My Personal Nursing Philosophy 


According to the American Nurses Association, nursing is defined as “protection, promotion, and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (American Nurses Association, 2004, p. 7). However there is much more to nursing, as a whole and throughout this I will be discussing my own personal nursing philosophy, which is what I believe to be the core characteristics of nursing. The aspects of my nursing philosophy and value/belief system are as follows: knowledge, time management, compassion/caring, advocacy, respect, honesty and patient privacy. For the above reasons and my own personal value system I chose a career in nursing. Nursing is a career one strategically chooses to help and care for others and many men and women who do choose this career share many common value and belief systems. 


Knowledge is the core of success in this career. As a nurse you must know your diseases and disease processes. You must be able to apply classroom knowledge and skills to the work place in order to be effective as a nurse. Just because you can take a nursing exam and be successful does not mean that you will be effective at applying it in the health care setting. Therefore, I believe that application of knowledge is much more important. Personality and bedside manner are also extremely important when caring for patients as well; however it is not the only aspect of nursing that will allow success. As a good nurse you must be able to think holistically, constantly anticipating the needs of your
patient. You must be able to prioritize health care issues within your patient’s 
personal diagnosis and among the number of patients you are responsible for on a given day and be effective at intervening with these patients. Along with this idea of prioritization, you must be skilled in time management. With all the daily responsibilities to juggle on a given shift, poor organization and time management will contribute to inadequate health care for your patients. My personal value/belief system has always been to be compassionate and caring. This was instilled in me from my family upbringing. In the nursing profession you need to have an overwhelming amount of compassion and caring for your patients and their families. You are not only caring for the patient’s physical health, but also their emotional needs. For example this semester in clinical we are at a school, which is quite different than the previous semesters of clinical where we have been doing more acute care. In this school we mentored mentally challenged 7th-8th graders, there are a lot of complicated emotional issues that need to be recognized and addressed by the health care professional. I found that these patients, once you build a rapport and trust, are the more humble and neat patients to work with. We spend a lot of our time just talking to them about life and their interests and although we are still taking care of their medical needs, we are supporting them emotionally more often than not. In order to do this kind of nursing you must have a lot of empathy and compassion. The last four characteristics of my nursing philosophy are more ethical issues and basic human rights. Patient respect, advocacy, honesty and privacy are four issues that any human deserves and are especially important in the health care setting. The American Nurses Association states this idea well; the nurse promotes for, and strives to protect the health, safety, and rights of the patient (American Nurses Association, 2001, p. 12). However, it is important to understand that though these are clear nursing roles, all health care professionals such as doctors, therapists, dieticians, social workers, case managers, etc. all must collaborate and work together to maintain the patient’s rights and needs. With ineffective collaboration across the health care spectrum the patient will not get the managed care that they need and deserve. After thinking about and discussing my nursing philosophy, it is important to understand and relate it to our current health care system. At this point in time are country is experiencing a great nursing shortage which is only going to get worse in the future. As most people are aware, health care is expensive, insurance is expensive and often times not available to everyone. Also with our baby boomer generation getting older, the demand all of our knowledge, values and idealism into our job sites and apply them. If we are able to incorporate all the core characteristics of nursing, such as knowledge, time management, compassion/caring, advocacy, respect, honesty and patient privacy for health care is going to be greater. Another issue with the baby boomer generation is that many nurses at this time are approaching retirement and will again contribute to the decreased number of nurses in the health care field. Finally, we need to take a closer look at our society and the main health care issues we are seeing. What health problems are our patients’ presenting with? The leading causes of death in this country are diseases or conditions that are lifestyle choices. We need to concentrate on wellness of the population, instead of being treatment orientated as a health care system. This means, as health care providers, encouraging screening and early interventions such as education to reduce the number of patients presenting with these conditions and illnesses. If, as nurses, we are successful in health promotion then we are doing our jobs to best of our abilities. To conclude, as graduating class of nurses, we need to take all of our knowledge, values and idealism into our job sites and apply them. If you are able to incorporate all the core characteristics of nursing, such as knowledge, time management, compassion/caring, advocacy, respect, honesty and patient privacy we will be successful and well respected in our career not only by our patients and their families but also by other health care professionals and colleagues as well. I will strive to maintain and adhere to my personal nursing philosophy throughout my career. Nursing, as a whole, is a well-respected, rewarding and self-fulfilling career and I will continue to play a part in it. 



