The art of caring is essential to nurses who practice patient care. What caring is can be thought of as four parts of a continuous circle that include the nurse, patient, environment, and health. The metaparadigms of nursing are fundamental care processes that describe the meaning of Christian nursing and how nursing practices fit into the healthcare field. Nursing careers involve understanding the art of nursing so that we can assist others with goals in their health problems, issues, concerns, and emergencies. As nursing care evokes the conscious through each of the ethical principles that guide and direct patient care assessments, diagnosis, planning, interventions, and evaluation will be viewed through the Christian outlook that is part of the theory and underlying, crucial, and relational drivers of the nurse.
Metaparadigms of Nursing
Nurse
The character of a nurse is defined by Doornbos, Groenhout, and Hotz in Transforming Care: A Christian Vision of Nursing Practice to include prioritization skills, efficiency, and focus on the well-being and health needs of others (2005, p. 46-47). Nurses act with precision and skill with the underlying principles of ethics and compassion toward others in order to alleviate the suffering of human beings. Caring has been described in different contexts by Patricia Benner so that the act of caring can be understood for its part in healing and recovery as the “instrumental role” and the “expressive” role which are both founded in ethical principles, but contrasts the caring roles in the relational quality of nursing care as investigative or practical from those that are expressive and transformative (Benner, 2001, p. 170-171).
The American Nurses Association Code of Ethics for Nurses with Interpretive Statements discusses building a relationship of trust with patients and providing services related to healthcare needs (ANA, 2015, p. 1). Caring behaviors were studied in a medical surgical nursing hospital for the ethical perceptions that impacted patients and nurses as the healthcare services were provided, for example the questionnaire considered, “helping to reduce the patient’s pain” and “talking with the patient”, as well as “responding quickly to the patient’s call” in order to understand the effect of caring in different categories (Papastavrou, Efstathiou, Tsangari, Suhonen, Leino-Kilpi, Patiraki, Karlou, Balogh, Palese, Tomietto, Jarosova, and Merkouris, 2012, p. 374).
Person
In the social situations that nurses work, the persons with complex health requirements within the health care organization (patients) are often analyzed for hospital admissions or episodes during their hospital stay that contributed to simultaneous events and dual characteristics (Gonzalez, Comba, Esteban, Sanchez, Afonso, Perez, Rodriguez, Diaz, Elosua, and de Leon, 2016, p. 4). Persons are exemplified through nature, idealism, co-authorship, and community care according to Doornbos, Groenhout, and Hotz (2005, p. 51-65). In one patient care role for the nursing professional, a patient (Janet) is described where the nurse then takes the diagnostic information and, as a practitioner, derives knowledge from the most basic level with the theory of embodiment (Doornbos, 2005, p. 52-53). Embodiment shapes the sense of being similarly as described in the Bible in this quotation, “I thank my God upon all my remembrance of you, always in every supplication of mine on behalf of you all making my supplication with joy, for your fellowship in furtherance of the gospel from the first day until now; being confident of this very thing, that he who began a good work in you will perfect it until the day of Jesus Christ: even as it is right for me to be thus minded on behalf of you all, because I have you in my heart, inasmuch as, both in my bonds and in the defense and confirmation of the gospel, ye all are partakers with me of grace. For God is my witness, how I long after you all in the tender mercies of Christ Jesus. And this I pray, that your love may abound yet more and more in knowledge and all discernment; so that ye may approve the things that are excellent; that ye may be sincere and void of offence unto the day of Christ” (Philippians 1: 3-10, American Standard Version).
Patients are unique with individual data that influences healthcare decisions and ethical considerations with concern for the values and needs of each person (ANA, 2015, p. 1). The goal of nursing is therefore to help sustain the health of others through caring and caring practices that are focused on the individual, as well as collectively caring for the population.
Environment
Strategy and interventions completed in a teamwork climate are factors that are recommended for healthcare professionals working in hospitals so that nurses can collaborate when challenges in patient care arise to improve patient outcomes (O’Leary, Johnson, Manojlovich, Goldstein, Lee, and Williams, 2019, p. 5). Components of an environment are composed of the microsystem, mesosystem, exosystem, macrosystem, and chronosystem, with the complex assessment of needs pertaining to physiological, psychological, sociocultural, and spiritual arranged within the environment itself (Doornbos, Groenhout, and Hotz, 2005, p. 80, 82).
