All too often, providers of medical care overlook the fact that patients actually lead rich and multifaceted lives outside of the exam room or hospital unit. When approaching a patient, healthcare professionals---including nurses---will often refer to a patient as “the COPD’er in room 405”, “Kaposi’s Sarcoma in 7”, or “the man with rectal cancer”, overlooking that the patient may be a father, a husband, a CEO or a baker, all with their own unique history and personal circumstance. Whereas I have indeed witnessed many nurses identifying patients in this disconnected manner, doctors are, in my experience, by far the most frequent purveyors of patient depersonalization, and nurses can choose to proactively counter this very common practice as we interact with patients and their providers.

I would surmise that this shorthand of patient identification is fairly ubiquitous, and that it is (mostly) birthed in medical schools across the country as new doctors are pushed to the limits of their intellectual capacity yet rarely challenged when it comes to learning bedside manner and holistic assessment. Whereas doctors are trained to take extensive medical histories and keenly seek for clues to the cause of disease processes, psychosocial and psycho-emotional history-taking is often woefully inadequate. Meanwhile, nursing schools will often stress a more holistic approach to patient evaluation, with various assessment tools utilized to tease out a patient’s functional capacity, support systems, emotional well-being, and family structure. Additionally, nurses are instructed to use simple patient interactions and conversations for the purpose of gathering useful lifestyle data, as well as validating the patient’s unique experience of illness. Certainly there are doctors (and I have had the privilege to know several) who take these factors into account, but the medical educational establishment does not seem to actively propagate such a style of assessment.

In her excellent book, “Life Support: Three Nurses on the Front Lines ”, Suzanne Gordon writes of an oncology nurse’s approach to patient interaction:

"By her attentiveness to the mundane aspects of a patient's daily existence outside the hospital, Nancy also confirms that patients have lives whose meaning is not completely altered by disease."

This very telling passage clearly illustrates how a nurse can consciously use communication skills to assess a patient’s biopsychosocial wellness, with seemingly “every day” conversation opening the door for the recognition of the patient’s broader life apart from his or her disease state. Gordon elucidates further:

“When (the nurse) engages in what some would consider trivial chitchat, she is actually helping to create a semblance of normalcy in the extremely alien and abnormal environment of the modern hospital……(She) reassures patients that they can survive the experience of hospitalization and illness; they can find in this foreign land someone who speaks their language and tries to understand the culture they came from, who will act as their guide and companion.”

As nurses, we are in essence brokers of normalcy for patients, bridging the communication gap between the scientific and often depersonalized world of doctors and medical specialists that is starkly juxtaposed with the very human fears and preoccupations of vulnerable and frightened patients.

While it is not my intention to harangue the medical profession with lengthy critiques of its educational misfirings, I will state clearly that an enormous proportion of doctors (in particular medical specialists) with whom I have interacted over the years pay precious little attention to the broader aspects of patients’ lives beyond medications, disease processes, and symptom management. 

Thus, in this seemingly enormous chasm of communication and understanding which exists between medicine and patients, nurses step forward to mitigate the potential for patients’ alienation within the context of their own medical care. Nurses must assure patients that their lives at home and at work---as well as their families and their fears---will all be taken into consideration.

While working as a Nurse Care Manager from 2001 to 2008, it was my job to follow the care of more than eighty chronically ill patients, truly acting as a broker by greasing the wheels of the system along the trajectory of care. Some of the most important aspects of my work were to continually assess my patients’ home environments, their ability to care for themselves, their concerns and fears, and the support systems that allowed them to maintain their relative independence. When my patients would be hospitalized, discharge planning was a specific area wherein doctors’ inadequate understanding of patients’ home life would lead to poor discharge outcomes. Through the years, I consistently observed that my comprehension of a patient’s home environment and family dynamics was crucial to a successful discharge, and the doctors and discharge team would frequently ignore my opinion, much to my patients’ detriment. It was a constant uphill battle with victories that were few and far between. 

We as nurses must hold doctors and other providers accountable when it comes to assessing patients holistically. Despite the fact that we might be subverting a dominant medical paradigm that does not necessarily see the whole patient, that paradigm routinely fails to serve our patients’ needs, ignoring their concerns and the realities of their lives at home. It is into this breach that nurses must step.

We are responsible for thorough, holistic assessment, and for advocacy vis-à-vis our patients’ best overall interests. Nurses’ knowledge of patient’s lives is crucial data that must be documented, communicated, and seen as clearly relevant by the entire care team. If our non-nursing colleagues do not automatically recognize our input as such, we must be willing to grab them by their white starched collars and convince them of its relevancy.

Patients’ lives are indeed multidimensional, and nurses’ awareness of the breadth and depth of patients’ needs is a worthy cause and raison d’etre. If we hold steadfastly to our agenda of holistic patient care, our patients may very well actually receive what it is they came for in the first place. We are not at war with the practice of medicine, but we are often at war with what may be perceived as medicine’s lack of recognition of patients’ overall lives, as well as its ignorance of nurses’ crucial contribution to care. We must, in effect, keep our eyes on the proverbial prize, and continue to be the patient advocates that we were trained to be. And if that means stepping on a few medical toes in the process, then we might as well wear some heavier shoes.

NurseKeith is a nurse, writer, blogger, and nurse consultant. Please feel free to visit his blog, Digital Doorway .

TrackBack URI for this entry

Title

Comment

smaller | bigger

Subscribe via email (Registered users only)

I have read and agree to the Terms of Usage.

Add Comment