On Compassion.

[Virgo_RN, BSN, RN]

Compassion. In the nursing business, we hear a lot about it. Merriam-Webster (online) defines "compassion" in this way:

Pronunciation: \kəm-ˈpa-shən\

Function: noun

Etymology: Middle English, from Anglo-French or Late Latin; Anglo-French, from Late Latin compassion-, compassio, from compati to sympathize, from Latin com- + pati to bear, suffer -more at patient

Date: 14th century

: sympathetic consciousness of others' distress together with a desire to alleviate it

As nurses, we are expected to provide compassionate care. But what does this look like?

I am convinced that in the patient's (and/or their family members') eyes, this means being nice, sympathetic, and caring; providing a gentle touch, a sympathetic ear, a warm blanket.

These things are important, yet nursing demands so much more of us. Together with behaving in a caring way toward our patients, we must coordinate care for a group of patients, including but not limited to timely administration of medications, awareness of the nursing implications of each medication, ensuring that ordered diagnostics are carried out, lab specimens are obtained, awareness of the results of diagnostics and lab tests and what those results mean to the individual patient, and of course, responding appropriately to changes in patient condition. We must continually assess, plan, intervene, and evaluate.

I will admit that I bristle a little bit when, just moments after entering the room and before I've even had a chance to introduce myself, I am asked by an anxious family member if Mom, who has a fractured femoral neck and is awaiting an ortho consult, can have some soup. "They said they would get her some soup", the family member says in that tone of voice that is at once pleading and accusatory. I inhale deeply and slowly, measuring each word carefully as I explain why I can't feed Mom.

I find myself making the same stupid joke over and over again, as patient after patient complains about how hard the gurneys are. "I hear that a lot", I say, or "Nope, they're not built for comfort", trying not to sound flippant. Do I dare explain that the reason the gurneys are hard is so that we can do effective chest compressions should they go into cardiac arrest? Do I dare tell them that if they are able to complain about how hard the gurney is, then they're doing okay? While it might alleviate some of my pent up stress to be this truthful, which is the more compassionate response? The pat little joke, or the truthful answer?

As I hurry past the family member hovering at the doorway, intentionally avoiding making eye contact with them as they attempt to flag down anyone in scrubs to ask how long before the doctor comes or request another cup of ice chips, I know how uncaring this must appear. Yet I know that it would be far less caring to allow myself to be pulled in another direction while my patient down the hall is waiting for pain relief or life saving treatment.

The Dalai Lama says "True compassion is not just an emotional response but a firm commitment founded on reason."

To me, this means that providing compassionate nursing care is not exemplified by how many warm blankets, bowls of soup, and cups of ice chips I can bring. It's not about how many cold washcloths I can place on fevered brows, or how quickly I can bring the bedside commode.

To me, compassionate nursing care requires the ability to synthesize information, prioritize, and multitask, while behaving kindly toward those under my care. I must choose, based on reason, where my attention is most needed in any given moment in order to do the most good.

Sometimes this means that the guy in room 13 who has had back pain for 6 months and has decided to come in tonight, who has threatened to sue the doctor if he doesn't get what he wants, and is calling out "NURSE!!!" to everyone that walks by is going to get the door to his room shut, while I attend to the little old lady next door who is having a stroke. Sometimes this means that I can't change Dad's soiled briefs, because I am receiving a patient who came in by ambulance with acute onset chest pain and ST elevation.

And please, family members, don't try and trick me. If you tell me that Mom needs to eat because she's diabetic, this will not make a meal tray magically appear. I'm going to ask what kind of medications Mom takes for her diabetes and when was her last dose, and I'm going to do a fingerstick. The time I spend doing this is time that I could be giving to someone else who needs my attention more. And when it turns out that Mom is diet controlled and takes no insulin or oral agents, and I've wasted all this time to make sure she is safe, do not be surprised if I seem a little less than compassionate as I walk out the door. But I digress.

Compassion; it's a buzzword that hospitals like to use to bolster their image and attract "customers" (another buzzword that I won't address here). Unfortunately, compassion means something different depending on where you stand.

[Zookeeper3]

:bow:

thank you, my nursing soul mate

[jlr820]

That was an awesome piece of writing! I keep reminding myself that patients (and their family) are only cognizant of their own little "corner of reality." They are blissfully clueless of anything else that doesn't directly involve them. "Don't know, don't care" seems to be their mantra. It isn't that I don't want to fetch ice chips and blankets, stop and chat, hand-hold, or try to answer questions. I genuinely DO want to do those things, and I try hard to integrate them into my care. But, I can't let it derail me from an overarching priority. It's as if there's a bomb about to go off somewhere, and only I know where. I can't tell anyone else, yet I keep getting stopped and asked for directions to Costco or for the correct time while I'm running to get to it and defuse it. Sounds like a bad dream doesn't it? Reminds me of my previous career in law enforcement. It was nothing for me to be manually directing traffic at a four way intersection with three lanes in each direction at 5 pm only to have someone stop DEAD in the intersection to ask for directions to Wal-Mart (and I had to stand there and quickly/politely tell them before a major accident happened).

