Clinical Event

            Through the many patients that I cared for this past semester during clinical, there was one day and one patient in particular that stood out to me. I believe I provided empathetic and compassionate care to them; and I also felt as though I made the biggest difference in this patient’s experience. This patient was a lovely older woman who had previously lived alone and presented with the inability to walk and with delirium. The prognosis for my patient was not good; my clinical instructor informed me that she believed the patient had delirium resulting from a hyponatremic state and possibly from undiagnosed dementia. There were also other medical issues that needed to be addressed after she was discharged from rehab. From this information, and the information provided to me from the history and physical as well as the progress note, I knew this patient would require a little extra TLC. After getting out onto the floor and checking in with the RN about my patient, I met with them. Seeing how it was a slow morning out on the floor, I was relieved to know that I would have the extra time to spend with my patient.

            I began the morning by helping her set up for breakfast and checked in on her frequently to see if they needed anything. She was alert and oriented times 1 only, but was able to independently feed herself during breakfast and I just made some small talk. After letting her rest after breakfast, she wanted to get back into bed; and I decided it would be a great time to begin my bedside assessment. She was in a very pleasant mood all morning, so I simply talked with her all throughout the assessment. I also made sure to go a little slower than usual and be extra thorough. She told me all about her and her life and asked me some questions about myself as well. A little later during the assessment, she told me that she often gets lonely in the facility and was very excited for one of her sons to come visit her later that day. I replied that I was happy to hear that she had some company on the way and that she would have someone to interact with in the afternoon.

            At the end of the assessment, I thanked her for her time and told her I’d be in and out the rest of the morning to check in. She then thanked me many times over for taking the time to sit and talk with her. She even went further and told me that my talking skills and attitude were impeccable, and how it was such a joy to just chat. It became abundantly clear to me at that moment that she doesn’t get a lot of face time with the people here. It was also in this moment that I felt like I provided empathetic and compassionate care for the first time as a nursing student. I knew this to be true by seeing the massive smile on her face as I left that morning, something that was not there originally when I first arrived. 

Empathy vs. Compassion

            Jean Watson’s Carative Factors were the “format and focus of the nursing phenomena” back when they were developed in 1979 (Watson, 1996). To this day, they still function as a core concept of nursing. Empathy and compassion are highlighted in Watson’s Carative Factors through fostering a caring environment. Through this, you establish a caregiver-patient relationship which has the ability to foster these carative factors. When a caregiver provides care based on Watson’s Carative Factors, they are now effectively treating the person as a human being, and not just as a disease. It can be very easy to treat the disease process and not the patient; but these carative factors give us the tools needed to embody true care in a person, as a whole. As Watson states, “…as well as a critical starting point for nursing’s existence, broad societal mission, and the basis for further advancement for caring-healing practices” (Watson, 1996). Nurses have to begin somewhere, and it would be better for us to begin as human beings caring for other human beings than a robot treating a disease. Also, she is stating that these carative factors will give the caregiver a starting point not only in how to provide humanistic care, but also how to continue giving that care while the needs of the patient change and evolve.

            The difference that these carative factors make in client outcomes is that the client is now the priority of the caregiver. The differences can only be positive from this point onward. If these carative factors are followed, patients are more likely to be open with their caregiver and go to them when something is wrong or when they need something. This is healthy for the patient physically and mentally! If the patient isn’t keeping anything bottled up by expressing their concerns or fears, then the caregiver can help them before a crisis happens. The patient will also be more trusting of the caregiver, which fosters an open environment for this communication to happen. Along the lines of the patient informing the caregiver of any abnormalities, their prognosis will drastically improve. Patient outcomes can only improve with these carative factors because of the trusting and helpful environment that has been created. As Watson stated, “It [transpersonal caring] implies a focus on the uniqueness of self and other and the uniqueness of the moment, wherein the coming together is mutual and reciprocal, each fully embodied in the moment, while paradoxically capable of transcending the moment, open to new possibilities” (Watson, 1996). There’s a lot to unpack here, but I feel that the big picture of this quote is stating that through these carative factors and how they direct care. The possibilities of the new patient outcomes are endless through the mutual respect both caregiver and patient have for one another.

Self-Assessment

            My role in the event described with my patient was that of a caregiver. However, the aspect demonstrated was that of active listening. I was a listener for my patient, and that was something that they needed. My patient needed to be seen as a human being with human interaction needs; and my role as a caregiver is to provide that. A truly good caregiver embodies empathy and compassion. However, you cannot have compassion without having empathy. Empathy is only a portion of compassion. Without empathy, you just have the desire to help, but no reason as to why. Compassion is the ability to take the perspective of and feel the emotions of another person which include the selfless desire to help them. In my role, I felt the emotions of my patient and aided them so that they wouldn’t have to feel that way all day.

            Ways I could improve my response in the future could be to additionally offer ways for my patient to not feel so lonely. This could include encouraging them to go to the dining room for meals, read books to get lost in the world of fiction, ice-breaker examples to use with their roommate (if applicable), and encouraging them to go sit in the common area and socialize with others. I could also offer to take them there myself and aid them in the beginning. Lastly, I could encourage family intervention and have them brainstorm ways to help the patient become more involved. The family has the best insight into the patient and their likes and dislikes.

            I will incorporate caring behaviors into my clinical care by doing self-checks to make sure I am not just caring for the patient based off of their diagnosis. I will come up with a routine that incorporates the disease-treating part of the job in with the person-treating part so that flow together and one doesn’t dominate. I can also have my fellow students check me if they feel there are areas of patient care in which I can improve. Constructive criticism is one of the best checks we can have as students to prepare us for the real world and its experiences. The minute I enter the patient room, the priority is them and anything that they need.

References

Watson, J. (1996). Watson’s theory of transpersonal caring. In P.H. Walker & B. Neuman (Eds.), Blueprint for use of nursing models: Education, research, practice, & administration (pp.141-184). NY: NLN Press.