The Importance of Caring: My Journey Into Nursing
Nursing is more than treating an illness; rather it is focused on delivering quality patient care that is individualized to the needs of each patient. The purpose of this paper is to describe my personal philosophies of nursing along with the philosophy of a nursing theorist and a comparison. This paper also discusses my experiences in my journey of nursing along with my ideas on improving healthcare in the future.
Philosophy
Personal
Throughout my journey of becoming a nurse, I have started to develop my personal philosophy of nursing. My philosophy views nursing as a way of healing others, caring for others, respecting others, and treating others the way you would want to be treated. I believe that we learn from our mistakes. Each mistake is a learning experience that helps me become a better nurse. In my opinion, nursing is both an art and a science. To me, the art of nursing involves both the patient and the family. A collaborative approach helps the patient to recover faster. I believe nursing is about knowing how to connect with those around us through caring and compassion. Nursing is also a science. As nurses, we are taught the theories and scientific knowledge in order to understand a patient's disease process and medication needs which aid us in individualized nursing care. There is so much that I have already encountered as a nursing student and still have a whole lot more to learn. But one thing that has always stayed with me is my ability to heal and respect everyone. I always walk into my patient's room with a smile. A smile makes a big difference. My philosophy views nursing as a way of healing through trust and empathy. I am able to view the patient as a whole and not just as a set of signs and symptoms or as a disease. I don’t just give medications and leave. I talk with the patient and help them in all possible ways I can. As nurses, we heal by using therapeutic touch, active listening, being present in the moment, and instilling hope. I believe that I have learned just a bit and there is a lot more to learn. Each day and each patient is a new learning experience for me. As I continue my journey to becoming a nurse I will continue to learn new knowledge and grow from my experiences. These values and beliefs are what is built on my personal philosophy of nursing.
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Theorist
Patricia Benner is a nursing theorist, a nursing educator, and an author. She was born on August 31, 1942. She is best known for her book From Novice To Expert: Excellence and Power in Clinical Nursing Practice (1984). She is the first nursing theorist to develop a model for the stages of clinical competence. Her nursing theory proposes that expert nurses develop skills and understanding of patient care through a proper educational background as well as a multitude of experiences (Petiprin, 2016). Dr. Benner’s theory was basically focused on how nurses acquire nursing knowledge and not how to be a nurse. The theory consists of five phases which build on each other as the nurse refines and expands learned theories and develops clinical expertise through gained experiences. Dr. Benner used the Dreyfus Model of Skill Acquisition as the foundation of her work. The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsume ideas with regard to how individuals learn (Pẽna,2010). The Dreyfus brothers- Stuart and Hubert believed that learning was experimental (learning through experiences) as well as situation-based, and that a student had to pass through five very distinct stages in learning; novice to expert. Dr. Benner found nursing to be similar to this, where improved practice depended on experience and science, and developing those skills was a long and progressive process(Petiprin, 2016). She found out that when nurses were involved in various situations, they learned from the situations and they developed “skills of involvement” with patients and family. The five stages of clinical competence according to Dr. Benner include the following:
- Novice: This would be a nursing student in his/her first year of clinical education. According to Dr. Benner, novices have a very limited ability to predict what might happen in a particular patient situation (Benner,2001). A novice nurse has an incomplete understanding, approaches tasks mechanically, and needs supervision to complete them.
- Advanced Beginner: This would be the newly graduated nurses in their first jobs. They have had more experiences that enable them to recognize recurrent, meaningful components of a situation (Benner,2001). Advanced beginners have a working understanding and tend to see actions as a series of steps. They can complete simpler tasks without supervision.
- Competent: These nurses have a good working and background understanding, see actions at least partly in context, and are able to complete work independently to a standard that is acceptable, though it may lack refinement (Petiprin,2016). These nurses lack the speed and flexibility of proficient nurses but have some mastery.
- Proficient: At this level, the nurse has a deep understanding, sees actions holistically, and can achieve a high standard routinely (Benner,2001).
- Expert: These nurses are able to recognize demands and resources in situations and attain their goals. They know what needs to be done. They have an authoritative or deep holistic understanding, deal with routine matters intuitively, and are able to go beyond existing interpretations (Benner, 2001). They are able to achieve excellence with ease.
This is Patricia Benner’s nursing theory and I believe that each step builds from the previous one as we gain knowledge from experience. According to Dr. Benner, beginner nurses focus on tasks and follow a “to-do” list, whereas expert nurses focus on the bigger picture even when performing tasks and are able to notice subtle changes in a patient(Petiprin,2016).
Comparison
According to Dr. Benner’s theory, I believe that I am in the novice stage beginning to advance into the advanced beginner stage. As a nursing student, I know the theory; of signs and symptoms of certain diseases, but I am just learning on applying them to real-life symptoms. I agree with Dr. Benner on how expert nurses develop skills and understand patient care over time and experience. Like I said before, I believe that we all learn from mistakes. Just like that, Dr. Benner says that we learn from our experiences. It takes years to become an expert nurse, but with hard work and experience, I hope that one day I will also become an expert nurse.
