Running head: A PERSONAL REFLECTION

A Personal Reflection of Nursing

Valrey Llewlaka
Ferris State University

A PERSONAL REFLECTION OF NURSING

Abstract
This paper discusses skills necessary for private-duty home care nursing from one nurses point
of view. These abilities include knowledge, psychomotor skills and attitudes necessary to
complete the nursing services provided to clients. Select benefits and potential barriers to
professional nursing are explored.
A personal nursing philosophy can be important in directing a nurses actions. This nurses
personal philosophy is offered, along with examples of how that personal philosophy fits into
well-established nursing philosophies. The concepts of person, health, and environment are
explored from this nurses point of view in order to offer further insight into the nurses personal
nursing philosophy. This process can be seen to influence how this nurse understands the
significance of becoming a professional Registered Nurse (RN).
Certain knowledge, skills, and attitudes are seen as important to advancing nursing as a
profession. The American Nurses Association (ANA, 2010) provides standards to assist the
professional nurse in achieving the goal of universal acceptance of nursing as a profession.

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Reflection of Home Care Nursing

The purpose of this paper is to describe the current level of practice for this Registered
Nurse working in the private-duty home care field. This paper is an assignment that is geared
toward defining the nurses view of her current practice. This view is to serve as a baseline for
ongoing reflection and practice improvement while progressing through the nursing
baccalaureate degree program at Ferris State University (Singleterry & Eisen, 2013). One way
that a nurse may use ongoing reflection is through the use of a personal philosophy. Developing
a statement about ones views on his or her chosen profession can be seen to help the nurse
advance into the role of professional nurse. One way that this can be accomplished is by
following the American Nurses Association standards of practice and of professional
performance (ANA, 2010).
Current Practice
The Michigan Nurses Association (MNA, 2010) defines nursing as the protection,
promotion, and optimization of health and abilities, prevention of illness and injury, alleviation
of suffering through the diagnosis and treatment of human response, and advocacy in the care of
individuals, families, communities, and populations (p. 8). One area of nursing, comprising the
focus of this paper, is home care nursing. Nursing care in the home of individuals with special
health care needs prevails on the MNA definition in a variety of ways. It takes specialized
knowledge, proficiency with assessment and treatment skills, as well as a professional attitude
(Singleterry & Eisen, 2013). The ideals characterized in the above definition can be further
explained by using these categories of knowledge, skill, and attitude as a means to provide
examples of how home care nursing is delivered. It is beyond the scope of this paper to include a
comprehensive review, therefore certain specific highlights will be addressed.

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Knowledge
Nursing requires the ability to think, as well as understand science and humanities
(American Nurses Association [ANA], 2010). Nursing includes education and understanding of
disease processes such as microcephaly, and cerebral palsy. These diagnoses are often
encountered by this author when caring for special needs pediatric patients. Knowing how to
care for these patients when they experience a seizure, how to prevent aspiration when
administering an enteral feeding, and the proper technique for tracheal suction are examples of
home care nursing provided by this nurse. The ability to understand how a medication affects
the body, what side effects are common, and how to calculate the correct dosage are critical
aspects of nursing knowledge. This nurse has had occasion to discover that medications being
dispensed by milliliter required further clarification as to the appropriate milligram dosage.
The Nursing Process can be seen as a clinical tool which provides opportunity for the
nurse to gather knowledge. When gaps in the knowledge of a patient diagnosis have been
identified, this nurse has utilized the ability to access professional nursing resources to better
understand the patient condition and provide competent care. Following the steps of the nursing
process aids this nurse in adhering to established professional standards (ANA, 2010) that
distinguish nursing as unique. The nursing process steps are as follows: assessment ,
diagnosis , identifying outcomes , planning , implementation , and evaluation (White
& O'Sullivan, 2012, p. 12).
Skills
Home care nursing requires that this nurse perform a number of specific psychomotor
skills (ANA, 2010). These technical assessment and treatment skills are necessary aspects for
the physical care, comfort, and safety of the patient. For ease of presentation, these are grouped

