Individuals managing the challenges of life‐limiting illness require adequate social support to maintain quality of life. I have reflected on my experience as a student nurse, embodying a differential approach to care during the time being. An outsider such as myself, had a complete mesh in the center of my eyes, expecting the unexpected. There is a whole stigma about dying. “sadness succumbing to the people around me’ or so I thought. Quality of life before I even entered the corridors seemed like an abyss to me, that never seemed to end the shallow darkness. I feel like people have this misconception about the ideology behind the dying individual. What I am about to say based on my experience of course may seem to most like a sad story, an individual goes through the process of dying, the caregiver (myself) proving care, and then that’s the end of that story. But no. This experience was a very unifying one. Something that I took close to my heart, and reflectively analyzed to this day. In week 4, I was assigned to a lady that had been there for not too long. We chatted, I provided care, and I helped E.K. with her needs. Now keep this in mind, I was there with her for about two weeks which was not long, given that clinical is twice a week. For some reason, she felt drawn to me. We built such an explicit bitter-sweet bond that was very surreal. She shared intimate details about her family, where she came from, her past ambitions in life, and so on. She seemed so happy speaking about this, and she told me that it was nice to have someone listen to her. Under all those giggles and smiles, however… I still saw pain. The next morning, I came into her room for her daily bed bath, and I saw her jerked up on the bed, hands on her face, softly sobbing. I could not believe it because she was so cheerful the day before despite her stories. I sat down beside her, she looked at me and gave me a hug. She stated, “I am so happy to have found someone to talk to and to care for me, please don’t go, thank you for being here”. This broke my heart. I was so overwhelmed with emotions that I just could not help myself and started to cry…something prompted me to.
I felt so content because this person whom I barely knew was so comfortable with me that she was able to tell me the most entrecôte part of her life. The specialty of our relationship was so significant that I saw a bit of happiness peek out of her cloudy perception. She had someone to care for her not only as a caregiver, but a friend. I was able to provide touch therapy to ease her worries as she was contemplating life and the general sorrows she was experiencing. We created a lovely bond that even my instructor started to notice. Her family greeted me one day and saw the genuine behavior I was exhibiting toward their mother. From the care I was providing, to the emotional impact I had on her. One day when I approached her room, she seemed so sad. She had told me there was no one who wanted to talk to her about anything. But I do understand however that it is so difficult for nurses especially due to the time constraint that they have with each patient. Whenever she asked me “Will you please stay with me today”? and I would say yes, her smile brightened, and her demeanor changed which her family sensed too. My instructor came up to me and told me the work I was implementing astonished E. K’s family. They told me that they saw my generosity and my caring nature, and they tried to request to have me there every week. This was the most significant and memorable moment. I had people that I did not know well enough tell me that they wanted me back due to their mother's change of character around me. I had no words. To think that this family excepted me for me and nothing more or nothing less was signifying. I always found myself thinking about what other people are thinking, criticizing, constantly overthinking, etc. But at this moment, I felt like I knew my purpose, I knew who I was. They saw the real me. They did not see a falsified character, nor was there a misconception of clouded beliefs. This was purity.
Analysis
From my clinical standpoint/event, the issue exemplified is the psychosocial delegation of the palliative approach to care. Few interventions exist to address patients' existential needs. When patients are confronted with the seriousness of their diagnoses, many of them wrestle with emotional outpours and existential concerns. As days fill with treatments, health care visits, roles of family members, and daily care, it may make way for opportunistic emotional spills and become overwhelming for the patient/patients (Steinhaser,2017). As a result, many living with serious illness, especially in palliative care report a desire to affirm other aspects of their lives unrelated to physical functioning, such as human connection, pursuing activities that give meaning to life, contributing to others, and accomplishing important goals (Steinhaser,2017). There are five components to the nurse-client relationship: trust, respect, professional intimacy,
empathy, and power. Regardless of the context, length of interaction and whether a nurse is the primary or secondary care provider, these components are always present (CNO, 2006). We can define therapeutic care as a helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient's physical, emotional, and spiritual needs through your knowledge and skill (Richard,2010). In order to build up to these components/standards of care, a nurse must provide a timely approach to therapeutic care, rather than solemnly relying on the standards of regular care. E.K. felt as if the contribution of other healthcare professionals was not prevalent. According to the CNO practice standard, therapeutic care is vital in nursing practice. It is recommended to maintain the equilibrium of standardized care and therapeutic care in order to adhere to the client’s needs/specifications (CNO,2006).
Revision
The importance of this situation was the lack of maintenance of E. K’s psychosocial well-being. It is important to create a social dynamic of therapeutic approach to care, especially with clients who are affected deeply by whatever barriers they face in their life. The predisposing factors that have affected this patient had greatly impacted her quality of life. According to the CNO practice standard, the nurse should demonstrate an understanding of the need to establish, maintain, and re-establish therapeutic, caring, relationships with clients based on appropriate relational boundaries and respect (CNO,2006). In future practice settings, I will be relating the standards of the therapeutic nurse-client relationship and developing a timely approach to care by incorporating variations of tools/strategies to embody the psychosocial aspect of human involvement/needs.
New perspective
In order to provide recommendations to implement, developing systemic/newer innovative approaches to care needs to be put into perspective in order to increase the psychosocial aspect of the client. I can develop nursing care plans retrospectively, to provide variations in qualitative measurements to obtain desired outcomes. Facilitating a SMART criterion as a set point will greatly assemble a longitudinal array of interrelated interventions in order to display the development of a social-well being of the client. Furthermore, developing trust is a key factor that will be utilized in future practice settings with every nurse-client encounter. As stated previously, obtaining the necessary components of a therapeutic communication basis will further assess the development of the plan of care and further provide effective tools to utilize when in contact with the psychosocial aspect of a patient lacking that necessity, especially in the palliative care setting.
References
Fostering therapeutic nurse-patient relationships: Nursing made Incredibly Easy. (n.d.). Retrieved from https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2010/05000/Fostering_therapeutic_nurse_patient_relationships.1.aspx?WT.mc_id=HPxADx20100319xMP
Stechuchak, K. M., Zervakis, J., Steinhauser, K. E., Olsen, M. K., Tulsky, J. A., Alexander, S., … Byock, I. (2017). Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. Journal of Pain & Symptom Management, 54(6), 898–908. https://doi.org/10.1016/j.jpainsymman.2017.06.003
Therapeutic Nurse-Client Relationship, Revised. (2006) [PDF file].Retrieved from http://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf