B700 Adult Nursing

Contemporary healthcare practice is increasingly embracing the client-centered concept and empowering it in day to day practice (McCaffrey and McConnell 2015, 3007). A lot of efforts are being put in place especially at research level to ensure that person based care is as humanized as possible. However Norton (2015) posits that the existing knowledge on this phenomenon has not been adequately passed down and across the medical fraternity. Paolo (2017) criticises the implementation strategies for humanization approach in healthcare provision arguing that there are adequate and sufficient frameworks such as the Todres et al (2009) framework of encompassing humanization in healthcare but cites unprofessional working culture and apparent resistance to adoption among the previous and already practicing medics and caregivers. Todres et al (2009) came up with an eight-point humanization framework of introducing and adopting and maintaining humanized approach to healthcare practice. This paper will therefore discuss the humanization framework with specific reference to three of the eight dimensions proposed in this model. The three dimensions are insiderness versus objection, togetherness versus isolation and personal journey versus loss of personal journey. The author will refer to the online video ‘what do you see nurse’ to conduct a critical analysis of the patient-nurse association and relationship in personal healthcare provision.

The need to attend to a patient from heart has for long been a concern among healthcare professional (Pascuci et al 2017). Nursing is regarded a caring profession and it is challenging for one to fully meet the physical, emotional, physiological and psychological needs and expectations of each individual patients (Jacobs et al 2017). However, by adhering to the standards of best practice and such as the six C’s  of nursing profession and humanizing models in healthcare provision, quite a substantial level of satisfaction can be achieved in meeting the patients expectations. Several models including the Todres et al (2009) have been fronted to help nursing practitioners to improve their approach in person-based care. This section will provide an overview of the Todres model with a view of providing a snippet understanding of the humanized approach in healthcare. The framework presents key perspectives of the meaning of human in eight humanization and dehumanization dimensions.

The first dimension is the insiderness versus objectification which explains that being human as experiencing life in current state exhibited through emotions, mood and feelings. The second dimension is agency versus passivity which contemplates that humans make choices in life and are responsible for them. As such people do not always see themselves as totally passive (Hansen-Flaschen 2015, 318). Nurses therefore, ought to give room of freedom to their clients to make independent choices. Uniqueness versus homogenization is the third dimension and addresses the issue of each individual patient’s exclusivity. Although classifications such as gender, ethnicity, race and age do exist, they are not sufficient enough to discern an individual from another. The principle thus advises nurse to treat each patient as he or she is in his or her individual context. Togetherness versus isolation stipulates that being part of a community is what makes one feel human and separation bear’s detrimental effects to one’s health. This aspect will be discussed further in this paper.

Making sense or making none addresses the element of caring about the meaning of one’s environment which includes events and experiences. Humans naturally tend to be sensitive about their surrounding and in the event that they are unable to, nurses have an obligation to explain to their patients what is happening around them and help them fully understand the situation around them. The sixth dimension deals with personal journey versus loss of personal journey and talks about familiarity people bear with the past and present and the excitement or otherwise they have with the future. This dimension too will be explored in detail in this document. The seventh dimension is the sense of place versus dislocation. Every human has a sense of origin (Davidson et al 2017). Everybody wants to end up at home where home is not just a collection of objects but rather familiarity comfort and experiences. No patient in his or her right mind would want to stay in hospital any longer implying that the whole experience of being in hospital apart from illness is unpleasant. Nurses are thus called upon to create a homely environment to mitigate the sense of dislocation felt by patients. Last but not least is the aspect of embodiment versus reductionism which discuss the experiences humans go through with their bodies whether positive or otherwise. It is difficult to understand an individual’s body without keeping in mind their social, physiological and socio-cultural aspects. The element thus seek to instil sense of respect to the caregivers and treat their clients with respect and dignity (Todres, Galvin, and Holloway, 2009).

As already mentioned, this paper will refer to a short story titled ‘what do you see nurse?’ and attempt to resonate the application of humanized approach in health care by reviewing the events in the movie clip. ‘What do you see nurse?’ is a short deeply moving story extracted from a poem that revolves around an elderly patient in a medical facility. In the story, the old woman pleads with the care-giver to see beyond the feeble and confused old woman before her. The patient urges the nurse to bear in mind the life she the patient has been through since childhood. The hopes dreams and all the aspirations of a beautiful journey. With this overview in mind, the author will now attempt to analyze the three aforementioned dimensions and how they manifest in the story.

