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What Do I Think I Know Now? My New Philosophy of Nursing

Kayla Van Laeken

3647520

Faculty of Health Disciplines Athabasca University

Nursing 608: Philosophical Foundations of Nursing

Professor Margaret Scaia

March 26th, 2024

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What Do I Think I Know Now? My New Philosophy of Nursing

The profession of nursing has adapted, advanced, and developed over time through the

integration of philosophical foundations, evidence-based practice, and theories. The changes in

healthcare systems, technology, science, culture, and ideology have all contributed to the need

for adaptation and advancement in nursing care (Kim, 2015). The nursing profession is

everchanging, growing, and improving, requiring nursing to be fluid rather than fixed and

prepared for the uptake of new knowledge and challenging the status quo. Being exposed to the

evolution of nursing, and incorporating this new knowledge into my practice has broadened my

perspective of nursing, my values, and my beliefs to promote holistic high-quality person-

centered care inclusive to all. This paper will explore my nursing philosophy and what being a

nurse is to me while diving deeper into how I use nursing knowledge in practice. Finally, this

paper will expand on how I can contribute to the development of nursing knowledge in the future

as an emerging scholar and current pediatric operating room nurse.

What is a perioperative nurse? As a perioperative or operating room nurse, I work

specifically in the surgical suite. It is a uniquely specialized field of nursing that supports patients

and families through surgical procedures. I am fortunate enough to work at the Health Sciences

Center in the children’s operating room located in downtown Winnipeg where I care for children

from all over Manitoba. I care for children of all ages from birth to eighteen during a very

vulnerable and scary time in their lives.

The Meaning of Nursing to Me

Before moving into my philosophy of nursing, which I base my care upon, it is crucial to

expand on the ontology of nursing and what it means to be a nurse. Nursing is defined as “the

protection, promotion, and optimization of health and abilities, prevention of illness and injury,
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alleviation of suffering through the diagnosis and treatment of human response, and advocacy in

the care of individuals, families, communities, and populations” (American Nurses Association,

2003, as cited in Kim, 2015, p. 39). Nursing focuses on holistic care, encompassing all aspects of

the client. This includes the physical, psychological, social, cultural, and spiritual well-being of

the client (Canadian Nurses Association, 2015b; Como, 2007).

Nursing combines both art and science in practice. The art of nursing reflects upon

“caring and respect for human dignity” (American Nurses Association, 2015, p. 11). It embraces

compassionate care that focuses on healing, empathy, and mutual respect (American Nurses

Association, 2015). The science of nursing on the other hand refers to the “qualitative and

quantitative evidence to guide policies and practices” (American Nurses Association, 2015, p.

13). It incorporates a scientific approach to care that focuses on disease processes and the

evaluation of outcomes (American Nurses Association, 2015).

The field of nursing is continuously adapting and changing as new theories, foundations,

evidence, and frameworks are developed and implemented into practice. It has transitioned from

treatment-based care to holistic person-centred care that encompasses all aspects of the

individual (Como, 2007). The bridge between the art and the science of nursing has slowly

united to combine the two aspects of care. This transition is influenced by several factors such as

technology, co-morbidities, the aging population, healthcare systems, science, and ideology

(Kim, 2015; Star, 2023). The profession is broadening, and nurses must be present, adaptable,

and accepting of these changes. Expanding my knowledge of the definition of nursing, and the

changes in nursing roles over the years allows for further development of my nursing

philosophy.
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My nursing philosophy is founded upon the belief that nurses are health professionals

who work in unison with the client and interprofessional team to provide inclusive, equitable,

culturally competent, holistic, and high-quality person-centred care to all. A few key concepts

that guide my philosophical beliefs are culturally supportive care and holistic care. Culturally

competent care refers to care that is supportive of one’s values, beliefs, and cultural differences

(Leininger, 1988). It revolves around care that is unique to the individual, family, or group, and

respectful towards their care goals and beliefs. Holism or holistic care refers to care that

considers the whole person and focuses on the patient’s mind, body, and spirit (Kim, 2015). This

incorporates the psychological, social, physical, and spiritual well-being of others. My personal

philosophy and core concepts of my beliefs are exemplified by nursing knowledge, theoretical

and philosophical frameworks, and models of care.

In surgery, I have the privilege to work with children and families with diverse cultural

and economic backgrounds and beliefs. In my role as a pediatric perioperative nurse, most of my

time is spent in surgery, assisting in the operation, but before surgery starts, my role is to ensure

children and families feel comfortable and safe during a stressful time in their lives. This may

involve offering to uphold cultural rituals, such as bringing in a religious item into surgery or

taking time to allow the family to pray together. Furthermore, when it is safe, as a surgical team

we invite parents or guardians into the operating room to hold the child’s hand. This provides an

extra level of comfort and safety for the patient and creates a positive experience in surgery.

Overall, my goal is to foster a trusting relationship between the healthcare team, patient and

family that incorporates care that goes beyond the physical aspects of surgery. Integrating my

personal philosophy into my practice in surgery allows me to provide care that is supportive of

the needs of my clients and assists with creating a meaningful experience.

