Homework: Electronic Health Records Discussion

The St. Fleur family is well respected in the Haitian community because they are religious with great moral values. They moved to the United States because of political issues in Haiti. Ronald, the youngest son of this family, is 27 years old and lives at home with his mother and father. Recently, he began having fevers and subsequently developed pneumonia. He was admitted to the hospital, where laboratory tests were HIV positive. Ronald was in shock when the doctor informed him that he was HIV positive. He confessed to the doctor that he was gay but he could not tell his family. He said that he did not want to bring shame to the family. Because he couldn’t be in a formal relationship owing to his family and the Haitian community’s view of homosexuality, he has been very promiscuous over the years.

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What are Haitians’ dominant cultural views of homosexuality?
If Ronald’s parents were to learn of his positive HIV status, how might they react if they are religious and traditional?
Identify three specific culturally congruent strategies to address in designing HIV-prevention practices in the Haitian community?

Assigmnent 2

(Carper’s Way of Knowing)

Ways of Knowing in Nursing

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Death of a newborn: healing the pain through Carper’s patterns of knowing in nursing. By: Sherman DW, Journal of the New York State Nurses Association, 00287644, 1997 Mar, Vol. 28, Issue

Death of a newborn: healing the pain through Carper’s patterns of knowing in nursing

During a six-week childbirth education course, I teach expectant couples ways to cope with the physical changes they can expect during pregnancy and delivery, as well as the emotional changes they might go through. I encourage them to draw on personal experiences and accomplishments, which will enhance their sense of inner strength and lessen their fears. I tell my pregnant couples they can call me if they have any questions, concerns, or problems related to their birth experience or during the postpartum period. Living in rural upstate communities, many young couples have moved far from the support networks of family and friends, so I extend my role to that of a “community” nurse who offers guidance and encouragement in the early days of parenthood.

Jane and Jim Olsen enrolled in my Lamaze class to relieve their anxiety about childbirth. After several infertility work-ups and one miscarriage, this pregnancy was a testimony to their love and commitment to each other. They wanted to do everything possible to insure the health of their baby and a positive birth experience. They diligently attended class, read numerous books about childbirth, and openly discussed their fears and expectations. I promised to share with them everything I knew about childbirth. My knowledge was gained through graduate education in parent-child nursing, ASPO certification as a childbirth educator, and through my own lived experiences of pregnancy, birth, and parenthood.

Although in Lamaze classes I discuss all possible variations in birth experiences and potential birth complications, I focus on birth as a natural process, requiring intense work, which most often culminates in the joyful birth of a healthy child. The possibilities of death of a newborn or mother are approached as an unlikely reality, given the expertise and technology offered by current prenatal and obstetrical care.

Yet my work on a high-risk obstetrical unit has etched in my memory the grief and loss experienced by parents who have lost their newborns. Such experiences involve intense nurse-patient relationships requiring not only scientific knowledge and skill, but a nurse’s love, respect, empathy, obligation, and commitment. Through this work, I realized the importance of encouraging grieving parents to spend time with their critically ill newborns, and in the event of death, the opportunity to hold their son or daughter as they mourned a life that was never given a chance. Some health providers and family members express concern that this would add to parents’ pain. Yet I reamed that amid the suffering and loss, the healing process can begin. As parents hold and kiss their babies, the nightmares about deformed, monster-like children are put to rest. Looking at their newborn’s features, mothers and fathers recognize family traits and decide on names. This is not only important in coming to terms with reality, but it gives them tender memories of their precious infants to hold close to their hearts.

Jane and Jim Olsen had already experienced the grief and loss of having a first-trimester miscarriage. As we shared the excitement of childbirth through our Lamaze classes, I didn’t know that one day I would be called upon to holistically integrate empirical, esthetic, ethical, and personal knowledge to help this couple heal the pain of their newborn’s death. I realize now that my teaching and nursing practice were guided by what Carper (1978) describes as “patterns of knowing in nursing.”

Keeping a Promise

One evening early in May, my phone rang. Through his tears, Jim pleaded “Please come to the hospital. We need you right away!” I quickly made arrangements for my own children and sped off to the obstetrical unit of our community hospital. When I entered the unit, the nurses greeted me saying “Your Lamaze couple, Jane and Jim Olsen, are still in the recovery room. The delivery went okay, and the baby looked perfectly nominal, but she had trouble breathing and we couldn’t resuscitate her.” I asked if Jane and Jim had seen and held their baby. The nurse answered, “No, we don’t do that.”

I instantly asked myself, “Do you know what to do for this grieving couple?” The answer was yes. I had the nursing education and background to make a difference. I must be their advocate and do everything possible to support them in their grief and create a healing experience. As I had promised, I would share with them everything I knew about childbirth. Now I must go one step further and integrate the science and art of nursing with the ethical obligations of an advocate and my personal knowledge, all ways of knowing in nursing, in facing not only birth but death.

Ways of Knowing in Nursing

Each nurse-patient interaction is a holistic expression of different patterns of knowledge in nursing. Although nursing education provides the scientific knowledge and critical thinking skills to decide the appropriate course of action in many nursing care situations, the wholeness and complexity of human experiences require nurses’ openness and receptivity to other forms of knowing.

To provide excellent nursing care, nursing knowledge must extend beyond the descriptions, explanations, and predictions offered by the scientific method to an appreciation of patterns of knowledge involving the symbolizing, understanding, and creating of human experiences? Symbolizing is the identification of reality and description of the situation or experience as it is. Understanding involves a search for meaning van explanation of the patient’s experience. Creating focuses on the imagined possibilities, and the potentials of a given event or experience (Chine & Jacobs, 1987).

Carper’s (1978) four “patterns of knowing” are interrelated and link nursing theory and nursing practice. The patterns of knowing are identified are empirics or the science of nursing, esthetics or the art of nursing, ethics, the moral component of nursing knowledge, and personal knowledge in nursing derived from one’s own lived experiences. As distinct aspects of the whole of nursing knowledge, each is vitally important and may be communicated either through words or by a nurse’s behavior and actions.

Healing Through Empirical Knowing in Nursing

Empirics as a pattern of knowing is based on the assumption that what is known is observed through the five senses and can be verified by others. Empirical knowledge is thus factual in nature, and its processes involve describing, explaining, or predicting phenomena of concern to nursing. Empirics contributes to nursing knowledge by offering the descriptive knowledge regarding disease, illness, and technology. Empirical knowledge answers the critical question “What is this?” (Chine & Jacobs, 1987; Chinn & Kramer, 1991).

The art of nursing engages nurses in the critical life events of those for whom we care. I hoped that through my presence, Jane and Jim felt a sense of comfort and support. I held them both and cried with them. I listened as Jane sobbed, “This is not the way it’s supposed to be!” I gently wiped her tears.

I knew what this baby meant to them. They had been trying to conceive for the past four years, and this baby was a source of joy and fulfillment. Jane had done everything possible to ensure the health of her baby. She ate well, avoided alcohol, got plenty of rest, and vigilantly kept her prenatal appointments. Jim was extremely proud and protective of his wife, taking over any of her strenuous household chores, working two jobs so that lane could reduce her work hours, and rubbing Jane’s belly as he talked to his unborn child. Even Jane’s mother attended a class with her daughter and son-in-law, expressing her excitement about becoming a grandmother. Homework: Electronic Health Records Discussion

Homework: Electronic Health Records Discussion