1. Somerville, Jacqueline G. PhD, RN

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Risk for compromised human dignity has been recognized by NANDA International, Inc., as a nursing diagnosis.1 As nurses, we're called to ensure that the voices of the marginalized and often misunderstood are heard. The challenge for us is that we live in a society that views people with mental health challenges, including addiction, as "less than." There are many not-so-subtle assumptions made about the family that the person came from, his or her ethnicity and socioeconomic status, the "poor" choices that he or she made, a sense that he or she "brought" on these diseases, and, some would even say, that he or she deserves the consequences and suffering. Would we ever say this about a colleague diagnosed with cancer?

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The truth is that mental illness and addiction know no boundaries and cross all ethnicities and socioeconomic groups. Evidence suggests that mental health issues account for the majority of chronic medical conditions and speaks to the broken spirit of people who don't seem to "fit into" our society.2


The challenge for us as nurses is that we live in this society where mental health and addiction are underserved. Look at our healthcare system and the services insurers choose to cover. Most insured patients qualify for a bone marrow transplant, but on the other hand, try to help a neighbor or relative access mental health services. To say it's a challenge is an understatement. So, again, what does that say about our society's belief that those suffering have a right to evidence-based treatments proven to relieve psychological pain?


A 2013 article in the New York Times described a class-action lawsuit being brought by San Francisco on behalf of 24 mentally ill and homeless people who were bused out of Nevada, with little or no medication, no destination, and no contacts. One patient, after threatening to kill himself, was sent (after a 1-night stay in a psychiatric center) by bus to San Francisco with several bagged lunches and a day's worth of medication.3 The question we must ask ourselves is: Were nurses involved in the care and were nurse administrators involved in the policy decision?


Be the change you want to see

Nurses must challenge and change the attitudes of society and suspend societal biases that we're exposed to as we step into our clinical role, our professional role, our healer role, our leader role, and our nurse role. We know that to rewire what's hardwired into someone's DNA takes support and care. As nurses, we must try to erase all the societal biases that surround us when we meet our patients. We must enter each encounter fully present and with awareness of unconscious bias that may impact how we attend to others, especially those in mental health crisis.


Our roles as nurses are so powerful. We practice equanimity, approaching each patient with regard for his or her value as a unique human being, regardless of physical, psychological, or spiritual pain. This requires singular focus and courage, while resisting the labels our colleagues may use to describe patients during handoffs or intershift report, and always embracing the humanity of others, enabling faith within the other that there's hope for healing.


In acute care settings, delirium and withdrawal are life-threatening and largely preventable. The human suffering caused by both is great, and evidence now indicates that the effects of both are anything but temporary.4 There are often irreversible changes to the brain and spirit. Feeling out of control epitomizes the ultimate loss of human dignity. Nurses' work in assessing patients for emerging symptoms, and advocating and intervening on the patient's behalf, is critical to minimize human suffering and advance health and healing.


We have the power

At Brigham and Women's Hospital, our care delivery system, relationship-based care, calls us to focus on relationships across four levels. At the center is the major focus of our work as nurses: our relationship with patients, families, and the communities we serve. We're privileged to encounter patients at times of vulnerability and joy, to suspend all judgment and approach each person entrusted to our care with curiosity, with authentic presence, and with a genuine intention to understand his or her story, to understand what holds meaning and value for each individual, and to understand his or her hopes and goals of care.


The second relationship that we're called to attend to is relationship with self. We must care for ourselves if we're to have the capacity to care for others. We must be willing to reflect on our practice through clinical narratives and storytelling to celebrate the beauty and identify opportunities to strengthen our healing interventions. Next, we must attune to our relationship with colleagues. Caring for our most vulnerable patients is an intensely collaborative art and, when done well, creates a feeling of community and shared responsibility. We must be willing to listen, to contribute, to coordinate, and, most important, to ensure that the patient and family are at the center of all that we do.


Lastly, we must be informed by the diverse communities that surround us. As nurses, our practice must be informed by emerging evidence and by our professional organizations, and we must use our voices to impact society, our neighbors, and our peers to challenge the marginalization and stereotyping of those suffering mental anguish and addiction. Nurses must be willing and ready to advocate at the policy level on their patients' behalf.


Dr. Jean Waston, the founder and director of Watson Caring Science Institute, would challenge us to approach today as nurses valuing the mind, body, and soul connection, approaching each experience with curiosity and openness.5 Remember the power of our collective practice in service to patients and families.


I'm humbled by the practice that I'm honored to witness each day. The nurse becomes the intervention, creating an environment where each person, patient, family member, and peer feels cared for and valued. That truly is the foundation for a healthy work environment. When beauty, respect, dignity, wholeness, meaning, and comfort are attended to through a trusting relationship of mutuality, the nurse creates a healing space and mutual consciousness, which is so much more powerful than the traditional concept of team. All things become possible. Love of self and others[horizontal ellipsis]realization of the privilege and honor nurses experience[horizontal ellipsis]sharing that sacred space with our patients and families[horizontal ellipsis]it all leads not only to healing for patients, but to identity and meaning for each nurse.




1. NANDA International, Inc. Nursing Diagnoses: Definitions and Classification, 2009-2011. Oxford, United Kingdom: John Wiley & Sons Ltd.; 2009:181-183. [Context Link]


2. Stanton MW. The high concentration of U.S. health care expenditures, research in action, issue 19. [Context Link]


3. Lyman R. Once suicidal and shipped off, now battling Nevada over care. [Context Link]


4. Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Crit Care Med. 2014;42(2):369-377. [Context Link]


5. Watson Caring Science Institute and International Caritas Consortium. [Context Link]