Anthology of Compassion Case Studies
Produced by members of ENGL215: English Composition II-001
The Case Studies which I have received are posted below. I'll add others as they come in.
A Case Study of Patient-Care Provider Relationships
Jerome Avile
In order for healthcare providers to be as effective as they can be, they should be able to cultivate a healthy relationship with their patients. This relationship is vital in providing insight towards how the patient is feeling and what they are thinking and may prove to help progress their care exponentially. What is revealed between provider and patient could be as secretive as the real cause of an injury or disease and the patient may be too ashamed to reveal it to someone they may not be comfortable with, or as miniscule as telling the provider that they feel more comfortable when being told a story before going to bed. In either case, a healthy relationship between a provider and patient enables the patient the ability to be comfortable and confident in their provider.
The movie Wit provides perfect examples of the importance of patient-care provider relationships. In Wit, a terminally ill cancer patient gives a first-hand view of the various people and attitudes one encounters within a healthcare facility. Within this realm, the viewer realizes that the impersonal manner of some providers disables the human feeling in a patient while a caring, compassionate provider can be the consoling and desperately needed person a patient may yearn for in their lives.
A healthy relationship between provider and patient is becoming more difficult to obtain. With patients being rushed in and out of offices and providers receiving less face time with them, doctors and nurses must learn to utilize the time and use mannerisms and techniques that will help get the most out of their patients in order for them to provide them the care they need. This has been a huge problem proclaims Joanie Schrof, a writer for the U.S. News and World Report (1998). She shares that "6 in 10 doctors surveyed last year and said medical school had poorly prepared them to talk to patients, and nearly 7 in 10 said insufficient time with patients was a serious problem," (66). This is an amazing factoid that may help reveal why some providers just do not have the skills to deal with real patients in real, disconcerting and awkward situations. \
In any case, Shrof mentions a few things that can help providers collect useful information in the short time that they are given. For one, "a doctor should try no to interrupt the patients reply," when asking "what brings you here today" (66). Not only is this rude and shows that the doctor is not listening or is not as caring as he should be, but it also disallows the patient to fully explain exactly what it is the real reason for why they are there. Shrof also concedes that asking "what were you hoping I could do for you" is a vital question that reveals answers that had nurses and doctors "knocked off their chairs," (66). They realized that sometimes patients had unrealistic expectations and beliefs. Examples of this are "patients [that] want to be told they don't have cancer," or "tell my wife not to leave me," (66).
However, the biggest mistake that Schrof writes about is the way some providers "intimidate patients into silence," by displaying mannerisms that proclaim anxiety, awkwardness, and lack of care (66). This includes "tapping a pencil impatiently or keeping one hand on the exam room door handle," (66). Imagine if your doctor were to do the same; would it facilitate the same idea? When this happens, patients become less apt to give out meaningful answers as well as less trusting of the care-provider. The patient feels unimportant and may hold answers in that may actually help in assessing what may be wrong with them.
There are many reasons why patient-care provider relationships are important. George Castledine (2002), a professor and consultant of general nursing at the University of Central England, summarizes a list of ten of the most important. Though it was a list for nurse-patient relationships, it does apply for all healthcare providers.
For this case study, I interviewed my mother Lilia Aviles over the phone on Friday September 30th, 2005. I did not tape the interview though I had full permission to tape. I selected my mother because she became a nurse at the age of 21 when she graduated from Philippine Union College in Manila, Philippines. She has been a nurse for over 32 years and has worked in the Philippines, Saudi Arabia, Europe, and now in William Beaumont Hospital in Royal Oak, Michigan. My mother has been my inspiration to be a nurse and there could be no better an example.
In this interview I asked her questions such as "What is the most important part of your job?"; "What do you do to make your relationships with patients better?"; "How do you deal with patients who do now want to reciprocate?"; "How do you give personal care when being responsible for 9, 10 patients during one shift?"; "Do you find yourself still not giving patients enough personal care?"; and finally "Is there a personal benefit from providing personal care?"
When asked what the most important part of being a nurse is, my mother quickly and assertively replied, "The relationships you make with the people you treat and the way you help them deal with their problems and the way you help them be as comfortable as they can be." She adds, "What they do and say and the way they deal with you tells you a lot about how they are feeling and whether they are going to cooperate with you today!"
My mother revealed to me her secrets on what she does to make her relationships with her patients so fruitful; she proclaims that listening and giving meaningful feedback is the key to great relationships is the key to all good relationships. My mother also proclaims that the right tone of voice and attitude also go a long way in creating a comfortable environment with the patient, for when the wrong tone or attitude is used, you will definitely receive it right back. However, for my mother, the key is always trusting in God and being a witness for him wherever she is. She says that when people see the glory of Christ in you, they can't help but be influenced in a positive way.
In this world, you will always encounter people who just do not like people. My mother deals with these types of people all the time, she says. She has met all types of people, however it still bothers her that when she does her best to give the proper care, to cater to their every need, and to make them feel as comfortable as possible and still there is no sign of reciprocation, it gives her an empty feeling inside. As the years have gone by though, my mother has learned to deal with it in this way; just pray for them and know that what she has done to the least, surely she has done it to Jesus Christ. She knows that she is giving all of herself to the patient and that there is a blessing out there waiting for her somewhere.
When asked how she provides such taxing services to so many patients and sometimes at one time, my mother calls it a "blessing from God". She looks at it as a chance to minister to all the patients and to show that if she is able to give out love to so many people in the name of Christ, all the more people will want to become loved by Christ. Just being an image of God to man for her is a blessing. The more people she can affect and inspire, the better, says my mother.
Even love takes its toll, and when asked if sometimes she finds herself slacking in the care department, my mother says that God knows her true feelings and situation. When she feels like not being as nice today to her patients, she prays to God to help her be a witness to her patients regardless of time, place, and situation. She proclaims that God will provide when asked in prayer and says that for the most part, she is able to be a blessing to all her patients.
Finally, when asked for the benefits of providing personal care, my mother answers breathlessly, "The benefits are the smiling faces, the feeling of selflessness and accomplishment, and the feeling that you have affected someone's life in a positive way. All of these things are worth the hard work and long hours."
There are many issues in healthcare today, and I feel that the lack of nurses and doctors providing personal care is somewhat of a problem, though image seems to be the real issue. From articles I have read to people I have encountered in hospitals that seem so skeptical about the doctors and nurses and whether they are doing all they can to care for them, I feel that there is growing rift between people and their care providers. Though my mother tries to set an example and she knows plenty of great nurses, I believe that all we hear about however, are stories about bad nurses. We need to refocus on the good things that are happening within the healthcare realm and maybe that will help things to look up. Though we cannot just deny the problem of the growing lack of care in the healthcare profession, we should focus on the positives. I believe that if we truly put patients first and start new students out early in this mindset, the healthcare profession can once again gain the confidence of their patients for generations to come.
Reference:
Castledine, G. (2002). The importance of the nurse-patient relationship. Castledine Column, 45.
Schrof, J. (1998, December 21). Required course: bedside manner 101. U.S. News and World Report, 66.
**
Shelia Beaucejour
Technology replaces the
personal touch: A case study
Elizabeth Buck
Introduction and Review of Literature
The personal touch is being lost from medicine in favor of technology. Doctors get overextended in their practices. Some get bogged down in insurance paperwork. Others order every test in the book to protect themselves from malpractice lawsuits. Still others are more fascinated by research. In the process, doctors are spending less and less time with the patients. They are losing the ability to relate to them as anything other than "the underactive thyroid" or "the infected kidney."
A friend of this author had some strange symptoms that defied explanation until her doctor just sat down and visited with his patient. After years of saving her good things for later, her husband died. Her children were grown. She began to sense her own mortality. This lady decided that if she did not use some of the things they had collected over the years now, then using them "later" might never happen. So she got out and started using a beverage set that had been purchased in Greece during their honeymoon. In taking the time to listen, her doctor got an idea. He had the beverage set tested for lead, as it was extremely old. Sure enough, his patient was suffering from lead poisoning. He quickly put her on the correct treatment (M. Hutchins, personal communication, August, 1982). He learned she might have died had he not taken a few extra minutes just to talk with her.
In the movie Wit, director Mike Nichols (2001) suggests that the medical profession has become so technical that it has lost touch with the knowledge that personal interaction aids in the psychology and recovery of patients and eases the anxiety of their families. This, according to Davidhizar & Shearer (1998), is in spite of the acknowledgment of empathy as the basis of therapeutic relationships. Presenting the patient and the family with a caring, "I want to help" attitude makes all the difference in gaining the patient's trust and following that to cooperation with the treatment regimen (Davidhizar & Shearer 1998). Castledine (2005) notes that Peplau strongly emphasizes having a good nurse/patient relationship. It frequently has more effect on the patient's recovery than many of the technical procedures performed on him.
