Version One
Recently, I took care of a patient in the hospital who was diagnosed with cancer. One of the things I did that was important as a nurse was take the time to listen to the patient's concerns and needs. I saw him for a period of two days while I was on my shift. When I went into the room, I would reintroduce myself and take the time to ask how he was and to inquire about his needs. One of the other things I did was provide a daily bath. The patient was unable to bathe himself and required full assistance. While I did the bath, I took the time to make sure his skin wasn't broken down and to make sure he received the care he needed.
I washed patient's hair and brushed his teeth. One of other things I had to do was provide the patient with medications. He didn't know a lot about the medications. He didn't know their names; he didn't know why particular pills were being given. He didn't understand why the doctor had changed his medication. I took the time to explain to my patient that his pain was being managed by the medication he was receiving and to explain that he needed to tell me if he wasn't comfortable.
In this anecdote the nurse recounts some aspects of her care. However, the picture she paints is just a sketch. We don't know what kind of cancer the patient has or why he is in the hospital. We don't understand the importance and complexity of pain management. We don't see the medical and technical activities she undertakes to keep the patient safe. We are left with the impression that the nurse is a well-meaning person who is solicitous of her patient. One might conclude that she could be replaced by someone equally attentive but less educated and skilled, and therefore less expensive.
I washed patient's hair and brushed his teeth. One of other things I had to do was provide the patient with medications. He didn't know a lot about the medications. He didn't know their names; he didn't know why particular pills were being given. He didn't understand why the doctor had changed his medication. I took the time to explain to my patient that his pain was being managed by the medication he was receiving and to explain that he needed to tell me if he wasn't comfortable.
In this anecdote the nurse recounts some aspects of her care. However, the picture she paints is just a sketch. We don't know what kind of cancer the patient has or why he is in the hospital. We don't understand the importance and complexity of pain management. We don't see the medical and technical activities she undertakes to keep the patient safe. We are left with the impression that the nurse is a well-meaning person who is solicitous of her patient. One might conclude that she could be replaced by someone equally attentive but less educated and skilled, and therefore less expensive.
Version Two
I was taking care of a patient, Mr. R, who had with esophageal cancer, cancer of the tube that passes food from the mouth to the stomach. This is a serious diagnosis with an 80 percent mortality rate. Mr. R had surgery two days previously to remove part of his esophagus and reattach the remainder to his stomach. He was in a lot of pain and was very anxious about the chemotherapy he would eventually receive.
One of the things I did was manage his pain. Pain management is a critical nursing activity. Pain is not simply experienced at the emotional level. Unmanaged pain creates changes at the cellular and tissue level. We know that unmanaged pain retards healing, and can even lead to death. Patients who are in pain don't walk, and can thus develop deep vein thrombosis. They don't cough and are at greater risk for pneumonia. Some patients reject pain medication because they think that toughing out pain shows strength of character. When such a patient is asked if he is in pain, nurses know that he might say "no," while the expression on his face or his body language says "yes."
It's important to monitor the effectiveness of a patient's pain medication and stay ahead of the pain. You want to make sure he is always comfortable.
Mr. R was not able to eat. He was being fed intravenously. I monitored his fluid intake, and urine output to make sure he wasn't becoming dehydrated or malnourished.
I was also concerned about was the risk of pneumonia, so I listened to his chest every four hours for any abnormal sounds. I checked his temperature every four hours for any signs of infection. I checked his respiration and took his blood pressure. One of the risks of this surgery is internal bleeding. I needed to make sure blood his pressure was within the normal range and that he was not bleeding internally, which could lead to a cardiac arrest and death.
I listened to his concerns and reassured both him and the family. I didn't just care for him. His wife was at his bedside and was worried about what was coming next in his care.
One of the things I did was manage his pain. Pain management is a critical nursing activity. Pain is not simply experienced at the emotional level. Unmanaged pain creates changes at the cellular and tissue level. We know that unmanaged pain retards healing, and can even lead to death. Patients who are in pain don't walk, and can thus develop deep vein thrombosis. They don't cough and are at greater risk for pneumonia. Some patients reject pain medication because they think that toughing out pain shows strength of character. When such a patient is asked if he is in pain, nurses know that he might say "no," while the expression on his face or his body language says "yes."
It's important to monitor the effectiveness of a patient's pain medication and stay ahead of the pain. You want to make sure he is always comfortable.
Mr. R was not able to eat. He was being fed intravenously. I monitored his fluid intake, and urine output to make sure he wasn't becoming dehydrated or malnourished.
I was also concerned about was the risk of pneumonia, so I listened to his chest every four hours for any abnormal sounds. I checked his temperature every four hours for any signs of infection. I checked his respiration and took his blood pressure. One of the risks of this surgery is internal bleeding. I needed to make sure blood his pressure was within the normal range and that he was not bleeding internally, which could lead to a cardiac arrest and death.
I listened to his concerns and reassured both him and the family. I didn't just care for him. His wife was at his bedside and was worried about what was coming next in his care.
In Version Two, the nurse fills in the blanks. We now understand that she is dealing with a very sick patient who has a range of emotional, medical, and technical needs. We understand the intricacies of pain management and why vital signs are so significant. After hearing this nurse describe her work, the listener would understand the complexity of that work and why we need nurses, and not nurse substitutes, at the bedside.