The metastructure concepts of data, information, knowledge, and wisdom (DIKW paradigm) can be transformed in many areas of healthcare for generating knowledge and advancing healthcare delivery. Matney et al. (2020) describes the development of a theory, Wisdom in Action, to guide nursing practice and the transition from data to wisdom.  Matney et al. (2020) has identified wisdom antecedents; individual, pre-existing conditions which influence the development of wisdom.  The antecedents were categorized into two dimensions:  person-related and setting-related (beginning on page five of the article).

Share one antecedent from each category (person and setting related) which has an impact on the development of wisdom in your professional experience.

Here is the correct, APA citation for the article:

Matney, S. A., Avant, K., Clark, L., & Staggers, N. (2020). Development of a theory of Wisdom-in-Action for clinical nursing. ANS. Advances in Nursing Science, 43(1), 28–41. https://doi.org/10.1097/ANS.0000000000000304

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module. 

Wisdom in nursing is the productive use of date, information and knowledge in making decisions and realizing nursing actions. In other words, using the care, the cure and the care of nursing and applying it towards the better of another human being in need (Informatics: Evolution of the Nelson Data, Information, Knowledge and Wisdom Model: Part 1 | OJIN: The Online Journal of Issues in Nursing, n.d.)

In order to accomplish these tasks, one has to be formed and acquire wisdom. Below are discussed two dimensions in that very complex process.

Person related dimension

“He frowned as soon as he saw the needle in my hand. The epoetin alpha injection was the last action of the medication administration scheduled for the morning dose. My preceptor’s voice echoed in my ears: Injections are always last” “and don’t forget to pinch the skin and tell the patient as you do so…”

I have your injection Mr X I muttered and as if she was still behind me watching my every move, I administered cautiously the subcutaneous injection. The relief on my patient’s face was instantaneous. How did you do it? I did not feel anything” (own story)

Despite being a nurse for more than 12 years, the voice of my preceptor in the internship program, in my last semester of nursing, still echoes in my ear. I met this excellent RN, months before I officially became an RN, completed my education and passed the NCLEX. She precepted me as part of an internship program when I was still in nursing school and it always amazes me that she influenced greatly my nursing practice. 12 years after our brief encounter, her voice echoes in my ears when I give medications, her orders still save me from making mistakes, I remember her numerous times a day as I see how my patient looks neat in his bed, he instruction echoed in my ears at every IV insertion and she still dictates my documentation at the back of my head every time I need to write a sentence in EPIC.

This constitutes the clinical factors mentioned in the development of a theory of Wisdom.  (Matney et al., 2020)

Mentors are a big part of my wisdom, and I am a living witness to that. Moreover, what really intrigued me is that more than half of my nursing knowledge and wisdom is directly linked to a singly mentor. Initially as an RN and later as an NP, I have worked in different settings and hospitals, I started as a Telemetry RN and moved to Critical care and later on as a Cardiac Cath RN before becoming an NP. During those years, I have worked PD positions in more than 3 hospitals as SDU RN, Med-Surg and Spine floors. Hence, I have had many mentors in my nursing career. Why hence most of my knowledge comes from this single RN. This is a mystery I probably would never be able to answer.

 Setting related dimension

 remember my friend sending me a meme once, asking me if that was true. The picture was that of a patient in an ICU setting, on a ventilator, attached to many pumps infusing necessary medications, getting a slow dialysis from a sled machine, getting feed via a feeding tube an pump. Different monitors simultaneously provide data as to the patient’s hemodynamics. The meme simply said” respect your nurse as nobody can set up an ICU room.

What seemed like a picture from science fiction for my friend was in fact the image of a basic room in a critical care setting. Hence, my setting of comfort is indeed the critical care setting. Despite working on numerous settings, critical care was where I really felt I was bringing change in the patient’s status. Understanding the different complex machines and hemodynamics, the autonomy I get in that setting was a big motivation to my career and always gave me a big satisfaction. 

I truly believed that was where my service as a nurse was well appreciated. I always feel a part of the medical team in critical care. Rounds were an unofficial learning tool. Machines which seemed out of reach in other settings like a ventilator or a pacemaker, were actually tools that were routinely monitored and calibrated as needed by me in critical care.

An area where I see myself flourish and at ease. A setting related dimension (Matney et al., 2020).

References:

Informatics: Evolution of the Nelson Data, Information, Knowledge and Wisdom Model: Part 1 | OJIN: The Online Journal of Issues in Nursing. (n.d.). Ojin.nursingworld.org. https://ojin.nursingworld.org/table-of-contents/volume-23-2018/number-3-september-2018/evolution-of-nelson-model-part-1/

2- Matney, S. A., Avant, K., Clark, L., & Staggers, N. (2020). Development of a Theory of Wisdom-in-Action for Clinical Nursing. Advances in Nursing Science, 43(1), 28–41. https://doi.org/10.1097/ans.0000000000000304

There are many traits that successful nurse practitioners share, including compassion, empathy, good clinical judgement, and a strong nursing knowledge base. While each plays a part in developing competency and expertise, the concept of wisdom as it applies to nursing practice is the highest achievement to attain. Wisdom and motivation are intimately intertwined and are essential to personal growth (Using Wisdom, n.d.). Similar to respect, wisdom is something that develops and strengthens with experience and dedication to the nursing profession. 

