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Posts Tagged ‘Patient Care’

nurseI drove past a billboard the other day advertising a hospital in the Knoxville area. The motto read “Experience Mercy 24/7.” This really struck me, and as I drove south through Tennessee and into Georgia and Alabama, I  pondered the concept as it applies to nursing. Being a “new grad” and GREEN, it is perhaps premature for me to comment on anything I see at the hospital, especially if those comments might be considered critical in any way. So, those of you who read, please understand that I mean no offense – I’d rather that these thoughts be taken in an motivational way rather than as a criticism.

I looked up mercy at www.thefreedictionary.com and found these definitions: Compassionate treatment, especially of those under one’s power; clemency; A disposition to be kind and forgiving;  Something for which to be thankful;  Alleviation of distress; relief. Personally, I believe that mercy is a one-sided action – the recipient need do nothing to deserve or receive it. Watching many nurses react to their patients, I am beginning to realize that this quality is sadly lacking in hospitals. Some units are trying Disneyesque methods to monitor attitudes of their healthcare providers – the motto “On Stage” is used on some units, with some success. However, the deeper quality of mercy is just about lost. Patients are labeled as “good” and treated accordingly, or ” a doozy,” “high maintenance,” or ” a handful” and treated either minimally or with poor attitudes. Many nurses would resent the implication that their attitudes show to their patients, but I maintain that it is nearly impossible to be complaining about a patient at the nursing station one minute, and offering caring, merciful nursing care in their room the next. Really, the “good” patients don’t need merciful care. They elicit good care by being appreciative and gracious. It is the high maintenance patients that need merciful care – care that is given not because it is so enjoyable for you as the nurse to be in the room, but because you are in the position of clemency.

Birthplaces are quite possibly unique in that the majority of the patients are actually healthy people. However, often the experience of giving birth is as shocking and overwhelming in every way as a major illness. Although our patients are generally with us only a short time and may not be “sick” per se, we are still called upon to provide merciful care. Sadly, many of our patients have personal lifestyle habits that do not promote respect. It is very difficult for a nurse to feel sympathy in herself for a patient who has taken drugs during her pregnancy and now has a baby with symptoms of withdrawal. Our sympathy towards the helpless infant implies near outrage towards the perpetrator of the suffering – who, incidentally, may have been our patient yesterday, or will be tomorrow.  The patient who is so concerned about getting up and out of her room to smoke immediately after delivery that she is indifferent toward the infant is another patient who challenges the attitudes of the nurses. These patients require merciful care – not because they deserve it, but because they are the patient and we are in the position of clemency.  Some patients are particularly demanding, making it difficult for the nurse to stay compassionate and not get frustrated. However, patients have the perogative to be demanding. Are we not all somewhat demanding in our own way? Do we not have family members that we know would make demanding patients –  yet we still want them treated well? Do we all not expect good customer service in restaurants, hotels, and stores? The hospital is a customer service agency that is intensely more personal. It is in our power to treat the patients with kindness, whatever attentiveness we can allow while not neglecting other patients, and respect. This doesn’t mean that you must feel as though you would want to be that person’s best friend outside the hospital, but we must detach ourselves from our personal judgements about the patient, their family, their habits, and their ignorance and provide mercy 24/7. 

We, as nurses, recognize the appalling level of ignorance too often evidenced in our patients. Our region is particularly infamous for poor education, poor nutrition, and a lack of attention to personal well-being. Facts such as these are glaringly apparent in a birthing center. Teaching new mothers is a tremendous responsibility of nursing care. When your patients are in pain, more exhausted than they have ever been, and caught up in the adrenalin rush of giving birth, they are not really receptive to teaching. Still, it is our responsibility to teach to the utmost possible level – if one small lesson makes the difference for one mother-baby dyad, our efforts have not been in vain. Every patient may not be affected by our merciful care, and many will remain unappreciative. Still, when we, as nurses, lay our heads on our pillows to sleep, we will be able to rest easy knowing that we have provided the care that we would want to receive – and treated our patients as we would want our families to be treated.

If you commit yourself to merciful care, the main point to remember is that merciful care is unmerited. The patients who need it are not going to make you want to provide it. That mercy has to come from deep inside you when your personal desire might be to never walk into the room again. It won’t be easy….but it will be worth it.

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Working temporarily on a medical-surgical unit at Bristol Regional Medical Center, I am developing some firm ideas about aging and the care that I would like to receive. One of my favorite soapboxes is related to advance directives – my advice to each one of you is to seriously think about the care that you want and the treatments that you do not want, and to complete some advance directives while you are still healthy and in your right mind. I do not intend to be an elderly person hanging onto the last shred of human life through any sort of artificial means or medical treatments. Should I live to a certain age when things start to seriously deteriorate, either mentally or physically, I would like for my terminal illness be allowed to run its course and carry me  off before I become either a burden to my family or find myself the victim of my own deteriorating body. I realize that some suffering may be inevitable, with possible loss of various functions before my time may come. If, however, I am found living in a nursing home with a very poor quality of life and I develop pneumonia, I would like to receive no other treatments beyond oxygen (to ease breathing) and pain medication. Rather than viewing the pneumonia as something that should be aggressively treated, perhaps it  might be the friend that ends my full life, saving me further debilitation and loss of dignity. Too many older adults are not allowed to die but are subjected to treatment after treatment, staving off death when their quality of life is very poor indeed. It may raise ethical questions to make judgements about someone’s quality of life, but I firmly believe that were these adults able to voice their sentiments on the issue, they would prefer to be allowed to pass on. Often patients will express this desire, but families step in and insist that everything be done. I know I would want to be allowed to die. Truthfully, once my mind has gone, I see no reason to linger. Legally speaking, the medical profession is obligated to treat until no further benefit can be gained. If the family insists, the medical profession can (and often does) give futile medical care. If you do not want these treatments as you age, you must indicate so on legally binding documents – advance directives – and let your wishes be known to your family and those who might become responsible for you in the event that you become incapacitated in any way. Advance directive forms can be found on the internet, and should be filled out while you are healthy, not once you become sick. Your families should also be notified of your wishes and the location of your advance directive papers. Too many times, this has not been done, leaving the families with decisions they are ill-prepared to face in crisis. Many families do not discuss these sort of topics, and those are most ignorant of wishes when dilemmas arise. Let your family know and sign those documents!

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