Dear Mr.X,

It was a pleasure to meet with you this afternoon. Thank you for taking the

time out to discuss the staff nursing position with me. I was impressed with the

departments’ energy and positive attitude. I would definitely enjoy being a part of

the team and know I could contribute even more creativity to your already well

rounded organization. I look forward to hearing from you concerning your hiring

decision. I appreciate your consideration.

Sincerely,

Charmaine Whitton RN

Discharge Planning for Adolescent Substance Abusers

Charmaine Whitton, AAS, RN

Nursing Case Management

Professor Kontzamanis, PhD, RN

This paper will discuss the concept of discharge planning for the adolescent substance abuser, as

well as cultural competence and how it is relevant to the identified topic. In addition to how the

culturally competent case manager will improve case management practice. Discharge planning can be

identified as a process that arranges for transition of care. It begins on the day of admission to prepare

the resources the patient may need to be transferred or transitioned safely. According to Powell and Tahan

(2010), “Transitional planning is defined as dynamic, interactive, collaborative, interdisciplinary process

of assessment and evaluation of healthcare needs of patients and their families or caregivers during or

after a phase or episode of illness. It aims to transition patients from one level of care to another. It

also includes assessment of the patient’s condition. In addition, the process ensures appropriate level of

care-at the right time, in the right amount, by the right provider, and in the right setting” (p.161).

In contrast, discharge planning is vital to and is incorporated to transitional planning. Ultimately it

focuses on discharging patients from an impatient hospital setting to another facility or home (Powell &

Tahan, 2010, p.161).

Despite the difference in the use of terms transitional planning and discharge planning,

regulatory and accreditation standards continue to focus mainly on discharge planning. The Joint Commission

requires procedures on discharge planning as well. It also requires procedures on patient flow that

indirectly implies standards around transitional planning despite the lack of use of such term (Powell &

Tahan, 2010, p.161). In the discussion of discharge planning for the adolescent substance abuser, the use of

alcohol and illicit drugs by adolescents continues to be a problem in the United States (Kellenher &

Chislom, 2006). According to the Substance Abusive Treatment Prevention and Policy, there are over nine

thousand admissions for substance abuse-related primary diagnoses in the United States (U.S) acute care

hospitals in the year 2000. Most admissions are related to drug dependency and drug/alcohol use (2006).

With numbers rising in today’s society, the number of admissions can be predicted to have doubled since the

year 2000. The National Institute on Drug Abuse, Monitoring the Future [MTF] survey indicates facts and

statistics about youth substance; stated that, “Illicit drug use among teenagers has continued at high

rates, largely due to the popularity of marijuana. Daily use of marijuana increased to 6.5 percent of

twelfth graders, compared to 5.1 percent in 2007” (2012).

The awareness of increasing rates in addition to the passion I personally have for our youth

made this a topic of interest. As a Registered Nurse, we consume the role of advocacy, education,

coordinating, and empowering, which to me indicates that we are strong enough to make a difference. The five

important functions of case management: assessment, planning, linking, advocacy and support are described

within the framework of each phase of an adolescent’s treatment programming which include assessment,

treatment, and continuation of care.

The Case Manager (CM) concept is definitely relevant to and influenced by cultural competence.

There is a need for case managers to be aware and up to date to new drugs and substances, both legal and

illegal on the market, streets, community and the society. The drugs popularity, and what social or

economical groups are at high consumption of these drugs. The CM must also have knowledge of what causes the

increase of substance use and dependency among the youth. Purnell (2009) states, “girls have considerably

less freedom in dating than their brothers. Suppression of personal freedom by parents is a major risk for

suicidal attempt in Greek adolescent girls. Additional areas identified a high-stress level for Greek

adolescents caused by extreme dependence on the family, intense pressure for school achievement, and a lack

of sexual education in the home (p.156). This example does not only disclose the stressors that adolescents

go through, but relates to the Greek culture; thus making cultural competency crucial in case management and

in the adolescents care. A cross-sectional study among university students in France from 2009 – 2011

reveals that university students face multiple stressors such as academic overload, constant pressure to

succeed, competition with peers as well as concerns about the future. Stress should not only be considered a

condition, but should be associated with potential risk behaviors leading to onset of substance use and

related problems (Tavolacci, et al., 2013). Adolescents spend a great deal of time inside and around their

schools where they directly and indirectly affected by school and community norms and culture (Kristjansson,

