Nursing Knowledge Essays

Nursing Knowledge Essays Nursing Knowledge Essay Nursing Knowledge Essay Over the years, nursing has evolved not only as a profession but also a hands-on discipline. Nursing is a theory-based practice that evolves and grows continuously through research. Fawcett (1984) defined nursing’s metaparadigm as the overall overview of nursing which consists the concepts of person, environment, health and nursing. Nursing practice began to evolve in the early 18th century. I will be exploring the different major influences that have altered the practice of nursing to what it is today, namely the traditional role of women, feminism, religion, military, apprenticeship, technology and medicine. In the 19th century, the role of women was traditionally one of a homemaker. She was responsible for the care of the family and managed all aspects of their household. Women’s role as a domestic specialist has many similarities with the nurses’ roles. According to Hughes’ (1990), the ideology of domesticity rationalised nursing as a legitimate, if temporary, occupation for women. Nurses had difficulty identifying themselves as professionals due to the perception of the society of their nursing roles. As a socially defined duty of women, caring for others was not seen by society as necessitating the specialised expertise that typified the work of a professional† (Hughes, 1990). This stressed the society’s perception that nursing is a women’s work by society. Over the years, this idea has changed as the roles of women in society became more important and the role of nurses became more defined. While it is still largely dominated by women we have seen an increasing trend of male nurses joining the nursing profession, not only in Singapore but also worldwide. In reference to a Sunday Times article by Nur Dianah Suhaimi in 2009, she mentioned that out of the 18,400 active nurses in Singapore, 7. 5% are male. There has also been an increase of male nurses in the profession over the years. Statistics showed that there were 998 male nurses active in the nursing workforce in 2001 and 1,363 in 2007 (Singapore Nursing Board [SNB], 2008). More male students are also enrolling themselves in the nursing programmes offered by different institutions in Singapore, namely Nanyang Polytechnic, Ngee Ann Polytechnic and National University of Singapore (Suhaimi, 2009). In an excerpt of an interview with the director of the School of Health Sciences in Ngee Ann Polytechnic, one of the institutions that offers the diploma in nursing studies, she mentions how Singaporean parents are less hesitant about their sons taking up nursing (Phang, 2009). â€Å"Australia and the United Kingdom claim a 10 percent male nursing workforce, while recent statistics place the male nurse workforce in the United States at 6 percent, up from just 2. 7 percent in 1980† (University of Pittsburgh, n. d. ). In my opinion, this is a positive change as men become more willing to take up the challenges of nursing. This change also further reiterates the changing view of nursing as a stereotypical female profession. Male nurses play a vital role in the profession. Besides having the skills and knowledge of nursing, their masculinity is an added incentive in restraining violent patients and assisting heavier patients in their ambulation. The change in view and statistics also reflect the change ideology that nurses no longer act as handmaidens and instead as an allied professional in healthcare. As nursing has been perceived as a female dominated profession, feminism in the profession is inevitable. According to Bunting Campbell (1990), feminism has been defined â€Å"as a world view that values women and that confronts systematic injustices based on gender. † Feminism began back in the late 1300s with Christine de Pisan being the first feminist who wrote about the feminist theory that transformed modern thinking of women’s roles in society. There were different views of feminism such as enlightened liberals, cultural feminism and radical feminism. The feminists typically disagreed with each other as they had â€Å"different philosophic points of view† (Bunting, 1990). These views would then alter the perception of nursing. Problems between the act of nursing and the idea of feminism began to arise in the 1960s, during the second wave of the feminist movement. During this period, women faced the battle for access to education, the professions, and freedom from abuse and exploitation occurred (Sullivan, 2002). When nursing leaders were torn between feminism and professionalism, many chose professionalism instead as they had more dedication with the sanitary ideal and not to the feminist mission (Bunting, 1990). However, the connection between nursing and feminism should be minimal. â€Å"â€Å"Nursing can embrace the movement because equality benefits individuals, society, and, thus, the recipients of nurses care† (Sullivan, 2002). In my opinion, nurses face different, individual experience everyday. They identify themselves as nurses and comparing with other women workers. Whilst the feminist movement has indeed made a mark in nursing history by allowing nurses to be advocators of the women’s movement, equal rights should be handed to men to be involved and be a part of the nursing profession. In the 19th century, designs of the nursing uniforms were greatly influenced by the church, the military and the