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The purpose of this caring paper is to reflect on a personal experience within our time at our clinical rotation in which a patient experienced two of Watson’s lower order of needs. Doris Grinspun (2010), a professor from York University defines caring as “thinking, doing, and being representing the ways in which nurses enact caring work and manages relationships and present key courses of action in which nurses enact their work focusing on rules of engagement and inequalities”. From this, we can establish that caring involves every interaction a nurse has with a patient, from the first introduction, throughout the healing process and the termination phase between the nurse and client. Caring science embraces all ways of knowing/being/doing: ethical, intuitive, personal, empirical, aesthetic, and even spiritual/metaphysical ways of knowing and Being (Watson, 2008). This paper will focus on a description of my patient and their diagnosis, caritas processes, two of Watson’s lower order of needs which will include activity/inactivity and sexual intimacy, and possible nursing interventions that can be put into place to help improve the quality of care for the hospitalized patient.
The personal encounter with a patient with two of Watson’s lower order of needs was diagnosed with dementia, or failure to cope. Dementia is the development of multiple cognitive deficits, manifested by memory impairment and other deficits affecting language, inability to carry out motor functions, failure to recognize or identify objects and a disturbance in functioning (Jarvis, 2009). It was evident when dealing with this patient that she had a cognitive impairment. I introduced myself to her on the first day, and when I returned to her bed side the following morning to get her up and take her vital signs, she had no recollection of who I was from the previous day. I had to continuously remind her who I was throughout the course of the two days I was in clinical. She referred to the nursing students as the kids in blue. Her diagnosis mainly affected her ability to remember people, place, and sometimes memories, but when it came to retaining facts, she was very capable; an example was the recreational therapy that she attended in which she was always able to answer the trivia questions or the answer to the crossword.
Over the course of the two days in which she was my assigned patient that I was to care for, I got know her well. She trusted me from the beginning because she knew I was just doing my job. She quickly began to open up to me and told me about her family. She came from a large family of six kids, of that she had four brothers all of whom always looked out for her and her sister. She was born and raised, and lived in Oshawa her entire life. While growing up, her family lived on a farm. Herself and her siblings assisted in the chores around the bard, including milking the cows and gathering the chicken eggs. My patient married her husband in her twenties and had four kids; three sons and one daughter. She informed me many times that she loved her family and enjoys when any member of her family is able to come and visit her.
One of Watson’s lower orders of needs is activity/inactivity. One of the health challenges my patients experiences was the fact that she was non-ambulatory. She was only allowed to be in her bed or in her wheelchair because she had a high risk of falling. Due to her lack of ability to move around, her muscles would slowly start to experience atrophy. Deconditioning is a process or physiological change following a period of inactivity or bed rest that results in a decrease in muscle mass, weakness, functional decline and the ability to perform daily living activities (Gillis & MacDonald, 2008). It is observed in an increasing frequency as a consequence of hospitalization for many older adults. While in the hospital receiving care, many elderly patients, due to age, begin to grow frail and are at a greater risk of falls. To counteract this problem, many patients are assigned bed-rest, or stay in their wheel-chair all the time. This limits the patient’s ability to get up and walk around. A recent study concluded that older hospitalized patients 70 years and up showed a decline in activities of daily living associated with deconditioning on discharge (Brown et al., 2004). To prevent deconditioning, a nursing intervention must be to look for risk factors and intervene proactively. This is assuming that nurses have the prerequisite knowledge, skills and attitudes to recognize and respond to the specialized needs of hospitalized older patients.
I found that my patient had a hard time accepting the fact that she was unable to get out of her wheelchair and walk around. At one point she was so determined she unbuckled herself and attempted to get out and walk. Having to go in there and tell her otherwise was a challenge because seeing the disappointment in her eyes upset me. Physical inactivity is a risk factor for many conditions experienced by the elderly. Exercise helps older people feel better and enjoy life more, even if they think they are too old or too out of shape (Ebersole et al., 2008). Gerontological continuing education programs should contain a core component on the prevention of deconditioning (Gillis & MacDonald, 2008). It should focus on diagnosis and assessment of risk for deconditioning, prevention, interventions, and strategies for the patient and family teaching. I believe that due to her inactivity, or lack of mobility, her routine was rather repetitive; get up, vitals, bed bath, get dressed, get into wheelchair and sit there until she wanted to go back to bed. A person’s need for activity/inactivity is fundamental and central to one’s life, as it affects the ability to move about and interact with his or her environment and to control one’s external surroundings (Watson, 2008). To maintain competency in the field, the nurse must use his or her knowledge, skill, judgment, attitudes, values and beliefs to perform in a given role, situation and practice setting (CNO, 2002). It is important to establish best practices in gerontology and implement them in a consistent manner to improve the knowledge of nurses. This will enhance the confidence level and provide to the elderly the quality care that they deserve.
