A Therapeutic Sighting: Take a Moment…and Just Ask

The following email was forwarded from Mary Del Guidice, CNO at Pennsylvania Hospital as her Leadership Tip of the Day. The initial email was sent to Mary by JoAnne Ruggiero, a nurse manager who witnessed a nurse, Dorkas, providing compassionate care to an elderly patient.  It is a beautiful example of a nurse caring for a patient and nursing leaders caring for nurses by lifting up and shining a light on their exquisite care and what matters in this sacred work. (Note:  we have altered the patient’s name to safeguard his privacy.)

snowstormToday’s tip comes from the bedside and truly demonstrates a nurse who took the time to attune and hold her patient. 

“I thought this would put a smile on all your faces. As you know Mr. Smith has been here quite some time. During the last snow storm he sat at the window for a while and watched the snow fall. When I asked him if he was ok he said, “Yeah, I’m just watching the snow come down.” Today he was doing the same thing and Dorkas noticed him watching the snow coming down. What she did next was so endearing.

She asked if she could take Mr. Smith outside for a while to let him watch the snow from the outside. When she received approval, she lent him her coat and found another coat for herself. She got him some pants and put them on him and wrapped him up in blankets. She then took Mr. Smith outside for at least 20 minutes and stood out there with him for him to watch the snow fall. I took a picture of the 2 of them. I can’t even begin to tell you how big he smiled when I asked him if he liked the snow coming down.

This is the essence of relationship based caring—to know your patients to the point where you understand that a simple walk outside would turn their entire day around. I encourage all of you to ask him how he enjoyed the snow!”

Mary Del Guidice wrapped up this message with the following thought for her team, reinforcing their “mantra” for what good care looks like:

Through this single nurse’s act of love and compassion, we have come together in recognition of our shared values and beliefs……in keeping the MAIN thing the MAIN thing!!!

A Therapeutic Sighting: “I Had a Great Nurse Last Night”

Many of you know that our daughter, Alicia, has end-stage renal disease and is on the transplant list.  She began peritoneal dialysis several months ago and is courageously coping with what that means day to day while continuing to work as a nurse in a digestive health clinic.

To say we are proud of her courage and stamina would be a tremendous understatement.

Alicia has been dealing with kidney disease since she was 13 and is quite experienced at hospitalization and relating to a variety of caregivers. A few weeks ago, Alicia now 24,  was admitted with some complications and spent 36 hours in the hospital until she stabilized. On the day of her discharge she and I had lunch together and she told me this story:

Alicia:  I had a great nurse last night. I knew as soon as he walked in the door that it was going to be good.

Mary:   Really…tell me…what did he do?

Alicia:   Well, as he came into the room, he looked at me, and then he looked around the room and I could see that he was assessing everything.

Mary:    How did you know he was assessing everything?

Alicia:   The first thing he noticed was that the call light had fallen off the bed, and he made sure I could reach it. Then he looked at me and he said, “How are you doing? Do you need something for pain?”

Mom, he knew things by looking at me. I said, “No, I’m okay.” He said, “Really?…your words say you’re okay, but your face and body don’t.” Then I said, “You’re right; I am feeling some pain, but I’m trying to hold off.”  And he said, “Okay, let’s see how that’s working for you, and I’ll check back in a little while.”

And he did! He came back in a short time! He also got a blanket for me because he felt it was chilly in the room. It wasn’t just that he noticed things; it was that it really mattered to him that I was comfortable.

Mary:    Would it be right to say he was genuinely interested in you?

Alicia:   Yes! He didn’t walk through the door looking like he was thinking about everything he had to do. I didn’t’ feel like I was on a list of things for him to do. When he was there, I felt like he was seeing only me.

When I had been in to see Alicia the night before, she told me that she was not going to allow the nurses to connect her peritoneal dialysis because she didn’t trust that they would know and follow the strict aseptic method.   The risk of peritonitis is high with peritoneal dialysis, and Alicia was advised to be very careful and assertive about who she let connect her.  So I asked her how her dialysis went that night.

Mary:    Did you connect yourself to start the dialysis?

Alicia:   No, I let him do it. I could tell he’d do it right.

Clearly that’s another thing that made him a great nurse. She felt safe and held by this nurse because she felt seen. She took his assessment skills and his attendance to her as evidence of all-around competency, and this was verified when he both voiced and demonstrated his competency when he skillfully helped her with the dialysis doing everything carefully and correctly.

As we continued talking, she mentioned that they didn’t get her dialysis hooked up until 3:00 in the morning because the equipment to warm the dialysate was not functioning. I was pretty unhappy to learn that, but she was completely forgiving because of her trust in the nurse and the rapport he established with her.   He joined her, and she was so much his priority, that a little technical problem was just that: It was a little problem.

Alicia could easily have seen the technical glitch as incompetence on the part of the hospital, but she was not queued up to see it that way. She was in the middle of an experience where someone in “the system” so clearly had her back that she was not poised to see a problem as incompetence. It was clear to her that they were in this together. That feeling of really being held is so big that it makes the other things seem small in comparison.

This was quite a contrast to the nurse she had the next day—a nurse she perceived as eager to get Alicia checked off her list. She told Alicia she’d be back in 5 minutes, but was back in 40. The promise wasn’t even necessary; Alicia didn’t need her back in 5 minutes. But a broken promise is a dropping of the patient and shakes trust.  The nurse came in (finally) and made a rather dramatic show of things, saying, “You poor thing…I got sidetracked with phone calls and just couldn’t make it back any sooner.” This second nurse was trying to be nice and soothe the situation, but she was not a partner. Alicia took in her words as a means of handling her not caring for her. In addition, her distracted care told Alicia more than any words could.  Alicia had concluded that this nurse did not “have her back.”

The man who cared for Alicia the night before—the nurse who helped Alicia to shape her very definition of a “great nurse”—was neither nice nor not-nice. Niceness had nothing to do with his greatness. He brought himself. He brought technical competency, and he brought relational competency. The great nurse brought the magic ingredient: the willingness to be genuinely interested, present, and focused in the care of his patient.