servant (Campbell et al. , 1999). According to Ellies and Hartley (2008), the nuns influenced early uniforms, which were starched white and covered from head to toe inclusive of a nursing cap. As such, this projected a â€Å"professional image for nursing, giving it status, respect and authority† (Ellies Hartley, 2008, p. 156). The white uniform â€Å"communicated an impression of confidence, competence, professionalism, authority, role identity, and accountability† (Ellis Hartley, 2008, p. 56). However, by the 1970s, a lot of changes were made to the uniform. One such example would be that hospitals no longer require the nursing cap. This aspect of the uniform was generally found impractical for nurses while carrying out their duties and also for infection control purposes. In the present day, it is observed that there are many changes made to the nursing uniform. Many institutions have incorporated the scrub suits as their uniform as they are found to be more comfortable and ease movements when performing tasks. For example, in Singapore, the nurses’ uniforms are easily identified by the general society despite its differing designs of the various hospitals. Emphasis has been stressed on the importance of donning the proper attire so as to project a professional image of nursing. In World War II, nurses were a part of the military and were appointed as officers. This gave them autonomy and also status in the military. Being in the military, a nurse officer has to be disciplined and adhere to uniform codes, follow rules, and respect the higher ranked officers. The military have a strong influence on nursing till the present day. For example, role calls are in place at the beginning of a shift so as to address issues in our workplace. As with most other organisations, there is a hierarchial system. The position in the hierarchy determines the power and respect one will have in the organisation. This will in turn teach nurses to be more disciplined, display more respect towards the individuals in the upper hierarchy and also towards each other. In the military, the senior officers will guide and hand down their knowledge to the junior officers. Similarly in nursing, an experienced staff will guide and teach junior nurses who have just joined the force, newly graduated nurses or nursing students. The experienced staff would then play a leadership role and an educator role. Also, it allows the new staff or nursing students to be exposed to the nursing environment and are able to practise the skills that they have learnt theoretically. Reading Benner’s (1982) article, I understood the methods of classifying nurses into â€Å"novice, advanced beginner, competent, proficient and expert† individuals. Benner listed out some examples of nurses in different stages of nursing practice to determine the most appropriate classification using a scientific model by Stuart and Hubert Dreyfus. Reading the article and reflecting on my current experience as a nurse, I believe that I am in between an advanced beginner and a competent nurse. Although I am no longer a novice, I encounter difficulties in keeping up with the different types of occurrences during work such as delivering the best nursing care to my patients with other things in mind. At times, I struggle with time management. I was given the preceptor role where I am responsible in guiding a newly graduated nurse. This taught me to prioritise my work and deal with time management. It provided me with the experience of having an educator role and the opportunity to teach. Experiential knowledge, as Benner identified, is widely observed in the nursing world. This group of nurses has the ability to diagnose a patient’s psychosis stage without any scientific means (Benner, 1982). Experience, in addition to formal education preparation, is required to develop this competency since it is impossible to learn ways of being and coping with an illness solely by concept or theorem† (Benner, 1982). With Benner’s classification of nurses in mind, nurses’ knowledge has changed with the advancement of technology in nursing. Over the years, technology has become an essential tool in every individual’s everyday life. With the introduction of tech nology, patient’s care and treatment is enhances while nurses need to acquire knowledge on the skills and keep up with it. In the 19th century, technology was mainly used to store patient medical records or to aid in the calculation of the patient’s hopitalisation bills. Presently, in Singapore, and I believe in many other countries, most of the hospitals have gone â€Å"paperless†. With the help of computers, nurses’ notes and patient’s medication record are now entered electronically through the various programmes designed specifically for nurses and nursing documentation. Technology in healthcare has its advantages and disadvantages. With computerized record, point-of care testing such as testing the patient’s blood glucose levels can be verified electronically and do not require a handwritten record. As the health systems are mostly integrated, healthcare providers all over the country can easily access the patient’s record allowing the continuity and consistency of care for the patient. Healthcare providers can maximize the availability of the hospital’s intranet to look up on information, policies or work procedures as and when they need to. This will help to keep nurses up to date on the