Caring distinguishes what matters to someone and involves portraying that something or someone matters to you. (Potter, Perry, Stockert, & Hall, 2013, p. 80) It is a process in which the patient as well as you as an individual benefits and grows. This is what caring can be defined as but it is does it no justice because there is no way to summarize it into a single definition. Many theories are around that help us to understand how caring can be used in nursing to provide better quality patient care including works from Leininger, Watson, and Swanson.
In nursing today, caring is a very important concept that sometimes seems to get put on the back burner as nurses get caught up in the skills and knowledge required to carry out their duties. Using effective communication, providing presence, active listening, attending to the patient’s needs, creating trust, respecting beliefs/values, maintaining dignity, and conveying competence are just a few of the many things that help to demonstrate caring within the nurse-patient relationship.
Throughout the novel House Arrest, Ellen Meeropol conveys the story of a visiting nurse and her unexpected assignment and she unveils the importance of caring as she describes the formation of the relationship between the main characters Emily and Pippa. (2011) As I describe the relevance of caring and the reason behind why I chose this topic I will use examples from this novel to further my explanations. The focus of nursing has gradually shifted more towards holistic care, which is why this topic is relevant.
Skills and knowledge help to meet the patient’s physical needs but caring can help attain mental, spiritual, emotional, and social well-being. Sometimes a patient’s physical needs are not a top priority but in order to reach a higher level of health or to recover from an illness other aspects take precedence. It is the nurse’s job to be able to identify which aspects need to be taken care of first because if not assessed properly they may cause barriers to reaching health goals.
In the novel, Emily not only has to explain to Pippa about proper prenatal care (physical) but she has uncovered details about her family structure including her husband being in jail (social/emotional) and her spiritual following in the Family of Isis which are more of a priority considering they will ultimately affect her cooperation with the plan of care. (Meeropol, 2011, pp. 13-17) This is one of the reasons why I chose the topic of caring because I see how many people assume that physical needs are always a top priority when other aspects may be obstacles that will halt a person’s progress towards their health goals.
Other aspects also affect the individualized care you must give to each unique assignment. No two patients are alike. Another reason this topic is so relevant is because caring needs to be expressed in order to create a trusting relationship with your patient. As the relationship progresses you want to establish mutual trust so that the patient will tell you everything in order for you to better help them. Without this trust you can only treat them for what they choose to tell you about which makes it more difficult on you.
In the novel Pippa says, “Don’t you fuss about the doctor Tian, because the nurse promised to come with me… She’ll make sure nothing bad happens” (Meeropol, 2011, p. 20). Even though Pippa is against the idea of going to the doctor and having him do this procedure she trusts that Emily will be there to comfort and protect her. With trust a patient can also believe that as a nurse you will look out for their best interests regardless of what others may think.
This is apparent in the novel when Emily called her patient Mrs. Newman’s attending doctor to report that it was unsafe for her to be living alone regardless of what her boss Marge would think. (Meeropol, 2011) When confronted by Marge Emily says, “It’s better for her. She wasn’t safe at home” (Meeropol, 2011, p. 130). Even though Emily eventually got put on probation and fired she knew it was what was best for Mrs. Newman and this showed that she was being a patient advocate. (Meeropol, 2001, p. 11) This further explains why I chose this topic considering the fact that you can greatly impact the well being of your patient’s if you do what you think is best for them and the consequences may not always be what you expected.
The concept of caring doesn’t get much attention in today’s world of nursing, or at least from personal experience I feel that nurses do not want to create that deeper connection with their patients but would rather just do what they have to do and get paid. What makes me want to be a nurse more than wanting to help people, which is the universal response, is the fact hat I want to be the nurse who makes an impact in people’s lives, who can change the way that people perceive nurses, and who can walk away from every shift satisfied knowing I’ve done everything to the best of my ability. Being present or providing presence is a key component of expressing a sense of caring and connectedness in a health care setting. At the surface, presence is seen as simply a physical presence of being there but if you dwell deeper it is about being in the moment and having the ability to get more out of your everyday experiences.
In the research article “Being Present-The Choice That Reinstills Caring” the author talks about the idea that caring takes knowledge and bundles it with feelings in order to be in the moment with a specific individual or group (Authier, 2004, p. 276). According to Authier, Being present with others means that you are fully there. You have dismissed the extraneous noise in your head by being present with yourself first. Now you can connect verbally with others. Listen – not thinking about what you are going to say next, but truly hearing what is being said.
And be present verbally- with your eyes, appropriate touch, and/or attentive body language. Truly a gift. (2004, p. 278) Putting aside everything else that is going on in an individual’s life is a very difficult concept to grasp especially for a nurse who must always put on a happy face regardless of what life hands him/her on a silver platter. An example of this from the novel House Arrest is when Emily was distracted after her initial meeting with Pippa’s probation officer and chose to spend twenty minutes in the parking lot clearing her head before she headed to her next patient Mr.
