Commentary

Ellen Liston

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

In this narrative, Michelle describes exquisite sensitivity toward a morbidly obese patient. As I read it, I imagined myself in this situation and wondered if my biases and apprehensions would surpass my ability to find compassion and deliver care that was responsive and caring. I spoke with Michelle, seeking to understand how she transcended the barriers. What was her approach to Mr. B, and what guided her judgments and interventions?    

I learned from her that she has cared for patients who overheard conversations by care team members that labeled and stigmatized them.  She has witnessed the loss of trust accompanying the experience and the difficulty in trying to rebuild it. She did not want that to happen with Mr. B. She acknowledged that she did feel uncertainty as her experience with managing obese patients is limited since they usually are not candidates for cardiac surgery. Because of the availability of supportive colleagues, the special bed and lifts, she felt assured that she and Mr. B would be safe. 

Michelle tells me that when she was ready to meet Mr. B, she took a deep breath before she entered his room as a way to center her mind. She says that she had a lot of things that she had to do for him but she wanted to set them aside and focus on her connection with him. It was important for her to see him, the person, first. This emotional connection and the knowledge she gained laid the foundation for her subsequent actions.  

The hand-off at the end of Michelle's shift and accompanying Mr. B to X-ray are two actions that I wanted to understand more fully. Regarding hand-off, I asked Michelle if it was a common practice to go into the room together. She tells me it varies, but for Mr. B it was intentional. She knew this would be the best way for the night nurse to engage with the person rather than the diagnosis. She facilitated the human-to-human connection as a way to extend caring and healing.  

The decision to accompany Mr. B to X-ray is central to this story. We read in the narrative that Michelle was concerned that Mr. B used humor as a coping mechanism and in a self-deprecating way. Michelle tells me that this observation guided her decision-making. She worried that Mr. B would not advocate for himself; if he thought he was at risk for a fall, he might use humor as a way to mask his vulnerability rather than ask for help.  However, this is not the whole story. When Mr. B says, "Michelle, I want to thank you.  Thank you being with me down there and through all of this...", we understand as does Mr. B, that her presence was more than prevention of a fall-she helped preserve his dignity and humanity.  

In the spring, Dr. Jean Watson, Karsh Visiting Professor, spoke of the caring-healing relationship between the nurse and the patient.  She emphasized the importance of connectedness and caring with loving kindness, not judgment. She spoke about caring moments and how recognition of them is important for our practice. This is a story where Jean Watson's wisdom comes alive. Both Mr. B and Michelle have a powerful experience. He recognizes the difference she made in his life as a patient, and she recognizes with pride how she was able to change his hospital experience and sustain his healing. They touched each other's minds and hearts for this moment in time.