A Therapeutic Sighting: The Power of Seeing Eye-to-Eye

We recently received a story highlighting what happens when a caregiver does what it takes to really “hold” someone in her care. At Covenant HealthCare in Saginaw, Michigan, a recent rise in teen suicide attempts has been met with a new kind of curiosity—one that has been actively cultivated in the staff. This story comes from an ER nurse:

Young woman suffering from a severe depression (very harsh lightI recently had a teenage child admitted with a drug overdose after attempting suicide. It seems like we have had an epidemic of these patients, every week admitting 1 or 2 children with this diagnosis. Some staff members seem to become resentful to these kids, assuming that they are over dramatic and making stupid decisions. (There may be some truth in that, but there is always a whole lot more to the story than what you see in front of you!)

This particular girl arrived to the unit acting out—belligerent in her behavior and language. She was placed in 4 point restraints while in the ECC for fear that she might harm herself or others.

After attending a recent See Me as a Person Workshop, I decided to wonder about this young girl: What was happening, and why was she behaving the way she was? I sat with her and spoke directly to her, allowing her the opportunity to yell and swear while I maintained my composure and just listened.

After a short time, and once she realized that I was no threat to her, she calmed down, and we were capable of having a real conversation. I was able to remove the four restraints with a mutual understanding that she would cooperate with the care we were providing.

Before attending the workshop, I would likely have left her in restraints and wanted to “get in her face” to redirect her behavior. I really see the benefit of taking the time to understand the patient and to gain their confidence and respect to help manage her care. What I learned in the workshop sure made life easier in the long run that night!

While this nurse doesn’t talk directly about a change in her “default” behaviors, that is in effect what she’s talking about. Her old default would have been to “get in her face,” and thanks to the time she had spent learning about, discussing, and reflecting on the See Me as a Person practices of attuning, wondering, following, and holding, she has found herself with a new default: she is now fascinated by the people in her care. She is curious. She knows that there is a backstory, and that whether she learns it or not, there is a reason for the person’s behavior. She also understands that part of that person’s healing is likely to be that she is seen, heard, and received without judgment by another human being.

When you know and are committed to using the See Me as a Person practices, you have the ability to receive the person you’re caring for without judgment. In the instance of a suicide attempt, medical treatment can address the physical ramifications of the attempt, but the physical ramifications are typically only a small fraction of the problem.  Because the person is probably also suffering from a sense of isolation and hopelessness (and/or a host of other mental/emotional/spiritual woes), it is largely in the relational care of the patient that some healing of the root cause could take place.

For years, the experience of receiving good relational care was left to the luck-of-the-draw. You might, if you’re lucky, get a caregiver who is willing to connect and knows how to do it. In cultures like the one at Covenant HealthCare, the odds are much better, however, that everyone walking through their doors will receive good relational care. For the past two years, Covenant has embraced the See Me as a Person practices. They have offered the workshop to their staff in all disciplines, and they have transformed their culture to one in which curiosity replaces assumptions, people are seen, people are heard, and people feel held.

We are always gratified to hear stories like the one sent to us by this devoted ER nurse. It is an honor to help caregivers in all disciplines to provide superior relational care, with greater consistency and mindfulness, to the patients and families they serve.

Q & A: What was the Inspiration for the RBC Model?

QUESTION:
Hello! I am in graduate school at Kent State University working to become a nurse practitioner. My group chose your nursing theory to present for our peers. We would like to know what was your motivation for developing the Relationship Based Care theory? What was your process used for developing this theory? Also if there is any information that you would like to add regarding the theory? I have recently purchased a couple of your books and your CD, and I love your theory!! I have practiced as a bedside nurse for fourteen years and have been inspired by your writing and stories! I am excited to present your theory to my classmates and also to my coworkers. Thank you in advance for your guidance, and I look forward to hearing from you!

Sincerely,
Lisa Meek, BSN, CMSRN

ANSWER:
Mary-Koloroutis-150x150Hello, Lisa! It is rewarding to know that Relationship-Based Care resonates with you and is helping to inform your practice. Relationship-Based Care has evolved over the past 25 years beginning with the seminal work of Marie Manthey on primary nursing—a care delivery system that puts the patient-nurse relationship central. My motivation for contributing to the development of the RBC Model is very simple, actually. When I entered nursing practice, it was clear to me that safeguarding the humanity of those in our care as well as the humanity of those of us providing care would take intention and awareness as well as leadership (whether at the point of care or leading in a role within the organization). Institutions are where most care is provided and they are, by nature and design, prone to dehumanizing processes. The volume of patients served, the complexity of human caring and the complexity and escalating development in the sciences and technology all take attention and can undermine our core purpose. Holding the person central takes mindfulness, teamwork, and perseverance, along with an established way of doing/way of being within an organization that supports caregivers in keeping patients and families central at all times.

The work I did with Michael Trout on the book and workshop See Me as a Person was motivated by recognizing that while we talked about the nurse-patient therapeutic relationship as the center piece of care in RBC, it was an elusive concept to many in practice.  The “how” of therapeutic relationships had not been fully addressed. Those who excel at establishing and nurturing therapeutic relationships were seen as “simply knowing how to relate” and thus, the knowledge and discipline behind therapeutic relationships and the fact that relational practices can and should be taught was missed. We deconstructed what it looks like when we as caregivers are at our best and in a therapeutic interaction with a person. When authentic connection was established, four things were nearly always happening: We are present and attuned (focused on the person); we are wondering (genuinely interested in the person and what the person has to teach us, so we can provide the best possible care); we are “following,” (remembering and acting on what we have been taught); and we are holding (creating a safe haven for healing by doing what we say we will do; safeguarding the dignity of the people in our care; watching over them, keeping them informed, etc.

I am so pleased that Kent State is integrating this into practice. I remain

Respectfully yours,
Mary Koloroutis