Caring Dialogues/ Family Nurse Practitioner

Read: Chapter 3 & 4 – (Smith, Turkel & Wolf)

Also read the following articles attached here and included in the text:

• Creating a Caring Practice Environment Through Self-Renewal-1.pdf (Chapter 28)
• Love and Caring- Ethics of Face and Hand-1.pdf (Chapter 37)

BELOW IS MY NURSING SITUATION TO ANSWER TO QUESTION #4

Nursing Situation

Caring can be related to everything we do in this world because we interact with living things every day that requires nurture (Mayeroff, 1971). As a bedside nurse, I can experience caring throughout my twelve-hour work shifts. Nursing is a profession that was built on caring. Patients rely on nurses to provide care in a manner that is pleasing to them. A caregiver, while providing supportive care can instill a sense of strength. As nurses, we have an essential role to inspire hope in our patients, which can help them to create a positive feeling.

Mrs. EN, a 51-year-old Hispanic female, arrived at the hospital with complaints of back pain and shortness of breath. Mrs. EN was admitted to the hospital with a diagnosis of respiratory distress and sent to the telemetry floor where I was assigned to be her nurse. I received Mrs. EN as a patient on her second day of admission.In report, I was told that her chest x-ray, done in the ER, showed a mass in her left lung. The next day Mrs. EN was sent to have more tests done. The day shift nurse informed me that earlier today the doctor gave Mrs. EN the terrible news that she had lung cancer.

I tried to prepare myself to care for Mrs. EN mentally and I couldn’t imagine how I would be dealing with such a devastating diagnosis. Upon entering Mrs. EN’s room, I could hear that she was speaking on the phone sobbing relentlessly. The shades were pulled down, television was off, and it was a very gloomy atmosphere. Mrs. EN composed herself and told the person on the phone that her nurse was here and she would call them back. I introduced myself and then approached her cautiously, as I did not know how fragile she was. I felt torn inside because I knew she had just received horrible news and probably didn’t want to be bothered, but I still had my duties as her nurse.

As difficult as it was, I proceeded to ask Mrs. EN the standard questions of how she felt if she had any pain or any concerns. She just sat there quietly with tears filling her eyes and gazed at me, no words exchanged, just watching in silence. Something about the silence and the sadness in her face touched my heart. I pulled up a chair and sat next to her bed.Now sitting at the same eye level, I took her hand into mine and said in a very calm voice, pretend for one minute that I’m not your nurse, but that I am a friend and we can talk. The tears that she tried so desperately to hold back came streaming down her face. I assured her she should not feel embarrassed, that it was okay to cry.

As her tears flowed freely, she stated, I could not believe I have cancer. I never thought anything like this could happen to me. She began to tell me that she moved from Nicaragua 5 years ago, and her husband and two children are in Nicaragua. She said the possibility of not being able to send for them was unbearable. She couldn’t imagine leaving her kids without a mother or her husband without a wife. She lives alone, and most of her family is in Nicaragua. She said, “the whole situation just seemed so unfair.” I stayed with her allowing her to express all her concerns and fears.

Caring Concepts

I choose Roaches 6 c’s of caring with an emphasis on compassion, competence, and confidence (Roach, 1992).During our conversation, she asked me if I attended church and believed in God.I responded to her questioned and I’ve asked her if she could share more information with me about her religious background. I showed compassion by listening, being sensitive and respectful to her spiritual belief (Roach, 1992). I demonstrated competence by using my nursing assessment skills to research her religious affiliation (Roach, 1992).

She said she had been talking to her Pastor on the phone when I entered the room. Mrs. EN confessed that although she was very fearful of her condition that she still had her faith in God. She said speaking to her Pastor just reinforced to her that God does not put any obstacles in your life that you cannot overcome. It was like she had a revelation and stated although she was terrified of what may happen she knows it was Gods will and that she had hope for the future.She said it is her hope that will give her the strength to live on and fight this cancer.

Mrs. EN thanked me for taking the time to listen to her. She said my genuine display of caring also gave her hope that there would be other medical professionals just like me to help her in the road to recovery I informed Mrs. EN that our interaction touched my heart as well and our conversation was very inspirational.Confidence was portrayed by establishing a professional and trusting relationship from a simple conversation. The essence of caring in this nursing situation is hope.