The importance of this medical staff/patient relationship can be told by Szegedy-Maszak and Hobson (2004). Ellen Stovall was twenty-four when she was diagnosed with Hodgkin's disease. The medical personnel thought she had only two years to live so they withheld vital information from her thinking it would be useless to tell her because she was just going to die anyway. She was never told that the treatment they came up with would cause her to enter menopause immediately. They never once discussed the possibility of banking her eggs or even hinted that it might be wise to do so. They made this important decision for her without once consulting her wishes or those of her husband because they thought she would die. She lived. She watched her friends have baby after baby and went into severe depression. This depression caused her to forget things, become disorganized and in general become less competent (Szegedy-Maszak & Hobson 2004). Because a doctor did not consider her opinion worth enough to ask for Mrs. Stovall is angry. She has been deprived of the family she wanted because of the arrogance of the medical profession.
Recently, Dr. Dean Edell (2005) was on WLS 890 radio. He was discussing the conditions in New Orleans following Hurricane Katrina. Medical people were having to work without power. They were having to treat people without machines. This is difficult for young doctors who were not trained to do these procedures the old-fashioned way, using their hands and eyes and listening to their patients. They acted as if these were some earth-changing new techniques, rather than the tried and true ones that have worked admirably for so many doctors for generations.
Method
Mrs. Evelyn L. Wilson was interviewed at her home early in the evening on 1 October, 2005. There was no tape recorder available. In August of 1993, Mrs. Wilson underwent open heart surgery as a result of heart disease. She had a double coronary by-pass operation which was performed to re-establish blood flow to her heart. What is significant is that although she had been under her doctor's care for twelve years she had no idea that she had heart disease.
Evelyn was asked about her health history; how long she had seen her doctor; what she was doing for her own health; why she did not know of her condition until she needed life-saving surgery; what her stay in the hospital was like; what she feels could prevent something like this from happening to someone else.
Results
Mrs. Wilson, throughout her lifetime, has had extremely low blood pressure. When she is stressed, is emotionally upset, or is undergoing surgeries, unlike most people whose blood pressure goes up, hers goes down. Once during eye surgery in 1971, the operating staff thought she had died on the operating room table when her blood pressure took its routine nose dive. Evelyn, sixty-four, had been treated by Dr. "X" for twelve years. He was very aware of her strange blood pressure pattern.
Still, when her pressure started climbing at alarming rates, he fell back on pills, pills, and more pills as the solution. He did not take the time to investigate why, after years of acting one way, her body would now behave differently. He was so busy treating her the routine way he would treat any other patient he failed to account for her peculiar blood pressure condition. In spite of a life style that included exercise, no smoking, eating lots of fruits and vegetables and small portions of meat, Evelyn's arteries were blocking. Her blood pressure kept climbing as the fluid fought its way back to her heart.
When she was first taken to the hospital by the ambulance personnel the emergency room staff considered her chest pains and indigestion the result of a carbonated beverage she had drunk shortly prior. They ran a couple of tests and sent her home. When she returned a few hours later with a full-blown heart attack they decided "maybe" they ought to send her to the specialists at South Bend Memorial Hospital.
At South Bend, the magnet cardio hospital for the area, she received excellent care. When she had her coronary episode she had one major artery blocked 99% of the way, and another had 97% blockage. The staff explained the tests and procedures and answered questions. The nurses showed movies to her family so they would know what their mother was going through and how they could help in her recovery. The workers stated that an informed patient and family took far less of their time than an uninformed one. Even in this personal touch they were being efficient. They were using the same technology that was also available at the other hospital but turned it into a tool rather then a shield to hide behind.
Mrs. Wilson had lost her appetite and the dietician personally came to her room to find out what could be prepared that she would eat. While in the Intensive Care Unit she had a male nurse on duty during the middle of the night shift. It seemed awkward to ask a strange man to assist her to use the bathroom. He remained professional even commenting that he hoped she wouldn't be overly modest. Then he set out to make her as comfortable as possible. He joked with her in the night when she couldn't sleep. After her surgery she was moved to a recovery ward, but he came up to visit once, just to see how she was doing. They still exchange Christmas cards.
After the surgery her blood pressure dropped back to its prior low numbers. Evelyn recently celebrated her twenty-second anniversary with her children and grandchildren and a call from that nurse, who heard about the gathering. (E. Wilson, personal communication, October 1, 2005).
Conclusions
The staff at South Bend Memorial has developed patient care to an art. It is a skill honed with much practice. They have learned that the respect shown for the patients and the personal contact with the patients and their families gains co-operation and speeds up recovery time
Evelyn Wilson's family doctor was a victim of overwork. He relied on the fact that so many of his patients were not taking care of themselves; he lumped her into the same category. He treated her with the same techniques he used for everyone else. He forgot that each patient is an individual and the treatments must be tailor-made. The emergency room attendants were so dependant on their machines that they did not pay any attention to the classic heart attack symptoms that were displayed on her earlier visit to the hospital. She could have died because of their inattentiveness. By becoming so used to dealing with patients as if they were parts on an assembly line and relying ever more on advanced technology, the medical profession is looking more and seeing less. They need to stop, take the time to look at, and listen to the patient. Who knows? Therein might even be the solution to the patient's troubles.
References
Castledine, G. (2004). Castledine column: The importance of the nurse-patient relationship. British Journal of Nursing, 13(4), 213
Davidhizar, R., & Shearer, R. (1998, March). Improving Your Bedside Manner. The Journal of Practical Nursing, 48(1), 10-4.
Edell, D. (Producer). (2005, September 26). The Doctor Dean Edell Show [Radio broadcast]. Chicago: Tribune Broadcasting.
Szegedy-Maszak, M. & Hobson, K. (2004, April 5). Beating a killer. U. S. News and World Report, 136(11), 56-67.
Case Study on Bedside
Manners
Sarah Cadet
In the world today, rushing seems to be the normal thing to do. We say the everyday expression "how are you?" as we run away from a known face. Forgetting birthdays, kid's soccer games and other important dates if it doesn't show up on our agenda of things to do. Fighting just to make first place and in result, we end up knocking others down just to put a few dollars in our pocket. Time is so short that we must not consider individuals around us, but ourselves.
This issue has affected the medical world as we know it today. Doctors rushing from one room to another, while keeping conversation short as possible. Then writing a prescription on a paper that has the letterhead The Medical Center of Doe and Doe*. There is power in such a paper, and the Pharmacist is the only one able to translate such jargon. Still, for the patient who has no idea what new drug is being positioned in his/her life, they believe that doctor and take the drug. Doctors and nurses are so busy with their everyday patient assignments, that they cannot form strong relationships with patients, causing them not to be fully restored back to good health.
Time restrictions on nurses and doctors have caused clinicians not to form a relationship with there patients. George Castledine, Professor and consultant of General Nursing, emphasizes that giving enough time to get to know a patient is hard because of lack of time. He writes, "In hospitals it is difficult to find the time to sit and talk with patients" (Castledine, pg.1). Even though they try to find time to form relationships, the restriction of time in this profession makes it almost impossible. Peplau, who wrote, Interpersonal Relations in Nursing, stresses, " Interpersonal interaction between a patient and a nurse (doctor) often have more of an effect on the outcome of a patient's problem than many routine technical procedures" (Castledine, pg.1). Peplau's reason for nurses (or doctors) to have a relationship is very important, the relationship is vital for the patient's well being. Castledine argues, "There is a desperate need to encourage nurses to listen to patients and respect the patient's need for empathy" (Castledine, pg.1). Listening to the patient and truly tending to their needs will cause fewer problems and build better relationships.
Even though time may cause an affect on this important relationship, it is very clear that the clinician needs to from one. Martha Buckingham, a retired nurse, explains how she is not pleased with the way clinicians treat their patients. She wrote, " I go into hospital to visit friends, I do get a little frustrated with the way in which some nurses (by no means all) address the patients in their care" (Buckingham, pg. 1) The way a patient is approached makes all the difference in how a good relationship is formed. She stresses, "if a patient's psychological problem are responded to by nurses, and the patient feels valued and listened to this will have a positive effect on his/her physical outcomes, compliance with treatment and relationship with the hospital and staff" (Buckingham, pg.1). Dealing with the patient's needs, beyond physical, can truly help then come out of the hospital with better outcome.
Christina Fisher, a student studying pre-optometry and a major in psychology, is the subject of my research at hand. Over a six-month period she was going to a chiropractor in the case that she had gotten into a car accident. Her experience wasn't very good, which caused her to discontinue her visits, even though she was still in pain. This individual was a good choice of subject because she proves that clinician- patients relationships has a lot to do with the outcome.