Stanisewski. (Meeropol, 2011, p. 79) This allowed her to provide presence by going about her normal activity of assessing his dressing while also listening to polka tunes with him and getting updated about his granddaughter’s plant and music experiment. (Meeropol, 2011, p. 79) Emily was able to put aside everything else that she was dealing with and continue in her normal interactions with Mr. Stanisewski. Authier (2004) also states that “There are times when being present does take longer, but the connections and outcomes are more than worth the extra time” (p. 79). In the novel, Meeropol (2011) enhances this idea by talking about Emily using an empty time slot in her schedule to go and visit Josue in the hospital, hugging him as she enters the room. (p. 80) She also explains that Emily would always go and visit her patients in the hospital before discharge so that they would recognize her prior to her first home visit. (Meeropol, 2011, p. 80) This shows that if you put in that little extra time it can make such a big difference because you are making the patient more comfortable and ultimately showing that you care.
As a nurse it also makes your experience more fulfilling and worthwhile. Overall this article attempts to amplify the importance of being present in the moment in your interactions with patients to convey caring because there is more to nursing than just tasks; it is also about the relationships, the patient, and their mind and spirit rather than just body. (Authier, 2004, p. 276) A huge part of caring is respecting the patient’s differences whether it be culture, beliefs, values, or opinions. It is necessary to approach every patient in an individualized way because every person is unique and requires a unique form of care.
In the article “Reflecting on Nursing and the Art of Caring” the author explains that the aspect of nursing referred to as the art of nursing tends to get lost and he also explains how he uncovered the importance of this topic through a particular experience with a client. (Thomas, 2011, p. 12) According to Thomas (2011), “… Mr. Smith was of a different culture – in the broadest sense of the term – simply because he was not me, and therefore had different experiences and perspectives from me” (p. 12). By saying this Thomas (2011) explains how as a nurse you need to respect any differences and not be judgmental. p. 12) This is seen in the novel when Emily encounters an assignment she is very uncomfortable with but is respectful of Pippa and continues to do her job as she would with any other client. (Meeropol, 2011) At one point in the novel Emily states, My job was to accept all my patients as they were, with respect… No matter how I felt about people who let their children freeze to death… I would do my professional best to help Pippa Glenning have a healthy pregnancy and a strong baby (Meeropol, 2011, p. 13). Another key concept in this article was empathy and sympathy.
Thomas (2011) stated, “Not many patients will recall how you took a temperature, but they will remember how you empathized and sympathized with them in a time of physical, emotional, and spiritual need” (p. 14). This proves that although as a nurse it is very important to be competent, a patient recognizes your ability to connect with them on a deeper level and/or put yourself in their shoes. This may have been taken to the extreme in the novel as Pippa states, “If the hives were gone by the time the doctors got around to seeing her, she and Emily would both be in big trouble.
Emily could lose her job for lying to Nan” (Meeropol, 2011, p. 203). Pippa showed she was appreciative of the fact that Emily fulfilled her spiritual and emotional needs of getting her to the solstice regardless of the consequences that may have come of breaking the law. Although she was appreciative of her competence with prenatal education, this demonstration of caring struck a cord for Pippa. All in all this article explains how the science of nursing is obviously important but until you become a practicing nurse you can’t even begin to understand the importance of the art of nursing.
Competence and developing trust are two concepts that are seen as being interrelated with caring. In order to demonstrate caring we must first be competent and confident and in order to build trust we must show that we care. In the article titled “Nursing at its Best: Competent and Caring”, the authors conducted a study in which they interviewed junior year nursing students to determine their primary motivation for entering the profession, their perceptions about competence in nursing, and their perceptions about caring in nursing. Rhodes, Morris, & Lazenby, 2011, p. 1) In terms of competence the students felt that it was a prerequisite to establishing trust with others, involving the theme of being other focused. (Rhodes et al. , 2011, p. 7) This concept appears in the novel where Emily stated, “Once Pippa trusted me, we would talk about herbal teas, but now she probably wouldn’t listen” (Meeropol, 2011, p. 13). This part of the book shows how Emily needs to create a caring, competent relationship with Pippa before she goes about telling her that raspberry tea can trigger a miscarriage.
