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Metaparadigms of nursing

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My experience as a volunteer at the Holland Christian Homes Long Term Facility was very enlightening as a person and more so, as a nursing student. Initially, as a student I believed health was merely an absence of disease and that one could only enjoy good health if there was a complete absence of medical, diagnosable problems. With more education in the health field, experience in the health industry, there was a shift in my ideas to a socio-environmental model of health Watching elderly residents who could not speak English in distress, when they could not convey their ideas to the English speaking staff, was quite memorable for me as it made me realize that it took away from them, their right to be nurtured, and understood and the right to make informed choices about their health. This paper will discuss the metaparadigm concepts underlining the nursing theory with reference to my memorable healthcare experience. The concept of Client and Person

The nursing approach taught in most nursing schools today, the client centered approach to nursing, focuses on the needs, desires and wants of the client and their families. It is based on understanding the client as a whole, with various social and environmental factors affecting their health. Since client centered care depends on forging a positive client-caregiver relationship, communication (verbal and non verbal) is essential to this process. In my experience at the nursing home, I frequently witnessed a communication gap between the client and nurse and how it hindered the client centered care – giving process. For example, their distress or dislike for the food. I felt quite helpless in this situation as I could not relate or understand the client’s needs and desires.

Also, this gap contributed to the poor quality of nurse-client relationship which is essential to the care- giving process. I believe clients’ right to contribute to their care plan, to the decision making process about the health interventions, and participate in the health related expected outcomes/goals could not be exercised in my experience. Furthermore, the nursing staff could not respect the client’s preferences when they did not know what they were: about food, social activities and daily routine activities. The barrier also contributed to the poor quality of nurse-client relationship as the staff could not get to know the clients as a person and facts about their history, family life, major life events and goals about the future. In this situation, I mostly relied on non verbal communication such as facial expressions, touch and body language to gauge the condition of the client, which I believe was not enough. Environment

The client’s environment reflects his immediate environment, in my experience, the nursing home consisting of the care-giving staff, the other residents and other staff. The social environment consisted of the person’s family and community ties, social values, their background, country of origin and the Canadian political system that influenced healthcare. Initially, my conception of the environment was limited to the immediate social connections and surroundings until I started nursing school. I thought the client’s health was only dependent on the living conditions in the nursing home and the quality of care provided. Moreover, I failed to acknowledge the geopolitical factors’ importance in healthcare. For elderly clients with dementia, the language gap aggravated the already poor client-nurse relationship as communicating major health issues was inhibited, such as current levels of pain or discomfort. Integration of cultural care practices and perceived threats into the care plan was difficult for the very same reason. In addition, according to me the nurses only had to rely on behavioral cues such as facial expressions and changes in vital signs to gauge the level of stress, discomfort, which are essential psychosocial factors affecting wellbeing. Being more analytical now, I realize how health policy could have enhanced the health experience in this situation such as, by providing more translators and hiring more inclusive staff. Health

In this situation, I thought, the nursing staff was focussing on merely the absence of illness and disease without paying much attention to enhance the residents’ dining experience, which would have increased the level of wellbeing. According to me, objective state of health and the subjective experience of wellness are important in establishing an overall state of wellbeing. Throughout my experience, the feeding of clients seemed more like a ritual and less like social event, with lack of food preferences available to the client, and lack of verbal communication between the nurse/volunteer and the client. Since most clients had some form of chronic disability, more efforts should have been made to enhance the dining experience and make it more enjoyable, for instance by incorporating family recipes, asking for resident’s preference for seating, using outdoor areas if weather permits, playing music chosen by residents and making the table visually appealing by using colorful table cloths etc. Nursing

Nursing in this situation would be mostly described as “patient-centered” instead of “client-centered”. The art of nursing focuses on the client holistically, as someone who continually interacts with his environment. Most of the nursing goals were met during my experience such as health promotion, disease prevention through timely screening schedules and medications. However, one of the important sources of data collection, interview with the client, was problematic as some clients did not speak English. Hence, most care givers had to rely on physical exam reports, family members and diagnostic exam results for assessment data. Therefore, it was not possible to integrate the client in the planning and implementation of the nursing interventions. In addition, I did not witness any advocacy on part of the nursing staff to resolve this issue.

To some extent, I succeeded in providing meaningful care to the client such as feeding, fulfilling their socializing needs by routine visits, and in establishing a caring relationship. Also, I did not feel the involvement of the client’s families in the decision making process which is essential in this situation as the clients could not participate in it. According to me, it is absolutely essential to involve the client in making decision about his or her health and the client himself is the best source of information in providing the most accurate information about factors that are subjectively most important to his health. Secondly, acknowledging the importance of social, psychological and environmental factors are imperative in establishing a care plan for clients.

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