I had talked to this young lady over the telephone, at 9:00 pm on September 25, 2005. I asked her questions about her experience as an outpatient, with the doctors and the nurses, my questions were: What was your first encounter like with the doctor? Did the same nurse receive you almost every visit? If yes how, if not how and was each visit different? Can you describe the relationship you formed with your doctor? Did he help you with your medical problem? If not how not, If yes how so? Do you think if you had a better relationship with the doctor the outcome would be different?
I asked Miss Fisher to explain her first encounter with her chiropractor. She pointed out, " The doctor spent about twenty minutes with me during our first visit. He had to ask me a lot of questions about the accident, for insurance reason. For example, when I got out of the car how did I position myself? He made me feel very comfortable and I truly felt the need to return" (C. Fisher, personal communication, September 25, 2005).
To get the full feel of the atmosphere of the clinic, I asked about the service she received from the nurses. She observed, that only two nurses would greet her every time. She said, "One nurse will take the x-ray and the other will setup the massage table. They would usually ask me how I am doing, and that would be about it. No, relationship came about, they didn't act extra nice or anything" (C. Fisher, personal communication, September 25, 2005).
I then asked her to explain her relationship with her and the doctor. She paused, "Hmmmm, to tell the truth I can't even remember his name. We really didn't have a relationship and there was no connection. If he saw me today I really don't think he would even remember me. He didn't spend that much time with me like he did the first time. He just kept the visits about my medical problem and that was about it" (C. Fisher, personal communication, September 25, 2005).
I asked her whether or not he helped her with her medical problem. "I had to discontinue the visits," She commented, " He was very convincing, but I saw no improvements over the six months" (C. Fisher, personal communication, September 25, 2005)
The last question I asked was, do you think if you had a relationship with the doctor the outcome would have been different? Fisher believed that it would have. She emphasizes, " I know that the outcome would be different. He should have known that I wasn't getting any better. I know that it had a lot to do with money, and caused a waste of time for me. I don't think my health was in the better interest of the doctor" (C. Fisher, personal communication, September 25, 2005).
After the findings of my results, I conclude that outcome of the patient's health depend on the relationship formed by the clinician. I noticed that this lack of good bedside manner is not just observed outside the medical field, but also within. My results show that the health care profession is not helping the patients to the best they can and it is unacceptable. My interviewee made it very clear that she was not pleased with the service she received from her doctor. The health care industry needs to focus more on proper bedside manners and how to manage time more appropriately. At this moment it is hard to place confidence in the health care industry with the state at which it stand in providing compassionate health care. The concern that I have gained from my research is the health of the patients that have to deal with such poor bedside manners.
Note
1. Not a real medical center.
Reference
Buckingham, M. (2002 June 13-26). Nurses must take time to talk to their patients "Nurses' bedside manner: is it deteriorating?" British Journal of Nursing, 11(10), 734.
Castledine, G. (2004). Castledine column: The importance of the nurse-patient relationship. British Journal of Nursing, 13(4), 213.
Case Study
Kelly Chichester
The appeal of bedside manner has been on the decline in recent years due to increasing demands on nurses, doctors, and other caregivers. According to Anderson (1998), CEO of the Parkland Health & Hospital System in Dallas, TX. "Doctor's get pressure from all sides to cut costs, and it takes their focus off the patient," he adds (Schrof, 1998, p 66). Though being a medical professional is a demanding career, there is simply no excuse for inadequate care and blatant disregard for patients. If good bedside manner is crucial (in some cases it can even accelerate the recovery process of some patients) and helps improve communication between doctors and patients, why is this all too important aspect of the medical world getting the cold shoulder all of a sudden? The only way to know it is to figure out its foes.
Understaffing
Understaffing may be one of the biggest reasons why nurses practice poor bedside manner. Most likely, it is not necessarily that caregivers are unconcerned with the welfare of their patients but simply because there are so many people to care for that nurses cannot reach all of them at once and in equal amounts. Schrof (1998) writes about Connie Cronin, a nurse who loves to work the overnight shift, was working one Christmas Eve all alone. Too busy to chat with a near death patient, she completely ignored the man why doing her rounds. When her shift was over the next morning, she left the hospital. In the middle of her drive home, overwhelmed with guilt, Cronin decided to go check on her forgotten patient when she went in for work the next night. However, it was too late. The man had died alone and Cronin felt nothing less than awful. "I abandoned that man during his last hours on earth," she later confessed (p 66).
Cronin's story is not unique at all. In fact, it is quickly becoming the norm. In my family, several of my aunts are nurses, home attendants or doctors and frequently are placed on night shifts all alone. What does this say about the medical profession? Are hospitals more concerned with saving money rather than saving lives? The main reason why hospitals, clinics, and medical offices exist is because the sick and downtrodden need healing. When nurses are too busy to even say, "How are things going for you, sir?" there is a serious problem with understaffing in their respective institution that needs to be dealt with immediately.
Demand for Increase in Education
Nowadays, more and more medical professionals are returning to school to supplement previous knowledge and experience. According to Gillian, "Some nurses and journalists have been insinuating that declining health care standards are due to nursing's pursuit of higher education (p 22)" While this may appear noble, in reality it is a detriment to the medical field, which negatively affects its most important patrons, the patients. Most of the time, the classes that nurses and doctors at this level are taking are almost completely devoid of bedside manner training. Medical professors and researchers deem more knowledge as the ammunition necessary to human disease. However, this is completely false. Yes, technicalities like expert knowledge of the heart is important for a cardiologist to know in order to care for his patients, however, if the doctor is not kindhearted in his dealings with his patients, he may be in danger of creating animosity between himself and his patients, which in turn makes an already difficult situation even more challenging.
Lack of Training
Professors in medical schools and other healthcare training facilities are not offering a lot of classes that focus on bedside manners. This translates into a future workforce that is inadequately prepared for service in the medical industry. M. Galaites, a 21-year-old Physical Therapy graduate student at Andrews University in Berrien Springs, MI cannot even recall having to take a course in bedside manner in her undergraduate program. "They [professors] want to get through all the knowledge part of it," she said in an interview that I conducted with her not too long ago (M. Galaites, personal communication, September 26, 2005).
Bias
Prejudice is everywhere. Unfortunately, it also rears its ugly head in the medical world. Nurses especially (who spend the most time with patients), have their own personal biases when it concerns certain patients. This is due not only because of socioeconomic status or ethnicity but simply because of the disease that the patient is infected with. An article written by Vesey (1999) states that, "Whatever the attitude held by the nurse, it may interfere with the nurse-patient relationship (p 24)." This is particularly the case with AIDS/HIV patients because of the social stigma of the disease (usually gay men or drug abusers are victims of this fatal illness). Considered as outcasts, drug users and gay men are treated with scorn, with the contraction of AIDS as their "punishment" for their "illicit and lewd" lifestyle. These beliefs are also carried by nurses and are manifested in the manner in which they care for these patients. However, this should not be the case. "The nurse caring for HIV or AIDS patients is not employed to change gay men or to help drug addicts to stop using drugs. The nurse must treat all patients individually," Vesey further adds (p 25).
Technology
Finally, though seen as a beneficial tool, can also be abused and affect the effectiveness of the patient/caregiver relationship. With more doctors relying on technological advances in medicine, in some cases, there is no need to even talk to the patient. This simply obliterates any opportunities for the doctor to develop a healthy relationship with his patient. Medicine needs to digress a bit and embrace the older practices that have worked for centuries-excellent, personalized care with a smile.
So based on the information provided here, is there hope for the medical field? Can bedside manner make a comeback and elevate the reputation of the medical industry from simply a moneymaking business to an actual service of society? I decided that it was important for me to know, but how was I to research this topic? I decided to conduct an interview with aforementioned 21-year-old PT graduate student, M. Galaties. Our conversation was very insightful and had proven to me that despite the destructive nature that the medical industry has taken, there are still people out there that really care and truly want to make a difference in humanity.
The Interview
Prior to the interview, I found out that Galaties had experience volunteering at a facility for the elderly near her home in Toronto, Canada. Though she shared with me that she was required by her school to do the volunteer work, she remembers the experience as being very beneficial. "I was forced to do it for school but I chose to do it there because of my love for the elderly." (M. Galaites, personal communication, September 26, 2005).
