Running head: HEALTHY PARENTING

Healthy Parenting for the Whole Family

Melissa Diebel
Ferris State University

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Abstract
Reflecting on my developed philosophies and understandings of the nursing paradigms
and theories. Applying them to our current practice through self-assessment. Analyzing my
developed of nursing philosophy, beliefs and identifying what was learned. The literature
researched and reviewed for this class are filled with a number of tools for building knowledge,
skill and attitude. The learning process is the transformation taking place towards a specialty
MSN role.
Keywords: attitude, knowledge, skill, transformational, transition, paradigms,
meteparadigms, leadership, philosophies,

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Healthy Parenting for the Whole Family

The purpose of this paper is to explain my personal experiences gained through the
nursing paradigms integrated with knowledge, skill, and attitude that has assist me as I transition
to a specialty nurse role in administration. Over the last two decades, I have obtained three
degrees. These degrees have contributed greatly to the knowledge and work experiences which
have enhanced my independence and ability to grow professionally over the past sixteen years.
The Bachelors of Science in Nursing (BSN) degree allowed me to apply for an entry level or
otherwise known as BSN prepared generalist (Kuss et al, 1997) position at the Oakland
County Health Department (OCHD) seven years ago. The standards of nursing practice were
modeled at OCHD by using the nursing process to assess, analyze, plan, implement, and evaluate
each client on the nurses assigned caseload. Recently, this standard of practice shifted when the
nursing department switched to using clinical pathways as our new standard of practice. Clinical
pathways entails the use of assessment, parameters, interventions, client education materials, and
outcomes. Using the clinical pathways has assisted with my current position as a nurse in the
Nurturing Parenting Program (NPP). It has also supported my philosophy of metaparadigms, as
well as my current practice that contributes towards transitioning to the role of a specialty MSN.
Current Practice
Currently, OCHD offers community support services for nurses to provide training and
education in parenting skills. The NPP assists with parenting skills by providing suggestions for
improved family behavior, and guiding the individuals and their families using a sixteen week
program. This is an evidence base program (EBP) that provides parenting education for families
at high-risk for raising children with abuse and neglect. The NPP promotes healthy parenting.
An important part of my role in this program is to identify the high-risk factors, and the parents
attitudes toward parenting through utilizing the clinical pathways. These high-risk factors can

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relate back to the way the client was parented as a child. For example, a parent might say to her
child, You cant do anything right, eventually the child could believe he or she is unable to do
anything right. When an opportunity arises and the child does fail, then he or she has just
confirmed that Maybe I cant do anything right. This example shows the importance of
assessment in the standards of practice by changing an individuals attitude and belief (ANA,
2010 p. 32). Gathering the needed information to assist these families is an ongoing task and is
broken into five categories. These categories include inappropriate expectations, empathy,
corporal punishment, role reversal, and independency (Bavolek, 2010). As an administrator,
incorporating the clinical pathways with these categories will strengthen my understanding to
provide additional guidance to the nursing staff. The following section details the knowledge,
skills, and attitude needed for being a nurturing parenting nurse.
Knowledge
A special three-day training session is needed to earn a nurturing parenting certificate in
order to educate families at risk. This program is an evidence-based program that has proven to
be effective (Bavolek, 2010). Clinical pathways are utilized with this certificate. The knowledge
needed for this position is having a clear understanding of the clinical pathways and ability to
assess parents at risk for abuse and neglect toward their children or children that are in their care.
The nurse must learn the ability to delicately and appropriately discuss corporal punishment and
explain alternatives to corporal punishment with families involved. It is important to have the
knowledge to identify the risk factors that lead to unhealthy parenting styles. These unhealthy
behaviors can lead to inappropriate expectations and role reversals. For example, an unhealthy
behavior trait that shows neglect is when I saw a three-year-old boy make a hot dog in the
microwave because his parents neglected his hunger needs.

