Soapbox
Your say about nursing issues
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 142 - 144
Article Text
Beyond the obvious
Clients are pictures, composites of brush strokes, shapes, textures, forms, and hues. Some nurses look at clients just as they look at pictures. They see the whole, but none of the subtleties. Other nurses are different. They see the picture and appreciate the underlying techniques. These nurses know that a client is much more than a medical diagnosis and that nursing care is more than following doctor's orders. If you're one of these nurses, applause and accolades.
You see a client first as a human being, a person with a health problem, not a health problem with a person. You know that clients are individuals who bring with them all of what they are-unique histories, needs, fears, cultural backgrounds, and concerns. You do more than give lip service to holistic nursing practice and individualized client care. You make it happen.
Remember the 85-year-old woman who kept saying 'I hope I don't lose my arm'? She had injured her elbow in a fall and the wound had become infected. It was healing nicely and amputation was certainly not a consideration to anyone but her. You found out that many years ago her niece had lost both legs below the knees to infection'. Not only did you ferret out the underlying reason for this client's concern, you shared this information with her doctor and your colleagues so that no one would assume she was confused.
Do you recall the client and her family who stopped talking whenever you entered the room. All eyes were on you as you checked the client's vital signs and monitored the nasogastric tube, Foley catheter, and intravenous infusion. It turns out that no one had explained the purpose and function of these tubes and why the fluids were the colours they were.
Think too of the times you've collaborated with your colleagues about client care issues. Recall the woman in liver failure for whom an antiemetic that had liver toxicity was ordered? You got the order changed. How about the client who had tugged on the small-bore feeding tube? You insisted on confirming its placement via X-ray before resuming the feedings.
Remember the client who was trying to decide whether to start constant ambulatory peritoneal dialysis (CAPD)? You asked him if firsthand information would be helpful. When he said yes, you arranged for him to talk with a person who had been doing CAPD for some time.
How often have you made it possible for clients to wear their dentures to the surgical reception area? You knew these people did not want to be seen without their teeth and you helped them maintain their dignity.
Knowing how little privacy clients have and the minimal amount of control they feel they have, you knock before entering their rooms. You introduce yourself and ask them how they prefer to be addressed. You give them choices and make sure they have the information they need to make informed decisions.
How many times have you simply listened to clients and their families as they 'talked things out'? They weren't asking you to fix anything or to give them advice. They needed an unconditionally caring ear and you provided it.
Just as you've made a difference in the lives of clients by seeing them as unique human beings, you've also made a difference in the lives of your colleagues. You have a positive attitude. You offer to help and you're supportive. Remember how you listened as a colleague wondered aloud if he had missed some early signs of impending respiratory distress?
Think of the new graduates who seek you out because they know you won't belittle them or ask then why they didn't have more clinical in their educational program. Rather, you help them think through a situation, build on their knowledge, and consequently help them increase their confidence.
To you who see yourselves in these situations, and thousands of others like you, Salute! You're the backbone of professional nursing practice. You see people as unique human beings. You go beyond the obvious.
Edwina A McConnell RN PhD
Winsconsin, USA
The positives and negatives of handover
My first clinical placement was a very emotional experience for a number of reasons, some good, some not so good, and others in particular which gave rise to the need for some soul-searching and questioning of my decision to take on nursing as a profession. As a mature-age student with a grownup family, I have had a lot of experience with hospitals and nursing from both a client and mother-of-a-client perspective. During the last five years, I have worked as a member of the ancillary staff in a small private hospital and have also spent a great deal of time at the bedside of a seriously ill child over an extended period.
With this background, I had witnessed a lot of nursing procedures and formed certain ideas about them. Handover is one such procedure that has given both myself and other ancillary staff members a reason for a good chuckle on more than one occasion!
The nurses' station in our workplace was a small glassed-in affair in the middle of the hospital. The seriousness of handover was not lost on the ancillary staff as we all felt obliged to clasp our hands to our collective breasts in a prayer-like manner, bow our heads and speak, if we must, only in dulcet tones! We did appreciate the hallowed ritual of the nursing staff known as...handover.
