Transforming Care: A Christian Vision of Nursing Practice (33 page)

The amount of care needed to sustain Mrs. Williams kept Susan moving constantly for the next several days. She was receiving eight intravenous drips, tube feedings, suctioning, positioning and repositioning, sedation, and hygienic care, as well as needing to have her oxygen, cardiac
respiratory and fluid status monitored. During the first day of care Susan
spoke with Mrs. Williams, orienting her, interpreting her environment, the
sounds of the ventilator alarming, monitors beeping, and the constant
noise created in a busy critical care unit. She provided reassurance when
Mrs. Williams suddenly became restless and stroked her hands and arms
to let her know someone was with her. She called family members in to sit
and hold her hands to provide comfort and to prevent Mrs. Williams from
accidentally dislodging her airway tube or intravenous therapies.

Although Mrs. Williams gave no indication of a response, Susan stimulated her as much as possible, talking with her about anything and everything: the weather, her grandchildren, recalling those who had come to
look in on her. As she ran out of these topics of conversation, Susan told
Mrs. Williams about her own family, her two children, the family dog, and
then moved on to what was on the news.

On the second day, Mrs. Williams was able to squeeze Susan's hand in
response to commands. Her blood pressure gradually rose, and it appeared
that the infection was reversing. Mr. Williams was elated. Even while the
nurses continued to remind him that his wife was still critically ill, he kept
repeating, "praise the Lord, praise the Lord!" Later that day it appeared
that Mrs. Williams was attempting to talk around her endotracheal tube.
Susan offered her a pad of paper and pencil and was astounded when Mrs.
Williams wrote, "How are your children today?"

We can see a number of the critical components of acute care nursing
in the case of Mrs. Williams. The care Susan provided was not a detached,
robotic response to purely physical symptoms. Good acute care nursing
requires involvement with the whole person of the client and with the client's family. This includes spiritual care. Susan rejoiced with Mr. Williams
as his wife improved and echoed his joyous praise to God.

Good care also comes from the whole person of the nurse. At one
point, Susan had strong feelings and was unable to maintain her composure when she saw Mrs. Williams. Nurses do not have to deny their own
human feelings to provide competent care. Many health care professionals
are frightened of emotional communication with their clients. Clients report that physicians, especially, are cold or seem detached from their situa tion, but many other health care professions share this demeanor. Perhaps
they fear that they will lose objectivity or lose sight of the client's autonomy if they identify too closely with the client's emotional situation. But
some contemporary research suggests that becoming emotionally involved
in client situations brings an essential depth of informed decision making
rather than a loss of objectivity. According to Jodi Halpern, for example,

Empathy involves discerning aspects of a patient's emotional experiences that might otherwise go unrecognized. Empathic communication enables patients to talk about stigmatized issues that relate to
their health that might otherwise never be disclosed, thus leading to a
fuller understanding of patients' illness experiences, health habits, psychological needs, and social situations. As for accuracy, to the extent
that emotions focus attention, training physicians to be aware of the
ways their emotions determine salience can also help them notice potential blind spots and biases. Empathy supplements objective knowledge and the use of technology, and other tools for making accurate
diagnoses. (Halpern 2001, 94)

God asks us to bear one another's burdens and sorrows. If we seek to walk
with our clients through sad and joyful circumstances, we may become
emotional as we experience the situation with them. Nurses or other
health team members do not have to deny their own human responses to
suffering. The nurse is a whole person who experiences the joys and sorrows of others while providing care to the whole person of the client. "Interestingly, however, it is seldom inferred that a nurse herself is a `whole
person', who therefore ought to be viewed holistically," one theorist notes.
"Does not a nurse's physical, mental, social and spiritual functioning mean
anything to her practice of patient care? Why are nursing theories and
models predominantly silent about this aspect of nursing practice?"
(Cusveller 1998, 266). Part of the spiritual care we mentioned earlier involves recognizing that one is affected by clients in emotional and spiritual
ways and responding to this influence rather than denying it.

The acute care nurse is also the one who is constantly present at the
bedside, providing support to the family on a regular basis. Many nurses
have difficulty coping with numerous questions from family members. Mr.
Williams, for example, was always at the bedside, where he would just
stand and look at his wife. Whenever the nursing staff was attempting to complete assessment and all of Mrs. Williams's required treatments, he
would try to engage the nurses in conversation. Susan sometimes found
his neediness overwhelming, coming as it did in addition to the daunting
job of providing care for a seriously ill client. She also knew that it was essential to respond to questions with realistic answers and not offer Mr.
Williams false hope.

We have discussed the concept of health as idolatry. There is another
type of idolatry in acute care, a worship of the latest technology. Cost cutting comes at the expense of human interaction with clients. No one proposes that the budget for new technology be cut to permit more nursing
time at the bedside. Funding new technology is a given. Advertising focuses on new technologies or treatments, and constantly escalating technology is assumed to be a fiscal necessity to attract clients. The technology
is valuable. Without it Mrs. Williams would have died. But the technology
is not an end in itself. It exists for the sake of good client care, and when it
gets in the way of that care it needs to be set aside.

In reviewing the case of Mrs. Williams, we note again that the nurseclient relationship is a reciprocal relationship. The nurse sees Mrs. Williams as a mediator of the divine, not only because the suffering Christ can
be seen in her frail body, but also because her strong and vibrant Christian
faith and the legacy she is leaving her large, loving family radiate God's
presence. As she improved, Mrs. Williams described her own experience as
the work of God. "My Jesus brought me through. I heard all those prayers
and I knew He would see me through," she told her family and the nurses.
Caring for Mrs. Williams became an experience of God's grace for Susan.

Mrs. Williams was able to go home and celebrate her 55th wedding anniversary. Susan knew this because Mr. Williams remained a fairly regular
visitor to the unit for a while, even after his wife moved to the oncology
unit, and he kept the nurses informed about the family. Before Mrs. Williams left the hospital she asked to see Susan. She was dressed in her own
colorful clothing and jewelry, sitting up in a chair, looking like a "regular
person," as Mr. Williams said. She lived another eight months before she
succumbed to her cancer, and her family was able to have the big celebration that they had planned.

Acute care nurses share joys and sorrows of the most profound kind
with their clients. Their lives are marked by the opportunity to provide
care in the fullest sense to the people with whom they work, and to experience the wonders and terrors of God's good creation of the human body. It is a vocation that can make its practitioners both proud and humble at the
same time - proud that they can participate in the healing process and in
providing comfort when healing is not possible, humble when they realize
how much of human life is not under our control but is sustained by the
power of God. But always it is a profession in which the nurse needs to remain rooted in her or his faith so that strength can be drawn from the loving Creator and Sustainer of the universe.

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