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The Mission and Philosophy of the Organization, Capstone Project Example

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Capstone Project

Abstract

The culmination of the courses taken during this Bachelor’s of Science in Nursing form and shape the knowledge of students to better serve patients and the community. Immaculata University and the Division of Nursing challenge students to recognize and realize the mission and philosophy of the organization. Developing the ability to understand traditional and holistic nursing theories, nursing research, and cultural competence fosters the role of the nurse as an advocate for ethical decision making throughout both their personal and professional practice.

Nursing Capstone Online Exam

This online exam for the Immaculata University is the culmination of all the concepts, theories and philosophies learned during the time invested by the students earning a Bachelor’s in Science in Nursing (BSN). This exam covers the mission and philosophy of the Division of Nursing at Immaculata University. The case studies are presented for the students to be able to demonstrate the acquired knowledge of nursing theories and practices through effective communication coupled with critical thinking skills which can be used throughout both our personal and professional life.

Research

Study on Health Habits of Nurses

Studies conducted on sample population often have limitations and generalizations of the outcomes.  The case study performed on the health habits of nurses with a convenience sample of 120 participants, all registered nurses between the ages of 2 to 47 years old, is a research project with limitations of the study. In this sampling 85% of the participants are Caucasian. The other 15% is not known. The goal of this case study evaluation is to determine the limitations as well as recognize any generalizations which could be assumed of the outcomes of the study.

There are various different sampling techniques which a research investigator can choose from.  The decision will be based on several factors to include the type of project, the hypothesis and what results are being searched for. Convenience sampling is a method which is dependent on the convenience of researcher. In this method researcher does not attempt to get an accurate presentation of the population. The concept is really more based on what works the best for the investigator. Typically volunteers are recruited for the convenience of researcher that does not have to search for a more selective group of participants. Or researcher will select participants by soliciting them from a common pool such as a shopping mall.  Along with the representation not being accurate of the population, it is also less definitive and is unstructured.  This method is not reliable since it is better to select a sample which will be as representative as possible of the population you wish to research and evaluate. This type of sampling is useful in preliminary research and is helpful in forming the hypothesis for continuing research and investigation.

Convenience sampling is a way to gain information in a prompt manner and is also inexpensive.  It is considered to be a method which is better used in exploratory research. When a problem has not been clearly defined exploratory research is useful as it often relies more on secondary research. This is used to gain greater insight into a subject matter in order to be able to conduct research with more in-depth information to better understand the problem and research for a solution. The researcher must also consider the types of people included, excluded and over-represented when using convenience sampling (Herek, 2009).

The limitations of a study on the health habits of nurses include the fact that there are a greater number of Caucasian nurses whereas the need for more cultural and ethnic differences would provide for a more accurate result. Diversity in ethnicity would be helpful. This study is also limited by the age ranges without grouping to provide a focus on ages closer to supply a precise picture of healthy habits according to age. With this large of an age range it is easy to generalize rather than be specific on the health habits. Using a convenience sample which is not an accurate representation lends towards the need for generalization of the findings. This places greater limitations on research and restricts the outcome to generalizations and assumptions.  In this case, it is easier to assume some factors rather than look for concrete evidence. This type of sampling is more of an informal way to view a theory or concept and to begin to get a baseline for further research.

Study Hypothesis

A hypothesis test is a research concept which is useful in making decisions based on experimental analysis. This is often performed by a researcher to prove or disprove a theory. In the study hypothesis ‘There is no difference between the pain level of clients who receive acupuncture and those who do not receive it’ – this is considered an alternative hypothesis. In research there are always two hypotheses; alternative and null. The alternative hypothesis is the support for the hypothesis statement and the remaining outcomes are called the null hypothesis.  In this case the null hypothesis would be ‘There is a difference in the pain level of clients who receive acupuncture and those who do receive it.’ A hypothesis is a prediction and research is then set up under the alternative and null hypotheses statements to begin research in an attempt to prove and disprove the statements.

In this study hypothesis, if researcher finds this statement to be true then the alternative hypothesis is accepted and we ascertain that acupuncture is not effective for pain management. This indicates that the study participants who received the acupuncture and the ones who did not receive the acupuncture responded equally without any change in their pain level. Therefore, the alternative hypothesis is accepted and the null hypothesis is rejected.

Ethical Principles

Beneficence, respect for human dignity and justice are the three basic ethical principles for which ethical research is based upon. Ethics is an essential principle of research which prepares a nurse to be able to use the guidelines and procedures appropriately. Research is necessary for many reasons. A few include acquiring the knowledge to alleviate human suffering from diseases and illnesses and to understand the human body and human behavior. Research is performed to test theories and hypotheses. This is varied and researchers determine what they are trying to determine and why there is a need to know this information.