Ways of knowing

The Aesthetic knowing is required in the way providers (nurse practitioners) perceive the patient reality. As providers (Practitioners) we are not to judge. Empathy we must demonstrate empathy and offer hope to all patients including this particular patient. Empathy is an essential mode in coming to know the patients in the context of a unique particular. It is also cautioned that without empathy and consideration of the patient as a unique, integrated whole, nursing action may become a mechanical routine leading to dehumanized care (Barry, Gordon & King, 2015, pp.23).Caring allows providers to act as an advocate representing the patient, defending them and their relatives from dehumanization and suffering when they cannot do so themselves from such disease (Söderlund, 2013).

References

Barry C. D., Gordon, S. C., & King, B. M. (2015). Nursing case studies in caring:Across the practice spectrum.New York: Springer.

Mayeroff, M. (1971). On caring.NY: Harper.

Roach, S. (1992). Caring: The human mode of being (revised ed.) Ottawa, CA: Canadian Hospital Association Press.

Söderlund, M. (2013). A Concept of Caring Aiming at Health. International Journal for Human Caring.

BELOW ARE MY CLASSMATES POSTING. PLEASE RESPONSE TO THEIR POST. THIS IS THE REQUIREMENTS TO RESPONSE TO THEM.

EVALUATION: You will be evaluated for your developing understandings, reflections, integration, discussion of critical analyses, and creative inquiry in group discussions. You will also be evaluated for your contribution and responses to dialogue initiated by your colleagues. Two posts for each Module of study are required. One with your answers to the questions posed and citations to your learning resource and one in response to a classmate’s response. Use at least one reference for discussion, none required for responses. Limit direct quotes in discussion to no more than 2 sentences. No direct quotes in response.

PART 2 – STUDENT POSTINGS

Meliza Commond (STUDENT POST)

12:08amSep 13 at 12:08am

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Caring as the ethical foundation of nursing means that nursing is built upon and derived from caring. Without the essence of caring, how can one be successful as a nurse despite the facts that there may be factors that impede or differentiate caring from one individuals from another; overall the true foundation of nursing is caring. The ANA code for nurses guides our moral and ethical choices because it provides us with a guideline and direction for us as nurses to be informed of and practice by. The ANA code is not a job description but addresses the sympathetic side of nursing or the unspoken side which is not commonly addressed such as health as a universal right, duties to self, conflict of interests (ANA, 2015). The code fits into caring as the ethical foundation of nursing because is broad and addresses many subjects such as trust, respecting colleagues, responsibility, judgement, decision-making and much more, thus the code doesn’t only apply to our relationship with patients but physicians, colleagues, external individuals, the interdisciplinary team and much more.

I interpret my nursing situation with this ethical framework because as nurses sometimes we want to give 100% of ourselves in caring for our patients however we have many hindrances that impede us such as personal factors, social factors, unexpected events in the workplace, education and much more. However, it is important that we are open to change within ourselves so that we can adequately provide care to individuals of different lifespans and overall backgrounds.

Transcultural nursing has great influence on ethical knowing/practice because as nurses we don’t get to choose who we care for, we come across many different cultures and it is imperative that we have some knowledge of each culture to adequately care for them. Each culture has different customs, acceptances, traditions and dynamics; nonetheless as nurses we have our own. We must assess our patients initially to know how to care for them while still respecting their cultural implications and giving them their autonomy. Our obligation with regards to individuals with another culture is respecting their ways of thinking, living, customs and dynamics. It is not our job to alter their ways or to make them adapt however we must respect and still provide care to these patients while upholding the code of ethics.

Cultural competence is about being knowledgeable enough to know the do’s and don’ts with regards to certain cultures. Developing a sense of cultural competency is vital for all the nurses because it will help build rapport with the patient and family, assess and implement interventions that can meet the needs of the patient offending them. In addition, nurses should get informed of different cultural backgrounds especially if you predominantly serve a constant population to provide adequate care. This can also be applied to the concept of nongeneralizable caring as stated by (Smith, 2013) which means caring in different cultures are interpreted differently.

Overall, as a nurse you may notice many differences however there will be many similarities as well or common grounds that you get to share with your patient. We must learn to accept and embrace each other despite the cultural differences that we may have. In a study that observed cultural awareness & sensitivity in nurses overseas, the author stated “it is important to note that not all nurses will have the same moral and ethical outlook as each other. Moral codes are culturally determined; people see the world in many different ways”, (Norton, Marks 2014).

