America that is not for me: Part 27

"No mockery in the world is as hollow as the advice given to the sick. It is useless for patients to say anything, for what the counselor wants is, do not to know the truth about the state of the patient, but so that all that the patient can say is based on his own argument, it must be repeated, without any inquiry into the patient's condition. "But it would be impertinent or indecent of me to conduct such an investigation," says the counselor. True; and how it is more impertinent to give your advice when you can not know anything of the truth, and to admit that you can not inquire about it (Florence Nightingale, 101). "

How Nightingale was right and prophetic! What she says is actually an experience that I personally experienced many times when I sought medical intervention or badistance in an American hospital. Some physicians tend to see themselves as the incarnation of human knowledge, from seemingly omniscient mortals to finite knowledge, who are persuaded to know more about the intimate and personal details of the body and mind of their patients. It's very unhappy, if not sad.

The formal education of these particular doctors – in addition to the elitist status that society usually badigns to doctors – causes some of them to despise others, for example, their willingness to disregard other forms of knowledge, including what patients have to say about their own bodies and states of mind, with an intimidating air of condescension. These health professionals are unaware of the fact that patients are an authority over their bodies and that specialized aspects of the finite knowledge of health professionals take the form of an affirmed complementarity of patients' self-knowledge.

Caring science is a knowledge market partnership of clinical relationships between health professionals and their patient communities, after all. Thus, benevolent science feeds on interpersonal relationships. Finally, my perspective on considerate science is not so much about the traditional authoritarian medical model as about patient and family centered care. R.D. Laing's Family policy and other tests and John Watson's Nursing: The Science and Philosophy of Care reinforce the dichotomy in the methodological approach of benevolent science and the philosophy of benevolence.

Here's another interesting hypothetical scenario to consider:

Introduction: The power of the patient-centered clinical method

Patient-centered care is the pillar of clinical relationships. It dictates how health professionals and other clinical staff put into practice the interests, care plans, satisfaction and safety of their patient community. Patient-centered care tends to bridge the professional, clinical and institutional gap between patients and health professionals, as it provides a platform for dialogue on which patients willingly participate in the protocols of their own care strategies.

Patient-centered care therefore considers the patient in a global framework of clinical evaluation and care delivery strategies. This involves considerations of spirituality, political correctness, respect for cultural differences, effective clinical communication strategies and the appropriate application of clinical hygiene, where health professionals do not insist the professionalism of their opinions to patients, to the near exclusion of the voice of patients who participate in the execution. of their care protocols. Nightingale admits that investigations of patient management protocols should be based on sufficient data (Nightingale, 1969, p.

Yet patient-centered care does not exist in isolation. He thrives on mutual respectability, beneficence, justice, non-maleficence, respect for life and autonomy, compbadion, faithfulness, kindness, love, family relationships and trust. As described by a team of scholars ((Millensen, Shapiro, Greenhouse and DiGiola III, 2016, para. 2) patient-centered care:

"Emphasizes respect for patient values ​​in individual care decisions and the role of patients and their families as key counselors and partners in improving care practices … It is characterized by a partnership double meaning."

These ethical values ​​overlap with my basic personal beliefs and professional philosophy regarding the patient-centered clinical method. These values ​​also underscore my zero tolerance approach to patient neglect. In addition, I strongly believe that family relationships are important facets of patient-centered care that health professionals should not ignore.

As a nursing student during one of my recent clinical rotations, I have witnessed negligence on the part of patients and a certain indifference to the participation of the patients. family members in the care of their loved ones. I write about them in the hope of not repeating them in my future professional practice.

An interesting case study
One patient who had undergone surgery reported a pain score of 7 to 9 on a medical pain scale of 0 to 10, with 0 being 0. no pain and 10 being worst pain imaginable. The nurse that I monitored reacted accordingly to the pain because she was careful to properly administer the pain medications recommended to this patient.

Under his supervision, I recovered pyxis pain medications and administered them using the six rights for safe medical administration. Before that I had done a patient badessment from head to toe, asked subjective questions, took vital signs and badessed hip pain using the acronym PQRSTU, where P meant palliation / provocation, Q quality of pain, R for region / location of pain (or radiation of pain), S for severity of pain, T for duration / onset of pain and the duration, and U for the understanding of the pain perception by the patient.

The nurse and I then examined the patient every hour to badess her pain level, determine if she needed help with anything, inspect her perfusion lines and surgical site, and dress the surgical site. . The patient reported a pain score of 4 on a medical pain scale of 0 to 10, a significant improvement over a period of about five hours since the nurse and I resumed our shifts at 7 O'clock. His condition seemed to be largely positive. She thanked us abundantly.

The patient's two children, a man and a woman, introduced themselves. Both, especially his daughter, harbaded from her bedding, why her mother had been in bed rather than on the couch next to her bed, why was the hospital continuing to administer the pain medication recommended by her provider, which explained why physical therapists and occupational therapists were not there with their mother. In addition, she wanted her mother to take painkillers stronger than those her mother was already taking. It has transformed the relative quietude of the room into a disturbing storm of psychosocial disorder.

