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Personal Philosophy and Reflection on Nursing

Madison Stewart

Dr. Marcella Williams DNP, RN, CNE, CMSRN

NUR 4140

Bon Secours Memorial College of Nursing

3/26/2021

“I pledge”
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Definition of Nursing

I define nursing by the care that is selflessly given to others. Nursing is something that

comes natural to many and is not able to be foundationally taught. Although people can be

trained on how to perform skills a nurse does, you cannot teach someone to have the heart that

is required for the profession. For instance, you cannot train someone to feel empathetic

towards a situation and respond appropriately. Nursing is a selfless profession that requires you

to place any hardships you may have going into the shift, on the back burner, so that you are

able to therapeutically listen to your patient. What you are currently facing is not important when

you are caring for others.

The Bon Secours Memorial College of Nursing philosophy includes being a patient

advocate and providing care that exceeds expectations. Not only should there be an

environment that has trust, but also one that allows for patient education to be provided. To me,

this relates to my philosophy through taking the extra time to care for your patient. Without

providing education to the patient, they may return to the hospital due to lack of knowledge. By

giving them the education that they need to keep them from readmission to the hospital, you are

in a way, still providing care for the patient.

Personal Philosophy

My personal philosophy involves the saying that nurses are born and not made. My

interprofessional relationships involve communication and trust. Without trusting the team that is

providing care for your patient, you may not be instilling faith into your patient. This trusting

relationship that begins between interprofessional team members, carries over into the patients

trust of her providers. Communication is key in these relationships because you don’t want to

redo work or charting that may be unnecessary. Delegation is a crucial part of communication

and allows for interdisciplinary collaboration for the patient.

In my nurse-patient relationships, I first build trust. After building trust with your patient

they are more inclined to being honest with you, which allows you to better serve them. If your
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patient is an alcoholic, for example, and you gain their trust, they may be more inclined to give

you information in regard to their readiness to quit. This is important to know a patients true

feelings regarding big factors in their lives, so that you can better assist them at what readiness

level they are. Understanding can become important when it comes to accessibility of health

care. If a person feels you have an understanding for what they are going through, they may be

more persuaded to being honest about their healthcare status.

Values and Beliefs

My nursing values have not greatly changed since my previous Personal Philosophy

Nursing Paper. I discussed how trust and honesty are important characteristics to hold when

caring for someone. My value that I largely attributed my nursing philosophy to, is empathy. As

discussed previously, you are a better caregiver when you are able to be empathetic. By having

this trait, you are showing the patient that you are a person who goes through the same

struggles and can provide insight. This allows the patient to feel supported and have their

emotional needs met. After empathy is shown, the patient may be more open to engaging in

more difficult conversations.

Lastly, a value and belief that I hold to be the same, is placing the patients desires above

mine. I may not agree with the patients decisions for treatment or lack of, but I have to respect

the patients decision and provide the care that they request. As empathetic as I can be, I still do

not know what goes into a patients decision for care, and I must respect their final decision and

trust it’s what’s best for them. Patient education can be provided to them if I believe there is a

knowledge deficit.

Nurse Patient Encounter

When working in an assisted living facility, prior to nursing school, I cared for many

elderly patients who I cared for deeply. I was aware of their past medical history and current

health status, as well as what medications and diets they were on. One of my patients was an

older woman who was on a mechanical soft diet with thickened liquids. At happy hour, a friend
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decided to give her some peanuts, that she normally is not able to eat. This patient ate the

peanuts, but unfortunately had aspirated them all. Within a few hours, the patient became

hypoxic and had shortness of breath on exertion. I assisted her to her room and listened to her

lung sounds. She had course crackles in both lungs and continued coughing despite getting

anything up. The on-call nurse was notified, and she was at the facility within minutes. The

patient was on hospice and had progressed dementia that allowed her daughter to be Medical

Power of Attorney. When the nurse and I called the daughter, she notified us that she is out of

town for the next few days. The nurse reiterated that this patient is in critical condition and

needs to go to the hospital or Morphine and Ativan need to begin so the patient is comfortable.

