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.

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?

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.