Nursing is more than delivering care; it involves patient advocacy as well. Because they have the most direct interaction with patients, nurses are in the ideal position to advocate for each one on an individual basis. The American Nurses Association (ANA) stresses the importance of patient advocacy in its Code of Ethics and lists three core values that form its basis: preserving human dignity, patient equality, and freedom from suffering. This three-part blog series will address each of these core values in turn.
Many RNs went into nursing in order to help others. From the patient’s perspective, managing or preventing suffering is one of the most important aspects of care. But how do we define suffering? What constitutes suffering for one patient may not be perceived in the same way by another. For nurses, viewing suffering as an individualized experience is an essential first step toward ensuring freedom from suffering.
There are two broad categories of patient suffering. The first stems from disease, diagnosis, and treatment. The second stems from breakdowns in the healthcare system and may include poor communication, excessive wait times, medical errors, or a poorly coordinated care transition. We should do everything we can to eliminate bad experiences for our patients.
We often think of suffering related to illness and treatment in terms of pain, nausea, or other physical ailments. Nurses have a variety of pain assessment tools and should be proactive about relieving physical discomfort. Not surprisingly, good pain management results in higher patient satisfaction scores.
But it’s clear that suffering can take on a mental, emotional, or psychological component as well—it is far more complex than pain.
Consider a patient who is suffering from extreme anxiety the night before a major surgical procedure. Anxiety is a nursing diagnosis that you might make based on increased blood pressure and/or heat rate, restlessness, and expressions of extreme fear or despair. If you’re not able to comfort the patient, for example, with information about the procedure or reassurances that he will be kept pain-free afterward, you could potentially alleviate his suffering by obtaining a physician’s order for an anti-anxietal drug or sleep aid.
A patient hospitalized for a long time might suffer from loneliness, social isolation, or a feeling of powerlessness. A dedicated nurse might find ways to intervene, such as finding time to sit down for a chat; encouraging a family member to bring photos or other items from home; moving the patient to a lounge or garden when possible and appropriate; or making sure the patient has easy access to the phone, reading material, TV, etc.
Suffering in particular has been linked to end-of-life care. It is often managed through narcotics, palliative interventions, hospice, and counseling. Nurses are often issued broad standing orders when it comes to palliative care at the end of life, and should be ready to offer both pain relief and comfort – not only to patients but to family members who need an ear as well. Providing compassionate care at the end of life is a crucial nursing skill. It often means switching roles from providing aggressive treatment in an ICU or oncology unit to assertively managing symptoms and quality of life. It may mean advocating for the patient who expresses a desire to die at home, or helping family members cope with compassionately extubating a patient. Nursing has a holistic focus, so nurses should not focus entirely on the physical condition.
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