The girl would not accept the nurse's clinical position – and even her own mother's claim – that pain medications were effective. A filial insistence convinced the mother to the contrary, namely the accuracy of the demands expressed by her daughter, and she immediately changed her initial story, succumbing to her daughter's insistence that she receive a new medication regime. pain. The nurse and I found ourselves in a state of cognitive paralysis – shocked.

My reaction
Our sincere efforts seemed to give nothing to the account of the patient's daughter. The nurse and I became nervous, sweating profusely and trembling at the mere sight of the nagging lady. The lady's demanding and imperative tone, her unwelcoming body language and intimidating affect almost immediately took me out of the room.

I fled to the staff washroom and locked myself in, contemplating the woman's behavior and its implications for professional nursing practice. My disabling concern about the lady's behavior had put me beyond immediate recognition that my absence could potentially result in negligence on the part of the patient. However, I did not seriously reflect on this line of thought and this legal and clinical interpretation, and I fled into my helpless moment of thoughtless confusion.

I should also point out that raw fear gave wings to my absurd absence, having momentarily lost my presence of mind under the effect of my thoughtless confusion. The fear factor thus emptied the strategic, professional and clinical content of my presence of mind, a difficult situation that partly led me to separate myself from the reality of my clinical and psychosocial expectations.

What's more, rather than seeing fear as a tactical psychophysiological response to a difficult situation, and making full use of realigning and redefining my clinical, professional and psychosocial orientation, I have instead turned to the disorganized wisdom of my deepest insecurities. And then, from nowhere, I suddenly remembered the following lines of Bob Marley's Running Away.

I was stuck with my questioning shadows on which I could not run!

I needed a moment of catharsis. I needed a moment of decompression!

I needed a moment of personal reflection!
I needed a moment of self-badessment!
I needed a savior!
I needed to save my self from the disastrous situation of my cognitive suicide, and this powerful song provided me with that long-sought psychological and emotional relief.

The end result was the resurrection of oneself, as the song took me out of my coffin, dead from a strategic naïve and became a professional and idyllic oasis of Joseph Schumpeter's creative destruction. Creative destruction then cast a lifeline to my self sink in the form of a diplomatic reincarnation. I quickly remembered my skills in human relations and my social sense of my subconscious lair, a time when it was too late to put them into practice.

I instantly became a thoughtful mutant, fully aware of my psychosocial and emotional limits in the specific area of ​​human relationships.

I run to myself!
I went back to myself!
I finally became myself, thus merging with the silent and yet eloquent dictates of my spiritual, intellectual and emotional capital, though my persistent consciousness systematically denies me a respite from my daring constellation of failings. I no longer saw myself as a "saint". George Orwell made the following critical observations in his 1949 essay entitled "Reflections on Gandhi" – after reading Gandhi's autobiography. The story of my experiences with the truth (Kwarteng, 2015):

"Saints should always be judged guilty until they are innocent … Holiness is also something that human beings must avoid … The average human being is a failed saint."

I was an insidious "saint" dead secretly hidden in a sarcophagus of cognitive paralysis, confused as always!

Whatever the case may be, I told myself that our patients must act correctly, no matter the circumstances! Still, I was not the only one out of the room. Other nurses did the same thing. These nurses gathered around the nursing station to criticize the lady in a low voice. I did not take part in the criticism because I felt that this amounted to a lack of professionalism. Here, I realized that my near-death experience with the protocols of human relations, it was a disappointing feint, a false dream, and I could always do better despite my disabling shyness and my selective silence.

Concluding remarks: Hypothetical solutions
The question is how to effectively treat unpleasant members of the family in the context of the patient-centered clinical method, particularly when family members make medical decisions that oppose those made by their family members. hospitalized patients. competent family member, so that neither the integrity of the patient-centered clinical method nor the concept of the rights and responsibilities of the patient are violated, and what happens to health professionals who are verbally abused by patients and their family members, health professionals doing their job?

However, in hindsight, the nurse or I should have rushed for the physical therapist and occupational therapist, reinstalled the patient on the couch, replaced the sheets and reported the problem to the nurse in charge.

The nurse should have reported the woman's concerns to the patient's provider. I think the word harbaded was inappropriate, perhaps even too harsh, because the lady had a say in confiding to her mother. I regret it now. That the nursing profession is part of human relations and that customer service is not lost for me.

I also think that I should not have escaped. In the future, I will make good use of therapeutic communication, empathy, professionalism, respect, and family recognition in patient-centered care to meet psychosocial and social expectations. difficult clinics. This is important for improving outcomes for patients. I also think that what a patient says about pain is definitive. That goes to the heart of Bob Marley's Running Away:

"Every man thinks his burden is the heaviest … who feels that he knows it."

This harmless sense of physiological, phenomenological, physical and intellectual relativity represents the defining professional anthem and strategic logic of the patient-centered clinical method.

In the end, all that remains of my clinical experience remains the same!