As I pondered what I would write for this blog, I kept going back to a chapter I wrote for the commemorative edition of Florence Nightingale’s Notes on Nursing: What It Is and What It Is Not,
that has just been published to celebrate Nurses Week. To elevate the nursing profession, we must understand where it has been, how has healthcare changed, the importance of being a leader at the bedside to the boardroom, and the responsibility of being an ambassador and advocate for our profession and our patients. I would like to share with you my entry in the book called, Notes on Nursing – Not Unlike the Lady With the Lamp
While attending nursing school, I was required to read the book, Notes on Nursing, by Florence Nightingale. And while I could certainly understand how addressing such issues as exposure to clean air and water, sanitation, hygiene, and exposure to sunlight daily, were important to the healing process, I did not fully appreciate the impact Nightingale’s work would have on methods of healthcare in the years to come.
During Nightingale’s time, nursing care was administered only by women, and in fact, Notes on Nursing was written directly to women with instruction on how to conduct themselves while caring for the sick as well as the healthy. Times have certainly changed since 1859 when the first edition was published. Men are now part of a fast-growing profession that has moved from one of mere servitude to that of equal partnership with all healthcare professionals. What is most remarkable about Nightingale’s work, is that she was one of the first clinicians to use the concepts of epidemiology and care quality to improve healthcare delivery and patient outcomes. Today, the use of evidence to inform practice and improve outcomes is the bedrock of quality care on a worldwide basis. And for those who doubt the power of the nursing profession to influence and make change, all one must do is consult the history books.
One topic that Nightingale writes about is the importance of listening and communicating with her patients. For me, the skill of active listening truly joins the art and science of what we do as nurses. However, this is perhaps one of the most difficult skills to employ. In today’s fast-paced environment where technology is ever present, and various medical apparatus such as intravenous pumps, mechanical ventilators, and other machines sit between us and our patient, stopping in for a moment to just be present with a patient to hold his or her hand, wipe a fevered brow and/or actively listen to what he or she is saying in acknowledgement to what they’re feeling is sometimes more of a challenge than it should be.
Not too long ago I went into a patient’s room in the critical care unit and had to find my way through the jungle of tubing and machines to speak with my patient, Helen, as I will refer to her. Helen was lying in her bed with her eyes closed and her face dwarfed by a breathing mask. She had a diagnosis of stage four chronic obstructive pulmonary disease and had been admitted for an exacerbation due to pneumonia. Her eyes fluttered open when I touched her hand. as I introduced myself, and asked her how she was feeling, she smiled and said “fine.” I could tell she was far from it, I sat down in a chair next to her bed and held her hand, and she said she had lived a good life, and just wanted to die peacefully. She then told me about her husband who had passed three years prior, and how she wanted to be with him again. She said me she was ready to stop everything and just die peacefully.
I explained to her about hospice, and then conveyed her wish to the attending physician who said he didn’t know she was ready to go on to hospice. I asked him if he had asked her what she wanted, and he told me, “No. I was busy with other patients and was told by the emergency room physician that she wanted to be a full code.” The physician spoke with her and her family, and ordered a hospice consult, and as luck would have it, she was transferred later that evening to an inpatient hospice unit.
As the ambulance attendants wheeled her out, she reached out to me and said, “thank you for taking the time to sit with me and listen.” Helen died the next day in hospice, on her own terms, and surrounded by her loving family.
That’s who we are. We are our patient’s advocate when they need a voice. We listen to their stories, help them come to terms with their diseases and conditions, make sure their basic needs are met and provide a hand to hold when that’s needed too. We look beyond the tubes and machines to see the life in the bed as one that is worthy of our time and respect, and so give them the choice to heal or to die on their own terms.
A lot has changed since Nightingale wrote Notes on Nursing in 1859. The access to medications, devices and medical breakthroughs has significantly extended our lifespans. But, one must remember that the concept of quality of time, versus quantity of time has remained constant. As nurses, we use the best available evidence to assist patients to make informed decisions about their healthcare. And yet, we can still have crucial conversations or employ the power of just being present and listening when that’s all that’s needed. We are caregivers who are privileged each day to practice our profession of nursing, so not so unlike the original lady with the lamp.
Thank you for your innovation, dedication, and courage to be a member of the nursing profession and give the gift of yourself every day to the patients you serve. You are the true heroes of healthcare!
*Reprinted with permission.
Dabrow Woods, A. (2020). Notes on Nursing – Not unlike the lady with the lamp. In Notes on Nursing: What it is and What it is Not. 160th edition. (54-56). Philadelphia, PA: Wolters Kluwer.