As many of you know...I am sad. It is the first time since I've been an onc nurse that I've realized how difficult our job really is. It's this patient...we all have one. A patient we really connect with, a family we totally click with. Relationships form and we begin to care for these people with more than our evidence based practice but with our hearts. We have several 12 hour shifts to get to know them, they talk about their family, their joys, their struggles...we tell them ours. We are there in their darkest moments, at times of diagnosis, teaching them blue book, handing them tissues to dry their tears, reaching out to hug them. They hug us back. Our heart begins to feel their pain. We are there on their joyous day, the first day their child wants to eat, the first day without pain, the last chemo. We celebrate these days; we reach out to hug them. They hug us back. The patient begins to ask about you, he smiles when you walk in the room, he asks you to sit by him, to hold his urinal (which is sometimes an earned privilege!) and then to hold his hand. Then he reaches out to you. You pick him up and hold him back. His small arms wrapped around your neck fills your heart with joy. You celebrate his health and you celebrate his friendship, his trust and his love. We aren't supposed to have favorites but we all do. We are nurses but we are also human, there are certain humans that our souls just connect with.
The news of his relapse literally broke my heart. I could feel it breaking. I tried to stay busy with my everyday life, my job as a mom, but I could not escape the feeling of defeat. That pit of sadness in my stomach. My heart ached for his mom and dad and for this little person that wouldn't get to see his 5th birthday. When I saw him I could not contain the tears. I wanted to take it away; I desperately felt this urge to turn back the clock. His mom's eyes met mine and she told me that it was nice to know that he is so loved. She feels at peace knowing that her time with her son is going to be very short and is grateful for each moment she has had with him and the few that remain. We held hands and we hugged, we talked for hours. My heart is still breaking for my special little buddy and the family I've come to know so well.
They say that these things contribute to nursing burnout. The continuous exposure to heartbreak and tragic situations. So I've asked myself...does this make me reconsider doing this job? Do I wish I had a job that wasn't so sad, a job that kept me sheltered from the horrible things that can happen to precious little children? My answer is absolutely not. My tears and heartbreak are not in vain. There is a child that knows he was cared for because he trusted me. There is a family that knows that their son has made a difference in my life. Caring for him has made me a better person and I thank God that I was blessed with the opportunity to meet this family that has changed my life forever. I know I made a difference in their lives too. It is only through my vulnerability that we were able to form this connection. It is that vulnerability that opened my heart to theirs and allowed us to embrace each other. We connected. Not nurse to patient but person to person. It is so powerful and fulfilling and at times heartbreaking as well.
My heart will heal. I will always think of this family and their powerful journey and how it further connected me to my passion for not just being a nurse but also to being a person that isn't afraid to love.
Friday, December 3, 2010
Sunday, November 21, 2010
You know on the end of shift note where it says, "Have you checked and updated the anticipated discharge date?" I used to say 'no' until Nancy informed me that 'no' was not really an option, that was there as a reminder to the nurse to confirm the discharge date. At the time I laughed it off and took her advice and began making sure that I do in fact check and or update the date. How does this relate to Caritas nursing????
I was taking care of a very special family who has been on a very long road that ended here on 7 west. After months and months of debilitating symptoms and tests and doctors they are here. They have watched their son struggle and suffer over this past admission and have been anticipating their discharge as the light in their very long tunnel. They were told on a Monday that the discharge was being worked on and the plan was to discharge on Friday. Throughout the week minutes and hours ticked by, the family and patient have been watching the clock with hopeful eyes. On Friday they waited anxiously to round with the doctors so they could start their long journey home only to discover that some of the medical equipment that needed to be delivered to the patient had not yet been arranged. Their dissapointed hearts were only lifted by the news the hospital staff was working to arrange things so they could go home by Saturday morning. The night was long, the bed was uncomfortable, the pumps were beeping and the light in the darkness was knowing this was the last night. I was assigned to this patient on Saturday morning, when I went in for my first assessment there was excitement in the air. The family had not been home in weeks, they had a short window in which they could go home before they had to return for more chemo. Unfortunately their hopes were shattered once again, the equipment wouldn't arrive until Monday (at the earliest) and they had to spend at least one night in the hospital using it to make sure it functioned properly. Now all day long this patient's mom had been strong, smiling and positive but when this news came she burst into tears. She was crushed, defeated. Sometimes when the mountain is so tall it's those tiny little milestones that make you feel like you're climbing it. This is not news to you guys, this is a scenerio we have seen played out time and time again. Here is an opportunity to be a Caritas nurse, we know how important discharge is to our families. We have great doctors and care coordinators on our floor but it is our job to make sure that we assist them as well, communicate with them so we can make sure everything is taken care of and we can get our families home. To where they heal, where they renew and regenerate, where they recoup and re-energize for the next milestone on that giant mountain. This may seem like a boring post, a small thing but it is something we can do to make this impossible journey more managable.
