Sunday, June 23, 2013

The Art and Science of Nursing

When I was in nursing school my teachers would always talk about the "art and science of nursing". The marriage of scientific knowledge and the intuition we have as caring professionals. Back then I understood it on an intellectual level, and I saw it in the experienced nurses who, due to years of hands on nursing, had this way of balancing their care with scientific precision and  compassion that drove everything they did. Over the years I have learned it more myself but it wasn't until last night that I realized just what my teachers meant all those years ago.

When I walked into work last night and saw my assignment, I knew there was a potential to have a rough evening. My patient was a young man I knew well. A guy who had been diagnosed with ALS many years ago... a disease that slowly takes away all ability to move, eat, go to the bathroom and breathe on your own... eventually even takes away the ability to speak. It is fatal and it is characterized by this "trapped syndrome" where your mind is completely alert and aware and yet your body is a hollow shell of what it used to be. In all honesty... ALS is my very worst nightmare.

I had been told that my patient was at a point in his disease process where he was not willing to participate in nursing care. No turning, no bathing, no suctioning... basically we were there to give pain medicine and offer sips of water and such... but only when he asked. He was still able to talk through his trach, despite being on the ventilator and he would let us know what he did and did not want. Oh great.... I thought to myself... this is gonna be a fun night.

If I had been given this assignment four years ago when I began my nursing career, I would have had a large amount of anxiety surrounding his decision. As a nurse who knows the implications of not turning your patients (bed sores that go down to the bone) and not suctioning your patient (pneumonia that could kill you) and the list of other things that this guy won't let us do... how do you just not force it on him and take care of him the way I know I should? I remember having these dilemmas as a new grad.

Now... four years in, I realize that I have begun to understand that age old wisdom my nursing instructors were trying to impart in each one of us. This man that I cared for last night is a man who is dying... not only that but he is dying from a horrible disease that leaves you completely paralyzed. You can control nothing. Not your body, your environment, your position... everything in your life is in the hands of a health care professional that doesn't know you from Adam. And sadly... most of the time, with chronic patients... nurses and doctors avoid them because they can come across as being needy and demanding... all in an effort to cope with the loss of autonomy they have had. So... you are left with a grumpy, isolated patient who tries to demand even more as a reaction to his surroundings and refuses to do the things we know need to be done... and often times you have a nurse who just wants to get in the room and get out.

So, last night I knew that this is where I needed the art of nursing. Instead of explaining to him why I needed to turn him, I asked him when he wanted his pain medicine. Instead of running out of the room at every chance and trying to just get my work done and get on with my busy day... I sat in the room and watched Ricky Lake and chatted with him about his time in the service. We watched the news and talked about the recent CIA scandals and the depressing state of our government. We laughed over remembering the taste of dimetapp as a kid and I told him about the time I puked all over my poor grandma when she made me drink theraflu when I was sick.

The funny thing is that I can't remember the last time I had such a good night at work. It was peaceful and slow and it felt good to actually connect with this guy. At the end of the day I was really thankful for him and our time together and I could tell that he was thankful to have a nurse that didn't force him to have his sheets changed or try to convince him that he was getting too much pain medicine. In the end I have a feeling that our time together did more for the both of us than my turning him ever would have. He actually looked happy when I said goodbye to him this morning... and I think it was because someone sat and treated him like a person instead of a patient for once.

So... four years in I am finally getting it. I'm still learning it and will probably continue to fine tune that artful skill of knowing what lines are hard and fast and which can be blurred around the edges a bit. I will say one thing though... my nursing instructors would be proud :)


  1. I'm proud too! :-)

    ~ Dad

  2. This put a smile on my face. My aunt passed away from ALS a few years ago and she would have been lucky to have someone like you as one of her healthcare providers. Thank you for all you do. I know that all of her favorite nurses were those that took care of her health, but also sat down with her and didn't forget that she wanted someone to talk to and also see her perspective on her health care. Thank you.

  3. This is a great example of being an extraordinary nurse. These are the types of nurses that make the biggest impact on patients. Great job and keep up the work!