Nursing Practice

Introduction In this essay my aim is to describe and discuss my own Filipino cultural background and how it might influence my nursing practice. Culture is our way of living (Wepa, 2005). It is also shaped by our values, beliefs, norms, and practices that are shared by members of the same cultural group (Giger & Davidhizar, 1995).

I will be discussing some of the values and traits that we Filipinos have in common such as pagmamano and po at opo or gestures that show respect to our elders, kagandahang loob or shared humanity, (pakikipagkapwa-tao or regard for others, bayanihan or comradeship or cooperation and lastly, tiwala sa Diyos or trust in God. I will also include some of our shared traditions and beliefs and try to link my cultural experiences to my nursing practice. Brief Background of the Philippines Philippine is located in Southeast Asia, with Manila as its capital city.

Filipinos are basically of Malay ancestry, though proof of foreign influence can be trailed in our culture. We are actually a blend of different cultures rolled into one. For three centuries we were under the Spanish colony, as a result, there is a significant amount of Spanish and Mexican influence in our customs and traditions. Then later, under the American regime for four decades and their obvious contribution to us is the English language. Other ethnic groups such as the Chinese and Japanese have also influenced our way of living.

Pagmamano, po at opo or gestures that show respect to our elders Pagmamano and po at opo or gestures that show respect to elders go hand in hand. Pagmamano is holding an elder’s one hand and placing on your forehead and the phrases po at opo are used to show respect and courtesy when talking to someone in authority and elder. Filipinos are not used to calling people in authority by their first names; we say their designation first before their name, as we consider calling them by their names as rude and mal educada or uneducated. I wish to take this trait of showing respect to the lders and to everyone in my nursing practice by advocating and protecting the rights of the client in order to prevent harm and recognizing their culture when it comes to collecting and storing health information (NCNZ, 2005). I can also apply this trait in my interaction with my colleagues by valuing their personal culture and contribution to the team. Kagandahang loob or shared humanity and Bayanihan or comradeship Kagandahang loob or shared humanity refers to being able to help others in time of needs. Related to this is the bayanihan or comradeship which Filipinos are famous for.

We come in unity to help our family or the community in one spirit in attaining a common goal. Best example is in time of calamity; we gather together and extend our helping hands to those who need them without expecting in return. It is an act of selflessness, willing to be of service for other’s welfare. Showing hospitality to strangers is also an example of kagandahang loob that we are famous of, not that we are the only one that is hospitable. Even the humblest home along the road can be offered as a temporary shelter for a stranger who has lost his way.

We consider it also impolite to not invite an unexpected visitor that arrived during mealtime, to sit down and share what we have on the table. In cases that the unexpected visitor needs to stay for the night, he or she will be offered the best room in the house to the extent of having the host to sleep in the sala or lounge. This trait I intend to instil in my nursing practice by being fair and truthful to my client and colleagues, by being competent in what I do thus preventing and ensuring that I am practising ethically. Shared traditions and beliefs

When I was a child, my family had lived at our Lola’s (grandmother) rural home. She was a tough lady, always want everything tidy and in place. One dinner time, we were all sitting and having our meal quietly, no one was allowed to speak as it was her sacred rule that it was rude to talk while eating; she also had this habit of observing us, as if she’s waiting for us to make mistakes. She noticed that I wasn’t eating the head of the fish; she then called my attention and told me that I should eat the head of the fish as well because it makes us brighter and smarter.

Thinking of what she said, I innocently asked her “how if the fish was dumb? ”. I got into trouble by asking that. I grew up following traditions and believed many beliefs that have been passed down from many generations to the next. For instance, we have these beliefs in child rearing of causes of a child’s disability have something to do with the mother not following her dietary practises during pregnancy. For example, eating crabs would cause an unborn baby to have clubbed fingers and toes, eating dark foods such as grapes, squids and chocolates would make the baby to have dark skin.