I was taking care of a very special family who has been on a very long road that ended here on 7 west. After months and months of debilitating symptoms and tests and doctors they are here. They have watched their son struggle and suffer over this past admission and have been anticipating their discharge as the light in their very long tunnel. They were told on a Monday that the discharge was being worked on and the plan was to discharge on Friday. Throughout the week minutes and hours ticked by, the family and patient have been watching the clock with hopeful eyes. On Friday they waited anxiously to round with the doctors so they could start their long journey home only to discover that some of the medical equipment that needed to be delivered to the patient had not yet been arranged. Their dissapointed hearts were only lifted by the news the hospital staff was working to arrange things so they could go home by Saturday morning. The night was long, the bed was uncomfortable, the pumps were beeping and the light in the darkness was knowing this was the last night. I was assigned to this patient on Saturday morning, when I went in for my first assessment there was excitement in the air. The family had not been home in weeks, they had a short window in which they could go home before they had to return for more chemo. Unfortunately their hopes were shattered once again, the equipment wouldn't arrive until Monday (at the earliest) and they had to spend at least one night in the hospital using it to make sure it functioned properly. Now all day long this patient's mom had been strong, smiling and positive but when this news came she burst into tears. She was crushed, defeated. Sometimes when the mountain is so tall it's those tiny little milestones that make you feel like you're climbing it. This is not news to you guys, this is a scenerio we have seen played out time and time again. Here is an opportunity to be a Caritas nurse, we know how important discharge is to our families. We have great doctors and care coordinators on our floor but it is our job to make sure that we assist them as well, communicate with them so we can make sure everything is taken care of and we can get our families home. To where they heal, where they renew and regenerate, where they recoup and re-energize for the next milestone on that giant mountain. This may seem like a boring post, a small thing but it is something we can do to make this impossible journey more managable.
Tuesday, November 2, 2010
November Caritas Meeting
Today we had our monthly meeting and, as always, I left it feeling rejuvenated and excited about the opportunity I have to touch families and patients as well as support the amazing staff I have the opportunity to work with. It is amazing to realize that our nursing practice is something that is continually evolving based on our experiences and our reactions to them. These experiences can leave us hardened and cold, closing ourselves off to our patients and working to earn a paycheck. Or we can use these interactions to help mold us into a more present and caring nurse, someone who is aware of the intricacies of the human experience and the diverse needs and requirements of those we interact with. It is a process that is constantly evolving and something that can always be improved upon. I am constantly amazed at the high quality of care the nurses of 7 West provide to our patients. I am always amazed with the kindness and teamwork that is displayed on our unit and I am excited to see how we evolve the possibilities are endless!
Wednesday, October 20, 2010
Pause To Care Campaign
We had our monthly house wide Caritas meeting a couple weeks ago and we discussed the Pause to Care Campaign. Because everyone hasn't seen the brochure yet I thought I would copy the pamphlet on the blog so everyone has an idea what it is...
