Theoretical Nursing Practice

Theoretical Framework for Nursing Practice – Module 8

A. Reflect on a case or situation from your personal practice or experience. Apply one of the theories to the situation. How does the perspective from the theory alter how you view the situation? Are the nursing interventions the same? Why or why not?

In a typical emergency department setup, caregivers deal with patients having acute cases, mostly involving pain or distress of some sort. In addition, patients undergoing treatment in this unit fall in a category known as “transient” – early in, early out. Because of these conditions, I have observed that the nurses in my area of responsibility have developed this notion that “nursing care” should be focused on the accomplishment
of the emergency physician’s orders. While this is somewhat true, Jean Watson’s Interpersonal Theory of Caring has demonstrated that this perception only fulfills a portion of what holistic nursing care is all about.

Back when I was still relatively new in practicing bedside nursing in the emergency department, I too have been guilty of ignoring the other carative factors that my client needs.
Having been rotated in a general nursing unit as well as in an intensive care unit before finally being assigned in ER, the new-found the conditions of the emergency setup has proven to be a convenient excuse not to perform the same level care expected of me compared with the expectations of care from my previous units. My belief was that, as long as I executed the doctor’s orders such as the initiation of an intravenous line and the administration of medication, I have already taken care of my patient. Every once in a while I try to go back to the patient’s room to evaluate the effectiveness of the treatment I gave (e.g. pain has been relieved, temperature of a febrile patient has gone down) but that’s the extent of the care that I try to give. I began seeing patients as customers I have to dispatch as fast as I could – by nature of discharge or transfer to other units for admitted patients. Effectiveness of nursing work is now gauged by how fast I could carry out the doctor’s orders, how quick I could relive a patient’s symptoms and/or how rapid I could stabilize a patient’s condition and how prompt I could finish my documentation. It is important to note that I used the term “work” as opposed to “care” because the humanity in the actual care-giving has been lost in replacement of
treating the illness and not the person itself, a characteristic that is easily attributed to medical physicians and not to nurses.

The longer I stayed I the emergency room, the better I got in terms of handling the stress and the pressure.
As got more and more efficient in performing my tasks, I got more and more free time on my hands. The more free time I earned, the more I got to interact with my patients. For the first time in a long while, I again started to see the patients as human beings in need of care and support, rather than objects that need to be sent home or transferred/deployed to its corresponding wards/private
rooms.

Now that I am an acting charge nurse who supervises the unit in the absence of our assistant manager and charge nurse, I have observed the same trend. The probationary and the junior nurses focus more on accomplishing the mundane tasks while the more senior nurses focus on giving the holistic care on top of the routine nursing work. From this observation, along with my observation of my own past experiences, I have come to analyze that delivering care the way Jean Watson expects every nurse to would prove to be a time-consuming process. ER nurses deal with clients on very short periods of time – less than 5 minutes of triaging, 5-10 minutes of assessment and planning, 10-20 minutes of intervention and another 5-10 minutes of evaluation. Then the nurse has to repeat everything on a new incoming patient assigned to her; with every new patient coming in every 15-30 minutes. Junior nurses who are still adjusting to the pressures of the unit and of the work are still trying to find ways of how to deal with the time restrictions without committing any significant variances that might be harmful to their patients. It is because of this reality that holistic caring has taken a back seat, given least priority for majority of ER nurses. If you come to think of it, common sense dictates that a nurse should prioritize in addressing a patient’s pain complaint and prevention of infection over her verbalization of anxiety towards possible scar development brought about by the unfortunate accident. However, more experienced nurses are better able to multi-task, with equal emphasis in addressing both problems without compromising the quality of care. In addressing the anxiety, the patient’s breathing pattern becomes better; her threshold of pain improves considerably, making the administration of IV pain killers more effective and recovery becomes quicker. Although caring takes “too much time” according to some people, I have found through experience that focusing on the patients’ priorities and meaning will often help them participate more actively in their healing process. Therefore, even though more time was taken initially, I observed that, eventually, more time is saved in caring for patients. As Watson emphasizes, the outcomes that may arise, develop from the process and are characterized and guided by the inner journey of the one being cared-for, not the one caring.

Reference:

Jean Watson's Philosophy of Nursing, http://currentnursing.com/nursing_theory/Watson.html, retrieved April 25, 2012