language. For those patients that are visually impared or cannot read I will collaborate with an onsite language interpreter.
My philosophy continues to evolve away from the doctor-patient order lists and the term “non compliance”. In my nursing theory course we viewed Dr. Prochaska’s lecture mentions how we can overwhelm patients. He discusses the scenario regarding diabetes and how most doctors call out orders such as take medications, test blood sugar, stop smoking, exercise, and lower stress. I see this type of doctor-patient recommendations occurring a lot in my facility.Sometimes as healthcare professionals we do not allow the patient to cope with this new diagnosis. It can be very scary for them. Medications have side effects , do we teach about that?
Blood sugar testing may be easy for us health care providers but can the patient actually self check, do they have the finances for the equipement’sometimes patients smoke because they are stressed, so how do we expect them to stop everything at once if this is their coping mechanism? I actually never believed in the term “non compliance”. I always felt if a patient refused treatment there was an underlying reason why. That reason can be lack of knowledge, fear, or a negative experience from the past. I agree with Dr. Prochaska views on starting with action with what the patient is ready to do. As J.O. Prochaska mentioned “less than ten percent are ready to take action on two or more behaviors”, (48:10). One of the biggest obstacles concerning the hopefulness of health behavior change is the lack of patient education on health promotion versus disease treatment.
Advance Practice Nurses play a crucial role in teaching patients what needs to be changed or lifestyle techniques to prevent diseases. I work with many cardiac patients and I always ask them “what has brought you here, how did you get to have cardiac disease and did you do anything to prevent it?” Some patients tell me that they smoke and don’t exercise. Others tell me they did not eat right or control their blood pressure. Majority tell me that they did not know that diabetes, HTN, and high cholesterol are all factors that will cause them to have triple vessel disease. Yes it is my belief that patients do need to take their health in their own hands, but as health care providers in the community or physician offices it is our duty to help patients understand that unhealthy habits will cause diseases. Encouraging blood sugar control, healthy eating habits, exercise, nicotine free, alcohol free modifications. If patients don’t have the knowledge how can they prevent diseases.
Influences of Philosophy Development
Precepting with Dr Hameed during my clinical rotation was an interesting journey. He served many underserved patients who were diverse. I noticed then that many patients based on culture had their own theory on health. Some did not want to change their health behaviors simply because they do not have the knowledge on why it should be done and how it could be done. Dr Hameed influenced me in so many positive ways to always treat the patient as an individual. He knew everything about their lifestyles, families involved, and their goal for that year. I was amazed how his patients respected him and enjoyed developing a plan of care that they would follow.
Dr Leininger’s theories and models also helped me explore the interaction of culture and culture values with health beliefs and the impact it has on our health system. During my classes and experience in clinical areas I found it interesting that there are many different approaches that can be used when directing care. I will continue to speak on culture and be an advocate for
my patients’ cultural rights and maybe inspire my peers to do the same. As an NP I will provide a holistic and individualistic health approach because it will have a reinforcing effect on the individualized approach in personalized nutrition.
Why is it Important to Develop and Practice from this Philosophy.
My philosophy is important to develop as it treats patients on an individual and unique basis. All diabetic patients are not the same and all cancer patients are not the same. We all have different cultures, views , health behaviors that all impact the way we take care of our health. In order to provide and promote the well being of a population you must first have knowledge on the individual of the population.
What I find to be useful for my patient population to increase health goals, self efficacy, develop positive health behaviors, are recognition and control of physiological states, incorporating culture and having mastery experience. For example if my patient heart rate increases it can be many factors that play a part. It could be anxiety, vasoconstriction, pain , or afib.
Teaching my patient about this increases self efficacy and gives them comfort that it might not be a significant problem. With assurance and my patient able to return an explanation on what to expect will help them feel less anxious. When teaching my patient how to clean his incisions and educate on s/s infection every day, my patient will be able to take care of incisions on his own and become experienced and self confident. As per Dougherty et. al, (2001), ‘the willingness of an individual to engage in certain behavior is related to the positive benefits expected if that behavior is performed.’ Education and consistency during patient care is crucial for them to feel a sense of security . Allowing patients to be actively involved in their care will help them feel confident when in the community.
Conclusion
Advanced practice nurses have the knowledge and expertise in meeting the health needs of individuals, families, and communities. They also both involve analyzing and synthesizing knowledge, understanding, interpreting and applying nursing theory and research on the profession as a whole.Considering the development of a new innovation requires careful planning and all benefits and risks should be considered. As an Advanced Practice Nurse I will provide a holistic and individualistic health approach because it will have a reinforcing effect on the individualized approach in personalized care.
Reference
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- Caplan, S., Escobar, J., Paris, M., Alvidrez, J., Dixon, J. K., Desai, M. M., & … Whittemore, R. (2018).
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