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Saturday, February 26, 2011

It's all about the patient.

A few months ago, I came across a text of a speech that was meant for the 2010 class graduating from Yale School of Medicine. I was intrigued to find out if the speech was in touch with the reality of every-day hospital life or if it was suited for the naiive, fresh-out-of-college young adults only. The speech pleasantly surprised me.
The speech that Doctor Berwick gave to the Yale Medical School graduating class was inspiring, sincere, and relevant to every practitioner. As I was reading the message, I felt as if Dr. Berwick was addressing his speech to me as well. I was especially touched by Don Berwick’s message, because I believe in patient-centered care; I believe that “all that matters is a person”.
Most of the hospitals have agreed on importance of involving family in patient care. Families are allowed to visit patients in an ICU, encouraged to spend time with the loved ones to help them recover. I think that this involvement should not be limited only to letting the family stay with their loved ones during procedures or preparing fold-out couches for those staying overnight. I think we all need to make an attempt to get to know our patients as people who have a life outside the hospital bed and gown. It is so easy to ask, “Who drew that Get-Well Card for you, Mrs. Jones?” to get Mrs. Jones to talk about her grandchildren, and put her at ease.
I am very lucky to work in the department where I take care of patients one at a time, because it gives me a marvelous opportunity to have conversations with them. Parts of the conversations include follow up care or description of image-guided procedure that we will be performing. Other parts are always about the patient. I ask non-intrusive questions about how they spent their holidays, or what their kids do for a living. As a result, I learn the most amazing life stories, and the patients learn to trust me. Moreover, if I know about the patients’ lifestyle, their hobbies and support systems, I can individualize their care.
In an idealized situation, finding a personal approach to each and every patient can easily be accomplished. Unfortunately, the society that lets practitioners “write rules and build walls” demands the same practitioners to treat a high volume of patients and comply with endless standards. An overworked telemetry nurse would gladly sit down and converse with Mr. Artist about his latest exhibition, but she is expected to finish a five-page admission on one patient, transfuse the second, update the family of the third, notify a physician about a change in reason on the fourth, and attend to the dying fifth… Does being task-oriented make this nurse a bad one? A med-surg nurse asks the family of her very ill patient to leave the room after ten o’clock at night, because the hospital is full and no private rooms are available to accommodate the patient and the family. The room-mate of a patient who is less sick, needs to sleep. Does this action make the nurse heartless? Increasing health care costs and high patient to practitioner ratios place constraints on health care workers.
In conclusion, I would like to note that I enjoyed Dr. Berwick’s speech greatly, and I think that we should treat our patients with respect, recognize their personal preferences and place the patient in the center of care. At the same time, I think the current state of health care does not always allow physicians and other health care workers to be as personal as they can and want to be.

Monday, February 21, 2011

My Nursing Philosophy

Before I describe my philosophy of nursing, I need to define the term “nursing philosophy”. A basic definition offered by a dictionary, suggests that philosophy is the critical study of the basic principles and concepts of a particular branch of knowledge, especially with a view to improving or reconstituting them. (Philosophy, 2011) I agree with Edwards, who writes that “philosophy is an attitude towards life and reality that evolves from each nurse’s beliefs”. (Edwards, 1997) My own interpretation of nursing philosophy arises from education, experience of working in health care and personal beliefs. Nursing philosophy in my understanding is a model that guides my thinking about observations and interpretations of events that occur due to interaction of four components of everyday nursing practice: nursing, patient, health, and environment.
For me, a profession, a vocation, art, and science coalesce to become nursing. A person must be truly devoted to caring to choose nursing as a career. A profession then matures into a vocation, a lifestyle, essence of life. A novice nurse launches her career after proving to the society that scientific knowledge obtained during college years are in compliance with the standards proposed by the board of registration. Applying knowledge gained in systematic study signifies nursing as science. On the other hand, being an accomplished nurse is not limited to being educated and experienced. When I think of a good nurse, I picture someone who mastered the art of caring. Each nurse develops her own style of caring, adjusting it to changing personalities and situations in her own distinct way.
The second component of nursing practice is a patient, a recipient of nursing care, although nursing care is not limited to the patient alone. Families, patients’ support systems, other health care workers, as well as community comprise a domain of recipients of care, because they are influenced by it in direct and indirect, negative or positive way. In my opinion, the recipient of nursing care remains the most important component of the four. I believe in patient-centered care, and that nursing would not come to exist if it were not for the patients. I think that patients’ physical and emotional environment should be viewed inseparably from the patient because of their constant two-way influences and interactions. I place a special emphasis on the link between caring and culture. Recognizing that cultures have both differences and similarities in ways of perceiving, knowing, and practicing care allows me to communicate with my patients more efficiently, develop a trusting relationship.
The last component to be addressed is health, which I view as some point on a continuum from wellness to illness. I deem nursing care to aid individuals in achieving their optimal level of wellness. In the effort to accomplish this goal, the nurses must consider the patient himself, as well as opportunities and constraints of the environment.
I apply abstract concepts of nursing philosophy in my everyday professional practice. The mission statement of my hospital emphasizes “delivering healthcare services in a personable, convenient, and compassionate manner, with respect for the dignity of patients and their families.” (Mt Auburn Hospital, 2011)  Although patients and situations change from day to day, my philosophy guides me in even the most difficult situations, and I compassionately treat each patient as a respected individual.

Edwards S.D. (1997). What is philosophy of nursing? The Journal of Advanced Nursing, 25, 1089-1093
Masters, K. (2005) Role development in professional nursing practice. Jones and Bartlett Publishers, Inc. 51-65
Mount Auburn Hospital. Mission and values. Retrieved February 2011 from
Philosophy. (n.d.) In, LLC. Retrieved February 2011 from