"As healthcare providers in today's world we have to deal with a lot of stress. We have high acuity patients who need our expertise to get better and our compassionate care to help them heal. Every shift we deal with all the demands that come with providing the best care we can. Charting, assessments, labs, pain, medications...the list goes on and on. All these pressures can often make us feel rushed. We find ourselves hurried when we still need to provide safe and kindhearted care. Rushed to get to your next patient because they also deserve all you have to give. We can become so task oriented that we often burst into our patient's rooms, quickly take care of our duties and leave fast so we can move on. In our rush we might lose focus that this is their space. We can overlook their need for privacy. We can briefly forget that they need an environment that is caring and calm so they can get better.
I wonder if we were to take a moment and see ourselves through our patient's eyes what would we see? Better yet, in these moments, I wonder if we were in their shoes what would we be feeling? Can others actually feel our stress? What so we really bring with us into our rooms? Medicine...sure, supplies...often, STRESS...possibly! What if everything weighing on our minds joins us at the bedside? Is there a way to enter our rooms so that we don't inadvertently make their environment less healing? Is there a better way to deal with our mounting stress so we can keep ourselves healthy and able to continue to care for others? This is where PAUSE TO CARE comes in.
Pause to care is a simple way to remind yourself that you are entering another person's space. To be mindful of what you are dealing with on the inside so that you are aware of what you are sharing with others on the outside. Jean Watson, through her theory, "The Philosophy and Science of Caring" points out that what you hold in your heart your patient can feel. When we are truly present with our patient and focused on only them, they feel cared for. On the other hand, if we are holding onto stress, they will sense that too. Have you ever felt like you were sharing another persons' stress? That they had a smile on their face but you just had to look in their eyes or watch their body language to know their mind was on something was on their mind other than you? To ensure that our patients and families don't feel that way we are asking you to take an easy step before you open your patient's door. We want you to take a moment for yourself...simply Pause. Pause and take a deep breath. Pause to help yourself focus solely on what the next moment may bring. Pause to give your patient's the gift of being completely present. Pause to let go of your stress and not bring it with you to the bedside. Pause so that you don't burst into their room and disrespect their need for privacy and security. Pause and remember that as soon as you enter their space you instantly become part of that healing environment. Simply pause to show you care!"
Benefits for Staff
- Calms us and eases stress
- Gives us a moment for just ourselves
- Reminds us that we are part of the healing environment
- Lets us collect our thoughts and enter more ready and focused to help the patient
- Caring moments happen more readily
- Care is more meaningful and fulfilling
Benefits for Patients and Families
- Shows privacy and respect are valued
- Feel more trusting of staff and builds on our relationship with both patient and family
- Safety - Fewer mistakes happen when staff is focused
- Illustrates how much staff at TCH care
- Shows we are respectful of both their time and space
Manifesting Care in the Midst of Stress
* Pause
* Calm
* Be Present
* Trust
* Care
* Healing Environment
* Focus
Since everyone can't see this brochure...there it is! What do you think? It reminds me a lot of an aunt I have, she is very nice and always kind but every time I talk to her I can tell she is rushed and needs to get off the phone or needs to be somewhere else. I find myself speeding up my conversation or not asking something I was going to ask because I can tell she is not really present, not really paying attention to what I am saying. It has become a running inside joke in my family, often I’ll tell my mom, “I feel like I’m talking to Aunt T! Stop what you’re doing, I need you to listen to me right now.” At that point my mom will stop what it is she is doing and apologize and give me her focused attention. No one wants to feel like they aren’t important enough to have someone’s full attention. Have you ever expirenced that? Do you know someone that is that way? On the other hand, do you have anyone in your life that is the opposite? That you cherish talking with because they always make you feel like you’re the only person in the room and give you their undivided attention, they seem genuinely interested in what you’re talking about, and make you feel valued? That is the difference we want to provide for our patients. It is not something that is easy or something that comes naturally for all people but it is such a wonderful tool and gift that we can give those we interact with.
I was actually asked at the meeting to bring this to 7West. Not only is it something we think about but the Council for Caritas partnered with the Inpatient Medical Customer Service Team to create signs that would be placed outside of each of our patient's rooms that say, "Pause to Care" as a reminder to take a moment to refocus and re-center before opening that door. I would love feedback! We are so incredibly busy on our floor and our acuity has been so high that taking a moment to pause could be incredibly helpful. On the other hand, the additional signage in addition to the hourly rounding that our staff is still adjusting too could just be another source of frustration for staff. That's where you come in. I need your feedback! Please, feel free to comment on the blog and get a discussion started that is why it's here! Thanks for continuing to do an amazing job for our patients and families. I am continually getting reminders of how lucky I am to work with such amazing people. You guys ROCK!