Respect for human dignity is the most cardinal principle and is the avenue for protecting the individual participant in a research study. It forms the basis for all aspects of conducting research on a human being.  This principle is meant to protect the individual on several levels; physical body, psychological, ethnic and cultural veracity. It governs researcher by providing ethical guidance to ensure harm is not imposed on the person, place or organization; it is meant to minimize harm while maximizing the benefits of research. The need for respect for human dignity is also a logistical problem, such as participants living in poor regions of the world, the homeless or mentally handicapped. Respect for human dignity is all encompassing regardless of the physical location of the participant or the financial status.

Holistic Nursing Care

Holistic nursing care is a philosophy based on treating and healing the person as a whole; not just one area of concern due to illness or disease.  This concept realizes the interconnectedness of the body and mind in balance with emotions and spirit flowing into society and community, culture and environment combined into a whole body relationship. Precisely holistic nursing recognizes the body-mind-spirit connectedness of the person (Frisch, 2001). This is the combination of beliefs and values on each individual’s personal experiences. Faith is a central component of holistic nursing care and emphasis is placed on the person as a whole and the belief that healing is possible through clinical intervention, nursing care, faith and the patient’s own attitudes and commitment to working as a team with the healthcare professionals to achieve a state of wellness.

Case Study A

This case study describes a stillborn child to a 36 year old mother with no prior pregnancies. She is obviously devastated as she has been joyfully waiting on her first child. At this age she realizes the odds and statistics for children born to older women. However, applying holistic nursing care may help her to realize the possibilities for trying for another child. Facilitating the healing process for this lady will require physiological with psychological therapeutic processes to heal her as a total person and help her to access her healing potential. The use of complementary or alternative modalities, known as CAM, enhances the patient’s potential for greater healing. Also empowering her to believe in herself and her body as one; supporting each other to endure and accomplish whatever tasks she decides to place on her body, mind and spirit.

In order to assist this patient under the auspices of holistic nursing care, the first step will be to address her comment of “at my age this was my last chance to have a child.” Using sympathy, empathy and compassion, I would explain to her that there is not a set age that defines when a woman can no longer have children.  By using respectful dialog, I would attempt to make her aware she should be able to try to get pregnant again if she so desires. This patient may benefit from learning techniques to realize the body-mind-spirit connection such as meditation.  I would also encourage her to meditate on an overall healing process so that she may be better equipped to deal with the death of her child and the realization of all of the possibilities, if she wishes to try again.

Overall I would take the time to not only talk with her but would also just simply listen to her and allow her to grieve appropriately. Next I would use touch to convey my sincerity in wanting to help heal her and also teach her to heal herself through self-care and self-accountability. I would either rub lotion on pressure points such as her back, feet or temples to help relax her body and mind for complete healing to take place. Another option is to give her a gentle back massage; preferably at night if possible to aid in her restful sleep.  I would also go over alternatives practices such as meditation and massage after she leaves the hospital.  I would empower her to realize her options have not been closed and she should first work on healing herself after proper grieving and then make a decision on whether or not to attempt another pregnancy.

Case Study B

In this case study an 86 year old gentleman has been diagnosed with diabetes and is not interested in learning how to take care of himself; believing he is too old and is going to die soon anyway. Using holistic nursing care, the goal for this individual would be to recognize his importance to his family and friends. Through compassionate care and sincerity, an attempt to make him aware of his surroundings and his place in his family and community should be attempted. Thinking through his care and education should include complementary and alternative modalities.

This patient in particular needs to understand his responsibility to himself and his health. Through the principle of caring-healing practices and environment, optimal health should be taught to this patient. Understanding that quality of life means more than just enduring a disease due to age or other obstacles will enable this patient to understand how the physical, mental, and emotional aspects affect wellness.  Also the concepts of environment, spiritual and social aspects of life are affected by not learning and practicing self-care and self-responsibility.

Florence Nightingale historically created this philosophy and has influenced nursing for many years. Her concepts were simple; the basic human needs included clean air, nourishment and a place to live. For this diabetic patient, he will also need to be taught the basics of how to care for himself to foster his wellness. This patient is reluctant to learn something new; however, if he is treated with respect and is taught the importance of living a quality life, a successful outcome of his compliance is expected. Once he is shown how the concepts of caring for his diabetes can be organized and complications eliminated, he should be receptive to trying to learn and follow the steps necessary to deal with his diabetes. This will take time and patience to guide this patient but there are not reasons why he cannot have quality of live at any age.

