2010 Winning Essay

2010 A Nurse I Am Scholarship winners were asked to answer the following: The metaparadigm concepts of nursing are person, health, environment and nursing. These terms are generally used to define nursing as a discipline. Pick two nurses from the film and tell how they fulfilled the needs of the patients they cared for using these concepts. Compare or contrast how these 2 nurses use these concepts to the way you plan to use them in your practice as a nurse.

Frank Mataska

Johns Hopkins University School of Nursing

"What exactly does a nurse do?" my friend asked. I had just started my first semester at Johns Hopkins School of Nursing and realized I could not answer her question. The career seemed so vast - ranging from labor and delivery to home hospice care - that I could not pin it down. "Well why don't you go on to be a doctor, though?" she followed. After all, I was smart. I could do it. I was insulted. The conversation ended with both of us feeling a little confused.

It may have helped to explain nursing with the metaparadigm that looks at the person, their health and environment in order to formulate their nursing care. It may have helped to explain nursing for what it truly is: holistic, not concerned primarily with disease but how that process impacts the whole person. Yet this may have been too general, too vague. It may have helped instead to tell a story or two.

Enter Mona Counts, whose name doubles as a declarative statement. How would Mona answer my friend? She might point to the environment of Mt. Morris, explain the term Health Professional Shortage Area and the ways she uses her nursing role to fill the primary care gap. She might explain how a nurse operates from a patient perspective. Mona barters, makes home visits, talks straight about the realities of insurance while effortlessly examining a patient's lymph nodes. She does not simply guide her patient through a mini-mental exam, but takes the time to address his debilitating fear of Alzheimer's. She recognizes in her patients a unique wisdom, explaining that, “If you focus and you listen, the patient will tell you what's wrong with them." Perhaps this is why the residents of Mt. Morris approach Mona at the local diner, throw her parties, and share their photo albums with her.

The doctor quickly runs through the plan of care. Does the patient understand it? The man lying in bed with a tracheostomy nods and the doctor walks away. Ardis Bush stays and hands the patient paper and a pen. She takes the time to make him understand and only then does the patient write: "Now I get it." As a hospital nurse manger, Ardis also monitors the nurses' environment. One nurse does not bring a patient's pain medication on time. Ardis calmly explains that nurses are human and will make mistakes. However, a patient's right to pain relief is paramount and she will talk to the nurse later. In her managerial role, Ardis also responds to an overburdened respiratory therapy department and secures pulse oximeters and training for her unit. Hers is a floor with high staff retention and fewer cardiopulmonary arrests. "I didn't depend on anybody else to do the things that I felt like I should have done," Ardis says.

This August I will join Mona and Ardis in calling myself a nurse and I will begin to tell my own story. After working for a time in a pediatric ER, I look toward service as a medical case manager for foster care children. While in the ER I hope to draw inspiration from Ardis, empowering my patients to communicate their needs and advocate for their education. I hope to use Evidenced Based Practice to meet any shortcomings on my unit, as Ardis does. As a child health nurse, I will also hone other skills, involving families in their children’s care and monitoring developmental status. As a future case manager for foster children, I will draw inspiration from Mona and take in the larger environmental picture of children in foster care. I will become savvy in connecting my patients with community and government resources. I hope to understand my patients as deeply as Mona does, and earn their respect. Working with children in foster care will lead me to collaborate with the school system, the foster care court, and mental health resources. My story will add to the panorama of nursing, but will also draw from the same holistic fabric that binds each and every member of this profession.

When I think back to my friend's questions I feel that these stories could help her and others understand what a nurse truly does. Watch Mona and Ardis take in all that makes a person complex – health, environment, personal limitations and strengths - to optimize healthcare. "Well why don't you go on to be a doctor, though?" I would now proudly and simply answer, "Because I want to be a nurse."

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