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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, please contact us at info@theberylinstitute.org.

 

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Patient Experience Sits at the Center of Nursing

Posted By Susan E. Mazer, Friday, October 21, 2016
Updated: Friday, October 21, 2016

The patient experience is neither new nor revolutionary in healthcare. 

Florence Nightingale, 1820-1910

In fact, it goes all the way back to the work of Florence Nightingale who, in response to what she saw in the Crimean War, realized so much suffering could be relieved with the standardization of nursing practices. 

In her first and most famous monograph, Notes on Nursing, Nightingale claimed that suffering should not be presumed as part of the disease. Rather she wrote that “the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different -- of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.” 

From experience and observation, Nightingale knew how rudeness and inconsideration on the part of physicians and nurses could cause patient suffering. The task of the nurse was to protect the patient.

She warned that the vital energy needed by the patient to go through the reparative process should not be wasted nor distracted. Nightingale considered all disease to be reparative, coming on over many years and finally showing itself in a serious of symptoms observable and obvious to both patient and nurse.

There’s no doubt that nursing is where the patient experience initiative began and is what should guide it today.

Our healthcare system has thrown out the idea that nursing might be where we could best learn about the patient experience. And yet nurses have always been the strongest clinical advocates for patients. They understand the source of pain and suffering first because of their intimate relationship with patients.

In truth, the patient experience began to deteriorate when our healthcare system became consumed with medications and technologies. Patients then became the last people to be consulted about their condition and their needs. And, nurses became medicalized as the whole system sought to make all symptoms ripe for medical diagnosis and treatment.

However, Nightingale defined nursing as managing symptoms of suffering that were neither medical nor complex -- symptoms that could be solved by manipulating the environment or paying attention to the patient’s spoken needs. Or, symptoms that reveal other issues that would undermine that patient’s own capacity to heal.

My relationship and work with nurses, which began in 1980 when I designed educational programs on the use of music as therapy, has given me perspective on the considerations prioritized by Nightingale. Dallas Smith and I wrote and presented a docudrama (now a podcast), “Florence Nightingale: In her Own Words,” that brought to life her frustrations with the system that inspired her work. Nightingale’s writings were and are consistent with her absolute commitment to the humanity of the patient, to the uniqueness of each individual and the specificity of their situation.

Additional study of nursing theory has also helped me understand and respect the transpersonal relationship that nurses have with their patients and the way that nursing holds the tradition and expertise of the patient experience.

Dr. Jean Watson, Professor Emeritus and Nurse Theorist, moved Nightingale’s work further in identifying the unique role of nurses in her Theory of Human Caring (or Caring Science). Her Caritas principles, which are the guide to her Nursing Practice Model, call upon nurses to be authentic in their caring for their patients, to treat themselves and others with loving-kindness and equanimity, and allow for the depth of physical and spiritual wholeness in themselves and their patients.

Our relationship with Dr. Watson has taken Dallas and I to Qatar and Jordan, working with nurses in the Middle East who are committed to human caring across borders and political conflict. There, where some Palestinian nurses are not paid for nine months, and where Israeli nurses take in Syrian children and love them as they heal their physical and emotional wounds, human caring has taken on profound meaning.

The bottom line for nurses is to respect patients and their autonomy regardless of their acuity, capacity, or personality. Then allow patients to do as much as they can for themselves and to not get lost in a system where patients are often just medical records.

May Solveig Fagermoen, Ph.D., R.N., associate professor at the Institute of Nursing Science at the University of Oslo, Norway writes, “In nursing, respect must be, or rather is, grounded in the inherent worth of individuals as human beings regardless of their capacities and characteristics (a nonsecular position). … a person is respected not because of his individuality, we do respect him in his individuality. We take his interests, purposes, and degree of autonomy itself into account in the particular way we treat him.”

If the patient experience demands respect from physicians and nurses, identifies the patient’s right to expect and need for quiet and cleanliness, and if it presses to not have patients wait for any reason, then the practical map of how to do this lies in Nightingale’s work and ultimately in nurses.

And, if there is absolute respect for the suffering that you could not know, the anxiety you do not want to cause, and a sense of professional accountability for each patient, then the patient experience sits at the center of nursing, in each nurse, in every hospital.