Sigfusdottir, &Allegrante, 2013). Likewise a population based data from 2009 Youth in Iceland school

survey, with seven thousand eighty four participants, analyzed that school-level peer smoking and

drunkenness were related to adolescent daily smoking and lifetime drunkenness. All respondents, irrespective

of socio-economic status and other background variables, time spent with parents, academic performance,

self-assessed peer respect for smoking and alcohol use, or if they have substance using friends or not,

support the purpose of prevention. They also believe that school communities should be targeted as a whole

in substance prevention programs in addition to reaching out to individuals of particular concern.

As a case manager, he/she must be conscious of the developmental stage of adolescents, young adulthood

carries significant risk for harmful use of alcohol and other drugs (Urbanoki, Kelly, Hoeppner &

Slaymaker, 2012, p.344). Therefore the CM should be unbiased and nonjudgmental. The role of family must also

be taken into consideration. The following should be of concern: What role does the parents and family play

in the adolescents’ life? As examined previously, it differentiates among cultures. What short and long term

effects can occur from the substance that is being abused? How does it affect their daily activities, mood,

or behaviors? What treatment plan is most effective? What will be a safe discharge or transition for this

adolescent or effective discharge plan?

Moreover, when the conversation of cultural competency arises in the relationship between case managers and

adolescents; the “culture” itself of the adolescent is not the only factor that has to be taken into

consideration, but the adolescent as an individual within society. Questions of significance should include:

What are the economical or sociological influences of adolescents in your community or hospital? What are

the contributing factors of the environment? How is culture perceived in a multicultural and behavioral

health setting?

“Substance-related disorders in adolescence are caused by multiple factors, including genetic vulnerability,

environmental stressors, social pressures, individual personality characteristics and psychiatric problems”

(The Center of Drug and Alcohol Program, 2013); all in which the cultural competent CM will need to be open

and receptive to, to collaborate effectively and successfully discharge to appropriate, efficient and safe

care.
Nursing case managers are suitable in assisting in intervention for substance abusers because they

generally have trouble with other aspects of their lives (Rockville, 1998).

Demographic realities in the US dictate that CM will come in contact and work with individuals of different

gender, color, ethnicity, and sexual orientation. Rockville proposes that case managers must respond

proactively and reactively to racism, classism, and sexism. He also discusses the five elements that are

associated with becoming culturally competent: valuing diversity, making cultural self assessment,

understanding the dynamics when cultures interact, incorporating cultural knowledge, and adopting practices

to address adversity (1998). Rockville continues to demonstrate that, “It is crucial for the CM to be aware

of what inhibit minorities participation in the substance abuse treatment continuum” (1998). For example,

the statement made in Alcoholic Anonymous (AA), “accepting ones powerlessness” is a central tenet of 12 Step

self-help programs. Members of oppressed groups may not accept it, given their own societal powerlessness.

“The case manager must always be sensitive to such cultural differences and identify resources that are

relevant to the individuals values. The basic function for the case manager, while being culturally

competent is to improve retention and outcome” (1998).

As anything in life there is always room for growth and improvement. The culturally competent case

manager has the capability to give adolescents hope, motivation, and perseverance with the knowledge that

some adolescents are just at a higher risk of developing substance-related disorders. Some of these

conditions are, but not limited to children of substance abusers, adolescents who are victims of

psychosocial, emotional, physical and sexual abuse. Those diagnosed with depression and suicidal ideations

are also some factors that the CM can be aware of. As well as taking into consideration the tolerance to

certain medications that are prescribed for therapy and expectations that goes along with the patients’

condition.

Prevention of substance dependence is key. There are several approaches that the case manager can

utilize to work with these individuals. This includes school based prevention programs that provide drug and

alcohol education, behavioral skills training along with interpersonal skills. Which is vital to adolescents

because school is a place where children learn to develop relationships, and the opinions of their peers

matter. Most importantly family focused prevention programs that include family therapy, family skills

training, parent training and family-self help groups are essential. I say family focused prevention is of

importance because support from ones family is greater than no other. The American Academy of Family

Physicians confirms that “Family therapy is crucial, and the provision of family support in strength

building” (2005). However, the case manager must also be knowledgeable to the patient’s substantial needs.