Middle Range Theory Continues to Guide Nursing Practice Lisa M. Sanford Maryville University Middle Range Theory Continues to Guide Nursing Practice Nursing theory has three distinct categories to describe the level of abstraction: Grand, Middle-Range, and Situation-Specific (Meleis, 2012, p. 33). Hugh McKenna (1997) defined these three categories, stating: Grand theory is highly abstract and is broad in scope. Middle-range theory is more focused and is normally the end product of a research study.

Narrow-range theory is even more specific and while also being based on research findings, it guides specific actions in the achievement of desirable goals (p. 17). When thinking about nursing theory, one might ask: What is the purpose of theory? Is it even relevant to current nursing practice? The best response to answer these questions I have found is from Meleis (2012): The primary uses of theory are to provide insights about nursing practice situations and to guide research. Through interaction with practice, theory is shaped and guidelines for practice evolve.

Research validates, refutes, and/or modifies theory as well as generates new theory. Theory then guides practice (p. 35). This explanation of theory by Meleis identifies nursing as a profession. Without theory to shape and guide nursing practice and research, nursing would not evolve and would remain stagnant. Additionally, without theory could nurses really claim that we are a profession? I think not. I believe that theory is necessary for the identity of nursing as a profession verses a vocation.

The nursing profession as a whole has had issues with identity for various reasons. I believe this to be true in part due to the numerous educational ways of entering the profession. I cannot think of any other field where one could earn either a diploma, two-year associate’s degree or a four-year baccalaureate degree as a starting point into a profession. The educational debate still continues, however, in recent years more emphasis is being made to have the baccalaureate nurse the entry level of the nursing profession.

Evidence from research has suggested that the baccalaureate-prepared nurse is associated with a five percent lower mortality rates in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue in hospitalized clients (Aiken, Clarke, Cheung, Sloane, & Silber, 2003, p. 1617). This research study was conducted because nursing is a profession. Would research in nursing even exist if there were no theory? All in all, taken to its end, the loss of theory could mean the demise of nursing as a profession.

When reflecting on current trends of clinical practice, I feel that middle-range theories are more applicable. Middle-range theories are broad enough to incorporate in everyday clinical practice for the average floor nurse without being too narrow in scope as the situation-specific theories. Additionally, middle-range theories are less abstract than grand theories and are easier to relate to and put into practice (Liehr & Smith, 1999, p. 85). One example of applying middle-range nursing theory into practice is patient education. Patient education is a major focus of the clients I serve post transplant.

It is imperative that a newly transplanted client understand his/her medications that are such an integral part of their new life in order to maintain the transplanted organ. “Caring through Relation and Dialogue: A Middle-Range Theory for Patient Education is derived from the two disciplines of nursing and education” (Sanford, 2000, p. 8). According to Sanford (2000), A middle-range theory addressing the phenomenon of patient education through caring can add clarity and direction to this area of concern for nursing, and it can provide an opportunity to link theory, practice, and research (p. ). Caring and dialogue are described in this theory as follows: Dialogue is a process of naming our world. It is a process that opens the possibility for participants to pose problems, to critically reflect, and to perceive solutions not previously realized. This process occurs within a caring relation where the carer and the cared-for exhibit receptivity and engage in “reflection, invitation, assessment, revision, and further exploration” (p. 9). Another example of the applicability of middle-range theory is the theory of care transitions.

A hot topic in today’s times involves hospital acquired conditions (HACs) and readmission rates. Medicare expenditures are estimated at $15 billion annually due to readmissions (Averill, et al. , 2009, p. 1). As a result, policymakers have implemented the The Deficit Reduction Act of 2005, which eliminates any increase in hospital payments due to the occurrence of HACs. Furthermore, it is viewed that high readmission rates are a reflection of poor quality, and ospital payments for readmissions were recommended in the FY2010 budget from the Obama Administration to reduce payments for readmissions as one way of controlling Medicare expenditures (Averill, et al. , 2009, p. 1). As a staff nurse, I am all aware of the importance of HACs and the importance of diligent documentation. For example, when a client is admitted a thorough assessment is completed. Wounds and skin breakdown are crucial to document upon an admission or a transferred client to our division.

