Interconnecction

The Interconnection The Canadian nursing profession is regulated by legislature and guided by nursing theories. College of Nurses of Ontario (CNO) and Canadian Nurses Association (CNA) are established to promote good practice, prevent poor practice and intervene when unacceptable practice occurs (CAN, 2008). The Registered Nurses' Association of Ontario (RNAO) also strives to influence and promote healthy public policy (RNAO, 2006). In this paper I will illustrate the interconnection of nursing regulatory documents and nursing theories. As examples, I will use such values as client well-being, client choice and trusting client-nurse relationships that are central for both human science nursing theories (NSNT) and regulatory documents. I will analyze similarities and contrasts based on three human science nursing theories: Parse’s theory of human becoming, Watson’s theory of human caring, and Newman’s theory of health as expanded consciousness. In addition, I will suggest how the gaps in reflection of these three points in HSNT and legislature and professional standards can be filled. Client Well-Being Client well-being, or health, is reflected and illuminated in all HSNT as a central value of nursing practice. Parse’s human becoming theory views health as a personal commitment, a process of becoming as experienced and described by the person. In this worldview, a goal and a purpose of nursing is quality of life from the person’s perspective (Parse, 1996). Newman's Theory of Health as Expanding Consciousness perceives well-being as the expansion of consciousness that encompasses conditions known as disease as well as states where disease is not present (Parker, p. 219). Watson’s Theory of Human Caring defines health as harmony of mind-body-soul human dimensions. Conscious or subconscious disharmony leads to illness and disease. Watson envisions nursing role in restoring the inner harmony of a patient (Parker, p. 299) or helping persons gain a higher degree of harmony” (Watson in Falk-Rafael, 2000, para 9). Similarly, the well-being, or health is given the highest priority in the documents. CNO recognizes client well-being as a primary value. Well-being as defined by CNO, is a client’s optimal function that can be attained, maintained or regained by promoting the client’s health through assessing, providing care for and treating the client’s health conditions. Consequently, the goal and purpose of nursing are promoting client well-being that means facilitating the client’s health and welfare, and preventing or removing harm (CNO, 2005). In congruence with CNO, CNA defines health and well-being as the most important concepts where nursing mission is providing care directed toward the health and well being of the person, family or community (CNA, 2008). CNA Code of Ethic outlines that nurses work with people to enable them to attain their highest possible level of health and well-being. In addition, RNAO defines health as a resource for everyday living and health-care a universal human right with nursing as a vital, significant and critical contributor to health (RNAO, 2006). Positions of both, CNO and CNA do not fit with HSNT. One of he main dichotomy is the angle from which persons are viewed in respect of their well-being. The HSNT belief system radically differs from nursing’s natural science tradition that are reflected in the documents. From HSNT perspective, the persons are experts of their lived experience and authors of their situations, responsible for their own choices in active participation and cocreation of their health. The nurses, accordingly, bear witness and are actively present with persons in processes of living value priorities, maintaining or restoring inner harmony, and living through periods of disharmony. On the opposite, in the documents persons are represented as clients, or objects that are being assessed, treated and healed by nurses. Position of RNAO is more aligned with HSNT. RNAO adopted new vision of nursing practice, called humanistic approach. It guides nurses to get to know client and client’s perspective through continuous dialogue. This allows the nurse to view the client as a whole, and recognize the interconnectedness and interrelationship between the client and the environment. This approach to care delivery focuses on restoring health, harmony and enhanced quality of life (RNAO, 2005) that is consistent with nursing theories. Client Choice. Another significant concept for nursing is patient choice, it’s respecting and honoring. It is tightly interlacing with principles of autonomy, respect, and preservation of dignity. HSNT are paying special attention to defining and explaining of the importance of this concept as well as teaching nurses how to care for persons in accordance with persons’ choices. In human becoming perspective the concept of choice is the cornerstone. Bournes points out that ethical framework for honoring people’s choice is embedded in the ontology of the human becoming (p. 182). The ability to express the own choice and acting accordingly constitutes personal freedom. When patients can make their own choice, they making plans for changing health patterns (Bournes, p. 18). Parse teaches that individuals are experts of their reality and health, freely choosing meaning in different situations, and responsible for the choices they make (Parse, 1981). The nurses’ role is to be with patients in a way