Including clothing, transportation, shelter, childcare or food. Treatment may not be an individual’s

priority; it may simply be safe shelter. The case manager can effectively collaborate for the adolescent to

supportive residential housing. While meeting the clients basic need he or she will be more comfortable to

endure the path of recovery. Adolescent drug and treatment programs are also options upon discharge in

correlation to relapse prevention plans.

Referrals may be needed for agencies, group, community or professional entities, case managers must

continuously assess and evaluate the referral resources to ensure that they are beneficial and appropriate

to the clients’ needs, and outcomes. Discharge information should be clear; language specific and delivery

of information should be at the adolescents and family level of education. The culturally competent case

manager, can improve advocacy, be willing to accept others, understand culturally specific responses to

problems, have the ability to view the patient as an individual and not just a member of a group, and most

importantly have the ability of have self-awareness. Optimally achieving improved mental and psychological

health by helping adolescents meet academic requirements and acquiring a positive support system. The

willingness to an open mind can ultimately improve, motivate and provide opportunities for adolescents and case managers to be a productive part of society.

References

Adolescent Substance and Abuse. (2013). South Carolina:

The Center of Drug and Alcohol Program. Retrieved from

http://alcoholanddrugabuse.org/addiction_education/adolescent_substance_abuse/

Chisolm, D., & Kelleher, K. (2006). Admission to acute care hospital for adolescent substance

abuse: a national descriptive analysis. Substance Abuse Treatment Prevention Policy.

1: 17. 1-17.
Drug Facts: High School and Youth Trends. (2012). Michigan: National Institute on Drug

Abuse. Retrieved from http://www.drugabuse.gov/sites/default/files/drugfactshsyt.pdf

Grisworld, K., Aronoff, H., Kernan, J., Kahn, L. (2008). Adolescent Substance Use and Abuse:

Recognition and Management. American Academy of Family Physicians. 77 (3), 331-336.

Kristiansson, A., Sigfusdottir, I., & Allegrante, J. (2013). Adolescent substance use and peer

use: a multilevel analysis of cross-sectional population data. Substance Abuse Treatment

Policy. 8: 27. 1-27.

Powell, S., & Tahan, H. (2010). Case Management: A Practical Guide for Education and

Practice. 3rd ed., New York, NY: Lippincott, Williams & Wilkins.

Purnell, L. (2005). Guide to Culturally Competent Health Care. 2nd ed., Philadelphia, PA: Davis

Company.

Rockville, M. D., (2012). Comprehensive Case Management for Substance Abuse Treatment:

Treatment Improvement Protocol (TIP) Series. Substance Abuse and Mental Health Service

Administration Center of Substance Abuse Treatment. 27 (5), 51-64.

Part of what makes every person unique is a personality that consists of both strengths and weaknesses. My personal strengths are having a good sense of humor, taking responsibility for my actions, ability to be trained quickly, and finding the most efficient way to execute a process. My weaknesses consist of having a lack of discipline to complete undesirable tasks, procrastination, punctuality, and introversion. I also tend to be very critical of myself.

I believe that finding the humor in any situation is my key to maintaining a positive attitude. Having a good sense of humor is very important and helps me deal with life’s day-to-day stresses. I enjoy an open banter with close friends and making fun of their decisions which, in hindsight, were found to be unwise. In addition, I can also laugh about something absurd that I did.

It is important that I take responsibility for my decisions and actions. More often, it seems that people are not held accountable. Society, in general, seems to be tolerant of excuses and reasons why a person should not be blamed. If I made a mistake, I am able to accept the consequences of my actions.

Learning how to do things has always come easily to me. Once I have been shown how to operate something or what process to follow, I am able to repeat it correctly. As a child I effortlessly learned how to play several instruments; the piano, saxophone and flute. As an adult, I quickly learn new processes taught at work and often assist the training team as they help others become knowledgeable. I hope to maintain my effortless ability to learn as I continue throughout my educational career.