Cultural Care

Nursing care extends beyond a patient’s disease or illness; the cultural background must be taken into consideration to be effective in delivering quality care. “Culture can be defined as a shared system of beliefs, values and behavioral expectations that provide social structure for daily living”  (Leonard, 2001). With the increasing immigration from other countries, the United States has shown a commitment to the growth of diversity. Nurses have to realize the importance of their own culture, the culture of the healthcare system and the culture of the individual patient. The approach to care must be evaluated individually to be able to earn the patient-nurse trusting relationship. This must become a part of the nursing process.

Case Study A

In this case study a young toddler is brought the emergency room by the mother; both are Vietnamese. The child is prescribed a liquid medication for a severe upper respiratory infection.  As the discharge nurse I am responsible to ensure the mother is aware of the instructions for taking care of her child and administering the proper dosage of medication. This will require patience and accountability to ensure the mother completely understands everything before discharge.

The first step is to attempt to communicate with the mother to determine her level of English.  If her English is plausible the task will be easier.  I would also inquire if there are any other family members in the waiting room in order to deliver the instructions to any persons available to ensure total understanding.  I would instruct the mother that she is to give the child one teaspoon before each meal and before bedtime.  I would ask the mother is she is knowledgeable with measurements and inquire if she needed a medicine measuring cup and would provide her with one. I would indicate on the measuring cup the exact level she should give.

I would also ask the mother if the child eats three times a day.  The instructions are the medicine is to be delivered before meals and therefore I would ensure that they are accustomed to three meals a day to ensure the proper amounts are given.  If not, I would give instructions for having the child eat three meals to allow the proper dosage to be administered. I would ask the mother if she understands and if she has any questions.

At this point I would have the mother restate the details to me on what she understands she is to do.  I would also ask her if she can read English and if she can, I would write the instructions down for her.  I would ask her to read them back to me to ensure she understands and can read the instructions. Before discharging the child and allowing them to leave, I would again ask her to repeat the instructions to me. I would ask her if she has a telephone or cell phone and would supply the number to reach the emergency room desk in case she has problems or questions.  I would reassure her that the child would be fine as long as she administered the medication and to bring the child back if symptoms worsen or any new ones were to develop.

Case Study B

A Muslim woman presents to the emergency room with abdominal pain. This case study is to detail a pelvic exam procedure performed by a male physician to the patient. Muslim culture for women is one of modesty and privacy. Women of childbearing age are commanded to be fully covered in public.  As the emergency room nurse it is my responsibility to assist this patient in helping her to understand the need for the pelvic exam and to alleviate her fears both as a woman and being respectful of her culture.

The first step will be to determine her level of understanding the English language.  Assuming she can communicate I would then ask her if she has ever had a pelvic exam before.  I would detail the procedure and inform her of exactly what the physician would be doing and the purpose behind the exam.  I would communicate the various problems which can be determined by performing the pelvic exam and that the physician needs to rule out these problems in order to better ascertain what is causing her abdominal pain.

I would help provide her with adequate cover with gowns and sheets to preserve modesty as much as possible.  I would also alert the physician as a reminder to perform the procedure in as timely a manner as possible. Additionally I would ask her to convey any questions or fears she is experiencing and attempt to discuss them with her to facilitate a higher level of healthcare specifics for her. The more she understands about the effects on her health, hopefully the easier the procedure will be for her.  Overall I would use open and honest communication and provide the highest level of privacy possible during the exam.

Ethical Considerations in Nursing Practice

There are several key concepts which personify ethics in the practice of nursing. Respect for the individual person, confidentiality, personal dignity and being a good moral and ethical citizen of the world describe the basics of the professional code of nursing ethics. Understanding beliefs and values and morally accepting and respecting each individual person’s views is a part of the ethical code nursing personnel use to shape ethical behavior. Ethical principles including autonomy, beneficence, nonmaleficence, and justice are the core concepts which support ethical considerations in the practice of nursing. Attempting to understand and follow these principles are essentially demonstrating moral courage, basic dignity and paving the way for a culture supported by high morals, ethics and integrity. The case study of R.J. demonstrates the violation of four basic ethical principles including autonomy, beneficence, nonmaleficence, and justice. These principles are the foundation for high morals and ethics in the profession of nursing and caregiving.

