Monthly Archives: September 2011

Plain Talk:  Thinking outside the box might mean that we’re really talking about something else…something besides the box.  We’re questioning all the conventional assumptions.

“Society shuns what society celebrates”.*
How true. We celebrate love, community, sacrifice for others, virtues, strong convictions in tandem with those esteemed virtues yet on another level we despise virtues and value our independent selves above community.  Where does healthcare focus its interventions?  On the SELF.

What’s wrong with us? In thinking about our philosophy of health, shouldn’t the litmus test for where we should place our healthcare dollars be grounded in what we value in our societal celebrations? Rather than focus health interventions solely on the self, shouldn’t it also be on how we, at the individual level, interact with the community at large? Shouldn’t it be in what we celebrate, like virtuous living characterized by love and unselfishness and giving? YES!

So rather than go with the status quo of independent enablement for health, what would happen if we assumed responsiblity for each other, beginning with love and social responsibility, those things that create health-enabling endorphins and other positive physical effects? What would change?

Am I crazy? YES!
Is it right? I’m sure of it.

We need to not only think outside the box, but question if what we’re in is really a box, after all.

*Scott Belsky, CEO, Behance.

Assignment:  Write a 10 page paper on nursing philosophy.  Expound how it relates to the theorist of your choice, the nursing metaparadigm, and implications for nursing practice.

Could anything be more painful?  Or boring?  Or seemingly unimportant and irrelevant?  Really….is this going to be of value doing CPR on your patient who just coded from a drug overdose?  How do these nurse academicians think up this stuff, anyway?  That’s what I used to think, too.
Set those thoughts aside.  Negativity is of no help to you now.  Nursing philosophy and theory IS important.  That’s why your professor created the assignment.  Don’t let the unfamiliarity of it scare you off.  I’ll help you with it.
Reality:  The paper is 25% of your grade.PLAIN TALK:  Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like. So philosophy affects both the beginning and end of nursing actions. It explains why you do the things you do, and why you do them in the way that you do them.

Let me help you tackle it.  These assignments are so often way too broad and extensive, mainly because professors often don’t appreciate the enormity of what they’re really asking.  The one thing that helps the most is to imagine how you would explain to a friend why you went into nursing, what “health” is, and what nursing should “look like”.  In this case, you’re explaining it to your professor.  Here’s how to do it:
1.  Break down the assignment into its basic elements:
     A.  Personal philosophy of nursingSee my prior blog post on this topic.
     B.  Metaparadigm:  Nurse, patient, environment, health.  Although this is taken as written as stone, you may, like I, not fully agree.  But accept it for now.  Changing metaparadigms is a lot of work.
     C.  Definition of nursing.  The most widely accepted definition is the American Nurses’ Association definition.
     D.  Theorist of choice.  This often depends on the type of patient you’re caring for.  No one theory works for every setting.  So state up front what kind of patient you are thinking of and that will direct your choice of theory.  Write in your paper that no one theory works for everything.  Justify why  you have chosen that particular theory for that particular kind of patient and that particular kind of nursing.  For example, a post-op orthopedic patient fits well with Orem’s self-care theory.  Care of the chronically ill/diabetic Hispanic patient is a nice fit for Leininger’s transcultural theory.  The newly divorced patient or newly widowed patient fits with Meleis’ transitions theory.
2.  Another element you need to think about is your philosophy of health.    Nobody ever talks about this.  You need to think about what is health?  It’s not necessarily the nursing metaparadigm.  Read through this blog to get more ideas.  Come to your own conclusions.  You need to state your beliefs about health.
3.  Once you’ve decided on the elements above, you need to figure out how these elements relate together.  The most common error is to try to say everything about every element.  That ends up a bloated, overwritten, blob.  Pick one small area of each element and link it logically to all the other elements.  For example, maybe you center it all on a hypothetical patient.  Maybe you will focus on the generalities of a quality of nursing, like caring and show what that looks like at each level.

What you are doing is building a pyramid.  The bottom layer is your philosophy.  The next layer is the nursing metaparadigm, then the theory, then nursing practice, then the particular patient where one-on-one nursing occurs.  Your job is to connect the dots from one layer to another.

Remember:  Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like.  So philosophy affects both the beginning and end of nursing actions.  It explains why you do the things you do, and why you do them in the way that you do them.

Good luck.  You’ll do fine.  Let me know how I can help.

Plain Talk:  Google’s search engine confirms it:  Philosophies of health don’t really exist.  And they should.  They must if nursing is going to advance in its philosophical work.  That’s the only way healthcare will advance past the current models.

The Details:
Nursing philosophy is hard because most of the time what is being referred to is not nursing philosophy, but health philosophy.  The professor assigns the nursing students the ever-elusive, most hated assignment:  “Write a 5-10 page paper on your nursing philosophy, undergird it with theory, and demonstrate how it is implemented in the four domains of nursing (nurse, patient, environment, health), and justify your reasons for your position.”  This is literally an impossible assignment.  Volumes have been written on these subjects.  It cannot be addressed in a short paper.  The single revelation here is that even professors don’t understand it.  I don’t fault them, though, because our discipline has not adequately pursued the development of philosophy.

I’ve realized over the last few years, though, that the main difficulty lies in the fact that we have not adequately stated a philosophy of health.  With all the various interpretations and dimensions of health discussed in nursing, psychology, medicine, and sociology, we are still missing something.  I think that “something” is found in our presuppositions…our fundamental beliefs and assumptions that guide our view and interpretation of the world. 

The quandaries of the nursing philosophy assignment is a clue to the fact that we don’t have it quite right.  Look at how nursing views “health”:  physical, emotional, spiritual, environmental.  It’s a modular idea.  We took the medical paradigm of the body’s mechanical functioning, glued on emotional and spiritual dimensions, and set it against a backdrop of environment.  When all systems are “go”, we want to call it “health” or “energy” or “being”.  Even integrative medicine that emphasizes nutrition, stress reduction, and exercise are generally based on a modular approach.

If nursing is going to make sense of nursing philosophy, it needs to consider philosophies of health.   The current philosophy of health as stated in the paragraph above is inadequate.  Before we can be prescriptive (make recommendations for people’s health) we must be proscriptive (describe what health is & is not).  Since health has come to mean more than the physical, and more along the lines of human flourishing, then we have to figure out what constitutes human flourishing.

Enough for now.

(Photo source:  Research Haven)

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