Personal Nursing Philosophy

Purdue University  
Every nurse determines the way they will practice in the beginning of their career. More than likely these roles and values are created and sparked in nursing school. As time goes on, nurses dig deeper and establish who they are in their new role as a professional. When the metaparadigm of nursing and personal philosophy coincide with one another, individualized concepts, care, and professionalism are achieved and delivered in multiple settings. From a personal perspective, these concepts were established and developed very early in my career. Maintaining and establishing myself as a nurse remains a top priority ten years later in my practice.
Pediatric nursing has been my specialty throughout my entire ten years as a nurse.

I have gained lots of experiences in various settings, primarily in the inpatient hospital setting, as a bedside nurse. Working with kids allows you to define yourself as a nurse not only to the patient but also to their family, in which you learn the value, meaning, and importance of family-centered care. For the most part, kids are not alone in the hospital. They are accompanied by at least one parent and possibly a sibling in some situations.
While working on the inpatient unit at the children’s hospital, I met a boy diagnosed with Acute Lymphoblastic Leukemia (ALL). In this context, his name will be Jose and he will be seventeen years old. He had a mother and father who were both involved with his care and treatment as well as a younger brother and a younger sister. Jose was also a Jehovah’s Witness. Throughout his treatment which consisted of approximately five inpatient hospitalizations he encountered several complications and reactions that caused alterations in his treatment.
As with most chemotherapy and cancer treatment, the normal cells are affected along with the cancer cells resulting in anemia, thrombocytopenia, and neutropenia. One difference with Jose is, he is a Jehovah Witness and they do not consent to blood transfusions. Jehovah Witnesses believe their relationship with God is compromised if they receive a blood product. The eternal life is put on the line which is why it is so difficult for them to agree to a transfusion (Knuti, Amrein, Chabner, Lynch, & Penson, 2002). Throughout one cycle of his treatment, Jose became very sick. He desperately needed a blood transfusion and more than likely would need multiple throughout the course of time. The physicians, nurse practitioners, clinical nurse specialists, and nurses had a care conference with Jose’s parents stressing the importance of Jose’s survival and the need for blood and blood product transfusions. After much hesitation, his parent’s consented. They requested that Jose be unaware of the transfusion and that it not be discussed with him.
Jose received blood transfusions without knowing.

They were often administered at night when his room would be dark and he could not see the bag of packed red blood cells hanging from his intravenous (IV) infusion pump pole. He was receiving narcotic pain medicine resulting in very mild sedation and causing him to sleep more. Jose was also persistently febrile and overall did not feel well so his wakefulness and alertness were decreased. If he questioned what was hanging from his IV pole or why his vital signs needed to be checked again, he was told it was a different type of IV fluid or a different type of medication he needed to

receive.
This situation helped shape me into the nurse I am today. The values, morals, and ethical dynamics of my philosophy of nursing were tested and overstepped. The metaparadigm of nursing discusses the human being/person, environment and society, health, and nursing. Butts and Rich (2015) state, “A metaparadigm, which is thought to be the most abstract viewpoint of a discipline, is made up of concepts that define the discipline” (p. 90). As a nurse, an establishment of ethical and moral values were determined early in my professional career. A hard line is drawn when a situation steps out of the boundaries that I have set for myself and what I am willing to do.
The nursing concept of metaparadigm relates to the nurse and her interactions with the patient. The primary focus is not a physical interaction, rather a focus on the behaviors and interpersonal interactions and relations. There are many different views and conceptualizations relating nursing to part of the metaparadigm. Despite the different concepts and models “the common significant thread is the primacy of human interaction for creating health and human wholeness” (Chinn & Kramer, 2015, p. 46). In regards to Jose’s situation, Jose’s interaction is the basis for the relationship. He is in control with how he interacts with nursing staff and the choices he makes with his care. This view is changed when his parents deny his rights and go against his wishes. From a nursing perspective, the goal for this relationship is for Jose to be in control. “When this view of the nature of nursing is incorporated into a framework or model, nursing is viewed as enabling the will and behavior of the person who is receiving care” (Chinn & Kramer, 2015, p. 46).
The conceptual framework relating to the individual as a person references the nature of all humans.

A nursing philosopher discusses wholism as viewing “the biophysical, psychological, and sociological subsystems as related but separate, thus the whole is equal to the sum of the parts” (Alligood, 2014, p. 20). As with all the components of the metaparadigm, nursing scholars have varying perspectives. Jose was not looked at as a whole person. His age, situation, beliefs, and culture separated him from having any consistency with his whole self and what he believed. His personal opinion was considered but was not taken seriously. This resulted in Jose receiving treatment against his will.
Society and the environment are key components to the nursing metaparadigm. The place that allows nurses to be nurses and facilitates their interactions with others. The environment varies from nurse to nurse and place to place. Some environments shape more of the framework than others but facilitate the interaction between the patient, their culture, and their relationships. Speaking to Jose, he was in the hospital but his home environment and culture were very prevalent in his experience. He did not lose sight of his culture and his beliefs remained

prominent.
As with the other components of the metaparadigm of nursing, health also has different meanings to different scholars. Florence Nightingale discusses health and that is the goal of nursing. Achieving optimal health was a priority in Jose given his medical condition and situation at hand. This became the focus. He needed transfusions to save his life, so he got them. The other components of the metaparadigm, ethics, morals, and beliefs became not important and health became the priority.
I am not proud that my patient unknowingly received multiple blood transfusions. I am not proud that his religious rights and preferences were violated. I am most disappointed in the fact that his family wanted to hide this from him rather than discussing it with him from a medical perspective while supporting is culture and beliefs. Making him aware while recognizing and understanding his beliefs would have been more appropriate than secretly going against his will. Consulting a representative from his church to sit with the medical team and his parents to discuss the options and devising a plan could have made this situation a little better for him. Jose was 17. According to Geist and Opler (2010), any person in the right capacity is capable of making their own decisions until proven otherwise (Geist & Opler, 2010). Jose was well aware of what was going on with his condition and could knowingly participate in the decisions made on his behalf.
As mentioned above, when a nurse becomes a nurse, she develops her own set of morals, values, and ethical implications as she establishes herself as a professional. These boundaries are tested frequently in multiple ways, in many situations. Nursing theory devises and depicts ideas relating to how nurses practice and what they do. These have evolved over time by theorists through ideas and observations. From these theories, nursing research is performed and focuses on how nurses practice and their actions, response, and relations to certain situations rather than the medical component of the care they are providing. Nursing research focuses on the relationships between the patient and the nurse and the nurse and herself. From this research, practice evolves, which then aids in the development of nursing theories.
Jose’s situation advanced my nursing practice to a whole new understanding of ethical dilemmas. His story allowed me to refocus my own nursing philosophy, reset my boundaries, and reestablish my own values and morals not only within myself but within interpersonal relationships with my patients. Cultural beliefs are key components to an individual’s emotional well-being and should not be overlooked or ignored. In most situations, they are just as important as the medical treatment at question. When the five patterns of knowing and the components of the metaparadigm align, praxis is achieved.