A Picture Is Worth a Thousand Reminders

JustEnuff2BDangerous, BSN, RN

That One Patient takes the shape of many different things, and for me, it was Mr. Smith, a patient admitted with Altered Mental Status due to an infection in his spine that had allegedly gone to his brain and made him a completely different person than the one he used to be. He now had transient confusion, literally from one minute to the next; he lost the ability to use his "inside voice" and now yells instead of talking quietly, or at a normal volume and has a sitter 24 hours a day to quiet him down and reorient him; he is usually less than cooperative.

He has been in the hospital now for well over a month in a half; I'm just coming up on my one month mark as a [still new] RN in my very first nursing job. On my first day on the floor, he was one of the patients assigned to me and my preceptor. Every nurse on the floor had something to say about Mr. Smith, and admittedly I have yet to hear anything positive, only frustrations and exasperations to the tune of, "He's STILL here?" and "Seriously, they need to find somewhere else for him to go."

I was always warned by my nursing school instructors to not let a noxious atmosphere like that warp me into having that same attitude about a patient. Unfortunately, it's easier said than done when the nursing instructors are gone and you are with your new coworkers; their opinion will begin to change yours if you're not vigilant against it. And that's exactly what began happening - their exasperation became mine when it really had no reason to because my preceptor was always the one who would "deal" with him, I hardly ever even went in his room, only heard his yelling from outside his room and down the hall.

All of this changed yesterday.

My preceptor had received an order from the doctor to put a Coude catheter in him; he had not voided all day and was bladder scanned for almost 800 ccs of urine. I went into the room with my preceptor and another new nurse to watch the procedure. As my preceptor was getting ready, I looked around his room. His wife had printed out pictures and posted them on the wall; below each picture was written Mr. Smith's name and the date the picture was taken: "Earl Smith, March '09". One picture was of Mr. Smith and his wife, holding their young grandson. Another picture was Mr. Smith and his wife, and another picture was Mr. Smith, his wife, and their children. Mr. Smith in the pictures bore little resemblance to Mr. Smith now in the hospital bed, but there was still resemblance.

And it was then that I realized something that I think many people, many nurses, forget: This person is not their illness. They had a life, a family, friends, hobbies, a job, outside of this place before their illness took that all away. Mr. Smith had a wife, children, and young grandchildren. He was a normal, lucid, functional individual, and how quickly that all changed. Suddenly I realized how heartbreaking it must be for his family to look at those pictures and remember their husband, father, grandfather, friend, and then look at him now and see that he is only a glimmer of the person he used to be.

But he is still a person, and I have no doubt that his wife put those pictures up to remind us, the medical and nursing staff, of that fact. And I am very grateful for that reminder because I did not want to be the kind of nurse that I was becoming for Mr. Smith. Even if her intent is lost on the rest of the nursing staff, it is not lost on me, and I hope that I always remember the lesson I learned yesterday in Mr. Smith's room.

nursejoy1, ASN, RN · Aug 25, 2009

I think it is wonderful that you see this now, early in your career. It is hard , at times, to see the person as they used to be before the illness, but we must always strive hard to treat this person as a human being. I teach CNA's in my job and I always tell them- this is someone's mom, dad, brother, sister, etc and could easily be your's. Treat them the way you would want YOUR family member treated. Again I say- good for you AND for Mr. Smith:redbeathe:redbeathe:redbeathe

MedSurgeMess · Aug 25, 2009

Yes, a lesson well learned

AnthonyD · Aug 25, 2009

So true. We love it when families bring pictures into the ICU, as most of our patients hardly resemble their real world selves. It is a great reminder that they are real people that have actual lives when they are healthy.

CASTLEGATES · Aug 28, 2009

Great post!

Statistics suggest 1. Families that visit-their loved one gets seen more frequently by staff in long term care resulting in better outcomes.

2. Pictures have the same effect to some extent.

It's the "lost" patients who are just "there" that seem to be passed by when staff has a few extra minutes to divide between patients. I think it's human nature to want to detach from someone who may be checking out soon. It takes a conscious effort to continue to see them as a person with a life and pass that information to the others.

During report, an extra story about their life (what they did, were, etc) seemed to keep me in the room a little longer, too. A little information makes a big difference IMHO

MT86 · Aug 31, 2009

What an amazing post. Really makes you think. Thank you so much for sharing!

psalm, RN · Aug 31, 2009

Yep, had a pt. recently who sold exclusive gowns for a living. She talked about wearing a $700 dress..."back then that was a lot of $$". Quite a different "picture" of my 80+ y/o pt.

**VivaLasViejas, ASN, RN** · Aug 31, 2009

This serves as a great reminder that everyone was "someone" once..........even the mean old goat on my unit who spits chewing tobacco everywhere, rams his wheelchair into other residents when he thinks they're in his way, curses like a drunken sailor, yells "Help!" repeatedly and then beats up the aides when they offer that help. I can usually find SOMETHING to love in a notoriously crusty individual, but I have yet to find even a single redeeming quality about this man.

Thank you for a wonderful article! Sometimes, it takes a fresh perspective such as yours to remind us old nurses that our patients are placed in our care for a reason, and that all of them deserve our best efforts no matter how we feel about them personally. :nurse:

amccall4 · Sep 1, 2009

That was an amazing and very true post. It helped me to remember that each patient is a person and deserves to be treated with dignity and respect b/c God created us to love and treat others as we would want to be treated....:wink2:

DCR RN · Sep 2, 2009

Add a boy to you for standing your ground. Many pts give back what they get and when they sence they are no longer wanted or cared for but are stuck there then it must be terribly uncomfortable to them. We have to remember that they are all guests in our "home" while they are with us. :nurse:

RebeccaD40 · Sep 5, 2009

This is why I love it when families post pictures in my patients room. I want to know that person lying in that hospital bed, who he/she is and what they represent. I want them to know that I am trying to treat them, the patient, and not the disease. I have found this especially true with my older patients and it so breaks my heart when I hear the docs talking medical facts all around the patient but not about or to the patient. For example "we need to push on - this tumor has an 80% response rate" while the frail little elderly woman lies struggling to have the energy to just breathe, tugs at my scrub top, shaking her head no. Yet they won't ask her what sh wants and does not want with what life she has left. She tells me and she tells the other nurses. We communicate this to the docs and to the family but their reply is "But this tumor has an 80% response rate - we need to push on". Why can't she have a say in it? Why can't she be made to feel like she still has some sort of control in her own life anymore?

For me, to feel like I have no more control or say in my own life would be all the reason to feel like "giving up" as the families so often ask "Do you think she has just 'given up'?"

Roy Fokker, BSN, RN · Sep 17, 2009

I'm often complimented by random, non-medical strangers about my career. They often say "I could never do what you do. How do you do it?"

My response has always been the same: "They are always somebody's wife, mother, husband, father, brother, sister, friend. No human being came to this Earth by themselves. We all belong to somebody and the minute we see that, and understand that, and believe in that; then patient care no matter who the patient becomes clear and possible".

A Picture Is Worth a Thousand Reminders

About JustEnuff2BDangerous, BSN, RN

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