"As healthcare providers in today's world we have to deal with a lot of stress. We have high acuity patients who need our expertise to get better and our compassionate care to help them heal. Every shift we deal with all the demands that come with providing the best care we can. Charting, assessments, labs, pain, medications...the list goes on and on. All these pressures can often make us feel rushed. We find ourselves hurried when we still need to provide safe and kindhearted care. Rushed to get to your next patient because they also deserve all you have to give. We can become so task oriented that we often burst into our patient's rooms, quickly take care of our duties and leave fast so we can move on. In our rush we might lose focus that this is their space. We can overlook their need for privacy. We can briefly forget that they need an environment that is caring and calm so they can get better.
I wonder if we were to take a moment and see ourselves through our patient's eyes what would we see? Better yet, in these moments, I wonder if we were in their shoes what would we be feeling? Can others actually feel our stress? What so we really bring with us into our rooms? Medicine...sure, supplies...often, STRESS...possibly! What if everything weighing on our minds joins us at the bedside? Is there a way to enter our rooms so that we don't inadvertently make their environment less healing? Is there a better way to deal with our mounting stress so we can keep ourselves healthy and able to continue to care for others? This is where PAUSE TO CARE comes in.
Pause to care is a simple way to remind yourself that you are entering another person's space. To be mindful of what you are dealing with on the inside so that you are aware of what you are sharing with others on the outside. Jean Watson, through her theory, "The Philosophy and Science of Caring" points out that what you hold in your heart your patient can feel. When we are truly present with our patient and focused on only them, they feel cared for. On the other hand, if we are holding onto stress, they will sense that too. Have you ever felt like you were sharing another persons' stress? That they had a smile on their face but you just had to look in their eyes or watch their body language to know their mind was on something was on their mind other than you? To ensure that our patients and families don't feel that way we are asking you to take an easy step before you open your patient's door. We want you to take a moment for yourself...simply Pause. Pause and take a deep breath. Pause to help yourself focus solely on what the next moment may bring. Pause to give your patient's the gift of being completely present. Pause to let go of your stress and not bring it with you to the bedside. Pause so that you don't burst into their room and disrespect their need for privacy and security. Pause and remember that as soon as you enter their space you instantly become part of that healing environment. Simply pause to show you care!"
Benefits for Staff
- Calms us and eases stress
- Gives us a moment for just ourselves
- Reminds us that we are part of the healing environment
- Lets us collect our thoughts and enter more ready and focused to help the patient
- Caring moments happen more readily
- Care is more meaningful and fulfilling
Benefits for Patients and Families
- Shows privacy and respect are valued
- Feel more trusting of staff and builds on our relationship with both patient and family
- Safety - Fewer mistakes happen when staff is focused
- Illustrates how much staff at TCH care
- Shows we are respectful of both their time and space
Manifesting Care in the Midst of Stress
* Pause
* Calm
* Be Present
* Trust
* Care
* Healing Environment
* Focus
Since everyone can't see this brochure...there it is! What do you think? It reminds me a lot of an aunt I have, she is very nice and always kind but every time I talk to her I can tell she is rushed and needs to get off the phone or needs to be somewhere else. I find myself speeding up my conversation or not asking something I was going to ask because I can tell she is not really present, not really paying attention to what I am saying. It has become a running inside joke in my family, often I’ll tell my mom, “I feel like I’m talking to Aunt T! Stop what you’re doing, I need you to listen to me right now.” At that point my mom will stop what it is she is doing and apologize and give me her focused attention. No one wants to feel like they aren’t important enough to have someone’s full attention. Have you ever expirenced that? Do you know someone that is that way? On the other hand, do you have anyone in your life that is the opposite? That you cherish talking with because they always make you feel like you’re the only person in the room and give you their undivided attention, they seem genuinely interested in what you’re talking about, and make you feel valued? That is the difference we want to provide for our patients. It is not something that is easy or something that comes naturally for all people but it is such a wonderful tool and gift that we can give those we interact with.
