Soapbox
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 133 - 134
Article Text
The disabled well nursing home resident
During periods of fieldwork in a study on the articulate resident's perspective of nursing home living, I noticed aspects of nursing practice that I thought needed to be discussed. One aspect was the challenge registered nurses face in working in nursing homes with so many people of such diverse characteristics. Another was the need for nurses to work more collaboratively, particularly with long-term nursing home residents.
Nurses are required to attempt to balance the nursing care of the sick and dying as well as the care of the disabled well nursing home resident in the same environment. The requirements of large numbers of people with differing health needs, and the registered nurses' time limitations, result in a 'hospital' culture where urgent matters are dealt with first as a priority, and issues not of a life or death nature are down the list. The disabled well, often permanent long-term nursing home residents, experience the nursing home as a hospital.
Findings from the study indicate that while acutely ill clients may accept nurses' clinical authority, ritualistic practice and continual surveillance, long-term residents have a different perspective. Nursing home residents who were not very ill and who did not need high intensity nursing said they are tired of being under surveillance in that nothing they do is private. For example, personal information is transmitted verbally from nurse to nurse within the resident's presence. Registered nurses document private information in the residents' files and talk about them at handover. There is a sense that their lives are an open book.
Several nursing home residents believed that they should be able to access their medication whenever they want it. An articulate person's right to medicate themselves according to their doctor's prescription, an everyday right in the mainstream culture, is denied the residents in the nursing home under study. In this sense, residents appeared to experience the disadvantages rather than the advantages of being observed and monitored by nurses. Nursing notes could even be written in the resident's presence and discussed with them.
It is clear that nurses and residents need to determine a nursing home environment that is suitable. This includes an overall philosophy of personalised care and collaborative arrangements between the nursing staff and the residents (Christensen 1993).
Barbara Fiveash
RN DNE BHSc MN
References
Christensen MJ (1993) Nursing Partnership. Churchill Livingstone, New Zealand.
Fiveash B (1994) The articulate resident's experience of nursing home living. Unpublished Masters Thesis.
The client in 14A
Are hospital trained nurses undervalued? Or, to be more correct, is the training that they received undervalued? It would seem to follow that the training maketh the nurse, not the nurse maketh what she will out of the training. Is that a valid point of view? I sat down to compare my three years of hospital training to my three years in the university system.
From my days in the hospital, I learnt diseases and drains, washes and washouts, and shaves and enemas. I learnt fear, exhaustion and confusion. I'd also like to think that I learnt respect, empathy and compassion, but maybe that just came from living life. Although, I'd like to think that the time I spent sobbing in the pan backs over the client in 14A, who was dying of cancer, wasn't.
At university I learnt dimensions and paradigms, epidemiology and hermeneutics, and law and ethics. I learnt that not all heroes have a cape and fly, most of them look after families, study and get to their shifts on time. I learnt that university libraries are invariably freezing, presumably to keep students awake. I learnt that professors may be able to write sentences of fifty-four words, but undergraduates have to stick to less than twenty. I learnt how to reference. I learnt why the client in 14A suffered so much, and what chemicals were released when she did so.
So now, when I walk into 14A, in order to have an adult to adult complementary transaction, based on a learned American philosopher's idea of care-I know. I know that the terminally ill client will have trouble reading a telephone book due to her miotic pupils. I know how to write the correct nursing care plan for her. I know what is going on in her body at a cellular level. I know so much that I wouldn't need to cry in those pan backs for her, or would I?
As I watch this person in 14A dying by degrees and stages, past the denial, past the guilt, past the bargaining, a thought occurs to me. It sneaks around the post-modernistic trends and the politics of health care. I wonder whether this human being in the bed in 14A would prefer the nurse whose ghost once sobbed over the pain, the suffering and the things that can't be changed. Can tertiary education really make a nurse, or is the nurse made from what she finds within the nursing? If the latter is the case, then what are today's nurses finding within the education they are being offered? Are we really making nurses? Ask the client in 14A.
Catherine Jones RN
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