Running Head: THINKING LIKE A NURSE

Thinking Like a Nurse

Faith Burkett
Auburn University at Montgomery

THINKING LIKE A NURSE

Thinking Like a Nurse

Nursing has changed dramatically over the years as have the methods we practice when
caring for individuals and families. Movement toward holistic care is evident in the hospitals
today, from the initial assessment to the discharge instructions. Incorporating significant others
and family members along with addressing social and emotional needs are part of routine care.
As I am furthering my education and studying nursing theories, I would like to reflect on a
patient I cared for that could have benefited from my new knowledge and the movement to
holistic care.
This is a situation I will never forget. I had to care for a patient having a surgical procedure
that was in the midst of having gender reassignment surgery. I grew up primarily in the south
and at times feel very sheltered. I had only watched talk shows about the individuals who were
undergoing gender reassignment surgery. I had made the assumption they were primarily in New
York and California. But that day, the sheltered nurse from the south would have to care for and
spend the day with a patient that was in the midst of this process.
This was no ordinary day in the life of a Day Surgery nurse in a small town in Alabama. I
was approached by my nurse manager that we would be having a very important person (VIP)
coming for surgery. She told me the Director of Nursing had chosen me to take care of this
patient. The patient had contacted administration to discuss his special circumstances. The
patient was married and had a son, but was in the process of gender reassignment surgery. He
was undergoing hormone therapy and already had undergone part of the surgical process. The
patient came to our hospital for a routine inguinal hernia repair but considering his

THINKING LIKE A NURSE

circumstances, this would not be an ordinary procedure. The patient entered under his legal
name which was male, but was very adamant that his caregivers would refer to him by his female
name and would use Mrs. and not Mr.
The patient expressed his desire to have limited staff be involved in his care in order to
maintain his anonymity. The wife remained at his side, and had shared with me her decision to
stay with him. They would live together and provide two mothers to their son. His son appeared
to be in his own little world. He was seven years old, and was appropriate for his developmental
age. I was extremely worried about the patients son. I was worried how he would be affected by
this change in environment and situation. I believe this hindered my communication with the
patient.
The patients surgical procedure was uneventful. The patients recovery stay was fairly
routine, but did require a straight catheter insertion after the patient was unable to void. This
would mean part of the transformation would be exposed. He requested that his family be
present during this intervention. Was this appropriate, a young boy to be present during this
procedure? I did not think even in a normal circumstance this was appropriate, but under these
circumstances I thought it was even more inappropriate. I felt like the patient would be mad if I
suggested anything different, and would think that I didnt understand him. I chose not to speak
up. I feel like if I had established some open dialogue with the patient and allowed him to
express his needs, he would have been more open to my suggestions.
I provided this patient with your routine recovery care. Routine recovery care would consist
of vital signs per the routine, intravenous fluids, fluids by mouth, pain medication for comfort,
and observing for any signs and symptoms of any complications from the procedure. When the

THINKING LIKE A NURSE

patient became uncomfortable from the inability to void, I tried some additional measures to try
to avoid having to catheterize patient. I tried pushing oral fluids with caffeine and ambulating
the patient in room. The patient also tried sitting in the bathroom with the water running. There
were other interventions the staff could have offered such as ambulating in hallways, but the staff
was not afforded this opportunity in order to maintain the patients anonymity.

All of the

measures were unsuccessful, so we had to insert a catheter. The patient tried really hard to avoid
having a catheter. The patients anatomy had been altered, and he also needed to keep the
anatomy remaining in good health. The insult of a catheter could compromise the next surgery if
there was trauma to area.
The typical recovery for this type of surgery would be around an hour. This patient had
prolonged his stay to 6 hours, and way past the time my shift was over. In order to maintain his
continuity of care, I stayed past my shift. I was really ready for him to go home, and the
uncomfortable situation I had been placed in to be over. The longer he stayed, the more I felt
like I was failing him as a patient by calling him mister. The harder I tried, the more I was
failing. The patient had expressed his desire to be called by his feminine name, but I could sense
each time I failed, he was getting frustrated. I knew this would hinder further communication,
even though I felt he was trying to understand.
According to my values clarification, the first quality I had assessed was justice. I had
ranked this quality as very important to me. Justice is fairness to all and avoidance of
favoritism. All clients deserve fair access to quality healthcare. The concept of justice embodies
health equity and the fair distribution of resources (Nunnery, 2012, p. 228). Critically reflecting,
I do believe I used honesty, skill, knowledge, and family while I cared for this patient, but some
of the assumptions I had made about the patient lacked the quality of justice.