There is a big difference between being culturally competent and culturally sensitive. Cultural competence is the act of being knowledgeable or informed of different cultural backgrounds. However, cultural sensitivity is the act of respecting the culture without labeling it as right or wrong. For instance, to be a cultural sensitive nurse, you’ll have to accept that your patient who is Jehovah witness with a hemoglobin of 5.5 refuses blood but will take iron infusions. Whereas culturally competence requires you to be knowledgeable, you must be able to advocate for your Jewish patient concerning dietary needs.

References

oSmith, M. C., Turkel, M. C., & Wolf, Z. R. (2013). Caring in nursing classics: An essential resource. New York: Springer.

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Desonta Holder (RESPOND TO MELIZA)

10:51pmSep 13 at 10:51pm

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Hi Meliza,

I agree that developing cultural competence can help build rapport. I recently had a patient who was very angry and irritable because she had been Baker Acted. She spoke with an accent and when I asked where she was from she tersely answered, “Czechoslovakia.” When I told her Czechoslovakia no longer existed, she smiled and said she was impressed that I knew that. She then became less irritable and we built rapport while discussing how Czechoslovakia split and became the Czech republic and Slovakia.

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Desonta Holder (STUDENT POST)

10:17pmSep 13 at 10:17pm

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Your readings and power point lectures focused on caring as the ethical foundation of nursing. What does this mean?

According to Roach (1998), ethics is a system of moral inquiry into right and wrong, but in the context of caring, ethics is about behavior and the moral call to be human. (p. 32). This means the nurse who cares must embrace beneficence, non-maleficence, autonomy, veracity, and fidelity. These principles should be considered in all facets nursing — patient interactions, decision making, advocacy. In the absence of caring, the nursing profession suffers. We’ve all heard about nurses who purposefully kill their patients — Charles Edmund Cullen, Beverley Allitt, Elizabeth Wettlaufer. We also know that some nurses falsify vital signs to avoid taking action. Their lack of caring speaks volumes.

How does the ANA Code for Nurses guide our moral and ethical choices?

The American Nurses Association Code of Ethics for Nurses with Interpretative Statements is a reminder that the nurse is morally bound to care for the patient while always keeping the patient’s best interest in mind. It’s a non-negotiable contract for anyone who enters the nursing profession. Following are a few specific examples of how the code guides our choices:

oProvision 5 focuses on the nurse’s responsibility to promote heath and preserve character (ANA, 2015, p. 35.). Just as the nurse encourages the patient to eat right, exercise, avoid smoking, and get enough sleep, she or he should also heed that advice. It would be immoral to show up for work so fatigued that you could barely keep your eyes open. Nurses who do show up for work fatigued may not be cognitively impaired, but many have reported difficulty in both self-care and patient care (Brunt, 2017). As Turkel and Ray (1994) point out, to awaken the caring spirit within us, we must acknowledge the power of caring for ourselves, otherwise we’ll face burnout and compassion fatigue (p. 251).

How does the Code fit into Caring as the ethical foundation of nursing?

Caring is a moral commitment to become involved in patient care. It requires that we connect with the patient, and as we connect we develop a heightened awareness for the patient’s needs – spoken needs and unspoken needs. Through this deep connection we are often faced with ethical dilemmas and we can turn to the ANA Code of Ethics. Provision 2 states that our primary commitment is to the patient, and when conflicts arise they must be handled in ways that ensure patient safety while promoting the patient’s best interest (ANA, 2015, p. 5).

Ethical knowing, per Boykin and Schoenhofer (2001), focuses on what “ought to be” (p. 42). We know that the patient addicted to opiates ought to be given higher doses of pain medication, and we know that the patient who is dependent on alcohol ought to be given Librium or Lorazepam, and since we are committed to the patient we should care enough to confront the resistant physician.

How do you interpret your nursing situation within this ethical framework?