The types of nursing care can extend to physical therapy, occupational therapy, psychological care, and speech therapy. Caring for other persons can help identify patient needs and the causes are included in nursing documentation which is an extenuation of the act of caring and a time to establish outcomes and interventions.
Health
In a study led by the Department of Geriatrics, which included a comprehensive assessment, determinants of health problems, and the level of care for the demands of nursing, the diseases frequently included among clinical interventions in the patients included the top five diagnosed diseases; 59.7% of patients had arterial hypertension, 41.9% were diagnosed with musculoskeletal disorders, 35.8% were diagnosed with coronary heart disease, 33.8% were diagnosed with chronic heart failure, and 21% diagnosed with diabetes (Borowiak, Kostka & Kostka, 2015, p. 407). Patient mortality is always avoided in healthcare practices with caring in place for the benefits of the nurse and person (patient), environment and health of others. Health factors are variable depending on social demographic conditions, so the study details I have described explain conditions among older adults, however, conditions can vary depending on affluence, vulnerability, and age.
Christian Worldview of Caring
Monitoring
The Oncology Nursing Society highlighted an FDA warning about rare lung inflammation pertaining to CDK 4/6 inhibitors in their recent ONS Voice journal (ONS, 2019, p. 1-2). It is important that prescribing information is monitored so that benefits are communicated to patients with notifications given in any environment including low activity or patients who are hospitalized. As Christians, ideas and theories are central to the processes of healthcare, including healthcare management. For instance, in the book of Nehemiah in the Bible, principles of management are discussed in the following quotation, “for the children of Israel and the children of Levi shall bring the heave-offering of the grain, of the new wine, and of the oil, unto the chambers, where are the vessels of the sanctuary, and the priests that minister, and the porters, and the singers: and we will not forsake the house of our God” (Nehemiah 10: 39).
Prescription information and “quality care” are often interchangeable in models which begin to provide safe care and then build evidence-based practice to research the standards and best care (Benner, 2001, p. 240). Nursing standards of care are faithful to the resource by the intention of consenting to the divine ordering of the world and caring for others in nursing practice. Jeremiah described encouraging the practice of caring about the meaning of events and their impact and influence on the future in the Bible in the quotation, “arise, cry out in the night, at the beginning of the watches; pour out they heart like water before the face of the Lord: lift up thy hands toward him for the life of thy young children, that faint for hunger at the head of every street” (Lamentations 2: 19).
Risks
In younger generations the Pediatric Oncology Group of Ontario, found that survivorship increased the risk of all cardiovascular disease (Khanna, Pequeno, Gupta, Thavendiranathan, Lee, Abdel-Qadir, and Nathan, 2019, p. 1041). In terms of risk groups, however, evidence-based research in nursing care, has considered the way that individualized care is important for treatment modalities for many years, but the new research suggests to oncology nurses that coupled with the knowledge that hematologic cancers have high risks of clots and bleeding are factors related to cause-specific hazard ratios (ONS, 2019, p. 1). Biomedical principles of nursing care and holistic nursing care together guide decision making for members of the healthcare teams as they include caring in their nursing skills.
Risks help determine assessment criteria that include patient treatment planning. Nursing care can implement care plans using templates from the website www.journeyforward.org if the patient has been diagnosed with cancer for instance. Other care plans may involve cardiac care, musculoskeletal care, diabetic care, or emergency department assistance and critical care support using websites that patients can access such as https://online.epocrates.com/. Health risk assessment is a valuable way of caring and providing quality nursing care.
Questions Arise About Compassion and Biblical Insight
I think it would be helpful to end this chapter with an exercise. Think about the person who has shown you the most grace. Maybe close your eyes and get their face in your mind. Think about how they have affirmed you as a person, how they have had compassion on you even in your struggles, how they have loved you deeply as a person, how they have accepted you knowing both the good and the bad of who you are. As you stare into the face of this person, just know that God is far more gracious to us than this person. God is a God of all grace!