THINKING LIKE A NURSE

My current nursing philosophy states, Nursing is a commitment to caring for individuals in

need and delivering safe competent nursing care. Nursing is a patient centered holistic approach
and involves collaborative efforts with families and caregivers. Nurses should be kind, honest,
and compassionate as well as treating the individuals with respect and dignity while serving their
health needs. As I reflect on this statement, the core of my nursing, it affected a lot of my
decisions that day. First and foremost, putting any special circumstances aside, the safe
competent nursing care was of utmost importance. I put all beliefs aside, and took care of this
patient to the best of my ability. I could not let any biases or opinions interfere with the care this
patient deserved.
As I am furthering my education, we are studying different nursing theories. One theory that
would have been helpful in caring for this patient is Madeleine Leiningers theory of cultural
care diversity and universality. The goal of nursing practice is to provide culturally congruent
care that will benefit, fit, and be useful to the client, family, or culture group and will offer a
different kind of nursing care to people of diverse or similar cultures (Fawcett, as cited in
Nunnery, 2012, p. 53).
According to Leiningers theory (2012), the nurse knows his or her own culture and
subculture and particular variabilities, strengths and assets. The nurse must also discover
and remain aware of his or her own of his own cultural beliefs, values, lifeways, biases,
attitudes and prejudices to avoid cultural blindness (p. 53).
According to Leiningers theory (as cited in Nunnery, 2012),
the nurse knows his or her own culture and subculture and particular variabilities,
strengths and assets. The nurse must also discover and remain aware of his or her

THINKING LIKE A NURSE

own of his own cultural beliefs, values, lifeways, biases, attitudes and prejudices
to avoid cultural blindness. (p. 53)
The client is also aware of their cultural beliefs but it may differ from the nurses beliefs. The
nurse should show genuine interest in the client and ask open ended questions and maintain an
active listener role. Professional knowledge will be given only if the client asks about such
knowledge (Fawcett, 2012, p. 53). This theory is very relevant in this situation. If I had applied
this theory to caring for this patient, I feel like I would have asked more open ended questions
and allowed him to express needs he may have had that could have facilitated the care he
received at the hospital as well as his needs at home. I would have allowed the patient to talk
about his struggles, and offered any help or resources in dealing with his current issues. I was
really focused on the task at hand, which was his physical process, and I dont feel like I was
focused on emotional or spiritual aspects at the time.
As I reflect back on that day and move forward practicing the knowledge I am obtaining, I
have realized that my professional values play a large role in how I care for patients and families.
I will continue to honestly evaluate on a regular basis my professional values and refer to my
nursing philosophy as a reminder of the commitment I have made to my patients.

THINKING LIKE A NURSE

7
References

Fawcett, J. (2012). Evolution and use of formal nursing knowledge. In R. Nunnery

(Ed.) Advancing your career concepts of professional nursing (pp. 39-63).
Philadelphia, PA: F.A. Davis.
Nunnery, R. (2012). Professional Ethics. In R. Nunnery (5th ed.) Advancing your career
concepts of professional nursing (pp. 225-240). Philadelphia, PA: F.A. Davis.

THINKING LIKE A NURSE

WRITING INTENSIVE GRADING RUBRIC: THINKING LIKE A NURSE

Writing Elements
Focus:

2 points: Inadequate
Student demonstrates a
lack of awareness of
purpose and audience;
Unclear Focus;
Inappropriate tone.

4 points: Marginal
Student demonstrates
minimal awareness of
purpose and audience;
Marginal ability to provide a
clear focus; Borderline
ability to convey
appropriate tone.

6 points: Acceptable
Student demonstrates
acceptable awareness of
purpose and audience;
Somewhat clear focus;
indication of
understanding of
appropriate tone

8 points: Good
Student demonstrates
accurate awareness of
purpose and audience;
Mostly clear focus;
Satisfactory use of tone in
writing

10 points: Excellent
Student demonstrates
perceptive awareness of
purpose and audience;
Clarity of focus; Deep
understanding and ability to
create appropriate tone

POIN
9.5

Content: Idea Development

Student provides no
explanation and
illustration of key ideas
demonstrated in
responses to paper
criteria; No attempt to
incorporate primary
concepts of the discipline
or to analyze and weigh
differing facts and ideas;
No synthesis of contentarea materials or facts

Student provides vague

explanation and illustration
of key ideas demonstrated
in responses to paper
criteria; Inconsistent
incorporation of primary
concepts of the discipline;
Weak effort to analyze and
weigh differing facts and
ideas; Incomplete synthesis
of material