Galaties' duties included spending time with the patients, entertaining them, as well as administering some drugs under close nurse supervision. Whenever nurses were too busy doing their rounds, Galaties was there as an emotional crutch to the elderly that lived in the residency. Though the responsibility of caring for the elderly can be tasking, Galaties took everything with stride, saying, "I enjoyed it!" She credits her positive attitude toward the situation as the main component of how she treated her patients. "You have to want to care in order to practice good bedside manner with patients." (M. Galaites, personal communication, September 26, 2005).
After her time was done at the home (she had volunteered there in the summer of 2002 for over 3 months), Galaties believes that the experience only deepened her desire to study medicine, particularly, physical therapy. "I really didn't have any motivation to enter the medical field." However, afterward she admits, "One of the reason's why I'm dong PT is because of the personal contact between the patient and the doctor." (M. Galaites, personal communication, September 26, 2005).
Obviously, empathy and compassion are natural aspects of Galaties' character. When she does finally graduate and begins to practice medicine, Galaties plans to change the perception of medical professionals (who too often are seen as money hungry drug dealers and not healers). "I want to not only create a change in their [patient's] recovery but show them that there are professionals that do care and not use their status to gain influence." When asked about her personal definition of what good bedside manner is, Galaties replied, "Proper care of the patient, showing interest in their physical, mental, spiritual, emotional, and social needs." She also believed that it also included clearly explaining to the patient what procedures or test they will go thru as well as simply keeping in mind that the patient is human and should be able to demonstrate some form of choice in terms of how far their treatment goes. (M. Galaites, personal communication, September 26, 2005).
Clearly, Galaites is a first-rate example of how a medical professional should be-knowledgeable in their field yet compassionate and genuinely concerned about the welfare of their patients.
Though the establishment of bedside manner is fast loosing its significance, all is not lost. Fortunately, according to Schrof (1998), there are medical schools that are beginning to require all of their students to take yearly courses focusing on bedside manner. Medical examiners are also predicting that in the near future, students will be tested on their bedside manner if they ever wish to be licensed to practice medicine (p 66).
In conclusion, bedside manner in the medical world is just as important as medical advances in technology or knowledge. It is the backbone of the medical profession and the reason why people visit the doctor. The "human touch" is absolutely essential to the effectiveness of proper patient care and may just be the only thing that really makes the difference in the lives of so many.
References
Gillan J. (1999, January 27-February 4). Arena: bedside manner misses the point. Nursing Times 95(4), 22.
Schrof, J.M. (1998, December 21). Required course: Bedside Manner 101: Why doctors shouldn't touch that door handle. U.S. News & World Report, 125(24), 66.
Vesey, M. (1999, Nov). Prejudice makes a very poor bedside manner. World of Irish Nursing, 7(9): 24-5.
Case Study
Valencia Derice
Good patient and health care provider relationships are very crucial for the patient's well being and the hospital's environment. Patients need to not only feel like their needs will be met as far as treatment is concerned, but they also need to feel the love and support from their doctors and nurses. Giving the patient tender love and care can determine how well the patient will progress. Humans respond more efficiently to human contact. George Castledine asserts, "So much can be gained by picking up clues expressed through the patients' eyes, voice, mood and body" (3). That is the reason doctors should make an effort to build patient morale. But it is important that the health provider not get too involved with the patient.
Becoming too involved can interfere with work performance. It's important to give just enough where it does not interfere with the work and the patient still benefits form it. If such a thing were to happen where the nurse would get emotional over patients illness or death, the hospital should provide counseling.
We know that good patient care is important. But there are some health facilities that do not provide good patient-care. Gooderige declares, "I received excellent medical treatment, so it was a pity this was marred by the quality of nursing care, which left me feeling aggrieved to the extent that I considered taking action". "There were a number of shortcomings which, together, might have led to a sustainable charge of negligence and certainly amounted to sloppy treatment" (2). Like I mentioned before, doctors should stop treating the illness and start treating the patient with the illness. Situations like this cause the patient to lash out and complain. And it looks very poor on the hospitals part.
Sincere communication aids the trust development in the patient. Joannie M. Schrof claims, "A clinician's biggest mistake, researchers say, is intimidating patients into silence by tapping a pencil impatiently or keeping one hand on the exam room door handle. No visit should end without a doctors asking, "Is there anything else you would like to tell me"? If the doctor appears uninterested, the patients may hold back and are too afraid to say too much. They develop something the doctors call "good patient syndrome".
My friend Diana went to the doctor this morning so I decided to do an interview on her. Her shoulder was hurting since the day before and the pain started to go away until that night when she participated in one of the events on campus. She was so eager to participate that she forgot all about her sore. Then the next morning she awoke with an excruciating pain and with a swollen shoulder. I tried to massage it but that wasn't working so we took her to the hospital. Since it was a small town and it was early in the morning the hospitals' atmosphere was quiet and desolate. When we got inside we spoke to the receptionist who was fairly kind. Then we were sent to another person who took her insurance and other information. She was very quick and straight to the point. She barely smiled or even looked at Diana. The tone in her voice gave the impression like she was bored and the job was just getting to redundant. Before going into the doctors office Diana said, "I hope the doctor isn't like her, or I'm out" (D. Pastor, Andrews University student).
Later on in her bedroom I asked her about how the doctor treated her. I wondered if the fact the doctor was a male bothered her. She replied that she actually preferred male doctors. I even asked if the doctor touched her inappropriately, and her response was no. She explained that she was treated like a patient. He didn't ask her any personal questions like how was your day" or "how's school coming along"? He just went straight to the subject of the matter. She overall had no problems with the doctor.
Since her visit to the hospital was a short one, there was no need for incredible amount of patient-care relationship. But that does not give an excuse for a doctor to treat a patient poorly. For example, my mother went to the dentist and when she came back she was in more pain than she expected, but was more aggravated with the care she received from the dentist. She claimed that he was racist, because of the way he handled her. Diana led me to believe and realize that no matter how long the patients stay, they should always be treated with kindness and respect.
It also let's me know that not every health facility is terrible. There are many that provide excellent care professionally and emotionally. For Diana, as long as the doctor wasn't going to treat her the same way the lady treated her, she was fine. However, I slightly disagree. I believe that everyone who works in a hospital down to the janitors should treat everyone with respect. I can't exactly say that I am confident about the entire healthcare industry being capable to provide compassionate health care. But I also can't say that you won't find it at all. I just pray that the facilities that do lack the patient- care compassion will improve.
References
Castledine, G. (2002) The importance of the nurse patient relationship, 36-39.
Schrof, J. (1998). Required course: Beside manner 101. Why doctors shouldn't touch that door handle, 66-70.
Case Study:
Healthcare Field
Jenica Greenaway
In Mike Nichols' movie Wit', the story tells of a lonely professor who has just found out that she has cancer. The story line starts when the Doctor without any feeling just blurts out that she has cancer. He doesn't give her time to understand and process what he has just told her, he immediately tells her what the next step should be in order to try and make the cancer go away. The professor is soon admitted into the hospital and has a variety of healthcare workers poking and prodding at her. When it comes time for the professor to be examined, the doctors just come in and do what they need to do and go about their business. The healthcare workers don't take the initiative to talk with her and find out how she is doing. The doctors are so into treating the professor as a research project that they don't have time to see how the professor feels about what is going on around her. In one scene of the movie, a set of doctors had come in to examine the professor. They just walked in and they all started to discuss her condition and come up with different diagnoses and ideas of what they can do next. At the end of the examination when all of the doctors had walked out, one doctor turned back and said how are you doing. That question should have been at the beginning of the examination. Just like in the movie the healthcare workers in our society in the hospitals act the very same way. They give the impression that the don't care about their patients and what they are going through. They don't take the time to get to know their patients and help them out during their time of need. The communication between the healthcare workers and their patients are decreasing due to their very busy schedules. Communication is a means of sending information. Sending information is a very important key in the communication process. Communication involves the transmission of ideas from one person or people to another. Healthcare workers and their patients both agree that there is a lack of communication between them which is continually decreasing and something needs to be done to ensure that healthcare workers start to communicate more with their patients. Healthcare workers suggest that the lack of communication may come as a result of them trying to keep up with the various technological advances in various devices surrounding them and "the more technical skills nurses have to carry out".
Proper bedside manners includes, communicating with your patient. Counseling them in their hard times and always being there support and guide them through decisions when they do not understand. A good bedside manner experience would be one in which a nurse comes in and greets her patient saying good morning and asking them how their doing. The nurse should them draw the blinds to allow some light in the room while asking the patient how their night was and if they slept comfortably. The nurse should them proceed to check the patients vital signs and ask them if they are ready for breakfast, while still communicating with them throughout this whole process. In an article entitled, The importance of the nurse-patient relationship', it lists ten reasons why a nurse-patient relationship is important. "To (1)help patients make informal decisions, (2)avoid isolating and dehumanizing patients, (3)act as an advocate for vulnerable patients and those unable to express their wishes, (4)nurture cooperation and understanding, (5)help in patient assessment and problem solving, (6)help patients cope with their problems, (7)help patients undertake, or carry out for them activities of living and human needs, (8)nurse dying patients and those with terminal illnesses and palliative care needs, (9)teach and promote health education, and (10)learn about new ways of nursing and caring for people in a changing world". Healthcare workers should learn to abide by these rules when it comes to taking care of their patients.
