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My Nursing Philosophy:

Developing an effective Nurse/Patient Relationship

Achieving Patient whole body homeostasis by incorporating the personal wellness of both the Nurse
and the Patient as individuals and together as a team:

By: Shannan Wyre, RN

Homeostasis is defined the property of a system within an organism in which a variable, such as
the concentration of a substance in solution, is actively regulated to remain very nearly constant. Zorea,
A. (2014). This concept of biological stability with consistency of the internal environment, in which all of
the cells of our bodies live and survive, was first described by Claude Bernard, a French physiologist in
1865, and the word homeostasis was coined by Walter Bradford Cannon in 1926. ( Cannon, W. B
(1932). As the basis of my own philosophy in nursing, I believe that an effective Nurse/Patient
relationship involves a trust and unique rapport to achieve success of patient and caretaker roles with
completion of nursing care plans and achieving patient goals. Many factors are present to ensure this
optimal relationship is met and patient comfort is obtained with the nurse as advocate, provider of care,
support and source of education and guidance.

Martha Rogers identified a key idea component in the caretaking role of the nurse and agrees
every nurse should identify that Nursing is a science and that people need knowledgeable nursing. It is
also important for the nurse to remember the purpose of nursing practice which many believe is first
and foremost to promote patient health and achieve an overall feeling of wellbeing.

Personal Health and Wellness of both the nurse and patient should be addressed and achieved
on all five major components to develop stability within the Nurse/Patient relationship. Healthy closure
of the nurse/patient relationship should occur when this patient homeostasis and overall satisfaction of
care is received as well as the nurses professional sense and reality of fulfillment of duty has been
identified and obtained. A person becomes a patient defined as a person who is under medical care
or treatment by seeking treatment for a symptom, disease or ailment either physical and/or mental in
nature. In the first component of physical wellbeing the patient may be and feel ill, sick or impaired. He
or she may have pain or loss of physical function. It is important for the nurse to have the same
understanding of his/her own physical wellbeing in order to think and act at optimal level during
delivery of care and collaboration with the patient and the patients care team members. Nurses should
be role models of physical wellbeing and practice what is recommended to their patients i.e eating
healthy, obtaining regular exercise to individuals ability and having basic needs met. On the second
component the nurse and patient should identify their own spiritual wellbeing by recognizing how each
perceives the meaning of life and how they find meaning, hope, comfort and inner peace. Within the
third aspect of wellbeing, each of the nurse and patient can identify a social component of wellbeing
and how they see themselves in society. This is an important concept in the nursing care planning
process as the patients family, friends or other sourse of support system is often needed in the
intervention process for healing and obtaining comfort. As humans, we are social creatures and
therefore need interaction and touch, love and support as well as physical and emotional exchange with
other humans to assist in the overall wellbeing process. We as nurses often rely on patients personal
caretakers as a primary role for medications administration, hands on care, education and guidance
when the nurse is not or cannot be present, as in- the patients home life. The forth component of the
wellness model evaluates a persons emotional status and looks at each individuals ability to deal with
feelings and general outlook on life. Here it is also important to understand that the nurses own stress
levels may affect his/her performance within the relationship, while the patients stress levels are likely
to be high in the time of illness and discomfort. The fifth and final component of wellness incorporates
the intellectual aspect of personal health. Patients often need much education on their admitting
diagnosis, symptoms and aspects of disease process in order to optimize healing, achieve resolution of
present illness if possible and aide in the prevention of the returning illness/symptoms. Nurses need to
identify the level at which their patient can receive this education and information and take into
consideration knowledge background and effect of current illness on the patients ability to process and
retain information given to them. This again, is why it is often very helpful to incorporate a family,
friend, or support person in the work towards nursing and healthy outcomes. Nurses need to identify
the concept of lifelong learning and realize that the medical field is ever changing as new technology is
developed and research is conducted and implied into practice. As we as human and a society evolve, so
does the medical field with new knowledge and evidence based practice. Nurses need to be able to
critically think and utilize their own intuition with reflection on experience and continuing education.

Within the realm of human beings, we identify personality traits that help define us as people
and guide our thoughts, ways of thinking and behaviors. There is potential for conflict within the nurse
patient relationship as certain personality traits can work together or differ greatly resulting in difficult
differences, viewpoints and goals in life and care given or received in the medical field. Nurses need to
always keep in mind that people of different personalities, cultures, backgrounds and past experiences
may be coming from a different place and all may view the world differently from the nurse and/or
other individuals, groups and populations. Nurses can be competent in resolving conflicts that arise in
life, in personal relationships, at work with colleges/coworkers and within their nurse/patient
relationships by identifying their own strengths and weaknesses, keeping an open mind on others traits
and being supportive in meeting each patient where they are at in the spectrum of their disease process
and goals.

