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Personal Philosophy Paper

Nirmala Dahal

Bon Secours Memorial College of Nursing

NUR 4140: Synthesis for Nursing Practice

Dr. Christine Turner

April 3, 2021

Honor Code: “I Pledge”

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Definition of Nursing

Prior to starting life in the United States of America at 11 years of age, I was a little girl

who lived in a refugee camp, where children had to step up and endure child labor to support

adults facing life challenges to make ends meet each day. As my parents struggled to fulfill the

basic need of the family of five, I was raised to have survival skills more than having a dream of

perusing educational goals. If I had not moved to the States, I would have never dreamed to

attend higher education, let alone becoming a nurse. As I reflect on why I chose to become a

nurse, I believe the nursing profession chose me instead, so that I could help people from all

walks of life.

I define nursing as a profession that gives dignity and respect to people in different

circumstances and helps them alleviate their suffering. As I compare my definition of nursing

with that of Bon Secours Memorial College of Nursing, there is a commonality where nurses

strive to serve those who are in need with compassion, provide quality care, and serve people by

putting their needs before our own. During my different clinical experiences, including the

clinical immersion, I have learned to prioritize care, treat patients and their loved ones with

respect, advocate for those who need it the most, and work in a team where we have a common

goal, to provide holistic care to our patients.

Personal Philosophy

I am among many people who came to the U.S without anything and adapted to its

diverse culture and embraced everything around me with grace and gratitude. My hardship as a

child has taught me to be a strong and compassionate individual, which is reflected in how I

provide patient care in different clinical settings. My philosophy of nursing is to treat people with

compassion, provide culturally competent care, and fulfill their holistic needs. To adhere to my
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philosophy of nursing, I must be assertive when it comes to advocating for my patients and

compassionate when I am required to comfort them. I believe in making sure patients’ wishes are

carried out in their best interest while making sure I am inclusive of their loved ones who are

participating in patients’ wellbeing.

Values and Beliefs

We live in a society where diversity is cherished and prosperity is gained as a result of

coming together despite our differences in culture, believes, and values. One's values and beliefs

change throughout the life span, and we, the nurses are obligated to always put our beliefs aside

and respect those we serve. In my original dictation of Personal Philosophy Paper for NUR 1100,

I wrote, “I think my value defines who I am as a person, what I care for, and what I strive to

achieve. My value is dignity, which means treating everyone with respect.” Not so much of my

values and beliefs in providing patient care have changed, but my attitude towards how I can

sustain my beliefs and values and act in the best interest of my patients has genuinely developed

over the past three years. The knowledge I have received at Bon Secours Memorial College of

Nursing (BSMCON) has allowed me to feel as I am in a position of a leader as I transition from

nursing student to becoming a Registered Nurse (RN). To this date, I still believe patients have

the right to receive dignified care and as a nurse, I am their best advocate. As a nurse, I have a

responsibility to treat my patients with respect, provide holistic care, and ensure their right to

proper medical treatment is not neglected.

Nurse Patient Encounter

During my clinical immersion experience in the Neuroscience Telemetry Unit (NSTU), I

cared for many patients while completing 215 acute care clinical hours. Through this experience,
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all the patients I cared for gave me meaning to life in different forms, and for that, I am forever

grateful.

One particular situation included a gentleman, who had an English language barrier and

happen to speak the Nepali language, which is also my native language. I was not assigned

caregiver for this patient, but staff caring for him knew I spoke the same language. I was asked to

assist nursing and medical staff to understand why this patient was refusing care, especially

treatment for his elevated ammonia level. Upon my assessment of this patient, I realized he was

confused about his situation, he did not understand the treatment process and its reasoning. Most

importantly, he was not refusing care; however, he simply wanted to understand his care

interventions better. After I spoke with the nursing staff, they simply said he was "refusing care"

and providers perceived this patient as non-compliant to medical interventions. When I realized

he had not been informed of his disease and treatment adequately, I initiated the use of a

professional interpreter. At the time, I informed this patient of his situation and what the initiated

treatment would do to help him get better. He was very appreciative of my time and assistance. I

was able to facilitate the communication gap between this patient and his caregivers, because of

which he agreed to receive treatment to lower his ammonia level.

Effective communication is vital in improving patient care, especially in inpatient

settings. As a result of my ability to understand his needs and help him make an informed

decision, I acted as a patient advocate to make sure he received dignified care instead of letting

"refusing treatment" as part of nursing care. I am so fortunate that my philosophy of nursing has

been prospered due to the education I have received at BSMCON and I can act as a servant

leader without hesitancy regardless of whether I am a student or when I go on to become an RN.

