According to the international standards, the conceptual model of nursing is a structure based on the philosophy of nursing, including four paradigms: nursing, personality, environment, and health. The philosophy of nursing reflects the worldview of nurse in relation to nursing activities, the formation of a holistic view of nursing, the role and place of the nursing staff in it. The philosophy of nursing makes focus on a person – sick, healthy or dying; on a person possessing biological, psychological, social and spiritual needs, and who has a right to active, harmonious life and development, to health care, regardless of religion and social status (Seedhouse, 2000).
The basic principle of the philosophy of nursing is the respect for life, dignity and rights of the patient. The philosophy of nursing sets moral responsibilities of a nurse (keep confidentiality, respect the autonomy of the patient, tell the truth, etc.); objectives, a nurse is striving for (independence, health, knowledge, skills, etc.); moral qualities or virtues (wisdom, compassion, mercy, patience, etc.). From this point of view, the ethical code of nursing is an important part of the philosophy, because it presents moral principles formulated by representatives of nursing profession for their colleagues in each country (Seedhouse, 2000; Esterhuizen, 2009).
A nurse must take all necessary steps to preserve the safety of the patient, if there is a threat to his health. The Code of Ethics of the International Council of Nurses states that neither doctor’s prescriptions, nor politics or the administration (their actions, decisions, or policies) exonerate the nurse from moral or legal responsibility for actions and decisions (Esterhuizen, 2009). It is no accident, that the basic requirements to the character of a nurse are intercession, experience, sympathy. This is also consonant with the motto of the first international nursing community: love, courage, and honor.
International Council of Nurses has developed Code of Conduct for nurses. According this code, the fundamental responsibilities of nurses have four main aspects: 1) contribution to the promotion of health; 2) prevention of diseases; 3) restoration of health; 4) alleviation of suffering. This code also defines the responsibility of nurses to the society and colleagues (Seedhouse, 2000).
It should be marked that the concept of personality has a special place in the philosophy of nursing. The object of nurse is a patient, a man as a combination of physiological, psychosocial and spiritual needs, determining his growth, development and merging with the environment. Nurses have to work with different categories of patients and should create for each patient an atmosphere of respect for his present and past, for his life values, customs and beliefs; they take necessary security measures for the patient.
In my personal belief, not only spiritual, but also external appearance of a nurse is important in the formation of right relationship between the nurse, patients, their relatives and colleagues. Clothes, facial expression, manners reflect some aspects of nurse’s individuality, in particular, the degree of care, attention towards patients, empathy. Hippocrates pointed out that doctors should keep themselves clean, have good clothes and rub scented ointments, all of which are usually pleasant for patients.
Medical staff should never forget that patients want to see a medical specialist as an ideal employee, but if patients detect flaws in nurses’ appearance, they consider these flaws as a part of professional activities. Bright lips, long lacquered nails, fingers with jewels, hyper trendy hairstyle are unacceptable in the work of nurses. Patients may suspect the lack of attention to themselves as to patients in an overemphasis of nurses on their own appearance. However, the desire to have a spectacular appearance prevails in some nurses over the professional discretion; they forget that a partly disclosed knitted sweater or woolen dress increase the possibility of infection, while nurses actually have no right to allow carelessness in the examination of patients. Thus, unpleasantness is unacceptable; it reduces the prestige of medical workers in the understanding of patients (Edwards, 2009; Esterhuizen, 2009).
Appearance should reflect inner composure, self-discipline, combine soft severity and beautiful simplicity of forms, and remain unchanged within certain limits. For example, medical uniform does not need embellishment; it decorates a person itself, symbolizing the purity of nurses’ mind, severity in carrying out their professional duties. Neatness is always associated with the high professional qualification; a patient is sure that a neat medical worker is a professional. At the same time, bright lipstick, catchy hairstyle, and knocking heels remind seriously ill people about all the joys, they are temporarily or permanently deprived of. Self-pity, involuntary envy, and dissatisfaction with the personnel appear; and patient’s suffering becomes even worse. Thus, external appearance should harmoniously complement attractiveness of a nurse, calm the patient down, make pleasant impression on relatives, and help establish good, friendly relations (Edwards, 2009; Esterhuizen, 2009).
There will also be no trust towards nurses, being frown, having careless pose, and talking like doing a favor. The real sincerity soon becomes clear for the patient, if he sees intentional politeness, obtrusive helpfulness, social smile, while medical personnel must be able to keep simple, speak clearly, calmly, discreetly and without visible effort to win over patients, be naturally beautiful. Moreover, it is well known that the effectiveness of treatment largely depends on the faith of patient in recovery, and this, in its turn, is closely connected with the degree of trust, which he feels towards the medical staff (Steis, 2009). Figuratively speaking, the treatment begins with the registration office and the hospital admissions.
The direct responsibility of the nurse is to ruin the psychological barrier in contact with the patient, make him trust, creating the climate of involvement and warmth. It should be remembered that patients, especially when they meet a nurse first, are closely monitoring every gesture, facial expression and speech, trying to catch trust and frankness in words and behavior of a nurse. Depending on how the patient’s desire to talk about himself will be understood and supported during the first conversation, the stronger will be the contact in the future.
Only after establishing contact with the patient a nurse can proceed to the evaluation of test results and other auxiliary examination methods. It is essential that the patient understands that health care workers, to whom he had come for help, are interested not only in matters of diagnosis, but also in people, who addressed them (Steis, 2009).
The culture of speech, as well as the content of the conversation, has a particular importance. The response to patient’s questions cannot be limited to generalities, as this will cause concern for the outcome of the disease, doubt about the qualification of his doctor. In addition, the patient’s trust towards medicine could be greatly undermined, if he notices that the doctor and nurse are in strained relationship, if the nurse allows irrelevant remarks and doesn’t carry out doctor’s instructions clearly. The patient may have doubts about the competence of health workers, about feasibility of their appointments, especially if the reception is held stiffly, formally, without proper examination and listening to the patient and is limited to prescribing (Steis, 2009; Esterhuizen, 2009).
Thus, philosophy of nursing sets the basic ethical responsibilities of professionals concerning the service to individuals and the society; objectives aimed by professionals, moral qualities, virtues and skills expected from them. The basic principle of the philosophy of nursing is respect for human rights and dignity, which is realized not only in the work with patients, but also in nurses’ cooperation with other specialists (Seedhouse, 2000).
The relationship between patients and nurses depend not only on individual characteristics of a patient, his psyche, but also on personality and behavior of a health care worker, his general and professional culture and ethics. The primary responsibility for the nature of these relationships (so important for the successful treatment), is always lying on nurse, who is obliged to take into account the peculiarities of patients’ personality and experience, while building relationships with them.