Defining Care

Define "care" as it relates to everyday nursing practice.

The term care to the author has a holistic meaning.  Care should include three very important aspects:  physical, mental, and spiritual.  The author does not mean that the NP has to be everything for everyone but to have the knowledge to provide needed information to help assist a particular patient in any of the three areas of concern.  The term holism, as described in Hamric, takes on a broad meaning.  The NP is to develop an understanding of each patient individually and to recognize the each person and the vast dimensions of an individual (Hamric, p.126).  In doing so, the NP must take into consideration that the patient’s mind, body, and spirit are all intertwined into one dimension and not separately seen as individual aspects (Hamric, p.128). 

Discuss the role of experience and ethical comportment in caring practices.

The role of ethical care of the patient involves allowing the patient to make choices based on the patient’s belief system.  The patient should be allowed to make a decision involving the care and treatment of the patient’s disease and illness and management thereof (Hamric, p.129).  The APN should be supportive and intuitive to the patient’s decision regarding care and assist the patient, if the decision is not against the APN’s belief system.  For example, if a patient desires to end a pregnancy and the APN cannot agree with the patient’s decision, the APN can state this respectfully.  The author does not feel the APN should apologize but be professional and factual about the APN’s decision.  The ethical component of the APN’s and patient’s decision has to coincide for the decision to manifest into an interaction.  Neither the APN nor the patient should be forced to make a decision based on guilt or pressure. 

Differentiate among various narrative themes as defined by Benner.

Hamric defines many areas of care regarding ethical decision making and the choices made by the patient during an aspect of decision making.  One aspect involved in the decision making process is eliciting information.  The patient cannot make a decision on the patient’s care without knowledge. The patient needs to be informed of all aspects of care and what to expect during the treatment and procedure.  For example, a terminal patient with cancer should know what the effects of chemotherapy and radiation will entail in order to make a decision to have such treatments.  The NP does not need to paint a picture of absolute cure nor that will the treatment be easy for the patient.  The patient has the right to decline such treatment if the treatments will offer little hope of extending life or quality of life. 

Decisions made by the patient may have cultural influences and these influences should be taken into consideration.  In the Christian belief, the patient who has accepted Jesus Christ as Lord and has forgiveness of sins, believes the reward of going on to a better place, heaven, is a better choice than suffering for an extended period of time on earth.  This is just one example. There are other cultures who believe that giving in to death is defeat but in the Christian belief, death is victory in a relationship with the Lord Jesus Christ.  Jesus Christ, according to the Holy Bible defeated death in these scriptures:

Jesus Defeated Death

HEBREWS 2:14-15 Forasmuch then as the children are partakers of flesh and blood, he also himself likewise took part of the same; that through death he might destroy him that had the power of death, that is, the devil;
Vs.15 And deliver them who through fear of death were all their lifetime subject to bondage.
REVELATION 1:18 I am he that liveth, and was dead; and behold, I am alive for evermore, Amen; and have the keys of hell and death.

In the Christian belief the scriptures reflect victory:

2 CORINTHIANS 5:8 We are confident I say and willing rather to be absent from the body and to be present with the Lord.

Although the NP may be able to share with the patient the victory an individual has in Christ Jesus, the NP cannot force the patient to change their belief system or make decisions that the patient does not agree with.  This is sometimes tough for the NP with strong Christian beliefs.  However, the Bible states in James 1:5 “If any many lack wisdom let him (or her) ask of God who gives to all men liberally.”  This is what the author does on a daily basis.

Develop a narrative from your own practice, identifying which type of narrative it is, and analyze the nursing care you provided.

The author takes the narrative of “being open to experience, about turning around, being “upended” (Benner, et al., p.289).  This narrative implies that one “learns from one’s mistakes.”  Over the seventeen years the author has been in nursing that has definitely been true in my life.  The author has many “war stories” that I could share with others that would definitely help someone to not fall to the same error in judgment.  

One particular circumstance was when the author was a young novice nurse working in the ICU unit.  Back then, the physicians used Swan Ganz catheters for diagnostic purposes quite often and the nurses were responsible for obtaining those values two to three times per shift to determine the patient’s pulmonary wedge pressure and the volume return to the right side of the heart.  The author had a bag of normal saline just hanging at the bedside supposedly clamped and used for flush purposes but the bag of saline was connected into the patient’s swan ganz.  The author accidently left the roller clamp open and an entire bag of fluids; 1,000 milliliters went into the patient.  The patient went into pulmonary edema but thankfully did not die.  The cardiologist ordered Lasix and the patient diuresed and came out of this situation stable and unharmed.  The author remembers going to the cardiologist and crying and telling him what I did.  I was so upset.  This was a lesson that almost cost a patient’s life.  I thank God every day that I have not killed a patient with an error.  I am going to continue to pray and ask the heavenly Father for wisdom and guidance so I “do the patient no harm.” 

Healthcare is becoming more and more challenging.  There is tremendous pressure on the nurses, physicians, and practitioners to see more and more patients at a faster pace.  The author knows this from working in the emergency room and the pressure that administration applies to staff.  This is why the author insist on not only becoming knowledgeable in medical knowledge but in the Word of God.  The Bible states: 

Call to me and I will answer you and tell you great and unsearchable things you do not know (the Bible, New International Version, 1984).

Ask me and I will tell you remarkable secrets you do not know about things to come (the Bible, New Living Translation, 2007).

Call to me and I will answer you, and will tell you great and hidden things that you have not known (the Bible, English Standard Version, 2001).

Call to Me and I will answer you, and I will tell you great and mighty things, which you do not know (the Bible, New American Standard Version, 1995).  

The author’s plan is to never let go of the word of God and to rely on Him daily for knowledge, answers, wisdom, and assistance.  For it is “in Him I live and have my being” (Acts 17:28).

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