Nursing Situation Synthesis
The Nursing Situation
Hassmiller (2017) asserts that caring for a patient unreservedly as a whole person in situations where both environmental and organizational factors that a nurse must overcome exist is the basic essence of excellent nursing practice. According to Mayeroff (1971), the real quintessence of nursing does not depend on the overall number of people who are healed in the end, but rather, it depends on the level of care given to those who need it the most when they need it. Working in the Pediatric unit as a nurse is undeniably one of the most challenging things I have had to put up with in my career as a nurse. Caring for children with special needs and conditions such as “Joey” who is a three year old boy diagnosed with Treacher Collins Syndrome require basic nursing practical skills, knowledge, an enduring heart and dedication. Taking care of Joey who had Pneumonia superimposed on Treacher Collins Syndrome not only involved administering medication but also psychological, physical and spiritual support both to him and his mother and family at large. Taking care of the “Joey” at night because of his predisposition to recurrent respiratory tract infection, reassuring his family of a better future, stimulating him to play and interact with the environment and educating his family on ways they could prevent further respiratory diseases were all inspired and guided by the need to offer the best quality care for the good of my patient. I strived to ensure that my patient recovered well and within the shortest time possible without acquiring further medical complications as a result of his condition. The essence of caring in this nursing situation is to demonstrate compassion to all clients as whole human beings who ought to be respected and their dignity upheld at all times.
Empirical knowing is the major way of knowing that made me compassionate and informed my caring of the patient. Designated as the ‘science of nursing’, empirical knowing involves the use of scientific and evidence based knowledge, facts and figures in understanding the patient (Zander, 2007). It is inspired by the growing need for empirical knowledge about the world that can be ordered into principles and theories to aid in the description, explanation and prediction of phenomena of interest to nursing (Mayeroff, 1971; Barry et al. 2015). Understanding that children living with Treacher Collins Syndrome which is characterized by abnormal facies are prone to experience breathing problems and thus suffer from recurrent upper and lower respiratory tract infections according to the severity of their condition helped me in planning my nursing care to the patient. Ensuring that the patient’s airway were always clear, availability of oxygen and nasal prongs to support ventilation when the oxygen saturation went below 90% and keeping him in a supine position were some of the measures I adopted to help the patient recover better. Playing with the patient in order to make him happy while giving moral support to the mother helped to build trust with them and give them hope. Being compassionate entails understanding the pains of others and consequently sharing in their problems (Vance, 2003).
Esthetic knowing guided my supportive care not only to the patient but also to the mother and the entire family. Esthetic knowing is a way of knowing that looks at nursing as an art rather than just a science that must be explained empirically (Zander, 2007). It helps in the understanding of unique and unquantifiable aspects of a patient such as attitude, emotions and thoughts that are important in nursing care (Mayeroff, 1971). The knowledge described by esthetic knowing is gathered through subjective acquaintance and the personal direct appreciation of experience. Knowing that the mood of the mother significantly affects how the Joey responds to medication and the entire prognosis prompted me to encourage her to always be jovial when handling him. It was apparent that the genetic condition of the patient was a big cause of low self-esteem to him and his family. Esthetic knowing helped me to effectively counsel and advice the mother on the basic danger signs associated with respiratory infections and the need to be enthusiastic about her son in order to boost his esteem and realize positive outcomes.
Every nursing situation according to Boykin and Schoenhofer (2001) is a unique lived experience that involves at least two very unique and caring people. The two are linked by the call for nursing and the response to the nursing call. A call for nursing care is a call for individualized nurturance by people, patients or clients who dream and aspire to grow in caring. Nurses’ response to calls on the other hand involves the bringing of expert knowledge of what it actually means to be human and caring as a full-fledged obligation to nurture and appreciate caring in all situations (Boykin & Schoenhofer, 2001). During my rotations in the pediatric unit at night, ensuring that ‘Joey’ was comfortable and relaxed was one of the most important priorities. I constantly reminded his mother to immediately raise an alarm if she noted any signs of difficulty in breathing, extreme hotness of the body, profuse sweating and wheezing. Patients in the pediatric unit with special and rare life threatening conditions such as Treacher Collins Syndrome require swift and immediate nursing response in case of a nursing call. Every time my interaction with the patient caused discomfort especially when taking the vital signs, I had to respond to that by making funny faces or distracting him in order to reduce anxiety and build trust between us. According to Boykin and Schoenhofer (2001), nurses responses by all means should be expressions of caring.
The Theory of Nursing as Caring
The theory of nursing as caring, as put forward by Boykin and Schoenhofer (2001), is a broad-spectrum theory that seeks to offer a wide idealistic framework with realistic implications for renovating and improving the practice of nursing. The main focus, aim, and principle of the theory of nursing as caring is to define nursing not only as a discipline of acquaintance and information but also as a professional service that nurtures persons living and growing in caring (Boykin et al. 2003; Smith & Packer, 2015; Alligood, 2014). There are two assumptions that govern and anchor the theory. First, the assumption that being human means being caring. It asserts that “All persons are caring. This is the fundamental view that grounds the focus of nursing as a discipline and a profession” (Boykin& Schoenhofer, 2001, p.34). Secondly, the undertakings within nursing as a profession and a discipline coalesce in the knowledge that persons are caring and thus ought to be nurtured as individuals who are living and growing in caring. According to Boykin et al (2003), caring does not just end at the side of the bed but rather continues even after the patient has recovered because there is always a need to prevent similar problems in future. The principle that every person is caring, grows and lives in a caring environment compelled me to research on the rare genetic condition that Joey had, shared the information with his mother and family on ways to prevent future respiratory infections and even made sure that every member of my team and the physicians knew about him and ways of caring for him.