[kchic08]

It's nice to have this validated by another nurse! Working with families, while trying to stay on top of my patient care duties (namely documentation) was something that I struggled with as a new nurse. I worked on a busy rehab unit and it definitely takes time to help people with their ADLs and transferring, along with the regular duties of assessments, skin cares, and medication administration. A key thing I noticed is that there are ALOT of patients and families out there who want more time than you're able to give them....and can get quite frustrated if you have more important priorities to attend to. It makes for a challenge when trying to organize report and new admit orders and then having a patient needing assistance to the bathroom twice within a 1/2 hr, along with needing to get others some meds during that time, or trying to come up with polite ways to get patients and family members hurry up with their answers to the admit questions, as there are other duties you need to tend to. I had an admit before whose patient's daughter insisted that her mother's psychosocial needs were just as important as her medical needs and therefore monopolized quite a bit of my time during the shift (which I esp. felt that I HAD to attend to, given that I had some previous reports of patients complaining that I was too "rushed". ). It's not that you don't care about your patients....it's just that you DO NOT have the time to attend to some of their lesser needs, as you do have others with more important needs....along with your needs to keep accurate documentation and leave your shift on time. It's tough when there's not enough people around to keep everyone reasonably "happy", along with healthy and alive. The idea of Nursing being an art and a science comes to mind, with trying to find the balance between managing patient care, while trying to provide each patient with a sense of comfort and understanding that they desire. But, it's not a perfect world and the fact is that there are probably plenty of patients and family members in the hospital who leave unhappy with the care they recieved, in terms of having their wishes, in terms of compassion, met despite having nurses who did their best. What it comes down to is that for a more pleasant hospital experience, patients need to know how to be their own advocate, but also know that things on the unit can be quite busy. Family members can for sure be your greatest help or greatest hindrance....

For my next job, I have addressed the importance of keeping open, honest communication with my supervisors and have come to a much better accepatance that no matter what I do, there very well could be some patients who are not satisfied with me....given the acuity these days, going above and beyond in terms of psychosocial needs can be next to impossible!

[TheCommuter, BSN, RN]

Thanks for the thought-provoking post, Virgo_RN. You have bestowed some very powerful points upon us, and I happen to fully agree with you.

[sistasoul]

I agree with this. I am so frustrated with all of the above things that you mentioned. This is why I want out of hospital nursing. I wish I could just take care of people who were sick instead of dealing with the "needy" young healthy person who is alert and oriented and in for something minor who are on the call bell constantly for their narcotics. The family members are sometimes worse and monopoloze all of your time. They want to know about this test and that test and come running out and hunt you down if you are not able to get into their room in 1 minute. Don't even get me started on the ETOHers. It doesn't matter that you had a sweet little old lady with a BP of 220/110 or someone needed a heparin drip started so their massive clot would not break off and travel to their lungs or brain. They just don't care.

I feel like I am there for their medical needs first and their psychosocial needs second. I would love to be able to talk to my patients more but I just do not have the time. I get out late everynight after running all night without a break or a lunch and it still feels like I did not do all that I should have for my patients.

I wish there was a documentary about a day in the life of a nurse that would be required viewing for the masses. People think nurses just go around and pass out medications. I have been a nurse for only a year and cannot wait till I can get out of the hospitals. It is too bad because I love being at the bedside it is just all of the other crap you have to put up with that takes you away from the patients who really need the attention and care

[Virgo_RN, BSN, RN]

It's as if there's a bomb about to go off somewhere, and only I know where. I can't tell anyone else, yet I keep getting stopped and asked for directions to Costco or for the correct time while I'm running to get to it and defuse it.

This. You have stated succinctly how I often feel, and I never would have thought to put it that way.

[twentytenRN]

Very nicely written and a great perspective.

[RNMLIS]

What is compassion?

compassionate fatigue?

This site might be useful

http://www.healthycaregiving.com/index.html

check out the 8 laws and caregiver's bill of rights

[Ivanna_Nurse, BSN, RN]

Virgo, you write so well. :) Happy Sunday, Ivanna

[snoopy29]

What a truly outstanding post.

I concur with every word and believe you effectively managed to summarise the impossible and often unrealitistic expectations whilst also highlighting the importance of what we do.

There is nothing I could add except my wholehearted agreement and thanks. When I read a post like this it gives me an amazing sense of solidarity that nurses all over the world are facing the same issues but sill manage to do so with absolute kindness and care.

Really excellent post :)

[tencat]

Very nice and VERY helpful. I'm going to see if my boss will let me do an inservice on the subject using the tools from the website.