by Regina G. Goldwire, M.S.N., B.S.N., R.N. Minority Nurse Writer
The distinctive nature of nursing affords us the unique ability to be able to communicate with both medical professionals as well as patients, bridging a crucial gap. We strive to address patients in a therapeutic, non-condescending manner. Yet, with added responsibilities, a harried pace, and the familiarity of day-to-day work customs, it seems we are becoming more anesthetized. Do we still notice when a patient’s dignity is impugned, and more importantly, are we being taught to do so in the first place?
Mrs. Johnson’s story
Mrs. Johnson is an 89-year-old living at home. She has been ill and her adult children take her to the hospital. The emergency room is crowded with crying children, buzzing television sets, random conversations, and the extraordinary hustle and bustle of working health care professionals. She remembers the days of being a busy worker herself, as well as a soccer mom, an active churchgoer, and a vital member of her family. But time has moved on. She now feels like a burden—a nobody—to so many.
Though feeling weak, Mrs. Johnson manages a meek smile as the ER nurse approaches. This nurse is going to talk to me, see me, and care for me, Mrs. Johnson thinks. But the nurse turns to the family member that brought her to the emergency room, asking her about Mrs. Johnson’s condition. Talk to me! Mrs. Johnson wants to say. I’m a person! Don’t you see me?
Mrs. Johnson is then taken in to see a doctor who hurries through an examination; she is subsequently admitted to a unit. The transport staff rolls her down the hall, engaged in small talk with one another. Mrs. Johnson again feels invisible.
In the unit, the bedside nurse assesses Mrs. Johnson, saying very little, and certainly not describing what she is checking or why. The nurse leaves, but not long after, Mrs. Johnson feels the urge to use the bathroom. She buzzes for assistance getting out of bed. One minute, three minutes, five minutes go by. Still alone, Mrs. Johnson eventually feels ashamed at her incontinence. She waits another five or 10 minutes until another nurse and aide to come in, wearing the unmistakable look of disgust on their faces as they eventually begin to clean her. I want nothing more than to be able to clean myself, she thinks, feeling depressed and guilty.
While in the midst of cleaning her, the nurse and aide hear a knock at the door. Mrs. Johnson is shocked when the aide opens the door, exposing her backside to the hallway, to let in a respiratory therapist. Give me my dignity, please, Mrs. Johnson thinks. I am a somebody, not a used-to-be.
This fictional anecdote, written in accordance with HIPAA guidelines and inspired by true events, is meant to remind nurses that we must preserve our patients’ dignity as well as their physical health. An appreciation for human dignity must be cultivated, as it can get lost when most nurses train using SIMS mannequins.
While in school for our prospective medical careers, we are so excited to see procedures and learn about diagnoses. Students may forget that the patient they are gawking at is a person and not just a piece in the lab. This behavior transcends into our professional careers; as we begin in our practice, procedures become routine and mundane. Indeed, our typical workday might be a patient’s worst day.
What can we do?
Sensitivity training is essential and should include role-playing, personal reflection, and discussion. If required to analyze their own actions, nursing students (or practicing nurses) might see the need to change their approach to patient care.
Foundations in education could also include emphasizing the “holistic” elements of patient care, such as discussions of humility. I know of one particular nursing instructor who was mortified at how she perceived some long-term care facilities conducted patient ADLs. She described residents heading in to the shower as “looking like herding cattle off to the slaughter house.” In horror, she observed residents being rolled down the hall undressed and wrapped in sheets. Often these patients’ bottoms were exposed for all to see, she said.
I have heard of professors, in an attempt to teach future nurses a lesson in dignity, who required students to walk around the long-term care facility with a sanitary napkin taped to the front of their uniforms. Another instructor who noticed a disregard for patient dignity required students to be placed on a bedpan (fully dressed, of course); the students were then left alone in the room with no access to a call light. One could say there is nothing sensitive about these training exercises; they would be correct, but a little lesson in humbleness may go a long way in one’s future practice.
Communication is paramount when speaking of patient dignity as well. It’s not hard to understand why a patient may feel a sense of loss and grief when placed in a medical setting. And who wants to be in a room full of people, yet ignored? Or, even worse, spoken at? Creating a therapeutic rapport is a skill that requires compassion and practice.
Through nursing, we are able to care for people when they’re most vulnerable, during their most frightened moments, at times they may never forget.
All patients are deserving of the standard of care we would show our mothers and fathers, our grandmothers and grandfathers, our own Mrs. Johnsons. In many ways, we should feel honored to play this part in patients’ lives. The calling to participate in nursing is not an inconsequential one. Nursing is widely considered as the most trustworthy profession, an art and a science. A nurse’s objective should be providing a safe—and dignified—place for patients to receive care.