The other lower orders of need of Watson’s that will be discussed in this paper is sexuality and intimacy. Touch affects almost anything we do; all humans require touch (Ebersole et al., 2008). To a palliative patient in a hospital or in a nursing home, they tend to lose the sense of touch, which can be a form of comfort or help decrease anxiety, from their loved ones, due to them passing on or the distance put between the patient and the remaining family members. Hollinger and Buschmann (1993) proposed that attitudes toward touch and acceptance of touch affect the behaviour of both caregiver and patient. As a nurse, either a task related touch, or even an expressive form of a touch such as holding the patient’s hand will show a supportive nature, and that is all the patient requires, a form of touch and belonging.
When working with my patient, although she had a few family members who did come to visit her, they lived a bit farther away so travelling to pay a visit was a challenge. With her diagnosis of dementia, she also tended to not remember clearly. She told me various times that everyone just forgot about her, no one cared and she was stuck in the hospital until she was gone. She did not lack the companionship of others; she just tended to forget about it sometimes. Nurses provide health services to an increasing number of older adults in acute care settings (Turner et al., 2001). Although there are many patients requiring care in either a nursing home or on a geriatrics ward of a hospital, every patient requires the companionship of others, especially if the patient does not have visitors to come. Just a couple minutes taken out of your day to talk with, or give a back rub to a patient is all they need rather than being stuck with a window to look out of, or a roommate that does not want to talk, or sleeps all day. We all need each other to maintain a healthy lifestyle. Nurses need to think about touching as part of caring (Ebersole et al., 2008). A nursing intervention that could be helpful to improve this order of is the type of culture that you were born into. It will give you the experience you need and will have a large influence on your comfort level with touching others. Be sure to assess a patient’s readiness to being touched with a “social touch”. Enhance the knowledge and skills of staff nurses in providing care to elderly patients (Turner et al., 2001).
One cannot enter into and sustain Caritas practices for caring-healing without being personally prepared (Watson, 2008). Developing and sustaining a helping-trusting caring relationship is one of Watson’s Caritas Processes (2008). For a nurse to be personally prepared means knowing and understanding the practice to which will be carried out and providing the best safe, competent, quality care to which the patient deserved. For this process to be carried out in regards to caring for an elderly patient would be to be a positive role model who understands the job description and articulates professional practice while providing care. As a nurse, the best way to provide care to any patient, no matter what the diagnosis is to develop a caring relationship of skills and caring competencies, not necessarily about the technique. As a nursing student, while I was caring for the patient I described above, although I learned the technique to take vital signs, perform a bed bath, and perform assessments, it is about the relationship which I form with my patient. From the beginning, ensure that the patient feels a sense of trust and feels care, not just the sense from the nurse “this is my job, I’m just doing my job and leaving,” making the patient suffer the consequences of noncaring such as fear, helpless, and vulnerable. Authentic caring relationship building is concerned with deepening our humanity; it is about processes of being-becoming more humane, compassionate, aware, and awake to our own and others’ human dilemma.
Being present to, and supportive of, the expression of positive and negative feelings is another of Watson’s Caritas Processes (2008). The first priority nurses should consider when caring for patients is their health and safety. In order to do this, a nurse must be open and supportive of the care that is being given to the patient. It is through being present to and allowing constructive expression of all feelings that we create a foundation for trust and caring (Watson, 2008). When caring for my patient described above, there was a moment where she was having negative feelings about being in her wheelchair. I allowed her to express all her thoughts and opinions on the issue she was having and from there, using communication and problem solving, together we were able to solve her problem. The best way to achieve a solution when dealing with a client with a problem is through the connection with the patient. A nursing intervention is to allow the patient to express his or her feelings, whether they are positive or negative. By allowing the facilitation of expression, the nurse permits the process of personal expression and acceptance of one’s feelings while also creating an awareness of feelings put out into the open to release and form a constructive way to deal with them. The nurse can provide the older adult with a therapeutic environment that supports the client’s independence (Arnold & Boggs, 2007). Make sure the client feels safe both physically and emotionally to open up and express the problem and ensure that the problem will be resolved if both the client and nurse collaborate together to fix it.
While caring for clients during clinical, we learn hands-on skills, experience things first hand, make mistakes and learn from them, and provide the best quality care to patients. The best parts of caring for the older patients are the conversations, positive attitudes, even though they are in a hospital and the encouragement they give. The encouragement that our group of nursing students will be great nurses, and have the qualities of a good nurse to provide safe, competent, quality care. Given the increase age of population and the small decrease in the number of family physicians, we need to do a better job preventing frailty and common conditions of aging (Frank, 2010). This can be done through advocacy and health promotion. Enjoy the interactions with the elderly people as a special part of providing care. The caring component of nursing practice has become an increasingly visible activity of nursing (Clarke, 2007). Patients expect nurses to provide treatment to assist with health promotion, but they also expect to receive safe, competent care. The patients do not want to feel that they are a hassle, or are looked down upon because of a disease or diagnosis. A nurse must respect each individual need and not pass judgment. The role of a nurse is to put the patient in the best condition for nature to act upon him or her; caring, healing, loving relationships are natural (Nightingale, 1969).
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