For nurses to be truly effective in the 21st century, nurses must support expanded access to wellness promotion strategies, like having affordable and nutritious food in low-income community, more movement-friendly urban design, and expanded access to healthcare and health insurance for individuals in all locations, and in all demographic segments of America.
As nurses face increasingly cost-conscious environments, the ethical issues related to providing care for all will become even more manifest, and in promoting improved healthcare knowledge nurses must acknowledge the economic and political impact of decisions that are made outside of their immediate nursing environment.
The concept of ways of knowing, particularly aesthetic ways of knowing, is an important component of understanding why more experienced nurses seem to have additional advantages that new nurses, regardless of their technical qualifications, do not posses. I believe this is for two reasons: one, an older nurse has more hands-on and empirical knowledge based upon personal experience and practice. But this phenomenon is also due to the aesthetic or art-based elements of nursing, which encompasses nursing instincts about patient needs and what is troubling the patient. The ethical component or the striving of the nurse to become a morally sound professional is also a continual negotiation or struggle. Mentorship is thus a vital component of nursing education, to maximize the possibilities that new nurses have a wider range of experiences and practice-based knowledge to draw from.
The example of treating bed sores is interesting: on one hand, it is vital on an empirical level to turn a patient to reduce the chances of sores and infection.
But the nurse should also ask why the patient is not mobile — is physical therapy possible to help the patient become capable of moving him or herself? While not possible for all patients, the nurse should at least entertain the possibility, and not simply look at the patients needs in a technical fashion.
I agree that viewing patient care in a holistic fashion is required. Quite often, care deficits are linked to social and other life circumstances of the patients that cannot be treated purely through medical care. To look only at nursing from a physical or empirical point-of-view frequently results in simply treating the symptoms, rather than the larger cause of the patients lack of wellness.
Heath, Helen. (1998). Reflection and patterns of knowing in nursing. Journal of Advanced
Nursing, 27: 1054-1059. Retrieved February 4, 2011 at http://www.uic.edu/classes/mhpe/mhpe494dcme/Heath-reflection%20&%20knowing%20in%20Nursing.pdf
Van Sell, S.L. (2002). Nursing: Receding and evolving paradigms (editorial). ICUs and Nursing
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