Application of the Professional Practice Model
Children’s Hospital of Michigan
By Lisa Schaecher BSN, RN, CPN
1st Activity--Level 3---Application of the Professional Practice Model
“The Children’s Hospital of Michigan Professional Practice Model is outlined above. Our
practice model defines nursing as a profession. It outlines how nurses practice, collaborate,
communicate, and develop professionally to provide the highest standard of care to our patients
and their families. Four magnet components are Transformational Leadership, Structural
Empowerment, Exemplary Professional Practice, and New Knowledge, Innovations, &
Improvements are all interrelated and connected in such a way that the impact of each in turn
influences patient outcomes.” (CHM web site, April 15, 2012).
As nurses at CHM, we have a philosophy as a professional, and as a employee in the institution
in which we practice. CHM excels in providing collaborative, state of the art, holistic care across
all settings. We practice this by evidence based practice, teaching and mentoring, and by
becoming involved in the community. Our theoretical framework describes specific
characteristics or relationships between individuals, groups, situations or events. CHM’s
theoretical framework is depicted in Kristen Swanson’s Theory of Caring. Her theory of caring
focuses on the caring process during nursing interventions. A patient’s and their family's well being
should be enhanced by a caring nurse who understands common human responses to a specific health
problem. The most positive outcome that can be obtained for the patient is essential.
Our care delivery system at CHM approaches the types of care that are given within a unit.
There are different types of nursing utilized at our hospital. Team nursing, Functional nursing, Primary
nursing and total patient care, are the different scopes of nursing that we utilize in the hospital on
a daily basis. As nurses that follow the practice model, we have the responsibility to engage in
clinical practice related to children and their families regardless of the setting. We follow the
standards of nursing practice:
•
Assessment
•
Diagnosis
•
Outcome Identification
•
Planning
•
Implementation
•
Evaluation
We also follow the Standards of Professional Performance:
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Quality of Practice
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Professional Practice Evaluation
•
Collegiality
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Research, Evidence based practice and clinical scholarship
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Resource Utilization
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Leadership
•
Advocacy
The professional model component is designed to enhance our scope of practice as a nurse. We
are defined as people that have the best overall intentions to provide our families and patients
with the most optimal care. We follow the mission, vision and values of CHM in our daily
practice regardless of where we reside in the hospital. Whether, we work in the OR, or on the
patients floors, our overall achievement is to provide the best possible care for our patients and
their families.
Nurses follow the same guidelines and our responsible for the delivery of satisfying positive
patient outcomes. CHM’s mission is to improve the health and well being of all children and
their communities by advancing the science and practice of pediatric health care and through
advocacy efforts. Nurses are patient advocates at all times. We also follow the vision of CHM.
CHM’s vision is basically the hospitals plans and dreams for the future. CHM will fulfill its mission
by being an outstanding provider of child health services within the Detroit area and throughout
the state of Michigan to patients around the region, nation and globe. Nurses are outstanding
providers to their patients within the realm of CHM, as CHM is to the community. CHM’s values are
core beliefs that guide and motivate attitudes and actions. The institution provides:
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Accountability
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Compassion
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Excellence
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Innovation
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Integrity
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Partnership
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Respect
•
Unselfishness
Nursing practice shares the exact values in their setting. Pediatric patients and their families are
entitled to our compassion, excellence, respect and unselfishness. Our accountability, innovation,
integrity and partnership help define how we practice. We are accountable for our actions and we
are responsible to provide our clientele with the most outstanding care each and every day that
we practice nursing. High quality outcomes are what our patients and family deserve every
second they are in our care.
I have been a pediatric nurse for over 15 years. Pediatrics has always been my passion. I love
the interaction within the family, good or bad. I work 4SW, which is a very busy, high acuity floor. We
have ICU extension patients, that often times need more elaborate care than stable floor patients. I work
with Tracheostomy-Ventilator Dependent patients. I follow the professional Model component by
utilizing Swanson’s Theory of Caring.
Here is how my nursing practice coincides with Swanson’s Theory
Maintaining Belief
I have been one of MJ's primary nurses for over a year now. Within that year, he has had
many ups and down during his short life. His mother was 14 years old when he was born. He
was born with many birth defects, including the inability to breathe adequately on his own. He
would have to be trached, and connected to a home ventilator. She was not able to care for him,
due to her age and financial resources. Luckily, his “Nana” not only became his guardian, but his
mother’s guardian, as well. That way the could still be together, and be a family. MJ did well at home
with his two mothers for awhile, then he became more dependent on higher ventilator settings, and
ended up on our unit quite frequently. He became a “frequent flyer” as we like to call him.