Pippa has to feel confident in the knowledge Emily is providing her before she chooses to trust what she says and make changes to her lifestyle habits. This leads in to what students said about the theme connection and trust where they believed caring leads to trust which results in a positive impact on the patient. (Rhodes et al. , 2011, p. 8) Prior to being able to promote the health and well-being of a patient the nurse first needs to create a strong, caring, trusting, and competent relationship otherwise walls will be built that could cause obstacles to creating a plan of care. (Rhodes et al. 2011, p. 8) You can also infer that competence and trust and caring result in higher incidences of patient satisfaction. In terms of motivation for choosing this profession most students identified altruism as a major theme as well as attractiveness of the profession (job security, etc. ), background knowledge of the profession, spirituality, and fulfilling nature. (Rhodes et al. , 2011, p. 6)
In the novel Emily was definitely an altruistic nurse and this could be seen when she says, “This was all about Mrs. Newman, and I had no reservations at all about what I did for her” (Meeropol, 2011, p. 11). Through this quote Emily proved that she truly cared about all of her patients, in this case Mrs. Newman, because she was not upset about the part of getting fired because she knew she did what was best for her patient and that was what was most important to her. From reading this novel and seeing the relationship form between the visiting nurse Emily and her clients as well as reading the three nursing journal articles described above I was able to gain a much better understanding of the concept of caring and this has in turn improved my ideas about caring for individuals.
By seeing how the main character Emily integrates the concept of caring into her nursing practice I am better able to see how the concepts we learn in nursing school have amplified importance once you start practicing. Also, by reading the journal articles I was able to see how important patients view caring as a measure of their satisfaction with nursing care. Both of these sources of information will help me to become a better nurse in the future and have also encouraged me to consider reading more into health literature because nursing is a profession of continuous learning.
One important thing I have learned is that nurses are more than just a wealth of knowledge they are real people with real feelings and real experiences. Patients like to look up to nurses as being knowledgeable and competent especially in the area of health which they are most likely unfamiliar with, but they also like to feel like an equal. Patients enjoy hearing your stories and being comfortable around you considering they will be interacting with you a majority of the time because doctors do not have as much patient contact.
In the novel Meeropol (2011) explains how Emily talks to Pippa about her cousin’s daughter Zoe and how Pippa becomes extremely concerned with her spina bifida and when Zoe becomes sick she risks getting in trouble to go see her in the hospital. (p. 115-117) This shows Pippa that Emily is a normal person who she can connect to. Through understanding this I now can take away the fact that when I step out into my first clinical assignment and then in the future to my first job I will have a different outlook on what patients look for in a nurse and what makes them feel more comfortable. In forming any type of relationship being relatable is key.
Another important thing I learned is that you want to see the patient as more than just a patient rather you want to see them as a normal person. The concept of caring is seen in this because you want to maintain their dignity, respect them, create trust, and be there when they need you. A patient is almost like having a friend because you want them to be able to come to you with any questions or concerns that they may have without feeling embarrassed or afraid. As a nurse your goal should be to make a lasting impact on each patient you interact with.
In the novel Emily definitely did this as evidenced by the statement from Mr. Stanisewski “then you won’t need to visit me anymore? ” (Meeropol, 2011, p. 79) This statement shows that Emily has created such a connection with Mr. S. that when he starts getting better and can do things on his own he doesn’t want to loose her as a nurse. Emily has created a connection with all of her patients and not only can the reader see it but other characters can too. In particular when Emily is away and Gina takes her assignment she leaves her last client and then begins to wonder “if her own patients would miss her as much as Emily’s seemed to”(Meeropol, 2011, p. 113).
As a nurse taking care of individuals I want my patients to miss me like hers do because then I will know that I have done my job to the best of my ability. The only way to know your strengths and weaknesses as a nurse is through experience and practice. Personal knowing is developed through this research and application. By reading the novel House Arrest you are able to watch Emily develop into a better nurse through her interaction with Pippa. Emily went from being skeptical about working with a client who is on house arrest to actually forming a strong relationship with her and being able to learn from her. Meeropol, 2011, p. 17-18) Emily learned not to judge a book by its cover and to see every opportunity as a chance to grow as a person and learn. As a nurse you never know what you will learn or from who you will learn.
The knowledge you learn may not be apparent at first but down the road you will realize when you come to a similar situation. “Going with your gut” is a good example of using personal knowing because you might not know how you know something but it may be the right thing to do. Personal experience is a very powerful tool and you have to be open to learning because you never know when a situation ill present itself. To conclude, caring is a very important concept and can greatly impact other aspects of nursing such as the formation of the nurse-patient relationship, being culturally competent, assessing spirituality, and many others. This proves that without caring we are not being genuine caregivers and other aspects of our practice will suffer as a result. Caring benefits you as the nurse through fulfillment, satisfaction, and purpose as well as the patient through dignity, enhanced healing, and a decrease in alienation. Potter et al. , 2013)
Non-caring causes harm for the nurse because they are depressed and worn out as well as for the patient who feels helpless, vulnerable, and humiliated. (Potter et al. , 2013) Nurses need to treat the whole person and create a comfortable environment in order to enhance healing. Walking away from this assignment my eyes have been opened to the way in which the things we are taught in nursing school are clinically applied. Everything we learn has a meaning; it just takes experience for us to see its purpose.