My commitment was to a patient on the psychiatric unit who had signs and symptoms of a urinary tract infection but kept forgetting to provide a urine sample for a urinalysis. Although other nurses avoided him because he was sexually inappropriate, I approached him with the same compassion and respect I approach other patients, as Provision 1 of the Code demands (ANA, 2015, p. 1). As we built rapport, I understood his inappropriate actions, his vulnerabilities, and his needs. Through ethical knowing, I was aware that he ought to be reminded to provide a urine sample. Documenting “patient refuses” would have been unethical and uncaring. After being given multiple reminders, the patient did provide a urine sample, the UTI was confirmed, and he received the required treatment.

How does transcultural nursing influence ethical knowing/practice?

Cultural differences are prevalent in healthcare settings. Often when patients have different goals or care proposals they are considered non-compliant unless the nurse really makes an effort to understand conflicts in ethical principles and values (Ray, 1994, p. 254). The nurse with knowledge of transcultural nursing can improve care for culturally diverse patients through ethical knowing and cultural sensitivity. By understanding the beliefs and values of others and how they define their world and express feelings, the nurse can diplomatically question and understand ethical issues of others (Ray, 1994, p. 258).

What is our obligation with regard to persons from another culture?

In the 1950s nursing theorist Madeleine Leininger emphasized the need to comprehensively understand other cultures to provide holistic care, and today the world’s population has become more diverse (Leininger, 2006). Simply being the nurse for patients from different backgrounds does not make you culturally competent. We are obligated to provide language interpreters if necessary, and to listen and respect decisions and opinions that differ from our own.

Nurses also should be aware that healthcare disparities persist and patients from racial and ethnic minorities fare worse, even when income, insurance and access to care are taken into account (Martin, 2014, p. 2). By keeping this in mind, nurses can make a conscious effort to avoid implicit bias.

Is cultural competence about discovering how different and yet how alike we all are?

Cultural competence extends beyond discovering our differences and likenesses. In nursing, it involves the “ability to provide individualized culturally sensitive patient care with a respect and an openness to the patient’s social and cultural background” (Min Hyun, Won-Oak, & YeoJin, 2018, p. 1). For example, many patients of Eastern Asian descent do not like to be generalized with other Asian cultures; some religions don’t permit cross-gender contact; and it would be inappropriate to explain that death is imminent to an Arab Muslim’s family (Busher Betancourt, 2015, p.4).

Is there a difference between being culturally competent and culturally sensitive?

Yes, there is a difference. Being culturally competent involves knowing. Being culturally sensitive involves doing. The culturally competent nurse who knows that Eastern Asian patients have a unique culture might continue to generalize their culture as Asian. The culturally sensitive nurse, however, would treat Eastern Asians according to their own standard of care. If we fail to act on cultural knowledge, we weaken the potential for positive outcomes, and this creates irresponsible caregivers (Busher Betancourt, 2015, p.5).

References

American Nurses Association. (2015). Code of ethics for nurses with interpretative statements. Silverspring, MD: American Nurses Association

Boykin, A., & Schoenhofer, S.O. (2001). Nursing as caring: A model for transforming practice. Sudbury, MA: Jones and Bartlett Publishers and National League for Nursing

Brunt, B. (2017). Too tired to function: Nurse fatigue. Ohio Nurses Review, 92(3), 6-9.

Busher Betancourt, D. A. (2015). Madeleine Leininger and the transcultural theory of nursing. The Downtown Review, 2(1), 1-7. Retrieved from http://engagedscholarship.csuohio.edu/tdr/vol2/iss…

Leininger, M. (Producer). (2006). Dr. Madeleine Leininger: Her life career [Video file]. Retrieved from http://www.madeleine-leininger.com/cc/video1.htm (Links to an external site.)Links to an external site.

Martin, M. (2014). Transcultural advocacy and policy in the workplace. Journal of Nursing in Professional Development, 30(1), 29-33.

Min Hyun, S., Won-Oak, O., & YeoJin, I. (2018). Factors affecting the cultural competence of visiting nurses for rural multicultural family support in South Korea. BMC Nursing, 17, 1-9. doi:10.1186/s12912-017-0269-4

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Ray, M. (1994). Transcultural nursing ethics: A framework and model for transcultural ethical analysis. Journal of Holistic Nursing, 12(3), 251-264.

Roach, M. S. (1998). Caring ontology: Ethics and the call of suffering. International Journal of Human Caring, 2(2), 30-34.

Turkel, M. C., & Ray, M.A. (2004). Creating a caring practice environment through self-renewal. Nursing Administration Quarterly, 28(4), 249-254.