Student provides
explanation and
illustration of most key
ideas demonstrated in
responses to paper
criteria; Incorporation of
some primary concepts of
the discipline; Analysis of
differing facts and ideas
and an effort to
synthesize all materials,
although possibly
inconsistent

Student provides detailed

explanation and illustration of
key ideas demonstrated in
responses to paper criteria;
Incorporation of several
primary concepts of the
discipline; Accurate analysis
of differing facts and ideas
and a clear synthesis of all
material

Student provides extensive

explanations and illustrations
of key ideas demonstrated in
responses to paper criteria;
Thorough incorporation of
primary concepts of the
discipline; Sophisticated
ability to analyze and weigh
differing facts and ideas and
synthesize all material

10

Organization

Student does not use

transitions or headings;
Student writing is absent
of logical and clear
arrangement of ideas;
Writing lacks unity and
coherence of paragraphs

Student minimally uses

transitions or headings;
Provides inconsistent and
sometimes unclear logic
and arrangement of ideas;
Creates borderline unity
and coherence of
paragraphs

Student uses some of

transitions or headings;
Provides fairly logical and
clear arrangement of
ideas; Creates adequate
unity and coherence of
paragraphs

Student appropriately uses

transitions or headings;
Provides mostly logical and
clear arrangement of ideas;
Creates consistent unity and
coherence of paragraphs

Student efficiently uses

transitions or headings;
Provides highly logical and
clear arrangement of ideas;
Creates comprehensive unity
and coherence of paragraphs

9.5

Style

Students ability to use

discourse and language
appropriate to their
academic discipline is
weak with several
redundancies; Student
does not use appropriate
word choice and/or
vocabulary of field;
Student does not
demonstrate an
understanding of specific
style guide for
documentation (i.e., APA,
MLA, etc.)

Student uses minimal

discourse and language
appropriate to their
academic discipline with
some redundancy;
Inconsistently uses
vocabulary of field and
some inappropriate word
choice; student makes
several errors in using
discipline-specific style
guide for documentation
(i.e., APA, MLA, etc)

Student sometimes uses

discourse and language
appropriate to their
academic discipline with
some redundancy;
Attempts to use
appropriate word choice
that is specific to
vocabulary of field; makes
an effort at following
discipline-specific style
guide for documentation
although some errors
occur.

Student mostly uses

discourse and language
appropriate to academic
discipline; avoids
redundancy; Demonstrates
good use of appropriate word
choice and vocabulary of
field; demonstrates
competence in following
discipline-specific style guide
for documentation (i.e., APA,
MLA, etc.)

Student demonstrate an ease

in using discourse and
language appropriate to
academic discipline; Is not
redundant; Selects
sophisticated word choice
and masters accurate use of
vocabulary in field;
demonstrates accurate ability
to use discipline-specific style
guide for documentation (i.e.,
APA, MLA, etc.)

Student writes with many

patterns of errors in
grammar, frequently
includes comma splices,
run-ons, and/or
fragments; writing exhibits
patterns of usage and
grammatical errors;
numerous misspellings

Student writes several

grammatically incorrect
sentences, comma splices,
run-ons, and/or fragments
and a pattern of errors
begins to emerge in any
one error type; several
misspellings

Student writes some

grammatically incorrect
sentences, and has some
comma splices, run-ons,
and/or fragments but not
a clear pattern in any
error type; some
misspellings

Student writes mostly

grammatically correct
sentences, with few comma
splices, run-ons, and/or
fragments; writing has few to
no misspellings

Student writes grammatically

correct sentences with an
absence of comma splices,
run-ons, fragments; Writing is
absent of usage and
grammatical errors and
maintains accurate spelling

Discipline-Based Written
Product

Language Conventions

10

THINKING LIKE A NURSE

COMMENTS:
Focus Element: 9.5
Content Element: 10
Organization Element: 9.5
Style/ELC: See comments related to APA errors and use of feel and contractions. I however see no major
patterns of problems with APA and/or ELC
POINTS EARNED = 46/50
GRADE = 96 = 38.5 total points Very interesting difficult case Patricia. Why do you think your DON asked for
you to be the patients nurse. I have an assumption but I would be interested in your thoughts. You will have
no problems with your writing in this program Patricia
NOTE: GRADE is determined by dividing points earned by 50 and multiplied by .40 For example:
Points Earned
50
45
40
35
30

Grade
100
90
80
70
60

Final Pts.
40
36
32
28
24

NOTE: Grades for papers that require revisions will be averaged. For example, a grade of 70 earned on 1 st paper and 80 on second paper would result
in a final grade of 75 x .40= 30 points.