For my interview I selected my friend Chantel Ryerson because I felt that her visit to the hospital was an interesting one even though she was a child when it happened to her. Chantel is a person who likes to communicate with others and likes to know details about everything no matter how important it is. When she was a child she had tonsilitis, so she had to have her tonsils removed. She remembers the doctors taking her away from her parents and putting her on the examination bed. She remembers crying and the doctors didn't do anything much to comfort or stop her. They just put the mask over her face to make her go to sleep. When she thinks back to that event, she wishes that the doctors would have communicated with her more, telling her it would be alright and making her aware of what was going to happen during the operation. I asked Chantel, what her hospital experience was like and if she enjoyed it, and if she thinks it is similar or ideal from an ideal hospital experience. I also asked her why she thinks healthcare workers don't take the time to communicate properly with their patients. This interview was done over the telephone so I was unable to have the interview taped. Chantel did have some interesting answers to the questions I had asked.
Chantel describes her hospital experience as one that will always be stuck in her mind. Because she was so little she sort of describes it as traumatic because she was unable to understand the procedure and why they where happening to her. She thinks that the hospital experience was similar to the hospital experiences in reality, but compared to television it was so different from what you normally see. She thought that healthcare workers being in the field of work that they are in need to pay more attention to their patients, especially the children because they are the ones who are more impressionable and feel like no one cares about them. She feels that the communication between healthcare workers and their patients needs to increase because this may soon be the reason why patients wouldn't want to seek medical help when needed.
This research was done to understand the communication techniques between healthcare workers and their patients. I noticed that the image we see on television of hospital situations isn't the actual reality of what really goes on. The results of my research show that healthcare workers aren't trying to communicate with their patients, even when it comes to children. I don't believe that my interviewee, Chantel Ryerson was happy with the way she was treated and the care she received when she was in the hospital. The healthcare industry is obviously decreasing in value and needs to get their priorities which are their patients straight. I feel that the healthcare industry is capable of providing their patients with compassionate health. They have done it before and I believe that they can do it again. I hope in the future the communication between the healthcare worker and their patients will increase and they are able to manage their busy schedules better.
References
1. Interviewed Chantel Ryerson (pseudonym) September 29, 2005
2. Castledine, G. (2004). Castledine column: The importance of the nurse-patient relationship. British Journal of Nursing, 13(4), 213.
A Case Study
Ana-alisa Guthrie
People who have had a bad experience with the hospital care system have found their success in a speedy recovery forthcoming. Research has shown that positive patient-doctor relationships are extremely essential during the recovery process. Not all situations are the same and documentation of each of these situations is difficult, but most definitely this would easily help us see just where the system falls short so that we may be able to correct the problem. We know that doctors and nurses are human beings just like us, but yet when they make an honest mistake that we ourselves could have made if placed in the exact situation, we are surprised. Why is that? Why are we totally appalled and start asking questions like: "How could they?" "What on earth were they thinking?!"
Upon reading the article, "Botched Surgery Prompts Lawsuit" I really couldn't help but have the exact reaction as I described earlier. It really surprised me when I read how the doctors accidentally sewed up a surgical sponge within the patient during a previous procedure. Then the doctors had the gall to charge the patient for the second surgery. I didn't believe it was entirely wrong for the doctors to sew up the sponge within the man because obviously the sponge must have gotten lost and as they finished up they were unaware of the mistake. On the other hand, I was really finding it hard to understand the logic of making the patient pay to fix the mistake that was the doctor's fault.
Along with doctors making mistakes they may also come to the job with various prejudices and biases according to the article by Maura Vesey, "Prejudice makes a very poor Bedside Manner." The way a person may have been brought up, and the things they may be used to, or in this case not used to, causes them to have a different outlook on certain things. Of course this alone does not make it right, but it's still not okay. Vesey went on to state the fact of how nurses may also be prejudiced against persons with HIV, Aids, or some other major disease. Because of the obvious realization of the importance of a positive patient-nurse relationship, it definitely would be best if these stereotypes were left at home and not brought to work.
Now I have decided to do my study on the experiences of an old friend of mine. She asked that her name not be mentioned, so we will call her Bobbie. Bobbie is a girl I have known since my years in middle school. I guess you could say we kind of grew up together. She has been through a lot for her young age seeing as she is not much older than me. I decided to interview her rather than an older person because I thought it would be nice to document someone's experience that was closer to my own age instead of someone older. The suggestion was thrown out to interview our own mother or a doctor or a nurse and I wanted to be different. We decided not to tape-record the interview and we decided to meet and talk at a park near her home in South Bend.
I started out by asking Bobbie if she has had any positive experiences while under the care of a doctor and she recalled of the time when she had her first baby. She said, "I knew the doctor cared about what happened to me and the baby because he would always tell me what he was doing or what he was going to do. It was like he was always trying to make sure that I was comfortable so as to build my confidence in him." I then asked her if she had any family members around during this time and she told me that yes, her mother was there. She told me that after everything was over her mother came to her with wonder since she was very impressed with the doctor and his ability to actually keep up with the nurses and ask them how she was doing and even helped to make their work easier, as if that is possible. During the interview I was looking at her wide-eyed with amazement. I couldn't believe it because I have always thought of doctors as some of the most uncaring and rough people around. To me this doctor sounded like a super man because with all the work and random things doctors have to put up with I wouldn't expect them to have a genuine caring bone in their body. I'm sorry to make doctors sound this way, but this is really how I view them to be. This is my personal opinion, but I also know that this is a common assumption made by most people and I also recognize that all doctors are not the same way. Doctors simply have too much to do to be genuinely concerned about each and every patient and to be honest, I don't expect them to be. I just expect them to do their job with as much thoroughness as possible, nothing more.
For the remainder of the interview we talked of how much easier it was for her to recover from the experience of having a baby. I asked her if the delivery seemed easier than what she thought it would be, and her response was, "It was a piece of cake." Of course I was thinking in my head that usually having a baby at a young age puts you at risk for countless complications especially since she was pretty sickly when we were younger. I found it shocking that she had absolutely no problems. For her to have a smooth delivery was obviously because of the doctor and the kind of vibe he gave off. You could tell he left an impact on her even till this day. Studies have shown that patients who were prescribed sugar pills for an illness they thought they needed medication for got better nine out of every ten persons observed in the study. This is because the mind is powerful enough to make the body function better because it thinks it is getting help to perform its job better. This doctor's ability to build everyone's confidence in him because of his positive attitude is what being a doctor is all about.
References
Steiber, S. (1997). Botched'' surgery bill prompts lawsuits. Patient-focused Care.
Vesey, M. (1999). Prejudice makes a very poor bedside manner. The World of Irish Nursing.
Case Study
James Hood
Introduction
The movie "Wit" is a commentary on the state of health care. Director Mike Nichols did an excellent job of portraying the reality that not everybody in the health care industry cares for the complete well being of the patient. The movie shows how some health care professionals can act and behave towards patients without compassion, kindness, or care. It would appear that although the technology of medicine has increased, the bedside manners of those who administer the treatment has decreased. The first priority of all healthcare providers should be to ensure that patients are not just treated, but cared for.
Review of Literature
Recent research suggests that health care professionals are having problems caring for the patient on a personal level. "6 in 10 doctors surveyed last year said medical school had poorly prepared them to talk with patients, and nearly 7 in 10 said insufficient time with patients was a 'serious problem'" (J. Schrof, 1998). Schrof suggests that if medical professionals take time to sincerely listen to their patients and find out how they are doing, the patient will feel more inclined to be open with the medical professionals. This openness can lead to better care and treatment for the patient. Schrof asserts that many schools are beginning to require courses where actors present a myriad of cases to students to assess and improve their bedside manners. With proper training, medical professionals can help patients feel at ease and open to voicing their concerns and problems. This is an essential aspect of caring for patients. Making sure a patient feels comfortable talking with the doctors and nurses is essential to ensure that they receive the best treatment available.