If the documentation of skin assessment is not completed correctly, then the “blame” is placed on our unit for an ulceration if it was not charted within 24 hours of admission. What are the causes or issues that surround care transitions? Increasingly fragmented care is one reason associated with hospital readmission rates. Issues include communication breakdowns related to plans of care, unclear expectations, uncertainty about illness trajectories, lack of continuity in medical follow-up, and incomplete or inaccurate understanding of medication regimens (Geary & Schumacher, 2012, p. 237).

In my practice of nursing, the utilization of inpatient care management for clients begins upon admission in preparation for discharge. A multidisciplinary approach of the transplant team includes the doctors, inpatient nurses, social workers, dieticians, case coordinators, post-transplant coordinators, and transplant pharmacists working together to coordinate and ensure continuity of care upon discharge. According to Geary & Schumacher (2012), “Through the transition process, agents act and interact within relationship with each other, causing emergence of new behaviors and outcomes.

Just as important, through supportive dialogue and discussion, sensemaking is enabled for everyone involved in the transition, effectively reenvisioning multiple understandings of the situation and changing outcomes for the better” (p. 246). Middle-range nursing theories can be viewed as a cookbook for nursing. There are many recipies in the middle-range theories which can be utilized by the average hospital-based nurse in a variety of ways. In any given 12-hour shift of a nurse, there are several theories which can be applied to specific situations.

I have unknowingly used nursing theory in my practice over the years. This course has brought to my attention the diverse ways in which I have used middle-range nursing theories and has given me a better understanding of how nursing theory is applied to current clinical nursing practice. It is my opinion that middle-range nursing theories will continue to guide nursing practice throughout the 21st Century. References Aiken, L. H. , Clarke, S. P. , Cheung, R. B. , Sloane, D. M. , & Silber, J. H. (2003).

Educational Levels of Hospital Nurses and Surgical Patient Mortality. The Journal of the American Medical Association, 290(12), 1617-1623. Averill, R. F. , McCullough, E. C. , Hughes, J. S. , Goldfield, N. I. , Vertrees, J. , & Fuller, R. L. (2009, Summer). Redisigning the Medicare Inpatient PPS to Reduce Payments to Hospitals with High Readmission Rates. Health Care Financing Review, 30(4), 1-15. Geary, C. R. , & Schumacher, K. L. (2012). Care Transitions: Integrating Transition Theory and Complexity Science Concepts.

Advances in Nursing Science, 35(3), 236-248. Liehr, P. , & Smith, M. J. (1999). Middle Range Theory: Spinning Research and Practice to Create Knowledge forthe New Millennium. Advances in Nursing Science, 21(4) 81-91. McKenn, H. (1997). Nursing Theories and Models. New York: Routledge. Meleis, A. I. (2012). Theoretical Nursing Development and Progress (5th ed. ). Philadelphia: Lippincott, Williams & Wilkins. Sanford, R. (2000, March). Caring through Relation and Dialogue: A Nursing Perspective for Patient Education. Advances in Nursing Science, 22(3), 1-15.

According to Hall, (1992; cited in Silva and Ludwick, 1992), “the ethics incorporated into good nursing practice are more important than knowledge of the law; practicing ethically saves the effort of trying to know all the laws. ” Clinical ethics literature pertaining to nursing profession identifies four important values and principles, namely, respect to autonomy of the patient and to act with nonmaleficence, beneficence and justice (Nettina, 2006).

Of these, beneficence is the fundamental principle that affirms the inherent professional aspiration of not only the nursing personnel, but also other health professionals to help promote other’s well-being. Infact, it is the main motivating factor for many nurses to opt for this profession as career. This essay will discuss the concept of beneficence relevant to nursing practice. Beneficence and ethics related to nursing profession The principle of beneficence comes across in everyday nursing practice.

