What is at the heart of nursing?: My recent Reflections

Erika Cleborne-Bérubé, Edinburgh

I maintain that being a nurse involves far more than competently completing a set of clinical tasks, such as recording clinical observations, it must involve the care of the patient as a whole person.

How one nurse can be the difference

Let me start with some contrasting examples from years ago, when I worked in a care home in Scotland.

One day, when I walked into the day room there was total silence, except for the sound of a daytime TV show. The residents were not sleeping, but they were not engaged in any way. Their physical needs had been met, but the carer tasked with being with them in the lounge had not reached out to the patients in front of her, as people. She had completed her assigned tasks, but, looking around, it was like the lights had been dimmed behind all their eyes.

On a different day, with a different team, however, I found the same residents in the same lounge, but the scene was different — entirely so. Some residents were playing a game, others were chatting while they knitted. A group was in the garden. There was laughter and life. The person inside their aged bodies were lit up again.

What had changed? As before, their physical needs had been met, but this time, so were their emotional, social, and in some cases, intellectual needs. And it was all down to the nurse in the room with them, who had put the people at the heart of her care, reaching out and engaging them, and just like that, her day and theirs became more meaningful.

Why did we become nurses in the first place? What is it all about?

The risk of increasing demands on the role of the nurse 

As nurses are made to take on more tasks with increasing demands and working to an ever-tighter budget we can forget why we became nurses in the first place, and what it is all about.

I remember when taking a blood pressure or doing a basic set of observations was new and exciting. It is exciting, as a student, to learn new clinical skills, and to add something to our tool belts. But that was never the whole point of the exercise. The observations without reference to the person in our care, is meaningless and dangerous.

We are there to care for a person, a human being, with likes, dislikes, hopes, fears, peculiarities, and a life. This life is made up, yes, of the physical body the person s, but more than that, the person has emotional, spiritual, social and intellectual sides to them, too. Failing to take any of these parts into account, and failing to care for the person as a whole, has dire consequences.

The danger is that in these times of understaffing and budget cuts, and especially after the pandemic, more and more health care staff are finding themselves too often pushed up against their emotional walls to see beyond the physical care. With no time to breathe, no time to grieve, no time to think, this can lead to burnout. As a result, it becomes more and more difficult to keep our patients at the heart of our care, or to look past our own stress and exhaustion to our patients’ psychosocial needs.

What can happen when we keep people at the heart of our care?

With the people we are caring for at the heart of our care, care becomes an opportunity, an encounter, a chance to truly see, and in turn, to be seen. This is true even for the simplest tasks. One of my favourite times was when providing personal care. it is a time offering privacy and intimacy. I noticed that when I am I attentive to this opportunity I see the person behind the patient. And for me that is what I loved about my role. 

A moment of care I will always remember was on one night shift.

All is silent, all is well. I am alone, my colleague is on his break. I have done my rounds and checked on everyone. All my patients are comfortable and sleeping. Except for one. Suddenly the silence is shattered by her. She is in her mid-eighties and has suddenly deteriorated. Stable and compos mentis two days ago, now she is more and more disorientated and distressed.

She was sleeping when I passed a quarter of an hour ago but has now very audibly woken and is making her distress known. I go to her room, resettle her in her bed, give her a sip of water. She is in no pain, has no nausea. Medically I have done all I can to make her comfortable, and yet she is suffering, terrified and distressed.

She is mixing languages and no longer seems to understand what I am saying to her. She keeps crying out for her mother, doesn’t know where she is anymore. But she says she is pain-free. She says she is comfortable. The suffering is on a psychic rather than a physical level.

I pull up a chair and sit by her. I talk to her quietly, although I don’t know what I tell her about, I just talk, quietly, reassuringly. I hold her hand and stroke her forehead, the back of her hand. Gradually she settles down, from a scream to a complaint, to a whimper. Then, just like that, within a half hour of my coming in, she is calm, dozing off comfortably, reassured. I have done my job.

Such nursing care interventions we know can have a real impact as seen here but too often we can reach for pharmacological solutions to such distress.

What nursing care offers something much older and much more fundamentally humane.

This person needed human contact, reassurance, and for the lonely gap between her and the outside world to be bridged. Once that gap was bridged, she was at peace.

Meaningful work brings satisfaction, and satisfaction brings resilience.

The satisfaction of such an encounter leads to greater motivation for us nurses to care well for the patient, but also builds up a greater resiliency and a greater ability to push through the difficulties in the job. Nursing can be tough. This is the part that gives back. Meeting each person on their journey, in their life.

Just as we must not forget that our patients are people, the same is true of us nurses. We, like our patients, are not just bodies, robots in place to give injections or monitor blood pressures. We are people in the most complete sense of the term, with emotional, social and spiritual needs.

Finding purpose and meaning in our care as we see the other person before us and being seen by them, leads to greater spiritual health, a greater belief in the work and in the role of caring for another. Ultimately, finding meaning in our work leads to a sense of fulfilment.

And this care for the person extends beyond our patients to our colleagues so that all are caught in the person-centred web of care and support. All are helped to feel whole and seen, in good times and in bad.

One area of development I would suggest would support role satisfaction and resilience is building mentoring capacity within the workplace. When nurses are stretched beyond their comfort level and capacity without a safety net of support they can become so caught up in their own fears and anxieties that tasks, even small ones, can loom large.

How do we stay engaged in our care?

As I have said, nursing can be tough, but our mindset is key to understanding our motivation and what makes it meaningful. A key factor as with so many things, is self-care. Put on our own oxygen mask before helping others.

Another factor is fostering healthy teams and ward environments, where support and caring for each other are valued, is paramount. It means putting people, even on a large, institutional level, at the heart of all we do. People, from the cleaning staff to the CEO, right through the nursing and medical staff.

Caring for staff IS caring for patients. Happy, supported and safe nurses are in a place to put people at the heart of their care. That, I believe, is what is best for the patient and their care, but also for those caring for them.

About the Author:

Ms Erika Cleborne-Bérubé is a nurse, who trained at Edinburgh University where she earned a first class Bachelor in Nursing with Honours, She has been a nurse for about 10 years, and has worked in a variety of contexts, including a hospital in Ghana that was supposed to be focussed on obstetric fistula, but the need was too great so they were a general hospital; 4 different refugee camps in Greece; a health outreach organisation in South Africa, especially for HIV and TB and a palliative care programme, as well as in a variety of wards in Switzerland and the UK, and now Kurdistan. She likes the term Nurse Errant to explain her current work life.

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