EDITORS’S COMMENT

'Walk in your patients’ shoes to ensure good care'

13 September, 2011 | By Jenni Middleton

It’s a question we have been pondering in the office this week - whether you really need to have a rich life experience to be able to offer care to a patient or show empathy to a relative.

Are young, newly qualified or student nurses less able to deliver bad news or understand how to comfort a relative than a nurse with many years’ experience? Or does desensitisation come with experience, making you less emotionally intuitive than a colleague with less experience of such situations?

One of my colleagues says the most powerful lecture she attended was by an oncology nurse, who explained how she only realised many things about caring for patients with cancer once her husband had been diagnosed and later died of the condition. Her experience tended to suggest that while she had always been a technically excellent nurse, I presume, she only refined the emotional intelligence once she had personally been through such a terrible experience and learnt what patients and their carers need.

But is such extreme training necessary? I don’t believe that it necessarily is. No nurse can really have to experience the agony of every symptom to know how to alleviate them or provide comfort. But they do need to see things from the patient’s perspective. How long can an older patient with arthritis stand up for when they are helped out of bed to change their nightgown? How much can patients see and hear of what is going on around them when lying supine? What does it feel like to go nil by mouth and not know when you will finally go for your procedure?

Recently, I heard of an initiative where learning disability staff in Bury spend their first days learning the history of the institutions where their patients were formerly housed. This enables them to appreciate why patients who have been institutionalised for a long time behave the way they do out in the community.

The message this sends is the most important part of care isn’t the medication or treatment, but having the understanding of how that patient feels. Only that can lead to the right treatment.

Readers' comments (23)

teresa chinn | 13-Sep-2011 11:38 am
Interesting points raised here - I feel that as we go through our lives and our careers we develop through our experiences both professionally and personally, however just because i don't have the same experiences as someone older than me does not make me any less or more of a nurse. We are all different and have different life experiences and we all bring our own special qualities to the nursing team.
Unsuitable or offensive?
Anonymous | 13-Sep-2011 12:41 pm
it is called empathy or empathizing with the patient and their entourage.

Jenni, you forgot the one of going for an abdominal ultrasound with a full bladder and then left desperately worrying how long you were going to have to sit in the waiting room before being called!

A very perceptive article and after 20 years in nursing my eyes were opened in mid-life by the deaths of my parents and then a couple of periods in hospital in different departments.

Being in hospital and on the receiving end of medical, and especially nursing care, and facing bereavement and grief has changed my attitude and empathy towards others totally and led me to a further and more in depth study of psychology of interpersonal relationships, emotions, grief and bereavement to see what it really needs to help the most.

Being in hospital also taught me about the different staff and their attitudes and ways of relating to and working with patients as well as the real and perceived fears that go with the treatment and care as well as expectations. The care was so compassionate and excellent many of my initial fears proved totally unfounded and needless. Excellent communications and asking the patient's permission proved key in my experiences as well as carrying out tasks with confidence and competence, even when carried out by students under the watchful eye of their monitor and what appeared to be a good, relaxed and trusting relationship between them.

One learns enough in school to qualify and do a good job but this does not give personal experience of suffering. Much training nowadays, where possible, allows nurses to go into controlled situations such as you describe to give them a feeling of some of the experiences clients/patients may go through.

sorry can't expand more or write the post more clearly or in greater detail but am in a rush but hope it gives some useful feedback.
Unsuitable or offensive?
mike | 13-Sep-2011 3:43 pm
No, I do not think so.

First of all, let us not make the mistake of distinguishing between experienced Nurses and newly qualified.

Nursing is a fantastically varied and diverse profession, with each individual able to offer different things. Emotional intelligence is a hard thing to quantify and is not specific to those with years of Nursing behind them or certain life experiences. Newly qualified, even Nursing students, can care just as much, and give care just as much, as a specialist with 20 years experience!