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How Do I Use Nursing Knowledge in Practice

Nursing epistemology is the study of nursing-specific knowledge that guides nursing

practice (Carper, 1978). Knowledge incorporates evidence and facts but also wisdom, intuitions,

and past experiences to guide decision-making and generate a targeted care plan for individuals

(Kim, 2015). According to Kim (2015), there are five types of nursing knowledge which are

generalized, situated hermeneutic, critical hermeneutic, ethical, and aesthetic. While all are

utilized in my practice, one stands out. Ethical knowledge refers to the knowledge necessary to

practice within the standards of nursing (Kim, 2015). In surgery, we are always making quick

decisions in the best interest of our patients. These decisions impact the overall care of our

clients and are informed and guided by the standards of care. Furthermore, three specific fields

of nursing knowledge that guide my practice and inform my nursing philosophy are the Code of

Ethics, the Cultural Care Theory and the Nursing Metaparadigms.

Code of Ethics in Practice

The Code of Ethics contains the standards of nursing practice that nurses must adhere to

and is a guide to clinical decision-making (Canadian Nurses Association, 2017a). Ethical

foundations regarding life, health and humanity are the basis of nursing practice and are used to

protect patients (Vryonides et al., 2015). Nurses are obligated to protect patients from harm and

respect cultural rights, human rights, dignity, and autonomy when providing care. (Vryonides et

al., 2015). As nurses, we have committed to putting our patients first and providing care that is

congruent with their unique goals and targets the physical, psychological, social, and spiritual

aspects of care.

The Code of Ethics is a foundational component of my philosophy of nursing and a key

aspect that guides my way of providing nursing care. In my practice, I work with individuals
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from various health and cultural backgrounds, socioeconomic status, and perspectives on care.

No matter the situation I provide safe, competent, compassionate ethical care that is fair and

equitable to ensure everyone has access to proper health care and treatment. In surgery, an

important ethical responsibility is “promoting and respecting informed decision-making”

(Canadian Nurses Association, 2017a, p. 3). Surgery requires consent to be signed before

entering the operating room. As a nurse, I am required to confirm the consent with the family

and patient to make sure they are informed and can make an educated decision with all the

information. The surgeon goes through the initial explanation of the procedure, and then as a

nurse, I always make sure they understand what will be happening to their body. When ethical

dilemmas come up at work, I revert to the Code of Ethics, my nursing education, and

experiences to guide my decisions to make the best possible choice for my patients and family.

Cultural Care Theory

Understanding and incorporating theories into practice are essential for learning and

gaining knowledge in the field of nursing. I have learned about several theories this term, but

there is one in particular that stands out and influences my nursing philosophy. This is the

Cultural Care Theory by Madeleine Leininger. This theory provides nurses with knowledge of

the importance of culturally supportive care and how to provide care that is safe and congruent

with one’s cultural beliefs (Leininger, 1988). In my practice, I work with a diverse group of

individuals from all over Manitoba. It is essential to provide care that supports the beliefs and

care goals of my patients and families, to create positive, meaningful relationships and promote

health. I always want to be respectful of the diverse cultural backgrounds and beliefs of others.

The Cultural Care theory, a concept I have connected with this term, is a guide for my nursing

philosophy and a core component of my care plan for patients.

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Nursing Metaparadigm

My nursing knowledge can be further supported by Fawcett’s Nursing Metaparadigm.

The Nursing Metaparadigm, a concept taught throughout nursing programs, consists of four main

spheres of nursing which are person, environment, health, and nursing (Thorne et al, 1998).

Person. Wu (2008) describes the person as the recipient of care, which pertains to

individuals, families, and communities. In the operating room, the person I provide care for goes

beyond the child and includes family and legal guardians. A therapeutic approach is required to

promote care that is congruent with my nursing philosophy. This involves, creating a positive

trusting relationship with the patient and family which can assist with creating a safe and

comfortable space that promotes open dialogue and expression of goals of care (Wu, 2008).

During surgery, I am caring for the patient physically, but also the family emotionally. I try to

always update family and loved ones throughout surgery to help ease the stress and fear of the

operating room.

Environment. This is the setting where care is provided (Wu, 2008). In surgery, I am

working within the client’s external environment. It is often a new and unknown space for the

patient and family eliciting feelings of stress and worry. It is important to recognize how to

provide supportive care within the context of an unknown external environment. This can

involve altering the environment by creating a quiet space pre-operatively away from other

families and providing the patient with comforting items like stickers or a warm blanket. Intra-

operatively, as nurses, we can create a culturally safe environment by limiting the people in the

operating room while the patient is going off to sleep. When caring for the patient within the

environment I try to support all aspects of care, including their mind, body, and spirit (Kim,

2015).
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Health. The concept of health is described as a continuum of wellness or illness

experienced by the person (Wu, 2008). Patients are experts in their health, and determining their

understanding and definition of health is essential when providing care. In surgery, children

come in with various health conditions and different care goals. It is important to provide care

unique to them, their health goals, and their perceived level of health. An example is hip

reconstructions for children with severe cerebral palsy. Often the goal of the surgery is to

improve the quality of life, and reduce pain for the client, not to improve physical movement or

gain the ability to walk. When starting my career, I can admit I struggled to see the benefit of this

surgery because of the post-operative pain. I was fortunate enough to spend some time with a

family, who was waiting for their child to have their second hip done and they explained the

benefits they have seen for their child with improved range of motion and decreased pain. This

helped me recognize how important it is to provide individualized, holistic, person-centred care

that accounts for one’s perspective of health and illness.