Insiderness versus objection is the first of the eight dimension the humanization /dehumanization framework. This dimension recognizes that one’s current state of mind determines his or her current feeling of association to human family. This is what Todres et al (2009) define insiderness. Care givers should work focusing on the patients knowledge, motivation and skills and attempt to improve the rather than looking at their problems. The moment they focus on the patient’s problems then they will end up treating them like objects. I the short story, there are two instances where the patient experiences objection rather than insiderness. While in a bathtub, she feels some sort of sharp pain and tries to speak something. Although the nurses were busy washing cleaning her, they do not pay keen attention to find out what caused the sharp pain or even what the old woman could be saying. She is left to feel like a burden or an object of need. In a second instance, one of the nurses is seen feeding the elderly patient. At some point, the woman does not want to feed and the nurse simply tells her “I wish you could” but does she bother to make her express herself or tell why she isn’t eating anymore? No. This focus does not bring out a shared vision of care but rather an absolute dependency on the care-giver to make decisions.

A more humanized approach would be to try and involve the patient as much as possible in activities and decisions pertaining to his or her welfare. For instance the nurses would have tried to find out what happened to the lady in the bathtub instead of merely asking “what did she say?” Asking another person what a patient said while with the patient herself makes the patient feel completely incapable and dependent on other people including their opinions. Showing care and compassion as part of the Insiderness can be enhanced by creating a culture that works for, on and with the patient (Cowie and Jones 2017). Nurses need to be trained to never make those under their care feel helpless or merely objects.

The togetherness versus isolation dimension recognizes the human desire to associate and relate with others. This is achieved through communication. Pound and Jensen (2018) note that the communication doesn’t have to be necessarily verbal, in fact body language speaks volumes. Cheraghi et al (2016) observes that social seclusion bears detrimental effects health and is responsible for a number of psychological and chronic physical ailments. Caregivers therefore need to know the significance of interacting with patients even if the latter incapacitated in some way. From the beginning of the story, one does not see anywhere where the nurses attempt to communicate or establish some association with the elderly patient. At the beginning we see them talking to each other and although one of the nurses tries to talk to the elderly woman later, her body language and facial expression is nothing short of ‘duty only’.

Nurses need to establish friendship between themselves and the patient, friends, care-givers and family members of the sick. This leads to development of trust between patients and nurses and is significant to the dignity of the patient (Cowie and Jones, 2017).  In the story a friendly face and gentle approach when attending to the old woman or even a smile will make her feel part of the society but cold face on a sick person will drift her into isolation and begin thinking about the past and the moments he was in society just like the woman in the video did.

Nurses have an obligation to offer support to their patients and open opportunities to develop relationships. Traditionally, nursing as a profession has been perceived as a vocation that provides divine care and services to the society and some of its doctrines have their origin in religious principles (Rathert et al 2016, 141). Nurse are bound to inspire hope into the patients and make them feel wanted rather than needy. They, therefore, should encompass compass as much as possible in their practice. Body language such us eye contact and facial expressions such as smiling provides mental healing and spares the patients the worries, distress and agony of feeling isolated or miserable (Brousseau et al 2017).

People’s lives can be summed up in three aspects that is the past present and future. People are familiar with the past and will tend to drift back to the same and admire the good moments they had then. This is common when confronted with unpleasant experiences like being hospitalized. As Walker and Mann (2016) assert, this throwback does not only deter quick recovery but may also be a source of other complications. When patients are labelled or perceived as being needy, the resultant distress becomes overwhelming and tend to forget to live their present and drift to the past. It becomes worse if they drift into the past and reflect on the bad moments they had as this only adds to make them feel more miserable.

Although the nurse does well to feed the elderly woman, the hasty way she does it makes the patient feel like the former is wasting the latter’s time and that she is a bother. Bradshaw (2016) observes that nursing is an emotionally and physically demanding profession. There are six qualities that should be adhered to when practicing as a nurse. These are care, compassion, competence, communication, courage and commitment. Of the six, compassion is the most valuable virtue for a nurse (Walker and Mann, 2016).

Quite often, patients find themselves in unfamiliar conditions that they have no control over (White 2018, 52). Nurses need to appreciate the value of their patients’ trepidations and lend them a hand in adapting. They bear the responsibility of psychologically creating a soft landing for the patients who may be still struggling to come to terms with their current condition. In the video, the old woman needed to be assured that she is still as loved, needed as she was in her childhood and teenage years. That is why she urges the nurse to see and regard her as she would have seen her in her early life.

This paper agrees that although adult nursing is an arduous specialization, nurses taking care of the aged have to put care and compassion at the center of their practice. By understanding the eight dimensions of humanizing healthcare, nurses can deliver their services without appearing to be uncaring. As qualified professionals nurses have both a collective and individual obligation to maintain best standards of care. Focusing on what is important to each individual patient as members of one human family will enable caregivers to comprehend and fully appreciate each individual patient’s experience and expectation in ill health. By so doing, dignified and respectful approach in service provision could be ensured.

References

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