Commentary

Ellen Liston, MS, RN
Program Director, Nursing Practice Development

Ellen Liston

At a recent meeting of the Practice Committee, members were asked for the definition of a therapeutic relationship. This line of inquiry was related to a discussion of relationship-based care.  One of the definitions offered was "when the patient becomes a person." This definition resonated with me as I read this narrative.    

For much of the day, Suzanne and Mr. A spend the time waiting together. When I ask Suzanne what good care is in this situation, she says you use the time as an opportunity to open up conversation. In doing this with Mr. A, she learns who he is and what gives him a sense of meaning and purpose. Suzanne also reveals that she talked to Mr. A about herself, and I ask her to tell me more about that. She says it is about showing empathy and that it is important for some patients to see her as another person with human vulnerabilities. She believes it "levels the playing field," and it may become easier for some patients to share their concerns.  Suzanne, however, makes it clear to me that it is always about the patient.   Suzanne is describing an aspect of skillful involvement.  She was in tune with Mr. A's need to talk about what was important to him and talked about herself as a way to foster communication and connection.    

It could be a coincidence or fate, but the next day Suzanne is assigned to care for Mr. A in the Thoracic ICU.  She was happy to be there with him as her familiarity with him could offer him some comfort.  They learn together from the transplant team that Mr. A is not a candidate for a transplant.  I ask Suzanne to talk about that moment.  "It is a difficult time - you really don't know how to find the words."  She told him she was sorry, and that she wished it could be different.  She stayed and held his hand. Through presence and human touch, Suzanne honored him by bearing witness to his suffering.  

I wanted to explore with Suzanne how she coped with this intense emotional situation. The reason for this line of questioning was also a result of a discussion at the Practice Committee about relationship-based care. The first crucial relationship of relationship-based care is with the patient and family, and the second one is with self. The relationship with self is nurtured by self-knowing and self-care.  How did Suzanne address her needs?  Suzanne says reflecting upon it gave her some solace. She acknowledged to herself that she was the one with him and attempted to do everything she could to make him feel cared for. She says this reflective process is helpful to her as a source of both learning and rejuvenation.       

Suzanne ends her narrative with, "I hope he really felt like I was there for him in his corner..."  As nurses, we try to provide our patients and families with the care and support they need.  Suzanne learned who he was when she made the choice to open up the conversation; she comforted him with her presence when he was suffering; and she supported his family when he died.  We cannot know how Mr. A felt, but we know that the characteristics of excellent practice were visible in the care Suzanne provided.