Fresh from a stint as patient rather than as nurse – I couldn’t help but reflect on my experiences on the flipside. I was lucky enough to have a great bunch of nurses – I am grateful!
But, my senses were sharpened for the patient experience as well, and I wanted to learn from my patient experience to inform my own nursing. Here are some things that I thought about in relation to the ways that expert nurses care based on my own in-bed experiences:
- “Hello my name is…. I am the registered nurse looking after you today…” I was so pleased to see that most nurses do this. It is SO important to orient the person to who is coordinating their care each shift. Knowing who has your back when the chips are down really helps!
- Patient Care Board In one unit, the health service had implemented a new concept of the Patient Care Board which consisted of a large template on the wall near the bedside which includes a daily update of key information. Name, plan for the day, nurse’s name, and medical officer’s name… etc. I was not convinced about its usefulness. To my mind, the information seemed to condense the person rather superficially into a list of tasks (eg ‘observations and medications’). It is reminiscent of a return to task orientated nursing and amplifies the current trend for excessive lists, forms and processes which detract from actual person-care and transcend into attention to documentation rather than attention to person – amber light on! Another interesting observation was the inconsistency of title for health professionals on the boards. The nurse was identified by a first name only and with no designation, while the doctor was identified by title and surname. It is a small matter, but the lack of consistency may serve to perpetuate the invisibility of nursing generally. Nurses, who are most likely to update these boards, should drive a consistency that promotes even handedness. If titles are used for one health professional, then it is reasonable that the same courtesy should be adopted for nurses as well – eg RN Rhonda Wilson/ Rhonda Wilson RN and the same for the medical officer – Dr Susan Smith (eg). If first names are used for one –they ought to be used for the other as well (and in my view first names should be used J). Patient Care Boards – not a fan yet! If they are useful, they should be used well. Otherwise, they risk becoming another ‘busy’ task that detracts from actual person-centred care, despite appearances. Yellow light on this one from me for now, but I am prepared to be convinced otherwise!
- Bedside hand over – not one size for all. The concept of a bedside handover where the person being cared for is included in the conversation and transition of care from one shift to another is a great one – but in a shared bed unit, it is awkward. My lived experience of this was both good and bad… Being included in the discussion and the transfer of knowledge about up to date care is important for people, but personal and intimate information get shared in public spaces too – I just didn’t need to hear about the bowel activities of my neighbours in the in-depth details that I was exposed too. They didn’t need to hear my personal stuff either – and I felt uncomfortable that they could hear that discussion. Bedside handover is an excellent concept –but one size doesn’t fit all. Context, environment and cultural safety are critical factors to consider in a sensitive person-centred and person inclusive model of care transition. The curtains are still thin buffers for voice!
- The linen. Those I have taught over the years will have ringing in their ears – ‘do one more thing’ and ‘make sure the bed is tidy!’, at least I hope they will! A well made bed, and a well maintained bed, matters. I am not talking about mitered hospital corners, but I am looking for more than a compost heap of linen dumped on a person. It takes very little time to straighten the linen, and make it tidy and comfortable. A doubled up blanket tossed under a sheet and precariously balanced on top of a person in a bed just doesn’t cut it for very long! A warm blanket is a kind offer, but a sheet is more comfortable then a blanket for a longer period of time – remember to come back (or hand over) and maintain the comfort level! Remember too that the person is probably sick and not feeling well and they are probably uncomfortable, so don’t add to their woes with omitting to do what you can to increase comfort. Pain relief can be enhanced by ensuring that the person is comfortable in the bed. These are the little invisible things of nursing that make a very real and present difference. The linen – the blankets the bed cover… they matter, they increase comfort, and decrease the experience of pain. Do one more thing – every time! I had some very caring nurses in this regard for most of the time, but there is skill to be recognized in regard to the linen! It takes an investment of caring by the nurse –it is not just a mindless task, and not one that should be overlooked as irrelevant. Expert nurses were the ones that saw the relevance and could carry out nursing care that included acting on their intuition about ensuring that the bed was comfortable for the person – Now THAT IS NURSING!
- Quiet and present nurs-’ing’ around the bed. Bedside care is nursing territory! It is our space for the delivery of professional health care. How we manage that space is critical to the health of the person in the bed! Nurses are responsible for the bed-based hospital environment and that includes the people who travel in and around the beds to deliver care or related services. Quality nursing is, in part, about managing the micro and little seen or noticed aspects of the health care environment. Privacy, gaps in curtains, the light and noise levels, the smells, hydration and water jugs, accessibility of patient personal items (eg tissues), the conversations in the uni/ward etc… My recent visit as a patient reminded me just how noisy the health care environment is! And, how uncomfortable that noise can be! We talk so LOUD! And we talk LOUDER to be heard over the LOUD! An expert nurse is able to moderate this by practicing in a quiet, present, mindful and listening manner. These are real nursing skills, they are not on any of our fancy flow charts or tick and flick lists to say we have carried out that particular intervention – But, never-the-less, they are extremely important nursing skills – that is practicing quiet and present nursing care. The demeanor of these nurses is noticeable from within the bed – and I am pleased to report that I had the expert care of some especially proficient nurses in this regard. The more of this type of nursing that occurs, the more likely it will mitigate the loud and overly familiar, less sensitive type of care that results in a downward spiral of quality… you might have seen it… the loud abrasive humour, the use of profanity as a frequent descriptor of adverse circumstances, a ‘Darl’ in every bed, and the lazy dropping of the ‘ing’ on words that more properly usually end in ‘ing’. When we let the bar lower to this ordinary type of care, we do nursing a disservice and we do the people we care for a disservice. Nurses are powerfully influential in the bedside environment. Lets lift the bar for our other health sector colleagues – medicine, allied health, administration services and domestic/ hotel services. If we lead by example, and expect a higher standard, other will follow. And, the people we care for will have the optimal environment for recovery. It’s our call.
Nurses – We have extraordinary capacity to do good, and to help people recover. Most of the ways we do this lacks prominence or visibility. I hope I have been able to make some of the invisible a bit more visible today! It is the little things we do that matters and that is how we show that we care.
Here is to my nurses! Thank you for your care extended to me! And thank you for helping me to think more about the importance of what we do to deliver quality nursing care to others.