that respect and honoring individual’s choice (Bournes, p. 21). In accordance with human becoming, the nursing’s responsibility to society is guiding the patients in choosing possibilities for changing their health pattern. And the nursing goal is improving quality of life from the person’s perspective, which is a person’s choice. Newman’s theory describes disease as disruptive state that presents a choice point for the person. At this point person decides to continue their previous way of being, or to change the pattern. During this process, the person develops of individual self-identity, self-consciousness, and self-determination (Parker, 2006, p. 217). Thus, the choice point, when the person has to choose either new way of being, or continue the same as before, is the most important for changing the pattern, or healing. As per Newman, the disorganized time in the patient’s life presents the opportunity for growth (Parker, 2006, p. 222). In Watson’s theory the client’s choice is not emphasized that clearly, however, it is mentioned as a part of caring moment, when the person and the nurse come together in a human-to-human transaction. At that time the two are deciding how to be in the moment, expressing their choice (Parker, 2006, p. 300). Similarly, the concept of person’s choice is a part of Martha Roger’s moral ideals. She wrote that persons have the freedom to make choices and act intentionally (in Butcher, p. 115). Rogers placed nursing in the context of being a service for mankind. Another way to respect patient’s choice as posits Tarlier, is willingness to listen to others, genuine attempts to understand another and other’s situation (p. 237). Respect for patient’s choice is one of the moral values that are related to professional qualifications, skills and competence (Tarlier, p. 237). Correspondingly, the value of client choice is emphasized across all nursing regulatory documents. According to CNO, client choice means self-determination and includes the right to the information necessary to make choices and to consent to or refuse care. In tune with theory of human becoming, CNO asserts that clients know the context in which they live and their own beliefs and values. As a result, when they have the necessary information, they can decide what is best for them (CNO, 2005). CNO states that nurses demonstrate regard for client choice by: respecting clients even when the clients’ wishes are not the same as theirs and following clients’ wishes within the obligations of the law and the standards of practice (CNO, 2005). Giving priority to client’s choice, CNO requires that nurses use the client’s views as a starting point in cases when it is difficult to balance potential benefits with the potential harm of a given treatment choice (CNO, 2005). In the same manner, CNA designates promoting and respecting informed decision-making as one of the primary nursing values, and advise nurses to recognize, respect and promote a person’s right to be informed and make decisions (CNA, 2008). CNA obligate nurses to ensure that nursing care is provided with the person’s informed consent as well as to recognize and to support a capable person’s right to refuse or withdraw consent for care or treatment at anytime (CAN, 2005). RNAO in alignment with CNA, outlines such notions as clients are experts of their own lives, client’s are leaders, and clients’ goals coordinate care of the heath care team as foundational to client centered care. RNAO Best Practice Guidelines directs nurses to incorporate into, and demonstrated throughout, every aspect of client care and services this values and beliefs (RNAO, 2006). The meaning that nursing theorists are assigning to the concept of choice is very different from what is outlined in the documents. It is evident, that in legislated documents the definition of client’s choice is made within standards and norms that require introducing of the legal terms of informed consent, substitute decision maker or limit to client’s choice. Very awkward, I know. Trusting nurse-patient relationships. The third point for illustration of interconnection between nursing theories and nursing legislated and professional standards is trusting nurse-patient relationships. Similar to the first two, this concept is critical for all nursing theories. Theory of human becoming represents true presence, a unique kind of relationship that nurse practices with patients in the process of illuminating meaning, synchronizing rhythms and mobilizing transcendence (Parse, 1998, p. 72). In this relationship is the client, not the nurse is a prime decision maker. The client in presence with the nurse is changing his or her health pattern. Nursing defined by theory as loving, true presence with the other to promote health and quality of life (Parse, 1998, p.74). Correspondingly, transpersonal caring relationship is the core concept of Watson’s theory. It is defined as a human-to-human connectedness occurring in a nurse-patient encounter within a caring consciousness (Watson, 206, p. 300). Developing and sustaining a helping-trusting authentic caring relationship is one of ten carative factors. Those factors are guiding nursing practice from Watson’s theory perspective. They characterize nursing caring transaction occurring within a given caring moment (Watson, 2006, p.301). Transpersonal caring by Watson is an ability to connect to the spirit and soul of the other in the relationship