I was actually asked at the meeting to bring this to 7West. Not only is it something we think about but the Council for Caritas partnered with the Inpatient Medical Customer Service Team to create signs that would be placed outside of each of our patient's rooms that say, "Pause to Care" as a reminder to take a moment to refocus and re-center before opening that door. I would love feedback! We are so incredibly busy on our floor and our acuity has been so high that taking a moment to pause could be incredibly helpful. On the other hand, the additional signage in addition to the hourly rounding that our staff is still adjusting too could just be another source of frustration for staff. That's where you come in. I need your feedback! Please, feel free to comment on the blog and get a discussion started that is why it's here! Thanks for continuing to do an amazing job for our patients and families. I am continually getting reminders of how lucky I am to work with such amazing people. You guys ROCK!
Saturday, September 4, 2010
PART II - Life Neutral
According to the article, "life neutral, or biopassive, mode of being with another occurs when one is detached from the true center of the other and when there is no effect on the energy ot life of the other. This lack of response, interest, and affect derives from inattentiveness or insensitivity to the other. It refers to the lack of a positive or caring approach rather than the presence of something destructive. Although it has no real effect on the life in the other, it sometimes creates a feeling of loneliness, because there is no mutual acknowledgement of personhood, no person-to-person contact. Furthermore, many seem to experience this apathetic inattention not only as lack of care but as non caring or uncaring."
Have you ever arrived at work and felt so drained by your last shift, or what is going on at home or your horrible drive that you just didn't feel in the mood to be caring and sincere? That feeling of being 'tapped out' can really break a day. The difficult thing to realize is the effect it has on our patients. When we are not present, when we are just attending to the 'patient' and not the 'person' this can negatively affect our patient's outcome as well as their perception of their situation. It is hard to think that we can never have a bad day and unfair to think that is possible. It is just important to realize the effect our attitude and our sincerity has on our patients.
Jean Watson says, "a nurse can make the patient's world larger or smaller, brighter or drab" we have to choose what kind of world we want to give to our patients.
Today I am floating to a different unit. I have such a place in my heart for oncology patients and their struggles and the turmoil their families go through, I have become somewhat desensitized to the smaller yet in some ways, equally frightening illnesses that effect other kids. Today I am taking care of a child with Strep, no cancer, no previous health history...just plain strep. At first it was a little bit of a stretch for me to find the deep empathy and compassion that usually comes so easy for me on 7 west. However I was aware of my own attitude and did my best to stay connected to this family, their fears and worries. I had to remember that while their child does not have cancer, to them, strep may as well be. They are sleep deprived and deeply worried about this child who is the center of their world. Nursing isn't a job it is a practice, it is something that is constantly evolving and something we can continually improve. Even on the most mundane and slow days we can grow and cultivate our own practice.
Have you ever arrived at work and felt so drained by your last shift, or what is going on at home or your horrible drive that you just didn't feel in the mood to be caring and sincere? That feeling of being 'tapped out' can really break a day. The difficult thing to realize is the effect it has on our patients. When we are not present, when we are just attending to the 'patient' and not the 'person' this can negatively affect our patient's outcome as well as their perception of their situation. It is hard to think that we can never have a bad day and unfair to think that is possible. It is just important to realize the effect our attitude and our sincerity has on our patients.
Jean Watson says, "a nurse can make the patient's world larger or smaller, brighter or drab" we have to choose what kind of world we want to give to our patients.
Today I am floating to a different unit. I have such a place in my heart for oncology patients and their struggles and the turmoil their families go through, I have become somewhat desensitized to the smaller yet in some ways, equally frightening illnesses that effect other kids. Today I am taking care of a child with Strep, no cancer, no previous health history...just plain strep. At first it was a little bit of a stretch for me to find the deep empathy and compassion that usually comes so easy for me on 7 west. However I was aware of my own attitude and did my best to stay connected to this family, their fears and worries. I had to remember that while their child does not have cancer, to them, strep may as well be. They are sleep deprived and deeply worried about this child who is the center of their world. Nursing isn't a job it is a practice, it is something that is constantly evolving and something we can continually improve. Even on the most mundane and slow days we can grow and cultivate our own practice.
