In the midst of doing nursing, we don’t often stop to define what nursing is.
This assignment challenged me to consider what I *thought* I knew about nursing. In considering this, I was able to determine what being a nurse is to me and identify how aspects of the nursing metaparadigm and other views of nursing have influenced my ontological stance.
My Ontological Stance
My worldview of nursing has been defined by my professional experiences as both an emergency and intensive care nurse. Nursing is meeting a patient where they are and piecing together assessments with knowledge to achieve the best outcome for the individual. Collaborating with each patient with compassion, empathy and understanding, embodying the view espoused by Christie Watson (2021) of “belief and respect in every single individual’s worth, regardless” is to be a nurse (8:59). In the fast-paced, ever-changing, and complex healthcare system, to be a nurse is to “be a vocal advocate” for our patients (vanDaalen-Smith, 2019). Nursing is a practice in which the nurse brings these components together with the goal of making each person with whom they interact with a little better and their lives brighter.
Synthesis
Meeting the patient where they are.
The nurse-patient relationship is a prerequisite for nursing to exist as it is the vehicle through which assessment is conducted, goals are identified, and trust is established (Senn, 2013). Nursing is ‘meeting a patient where they are,’ sifting through the information that is presented, selecting and seeking out pertinent details and combining these details with knowledge to achieve the best outcome for the individual. In Fawcett’s nursing metaparadigm, there exists a person-health relationship which is independent of the environment (Fawcett, 1984). However, as Bender (2018) argues, nurses must navigate relational patterns to determine what care a patient needs in the moment within the environment. Likewise, when considering ‘where the patient is’a nurse must consider the individual’s health-beliefs within the social and community context or environment that surrounds them.
If a patient presents with an open wound requiring cleansing, closing and bandaging, a nurse will employ nursing knowledge within the therapeutic nurse-patient relationship to guide the patient through the process and teach them how to complete dressing changes independently at home. However, if the patient’s environment is not considered, barriers to the patient engaging in the health behaviour may be missed rendering the health teaching ineffective. To truly meet the patient’s needs, a nurse must consider the interconnectedness of the central metaparadigm concepts, modify their instructions accordingly and collaborate with the patient and other members of the healthcare team to achieve the best outcome for the patient (Bender, 2018).
Collaborating with compassion, empathy and understanding.
Collaborating with each patient with compassion, empathy and understanding, embodying the view espoused by Watson (2021) of “belief and respect in every single individual’s worth, regardless” is to be a nurse (8:59). This belief aligns with the Canadian Nursing Association (CNA) Code of Ethics for Registered Nurses guidelines for “promoting justice”, specifically nurses’ responsibility to provide care to all persons without discrimination, “judgement, labelling or stigmatization” (2017, p. 15). By recognizing the interconnectedness of each component of the metaparadigm, the nurse can understand the person-health-environment milieu and thus provide an opportunity for the person’s health needs and potential to be met (Bender, 2018; CNA, 2006). Compassion, empathy and understanding are essential to maintaining the dignity of persons during care and facilitate the development of the nurse-patient relationship within the healthcare environment.
A vocal advocate.
Within a care encounter the nurse-patient relationship is essential to identify the concerns, needs and desires of the patient (Senn, 2013). To be a nurse is to “be a vocal advocate” for our patients in the fast-paced, ever-changing, and complex healthcare system (vanDaalen-Smith, 2019). From a social justice perspective, advocacy is defined as “the act of supporting or recommending a cause or course of action, undertaken on behalf of persons or issues” (CNA, 2017). Nurses must be master communicators, translating healthcare jargon for patients and bringing the concerns of the patient to the rest of the healthcare team. Consideration of the interdependent and dynamic relationship of people to their health/environment circumstance is essential for the nurse advocate to determine which information is crucial to creating the most desirable health outcome for the patient (Bender, 2018).
Advocacy also “relates to the need to improve systems and societal structures to create greater equity and better health for all” (CNA, 2017, p. 5). Consider the example of the patient shared previously. Following a social justice framework, nurses may work within the care team to identify factors responsible for creating health inequity for this patient and advocate for policy change at an organizational or systems level (CNA, 2017). Thus, I consider a nurse as an advocate in two ways. First, as the connection between the patient’s needs and the healthcare setting and second as an advocate for change when inequities are identified within systems at an organizational, societal or community level.
Conclusion
My nursing ontology is founded within concepts of the nursing metaparadigm, the social justice view of nursing and the fundamental importance of the therapeutic relationship. To be a nurse is to combine assessments with knowledge in the context of the person having a health/environment experience, establish a collaborative nurse-patient relationship comprised of compassion, empathy and understanding, and act as a vocal advocate within the nurse-patient relationship and from a broader health equity lens (Bender, 2018; vanDaalen-Smith, 2019). While each of Fawcett’s metaparadigm domains are important for nursing, as Bender (2018) argues, it is the nurses’ interpretation of their connectedness that makes them so and it is through the interdependent, dynamic relations of person, environment, health and nursing that my ontological stance is realized.
References
Bender, M. (2018). Reconceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(e12243). http://doi.org/10.1111/nin.12243
Canadian Nurses Association. (2017). Code of ethics for Registered Nurses: 2017 edition. https://cna.informz.ca/cna/data/images/Code_of_Ethics_2017_Edition_Secure_Interactive.pdf
Canadian Nurses Association. (2006). Social Justice: A means to an end, an end in itself. https://central.bac-lac.gc.ca/.item?id=social_justice_e&op=pdf&app=Library
Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: The Journal of Nursing Scholarship, 16(3), 84-87. https://doi.org/10.1111/j.1547-5069.1984.tb01393.x
Senn, J.F. (2013). Peplau’s theory of interpersonal relations: Application in emergency and rural nursing. Nursing Science Quarterly, 26(1), 31-35. https://doi.org/10.1177/0894318412466744
Thorne, S., Canam., C., Dahinten, S., Hall, W., Henderson, A., Kirkham, S.R. (1998). Nursing’s metaparadigm concepts: Disimpacting the debates. Journal of Advanced Nursing, 27(6), 1257-1268. https://doi.org/10.1046/j.1365-2648.1998.00623.x
vanDaalen-Smith, C. (2019). The Necessity of social justice nursing. Witness: The Canadian Journal of Critical Nursing Discourse, 1(2), 1. https://doi.org/10.25071/2291-5796.60
Watson, C. (2021, October). What nurses can teach us [Video]. TED Conferences. https://www.ted.com/talks/christie_watson_what_nurses_can_teach_us?language=en
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