The term beneficence actually connotes acts of merciness, charity and kindness which are suggestive of love, humanity, altruism and promotion of good to others (Stanford Encyclopedia of Philosophy, 2008). This broad notion is a principle or rule when it comes to medical profession. Nurses have a moral obligation to act in ways which benefit others. There are many theories which have been put forward about beneficence. These include the moral-sentiment theory of David Hume, the Utilitarian theory and Kant’s theory. According to Hume’s theory, in any moral life, motives of beneficence are very important.

Hume’s arguments were much against the Mandeville’s theory which proposed that most of the human actions are based on private interest and human beings are neither benevolent nor sociable. Hume argues that beneficence is an “original” feature of human nature and it designates a class of virtues which are rooted in generosity, goodwill and love directed at others. According to the utilitarian theory by John Stuart Mill, “actions are right in proportion to their promotion of happiness, and wrong as they produce the reverse.

” Thus, as per this theory, concepts of duty, right and obligation are actually determined by balance between maximum benefits and minimum harm. However, Kant argued that every individual has a duty to be beneficent, in the sense, that every one has to be helpful to others as per one’s means without any hope for personal gain (Stanford Encyclopedia of Philosophy, 2008). Whenever there is a conflict between what is good between patients and nurses, between organizations and patients, between states involved in interstate practice and also between patients, the principle of beneficence rises certain ethical issues.

Any differences in the ethical issues can initiate ethical implications which can terminate in approved cervices, financial reimbursement, change in laws on reporting certain diseases and abuse and also development of protocols from whom nurses can accept orders (Silva and Ludwick, 1999). Beneficence has a major role as far as conceptualizing the goals of medicine as a social practice is concerned. The goal of medicine becomes a beneficent undertaking only if the end of medicine is healing. Nurses are often confused as to what act of theirs is good for the patient and what is bad.

What they believe is good for the patient may not be what is actually good for the patient and it is very difficult to act in a way which is against anyone’s belief. Another famous debate about constitutes of what is good for the patient without infringing on the autonomy of the patient or causing serious harm to the patient (Silva and Ludwick, 1999). The question that pops up in the debate is whether it is ethical to overrule the preferences of the patient. Beneficence issues also rise when a patient is not in a position to make any decisions as far as his or her treatment is concerned.

Beauchamp and Childress (1994; cited in Silva and Ludwick, 1999) used paternalism to discuss this aspect of argument. According to them, paternalism can be weak or strong. While weak paternalism means “that the health care provider is protecting the patient when the patient is unable to make decisions due to problems such as depression or the influence of medications”, strong paternalism refers to “interactions intended to benefit a person despite the fact that the person’s risky choices and actions are informed, voluntary, and autonomous” (Beauchamp and Childress, 1994; cited in Silva and Ludwick, 1999).

As Thompson (1987, pg. 1465) rightly put it: “The duty to care is not only about recognizing a reciprocal responsibility for one another but also in particular about recognizing a duty to protect the vulnerable- that is, accepting the role of advocate of the rights of those who are unable to defend their own rights. ” Conclusion To conclude, it can be said that beneficence is a fundamental principle in nursing ethics with definite meaning and implications when applied to the analysis of the relationship between the nurse and patient.

Though beneficence is a natural human feature, it becomes a moral obligation in certain professions like nursing and thus is a source for ethical issues and implications. References Nettina, S. M. (2006). Lippincott Manual of Nursing Practice. 8th edition. Singapore: Lippincott Williams and Wilkins. Silva, M. C. , and Ludwick, R. (1999). Ethics: Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century. Online Journal of Issues in Nursing, 4(2).

Retrieved on July 18th, 2009 from www. nursingworld .org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/  Volume41999/No2Sep1999/InterstateNursingPracticeandRegulation. aspx Thompson, I. E. (1987).

Fundamental ethical principles in health care. British Medical Journal, 295(6611), 1461- 1465. Stanford Encyclopedia of Philosophy. (2008). The Principle of Beneficence in Applied Ethics. Retrieved on July 18th, 2009 from http://plato. stanford. edu/entries/principle-beneficence/