In the theory of nursing as caring, compassion, empathy and care must be experienced by the nursed, the one providing the nursing service and everybody else within the nursing situation restating the concept of compassion (Boykin & Schoenhofer, 2001; Boykin et al. 2003). My dedication towards ensuring that my patient was comfortable, happy and relaxed while receiving his treatment was inspired by the fact that as a caring person, instilling a sense of belonging in my clients was as good as helping them to recover. Furthermore, assuring his mother who was always beside him of positive outcomes ensured that caring was not only confined to the nursed but also all people within my nursing situation which is in line with the principles of the theory of nursing as caring (Alligood, 2014; Boykin & Schoenhofer, 2001). Being compassionate towards ‘Joey’ and his mother because of his sickness and underlying genetic condition to the extent of encouraging his family to frequently visit him due to prolonged medication duration is a show of care and concern. Through creating an environment that radiates a feeling of caring and nurturing really helped Joey to recover well without complications.
The essence of caring in this nursing situation is the concept of compassion which according to Boykin and Schoenhofer (2001) is the selfless act of being concerned by the suffering and pain of other people who ought to live and grow in caring. Compassion in the context of the theory of nursing as caring involves living out the real us, grounded in caring, displaying correspondence between our beliefs and our actions as caring persons and above all, walking in the shoes of those in pain and suffering. The concept of compassion reflects the theoretical perspective of the Nursing as caring theory since it entails handling the nursed as a whole person who is caring and with a desire to live and grow in caring. Through showing compassion to the nursed, his family and his state, the principle that define nursing as caring are displayed within the nursing situation.
Mayeroff (1971) denotes that caring that is founded on compassion stands a better chance of being reciprocated because it brings harmony between what the carer thinks are the need of the patient and what the patient and his family believes are their needs. Being compassionate allows a nurse to be attentive to the most important needs according to the nursed in order to create a caring environment that favors the patient instead of him or her. Nurses providing care always endeavor to have their services accepted by the nursed thus emphasizing the need to be compassionate, empathetic and considerate (Mayeroff, 1971). In the Leininger theory of nursing, caring is distinguished into scientific and humanistic aspects (Smith & Packer, 2015). Compassion is a humanistic aspect that allows the nurse to put away the basic skills and knowledge of nursing and attend to the patient as a human being with feelings and emotions (Smith & Packer, 2015; Vance, 2003). Compassion is a subjective feeling that is not based on any tested empirical and scientific knowledge which helps to create a caring environment within any nursing situation (Mayeroff, 1971). It comes out of understanding the individual needs of patients and the knowledge of how to uniquely respond to them in ways that fit the circumstance of each patient.
Sinclair et al. (2017) affirms that compassion is the greatest enhancer of the aspects of empathy and adds the unique features of being driven by love and kindness. Most patients according to Sinclair et al. (2017) study revealed that empathy and compassion are significantly important and beneficial than just sympathy. Being compassionate helps the patients realize that their condition, pain or illness is not just unique to them and they will recover and resume their daily lives. Watson in her theory of human caring presents four major theoretical elements build around the need to care for patients with love and compassion. The ten carative factors that define Watson’s theory revolve around being compassionate with patients as the foundation of caring. The third factor among the ten components of the caritas emphasize the need to cultivate sensitivity to both self and others with the eight emphasizing on the importance of providing supportive care physically, spiritually, mentally and environmentally to the nursed (Smith & Packer, 2015). All these revolve around being compassionate and considerate for others.
Finally, many people choose to become nurses in order to serve humanity and help save the lives of others with the thought that the profession will be interesting and equally rewarding (Hassmiller, 2017). However, this usually is not the case as many individuals come to realize that nursing is not only a profession, but also a discipline, an art and a business that requires more than just the practical skills and knowledge acquired through the basic training. I believe that practicing nursing according to the principles laid out in the theory of nursing as caring injects a new feeling and perspective as far as the returns, rewards and satisfaction are concerned in the practice of nursing. Knowing that human beings are caring persons who deserve caring unconditionally from caring persons is enough to inspire best quality nursing practice. This a new understanding that I seek to integrate and cultivate in my practice through constantly reminding myself of the holistic nature of nursing and need to put a smile on the face of every person I come across in any nursing situation. I will endeavor to not only address the nursing and medical aspects of my patients but also find ways to connect and access their spiritual, emotional and psychological worlds in order to make them value themselves and feel cared for. I believe that through building trust, being there for my patients when I am on duty and swiftly responding to their needs will go a long way in making my patients feel loved, appreciated and inspire positive outcomes.
References
Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.
Barry, C. D., Gordon, S. C., & King, B. (2015). Nursing Case Studies in Caring: Across the Practice Spectrum. London: Springer Publishing Company.
Boykin, A., & Schoenhofer, S. O. B. (2001). Nursing as caring: A model for transforming practice. Boston: Jones and Bartlett Publishers.
Boykin, A., Schoenhofer, S. O., Smith, N., Jean, J. S., & Aleman, D. (2003). Transforming Practice Using a Caring‐based Nursing Model. Nursing Administration Quarterly, 27(3), 223-230.
Hassmiller, S. B. (2017). The essence of nursing care. AJN The American Journal of Nursing, 117(5), 7-15.
Mayeroff, M. (1971). On caring. New York, NY: HarperCollins Publishers
Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Raffin Bouchal, S., Chochinov, H. M., & Hagen, N. A. (2017). Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliative medicine, 31(5), 437-447.
Smith, M. C., & Packer, M. E. (2015). Nursing theories and nursing practice. Philadelphia: F.A. Davies Company.
Vance, T. (2003). Caring and the professional practice of nursing. RN Journal.
Zander, P. E. (2007). Ways of knowing in nursing: The historical evolution of a concept. Journal of Theory Construction & Testing, 11(1), 7-11.