Autonomy

The principle of autonomy is to be autonomous or self-determining.  This is not the same as demonstrating respect for autonomy.  One must understand that respecting autonomy is acknowledging that the individual has freedom of choice and can make these choices based on their personal values and beliefs.  R.J.’s autonomy was disrespected early when he was anxious over the surgery and the healthcare professionals dismissed his concern with a simple ‘not to worry’ attitude. During the pre-admission exam the staff should have taken more time to understand his anxiety and to consider any family history which may indicate problems with surgical procedures, anesthesia or other medications which may be administered.

Beneficence and Nonmaleficence

The principle of beneficence is one of how it is determined what is good. A basic concept associated with this principle is simply that a person should be good towards others and avoid wrongdoing or ‘evil.’  This principle does not stand alone but is directly related to nonmaleficence which literally means that a person should be committed to not harm another.  Therefore, these two principles work together to promote the theory of doing something good by first preventing any harm to the person. These principles are the foundation for moral normalcy across the continuum of society.

These principles were violated in this case study as R.J.’s history and medical condition were not carefully reviewed. He had extra weight and had a family history of laryngospasm at intubation.  Although gall bladder surgery is considered common and not a serious invasive procedure, the healthcare team conducting the pre-admission exam and interview failed to consider any harm which may come to this patient. By not taking his autonomy fears seriously, harm was done before any good could be performed.

Justice

The principle of justice pertains to ownership of what one has done to another and what is actually owed or due to another person. “In nursing, justice often focuses on equitable access to care and on equitable scarce resource allocation” (Silva & Ludwick, 1999). In this case study the family holds the hospital staff accountable for the loss of functioning by R.J. However, the hospital staff are also not being sympathetic to the plight of the family. The hospital wishes to move R.J. out and the family are adamant that he not be placed in a nursing home but rather in a rehabilitative facility. It appears that denial is a problem with who is actually responsible for the error and who will find a place for him to live and be cared for. None of the healthcare professionals want to deal with the problem and are in denial as to what to do or how to handle the patient or the family.

Professionalism

Professionalism is the conduct which a person demonstrates of a certain profession. In nursing professionalism is not only the conduct but also the aim which is directed towards helping others. Being a nurse professional is very powerful and is manner in which  a nurse dresses, their cleanliness and overall demeanor personifies true professionalism towards their intent and drive to be high quality or mediocre in their profession. For a nurse a first impression can be vital in earning the patient’s trust and also in showing the patient’s family that you are qualified and competent, with a loving and caring heart committed to each patient as a person with dignity and respect. You want that patient and family to quickly feel at ease and encompass the feeling and knowledge that as a nurse and person, you are going to care very good care of them; just like you would your own family.

Historically nurses always wore white uniforms with a nursing cap earned by completing their Bachelor’s of Science in Nursing.  Nurses would know what college you graduated from by the shape and design of the cap worn; each college had their own specific design. As time has passed the nursing profession has evolved to colorful uniforms and less rigidness on hair, cap and shoes. Dress is determined largely now by the specialty a nurse works in. Pediatric floors may use colorful uniforms whereas in emergency medical they may wear darker colors to hide the spills of the daily fluids and blood encountered.

In my practice I consider the fact that cleanliness, neatness and attention to hair and nails are a sign of presenting a professional appearance. However, professionalism does go beyond just the notion of presentation. Actions are also a representation of a person’s personal beliefs, attitudes and competency. Conducting myself in a professional manner means keeping a patient’s confidentiality and treating others with respect and personal dignity is a sign of true professionalism.

Therefore, I dress in a nursing uniform with the color as dictated by my supervisor, and I keep jewelry to a minimum and always present to work in clean uniform with hair neatly held back, no lotions or colognes which have any scent, and ensure my shoes are clean and in good repair. I further conduct myself in a professional manner through respectful communication and dialog and do not discuss patients out in the open and never engage in gossip or nonproductive talk which may interfere with performing my nursing responsibilities to the fullest.

Mission and Philosophy of the Department of Nursing

The nursing mission and philosophy of the Department of Nursing at Immaculata University is centered on faith, education, values, truth, dignity and respect for the individual person. The purpose is to prepare the person for a lifelong application to the art and science of the nursing profession. Educational, personal and practical experiences with cultural awareness are the goals for the students of this university.

Aspects in RN-BSN Course Work

The Department of Nursing and the criteria and coursework are obviously constructed from the mission and philosophy statements. During the classes and coursework performed I found the mission statement to be echoed throughout my tenure at Immaculata. The faculty work to train the students to be able to care for all ages of patients in all areas of medical specialties.  This Catholic university instills social and spiritual concepts into the program for a well rounded curriculum. Morals and ethics are taught as well as personal and professional accountability with responsibility built into the model. These goals support the mission statement of value oriented with a commitment to truth, justice, service and peace.