     It is important to understand that each patient is unique, and has their own individual knowledge, life experiences, and personal set of values regarding health care, otherwise known as antecedents (Matney & Clark, 2020). Acquiring information and data about the patient is vital to formulating a plan of care and establishing a professional relationship. This is an example of wisdom in action. In my role caring for post-operative patients, the personal antecedent that has influenced my practice is procedural knowledge. Many years of working as a nurse in various procedural areas, including the Operating Room and Endoscopy, provided me with a solid foundation of anatomy, technical experience from equipment use, as well as problem solving when equipment did not work properly. The surgical knowledge gained as an Operating Room nurse provided me with a good foundation as a nurse practitioner in the surgery department. Benner’s Novice to Expert Model guides nurses through the stages of becoming competent, proficient, and finally expert status, supporting the dynamic wisdom in action theory (Ozdemir, 2019). 

     According to Matney and Clark (2020), environments that are familiar help the nurse exhibit expertise. Environments such as the Operating Room require working with a small core group of staff including a surgeon, scrub nurse, circulating nurse, and anesthesia provider in a collaborative team setting. Aside from teamwork, collaboration taught me how to communicate more effectively and confidently, anticipate needs of others, and has strengthened my decision making abilities and critical thinking skills. In my work as a nurse practitioner, I can speak confidently to patients about their surgery, despite being in my current role for only four years. One additional aspect to consider regarding antecedents is the question of time. There is no substitute for years of experience. Becoming a nurse practitioner at a younger age was not an option for me, however, the time I waited before returning to school, gave me the ability and confidence to succeed in graduate school, and now as a practicing provider. It is interesting to ponder if, or how, time influences other antecedents.  

     Wisdom is made up of scientific knowledge, theoretical knowledge, technical skills, practical wisdom, and the pursuit of truth, which help define the art and science of nursing practice (Matney et al., 2016). Wisdom in action goes beyond obtaining data and information. Plans of care must be translated and interpreted to reflect the uniqueness of each patient. As investigators and caretakers, nurse practitioners learn about patients through communication and work to develop a trusting relationship with every patient. Insight into patient’s lives helps clinicians provide optimal care.      

References

Matney, S.A., Avant, K., Staggers, N. (2016). Toward an understanding of wisdom in nursing. The Online Journal of Issues in Nursing, 21(1). https://doi.org/10.3912/OJIN.Vol21No01PPT02

Matney, S.A. & Clark, L. (2020). Development of a theory of wisdom-in-action for clinical nursing. Advances in Nursing Science, 43(1): 28041. doi: 10.1097/ANS.0000000000000304

Ozdemir, N.G. (2019). The development of nurses’ individualized care perceptions and practices: Benner’s novice to expert model perspective. International Journal of Caring Science, 12(2): 1279-1285. https://internationaljournalofcaringsciences.org/docs/81_ozdemir_special_12_2.pdf

Using Wisdom (n.d.). Models of wisdom from leading wisdom experts. https://usingwisdom.com/models-of-wisdom/

Regarding the two dimensions: person-related and setting-related, as described in Matney et al. (2020) Wisdom Action, I believe the antecedents that impact my professional experience are culture and religion as well as setting type.

              Patients have many differences based on their culture and religion, which can affect their mental health (Caplan, 2019). Understanding the rationale for these cultural and religious beliefs helps me to deliver patient-centered care. I can have empathy and compassion for patients. Cultural and religious backgrounds can influence patients’ mental and health problems. There have been times when I have been in a stressful situation with a patient where I had to recognize their culture or religion to find a solution. I was in a session with a patient diagnosed with depression, and suddenly, she started speaking in tongues, also known as glossolalia. Speaking in tongues is a culturally embedded religious activity where a person speaks in an unknown language (Keri et al., 2020). I knew immediately what the woman was doing because of my familiarity with it. Applying steps such as processing information, critical thinking, and clinical judgment outlined by Matney et al. (2020, I stopped the woman from doing this behavior and had a meaningful talk about religion with her. This situation helped me to better assist someone with problems stemming from religion.

               Clinical knowledge of setting type is another factor that enhances my professional experience. This knowledge gives me an advantage because I am comfortable and confident with my specialty. As a result, I can focus on a solution when a stressful situation arises. A part of the setting type is setting culture, which is a way of thinking. I practice positive thinking, which gets me through many stressful periods but also helps me manage the stress presented in healthcare. Stress in healthcare can lead to burnout if incorrectly handled.

Without the antecedents of culture and religion as well as setting type, I believe my job would be much more difficult. I truly believe as Matney et al. (2020) indicate that with the use of these antecedents, I am able to develop more wisdom.

References

Kéri, S., Kállai, I., & Csigó, K. (2020). Attribution of mental states in glossolalia: A direct comparison with schizophrenia. Frontal Psychology, 11, 638.

Caplan S.  (2019). Intersection of cultural and religious beliefs about mental health: Latinos in the faith-based setting. Hispanic Health Care International, 17(1), 4-10.

Matney, S., Avant, K., Clark, L., & Staggers, N., (2020). Development of a Theory of Wisdom-in-Action for Clinical Nursing. Advances in Nursing Science, 43.