Nurses need to be able to develop relationships with patients. G. Castledine (2004) states that the ability of nurses to develop these relationships has deteriorated due to the compulsion to get patients in and out of the hospital as quickly as possible. The rush of processing patients quickly certainly does not make it any easier for a nurse to be empathic towards a patient. Castledine states, "giving patients the impression that there is time to talk and express their anxieties is a way of being empathic" (G. Castledine, 2004). Empathy is important to caring for a patient's mental health. Many patients leave the hospital only being cared for physically, leaving their mind in some degree of distress. Patients need to be able to express their inner feelings in order to be comfortable and at ease. The nurse is the primary person who has control over how the patient feels about their situation and how they communicate their feelings. With the pressure of moving patients through the system as quickly as possible, it is easy for nurses to not have enough time to spend developing a caring relationship with each patient.
Method
I interviewed a friend of mine who has recently been in the hospital; we will call him J. Smith. I selected this person because his experience as a patient was common, but thankfully not commonplace. I interviewed him over the telephone on October 2, 2005. He was at home in the evening during the interview. I asked him questions about how he was treated by the doctors and nurses, how knowledgeable the medical staff seemed, how they responded to him, how they performed the diagnostics, how the they interacted with his family, if he had a case manager assigned to him, and who primarily took care of him. I did not inquire about permission to tape the interview because I have no resources for taping a telephone interview.
Results
When asked about how he was treated by the nurses, he stated that they treated him with "Businesslike detachment. Allowing for caring to be given, but withholding as needed to complete their job [quickly]" (J. Smith, personal communication, October 2, 2005). He also stated that "the nurses were only doing what they were told and shown." The doctors on the other hand treated him with "concern", but they "seemed to be concentrating on what they knew, and not what was known". When I asked him about how the diagnostic process went, he said, "From a medical point of view, they followed the steps [exactly], but from a civilian's standpoint, they dragged their heels and didn't want to make decisions." When I asked him if there was a case manager assigned to him, he stated, "No, not that I knew of. None was made known to me." When I asked him about who took care of his needs during his stay, he said that his fiancé did. He stated, "They had to keep a medical detachment because they had other patients. Maybe if there was a case manager that might have changed, but there was no one like that around besides [fiancé]." He said that the medical staff "didn't mind" that his fiancé was taking care of him (getting him food, helping him to the toilet, etc) because it was "[o]ne less person they had to take care of." At the end of the interview, he commented, "They did the best they could. I did not expect any more of them because they were all very frazzled and overworked. It seemed to me that they did the best they could."
Conclusions
During my research, I have noticed that a growing number of medical personnel only have enough time to treat their patients, and not enough time to fully care for them. From my interview, it seems that the health care profession is not doing an acceptable job of providing sympathetic care to its patients. My interviewee indicated that they provided him with good care, but not on a personal level, his fiancé being there may have influenced them away from providing this sort of care. If this was the case, they still should have taken time to listen to their questions and concerns and given answers. If the health care industry continues to try and push patients through the system as quickly as possible and if they continue to overload nurses and doctors, then the number of hospitals where patients are only receiving treatment will continue to grow. If this ideology continues to spread in hospitals and medical facilities, patients will be receiving less personal care more frequently and that could result in mental health issues. I believe that if the health care industry cannot turn itself around and start focusing on the patient, patients will continue losing respect for the industry, patients will file lawsuits more frequently, and patients could easily develop depression, anxiety, and other mental disorders. If patients only receive treatment, and not care, we will be having some serious problems in the future. The first priority of all healthcare providers should be to ensure that patients are not just treated, but cared for.
References
Castledine, C. (2004). The importance of the nurse-patient relationship. Castledine Column.
Schrof, J. (1998). Required course: Bedside Manner 101. U.S. News & World Report, December 21, 1998, 66.
Researching bedside
manner: Case study
Jason Micheff
While the health care profession, have both a medical and emotional effect on their patients, often it is the emotional effect that is important. When patients are happy and emotionally uplifted, they tend to get well sooner. But those patients that have a negative outlook and no positive support stay sick longer. So it should be the doctor's and nurse's job not only to help them physically, but emotionally as well.
In the earlier days of the medical profession, doctors and nurses used to help people more because they cared, rather then for the money. If someone was sick or needed help, the doctor or nurse would go out of their way to help them. Today our doctors and nurses are too worried about their careers, and don't put that extra care into their patients. Gillan (1999) states, "some nurses and journalists have been insinuating that declining health care standards are due to nursing's pursuit of higher education." They aren't satisfied with being just a nurse; they want to be as close to a doctor as they can. And if they can't move up in the nursing profession, they move on to something that they can advance in. If we don't offer young people higher education we will lose them to other professions that do (Gillan, 1999). Those that do advance in the medical profession seem to lack in bedside manner. Their whole focus has drifted from patients to careers. Castledine (2002) says that the quality of the nurse-patient relationship is under threat form the more technical skills the nurse is having to carry out. So it might just be that the position of a nurse is at fault for the poor bedside manners, and not the individual..
To get a first hand opinion of what hospital care is like, I interviewed my grandpa James Micheff. He has been in the hospital for numerous things, such as back surgery, x-rays, and the most recent was a triple-bypass. So he has spent a lot of time in and around hospitals. While I interviewed him at his house, I asked him questions like :Do you think that the attention you received from the nurses was adequate? Where the medical staff kind and considerate? And did you see your doctor much during your stay in the hospital? How was your overall experience being in the hospital?
For most of my questions he had a positive answer. Obviously his time wasn't enjoyable due to his pain, but the atmosphere was nice, he noted. When I asked him what he thought about the attention received from the nurses, and if it was adequate, he said that they did everything he needed. He said that the nurses didn't stay long, and always did things in a hurry, but for the most part they were friendly toward him. I asked him if they were kind and considerate toward him, and he thought they were always cheerful and pleasant. They didn't stay and talk long, but they were always nice to him.
I then asked him about his doctors, and if he ever saw them much. No, he said, that he only saw his doctor a few times during his triple-bypass, and never had more than a two minute conversation with him. The doctors where always nice, but just never around. To wrap up the interview, I asked him about his entire hospital experience. It was good as far as the staff went, but he still didn't like going. In all the visits to the hospital, most of them, the staff were all very nice. He never had any problems with the staff from the hospital.
My grandpa is the perfect person to ask about medical care. He has spent his share of time in a hospital. His experience shows that not all nurses and doctors have bad bedside manner. However he did say they were always in a hurry, and that can be taken in a negative way. So with the articles on the declining bedside manner and the first hand experience, I think it's safe to say that bedside manner isn't where it should be. It's ok, but obviously taking a drop. And most of this can be accredited to the position of a nurse or doctor. It is pushing them to advance in their field, giving them little time for each patient. Our medical profession needs to slow down and put more interest in its patients. If it could do that, I think there would be a lot fewer sick patients.
References
Gillan, J. (1999, January 27-February 4). Arena: Bedside manner misses the point. Nursing Times, 95(4), 22.
Castledine, G. (2004). Castledine column: The importance of the nurse-patient relationship. British Journal of Nursing, 13(4), 213.
A Case Study exploring
some flaws in the medical industry:
Communication Basics
Edson Patrice
Introduction
The health industry is probably the fastest growing business in America. Americans are constantly searching and achieving to live the "American Dream." While the meaning of that dream is not completely clear to everyone, the effects of its pursuit are universally felt throughout the nation. Overworked men and women who are aspiring to be like the Joneses are trading in their health for wealth. In addition, a growing elderly population has only added to the already towering numbers of patients seen by doctors and nurses everyday. From stress and genetics to aging and lifestyles there are a number of factors contributing to this epidemic. While this predicament has been met with exceptional technology, well-educated staff, and fast treatment regimes, there are still many pieces of the puzzle left out. Specifically, the patient-care provider relationship has been forsaken to provide more time to see more patients. Though this shift has accommodated the fast growing number of patients the results are minimal. Meanwhile, patients are left disgruntled, confused and uninformed about their wellness needs. Indeed this industry has grown considerably. Notwithstanding, the outcome is an understaffed and overworked employee who in addition to not having anytime is poorly educated on the subject of beside manners and compassion.
Review of Literature
The patient-care provider relationship has more to it than what meets the eye. In just the few minutes it takes to have a visit with the doctor are integral steps that if missed can domino into a million other problems. For example, a doctor who rushes through the history and physical assessment, commonly called the H and P, will miss clear red flags that could lead to major errors in the treatment regimen. It is noteworthy to mention that this will not only help the patient but the doctor as well. One source presenting results from a JAMA1 survey suggest that doctors who spend extra time with their patients are more likely to prevent a malpractice suit, even if one is called for. The idea is to spend more time with the patient doing things that aren't learned in medical school. This includes, but is not limited to talking with them, listening to them, and laughing with them as the article suggests (Patient Focused Care, 1997). Though it may be profitable to avoid lawsuits this should not be the only motivator for improvement. From it's very beginning patients have always been the center of this thriving industry. Evidence has shown quite the contrary. Joannie Schrof suggests health-care workers can still do much to improve their conversations with their patients. She notes that a study has shown that doctors will usually interrupt the patient after only eighteen seconds from the initial question. That same study proves that if allowed to speak uninterruptedly, the patient will finish in two and a half minutes (1998).