Patients deserve and seek out quality and safe care in all aspects of healthcare. As a registered
nurse who has also been on the other end of the spectrum as a patient myself, I can identify with the
patient population on expecting safe, effective and efficient medical care to be provided by a healthcare
team. Relating this concept to my personal nursing philosophy is a key component in helping my
patients achieve a state of whole body homeostasis by promoting the best care administered to every
patient at all times. QSEN also known as Quality and Safety Education for Nurses developed in 2007
identified a redefined six core competencies to be able to deliver patient centered care through
teamwork and collaboration, with evidence based care from continuous quality improvement, with a
mind set for safety and employing informatics. (Cronenwett et al., 2007) Patients depend on nurses
and their team of professionals to make informed educated decisions in their course of action for health
care needs and services. Thus, it is a very important aspect of this successful nurse/patient relationship
for the patient to instill confidence and trust within their nurse to advocate for them and coordinate
with them a plan of care that is both medically appropriate and also preferred by patients/families of
patients. Nurses can achieve a good rapport with their patients when the patients feel safe and trust
that they will be given the most up to date care, studied as best in evidenced based practice. Patient
care is based on evidence-based practice standards and industry best standards. (Tracey & Barnsteiner,
2012). Florence Nightingale has gained recognition over the years in adopting the environmental theory
of nursing into nursing care provided in practice. As an expected patient expectation, safe care also
incorporates prevention of harm and infection. Nightingales identification of unsanitary conditions in
relation to patient infection and illness continues to this day as an example of evidenced based practice
and continuous evolving nature of medical care provided.

The nurse/patient relationship often occurs between nursing supervisors and staff leaders
within the team of professionals caring for a patient. A patients staff nurse, home care nurse and or
case manager nurse may also act as a leader with their team. Team leaders and nurses that adopt
leadership qualities are usually able to gain patient and coworker respect and feel comfortable and
confident in advocating for their patients and their colleges. Nurse leaders are often concerned with
overall wellbeing of patients and serving for what is right. They often lead team members in maintaining
group effectiveness and seek to inspire others. Leadership is defined as a multifaceted process of
identifying a goal or target, motivating other people to act and providing support and motivation to
achieve mutually negotiated goals. (Porter O Grady, 2003). The ANA (American Nurses Association)
defines nine principles of successful nursing leadership which includes 1. commitment to excellence, 2.
measure the important things, 3. Build culture around service 4. Create and develop leaders 5. Focus on
employee satisfaction 6. Build individual accountability 7. Align behaviors with goals and values 8.
Communicate on all levels and 9. Recognize and reward success. Participation in these nine principles
will help nurses incorporate leadership skills into practice and hopefully strengthen the nurse/patient
relationship.

Throughout practice as a nurse I feel as though it is important to look every day at why do I do
the work that I do?. The Nursing Profession can be distinguished from all other aspects in health care
by examining the concepts and perspectives of the reality of nursing. Personal philosophys and nursing
theories are focused on where the nursing profession came from and guides the practice of the RN each
and every day. Some individuals know from a young age that they care for people and like taking care of
people. Other professional may have come to the path of obtaining a degree in nursing by influence
from following the example of family and or/friends. Other people choose a career in nursing after other
employment history have failed or personal preferences changed. In conclusion, I believe that all nurses
in the medical field may have many different backgrounds and personality types and may view the world
differently from one another however, success as a nurse I believe incorporates the mind, body, soul
and environment of both the provider of care and the receiver of care in a synchronized aspect to which
both entities work separate and together simultaneously to achieve goals of patient care. The successful
nurse/patient relationship is therefore the heart of the philosophy in that patients whole body
homeostasis can be achieved when the nurse and the patient together work as a team.
References:

Cannon, W. B (1932). The Wisdom of the Body. New York; W. W. Norton pp.177-201.

Cronenwett, L. Sherwood, G., Barnsteiner, J., Disch, J. Johnson, J., Mitchell, P. Warren, J., (2007).
Quality and safety education for nurses. Nursing outlook, 55(3), 122-131.

Porter O Grady, (2003). The Nursing Times

Tracey, M.F. & Barnsteiner, J. (2012) Evidenced based practice. Quality and safety in nursing : a
competency approach to improving outcomes(pp. 133-148) Hoboken, NJ Wiley- Blackwell

Zorea, A. (2014) Steriods (Health and Medical Issues Today Westport, CT; Greenwood Press p.10.