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A nurturing parenting nurse needs a strong grasp on how to use the assessment tool in
clinical pathways with these families. Noticing unusual signs in developmental stages can also
help to identify problems or neglect in the family. If appropriate developmental levels for
children are not being achieved, resources and referrals are provided to the parent for follow up.
This is supported by assessment, diagnosis, and expected outcomes which are presented in the
Standards of Practice by American Nurses Association (ANA, 2010). During family discussions,
it is important to know how to provide empathy. In return, the clients need to understand
empathy and how to be empathetic to their own families.
Skills
A skill needed for this position is having an appropriate disclosure of self and referencing
my own parenting experiences to the clients served. Another standard of practice (ANA, 2010)
supported is planning. Prior to each visit, planning and preparation is highly recommended.
Maintaining this standard is not easy to accomplish prior to each visit, especially with increased
caseloads and the multiple challenges of individual differences in behaviors of the families I
serve. During a typical home visit, information is shared through personal stories and exercises
to enhance the individual to except new approaches to parenting. The nursing standards of
practice (ANA, 2010) of implementation is demonstrated through the clinical pathways by using
parameters and providing interventions that are useful in guiding the parent. For example, the
nurse demonstrates the correct use of manners and later are displayed by the family. Appropriate
disclosure for one family member may not be appropriate to share with another person in the
same family. Therefore, establishing personal and professional boundaries are necessary for both
an entry level nurse and for a role of the specialty MSN (ANA, 2009). Guiding parents through
this process can be exhausting. Especially, if the individual does not believe change is needed.
Therefore, my responsibility is to approach the needed changes at their level to help them

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understand and recognize the need for change. A clients need for change is identified through a
referral from an outside agency, or the agency highly recommends the client to call the health
department to request nurturing parenting program services.
On the initial visit to the clients home, the client fills out a pre-assessment questionnaire
that points out areas of risk. The results of this questionnaire are discussed with the client
bringing out the areas of risk that need to be changed. Although the client may see the results,
they still may not understand why they need to change. It can take multiple visits using various
strategies to expose the high-risk factors that allows the client to recognize a change is needed.
Attitude
The approach needed to be a competent nurse in the nurturing parenting program is best
explained by (ANA, 2010) Register nurses employ critical thinking to integrate objective data
with knowledge gained from an assessment of the subjective experiences of healthcare
consumers (p. 22). This critical thinking provides a positive approach to continue weekly
visitations. Most families in this program present negative attitudes toward change. This
negative attitude can spread to multiple members within the family and usually does over time.
For example, the attitudes that children present usually stem from the display of the main parent
or care giver who represents the childs role model. The key focus for the NPP is attitude. The
term attitude can be perceived in multiple ways such as demeanor, body language, tone being
used, or overall mood. For example, the parent is sitting on the couch and the child comes home
from school leaving the front door wide open. In the middle of our meeting the parent yells out
Cant you shut that door?, and the child yells back you do it! The parent expressed negative
attitude then received negative attitude back. This is where the nurse needs to recognize and
address the exchange of attitude at the moment it happens. This can be an example used to role
play what happened and provide the family ways to manage their own attitude for positive

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outcomes. Situations such as this happen regularly, so it is important for the nurse to use these
situations as part of his or her training showing how the situation could have been handled
differently. It is critical for the nurse to mirror this role as a model for familys to learn from and
display toward others. Therefore, I am responsible to follow the core standards of nursing and
continuously reassess my abilities to perform as a NPP nurse.
Reflection
A NPP nurse is unique to the healthcare consumer compared to a normal health care
setting such as a hospital. Providing home visits allow the consumers to have privacy and
practice change in their own home. As I implement the nursing standards of practice within the
scope of nursing at OCHD and I believe I make a difference for the familys I serve. Registered
nurses employ practices that are restorative, supportive, and promotive in nature (ANA, 2010,
p. 23). Knowledge, skills, and the proper attitude are needed for critical thinking to ensure the
client receives quality care from the NPP. The knowledge, skills, and attitude gained through my
experiences will allow me to transition into a specialty role in administration and believe I can
make a difference at the next level.
Philosophy
My philosophy on nursing is about caring for the individual with efforts to bring them
back to a healthy and functional life. It is important to support the family with coping and
coaching strategies throughout the healing process of the individual. I believe the environment
in some way or another is the leading cause for many of the problems public health nursing
(PHN) is servicing today. I believe negative impacts of environment within the community can
be reduced by offering the clients options of having a visiting public health nurse (PHN) or
community health nurse (CHN). The CHN role was described in the PHN model of care as
another version for serving the community. This role of CHN is explained as a more specific