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into categories that are not intended to be all inclusive, but rather a representation of the most
common skills utilized.
The first, and likely most important skill, is the ability to perform a comprehensive
assessment (ANA, 2010). This includes a physical assessment of the patient. Observation of the
environment and patient position in that environment are two aspects of a general impression
Horeczko, Enriquez, McGrath, Gausche-Hill, & Lewis, 2013, p. 183), which can contribute to
the nurses overall assessment. Additionally, the skills necessary to obtain and record vital signs
(respiratory rate, heart rate, temperature, oxygen saturation, and blood pressure) can be
invaluable when monitoring a patient over time for changes in condition. Heart and lung sounds
can assist the nurse in determining the respiratory and circulatory status of the patient.
Review of patient charts for care orders or changes initiated by physicians, therapists, or
other health care providers assures that the nurse is following a prescribed plan of care (ANA,
2010). Reviewing the most recent care records can allow the nurse to monitor trends and
changes in the patient condition occurring in previous shifts. The nurse can use this information
to determine patient care issues that should be addressed during the nurses duty shift. This
information can contribute to the nurse forming or revising a nursing diagnosis (Ackley &
Ladwig, 2011).
The ANA (2010) indicates that a nurse may deliver safe patient care through
administration of medications, feedings, and small volume nebulizer treatments. Patients may
also require support with activities of daily living (ADLs) such as bathing, and shaving.
Patients who are unable to independently attend to ADLs may need assistance with these
activities (Ackley & Ladwig, 2011).

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Communicating professionally and effectively with patient caregivers, physicians, and

pharmacies, with regard to the needs of the patient, aids in collaborative care (Ackley & Ladwig,
2011, p. 9). These communications may be related to the status of supplies and/or medications
as well as information about the patient condition as it may deteriorate or improve. Establishing
a professional relationship with other nurses and caregivers is vital to the continuity of safe and
effective care (ANA, 2010). Accurate documentation is a form of communication that becomes
as permanent record of the assessment and care performed for the patient while ensur[ing]
continuity of care (Ackley & Ladwig, 2011, p. 9).
Attitude
In The right attitude, Dean (2012) uses a quote that good customer service is about
having an experience that is personalized (p. 16). The article indicates that poor staff attitudes
were identified as a key concern (Dean, 2012, p. 16). Because beliefs affect behavior
(Black, 2011), a nurse who takes the time to examine her own attitudes and personal bias may
improve her communication skills and long-term personal job satisfaction. How a home care
nurse interacts with the patient, family, and other members of the health care team makes a
difference in overall patient care. This nurse takes the initiative to listen closely to the family
and caregivers of a special needs child who cannot speak for himself or herself. Careful
attention to the patient may also reveal body movements or facial expressions or vocalizations
that can be clues to how the patient is responding to care or how the physical condition of the
patient may be changing (ANA, 2010).
The Registered Nurse in a home care environment faces unique challenges. Home care
nursing requires knowledge related to specific disease and injury processes, as well as
medication administration and the steps of performing the nursing process. Being a home care

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nurse calls for technical assessment and treatment skills such as listening to lung and heart
sounds, observing the condition of the skin, and positioning the patient to prevent injury. As
with any customer service position, attitude counts. How a home care nurse interacts with the
patient, family, and other members of the health care team makes a difference in overall patient
care.
Philosophy
Nursing philosophies can be collective or individual (Black, 2011). The author states that
a collective nursing philosophy is common for hospitals and schools [for guiding nursing
practice] in that setting (Black, 2011, p. 262). An individual nursing philosophy is a
statement of beliefs (Black, 2011, p. 262) made by the nurse that expresses his or her values. It
can be beneficial for a nurse to consider what he or she holds to be the essence of his or her
belief of nursing. Blacks (2011) statement that beliefs affect behavior (p. 257) emphasizes
the importance of a nurse defining his or her values. Once identified, these principles assist the
nurse in understanding his or her own thinking and conduct (Black, 2011, p. 262). A welldefined nursing philosophy can be seen as paramount to the delivery of excellent nursing care.
Black (2011) states that writing a philosophy can be accomplished by asking What is nursing?
and Why do I practice nursing the way I do? (p. 263). The personal nursing philosophy of this
nurse is addressed, as well as this nurses interpretation of the metaparadigm concepts of person,
health, and environment.
This nurse has identified her personal philosophy:
Nursing is a choice to care for the patient experiencing illness or injury. This
caring is not just performing the tasks necessary to tend to a diagnosis. It is about
caring for the patient, for the patients family, and for the community the patient

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lives in. Caring can be viewed to be accomplished when a nurse has a vested
interest in assisting the patient to achieve or maintain their best level of health.
To reach the highest professional level of nursing requires that the nurse stay
aware of the latest evidence-based research techniques. Evidence-based practice
can indicate skills and the associated knowledge that can be practiced within the
nursing scope of practice. Active membership in professional organizations is
important to stay informed about current issues. Professional organizations allow
for forming networks. Networks of peers provide access to additional viewpoints
and feedback. Peer relationships may contribute to a nurses feelings of being a
community member in the nursing culture. Along with membership in
organizations that offer information on advancements, nurses may care for the
self. Self-care is an important in order to maintain a professional perspective.
The patient is not an isolated individual. The patient is connected to others
through culture, and through family and community connections. The nurse has
an obligation to assist the patient in maintaining these connections. Reviewing
how the patient views his or her personal values and beliefs can be important to
determine in order to address or enhance an environment of caring (Black, 2011).
The nurse who identifies and makes efforts to maintain her own health has greater
insight into patient barriers. Maintaining personal physical, emotional, and
spiritual health can be seen to enhance the nurses ability to care for others with
fewer stressors.
This personal philosophy is found to coincide with the nursing theories proposed by
Watson and Leininger. Watsons philosophy emphasized the caring aspects of nursing (Black,

