Article Content

WELCOME to a column just for students!! Our purpose is to encourage you as a student in your spiritual journey, challenge you to integrate your faith and practice in the providing holistic care, and wrestle with nursing education and practice issues from a Christian perspective.


In each column you'll find a devotional, and other helpful tidbits, such as Web resources, trends, future employment, and the like.


If there is an issue you wish to have addressed, TXT us at It's your column!!


Saying Goodbye

These days, DNR (do not resuscitate) often is seen on patients' records. Ideally, it indicates that the person has weighed the pros and cons of having life extended by "heroic" measures. Sometimes, however, a life goes on longer than would seem humane, even without heroic measures.


Recently I cared for a 74-year-old woman who weighed less than 100 pounds. She had brain cancer and was emaciated, with broken-down skin and a broken spirit. The morning I entered her room, she was huddled under a quilt from home, curled in a fetal position and crying. She had cried all night for the past few nights, her pain and confusion worsening until she was calling out for her Daddy. The night nurse had left a note about the patient's refusal or inability to take anything by mouth.


I tried to keep the patient's wounded skin dry despite her incontinence and rigidity. As I explained my plan for her care, she made no eye contact. Between her cries, I heard one coherent phrase, "I want to say goodbye."


Others may have thought this woman was confused. But I think I understood her meaning. I assured her that I respected her wishes, that we would not prolong her life. I told her I would be giving her medicine intravenously to ease her pain before I turned her. I called the physician to obtain orders for more effective pain medication. I called her daughter and explained the option of hospice care. When the daughter came, we clipped the woman's nails so she wouldn't continue to injure herself.


I wish I had asked whether she would have desired pastoral care. I didn't even check her chart to learn what she may have claimed as a religious affiliation. I did, however, hold her shaking hand and say, "I will help you be comfortable. I will try to help you say goodbye."

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Sometimes patients understand sooner than their families when it is time to die. When we as nurses recognize this, we can be an advocate for the patient who is not able to communicate clearly, explaining signs to the family: cessation of eating, loss of eye contact, and a request to say goodbye. The family may need as much or more spiritual care than the patient. Gently guiding the family toward resources such as pastoral care, hospice, or each other may be ways the nurse can facilitate the family's readiness to hear an unspoken goodbye.


Rather than "managed care," a new trend in health is "messaged care." Text messages send reminders for meds (don't 4get ur pills!!) or appointments, or offer health information. Using the San Francisco Health Department's "SexInfo" service, callers can request answers to common questions (2 find out about STDs), as well as details about health services available in town. Advertised in public transportation and on billboards, the SexInfo text number received more than 4,500 inquiries in the first 25 weeks; more than half of those led to follow-up questions and referrals.


Usually text services are free as many cell phone packages include messaging. Added pluses are privacy, ease of response and recall, no e-mail device needed, and accessibility in remote areas.


Reflective Practice

"Test me, O LORD, and try me, examine my heart and my mind; for your love is ever before me, and I walk continually in your truth" (Psalm 26:2-3, NIV).


"Reflection is active, purposeful thought applied to an experience to understand the meaning of that experience for the individual. The aim of this purposeful thought is to gain understanding, which then leads to changes in what we do, and new perspectives. Reflectivepractice requires critical appraisal of experiences, and the understanding we gain through it adds to our knowledge" (Ashby, 2006, p. 1).


As beginning nurses, you will encounter new experiences that challenge your thinking and require purposeful processing for an understanding of practice situations. Ask God to guide this reflection, to open your mind to his truth so that you may gain wisdom to be his instrument in nursing practice.


The nurse in "Saying Goodbye" demonstrated reflective practice by reviewing what she did well and what she could have done differently. Likely, the nurse was providing care to several clients, yet she was aware of the needs of her dying client and the daughter. She provided pain control, physical hygiene, safety, and emotional support. She assisted the daughter in expressing care through the action of clipping her mother's nails.


The nurse reflectively thought she could have been more intentional in providing spiritual care. She realized she needed to look for evidence of the client's faith traditions. She could have asked the daughter about her mother's faith and what would be helpful, as well as reviewing the chart. The nurse could have prayed silently for her patient. Yet, the nurse's caring certainly would represent the hands of Jesus to this dying woman.


Ashby, C. (2006). Models for reflective practice. Practice Nurse, 32, 10. [Context Link]