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role serving a smaller number of people such as a community rather than a larger population or
public service. Kuss, Proulx-Girouard, Lovitt, Katz and Kennelly (1997), explain the CHN
practice setting as, The setting in which public health nurses work has been proposed by
Rothman (1990) to be primarily in official health agencies, or tax-supported agencies with legal
mandates (p. 82). For example, I have been working with the county as a PHN for seven years,
and just over a year ago our administration changed our titles to CHN without explanation of
why. My first reaction was negative, wondering why Community? We serve the public. The
Public Health Nursing Model helped me clear up the reasons for making the title change and
provided an explanation of how the CHN role was congruent with the model of care.
I also feel that family support is needed for creating a positive environment for an
individual to heal. In many family cases, the PHN is treating the demands of these stressors
from the environment rather than being able to focus more on providing programs to prevent or
manage them at a healthy level. The next few paragraphs will explain my philosophies through
the use of the nursing paradigms, providing examples supporting how I have developed these
definitions and beliefs.
Person
I have developed my understanding of person through Selanders who examined
Nightingales beliefs. Selanders, (1998) explained how Nightingale believed that Person is the
individual receiving nursing care (p. 253). She continued to explain this view was expanded as
public health nurses were introduced as visiting nurse, who also treated the family welfare
(Selanders, 1998). I believe person is an individual who supports the family as a role model.
Person is also the client, who participates in the NPP that receives the education, skills and
resources provided by the NPP nurse improving their ability to become a better parent. Both the
person and the family are a big part of the healing process that they have control over improving

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a positive family environment. For example, an individual follows up and calls the local health
department to request participation in the NPP. The ANA (2010) explains When the patient is an
individual, the focus is on the health state, problems, or needs of the individual (p. 146), this is
how the process is initiated.
Today there are more stressors placed on families making life move at a much faster pace
than it ever has in the past. It is a struggle for families to take the needed time with each other
when they are being pulled in so many directions. Focusing on the client as an individual and
including the family for social support is very large part of the NPP which treats the person as
well as the family unit.
Health
My development of health was built upon the ANA (2010), An experience that is often
expressed in terms of wellness and illness, and may occur in the presence or absence of disease
or injury (p. 65). I feel health is the wellbeing of the individual perceived during the time of
visit. For example, the client is wearing a summer short outfit while I remain with my winter
coat and hat while inside the clients house. As I assess the clients health, this helps me to
determine the state of mental and physical wellbeing. In this particular assessment the client did
not prioritize the need to pay their electric bill on time and failed to act on multiple shut off
notices and their power was turned off.
Selanders explains that Health is described by Nightingale as not only to be well, but to
be able to use well every power we have (p. 255). This explanation reinforces my knowledge
gained through the pursuit of my specialty MSN role. Providing the guidance for the community
to make the right choices as an individual.
Environment
Environment is the surroundings that influence the individuals behavior. I developed
this understanding through my knowledge learned in the metaparidigm assignment and

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understanding by comparison the environment that I work in. For example, if an individual is
seen in their own home by a visiting nurse, this could reduce stressors that they would otherwise
experience by venturing outside their home for care. I feel that the environment can lead to
altered results depending on the clients surroundings, physical and mental situations.
Environmental aspects such as internal (stress, financial, health) and external (shelter, safety,
transportation) can affect the individual from going to the hospital or keeping scheduled Doctor
Appointments to receive appropriate care (Carper, 1978). These negative environmental
situations can be reduced by offering the option of home visits for the client. This allows the
client to be in the comfort of their own home, and accommodates for most of the internal and
external environmental concerns the clients may have. According to ANA (2010), Nurse
administrators shape the environment in which nurses practice and teach and consumers receive
health care, with the goal of inspiring those around them to reach for excellence in their practice
(p. 5).
Technology has become demanding on families both professionally and socially effecting
everyone. The instant communication through texting, email, returning voicemail messages, and
answering a phone that is always within range, creates an environment that does not allow for
down time. These additional stressors create anxiety, fatigue, aggression, rage, anger,
depression, abuse, neglect, and many other physical or psychological issues we experience today.
I believe that many people are having difficulties coping with these added stressors and need to
learn how to manage them in order to improve their environments in a positive way.
Nurse
As a public health nurse (PHN) looking to advance to a specialty role as an MSN, I feel
nursing is best explained by achieving all that you can be through knowledge and research. ANA

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(2009) states, A masters degree with a focus in nursing is recommended, as is nationally