Christian salvation is not simply a definition to be understood, but a relationship with a gracious God to be realized. My prayer is that as we understand the various aspects of salvation that we will understand the grace of God! [Gabriel Etzel (2017). (p. 182). Everyday Theology. B&H Academic. Retrieved from https://app.wordsearchbible.com]
16 Jesus therefore answered them and said, My teaching is not mine, but his that sent me. 17 If any man willeth to do his will, he shall know of the teaching, whether it is of God, or whether I speak from myself. 18 He that speaketh from himself seeketh his own glory: but he that seeketh the glory of him that sent him, the same is true, and no unrighteousness is in him. (John 7:16-18)
John 7: 16-18, KJV
Conclusion
The metaparadigms of nursing are the nurse, the patient, the environment, and health. The nurse can be instrumental or transformative in the role of care provider, such as through applying a bandage or typing a series of notes about health conditions. Persons are those who receive care in the caring role by having diagnostic information and may be signaled by, pointed out by, or spoken about by others when they are need. The environment includes outcomes and interventions and may be a home, hospital, office, or unexpected place and considers many complexities of caring. Health is a multifactored area of caring for nurses which can be based on many factors that change and face concerns among vulnerable populations. Christian nursing is concerned with monitoring the care of others and documentation of risks in order to provide ethical nursing care which meets standards of excellence through the consciousness of nursing practice. As Christians, nurses care for others by planning for the future and researching through the use of evidence-based practice.
References
American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: ANA.org.
Becze, E. (2019). FDA Warns of Rare Lung Inflammation with Certain CDK 4/6 Inhibitors. ONS Voice, 2019(0):1-2. Retrieved from voice.ons.org/news-and-views
Becze, E. (2019). Hematologic Cancers Have Higher Long-Term Risk of Clots and Bleeding. ONS Voice, 2019(9):1. Retrieved fro voice.ons.org/news-and-views
Benner, P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Upper Saddle River, New Jersey: Prentice Hall Health.
Borowiak, E., Kostka, J., & Kostka, T. (2015). Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments. Clinical Interventions in Aging, 10, 405-412. doi:http://dx.doi.org.ezproxy.liberty.edu/10.2147/CIA.S72534
Doornbos, M., Groebnhout, R., and Hotz, K. (2005). Transforming Care: A Christian Vision of Nursing Practice. Grand Rapids, Michigan: William B. Eerdmans Publishing Company.
Gonzalez, R. P., Comba, P. C., Esteban, M. R., Sanchez, J. J., Afonso, J. H., Perez, d. C., . . . Leon, A. C. (2016). Incidence, mortality and positive predictive value of type 1 cardiorenal syndrome in acute coronary syndrome.PLoS ONE, 11(12) doi:http://dx.doi.org.ezproxy.liberty.edu/10.1371/journal.pone.0167166
Khanna, A., Pequeno, P., Gupta, S., Thavendiranathan, P., Lee, D., Abdel-Qadir, H., and Nathan, P. (2019). Increased Risk of All Cardiovascular Disease Subtypes Among Childhood Cancer Survivors: Population-Based Matched Cohort Study. Circulation, 2019(140):1041-1043. Retrieved from doi: 10.1161/circulationaha.119.041403
O’Leary, K. J., Johnson, J. K., Manojlovich, M., Goldstein, J. D., Lee, J., & Williams, M. V. (2019). Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems. BMC Health Services Research, 19(1). Retrieved from https://link-gale-com.ezproxy.liberty.edu/apps/doc/A586555816/AONE?u=vic_liberty&sid=AONE&xid=4da9e608
Papastavrou, E., Efstathiou, G., Tsangari, H., Suhonen, R., Leino-Kilpi, H., Patiraki, E., . . . Merkouris, A. (2012). Patients’ and nurses’ perceptions of respect and human presence through caring behaviours: A comparative study. Nursing Ethics, 19(3), 369-379. doi:http://dx.doi.org.ezproxy.liberty.edu/10.1177/0969733011436027
http://journeyforward.org/survivorship-care-plan-builder-end-user-software-license-agreement.
