Laura, a junior nursing student, began her day of clinical experience with a bad case of anxiety. She just knew she was going to do something dumb and kill somebody. However, her assignment looked pretty simple, so she gathered her courage and went to introduce herself to her patient, Bob Norris.
A muscular thirty-five-year-old construction worker, Bob was one day post-op from a splenectomy following an automobile accident. He'd had no fractures, only some abdominal bleeding from a ruptured spleen. However, today Bob seemed restless and pale. His skin felt clammy. Laura took his vital signs, feeling a thready pulse of 120. She couldn't hear his blood pressure, but she did not worry about it. She still hadn't mastered listening through a stethoscope. She reassured Bob that he was fine and went to look for her instructor to help with the blood pressure reading.
Of course, the instructor quickly recognized that Bob was in shock. Within twenty minutes, he was back in the operating room. Laura's anxiety had clouded her ability to think. The signs of shock were the farthest thing from her mind as she tried to master basic skills and remember the tasks she was supposed to perform.
No one would question the necessity of clear thinking in concrete, life-and-death situations in nursing. Laura would soon learn the assessment skills she needed to be a good nurse. However, when it came to abstract, philosophical thinking, Laura, along with most other nurses, would resist. That kind of thinking doesn't seem important when we are surrounded by the demands of acutely ill people with too few staff to care for them adequately. When terms like philosophies of nursing, nursing theories or conceptual models enter a conversation, I've often seen eyes roll and heard comments such as, "I'll leave that kind of thinking to the academics; I don't have time for such heady stuff!!"
However, God doesn't let us off the hook. He created human beings with the unique ability to consider the reasons for our existence and the consequences of our actions. It is not good enough for nurses to know what to do; we must also know why we are doing it. Otherwise, we may end up doing more harm than good.
Paul challenged the Philippian church to think when he wrote to them: "Finally, beloved, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is pleasing, whatever is commendable, if there is any excellence and if there is anything worthy of praise, think about these things" (Phil 4:8). His exhortation stands worthy of our attention today.
First, we are to consider what is true. Nursing has been hard at work in the past three decades determining what is true for us as a profession. Theorists and nursing faculties have labored over defining the concepts in the nursing metaparadigm. Why? Because the way you define person, environment, health and nursing determines the kind of care you deliver. For example, if you believe that a person is created in the image of God, you will approach that person with much more respect than you would if you thought that person were only a bundle of chemicals with no eternal significance. That distinction has serious consequences when the person in question is an HIV-infected drug dealer or a ninety-two-year-old woman with a fractured hip or an inconvenient unborn baby.
Similarly, we need to think about the environment. The Bible tells us that God created it good and then gave it to humankind to subdue and nurture. However, human sin brought the environment under God's curse. We are neither to worship it nor exploit it. This understanding of a good environment, tainted with evil, has far-reaching ramifications. It explains why bodies usually heal, why fresh air and sunshine invigorate us and why eating a balanced diet makes strong bodies grow. However, it also explains why we constantly face accidents and natural disasters, why families become dysfunctional, why drugs have side effects, why cells become malignant and why we die.
Furthermore, we need to think about the true understanding of health. If health is the goal of nursing, then we'd better know where we're headed. Some contemporary understandings see health as merely killing germs and surgically removing tumors (the much maligned medical model). Others see only the spiritual or mental dimension, discounting the need for physical care (some alternative therapies). On the other hand, the Bible describes health as shalom-an all-encompassing, whole-person wellness.
Now back to Paul's list. Paul challenges us to think about what is honorable, just and pure. God calls us to account for our ethical standards and moral behavior. Being honorable means doing what is right, even when it may bring dire consequences. It might include reporting medication errors, refusing to participate in collusion or cover-ups, crossing a picket line or volunteering to take difficult assignments. Being just requires us to open our eyes to things we would rather not see and then to take appropriate action. That action might include serving on a hospital ethics committee, confronting discrimination, reporting abuse, educating colleagues about important ethical issues, taking risks to serve the underserved or becoming involved in politics. It is never easy. Remaining pure in our motives and behavior results from deep introspection and serious pursuit of God's will. That involves prayerfully studying the Scriptures and consistently applying them to our lives.
Finally, we are to think about what is pleasing, commendable, excellent and worthy of praise. Thinking Christianly about nursing shouldn't just make us an annoying thorn in the flesh of our colleagues. As we look at the lives of the nurse mentors described in this issue, we see people who struggled-often for their faith-but their colleagues recognized the excellence of their work. Ultimately, if we think carefully about the meaning of nursing, seeking to glorify God in what we do, the world will be drawn to the truth of Jesus Christ reflected in our nursing care.
Jesus said, "Let your light shine before others, so that they may see your good works and give glory to your Father in heaven" (Mt 5:16). We should strive for excellence in nursing. The recognition the world gives to excellence provides an open door to share the basis for our actions. However, excellence begins with the hard work of thinking about what is true and right. I challenge you to read the thoughtful articles in this issue and think on these things.
JAS