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| Developing a Professional Practice Philosophy |
Tracy Young
I am in my fifth year at Brandon University, graduating this fall with my second degree from the Bachelor of Science in Psychiatric Nursing program. This paper was written as part of the process of developing my professional practice philosophy. It is an exploration of self -- of who I am and how my life informs my clinical practice. It has become a very important part of my journey to understand how I have come to be the individual that I am, and to be able to acknowledge the pieces of ME that will be reflected in my work.
August 15th, 1980 -- that is where it all began. That was the very day I came into this world, as an eight pound thirteen ounce bundle of hopeful aspirations (or so I'd like to think!). Now here I am, just over 22 years later, writing about life, learning, knowledge, and my developing philosophies of life and psychiatric nursing practice.
How do I know what I know? This is a difficult-to-answer question. It has, however, been part of my journey in life to discover why I feel the way I do; why I react the way I do; and why I carry specific determination about particular things. So, answering this question is a challenge I am willing to take on.
All of these ways of being are related, in one way or another, to a variety of knowledge bases. In order to explore the question of how I came to develop this knowledge, I will explain my ongoing path of self-discovery.
To describe my life journey, I use the metaphor of a tree. Starting at the roots of this tree we will work our way up the trunk, to the branches and then to the leaves. This will bring us closer to understanding what underlies how I know, how I do, and how I will reveal myself in my practice -- my existing philosophy.
My roots start at home, with Mom, Dad, and little brother. Until the day that I turned twenty-one, I lived with both of my parents west of Brandon on an acreage. It was there, within that context, that I began my journey. It was within the heart of our family that I started to know.
My family was always close and shared the highest regard for one another. My parents taught me to value life, to value my family and friends, to value love and to value hard work. Through our activities, celebrations, trips, and vacations, I came to see what life had to offer me. I learned to take the world by the toes and make the most of it.
I was fortunate to have had some of the very best role models along the way. My mother is the most generous spirit that I have ever known, and it is through her that I have come to understand what it means to be truly caring and giving of myself to others. I currently strive to be as selfless as she is, and I believe that in many ways it is because of her that I chose to enter the health care field. It was engrained in me, at an early age, to want to be in an environment that offered me continuous opportunity to practice being generous of myself. I came to know that it is important to give all that I can to others and to the understanding of their lives.
My father is the most content and patient individual that I have been exposed to throughout my journey. He taught me how to be happy with what is before me -- with life as it stands. He showed me how to be grateful and proud of what I have accomplished, rather than what I could, or should, have done. He taught me that it is what I learn on the way, to wherever it is that I am destined to go, that is of the most importance. This is what makes the difference in what that destiny will look like.
Though he did not exactly express it in words, he taught me to seek to learn more about myself, who I am, and who I want to be. He lead me to put together the pieces that make up my personal motto, 'regret nothing', a motto that ties my thoughts to the idea that I can learn something from every experience in order to better myself; to better my understanding; to strengthen my knowledge. I believe that this will make me a better caregiver and role model in my practice.
Finally, my little brother, though I am sure that he didn't know it at the time (nor did I), taught me how to have confidence and generated my search for independence. I continue to strive toward being more confident, as I am sure many do. It is my little brother that I give credit to, however, for giving me the surest opportunity as 'big sister' to know that I could be counted on, be responsible, and be a good role model. He showed me a way to an important element of practice -- making a connection of trust with another.
These elements -- caring, giving, contentment, patience, independence, confidence, and trust -- are some of my internal values and are expressed on a regular basis through my everyday choices, activities, and behaviors. In other words, my family proved to me, or had me prove to myself in a way, that all these pieces are important. Who I am, how I feel, how I react, how I behave, how I will practice are all rooted in my initial growth and development processes. They are all pieces of how I know what I know.
As we continue on my journey, moving upwards on the trunk of the tree, we can get a better picture of how I live out these values and continue to confirm them in what I do. This brings us to a second question -- How do I do what I know?
As I grew up I continued to learn more and more about the world around me, the opportunities it holds, and how I want to go about tackling presenting challenges. I took the knowledge created at home, in relationship with my family, and through my work experiences, varying levels of education, and new relationships I continued to create and develop my knowledge of what is to be human; a caring individual.
I have more recently started to see my developing characteristics as a psychiatric nurse shine through in my time working in palliative care. I am beginning to see that I do possess the skills that I believe constitute a psychiatric nurse.
I have learned how to put myself on my very own 'death bed' and to look at the world around me slipping away. I had no idea how much I took for granted in life until I really realized that it is not forever. I have always known that one day death will come for me, but I did not realize how hard this would be or how quickly it could actually happen. I try much harder to live each day as if it were my last, but in today's society it is a difficult thing to do. We are so overrun by 'time' and trying to fit things in under 'time constraints' that we often forget to stop, take a breath, and live a little.
This 'living a little' is what I presently try to do with the clients that I encounter. I take the time to talk to them and find out at least one thing about them that is outside of their illness or reason for needing care. It is this part of our lives that can connect us and is a focus in our relationship. There are some people that prefer to talk about their illness, their feelings surrounding it and surrounding death. This is okay too, as it can be therapeutic, but for others I try to shift the focus from the usual bombardment of illness related questions to something that is more life sustaining. The responses that I receive include smiles, trust, tears, hugs, etc., which has confirmed for me the fact that engagement is different from basic conversation.
