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Health Issues In The News |
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What it Means to be a Person
by Angela Herold, RGN |
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 (Editor: this unique article looks at taking care of another person's health needs from the point of view of a Nurse. It asks some searching questions.)
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As healthcare professionals we are inclined to replace our view of "a person", our patient, by our view of "a person with a condition (illness, ailment, disability)." We endeavor to see " the whole person", but how deeply do we really look into our patient. And how broadly do we look at what our patient is surrounded by?
In our daily routine as nurses we keep focused on "whatever matters to the patient" and call it care of the individual but every so often we restrict ourselves to looking at "what symptoms matter to the patient" and we forget about the actual person. Now and then we need to remind ourselves of all the aspects "wholistic care" comprises and reflect on the variety of aspects each patient brings with him/her into the care that we are supposed to provide.
But what does it mean to be a person? What is it that makes a living body alive?
What or who awards identity to "a body"?
There are three views, which are commonly used to describe how a person is constructed and shaped.
The Biologist's view
The Psychologist's view
The Sociologist's view
These views try to establish the extent to which being a person is determined by genetic inheritance, cognitive function and social context.
Nurses in their work deal with all of the three aspects of "a person". They try to integrate all three views into the care process, which involves thorough planning, focused action and individual evaluation about the effectiveness of care provided. Crucial is the integration of these three views into the daily communication with our patients. Each view requires a different response to presenting challenges.
In the Biologist's view a person is regarded as a construct of physical function, which seems 'miraculous' to a layperson, 'explainable' to health care professionals and 'factual' to a geneticist, as everything is encoded in DNA. Illness is defined as physical dysfunction and intervention is required.
Nurses have a broad knowledge about medical conditions and are able to competently explain basic physical functions or the necessity of interventions to their patients. They act as translators of complicated medical terms into understandable and illustrated description. Every day after a routine ward round, patients buzz for a nurse shyly asking: " What did the doctor say, I didn't quite understand what he meant. Could you tell me what he was talking about and what's happening next?"
A nurse's challenge here is to clarify each of the patient's concerns. It will make a real difference to patient's comfort when they have as many relevant details about the nature of an investigation, what is going to happen to their body, where and exactly when it is going to happen and who the person who performs a certain procedure will be etc.
Frequent queries are about medication, which can be answered by explaining how medication will take effect in a body. This can be done effectively by describing the purpose of the medication and the reaction after administration as concretely as possible rather than quoting the instruction leaflet. Patients appreciate a clear detailed description so that they can anticipate problems or side effects, which might arise after administration of a certain medicine. Diuretics for example get frequently prescribed by doctors with a warning smile "that tablet, my dear, will make you going to the loo a bit more often". The nurse will subsequently explain to the patient that taking "water-tablets" will mean to carefully monitor the amount of fluid intake every day to avoid dehydration and to weigh everyday to make sure the weight remains constant. If it varies it can indicate that the prescribed diuretic dose might be insufficient or too high. In my experience patients are less concerned about effectiveness of medication. They trust that prescribed medicines help them to get better. Problems arise about the integration into their daily life after discharge from hospital. Many patients are uncomfortable about the imposed increased frequency of toilet visits. Other patients need thoroughly be advised on diabetes and blood sugar regulation so that they are fully aware about tablet controlled diabetes or insulin administration. Too often patients need to be readmitted to hospital with far to high blood sugar levels stating, that they thought they could omit the tablets now that the blood sugar levels have been fine for the past two weeks.
Patients who have been newly diagnosed with a devastating condition like cancer or HIV-infection are in great need of knowledge about their illness and its consequences. Initially they feel bombarded with incomprehensible information or they feel nobody of the medical team is able to provide "good, helpful information". They feel incapable of coping with the amount of knowledge required in order to deal with the disease. A good way to introduce them to their illness is to use suitable comparisons, which help to visualize physical functions. Cancer gets very often compared to a "hungry tiger" eating away what comes along. The very complicated immune system with its active blood cells can nicely be called a collection of tiny greedy cells famous for their voraciousness feasting on 'rubbish' in the bloodstream and therefore cleansing it. The most important thing is to give the patient as many clear details of their illness as to prepare them for what they have to expect in their future life so that they can learn to accept it.
At this point the nursing process moves into psychological areas. In the psychologist's view one attempts to explain how a person's mind works. It acknowledges a person's perception, memory, language, thinking process etc. It extends the view of the biological determinism by regarding a person as having mental skills and emotions, generated in the brain, thus forming a human being's consciousness and the ability to attribute meaning to life.
A huge challenge for nurses is dealing with a patient's anxiety, which is the predominant emotion around illness. A patient's mental ability very much helps to understand illness and all related consequences and helps to draw conclusions about future impact. But the more uncertain and unpredictable the patient's future remains the more unbearable is his anxiety. Here is a good chance for the health care professional to educate and to raise awareness, to influence behavior by pointing out potential dangers and threats as well as chances and hopes arising from treatment.
The interrelation of 'body and soul' becomes obvious in illness-related change of behavior. Tumors in the brain, dehydration, pyrexia, intoxication they all interfere with brain chemistry and prompt a person to behave differently, even inadequately, sometimes leading to insulting behavior. A nurse's challenge here is to re-orientate the patient, which at times seems pointless and difficult as each attempt to approach the patient is perceived as a threat and will result in defensive aggression and refusal to accept care. Most patients, who recover from a temporary period of confusion, do remember that they behaved "oddly or mean" and are highly embarrassed and apologetic about it, though they will not recall how exactly they behaved. At this point a nurse can explain the connection between physical conditions and behavior to the patient and emphasize that there is no reason for embarrassment.
In the sociologist's view we see the individual embedded into society and try to understand to what degree social circumstances condition the behavior of a person.
It certainly applies to many patients with chronic illnesses or disabled people who, to compound matters, are confronted with unsuitable conditions such as layout of buildings, stairs, climate, hostility etc to cope with. Most HIV-positive individuals can report episodes of hostile rejection from indifferent people they've come across, which will have a big impact on their self-worth, self image and behavior.
Nurses can raise awareness in patients about issues they will have to face in the community when they return after their hospital stay. They can warn but also give coping strategies and empower patients to deal with disheartening events and to remain focused on their recovery. They can give recommendations on preventive measures or healthy initiatives to be found in the community as to help the patient to find his healthy niche. Patients, who have been discharged from hospital but are still in need of care, are usually handed over into the supervision of a community nurse (specialist nurse, e.g. cardiac liaison nurse), who will respond to any potential problems detrimental to health and help the patient to re-adapt to the demands of daily life. The nurse can put a patient recovering from a heart attack in touch with local cardiac fitness groups. She or he will point out the dangers of returning into a stressful job too soon, which could cause another heart attack.
The three views of "What it means to be a person" are an integral part of nurses' ambitions to provide wholistic care. If they accompany the patient, they allow her or him to go through the process and progression of illness in a wider frame than just the immediate response to acute symptoms.
© Copyright Wholistic Research Company 2001
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