Documente Academic
Documente Profesional
Documente Cultură
Paula Gravitt
March 4, 2017
PERSONAL PHILOSOPHY PAPER 2
A nurse is someone who provides holistic care (care that promotes wellness, prevents
disease, restores health, and provides comfort). The way a nurse is educated represents what
kind of nurse they will become. Nurses should be educated through hands-on and didactic
learning experiences. The nurses educational experiences are transformative and teach them to
be self-directed and motivated. A nurse should take care of herself because taking care of
oneself enables the nurse to better serve others and to advocate for their well-being. She/he
should be well rested and know how to handle her/his everyday stressors. She should have self-
respect and be able to stand up for and defend what she/he believes in. This paper describes my
It is Tuesday evening and I have a 12-hour shift ahead of me on Wednesday. The clock
says 9:00pm and I am getting ready for bed. By 9:30pm, I have written in my gratitude journal
and turned off the lights. My phone is on my nightstand playing soft piano music. It is not in
my hand and it is not the last thing I looked at. In my gratitude journal, I have written this
sentence, I will make a difference in my patients lives tomorrow. This is the mantra I fall
asleep to. The alarm goes off at 4:50am and I do not hit snooze. I get up and take a hot shower.
My clothes are laid out, my lunch and bag packed, so all I have to do is shower, put on a little
makeup, and eat before I leave. By 6:10am I am in the car with the radio tuned to either 80s or
90s music. I drive to the hospital singing my heart out. This is my stress relief before the day
starts. This routine is important to me. It keeps me grounded and helps me maintain a healthy
level of stress. I thrive on being prepared. I am on the unit by 6:30am. I like to be there early so
that I can see who my patients will be and get some background information on them before shift
report. There are so many days when I do not have time to read about my patients and I do not
feel that I am able to give them the best care if I only have a piece of their story. I like to read
PERSONAL PHILOSOPHY PAPER 3
the notes left by other nurses who have cared for them. This gives me an idea of what the patient
is like and what their emotional needs are. I am working on my speed in change of shift report.
I hate to slow the night nurses down by asking too many questions and they talk so fast that I am
occasionally unable catch everything they say. Some of them know this and will go slowly for
me, but others are in a hurry, so by getting some information ahead of time, I am able to get
everything I need. As our day begins, my preceptor and I prioritize care together. We look at the
physicians orders for the day and if there is lab work to be drawn, I am eager to attempt the
draw. I am not very good at venipuncture yet, but I am gaining experience and learning from my
mistakes and by watching others. I perform an assessment on each patient and as I am listening
to their lungs, testing their grips, looking at their feet, etc., I am also asking them questions about
themselves. I find out if they have family, how many grandchildren they have, what their pets
names are, and how they are feeling about being in the hospital. I look at each patient as a
person and not as the disease they have. It is important to know what will make them feel better
physically, but even more important to know what I can do to nourish them emotionally. If I can
provide them with comfort, and care for their physical well-being at the same time, then I am
There is a specific nurse-patient encounter that stands out in my mind and serves as an
fourth shift as an immersion student. I had a patient who was on contact precautions. She was
having great difficulty breathing and there was not much I could do to help her get comfortable.
My preceptor and I repositioned her. We elevated the head of the bed, made sure she was
receiving enough oxygen and checked her medications to see if there was anything we could
give her to make her more comfortable. We had done everything we could possible do according
PERSONAL PHILOSOPHY PAPER 4
to her physicians orders. Her breathing was so laborious that she was having difficulty
speaking. She had end stage COPD and her oxygen saturation was being maintained just above
85%. We called her physician to ask for help and he told us that he was waiting on her family
and palliative care to meet before he would do anything further. Meanwhile, this woman was
suffering and we were trying to make her feel better. We decided to give her a bath. If nothing
else, we could at least make her feel clean and fresh. As we bathed her, tears began to roll down
her cheeks. I looked into her eyes and held her hand and told her that everything was going to be
okay. She squeezed my hand and smiled. We changed her gown and linens and she looked very
fresh. She was breathing a little easier then and she told us how she was grateful for her bath.
She thanked us and cried because she was so happy to be clean and to be taken care of so gently.
Shortly after her bath, the physician called us and told us to put her on inhaled morphine. The
family had met and had decided that this is what was best for her. This hands-on learning
experience taught me so much. I was able to treat my patient holistically by nurturing her soul
and her body. The bath we gave her cleansed her soul and her body and in turn made her feel
better. Seeing her smile and her tears of joy were what bathed my soul. Knowing that you can
make a difference in someones day by doing something as simple as giving them a bath is
powerful food for your soul. It nourished me to take care of her needs. When I got home from
that shift, I took a few minutes to meditate on that experience. Taking that time for myself to
decompress and to reflect on my day is very important to maintaining my own well-being. I take
the time to center myself and to get enough rest and relief from an emotionally taxing day. It is
important for my patients that I am able to care for myself. If I do not, I am not going to be able
to take care of anyone. Nursing school has taught me so much and self-care is among the most
important lessons. Our instructors in every class, in every semester have reiterated this lesson.
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Take care of yourself, get enough rest, spend time with your family doing things that you like to
do. If you do this, you will live up to your full potential as a nurse and as a person.
