Friday, November 20, 2015

When Holistic Interventions Don't Get the Responses You Expect

As I continue to strive to remain present at the bedside, I find that I often feel defeated. That I am not doing enough. I wear my "Holistic Nurse" pin on my badge. I center myself and apply my essential oils each morning. But I continue to find myself feeling frazzled and frustrated with the process throughout my day. When I leave work I find myself wondering if I did enough. Did my patient feel touched, appreciated, and respected. Was my intention to be present recognized?

Occasionally, I have a patient or family member express their gratitude for my work that day. They make known their recognition that I am juggling five or six other patients and that they appreciate the care I have provided, that they enjoyed having me as their nurse. I try to remember those moments when I start questioning myself.

A few weeks ago, I had a moment of realization. I was speaking to another nurse about a patient who had backed out on a standard endoscopy procedure. She was a high anxiety patient, who had struggled with the overnight prep. But even before I had left her the day before, she had mentioned that she was scared and didn't really want to have the procedure. Her mother had died after a complication during a similar procedure several years ago, and at the same facility. I tried my best to reassure her, to not discredit her concerns, but to help her come to peace with where she was along her health and care continuum. But despite all of the things I said and did, she still cancelled the procedure.

I was frustrated at that moment. I didn't let my patient know that though. I took my frustrations to my nursing peer. I was explaining to the other nurse how I had helped coach my patient in a session of guided relaxation and deep breathing that morning while her eyes were filled with tears and her voice shaky. I explained that I had been doing that with the patient since the day before to help ease her anxieties. I explained that I had performed a short Reiki session. All of these things had helped to soothe the patient, but she still declined the procedure.

The other nurse laughed at my description of the interventions I had been carrying out with this patient for two days. I realize that not every nurse practices this way, but that response really shook me. Later that day, the patient was discharged to home with a plan for outpatient follow up. Before the volunteer took her to her car in a wheelchair, she reached out and pulled me close. She hugged me tightly and for a long time. She whispered in my ear her thanks. She said the usual thank you's - for the care, education, and services provided. But then she said something I will never forget.  "Thank you for helping me be at peace with my health. Thank you for not making me go through with that test."

My eyes filled with tears. I didn't succeed in convincing my patient to go forward with a procedure that may or may not have been beneficial. I did something better. I supported a patient. I gave her the tools she needed to make a tough decision. My presence and care helped her to say no to something that she was feeling cornered into. She was empowered by my interventions.

As I reflect upon that laughing response I received, I am saddened that my nurse peer does not realize a whole dimension of nursing care that she is missing out on, that her patients are not receiving. I envision a time when those nursing interventions are a normal part of the care every nurse provides. I may not have gotten the responses I hoped for (from the patient or peer), but I believe the patient got what she needed. And that's what matters.

With Love and Gratitude

April, RN