current nursing practices or policies. Although there are advantages, there is also a downside. Confidentiality is an issue. Although all systems require an individual password access, there are risks of illegal hacking into the main system and these illegal intruders may have an access to the confidential records of various patients. Hence, a high level of security should be in place to protect these systems. The healthcare system in Singapore aims to be a â€Å"paperless† organization as they believe that the change would benefit the nurses by easing their workloads. However, in my opinion, it is an additional workload and a complex task for nurses to assess documentation through the programmes on the computer. The hospital has recently introduced these systems. However they have to consider the time required for the nurses in order for them to acquire the skills in order to carry them out competently. For example, in the current practice, when serving medications, we need to verify patient’s identifiers against a Personal Digital Assistant or PDA, which lists patient’s medical records and identification. For novice nurses who just learnt on how to use the PDA, they will have difficulty in the administration of medication to the individual patient as it may be time-consuming. As such, the completion of the nurses’ workload will be delayed, resulting in a further delay in the delivery of care to the patient. With the advancement in technology and the evolution of nursing, Evidence-Based Practice (EBP) has been continuously put into use in nursing research. Evidence-based nursing is drawn from the evidence-based medicine collaboration that is predicated on rules of evidence that value strictly controlled, data-based studies and research critique† (Winch, 2002). â€Å"EBP first began in medicine and is expanding to all of health care† (Ellies Hartley, 2008). As nursing is becoming increasingly scientific, it is no surprise that a comparison is drawn between the nursing and doctoral profession. Henderson (1981) highlighted how similar the nursing roles are in the nurs ing process when compared with the roles of the physicians. This further illustrates Henderson’s belief that the nursing process is leaning towards the science of nursing. With the development of EBP, it has somehow contradicted with Carper’s (1978) article. In Carper’s article, she identified the four patterns of knowing; empirics which refers to the science of nursing, esthetics which is the art of nursing, personal knowledge which is based on experience and ethics which is the component of moral knowledge in nursing. Porter (2010) argues that Carper’s patterns of knowing have been challenged by EBP. Porter (2010) also mentioned, â€Å"the new problem of EBP requires nurses to change the shape and patterns of knowing to respond to the challenge it represents. The challenge involves its threat to reduce nursing knowledge to a very narrow form of empirics. † The sources that were chosen for this essay cover a wide range of opinions and concepts. From the traditional role of women to feminism and to how nursing developed by religious and military influences, the authors have in many ways potrayed the various varying points of view that influences the nursing discipline. With the new advancements and changes in nursing practice, nurses should bear in mind that they should always deliver the best nursing care to their patients. Nurses need to constantly upgrade themselves in order to be kept up to date with the latest development and practice in nursing in line with the advancement of technology. References Benner, P. (1982). From novice to expert. American Journal of Nursing, March, p. 402 – 407. Bunting, S. , Campbell, J. C. (1990). Feminism and nursing: Historical Perspectives. Advances in Nursing Science, 12(4), p 11 – 24. Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 31(4), p 296 – 307. Doheny, M. O. , Cook, C. B. , Stopper, M. C. (1997). The Discipline of Nursing: An Introduction (4th ed. ). Stamford, Connecticut: Appleton Lange. Ellis, J. R. , Hartley, C. L. (2008). Nursing in Today’s World: Trends, Issues, Management (9th ed. ). USA: Lippincott Williams Wilkins. Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Journal of Nursing Scholarship, 16(3), p 77 – 87. Henderson, V. A. (1982). The nursing process – is the title right?. Journal of Advanced Nursing, 7, p 103 – 109. Hughes, L. (1990). Professionalizing domesticity: A synthesis of selected nursing historiography. Advances in Nursing Science, 12 (4), p 25 31. Lefebvre, M. (2003). Nursing uniforms: dead or alive?. Nursing News, 27(4). Porter, S. (2010). Fundamental patterns of knowing in nursing: The challenge of evidence-based practice. Advances in Nursing Science, 33 (1), p 3 – 14. Suhaimi, N. D. (2009, March 31). Who says nursing is for sissies? The Straits Times. Retrieved from siaone. com/News/Education/Story/A1Story20090330-132089. html Sullivan, E. J. (2002). Nursing and feminism: An uneasy alliance. Journal of Professional Nursing. 18 (4), p 183-184. University of Pittsburgh . (n. d). Nursing: Options and Opportunities [Brochure]. Pittsburgh, PA: Author. Winch, S. , Creedy, D. , Chaboyer, W. (2002). Governing nursing conduct: The rise of evidence-based practice, Nursing Inquiry, 9 (3), p 156 – 161. Zerwekh, J. , Claborn, J. (2006). Nursing Today: Transition and Trends (5th ed. ). St. Louis, Missouri: Saunders Elsevier.