Tuesday, August 3, 2010
Caring: The Compassionate Healer
I read the most amazing article by Dolores A. Gaut & Madeleine M. Leininger called Caring: The Compassionate Healer. It describes the five basic modes of being with another: life giving, life sustaining, life neutral , life restraining and life destroying. I found this article absolutely amazing to see the depth of the impact nurses can have on patients. I will describe each of those modes as they are outlined in the article.
PART 1
Life Destroying
"This is the most severe form of indifference to the patient as a person. This involves harshness and inhumanity and is characterized by various forms of inhumane attitudes." Nine former patients were interviewed and researched for this study. Of the nine, four had a life-destroying experience. The major themes of these expirences included,"initial puzzlement and disbelief; which is followed by anger and resentment. Because of the patient's vulnerable circumstances, however, the patient is most often unable to act out feelings of anger and resentment, and these strong negative feelings seem to develop into despair and helplessness. Being uncared for in a dependant situation develops feelings of impotence, a sense of loss, and a sense of having been betrayed by those counted on for caring. If on top of that the patient is treated by the nurse as if they are somewhat less than human, the patient's feelings soon develop into feelings of alienation and identity loss. The patient feels he has no value as a person, that he is indeed less than a person: 'a side of beef', 'an object' or a 'machine'. Furthermore, experiencing uncaring increases the patient's own feelings of vulnerability within the hospital setting. Numerous coresearchers alluded to the threat of dehumanization within today's hospitals.
It was their unanimous perception that they felt vulnerable and in need of caring when they were in the hospital. Some suggested this makes patients more sensitive to caring and uncaring. One such former patient stated: I would expect that people being ill makes them vulnerable, so that when they have an uncaring transaction, like someone treats them rudely, they are more deeply wounded in that circumstance than if they were healthy and walking the street and someone on the corner said something stupid or insulting. I mean that they can shrug off and ignore, but here they are sick and in need, and probably feel weak in spirit, and weak in body, and so it hits home harder, any such transaction hurts them more.
Other coresearchers related that they perceived uncaring as a transference of negative enregy that affected their well being and delayed or even prevented their recovery. This percieved negative effect on well being and healing life would be a lot easier. The patient starts to feel that he is bothering the nurse when asking for help, and finds the nurse often cold and unkind, and the nurse's presence destructive in some way. This nurse approach is partly illustrated in the following account: The second one (uncaring nurse) was cold, and I can at least give her that much because I interacted with her enough. The first one, I would just say I was...what? I don't know, a piece of dust on the floor, I mean, I can't, I was a bother...The people in that room were just beds, that's all, you know, beds. She had prescriptions, she had a checklist of what she had to do, you know, your heart, etc., and that's all it was, for everybody, not just for me, you know." Another former patient said, "I had experiences of being in another ward for three days, and there was a tremendous high percentage of noncaring nurses. Actually, that is a nice description, to say noncaring nurses, they were completely cold...cold human beings, like computers. It's life, sometimes I was worried, I was...was wondering if they really even noticed that I was there.'