All jokes aside, while I did understand the process of handover, it was with a considerable amount of trepidation that I actually sat in on one - even in uniform, I felt that maybe I shouldn't be 'listening in'. Since nursing has always held a fascination for me, I was quite excited about this event, in spite of my feeling out of place. I was keen to be privy to the information shared by those nurses finishing their duties and those about to commence.
I loved being part of this procedure, at least to begin with, because it gave me the opportunity to learn the background of the clients with whom I had been involved during the day. My enthusiasm was soon dampened, however, when one particular nurse started 'handing over' her clients. This young nurse was very unprofessional in her approach. Her comments about clients were derogatory, to say the very least, and certainly unfair. The comments gave no right of reply to the clients concerned who would have wanted, I am sure, to defend these personal attacks if they were in a position to do so. I felt quite troubled by this incident and had to question my own attitudes. Was I being naively unrealistic? Aren't nurses only people, after all? There was much writing in my journal that night!
Upon reflection, I accepted that yes, nurses are only people, however I believe that any nurse wishing to be considered as a professional must rise above personal feelings and approach each client in a professional manner. If this is not possible, then surely it must be in the best interests of both the nurse and the client concerned if he/she is not placed in the position of caring for that client. Isn't this why communication is stressed so strongly in our studies? So. That's my 'beef!
Overall, I saw handover as a very positive and necessary aspect of the nursing routine, one that put the personal touches to the computer printouts listing each client's details. It was very worthwhile in that it gave nurses the opportunity to vent their feelings on what, for some, had been very emotional duties. My original, uneducated understanding of handover was in part, therefore, correct. It is a solemn time that allows for reflection, the sharing of knowledge, and the opportunity to release tension and share feelings with workmates in a caring and professional way. This can include a laugh, but please, not at someone else's expense.
This experience has perhaps strengthened my resolve to become a nurse and although the situation was troubling me at the time, and can still 'stir me up' if I dwell on it, my first handover had a positive side which can be turned to my advantage and also the advantage of those people whose care I am responsible for in the future. I will always have in the back of my mind the words of the young nurse involved in this situation and her indiscretions will act as a reminder to me to appreciate the feelings of others. I will treat and speak about others as I would like them to treat or speak to me, particularly at a time when they are vulnerable and reliant upon me for their care.
Deborah Wise, Undergraduate Nursing Student
What about undergraduate nurse education?
As a 1993 nursing graduate, I feel disillusioned with my preparation for registration. As I analysed and investigated the problems I have encountered, I learnt more about the various interest groups and their political agendas which have a powerful influence in determining the reality of nurse education.
Currently, it seems that an impasse exists regarding a commitment to clinical practice and skills development for nursing students in the tertiary education system. Despite the Nurses' Board of South Australia's requirement of ANCI competency standards for registration, at my campus, students' clinical competency was not measured against any consistent criteria during my final year of the undergraduate course. There must therefore be a significant risk of students graduating with inadequate skills/role development, leaving them ill-prepared and potentially unsafe to practice.
In the scramble to establish professional credibility for nursing, it seems that many nursing academics have developed an unrealistic single- mindedness in the pursuit of a sound theoretical body of knowledge. As a result, assessment of the students' competencies is left to the initiative of individual faculties. Where this initiative is weak, the tertiary sector has become a convenient vehicle for personal career development, while the interests of the students and the profession are being neglected.
From my experience, it seems that universities do not accept the premise that thinking and activity go hand in hand. If the professional standards for graduates (ANCI competencies) are to be taken seriously, then pre-registration nurse education needs to be clarified. Do we commit to improving the currently inadequate integration of theory and practice or do we create a post-graduate training period? Whichever way we go with nursing education, the implementation of ANCI competency assessment must be the prominent consideration.
David Nunn RN BNsg
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