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As a nurse, I must be able to understand and predict a patient’s needs. To do this, I must be flexible and knowledgeable. In nursing, epistemology is known as the study of theory and knowledge which includes Carper’s four fundamental patterns for nursing knowledge. Carper’s patterns include empirics, esthetics, personal knowledge, and ethics. (McEwen & Wills, 2014). Through this essay, I will discuss a personal clinical situation where I felt uncomfortable and use Carper’s patterns to analyze the situation.
When I became a nurse my first place of employment was on a cardiac critical care unit. Our orientation to the facility was only two weeks, which I felt was completely inadequate for the type of patients we were taking care of. The charge nurses did not put new nurses with the open-heart patients, but they did have us care for the VATS (video-assisted thoracic surgery) patients. Within the first two weeks of being off orientation, I was given a VATS patient to take care of.
I was very frustrated because these patients often had drains and were required to have much of the same care as the open-heart surgical patients, but we were not given the same types of case load as the open-heart patients. The nurses with open heart patients only took care of one other patient on the floor. During my first rotation where I had a VATS patient, I had four other patients to take care of at the beginning of the shift and picked up one more through the night.
Not only did I feel underprepared for the care my patient would need, but I felt spread too thin as well. My patient had part of his lung removed, so he had a large incision site, drains and other equipment that required extra attention. I felt like I was not giving my patient the best care he needed because I was constantly being pulled from his room by my other patients. My patient also required some prodding when it came to ambulating after the surgery. I was not able to get him to walk the halls as much as the surgeon wanted because I was caring for my other patients. Luckily, there were no negative effects with this patient, but I was still stressed and frustrated because as a new nurse, I felt I was not doing enough, and I was scared my patient would develop a post-surgical complication.
There were a few nursing issues that I felt played a role in this situation. The first nursing issue was the unsafe nurse to patient ratio. No nurse taking care of a post-surgical patient who required this level of care should ever have four to five additional patients. The second nursing issue was lack of assistance from other nurses. There is a saying that nurses eat their young, and this situation fell into that category. The other nurses did not offer help or advice on how to handle this difficult patient, and I felt like I could not ask them for help, or they would look down on me. Looking back now there was a lot I could have done differently to ensure the best possible outcome for my patient.
Carper claimed perception resulted in nursing actions having an esthetic quality, “It is this quality, Carper posited, that prevents any deconstruction of means from ends and unifies a holistic process of esthetics as a creative experience between patient and nurse.” (Jacobs, 2013, p. 280). Nurses gain esthetic knowledge through subjective data. In this case, the charge nurse did not take into account that I was a new nurse taking care of a complex patient with needs which I had not cared for before. The other nurses on the floor did not offer assistance in caring for the patient; under the premise that they were teaching me to handle difficult situations on my own. My personal feelings played a big role in how I cared for my patient. In this situation I felt insecure and afraid to ask for help. I also felt like the facility placed more importance on patients who had open-heart surgery than the VATS patients which led to more patients being assigned to me by the charge nurse and a lack of assistance from the other nurses on the floor.
According to McEwen and Wills (2014), “ethics refers to the moral code for nursing and is based on an obligation to service and respect for human life (p. 14). I feel that all of us in this situation ignored the moral dilemmas that were associated with the care of this patient. The charge nurse ignored the fact that I was a new nurse and that the VATS patient would require more care than the average patient when assigning so many patients to me. As stated before, the other nurses were more concerned about focusing on their patients and tasks and I was afraid of what others would think of me if I asked for help. This could lead to negative outcomes for my patient. “Healthcare increasingly emphasizes empirical knowledge and evidence-based care” (Terry, Carr, & Curzio, 2017, p. 87). Ignoring evidence-based practice can lead to mistreatment of patients. “Complication monitoring is one of the major nursing interventions for post-operative thoracic patients. Complications include post-operative bleeding, broncho-pleural fistula, persistent air-leakage, wound infection, etc. Failure in early detection or monitoring might result in irreversible and tremendous consequences.” (Yeung, 2016, p. 72-74). I was lucky that my patient did not suffer from any adverse consequences while under my care and I can say I learned a lot about voicing the needs of my patient.
Looking back and reassessing this situation from my past by using Carper’s four fundamental patterns for nursing knowledge allowed me to identify areas of weakness in myself and build my moral character. Implementing these changes in my daily practice will not only improve the care I provide to my patients but will also help identify situations where I should advocate for my patient. Improving care leads to a better outcome for patients, which is the goal.
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