recognized certification in nursing administration and an appropriate specialty (p. 64).
I would define nurse as a human being with a caring heart. I think of Florence
Nightingale with a lantern going around and helping the people in need. To me the nursing
paradigm is a very big part of my daily nursing activities as it is for all of us. The part of the
nursing metaparadigm that really fits my role best was explained by Tourville and Ingalls (2003),
when they explained that the nurse develops a plan of care and becomes actively involved in
education and interacting with him or her (p. 22).
Nursing Theory
In many ways my beliefs of nursing theory reflect those of Florence Nightingale. I feel
the best description of a nursing theory is explained by Selanders (1998), Through
environmental alteration, one is able to put the patient in the best possible condition for nature to
act, thereby facilitating the laws of nature (p. 252). One example I practice at home is that after
someone is sick, I open all the windows to allow ventilation for better quality air in the house,
even if it is in the middle of winter. It is my way of altering the environment and providing a
better quality environment in my home.
The Theory of Family stress and Adaptation by Geri LoBiondo-Wood was interesting to
study. The knowledge gained from this theory identified the need to support families in a crisis
and guide them to adaptation. This theory was actually my choice of study as I felt that I could
relate to it well through my practice. After more research, I was surprised to find myself actually
relating more to a different theory. The Theory of Usefulness Parent and Child Interaction by K.
Barnard easily fits the culture of nursing best for my line of work. I could benefit and utilize this
theory in my everyday practice as a nurturing parenting nurse. This is the type of negative
environments many of my clients live in. Defining resilience with these families is having the
ability to bounce back. This theory described this ability and clearly explains resilience in detail

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using the four metaparadigms of nursing. Werners study showed that resilient children have
protective factors that act as a shield against negative effects of stress (Mackrain & Bruce 2009).
Therefore, working in an advance role will only gain respect to those I encounter with and guide.
Transition
I view transition a little differently while thinking of Lewins Theory of Planned Change
as a Strategic Resource. In Lewins theory of planned change (2013), she explains change as a
three stage process, unfreezing, moving (or transitioning), and refreezing (p. 69). I now look
at transition as the phase in motion, just as I am in the transitioning phase of becoming an
advanced practice nurse. I had to unfreeze from my everyday practice, begin advancing my
education to build the knowledge, skills, and attitude needed as my transition phase to make it
to the next level of administration. I feel when transition begins to occur, the individual begins
to think of not just themselves, but rather as a leader. Marshall (2011), states, It is not about you
it is about listening and engaging, and being present in the moment of the other (p. 31). For
example, when listening to someone while your mind in running through your tasks for the day,
is not fully being present for the moment.
The purpose of this paper is to explain how I have grown to develop an understanding of
the knowledge, skills and attitude that I have acquired in this program. Providing my view of
how I would define each meteparidim as well an explanation of my understanding as I begin to
transition to an advanced practice role.
Knowledge
The knowledge I have acquired during my first semester in the MSN program, has
provided me with an enhanced view of the nursing profession. This program has already assisted
me with stepping out of the box for a birds eye perspective on my practice and role as a nurse,
as well as learning more about the leadership roles. It was interesting for me to see how the

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patterns of knowing, the metaparadigms, and the review of middle range theories have all
contributed to why I practice the way I do.
I feel the assignments have allowed me dig deeper through identifying that I engage in
the patterns of knowing every day. Learning the metaparadigms has allowed me to expand my
view of the nursing standards of practice and how they overlap one another to encompass the
healthcare profession as a whole. I have also learned how to research the scholarly materials to
learn from and possibly apply towards related issues we experience today in our profession.
I find it unusual that I am just now learning the definitions and theories behind what I
have been doing for years now, as they are the core aspects of the healthcare profession. This
additional knowledge has provided me with a broader perspective towards my transitioning to a
specialty nursing role.
The level at which I interrupted this interview is defined by Dr. Owens response from the
clarification center utilizing a clinical reasoning study supported by Health Science Clinical
Reasoning Test (Facione & Facione, 2006). According to Facione & Facione, there are two low
levels of thinking such as inductive and deductive reasoning. Followed by three other levels of
reasoning which is a higher level of thinking. The levels are inferential, analysis and evaluation
(2006). I feel this interview was based on more of the lower level of thinking because of the
limited number of steps that were discussed to achieve a specialty MSN degree. Compared to
the higher level of thinking which allows the individual to think outside the box.
Knowledge increases the thought process to advance in life through learning
opportunities. This knowledge has allowed me to question my philosophy and how I would
contribute to the healthcare profession. Understanding who, what, where, why and how as being
part of the quantitative and qualitative process and using evidence based materials really helps
me gain the knowledge needed for transitioning to a specialty role. ANA, (2010) states,
Evidence-based practice (EBP) is a scholarly and systematic problem-solving paradigm that