Three years ago I wrote a paper about my personal philosophy of nursing. In that paper I
talked about my values and beliefs and stated that the focus of nursing is the promotion of
health and wellness. I wrote that I believed that the nurse-patient relationship was the core of
nursing and that advocacy was a top priority for a nurse. Now, three years and several patients
later, I still find all of that to be true, but I look at it through a different lens. I look at it through
the lens of experience. What is most important to me now is that I make a difference (even if it
is a small one) in the lives of each and every one of my patients. If I can make their day better
than it was the day before, I have made a difference. Being sick and having to be in a hospital
for days, weeks, or longer is awful. I know this and in my practice, I strive to make it a little less
miserable. Treating my patients holistically, using my educational foundation is not the same as
I imagined it would be. I am not just a person who serves as their voice, I bring them comfort, I
help them to heal, and I listen. I have learned that the small things count just as much as the big
things. Combing someone's hair, swabbing their mouth, or even giving them a simple smile can
change the way they feel. The last three years of my life have flown by and as they have, I have
Patricia Benner uses the Dreyfus model of skill acquisition in order to describe how
nurses advance in knowledge and practice. The Dreyfus model includes five levels of
proficiency: novice, advanced beginner, competent, proficient, and expert. In her book, From
Novice to Expert, Benner describes the novice as one who has no experience with the situations
in which they are expected to perform (Benner, 2001, p. 20). She explains that the novice
nurses practice is rigid because it is rule-governed. This is because the novice nurse is lacking
PERSONAL PHILOSOPHY PAPER 6
in experience and experience is necessary for skill development (Benner, 2001, p. 20). Once
the novice has gained some experience, they move to the next stage of advanced beginner. In
this stage, the nurse begins to look at the aspects of the situation. Where the novice is looking at
the situation in measurements such as blood pressure, temperature, heart rate, etc., the advanced
beginner is looking at these measurements in terms of how they relate to the situation as a whole.
They are beginning to make connections; however, they are still unable to prioritize their care.
In two to three years the advanced beginner becomes the competent nurse. At this stage, the
nurse is able to prioritize care and sees each situation in terms of long-range goals (Benner,
2001, p. 25). The competent nurse is able to distinguish which aspects of the situation are most
important and which aspects or attributes can be taken care of later. They have seen enough to
understand which parts of the situation are the most important parts, yet they are still somewhat
rigid and slow because they have to take time to process each situation. After about three to five
years of experience, the competent nurse moves into the proficient stage. In this stage, the nurse
views situations as a whole rather than in terms of aspects. Their performance is guided by
maxims, cryptic instructions that make sense only if the person already has a deep
understanding of the situation (Benner, 2001, p. 10). The proficient nurse recognizes what the
expected outcome of a situation should be and is able to plan care based on those expected
outcomes. The proficient nurse is also able to utilize the early warning signal, a skill that is
acquired after years of experience with the same situations. This skill allows the proficient nurse
to recognize deterioration or patient problems prior to explicit changes in vital signs (Benner,
2001, p. 31). The last stage of Benners theory is the expert stage. The expert nurse has a deep
understanding of the total situation. They are able to recognize a symptom or an illness based on
their intuition and may not be able to explain why or how they have come to a particular
PERSONAL PHILOSOPHY PAPER 7
conclusion. They have witnessed the situation so many times, that they do not have to take the
time to analyze the aspects and attributes, they can see the whole situation and instinctively know
Benner's Theory can be compared to learning how to drive a car. In the beginning
everything is rule governed the novice driver gets into the car and has to be told what steps to
follow, put your seatbelt on, adjust the mirrors, turn on the car, etc. The advanced beginner
driver gets into the car and follows the steps methodically yet their movements are not yet
smooth. The competent driver is able to get into the car, start the engine, and move from point A
to point B but they are still slow and use GPS to show them the way. The proficient driver is
able to get into the car and go on a road trip. They understand the rules of the road and they
know how to go from point A to point B seamlessly. The expert driver gets into the car and
drives from point A to point B easily. It is a drive they have made over and over again and they
instinctively know how to get there yet they may not be able to tell you how.
performing tasks in the hospital for over a year. I am capable of looking at the aspects of the
situation and gauging the severity or seriousness. I am not yet capable of setting priorities unless
they are obvious. I rely heavily on the guidance of a preceptor. As I watch my preceptor and
other seasoned nurses, I am learning how they prioritize and I am drinking in their knowledge.
In order to move to the stage of competence, there are three things I must do. Watching
nurses who have more experience, following their lead, and asking questions is one way to
advance. Examining the situations as they present themselves and analyzing their aspects will
allow me to understand how to prioritize care. By thinking about the patient as a whole and
trying to understand how to get them from where they are to where they should be, I will
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understand what parts need to be met immediately and what can wait. I have watched my
preceptor decide that a medication for one patient can wait because another patient is having
difficulty breathing. She has made this decision based on the knowledge that breathing is more
important than a late medication administration. As Benner says in her book, experience is a
necessity for advancement among the stages. In order for me to transition to the next stage, I
will need experience and I plan to get that through working as a full time nurse. Benner also
speaks of the beginner nurse needing to be backed up by advanced nurses. To move to the next
stage, I will ask my colleagues about aspects I am unsure of and I will gain reassurance from
As I move forward from student nurse to registered nurse, I know that my philosophy
will continue to change. My experiences will guide my practice. There will be times when the
meaning of holistic care changes the way I see a situation. My educational background will be
challenged. My self-care might even suffer from time to time. In times of doubt, I will remind
myself that I am always growing and learning and that I have had the best foundation a nurse
References
Benner, P. E. (2001). From novice to expert: Escellence and power in clinical nursing practice.
(M. Connor, Ed.) Upper Saddle River, New Jersey: Prentice Hall.