I do not doubt that having a 'rich life experience' does help one grow and change as an individual, and it undoubtedly affects the way in which individuals express and show empathy and care, as well as often giving them a wider variety of tools to deal with the emotional drain of doing so. However, this does not in any way mean that someone else without that level of 'life experience' or without personal experience of suffering does not know how to give empathetic care, or give comfort or deliver bad news. I have never had Cancer for example, but that does not mean I cannot care for patients who do with empathy and understanding. It just means that those two individuals, one with 'rich life experiences' and one without, might display empathy and give care in slightly different ways, who is to say which is best?

But then as you say Jenni there is also the issue of desensitisation or emotional burnout with that same 'rich life experience'. This needs to be taken into consideration too.

I think what is most important is the fact that a Nurse - regardless of 'rich life experiences' or years spent on the job gives good, skilled Nursing care with empathy and understanding. Period. The way, or 'level' at which they do that is less important than the fact that they are doing it in the first place.
Unsuitable or offensive?
Sarah Stanley | 13-Sep-2011 6:52 pm
Hmmm... if I'm totally honest when i first qualified at the age of 21 i was pretty hopeless at communicating with patients, i would often feel awkward embarrased and scared of saying the wrong thing. I probably came across as cold or uncaring but it was just immaturity and lack of experiance. Over the next twenty years of my career I I changed dramatically, especially after a few spells as a patient myself!
Unsuitable or offensive?
judith willis | 13-Sep-2011 7:33 pm
I remember a tutor during my basic training way back in 1969, saying, treat every patient like your mother, father, brother, sister etc., and you will never go wrong.

Her name was Iris Mountey. I have never forgotten her words. To apply the principle works in all scenarios
Unsuitable or offensive?
Anonymous | 13-Sep-2011 8:14 pm
Judith Willis

that is fairly universal advice and I am pleased to say that I have also heard it from many nurses around the world. it is good to know that so many nurses have the same caring attitudes.

I think it is among the best advice you can get or give on how to treat others with respect and unconditional positive regard.
Unsuitable or offensive?
Anonymous | 13-Sep-2011 9:22 pm
Judith ..trouble with treating a patient as if you would your own mother, father etc

Well, I hated my dad - so probably best not to.
Unsuitable or offensive?
Anonymous | 13-Sep-2011 11:35 pm
There is a difference between sympathy and empathy.

Definition:
"Sympathy essentially implies a feeling of recognition of another's suffering while empathy is actually sharing another's suffering, if only briefly. Empathy is often characterized as the ability to "put oneself into another's shoes". "One feels empathy when one has "been there" and sympathy when one hasn't." Quotes, not my words.

You actually don't need any professional qualification to display either. Hence, I believe life experience plays a large part.

A student, newly qualified or experienced nurse will grow continually as they are faced with professional and personal experiences. If you don't think otherwise, then that is dangerous.
Unsuitable or offensive?
tinkerbell | 14-Sep-2011 9:26 am
the kindest nurse i ever met, Sally, was in her 20's, a ward sister who had been nursing since age 15 as a nurse cadet. She was just a 'natural'. I was a student nurse at the time on my first placement and it was her example of compassion towards others and myself that helped me continue my nurse training. If my second placement had been my first placement don't think i would have continued my nurse training as the staff on the second placement were abysmal. Don't think it has anything to do with age at all, because Sally had whatever it is in bucket loads. I never got back to tell her what a good impression she made on me as a role model and how her influence helped me continue my nurse training, but Sally, thank you. Hope life is treating you well.
Unsuitable or offensive?
Debra Smallbone | 15-Sep-2011 3:20 am
Mike, you hit the nail on the head again. Being a 44 yr old 3rd yr student,have had lots of life experience, so feel reasonably well equipped to be able to communicate with compassion/empathy and deliver dignified care. However, I think it is very much dependent upon the individual - some people, regardless of whether they are 'young' students or nurses with many years experience, have better interpersonal skills than others Some have a natural ability to be able to deliver empathic care and communicate effectlively but others, regardless of age/experience, sadly find it difficult. Ive witnessed it in clinical practice - patients sitting in the hospital bed,realise it too - they have said it too me - which is quite sad to hear. Experience, like you say,does not necessarily equate to better care - all nurses, regardles of age/experience, should strive to care with compassion and humility - surely, that's why we join the profession in the first place?