His Nana, has his best interests at heart. She cares for him, like her own. She studied and
researched his lung disease, and often times butted heads with physicians when she thought they
were incorrectly diagnosing MJ. She often became upset with nurses, and caused some
issues on the unit when he was admitted. Many staff nurses would not care for MJ due to
the increased stress that Nana created. It was an intense situation. One day, it was my turn. I
was not thrilled, but addressed the challenge as best I could. I usually take "problem" parents on
without a problem, and Michelle “Nana” was no exception. She had a difficult time with MJ’s
diagnosis as of late, and often chastised physicians and nurses that did not agree with her
opinions.
Being There
He was just diagnosed with a terminal component to his already problematic history. Michelle
reeled in pain, and sadness with this horrible news. MJ’s mom had left recently and MJ missed
her greatly. This all took a toll on them. Michelle became more problematic on the unit that day,
and MJ was having a bad day, as well. She was upset that nobody had called her, and let her
know that MJ was having trouble. She started yelling at me. I stood there, and listened to her get
her frustration off her chest. I explained all that had happened, etc. Again, she was angry regarding the
lack of communication. I was not to pass judgment on my co workers nor Michelle. I decided to
embrace the situation, as well as I could. I empathized with her since I have two children, as well. We
talked about it, while I tended to MJ. He was in respiratory distress, and had many issues going on at
that moment. I was frustrated that he wasn’t getting better, and that Michelle was issuing orders to
me like she was the physician. She told me that since I had never had him before, that I did not
know what his needs were, so I should listen to what she had to say.
I listened to her, but as time went on, I believed that we both shared something in common. It
dawned on me at that moment that both of us shared a relationship not only with MJ, but with
each other. This amazing kid was having trouble breathing. He smiled so much, even when he
could barely breathe over his ventilator.
Doing For
I realized that day, that all she wanted was the best for that little boy, and that often meant going
against what the doctors desired. I collaborated with Lauren, our Nurse Practitioner from the PICU, and
Becky, our respiratory therapist on what would be the best course of action. We made changes in his
ventilator, numerous blood gases, suctioned his tracheostomy, gave numerous inhalation and pain
medications, and even letting Michelle hold him to calm him down.
But, MJ became tired, and needed more support than what was offered on the step down unit.
He needed to go to the Intensive Care Unit as soon as possible. I sat Michelle down and told her this
is what needed to be done, to make him comfortable at this point. She was reluctant at first, but
after a talk between us, she relented. MJ went to the ICU.
Knowing
He still had a rough few hours afterward, but I went over a few times before the end of my shift
to check on MJ and Michelle. I comforted her, as the physicians and nurses in the PICU worked
to make him comfortable. I believed she blamed herself, and we talked for a while. I never really
thought about how the family can be impacted so greatly. While, we work on helping their child, we
tend to forget what the family is going through. She wasn’t a horrible person, just a mother worried
about her child. Biological or not. He was her son. I could relate, as my son just turned 9. I imagined
how I would feel if this was happening to him. I can not imagine.
Over the course of many months, we became pretty close. Even when I did not have him, I
always took time to sit with her and discuss what was going on. She told me that she liked my
opinions, and took what I said to heart. I cared for this family, not only physically, but
emotionally, as well. I wasn’t being just a nurse working my hours. I was being an advocate, and
more importantly, someone she could openly communicate with, and not pass judgment.
We have a great relationship now, and she always makes sure I have him when I am scheduled.
I actually know her phone number by heart. I do not mind, even though many people do not
understand my relationship with her. I call it compassion, and I can say I care enough to make sure
this family has positive outcomes. Nursing can be difficult at times, but, I can try to make a difference.
Enabling
I know he will not be here much longer, but I can help her get through the decisions she has to
make. They are not always easy decisions. She came to me after that first encounter we had on that first
day. She told me that just listening to her concerns without passing judgment, made an impact on her.
She trusted me, and my opinions. They are like my family. I always tell people that I treat families and
patients like I would want my family to be treated. Swanson’s Theory of Caring guides my nursing
practice everyday. It makes me want to be a better nurse, and more importantly a better person.
I was given this prayer on the day I graduated from Schoolcraft Nursing School. I believe that
Swanson’s theory of caring can be best summarized by reading this prayer. I think of this prayer
every morning prior to starting my shift.
A Nurses Prayer
Give me the strength and wisdom when others need my touch,
A soothing word to speak to them,
Their hearts yearn for so much,
Give me joy and laughter, to lift a weary soul,
Pour me in compassion, to make the broken whole,
Give me gentle, healing hands, for those left in my care,
A blessing to those who need me, this is a nurse’s prayer. :)
Some of my favorite quotes about nursing....
Bound by paperwork, short on hands, sleep, and energy…nurses are rarely short on caring.~ Sharon Hudacek
"…although the days are busy and the workload is always growing, there are still those special
moments when someone says or does something and you know you’ve made a difference in
someone’s life. That’s why I became a nurse."
- Diane McKenty, Renal Health Nurse
"To do what nobody else will do, a way that nobody else can do, in spite of all we go
through; is to be a nurse."
- Rawsi Williams
When you are a nurse you know that every day you will touch a life or a life will touch
yours."