Doctors however, are not the only problem in this equation. Nurses are also a very vital part of the patient-care provider relationship. As a matter of fact, nurses have traditionally interacted with the patients more than doctors do. Because of this fact one would assume that nurses have a leg up on doctors in regards to this relationship. Christopher Gooderidge, a medical negligence litigator begs to differ. During his own "first hand" experience at a hospital he asserts that he got excellent medical treatment. This however, was marred by the quality of care from his nurses. He may have been biased in his observations but he claims that there were a number of shortcomings that could very well lead to a charge of negligence (1999). The roots of these problems for nurses and doctors alike are too many to mention them all. Nonetheless, one stands out and screams for recognition. Ruth Davidhizar and Ruth Shearer put it best by saying: "The attitude and manner communicated by the staff will influence how the staff and the agency [hospital] are viewed and the confidence felt in the care provided (1998)." They emphasize eleven techniques to help nurses improve their bedside manners in tandem with their patients. Out of the eleven techniques they mention six deal with communication directly. The other five are related to communication in some way or the other. In total, no matter how you see it the health-care provider relationship cannot be over-emphasized. It is important and [gives patients the impression that there is time talk out their anxieties] (Castledine, 2004).
Method
Rosa Miranda, a middle-aged nurse of over thirty years experience, holds a Bachelors of Science in Nursing. Rosa has worked in a number of different environments prior to the current position she now holds at Lakeland Regional Health Systems. She works in their long-term and rehabilitative care facility in Berrien Springs, MI. At this facility Rosa deals with a number of challenges to include some that are unique to her specialty of nursing. Geriatrics is sort of a "bottom of the barrel type job". This may sound harsh but the intended meaning is that it's not very popular with the new kids. Most nurses and doctors who pick specialties rarely if ever pick this one right out of school. It is usually reserved for the unique, the called, or the temporarily misplaced. Rosa understands this dynamic as she followed the same trend. She's also worked in nursing outside of the U.S., Mexico to be exact. She was able to see the stark difference between the practices of two neighboring countries. I sought to figure out if she liked what she did for a living. This would establish her interest in some of the problems present in her field. I also wanted to see what she saw as some of the probable causes to these issues were and if she had any possible solutions to fixing them. Rosa's unique specialty compounds the shortage of nurses with an already unpopular vocation. I determined to see if and how this affected her professional and personal life respectively.
Results
Rosa Miranda cares about her job very much, or so she has told me. She has evaluated many problems in the medical industry. In fact when I asked her that question she emphatically said "what are not the problems?" Her experience has furnished her with more perspectives than I need to mention. She very quickly established how understaffed her job is. I didn't even have to probe her for another question and she began explaining to me the reasons why this happens. In comparing her experience in Mexico to her experience now in the U.S. she reasons that the nurse to patient ratio is too large. In Mexico she said she only had one patient if not the most it would ever be is too. She realized very quickly that this was not the norm in America. It has become apparent to her after all those years of experience that the first thing to do is equip staff with more help. She asserts that there should be less emphasis on big business and more emphasis on providing good well-rounded care. She says that we should also train staff on how to interact with the patients deeper and communicate clearer than before. Rosa has always wanted to spend more time with her patients but notices the reality would not let her. After working a total of 80 or more hours per pay period2 she has absolutely no energy left to devote to work. The truth, she claims is that she usually leaves work stressed-out from all the non-patient care tasks she is forced to do. Documentation alone has easily taken 2 or more hours out of her shift. That may not seem like much but as one considers the many other tasks such as medication pass, treatments, pain management, and many others for over 20 patients one nurse could be pushed to the brink of insanity. Rosa affirms that her relationship with her patients could definitely use some improvement, however she says managers need to cut down on the busy work that keeps her from doing so. One of her statements came as a complete surprise despite its obvious reality. She informs that any nurse who is deciding whether to document or spend time with their patients will almost always pick documenting. The lawsuits propagated by mistreated patients have caused the health-care managers to respond by imposing strict documentation standards on health-care workers. While these documents are helpful in court they are doing very little to improve the incidence of mistreated patients and the viscous cycle continues. At the end of our interview Rosa admits that it would benefit everyone if workers informed patients and families about some of the shortcomings of this industry and work together to avoid or decrease them.
Conclusion
It appears that all the articles about improving bedside manners, better communication with your patients and the like are directed at the wrong people. The problems that my interview with Rosa revealed were anticipated, as I am a nurse and I deal with them myself. However, I did learn something that I've never seen in my 2 years of nursing. While it's good to empower health-care workers to improve their overall performance in their respective fields, it is not effective yet still because the root of the problem may lie elsewhere. With Rosa I saw an experienced nurse who determined as she may be to improve her nurse-patient relationship could not fully commit when the rubber hit the road. It illustrates to me that we have to place more pressure on our management to reduced some emphasis on non-life threatening or support tasks. A major shift needs to happen in the litigation sector to decrease the amount of medical lawsuits and release some pressure on the workers and managers. Ultimately, less emphasis should be placed on making big bucks and more emphasis on improving the system.
Notes
1. Journal of the American Medical Association
2. A pay period lasts 14 days.
References
Castledine, G. (2004). Castledine column: The importance of the nurse-patient relationship. British Journal of Nursing, 13(4), 213.
Davidhizar, R., & Shearer, R. (1998, March). Improving your bedside manner. Journal of Practical Nursing, 48(1), 10-4.
Gooderidge, C. (1999, January). Is your beside manner negligent? Professional Nurse, 14(4), 291.
Physician beside manner linked to malpractice suit: laugh, listen to patients to reduce risk. (1997, May). Patient Focused Care 5(5), 58-9.
Schrof, J. M. (1998, December 21). Required course: Bedside Manner 101: Why doctors shouldn't touch that door handle. U.S. News & World Report 125(24), 66.
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Christopher Perry
Outcomes Related to Different
Styles of Patient Care
Rebecca Sowers
People that go to the dentist go because they have an issue with their teeth, or they just need to get checked out for a problem. People that go to to the chiropractor probably have a problem with their back; it could be disalignment, soreness, or maintainance. The point is, whichever doctor or health care professional you choose to visit, your choice is based on the kind of care that is provided. But narrowing down even further, even the type of doctor, or health care provider you choose for similar characteristics of treatment effects the experience and kind of care that you receive. The person I chose to interview was my mother, Mary Sowers, who was diagnosed with Hepititus C, that damaged her liver, in 1992. Mary's experience with that of the medical doctor and the naturopathic doctor brought about different outcomes, based on the very opposing views and attitudes of each one.
To present this idea, focus on how George Castledine points out that "The relationship has always been regarded as the essential' aspect of nursing but is now being ignored (2004)." What he means to say by this is that the health care providers have too many other aspects of their job to focus on; time isn't being made to focus on the forming of relationships because it isn't a priority anymore. Medical doctors can get too caught up in the technical areas of their job, and they don't always have an adequate amount of time to build a close relationship. In Mike Adams column, he mentioned in an interview with Dr. Pizzorno that the role of the doctor is to diagnose that disease and treat that disease (2005). Naturopathic doctors focus more on the patient as a whole being, and try to provide all aspects of health emotional, spiritual, as well as physical, through a close relationship. Adams also empashized that Pizzorno's perspective was that, "we treat diseases from the perspective of helping the body get healthier so that the body can get rid of the disease" (2005).
Castledine also has a list of top "10 reasons" why the nurse [health-care provider]-patient relationship is so important. The first one is to "help patients make informal decisions" (2004). If this is done, the patient can feel a connectedness and feel more independent because they contributed in some aspect to their plan of care. Another one that Castledine lists is "avoid isolating and dehumanizing patients" (2004). This is important because even though it seems like it is obvious and can be avoided, it isn't. Many patients feel they cannot express themselves because they aren't given the chance too. Medical doctors may present information to a patient about their health or plan of care and expect them to take it at face valueeven if the patient doesn't fully understand what is going on. Just because they are physicians and are "always right" doesn't mean they shouldn't provide explanations of care, especially if the patient doesn't agree. Again, this takes away from that interpersonal connectedness that should be taking place. Naturopathic doctors break it down for the patient and provide a type of care that is more basic and simple for the patient to understand.