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2011, p. 271). This nurses personal philosophy identifies caring as a choice. Caring is also
viewed as encompassing the patient, the patients family and the community in this nurses
philosophy. Leiningers Theory of Culture Care Diversity and Universality (Black, 2011, p.
277) is also apparent in the philosophy of this nurse. Leiningers theory addresses the patient in
the context of their cultures (Black, 2011, p. 277). A patients culture includes family and
community, addressed by this nurse as identifying a patient as not being isolated. Personal
philosophies based in defined theories are not isolated from the concepts of person, health and
environment. This nurse will make an effort to define these concepts so as to increase the
readers understanding of this nurses personal philosophy of nursing.
Person
This nurse sees the patient as an individual with connections to their environment.
Patients are unique and adaptable [and can be seen as] motivated by needs (Black, 2011, p.
240). This nurse sees those needs as including those identified in Maslows hierarchy of
needs. Every individual requires food, water, and air to survive. When physiological needs are
met, the attention of an individual will begin to move to needs that appear higher on Maslows
hierarchy (Black, 2011, p. 243). At every stage a nurse is able to offer support, whether through
physical care, emotional support, or offering referrals to specialized care or support.
Health
Health is difficult to define according to Black (2011, p. 250). This nurse offers the
personal definition of health as being a process. This process should be patient directed and
driven by the patients wellness goals for himself or herself. A holistic focus is the goal of this
nurse identified by Black as being the relationship of all the parts that make up a whole person

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(p. 250). This nurse believes that even if it is difficult to accomplish a completely holistic view,
the effort and intent should be foremost in nursing care.
Environment
Environment is considered to be all the circumstances, influences, and conditions that
surround and affect individuals, families, and groups (Black, 2011, p. 245). This nurse finds the
term environment as difficult to define as the concepts of person and health. A definition
offered by this nurse for the concept of environment is the space that a patient occupies. This
space includes family, culture, social systems and community (Black, 2011). The environment
of family comprises all individuals that the patient defines as family. Cultures are based on
attitudes, beliefs, and behaviors of social groups (Black, 2011, p. 246) that are passed from
generation to generation (Black, 2011). Social environments are those that support individuals
and communities, such as schools, churches, [and] civic groups (Black, 2011, p. 247). Each
of these identified environments can be seen to have some influence on a patient, who is
considered an open system (Black, 2011, p. 241). Open systems are defined as all living
systems exchang[ing] information with other systems (Black, 2011, p. 241). The
environments given as examples are also seen as open systems by Blacks (2011) definition that
they promote the exchange of matter, energy, and information with other systems (Black,
2011, p. 241). Systems that exchange information function collaboratively (Black, 2011, p.
241) thus creating influence on one another.
Nursing Theory
Progress through the FSU BSN program includes reviewing various nursing models and
theories. One of the models, called the Self-Care Model, was developed by Dorothea Orem.
Orem based her model on the assumption that patients would rather be in control of their lives

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(Black, 2011). The model explains how nurses work to assist patients with the self-care they are
not able to provide for themselves. Orems model is one that this nurse can relate to and utilize
when delivering specialized assistance (Holmes, Koch, Maliskey, Rosendale, & Wilson, 2013)
to patients.
Transition
Transitioning from RN to BSN has become a process of exploring and defining personal
understanding of the role of professional nurse. This nurse had previously held the opinion that
all RNs are the same, with a certain baseline knowledge and skill level. One semester of
attending FSU has changed that perspective.
A professional nurse has a list to guide him or her through the process of developing a
personal position. These positions may align with and be enhanced by professional standards.
Defining personal beliefs becomes a vital part of nursing when it is understood that attitudes and
actions are based on beliefs (Black, 2011). The ANA has put forth the standards as evidence of
the standard of care (ANA, 2010) for nursing practice. Included are ten Standards of
Professional Performance (ANA, 2010).
Standards
Standard 7, ethics; this standard addresses the role of the nurse as advocate while
maintaining confidentiality and protecting patient autonomy. It is important to respect the
patient, along with his or her loved ones, as the center of the health care team (ANA, 2010).
Taking action that is in the patients best interest by following evidence-based practice and
asking appropriate questions concerning safety are ways that nurses can meet this standard
(ANA, 2010).