Dossey (1982) asserts that a patient as object approach to care delivery is destructive because it violates the oneness and wholeness that are necessary for a healthy, viable living system. Similarily, Gadow (1985) states, 'in the view of the body as a machine, such reduction occurs because regard for the body exclusively as a scientific object negates the validity of subjective meanings of the person's experience. Those meanings are categorically nonexistent in the scientific oject. The exercise of power always increases the vulnerability of the one over whom it is exercised, no mater what benevolent purpose the power serves.' "
These are severe examples of what it means to be a life-destroying presence and I truly believe that these experiences are few and far between (if at all) here at Children's. But I am also aware that I have entered a room on a busy day with the single minded focus of checking the chemo or doing a quick assessment without really being aware or sensitive to the patient's personhood. A perfect example of this is one of my primary patients. He is very young, too young to really articulate his needs but perfectly capable of letting me know when something is wrong. He has had a really difficult admission and a hard time bonding with staff. I had finally developed a repoire with him and we were having a great day. He had just had a shower (the first one in weeks) and was finally (proudly) wearing clothes. However in the process of his shower his mediport dressing was saturated (despite the aquaguard!) so as soon as he was settled I asked him if I could do a dressing change. He nodded his head and helped me slip his arm out of his shirt. I tried to do the dressing change but was still not able to fully visualize the site. I asked him if I could slip off his shirt, just for a moment, to change the dressing. As I was asking I started to slip it off (he had been in such a great mood and so cooperative I didn't think it would be a problem). He was shaking his head and I misinterpreted that he was helping me to get it off. It wasn't until I fully pulled it off that I realized he was shaking his head 'no' and as the shirt came off he began hitting me and crying. Instantly I realized I violated his trust. He was telling me 'no' and I did what I need to, treating his body like a machine, not treating him as a person. Wearing clothes was a special treat, a true treasure in his day and I had ripped them off of him (at least that is how he interpreted my actions). I don't consider myself a horrible nurse for this but I am also aware that I am not a perfect nurse. I am needing to constantly evolve to continue to improve my nursing practice as a whole. I need to continually advance my knowledge through continuing education and deepening my knowledge about the disease processes I'm working to prevent and cure as well as the medications I'm administereing to do so, but I also need to work to deepen my knowledge about indivduals and how to care for them in a holistic way. Working to improve not only their physical state but their emotional, psychological and spiritual state as well.
PART 1
Life Destroying
"This is the most severe form of indifference to the patient as a person. This involves harshness and inhumanity and is characterized by various forms of inhumane attitudes." Nine former patients were interviewed and researched for this study. Of the nine, four had a life-destroying experience. The major themes of these expirences included,"initial puzzlement and disbelief; which is followed by anger and resentment. Because of the patient's vulnerable circumstances, however, the patient is most often unable to act out feelings of anger and resentment, and these strong negative feelings seem to develop into despair and helplessness. Being uncared for in a dependant situation develops feelings of impotence, a sense of loss, and a sense of having been betrayed by those counted on for caring. If on top of that the patient is treated by the nurse as if they are somewhat less than human, the patient's feelings soon develop into feelings of alienation and identity loss. The patient feels he has no value as a person, that he is indeed less than a person: 'a side of beef', 'an object' or a 'machine'. Furthermore, experiencing uncaring increases the patient's own feelings of vulnerability within the hospital setting. Numerous coresearchers alluded to the threat of dehumanization within today's hospitals.
It was their unanimous perception that they felt vulnerable and in need of caring when they were in the hospital. Some suggested this makes patients more sensitive to caring and uncaring. One such former patient stated: I would expect that people being ill makes them vulnerable, so that when they have an uncaring transaction, like someone treats them rudely, they are more deeply wounded in that circumstance than if they were healthy and walking the street and someone on the corner said something stupid or insulting. I mean that they can shrug off and ignore, but here they are sick and in need, and probably feel weak in spirit, and weak in body, and so it hits home harder, any such transaction hurts them more.
Other coresearchers related that they perceived uncaring as a transference of negative enregy that affected their well being and delayed or even prevented their recovery. This percieved negative effect on well being and healing life would be a lot easier. The patient starts to feel that he is bothering the nurse when asking for help, and finds the nurse often cold and unkind, and the nurse's presence destructive in some way. This nurse approach is partly illustrated in the following account: The second one (uncaring nurse) was cold, and I can at least give her that much because I interacted with her enough. The first one, I would just say I was...what? I don't know, a piece of dust on the floor, I mean, I can't, I was a bother...The people in that room were just beds, that's all, you know, beds. She had prescriptions, she had a checklist of what she had to do, you know, your heart, etc., and that's all it was, for everybody, not just for me, you know." Another former patient said, "I had experiences of being in another ward for three days, and there was a tremendous high percentage of noncaring nurses. Actually, that is a nice description, to say noncaring nurses, they were completely cold...cold human beings, like computers. It's life, sometimes I was worried, I was...was wondering if they really even noticed that I was there.'