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Change Agent

I am humbled by the knowledge I have received through BSMCON and grateful for the

resources available to learn competently, including over 900 clinical hours. Every course I have

taken at BSMCON has helped me grow professionally, but NUR 4140 has aided in synthesizing

all the information I have learned for the past three years. Besides, NUR 4140 has introduced me

to the field of research and evidence-based practice, which I believe will be vital in processing

the information as I peruse continuing education while practicing as a nurse. One of the course

assignments included a quality improvement project that had an objective to utilize evidence-

based studies and relate to the real-life challenges affecting patients in the hospital setting.

As a change agent, I collaborated with a group of fellow students to address different

ways MRSA infection can be reduced at Memorial Regional Medical Center (MRMC) in

Mechanicsville, VA. After extensive research on previous studies and data collection from

MRMC on how MRSA infection is acquired and transmitted, we believed that the practice of

proper hand hygiene is lacking, especially among patients who are admitted to the hospital. The

existing policy on MRSA precaution at MRMC included different ways staff can apply

precaution, but there was no specific information on how patients could be part of the solution

for such healthcare-associated infection. Our finding supported the proper hand hygiene to be the

most effective practice to prevent acquiring and transmitting MRSA. Our proposed handwashing

practice includes providing patients with anti-microbial wipes to wash hands before and after

each meal, after each bathroom use, and each time hands come in contact with other people or

the environmental surfaces. If proper hand hygiene education is provided and practice is

implemented among healthcare staff, visitors, and patients at MRMC, we believe MRSA

infection can be reduced by 50% at the end of nine months period.

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Benner’s Theory

In her nursing theory, Dr. Patricia Benner explained how nurses develop knowledge and

skills necessary for patient care throughout their work experiences. A Novice, the advanced

beginner, a competent, a proficient, and an expert was five different categories in Benner's theory

that explained how nurses advance to different categories progressively over the years of work

experience (Dreyfus, 2004).

At this stage as a nursing student, who has completed nurse externship and clinical

immersion in addition to all other practicum hours, I still feel like I am at “a novice” stage of

Benner’s nursing theory. In reference to the "a novice" stage, "The student automobile driver

learns to recognize such domain-independent features as speed (indicated by the speedometer)

and is given rules such as shift to 2nd gear when the speedometer needle points to 10” (Dreyfus,

2004). As a student, I have a responsibility to provide compassionate and competent care, but I

am also obligated to abide by the rules; rules that are part of my standard nursing practices, rules

established by the institution I represent, and rules that are placed by people in a supervisory

position. I trust my ability to provide patient care, critically think, and apply nursing processes to

provide holistic care to the patients I serve. Despite my abilities, I do believe that as a new

graduate nurse, I still have so much to learn and develop when it comes to providing holistic

patient care.

Action Plan

I plan on gaining experience in addition to all the clinical experiences I have received

through practicum, nurse externship, and clinical immersion during my first year of practice as

an RN. At the end of my first year of a nursing career, I hope to adapt and excel through the

"proficiency" stage of Benner's nursing theory. In Benner's "proficiency" stage of nursing theory,
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"…the performer acquires the ability to discriminate among a variety of situations, each entered

into with involvement, plans are evoked, and certain aspects stand out as important without the

learner standing back and choosing those plans or deciding to adopt that perspective" (Dreyfus,

2004). My goal is to independently provide nursing care and carry out provider's orders while

communicating patient care needs with the interdisciplinary team. As a student, I know what it

meant for me to have a good preceptor while in the clinical setting and my hope is that sooner

than later I can start precepting clinical immersion students, especially from BSMCON starting

the second year into my nursing practice.

The nursing profession is stressful due to its complex nature and involvement in the lives

of those who are suffering. My goal for self-care during any stressful situations includes making

sure I prioritize care, take breaks, communicate my personal and patient care needs with my

fellow nurses, and make sure management knows of my expectations from my workplace

leaders. My long-term professional development includes my desire to become an educator for

aspiring nurses and provide them with the knowledge and resources needed to succeed as they

transition into practice at St. Mary's hospital.

In conclusion, nursing is my calling in which I hope to provide dignified patient care and

be the best patient advocate possible as I transition into practice after graduation. Unlike many

people around the globe, I have been fortunate to have family support despite difficult

circumstances as a refugee and someone who started life in the United States at the age of 11

with very limited ability to speak the English language. My desperate desire to become a nurse

has been driven by my life experience, personal philosophy of nursing, and my values and

beliefs as a person. I would have not been able to succeed in nursing school to earn my Bachelor

of Science in Nursing if I did not have the support of my family, mentors, preceptors, faculties,
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and staff at BSMCON. To everyone who has helped me in the process, I am very grateful, and I

look forward to being the servant leader everyone wants to see in the nursing profession.
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Reference

Dreyfus, S. E. (2004). The five stage model of adult skill acquisition. Bulletin of Science

Technology & Society, 24(177).