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results in the delivery of high-quality health care (p. 16). ANA, (2010) also explained that
Nursings embrace of EBP is part of a larger call to integrate it into the entire spectrum of
healthcare disciplines and professions (p. 16). I feel that the knowledge that I have gained
already in this MSN program, will help me utilize my newly acquired research skills for
obtaining the evidence-based information to build upon and implement change in my
professional practice as a leader.
Skills
Building from the skills in paper A, I have moved from solely looking at my current
position, to a broader perspective by viewing much more of the healthcare profession. I have also
found that collaboration is a skill needed for working together with others over the past several
months. As defined by Ponte et al. (2003), Collaboration is often cited as a skill needed by
todays healthcare leaders (p. 596). I feel I have begun the early stages of my transition process
by gaining skills through literature, research, discussions, group learning, and class assignments.
They have all contributed to the new knowledge learned and applying them to skills being
learned as an outcome.
Performing the role of a nurturing parenting nurse, I believe that a skill needed for this
position is having an appropriate disclosure of self and referencing my own parenting
experiences to the clients served. Skill represents how you prepare yourself as you transition
into a specialty role. By identifying purpose for what you do and applying it to your vision and
organizational goals (Marshall, 2011).
Attitude
I feel the word attitude often reflects negativity. I believe attitude describes the
moment where the person is. For example, it is important for the NPP nurse to recognize and
address issues that appear to come across with negative attitude. One of the Merriam-Webster
(2013), definitions of attitude is a way of thinking and behaving that people regard as

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unfriendly, rude, etc. I guess this is the way I was viewing it. The better definition to use for
reflecting the positive side of attitude is a feeling or way of thinking that affects a person's
behavior (http://www.merriam-webster.com/dictionary/attitude). This definition supports
academic learning to the highest level of achievement. As I transition to a leadership role, I can
see the importance of having a strong emphasis for maintaining a positive goal oriented attitude.
I understand and believe that adaptation is through flexibility towards personalities, tasks and
situations (ANA, 2009).
Reflect
Reflecting on my acquired knowledge as a specialty nurse from this class, the ones that
stand out are the patterns of knowing by Carper, metaparadigm, and understanding the middle
range theory on family stress and adaptation. I feel these assignments allowed me dig deeper
and identify that I have been engaging in the patterns of knowing through my everyday practice.
The four metaparadigms allowed me to understand how the standards of practice are interrelated
to nursing as they overlap one another to encompass the healthcare consumer. As for the group
theory of choice, this allowed me to research a theory of interest to me. I also learned how to
research scholarly work to compare it with related issues to nursing care. For example, I chose
the American Nurse Association [ANA] (2009) Standard 9: Professional Practice Evaluation:
The nurse administrator evaluates own nursing practice in relation to professional practice
standards and guidelines, relevant statutes, rules, and regulations (p.37). This group activity
assists the measurement criterion, explained by the ANA Interacts with peers and colleagues to
enhance own professional nursing practice and role performance (p. 37).
I can envision myself as a charismatic leader working as a liaison between the
community served, staff and executive team. Creating such an environment that would allow me
to know what the clients need and communicate the needs to administration and the staff. I look

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forward to having a leadership style that allows me to be recognized as a transformational leader

within the organization.

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References

American Nurses Association. (2010). Nursing: Scope and Standards of Practice. (2nd Ed).
Silver Spring, MD: Nursesbooks.org.
American Nurses Association. (2009). Nursing: Scope and Standards for nurse administrators.
Washington, D.C.: American Nurses Association.
Bavolek, S. J. (2010). Nurturing Parenting Programs, Facilitator Training Workbook and
Program Implementation guide, (11th ed). Family Development Resources Inc., Asheville,
NC
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. ANS Advances in Nursing
Science, 1(1), 13-23. Retrieved from http://ferris.libguides.com
Kuss, T., Proulx-Girouard, L., Lovitt, S., Katz, C., and Kennelly, P., (1997), A Public Health
Nursing Model: Public Health Nursing 14(2), 81-91.
Marshall, E. (2011). Transformational leadership in nursing: From expert clinician to influential
leader. (1st ed.). New York: Springer Publishing Company, LLC
Mackrain, M. & Bruce, N. (2009). Building Your Bounce: Simple Strategies For A Resilient You.
Lewisville, NC: KPress, Kaplan Early Learning Publishing Division.
Merriam-Webster, 2013 retrieved from: http://www.merriam-webster.com/dictionary/attitude
Selanders, L. C. (1998). The Power of Environmental Adaption: Florence Nightingales Original
Theory for Nursing Practice. Journal of Holistic Nursing 16(2) 247-263. doi:
10.1177/089801019801600213
Tourville, C. & Ingalls, K. (2003). The living tree of nursing theories. Nursing Forum, 38(3), 2130, 36. doi: 10.1111/j.0029-6473.2003.t01-1-00021.