The daughter did not understand the circumstances despite how it was presented, and stated

she was on the way back and would make a decision when she arrived.

In the meantime, the patient was having frequent falls in her room, suffering with

increased confusion, and becoming very anxious due to her hypoxemia. After my shift, I stayed

over to stay with the resident in her room to make sure she was no longer having any falls.

When the daughter arrived, the situation was explained to her again and she was able to see

the status of her mother. Hospice explained that the patient would likely not be comfortable

without the removal of objects from her lungs/throat. The daughter was not receptive to this and

decided to begin Morphine and Ativan. Out of all of the patient’s that I have seen pass away, her

death was the most painful to see. Despite remaining on top of her medications, she was not

able to be kept comfortable. Towards the end of her life, her daughter voiced regret for not

allowing a procedure to be done to keep the patient comfortable in her last days.

This was a very trying scenario for my nursing philosophy. Education was provided for

the patient and the Medical Power of Attorney; however, it was not sufficient to receive orders

for the care we sought. Trust was built with the family by the nights I stayed with her without

pay, to make sure she would not pass away alone as this was her biggest fear. I felt as though I

was selfless in these moments, because I was present past when I was required to be. I felt
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empathy for not only the patient, but the daughter. I could not imagine how difficult the decisions

she was making, must be especially before she was able to see the distress her mother was in.

I felt empathy towards the patient because she was unaware of what was happening and was

scared that she was going to die before saying goodbye to her daughter. By staying with her I

was able to calm her of these anxieties and allow her to get rest.

Change Agent

As a result of this practicum experience, I have broadened my knowledge of information

that is available to me, to make a change. For instance, our EBP/QI Project involves

readmission rates to the hospital from Skilled Nursing Facilities. I was unaware that there are

jobs for this in the hospital setting to monitor this activity and seek out ways to prevent

readmissions. These roles act as important resources to prevent patients from returning to the

hospital for something that could have been prevented.

Benner’s Theory

Benner’s theory focuses on how nurses obtain their knowledge and skills. She notes

that experiences and education make for an expert nurse. The different levels of nursing

experience include novice, advanced beginner, competent, proficient and expert. My most

current stage of development would be advanced beginner. I believe this because I have prior

experience in the nursing field as a Certified Nursing Assistant and am able to use some of this

knowledge to guide my practice as a Registered Nurse. While I am still learning every shift and

gaining new skills, I am confident in those that I have previously practiced and am able to

perform at a higher level. In situations that I am placed in as a Registered Nurse, my priorities

are different than when I was a Certified Nursing Assistant. As a CNA I relied heavily on the

nurse’s delegation and supervision for direction. Now as the nurse, I have to rely on my

knowledge and experience to better care for the patient.

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Action Plan

To facilitate my movement to the next stage of skill acquisition using Benner as a guide,

I will attend continuing education programs and always seek learning opportunities. It is in my

nature to desire more knowledge. If there is a medication that I am unaware of, or a procedure

being done that I have not seen, I seek to learn more about it. This will guide me into the next

stage of Benner’s Theory, which is competency. Although there are some tasks that I may

currently be competent in, there are plenty of opportunities for competency in other deficits I

may have. By attending in-service meetings and continuing education courses, I am receiving

up to date information that will allow my knowledge to expand.

My plan for self-care is to not over work myself, and to take time to do the things that I

like to do. Throughout nursing school this has been difficult for me, as I’ve had to maintain a full-

time job on top of full-time curriculum. I currently have a 7-day vacation planned after graduation

and will begin taking time for myself then. This high stress environment has taught me how

crucial sleep and stress management are to every-day life. Though it has been tough to

maintain this schedule for over 2 years, I am thankful for the experience and believe it has made

me more resilient and able to apply small acts of self-care throughout the weeks.

My long-term professional development will include continuing education. This can be

through the hospital nurse residency program, or through in-service meetings. I have always

been eager to learn as much as I am able, and to continue lifelong learning opportunities. Even

if I don’t retain all of the information I am given, I will gain experience with the more exposures I

have to the education.