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Standard 8, education; it may be said that nurses are told from the first class they attend
to become lifelong learners. This standard goes beyond simply maintaining knowledge to
seeking out new experiences and information. Gaining this education may be done formally or
informally (ANA, 2010).
Standard 9, evidence-based practice and research, this standard is intended for nurses to
discover and utilize the most proven methods in delivering health care. Nurses can promote the
profession by asking questions and taking measures to contribute to research. These steps can be
seen as methods to improve the knowledge base of nursing (ANA, 2010).
Standard 10, quality of practice; nurses have a responsibility to not just perform nursing
tasks, but to assure that the measures they take are verified as effective. Nurses can assure this
standard by identifying daily problems and being involved in problem-solving them. Nurses can
further the professional role by taking the lead for quality assurance (ANA, 2010).
Standard 11, communication; this standard indicates the importance of clear, effective
communication with every health care worker and consumer. Health care workers include a
multidisciplinary team that may require the nurse to have additional knowledge and perspective
in order to communicate effectively. At times, communication may include conflict resolution
skill (ANA, 2010).
Standard 12, leadership; this standard involves the nurse becoming a mentor, serving as
an example, and joining professional organizations (ANA, 2010. Nurses can use their
communication and leadership skills to promote nursing as a profession. In addition, nurses may
have the opportunity to play leadership roles in arenas where decision-making bodies (ANA,
2010) are influenced.

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Standard 13, collaboration; collaboration involves team work, communication, and

cooperation. Team work is done with all members of the health care team, including the patient
and the patients representatives. Collaboration is aimed at improving patient outcomes (ANA,
2010).
Standard 14, professional practice evaluation; this standard reflects the importance of
caring for patients across the lifespan while utilizing cultural competence. It is important for the
nurse to obtain feedback and use that information to perform self-evaluation (ANA, 2010).
The evaluation should be done with professional standards as the baseline from which to
measure the nurses skill and knowledge competence. This evaluation should be performed with
consideration for culture, age, and lifespan of clients (ANA, 2010).
Standard 15, resource utilization; resources can include material items, personnel, and
time. The competent nurse will consider the resources available when making decisions for how
these resources will be used. Resources may be best applied safely if evidence-based practices
within defined legal and policy requirements are considered (ANA, 2010).
Standard 16, environmental health; environment can include light, sound, and odors.
Community health is an aspect of environmental health, as is a patients home. Not only is the
immediate environment deliberated by the professional nurse, so is the wider global impact as
well as the safety of medical products (ANA, 2010).
While these standards have been presented to this nurse from the beginning of nursing
classes, they can be seen as increasingly important in the wider view of professional nursing.
Many of the standards presented include guidelines that are relevant to the advanced practice
nurse who takes on the leadership role of promoting the nursing profession. Each professional

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nurse should take the responsibility for being familiar with these standards and for integrating
them into his or her practice (ANA, 2010).
Knowledge
Black (2011) states that knowledge is specialized training in a body of knowledge
(p. 53). This nurse appreciates the above standards as representing a means of obtaining
understanding of that specialized knowledge. The task of explaining the personal process that
this nurse experiences, beyond that already presented, is beyond the scope of this paper.
Skills
Skills can be seen to range from technical knowledge and manipulation of equipment to
employing techniques for advancing the nursing profession. Understanding concepts related to
nursing can be seen as moving further into the role of a professional nurse. Concepts are
important guidelines for daily practice, and for shaping (Black, 2010) the view of new nurses.
Attitude
Nurses can contribute to a stronger professional image in the eyes of the public and other
members of the health care teams by using theory to project nursing as a scholarly academic
discipline (Black, 2010). It may be seen as an advantage to have participants who consistently
see its membership as professionals.
Reflect
This nurse finds much to reflect on regarding the information presented. When first
enrolled in nursing classes, this nurse viewed nursing as a job, with a good promise of continual
employment. On continuing to the RN level of nursing licensure, this nurse began to see that
there was much more to learn about nursing. Now the challenge is to obtain a deeper

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understanding of the broader aspects of nursing as a profession. Writing this paper has offered a
glimpse to this nurse of how that process will continue beyond the conclusion of this class.
Conclusion
Professional nurses have an important role to fill. The efforts of these nurses can be
thwarted by their own doing, even if unconsciously (Black, 2011, p. 257). It then becomes the
responsibility of the professional nurse to become aware of self limitations that have been
influenced by his or her own open system (Black, 2011, p. 241) exposures. One way to
accomplish the task is through thoughtful insight while answering the questions What is
nursing? and Why do I practice nursing the way I do? (Black, 2011, p. 263). This nurse has
found the process valuable in identifying personal views on nursing. It is the wish of this nurse
to continue the process of insightfulness in an effort to continue to advance the professionalism
of this nurse while improving the quality of care delivered to her patients.

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