Further the program goal promote knowledge growth, skills and empowers students to reach for higher goals of graduate study as well as meet the demands and challenges of an ever changing and dynamic health care system. This is done in the coursework which fosters critical analysis and promotes teamwork, and develops the students into leaders. This program prepares the students for certification exams and encourages lifelong educational endeavors.

The faculty also plays an important role in fostering individual creativity and unique expression of styles to help students realize their potential as a whole person. The coursework supports the concepts including physical and intellectual with social and moral concepts. The general core and nursing concentration classes are multidimensional and work interrelated to accomplish these goals. Specialization core classes probe further into the specifics of the development of the person as a whole.

The university sees the world as all humans are comprised of body and spirit with an intellectual mind. All of these facets work harmoniously through cultural specific view of humans; all with equal value and worth. Classes to include “Issues in contemporary culture of the United States” and “Multicultural multilingual issues in education” are examples of the studies and implementing the concepts of involving the internal and external systems to form the individual.

Faculty and Study Interactions

In my experience the interaction between the faculty and the students has been one of mutual trust and respect. The faculty seem to promote the mission of the Department of Nursing through value oriented communications and interactions. They seem genuinely committed to the goal of education and teach the ethical principles of truth, justice, service and peace.  Anytime I have had problems or concerns the faculty member I trusted was always available and took the time to listen, advise and follow up on my progress.

The program promotes knowledge and skills by having faculty who are themselves well educated with nursing practice, education and administration.  They went over the courses and curriculum with me individually and addressed my objectives and special needs so I would be empowered to tackle my workload appropriately.  There was a time of planning and feedback provided to keep me appraised on my competency and to address any needs that I would have at the time. This kept me prepared and ready to meet the next challenge.  I can also see how this is encouraging for students who are considering going further to obtain a Master’s level.

To me this was the ultimate demonstration of my individual role and value to my goals. The faculty assisted me in determining the venues and choices for becoming a whole person and seeing myself as a nurse and person together in one identity.  This was vital in the turning point for entering the nursing profession and not just getting a degree. I was better equipped and able to see myself as a whole and also as a part of a larger community of physical, moral and intellectual humans.

Faculty interactions with the students always followed a faith based foundation embracing a holistic Christian attitude. It was evident that the faculty respect the student body as a whole with the acknowledgement that each person is a cultural being with a specific personhood. The faculty taught me through example that the internal and external systems of a person as unique and the spiritual as well as the societal aspects are just as important and that these internal and external components are intertwined and inseparable.

Conclusion

This online Nursing Capstone exam is a reflection on the courses and work done working towards a BSN degree. Throughout the program we have learned many philosophies, theories and concepts. Immaculata University, a Catholic centric college has taught me the holistic concepts of nursing theories affecting both my personal and professional life. Learning the concepts of research, morals, ethics, social justice and ethical decision-making skills paves the way for a successful nursing career.

Living the philosophy and mission of the University affords me the education, heart and soul and intuitive to consider working on a Master’s degree someday. I feel empowered to enter the workforce in the healthcare industry and look forward to broadening my practical nursing experience.  The faculty and college as a whole have recognized the abilities of both myself and my fellow classmates. The experience has been rewarding and my concepts of the mind, body and spirit as an intertwined and inseparable unity is strong.  I understand the concepts of internal and external environments and the specifics of how they unite the person with the environment for better perspective on healthcare and the human mind, body and spirit which lies in each of us, whatever our roles are in society.

Research

Frisch, N. (May 31, 2001). “Standards for Holistic Nursing Practice: A Way to Think About Our Care That Includes Complementary and Alternative Modalities”. Online Journal of Issues in Nursing. Vol. 6 No. 2, Manuscript 4. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.aspx

Herek, G.M. (2009). “A brief introduction to sampling.” Retrieved from http://psychology.ucdavis.edu/rainbow/html/fact_sample.html

Leonard, B. (May 31, 2001). “Quality Nursing Care Celebrates Diversity”. Online Journal of Issues in Nursing. Vol. 6 No. 2, Manuscript 3. Available: www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/NursingCareDiversity.aspx

Silva, M. C., Ludwick, R. (July 2, 1999). Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century. Online Journal of Issues in Nursing Vol. 4 No. 2. Available: www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/InterstateNursingPracticeandRegulation.aspx

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