Nursing: Commitment to quality health care
Caring nurses are the heart of nursing care, and quality health care. A postpartum nurse reminded me of the best of caring nursing. She introduced herself and talked as if she had a mental checklist of each system or need that could be addressed to make her patient more comfortable. Yet, the unit was so busy that this nurse had been called in on her day off, and she had a full load of patients. With a twelve-hour shift ahead of her, she acted as if one woman were her only patient.
Although the nurse fully knew the demands ahead of her that day, she conveyed an attitude of caring...caring about her patients, her job and her profession. It was her attitude, rather than what she did that made a difference. She wore her commitment to quality health care like a badge.
Nurses know what nursing care and quality health care are all about, but, sometimes, we become so caught up in procedure manuals, the mechanics of technology, the battle over the use of unlicensed auxiliary personnel, the politics of payer sources, documentation, patient loads and acuity that we are cannibalizing caring.
A nurse wrote recently that she hears the frequent comment from other nurses: "We never have the time, with the level of patient acuity we're dealing with, to sit down and ask patients how they're feeling."
She expressed her concern that nurses don't understand that psychosocial care isn't something we provide when there's an opportunity or extra minutes. She struggles to show colleagues that therapeutic relationships with patients are built while checking an intravenous, or changing a dressing, or teaching peri-care. Incorporating the concept of seeing the patient as a "whole person" helps the patient develop an understanding of illness/wellness.
The commitment to move from nursing care to caring nursing requires accountability, creativity, and attitude. Accountability introduces you as the nurse. Patients need to know who you are, understand what you do and how you are participating in their hospital experience. Accountability means giving the patient your name, role and expectations.
It only takes a few seconds to say your name and add: "I will be changing your dressings," "I will check your IV every couple of hours," "I'll be back in a minute with pain medication," "You can call me if you have a problem or question."
Creativity is a necessity in today's climate of cost-cutting, service-cutting and limited resources. Nurses must go beyond the care legislated by a procedure manual, hospital rules, unwritten agendas and "this is how it's always been done." Caring nursing must be summed up as simply "meeting the patient's needs."
The most important needs at any given moment are those which are unmet, and most frequently, they are elementary needs. Maslow's Hierarchy of Needs holds that basic needs must be fulfilled before more sophisticated ones. Therefore, the nurse should first consider survival and comfort needs: is the patient having pain, expressed or unspoken, does the patient have food, water (when appropriate), warmth, protection from injury, preservation of privacy? Moving up the pyramid of needs, the nurse must next address more complex psychosocial and emotional needs. When the nurse learns to view the person as a whole, these needs can often be handled at the same time simpler ones are being met.
Finally, attitude is a component of caring nursing. Yes, nurses are tired, overwhelmed, even burned out. Documentation, regulations, changes in healthcare systems often interfere. But, we need to remember and remind each other why we are nurses: because we care. Caring nurses are the heart of nursing care and quality health care.