Nursing. The Salem Press Encyclopedia (2023) describes the concept of nursing within

the metaparadigm as the actions taken by nurses, which encompasses professional knowledge,

procedural and technical skills, and care. Caring is an essential component of high-quality

nursing (Thorne et al., 1998). Nurses can provide patient-centred care by creating a safe

environment, that supports the individual’s unique health needs and goals of care. These actions

enable partnerships and initiate positive relationships between clients while simultaneously

promoting empowerment and self-determination (Kim, 2015). I can facilitate autonomy and

empowerment for my patients by promoting choice when possible. This includes music choice as

they walk into the surgical suite, choosing a flavoured oxygen mask, or letting them put stickers

on for the monitors.

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The Nursing Metaparadigm, while flawed due to its polarized views, is still believed to

reflect key nursing concepts and beliefs held by the nursing profession and is utilized to guide

nursing theory and practice (Schim et al., 2007). The knowledge gained from the metaparadigms

positively guides my nursing practice and is an important overarching framework in my

philosophy of nursing.

How Can I Contribute to the Development of Nursing Knowledge as a Nurse Scholar

Articulating my personal nursing philosophy has become a key element in my future

contributions to nursing knowledge. Thinking back on my growth as a nurse throughout my

career, taking a leap of faith beginning my Master’s of Nursing as a newer nurse, and looking at

all the valuable information I have gained this term has allowed me to recognize the importance

of reflection in practice. This is something I plan to take with me in my education and current

practice, and something I believe I can contribute to the development of nursing knowledge as a

future nursing scholar.

Reflective Practice

Reflective practice is “a cognitive skill that demands conscious effort to look at a

situation with an awareness of own beliefs, values and practice enabling nurses to learn from

experiences, incorporate that learning in improving patient care outcomes” (Patel & Metersky,

2022, p. 180). This skill can enhance one’s ability to understand their practice, learn from

experiences and recognize practice patterns (Patel & Metersky, 2022). I believe reflective

practice is crucial to grow, learn as a nurse and gain new knowledge.

This past year, I was placed in an uncomfortable situation in the operating room that

resulted in the loss of a patient. We were doing a laparotomy on a critically ill young child for a

Wilm’s tumour in the middle of the night when a fire broke out in the basement of the Health
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Sciences Center causing a power interruption in the operating room. This resulted in operating in

the dark, without monitors for several minutes until the backup generators turned on. As soon, as

we lost power, I immediately left the surgical suite to grab headlights. It was at this time the

surgeon and anesthesia decided that we were not going to be doing compressions if we lost a

pulse and that we had done all we could. This was not communicated to the members of the team

who were retrieving equipment outside of the theatre. When we eventually lost a pulse, the lack

of communication resulted in chaos, confusion, and many upset emotions. This situation

bothered me and went against my values as a nurse. I believe closed-loop communication is a

key component to nursing and the interprofessional team and this was not upheld that night.

Upon reflection, I have now altered my practice to ask in the briefing about surgical plans if the

patient deteriorates and remind the team of the importance of closed-loop communication, so

every team member is aware of the plan. Reflective practice is a skill I'm still improving upon,

but I see the value and potential to enhance patient care.

As a future nursing scholar, I want to promote reflective practice early on for students

beginning their careers. It will allow nursing students to learn from their experiences and use

these experiences to address future challenges that may come up in practice (Patel & Metersky,

2022). Nursing school can be overwhelming and stressful, and the implementation of reflective

practice is associated with improved learning, self-awareness, competence, and lowered anxiety

levels (Patel & Metersky, 2022). I want to promote a practice that is helpful and supportive of

new students beginning their nursing careers, improve patient outcomes and create a positive

impact on the field of nursing.

Conclusion
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Exploring my philosophical perspective of nursing has provided me with insight into my

practice and values as a nurse. I have recognized that my nursing philosophy is everchanging, as

is the fluid dynamic of nursing due to the incorporation of new knowledge, concepts, and

foundations. This makes it imperative to continue to be open-minded, able to adapt and willing

to challenge the status quo. Incorporating nursing knowledge and concepts into practice allows

nurses to provide holistic, person-centred, high-quality care that is culturally supportive and free

of judgment. The Code of Ethics and nursing metaparadigms are two components of nursing

knowledge that contribute to my nursing philosophy and help me provide meaningful care for

my patients. Further developing my understanding of nursing and my nursing philosophy has

opened my mind and broadened my perspective on nursing and my future goals as a nursing

scholar.
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References

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