A telephone interview was conducted with Mary. When asked if she felt a compassionate attitude from the medical doctor the answer was a firm "no". She said the doctor seemed angry and perturbed, because he was frustrated he could not help cure her Hepitus C. She explained this was the resulting attitude, because the interferon therapy was too strong for her and he had to end it. He sent her home to die, and didn't want anything else to do with her. That answers the next question about the encouragement or hope aspect. He did not display either, and seemed to only be interested in making money. He believed that the only answer was drugs, and since that didn't work, he came to the conclusion there was nothing that could be done for her. When asked if she felt dehumanized in any way, she expressed how she very much so felt that way. His uncaringness made her feel like a piece of meat, she said. Whether she lived or died, he was still getting paid the same. Although this was a barrier on her road to wellness, she didn't settle for less, in this case, death.
The naturopathic doctor took quite a different approach. Adams made that point in his article that these types of doctors would rather look at why the immune system isn't working and that it is more important to focus on diet, herbal elements, lifestyles, so that infection can go away and be prevented (2005). Mary explained he was different from the medical doctor in the compassionate attitude aspect. He was willing to work for little money, was never too busy, and always explained things thoroughly. She could even call him at home. Mary was also impressed with his encouragement and hopefulness. He was always researching and consulting other professionals to find other answers. When asked if she ever felt dehumanized, she illustrated how it was just the opposite. When she was under his care, her doctor always had nurses come in and give her backrubs, massages, salt glows, and also received hydrotherapy. He also set up classes for her to take to give her encouragement. He incorporated the spiritual aspect as far as setting times the pastor could come in and counsel and pray with her. This uplifted her spirits, and the emotional experience actually improved her physical well-being, she reports.
Looking at both sides of the spectrum, it is clear to see that the different styles, and attitudes can effect the outcomes of the patient. Mary did eventually gain her strength and wellness after she went through treatment with the naturopathic doctor. Not to say it was easy, but the medical doctor certainly didn't have the hope, and apparently the resources, to make my mother better. Mary's experience with that of the medical doctor and the naturopathic doctor brought about different outcomes, based on the very opposing views and attitudes of each one.
References
Adams, M. (2005). How the care of naturopathic physicians differs from that of conventional doctors: and interview with Dr. Joseph Pizzorno. News Target. Retrieved October 4, 2005, from http://www.newstarget.com/004780.html
Castledine, G. (2004, March). The importance of the nurse-patient relationship. Castledine Column.
A Case Study of
Nurse/Patient Relationships
Anthony Willis
There are many qualities in bedside manner that medical professionals may or may not care to develop in their relationships with their patients that are vital to the way they respond to their treatment. In this day and age, the medical world must make strides in becoming more adept in their knowledge of how to develop personal relationships with their patients. Now more than ever, people are becoming well-informed about issues concerning their family's health and need someone to relate to, rather than to educate them. Though patient awareness should be a high priority on the medical staff's mind, tact must be used when it comes to dealing with patients and the information that needs to be given in order to make the patients experience amore pleasant one.
Moreover, besides the emotional implications that the relationships between doctors and nurses and those that they care for have, there are psychological and even sometimes physical effects that arise as a result of the way that they deal with the patients. Patients will respond positively or negatively depending on how they feel about the person that is caring for them.
George Castledine once wrote in an article, entitled the Castledine Column, that, "The [nurse-patient] relationship has been regarded as the 'essential' aspect of nursing, but [it] is now being ignored in the race to get patients through the system." Thought the article was written many years ago and the author hailed from another country, this is becoming increasingly true as more nurses take on additional responsibilities in caring for their patients. Castledine goes on to say, "Peplau (1998) stated that nursing is an 'interpersonal' process and often a 'therapeutic' one. She always maintained that although some of the actions of nurses were technical, the interpersonal skills of the nurse were the most important part of the nursing role."
In essence, because of the profound influence that nurses have when it comes to the treatment of people in need of medical help, they can very well mold the health realm. Despite the different positions and levels and roles in nursing, all nurses play an equal part in the caring for a patient. The RN, nurses' assistant, and primary nurses are just some of the key functions that these medical professionals provide; from the registered nurse in their administrative care for the patient and ensuring that protocols are followed and that the patients have the most essential level of care. The nurses' assistant performs the necessary duties that are to be completed on a daily or regular basis; such as a body fluids check or linen changing. The primary nurse is the one who gives the patient the most intimate care and is the one who actually interacts with the patient on more than a basic level, caring for their psychological, emotional and other physical needs.
One can argue that the nursing profession has waned away from this very fundamental description of a nurse's job. When it comes down to the sheer volume of patients that they sometimes acquire, these duties can become less personal and more of a routine. Nurses then lack the time it takes to show each patient, total care. This is at times extremely detrimental to the care giving process in the nurse-patient relationship. Seeing that this is the normal behavior for most doctors and physicians, nurses usually become an intermediator that empathizes with the patient and conveys their thoughts and concerns to the physician.
As Joannie M. Schrof (1998) puts it, "most health professionals agree on the need for doctors and nurses alike to practice better bedside manners during increasingly short sessions with patients. Studies show that the greater rapport patients feel with a caregiver, the more likely they are to reveal key facts and to follow medical instructions."
When asked in a phone interview why she wanted to be a nurse, one responded, "I have always wanted to be a nurse, even as a child." (A. Green, personal communication, October 2, 2005). Ms. Green, currently a psychiatric nurse, gave testimony of her experience with being a nurse and bedside manner. In the 23 years that she has worked in the health profession after starting out as a nursing assistant, she has moved on to being a licensed practical nurse and eventually became an RN. She believed that communication is the most important part of the patient-nurse relationship.
She went on to tell of how she had to learn to deal with certain situations in her field of psychiatric nursing. "In psychiatric, non-verbal as well as verbal is a vital part of bedside manner. Sometimes you have to step out of the picture, [because] they may see you as someone that you are not." She recalled a patient of hers that had an episode of fits because in his mind, she reminded him of someone else. She had to forgo direct contact with this individual and request the help of a mental health technician to calm the patient down, relay to her exactly what was wrong, and provide appropriate care for the patient in that manner.
I came to find that sometimes bedside manner can take on a seemingly indirect feel to it, but in reality the ensuing care that is given is nonetheless vital in the nurse-patient relationship. In a film reviewed in class entitled "Wit", the nurse patient relationship was portrayed from the viewpoint of the patient Dr. Bearing as well as the medical personnel caring for her in her battle with ovarian cancer. She dealt with a range of feelings in when it came to her relationship with her doctor and primary nurse. They sometimes treated her as if they did not care for her and had no reservations about her well being and at times they seemed to only pretend that they cared as if it was only a part of their job.
"Physicians are very distant and they don't talk to the patient; rather they talk at them", responded Ms. Green when asked to expound on the very important area of communication. "They talk about the disease and not the patient dealing with the disease and address them by a number and not by name." She alluded to the notion that most physicians were not concerned with the actual patient that they were caring for, but in actuality wanted to deal with the case and find a quick solution for it. She even recalled a time when a doctor went in a room to "see" a patient but paid not more attention to them as he did his clipboard and 10 minutes later, when approached by them did not even recognize who they were.
Ms. Green went on to say, "Some doctor's actually sit on the bed and make physical and eye contact with the patient when they are speaking with them; they are focused on the person and not the problem." However she does admit that the same can go for nurses sometimes, whose role is even more pertinent in their engagements with the patient. Despite that, the patients usually prefer to speak to their nurse when they have a concern. "Sometimes patients don't even want to see the doctor and they only want to see their nurse so that they might relay to the doctor their concerns." (A. Green, personal communication, October 2, 2005)
Through careful scrutiny of all of the thoughts and facts given about the nurse/doctor-patient relationship, I can infer that the medical world is indeed becoming more detached from the emotional side of caring for their patients. Their concern is geared towards making sure that the patients recover from whatever may be ailing them, which is benevolent in its intent but can be detrimental to the non-physical aspect of the caring process. From her personal experience, Ms. Green is firm in her belief that the communication that transpires between the nurse or physician and the patient is what will help the patient more in the healing process. This helps to reestablish the initial conception that the bedside manner that is learned and practiced throughout a medical professional's career is what will determine whether or not they are successful in their endeavors to provide care to their patients.
References
Castledine, G. Nurses' bedside manner: is it deteriorating? Castledine Column, 11(10): 723.
Peplau, H. (1998) Interpersonal Relations in Nursing. London: Macmillan Education.
Schrof, J. (1998) Required course: bedside manner 101. U.S. News & World Report, 66
Nichols, M. (Director) (2001). Wit [Television broadcast]. USA: HBO Films