Theory and Philosophy of Nursing …

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My own philosophy of nursing is evolving, and the process of identifying, expanding on, and encoding its elements has been an important part of my development as a professional Registered Nurse. I have observed patterns during my years of practice that repeat in predictable ways – repeat not because of the inter-connectedness of ephemeral energy fields, but because the human mind has evolved to act and interact with its environment in structured, recognizable ways. I recognize in myself some of these patterns of action/interaction, and introspection has been an important part of my nursing theory development. But humans do not exist apart from their environment, and just as medicine, nursing, and other health-scientists debate the roles of nature and nurture, so must a nursing theory take the effects of all into account.

Environment. Every human being is born into an environment. The environment can be defined as everything that surrounds and affects that human, from other humans to the inanimate rocks on her path. Each element in the person’s environment has an effect on that person, and the effects of the elements are determined by external (it’s cold) factors, internal (I can cope with cold) factors, and distance (it’s cold outside but I’m not there) factors.

Health. In my evolving understanding of the interactions of humans with their environments, I have been able to define and detect patterns of human health and existence that make me more proficient at providing nursing care to those who come to me for care. In my theorizing I have found that everything from human anxiety to Maslow’s hierarchy has a place.

Nursing practice. I am taking control of my vision of nursing, in part by formalizing my own theories of nursing, from the grand to the practical. I may never reach the end of my explorations, and will certainly never be satisfied with “what is” or “what was” as long as there is a “how come?” left. While the answer may indeed turn out to be 42, I still need to know why. The process is more important to me than the product, and by continuing to write, I believe that I will establish a solid foundation for my future professional practice.

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I take the people who have nowhere else to go. My patients are those who exhibit what is known as BPSD – behavioral and psychological symptoms of dementia. They aren’t the “pleasantly confused” folks whom everyone loves. They’re the hitters, the spitters, the kickers, and the screamers. They’re the wanderers, the accusers, the punchers, and the shoppers. They throw food, smear excrement, and pee in the fireplace. They’re all mine – they literally have nowhere else to go. Some of my patients have failed a dozen or more placements at other facilities.

This week’s best intake – a 70-yo, hard-of-hearing, schizophrenic, alcoholic woman in stage 3 alcohol withdrawal. She was basically an after-hours drive-by-drop-off from the ER. The hospital’s Discharge Planner still hasn’t faxed me her orders. Her kids said they would be by the next morning to handle the paperwork.

“THOSE AREN’T BUGS, THEY’RE DEVIL BIRDS!”

“Berty, there aren’t any bugs or birds in your room.”

“I SAID THEY’RE ALL OVER MY WALLS! WHACK ‘EM! WHACK ‘EM!”

“Berty, there isn’t anything here that is going to hurt you. I’m here to keep you safe.”

“I’M NOT TALKING TO YOU! SHUT UP! I CAN’T HEAR THE NURSE WHEN YOU’RE YELLING LIKE THAT!”

She was having a very loud argument with the voices in her head about what was or wasn’t climbing the walls of her room. It was a lot like listening to Gilbert Gottfried on acid – for three. Fscking. Hours. Not a single one of my Resident Assistants would even come into her room until she exhausted herself (and until I had enough PRNs in her to quiet the voices).

It’s lonely at the top.

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