With regard to the comment made about treat patients as you would your own, I prefer to put it 'treat your patients as YOU would like to be treated yourself,' Just for the record, I was not keen on a certain family member myself but, if he were ever to become a patient of mine I would still give compassionate care - like I would to any patient because that's the essence of nursing.
Unsuitable or offensive?
Anonymous | 15-Sep-2011 2:27 pm
mike | 13-Sep-2011 3:43 pm

"Newly qualified, even Nursing students, can care just as much, and give care just as much, as a specialist with 20 years experience!"

You'll probably feel differently when you've got a bit more experience yourself dear
Unsuitable or offensive?
mike | 16-Sep-2011 0:10 am
Anonymous | 15-Sep-2011 2:27 pm, I don't think so deary, I've got enough experience thankyou, and a fair bit of life experience before I started training too. I have known students and newly qualifieds with as much empathy and care inside them as experienced Nurses 20 years their senior, and I've known Nurses with decades of experience who didn't have a caring bone left in their body. Just to reiterate dear, because I know you may need it spelling out, I'm not talking about technical skill and experience here, but care and empathy. I know, its a little difficult to understand deary, but never mind, you'll get there, just a little more experience eh?
Unsuitable or offensive?
Anonymous | 16-Sep-2011 0:23 am
Putting some of the condesending comments aside, compassion and empathy or sympathy require several attributes, which some are born with, and some gained by personal and professional experience.
Unsuitable or offensive?
mike | 16-Sep-2011 8:50 am
Anonymous | 16-Sep-2011 0:23 am sorry I had a sarcasm overload from the condescension of the anon above my last post. But you are right, which is why I argued in my original post that 'good care' as defined by the articles question, can come from anyone, student Nurse, newly qualified, or vastly experienced specialist, because we all have a wealth of different life experiences to offer to differing degrees.
Unsuitable or offensive?
Jodie's mate | 16-Sep-2011 10:17 am
Mike

It really seems as if this person's just trying to wind you up to be honest. Why give them the satisfaction of responding?

The last post seemed to upset you and I bet whoevers writing this stuff isn't getting upset. Probably just laughing when you lose your temper

Just ignore them. You're worth more than that, surely?
Unsuitable or offensive?
mike | 16-Sep-2011 2:23 pm
Thanks Geeze, very true. I din't get upset as much, I get a lot of responses like that (that was actually extremely mild compared to some), and I do ignore a lot, sometimes I just have a sarcasm fit and just fire a message off however. I'm only human, can't ignore them all! But thanks.
Unsuitable or offensive?
Anonymous | 16-Sep-2011 10:57 pm
From Anonymous | 16-Sep-2011 0:23 am

Geeze, if you are referring to me, not quite sure to be honest, I was not trying to wind anyone up at all, and I am not laughing. Perhaps I shouldn't have bothered to respond either. You haven't upset me, I think you are playing with Mike yourself. However, I don't want to get into personal knocks, there was none intended.
Unsuitable or offensive?
Steve Williams | 20-Sep-2011 2:40 pm
Walk in your patients shoes... as long as they are not crocs and you work in Wales I guess!
Unsuitable or offensive?
Steve Williams | 20-Sep-2011 9:27 pm
Oh BTW....

Most of my patients wear slightly furry slippers (with or without bobbles on) or Totes Toasties.

Can I possibly claim the cost for them back from my taxes?

Unsuitable or offensive?
Anonymous | 21-Sep-2011 10:48 pm
It's not always what you say, it's the way in which you say it..
Unsuitable or offensive?