Reflection
Perceptions
Before I came into the nursing program, I had many different views of nursing. I have heard opinions of what nurses are and what they do from many people. Everyone has different opinions and in my opinion, many people don’t know what a nurse actually does. I was told that nurses just bathe patients, feed them and pass medications. I was told that nurses have no value and that nurses are just like servants. They listen to doctors' orders and have no say in anything. These are things that I have heard and I still hear from random people. But I actually knew that people are expressing their opinion because of their lack of knowledge. Over the last two years, I have understood that nurses are much more than pill slingers. Nurses play a significant role in patient care. I never knew the importance of a nurse when it comes to patient care. They are critical thinkers. Nurses use their critical thinking skills to prioritize and make key decisions that can save lives (Nurse Journal, 2019). They are with the patient throughout the continuum of life. Nurses are teachers, advocates, caregivers, critical thinkers, and innovators. Nursing is an honorable profession and nurses are the heart and soul of the healthcare system (Weinstein,2020), but still, among many, nurses are looked upon with disdain.
Goals
My mom is a nurse and she has influenced me in becoming a nurse. I always wanted to help the sick and needy and felt nursing was my thing. She has always been a support. After nursing school, I plan on going straight into an RN-BSN program and later doing a master's. I hope that one day I become a Nurse Practitioner.
Incident
Situation
As a nursing student, an incident that occurred in my clinical rotation was a medication overdose error. The doctor prescribed 975mg of Acetaminophen every 4 hours. That would add up to 5850mg per day. The maximum recommended daily dose of acetaminophen for a healthy adult is 4,000 milligrams (Farrell,2020). That was truly a prescriber error. I was getting ready to administer 10 AM medications when my clinical instructor and I noticed this mistake. We stopped and reported this error to the patient’s in-charge nurse. The nurse then took a look at it and called the doctor. The doctor then changed the prescription to 625mg every 4 hours. Because the medication was acetaminophen nothing acute occurred. But if this was left unnoticed, it could have led to serious kidney damage, irreversible liver damage, and death.
Analysis
In the liver, most acetaminophen is metabolized through the glucuronidation and sulfation hepatic pathways; the remaining drug in the liver is metabolized by the cytochrome P450 system into a toxic metabolite (Smith, 2007). This metabolite then couples with hepatic glutathione to produce a nontoxic metabolite (Smith, 2007). When a patient overdoses on acetaminophen, the glucuronidation and sulfation pathways become saturated and more acetaminophen in the liver is metabolized by the cytochrome P450 system (Smith, 2007). This depletes glutathione stores and lets the toxic metabolite accumulate, causing hepatic injury (Smith, 2007).
The root cause of this error was basically due to the prescriber’s error. The prescription was taken off correctly as written, by the nurse, but the nurse should have noticed the error. At the same time, the pharmacy should have not allowed it to be dispensed. Also, as per hospital policy every day during the night shift a 24-hour chart check should have been done by the nurse. She had checked everything but had not noticed the error and it was not corrected. Therefore, in this incident, the doctor, nurse, and pharmacy are at fault. Like I said before since the medication was Acetaminophen, no acute problems were reported, but if this was left unnoticed it would have led to severe liver damage, eventually leading to death.
Prevention
Never events are serious medical errors or adverse events that should never happen to a patient (McKeon&Cardell, 2011). As nurses, we are often the last “gatekeeper” in the administration process to prevent medication errors (Maryniak, 2016). It is important to take the time needed to ensure patient safety and minimize distractions throughout the process (Maryniak, 2016). This incident could have been avoided by the nurse if she took the time to check the medication order and was able to recognize the overdose error. She should have clarified with the doctor about the prescription. Nurses who don’t follow the five rights (right drug, right patient, right dose, right timing, right route) of medication administration can contribute to medication errors (Chu, 2016). In addition, they must complete accurate documentation once the patient receives the medication. Failure to record the medication administered increases the risk that the patient will receive another dose (Chu,2016). Deficits in pharmacologic knowledge, miscalculations, distractions, increased workloads, and fatigue are common reasons why the five rights aren’t always followed (Chu,2016). Certain ways in which we can prevent a medication error in the future is by going over the rights of medication administration. If the nurse took a close look at the medication administration rights three times she would have noticed the timings and the dosage. Also, a medication review can be done which includes comparing the medication record and the patient record at the beginning of a nurse’s shift and determining the rationale for each ordered medication. Nurses must improve their pharmacologic knowledge and keep up-to-date about new drugs. Pharmacologic continuing education updates nurses about the safe use of new drugs, including appropriate indications and dosages, proper administration, drug actions, contraindications to use, drug-drug interactions, potential adverse drug reactions, patient monitoring, patient teaching, and documentation (Chu,2016). Medication errors should be reported. This helps identify failures in medication processes and may help to prevent further incidents.
I believe the only way to prevent this incident is to be more careful and follow all the instructions. No matter what, the nurse should check the 5 rights of medication administration. Also, the nurses make medication errors when they are interrupted when preparing medications. I believe if they have a quiet space to prepare the medications, many errors can be prevented. Adequate communication is an important factor in nursing. We could have prevented this incident if the nurse approached the doctor with doubt, or if the pharmacy had not dispensed the medication. Medication errors are preventable events. Safe medication practices, adequate resources, a work environment free from interruptions, and a nonpunitive approach to error reporting should be encouraged.
I would like to conclude this paper by saying that nurses make a big difference. Safe and effective care should be given to each patient and we should try our best to prevent life-threatening errors. It’s just a matter of time.
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