Some would explain this skill as empathy -- something that everyone is capable of showing if they want. As a psychiatric nursing student, however, I have come to acknowledge that it is not 'empathy' that is the actual helper in this process, so much as it is the characteristic that allows me to perform the act of engaging others. Without my underlying values of trust, honesty and connection, empathy, or the revelation of respect for others, would not exist in my practice.
As I continue in my education I am finding myself, within new learning environments, continually changing the way I look at the world. A few years ago I finally started to understand what the process of self-discovery was actually about. I have come to the conclusion that getting to know myself is not about being selfish, but rather it is the first and most important step in living a full life. It is about knowing who you are so that you can make yourself more useful and contributive to the world around you.
As a psychiatric nurse how can I be expected, or expect myself, to understand the people that I am dealing with if I don't know anything about me. If I know who I am, then I am much better equipped to do what I know. Thus, self-awareness becomes a critical criterion in my philosophy. Without self-awareness I would not be able to create the relationships that are our overall goals as nurses.
With this self-awareness comes the act of patience. I have come to recognize that patience really is a virtue, and thus another concept that I believe psychiatric nurses need to be able understand in a particular way. As psychiatric nurses, I believe we have to live patience to really make it useful. Patience must become part of each and every relationship and it cannot go away despite possible frustrations and roadblocks. It has to exist within the entire relationship, not just within the hour or so that you may be meeting with a client.
My relationships, current and past, have also given me the opportunity to express my knowledge, values, and factors influencing my current and future practice. My relationship with my fiancée has been the most miraculous thus far. It is through his eyes that I have really had the opportunity to see who I am and what I am all about. Within the context of our relationship I have been able to be exactly who I want to be without any barriers whatsoever. In past relationships I found that there were parts of me that I couldn't show or express, but with this individual there is no such wall. He has taught me how to be the person, who puts up no barriers, lets all people in and accepts all the differences among us. This skill, I am not really sure what to call it, is important for me to be able to carry out as a psychiatric nurse. For me it seems to fit quite well with the idea of empowerment, so that is what I will call it for now.
I have now looked at how my roots have contributed to my knowledge, and led me in certain directions in my work, my education, and my relationships. They have led me to do what I know. I have seen the connections between these roots, ways of knowing, and the type of person that I have become in the varying areas of my life. This takes us to the top of the of the tree trunk, to the point where the branches steer off in their own directions. This is where I can look at how what I know and what I do becomes who I am and how I practice as a psychiatric nurse. This is where the last difficult-to-answer question comes into play -- How will I reveal what I know in practice?
I have worked in a variety of health care settings, exposing me to terminal illness and palliation, long term care, severe and persistent mental illness, intellectual disability, and acute psychoses to name a few. My heart goes out to all of these individuals, it always has, and perhaps this is another reason why I entered into the health care realm. I can truly sympathize with people and situations -- but so can anybody. I wanted to be able to do something more than that.
So, for some reason in my fourth year of post-secondary education I decided that I wanted to be a Psychiatric Nurse. Something in what my definition of what that job entailed led me to desire to want to do it. So what is it that I, as an educated psychiatric nurse, will be able to do that is different from the majority?
In part I have given my answer to this question in discussion of the concepts of knowing and doing. I started to express that as a psychiatric nurse, I want to be able to continue to do what I know as a career. I will recapture the ideas that I presented, framing the philosophy I will take with me as I enter practice as a psychiatric nurse.
I believe that there are three essential skills, which are all related and necessary for me to have, to be a psychiatric nurse. They are represented by three main branches on my tree.
The first branch is made up of a certain amount of self-awareness, for the key to understanding and being able to serve others is to first understand yourself. Of course, this will be an ongoing process, but at all times I must be aware of who I am, who I am becoming, how I know, and what I do.
The second branch, closely related to the first, is that of empowerment. As a psychiatric nurse I will challenge barriers between clients and myself. This means that I will be able to facilitate openness that will enable the healthy development of a relationship, and of the self-identity of the client.
This brings us to the third, and possibly the most important, of the branches, which is also strongly attached to the first two. That is, as a psychiatric nurse I will have the skill of therapeutic engagement. I will strive to build a true connection in any given situation, in order to come to know the world of the client and in order to look at making positive changes in their lives. Yes, I will carry knowledge about medications, treatments, therapies, intervention strategies and the like, that can help better the lives of those presenting in need of care. However, without that initial relationship and formation of a trust-bond I will not be able to see which of these things might be the most appropriate for each situation.
In summary, through a patient way of being I will continue to grow increasingly self aware and work at empowering all clientele. Through genuine engagement and the building of a mutually trusting relationship, I will be skillful in drawing out the feelings, concerns, and values of others. These are the skills and characteristics that will be my expertise when I complete this program. I believe that with them I will be able to make a real difference in my future line of work.
There are many places that I would be interested in working in. The one criterion, however, that I feel is of utmost importance is being able to practice what I know. Therefore, when it comes to where I will work and what context I see myself in, I feel the need to find an environment that allows me the freedom to nurse as ME.
In a final summary, all of these dreams and possibilities, as well as my presenting philosophy, is represented on the tree by the leaves that will grow, change color, wilt and fall, but that will bloom on a continuous basis. I don't know exactly where my nursing career will take flight, but I am eager for the continuation of the journey.