Dossey (1982) asserts that a patient as object approach to care delivery is destructive because it violates the oneness and wholeness that are necessary for a healthy, viable living system. Similarily, Gadow (1985) states, 'in the view of the body as a machine, such reduction occurs because regard for the body exclusively as a scientific object negates the validity of subjective meanings of the person's experience. Those meanings are categorically nonexistent in the scientific oject. The exercise of power always increases the vulnerability of the one over whom it is exercised, no mater what benevolent purpose the power serves.' "
These are severe examples of what it means to be a life-destroying presence and I truly believe that these experiences are few and far between (if at all) here at Children's. But I am also aware that I have entered a room on a busy day with the single minded focus of checking the chemo or doing a quick assessment without really being aware or sensitive to the patient's personhood. A perfect example of this is one of my primary patients. He is very young, too young to really articulate his needs but perfectly capable of letting me know when something is wrong. He has had a really difficult admission and a hard time bonding with staff. I had finally developed a repoire with him and we were having a great day. He had just had a shower (the first one in weeks) and was finally (proudly) wearing clothes. However in the process of his shower his mediport dressing was saturated (despite the aquaguard!) so as soon as he was settled I asked him if I could do a dressing change. He nodded his head and helped me slip his arm out of his shirt. I tried to do the dressing change but was still not able to fully visualize the site. I asked him if I could slip off his shirt, just for a moment, to change the dressing. As I was asking I started to slip it off (he had been in such a great mood and so cooperative I didn't think it would be a problem). He was shaking his head and I misinterpreted that he was helping me to get it off. It wasn't until I fully pulled it off that I realized he was shaking his head 'no' and as the shirt came off he began hitting me and crying. Instantly I realized I violated his trust. He was telling me 'no' and I did what I need to, treating his body like a machine, not treating him as a person. Wearing clothes was a special treat, a true treasure in his day and I had ripped them off of him (at least that is how he interpreted my actions). I don't consider myself a horrible nurse for this but I am also aware that I am not a perfect nurse. I am needing to constantly evolve to continue to improve my nursing practice as a whole. I need to continually advance my knowledge through continuing education and deepening my knowledge about the disease processes I'm working to prevent and cure as well as the medications I'm administereing to do so, but I also need to work to deepen my knowledge about indivduals and how to care for them in a holistic way. Working to improve not only their physical state but their emotional, psychological and spiritual state as well.
The Caring Moment
Jean Watson encourages nurses to find the caring moment in each day and in each interaction with our patients. According to her definition a caring moment "occurs whenever the nurse and another come together with their unique life histories in a human to human transaction. A caring moment involves an action and a choice by the nurse and the other."
At one of our caritas meetings a nurse was describing how nursing becomes tedious and exhausting and asked what do you do when you don't have those moments? It's not about having the moments, about aquiring them passively, it's about finding those moments. It's about entering a patient's room, their private space and deciding to make your interaction with them one about connectedness. Entering in with the mindset you are going to make the best of their situation and their cirumstances. Nurses can make a patient's world bigger or smaller, brighter or drab, how do you want to effect that enviornment?
At one of our caritas meetings a nurse was describing how nursing becomes tedious and exhausting and asked what do you do when you don't have those moments? It's not about having the moments, about aquiring them passively, it's about finding those moments. It's about entering a patient's room, their private space and deciding to make your interaction with them one about connectedness. Entering in with the mindset you are going to make the best of their situation and their cirumstances. Nurses can make a patient's world bigger or smaller, brighter or drab, how do you want to effect that enviornment?
Monday, August 2, 2010
Bear Hugs for nurses!
We have all been through so much as oncology nurses on 7 west. This is a place we can debrief, vent, laugh and connect from the comfort of our own homes! So...get a blanket, a tissue (and a glass of wine, PRN) and open your heart to the stories of your friends and co-workers.
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