1. Elliott, Brenda PhD, RN

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As a nurse educator and a home care nurse I am always looking for opportunities to help students make connections from the classroom to the practice setting. This past fall I had an opportunity to take on a community nursing clinical group. To be honest, it had been awhile since I worked with undergraduate students and I was a little nervous about what to expect. One day, during a post conference with the group, a student shared a story from her clinical day about a hospice patient whose husband had been the caregiver for several months. The stress and strain of her care became more than he could handle and his health started to decline as well. As the student explained the heart-breaking story of this couple who had been married over 60 years, she highlighted the events of the care conference that had taken place the day before. The hospice agency had become aware that the living situation had developed into a safety concern. The nurse and aide had reported that the husband was no longer able to maintain cooking and cleaning. Bread was moldy on the counter; there was slimy outdated chicken in the refrigerator and evidence of stool on the floor. The house was a mess.


As the interdisciplinary team met with the family, patient, and spouse to discuss a plan to help, the husband was against every suggestion. He wanted to do what he could for as long as he was able. Unfortunately, the agency was going to have to stop services if he did not accept some help. The primary patient's health and safety were at risk. As the student spoke, I could see she had experienced a moment of uncertainty. On one side was the agency looking out for the well-being of the patient, and on the other side, she could see this caregiver was distraught that the agency was going to take away from him the only thing that gave him purpose, which was to care for his wife. With the husband's refusal to accept help, it became clear that a compromise would have to be made.


A few students chimed in about the safe handling of food and responsibility of the agency to protect the health of its clients. This was true. At the same time, the student sharing the story expressed "but no one bothered first to ask what the patient and her husband wanted." Right then and there it was clear to me. This student had figured out what some seasoned nurses may take years to learn-that the patient truly is the center of care and as nurses we should always be asking our patients "what do you want?" or "what are your goals for your health?" instead of trying to tell patients what we think is best for them.


I went home that day and felt a pang of sadness for this husband and wife. To the end they have tried to maintain dignity and purpose. Wouldn't we all be so lucky to make it late into our 80s and still have a significant other to care for us? How fortunate that my clinical student, who had not yet passed board exams, had a truly meaningful experience that day. In today's healthcare system we need to encourage patients to be their own best advocates. We need them to be accountable for their own healthcare needs. Without a doubt, this student will step into the RN role with a better understanding of what patient-centered care is. She will be ahead of many of her peers as she has seen the compassion and potential power of involving patients in their own healthcare decisions.