 

Susan E. Mazer, Ph.D. is the President and CEO of Healing HealthCare Systems®, Inc., which produces The C.A.R.E. Channel. In her work in healthcare, she has authored and facilitated educational training for nurses and physicians. Dr. Mazer has published articles in numerous national publications and is a frequent speaker at healthcare industry conferences.

Tags:  accountability  healing  nurse  Nurse Leadership  relational healthcare  relationship 

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Relationship and Resilience: A Twenty Year Journey

Posted By C.J. Weese, Tuesday, February 3, 2015
Updated: Tuesday, February 3, 2015

I have had 36 major surgeries and over 100 minor procedures, been rushed to the hospital 13 times, life-flighted three times and have had six flatlines. I have legally died six times. And all of this occurred before I was 25.

I was born with Tracheoesophageal Fistula (TEF) with atresia. I had approximately four centimeters of esophagus coming from my stomach, which formed a pouch, and less than two centimeters of esophagus coming from my mouth. That part of my esophagus was connected to my lungs. I was born at 5:43 a.m. and at 6:03 a.m., I was being rolled into an operating room for the first of many surgeries to correct my abnormality. Between 1989 and 2009, I did not go more than one year without having a surgery or some type of procedure done. To say the least, I am very familiar with the healthcare field, but I take a different view. My view is through the eyes of a patient – a patient who has not known a normal life, but rather a life that was controlled by my health and the doctors who treated me. I have spent my life gaining insight into what a talented healthcare professional is and during my college years I gained an even deeper understanding of the vital role of talented individuals to any healthcare organization.

Shortly after beginning college, I started having problems swallowing as well as a lot of pain in my chest and left shoulder. I went in for a routine appointment and brought it up to my gastroenterologist. My doctor decided that I had an esophageal stricture and needed a dilatation. After three unsuccessful attempts to fix the problem, my pediatric surgeon referred me to a new surgeon because he thought a new set of eyes could help.

The new surgeon decided the original four centimeters of esophagus needed to be removed. They were right. The surgery was a success, but it was also a battle in and of itself. The surgery was supposed to take four hours. It took 12. I spent 17 days in the hospital recovering, 11 days of which I was in a medically induced coma. However, during my time in the hospital, I had the opportunity to meet some amazing people.

My experience began when I first met "Dr. Jones,” the new surgeon my previous pediatric surgeon recommended. He was amazing from the start. Dr. Jones took the time to listen, and showed me compassion and empathy. After he listened to me explain everything, from birth on, he took a moment and just looked at me. Then he told me, "I can’t imagine how hard this is for you. But I know that I can fix it.” He did not jump into the medical terminology of what he was going to do, but rather spoke to me in a way I could comprehend and allowed me to answer questions as he spoke. I had a discussion with him rather than being told what was going to happen. Not only did he treat me like an individual, he was honest with me. While all doctors lay out the worst case scenario, he did so in a way that made me trust him and his competency. He was very direct about what could go wrong, but he also discussed how he would fix it if it did. He assured me he had a plan in place and several back-up plans as well. I trusted Dr. Jones – not just because he was a doctor, but because he built that personal one-on-one relationship with me and took the time to make sure I knew everything and was comfortable with it all.

When I was moved down to a regular recovery room, I was assigned a nurse whom I will call "John.” He was amazing. Most nurses I encountered have been compassionate, but he went above and beyond. When John came into my room, he always had a smile on his face. Even when I was in pain and struggling, he was able to brighten my mood. He instilled hope in me and faith that I would get through this and be stronger for it. He spoke to me and learned things about me – he knew what classes I was taking and about my family and friends. He cared. He took my mind off the pain. John helped to nourish and mature our relationship with one another, which ultimately helped me recover. He gave me hope and advice and always listened to me. His positivity was admirable and something I had not yet truly experienced.

The healing I found here was more than just physical, but equally as important. Oftentimes, I feel healthcare professionals forget their patient is a person. A person who is struggling not just with physical ailments but emotionally and mentally as well. The doctors and nurses I encountered during my stay were not only inspiring, they were life changing.

C.J. Weese works at Talent Plus, where she has learned new lessons about how important finding people with a talent for health care is. She spends her days joining the goal of Talent Plus to impact one million patient lives, much like the doctors, nurses and physical therapists who saved her and made her who she is today.

Tags:  doctor  empathy  nurse  patient  Patient Experience 

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