Knowledge Development in Nursing

A philosophy of nursing should be all encompassing, with its foundation based upon core values and beliefs, while building upon experience. Medicine is often comprised of controversial ethical dilemmas where we must be advocates. In a study that examined the relationship between nurses and physicians it was determined that “Differences in values, communication, trust, and responsibilities can precipitate conflict between nurses and physicians over ethical components of care. (Corley MC 1998) Developing ones theoretical knowledge and learning how to apply it successfully into their clinical practice is part of the evolving process.

The evolution that occurs over the course of a career can be empowering. Hence, it is important to develop positive nurse-physician relationships to bolster confidence and grow from those interactions. The importance of positive nurse-physician relationships has been widely acknowledged (Baggs, 1989; Baggs & Schmitt, 1988; Eubanks, 1991; Fagin, 1992; Mechanic & Aiken, 1982; Prescott & Bowen 1985). Therefore, it is our obligation as professionals to mentor our peers, not only for ourselves, but our patients and families, as well.

In an interesting illustration of self disclosure (Kim, H.S., 1999) a practitioner was able to identify the needs of a patient, but clearly had difficulty communicating the needs of the patient to the physician, although some of the difficulties appeared to be cultural in nature.

The way we communicate with one another as practitioners, in addition to, how we collaborate and communicate with physicians has a direct impact on patient outcomes. As practitioners we are restricted in performing our jobs if we can not effectively collaborate with the physician.

It is herein that the problem lies. The inexperienced or less assertive practitioner will often find it difficult to approach a physician when faced with perhaps the “Do Not Resuscitate” order that has yet to be signed. With that being said, approaching a family that needs to be educated on the implications of G-tube placement on their family member with prolonged intubatation and no signs of improvement can be daunting without interdisciplinary support.

The more experienced practitioner’s clinical judgment is more easily verbalized because he/she is comfortable in interdisciplinary collaboration, therefore the physician is more likely to involve them in the decision making process. For example in an ICU setting where often times the physician does not involve the practitioner in the decision making process or inform them when a decision has been made it generally creates one of three things. A. the nurse will continue to aggressively pursue the physician until an order is received B. resort to “slow codes”, or C. resuscitate all patients until told otherwise by the physician (Michael I Rauchman, BA). All of these things lead to negative outcomes for both the families and patients, and we as practitioners. “Future directions of the discipline are revealed when these linkages between philosophy, disciplinary goals, theory, and practice are strengthened” (McCurry, et al). It is for these reasons, we as practitioners must continually grow and develop through our experiences, always expanding our knowledge in the ever-changing profession we have chosen.

Corley MC (1998). Ethical dimensions of nurse-physician relations in critical-care (The Nursing Clinics of North America) 1998 Jun; Vol. 33 (2), pp. 325-37. http://ehis.ebscohost.com.proxy.library.maryville.edu/ehost/detail?vid=19&sid=78745a3b-d950-4ea0-890c-4ee4ab4c4b46%40sessionmgr112&hid=101&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cmedm&AN=9624207 ISSN#0029-6465

MICHAEL I. RAUCHMAN, BA
Medical student
McGill University
Montreal, PQ
RABKIN MT. GILLERMAN G, RICE NR:
Orders not to resuscitate. N Engi J Med
I 976; 295: 364-366
http://www.ncbi.nlm.nih.gov.proxy.library.maryville.edu/pmc/articles/PMC1875656/pdf/canmedaj01406-0055.pdf

Expertise in Nursing Practice
Caring, Clinical Judgment, and Ethics