through the process of healing and caring. In this type of relationship, the goal of nursing is to restore the inner harmony of a patient (Watson, 2006, p.299). A transpersonal caring moment occurs when both the nurse and the person is connected at a spiritual level (Parker, 2006, p.300). The nurse in this relationship with the person becomes a coparticipant of the change, and nursing care is the way of being rather than doing (Watson, 2006, p. 298). In congruence with Watson and Parse, the central concept of Newman’s theory is meaningful client-nurse relationship. Newman believes that in forming a mutual partnership to attend to the pattern of meaningful relationships and experiences in a client's life, nurses can assist a client to gain insight and experience of expanding consciousness (Parker, 2006, p. 220). This new insight, according to Newman, will help a client to cope and move on with life (Parker, 2006, p. 221). This insight or transformation to a level of higher, expanded consciousness is often brought on by disruptions to their old way of life (Parker, 2006, p. 222). Newman postulates that caring relationship involves the whole of nurse, and the whole of client, who become partners in living through the period of disharmony (Parker, 2006, p. 221). Consistently, human science nursing theories look into nurses’ roles not as professional help or advise guided by medical or nursing diagnoses, but rather a change agent. As per Parse, “nurse is a nurturing gardener, not a fix-it mechanic” (Parse, 1998, p///). Patient-nurse relationships are also given high priority across the documents. CNO recognizes therapeutic relationships as fundamental to all nursing practice as being either primary intervention in some areas of nursing practice or in the background in other areas (2005). Regardless of setting and clinical situation, the therapeutic relationship always needs to be established, outlines CNO (2005). The therapeutic relationships are vital in everyday practice because comfort, support, and provision of care can be facilitating through it (CNO, 2005). Granting the same high priority, RNAO recommends organizations to consider the therapeutic relationship as the basis of nursing practice. The qualities of the therapeutic relationship, outlined by RNAO, include: active listening, trust, respect, genuineness, empathy, and responding to client concerns (2006). However, in contrast with CNO that stands on the client’s positions, RNAO, talking about therapeutic nurse-client relationships, shifts the attention to nurses’ well-being. RNAO Best Practice Guidelines accentuates that maintaining an effective nurse-client relationship in increasingly acute, complex and, at times, violent surroundings are emotionally and often physically demanding for the nurse. Emphasizing the importance of the nurse’s well-being, RNAO recommends organizations to support the nurses as necessary (2005). Similarly, CNA provides that nurses build trustworthy relationships as the foundation of meaningful communication, recognizing that building these relationships involves a conscious effort. Such relationships are critical to understanding people’s needs and concerns (CNA, 2008). In opposition to HSNT perspectives, the traditional nursing role as caregiver, advocate, counselor, and leader in client-nurse relationships is traced across all documents. This role is a reflection of medical model within which paternalism would take precedence over respect for autonomy (Pilkington, 1999, p.23). In conclusion, although all three points of comparing and contrasting of human science theories and nursing regulatory documents position are represented in all aforementioned sources, the angles of view differ significantly. Alina, if you can strengthen it. She also requires suggestion how to fill the gaps. I do not think I can do it. Reference: I will finish later College of Nurses of Ontario (CNO) Standards of Practice: http://www.cno.org/prac/index.htm Registered Nurses Association of Ontario (RNAO) Best Practice Guidelines: http://www.rnao.org/Page.asp'PageID=861&SiteNodeID=133 Canadian Nurses Association (CNA) Code of Ethics: http://www.cna-nurses.ca/CNA/practice/ethics/code/default_e.aspx Newman, M.A. (1999). The rhythm of relating in a paradigm od wholeness. Image: Journal of Nursing Scholarship, 31(3), pp. 227-230. Parse, R. R. (1992). Human Becoming: Parse's Theory of Nursing. Nursing Science Quarterly, 5(1), 35-42. doi: 10.1177/089431849200500109 Parse, R. R. (1997). The human becoming theory: The was, is, and will be. Nursing Science Quarterly, 10(1), 32-38. Rafael, A. (2000). Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. Advances in Nursing Science, 23(2), 34-49. Retrieved from journals.lww.com/ advancesinnursingscience Watson, J. (2002). Intentionality and caring-healing consciousness: a practice of transpersonal nursing. Holistic Nursing Practice, 16(4), 12-19. Retrieved from http://journals.lww.com/hnpjournal Watson, J. (2007). Watson's theory of human caring and subjective living experiences: carative [sic] factors/Caritas Processes as a disciplinary guide to the professional nursing practice... This manuscript draws upon a previous publication with modifications: Watson J. Carative factors, Caritas processes: guide to professional nursing. Danish Clinical Nursing Journal. 2006;20(3):21-7. Texto & Contexto Enfermagem, 16(1), 129-135. Retrieved from http://www.textoecontexto.ufsc.br