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By Rebecca A. Hampl
It was May 1980; nursing graduation day and the reciting of the Nightingale Pledge, that includes, “I will devote myself to the welfare of those committed in my care.”
In my first position as a floor nurse, I learned from doctors and seasoned nurses that if the patient followed the physician’s plan of care, his or her health would improve. If treatment recommendations were ignored or not followed to the letter, the patient was labeled as non-compliant. This labeling was not an accuracy I embraced. My mind was bombarded with questions. ‘What if the patient doesn’t truly understand their condition much less the treatment recommendations? ‘What if they never verbalize their lack of understanding?’ ‘What if they are devastated by their diagnosis rendering them inert?’ To me, these types of scenarios could factor into whether or not patients were compliant.
At that time in nursing history, the words health and literacy were not always clearly connected. I watched doctors describe illness and treatment, but miss patient’s confusion. I’d re-explain using laymen’s terms instead of medical jargon and I’d witness relief. The simplicity of our conversations lessened their misperceptions, enabling them to ask clarifying questions. Devoting myself to my patients’ welfare meant allowing the patient time to describe the whole of themselves which includes the physical, social, emotional and work and family aspects of their lives. This would bring some colleague ridicule, ‘Don’t you realize that it is the medical research that bolsters the best treatment plans and not what the patients think they can or cannot do?’
I’d like to believe that health care becomes personal for a patient and/or family when collaboration is established. But sadly I’ve personally experienced the 1980’s philosophy in the 21 century. In 2007, I began my quest for identifying the cause of unexplained abdominal pain. For 2 years exam rooms became synonymous with closed-ended questions. Simple yes or no answers ostensibly saved physicians’ time. Frustration rang in each voice. “Your tests are negative.’‘ This is simple. It’s IBS.’ ‘Just take the medication as prescribed and you’ll be fine.” I’d be shuttled out in 15 minutes or less. Turbulent feelings assaulted me upon departure.
Congratulations, you are now a full-fledged non-compliant label. How dare you even waste their time? These sessions forced me to look inward. Thirty-four years is a very long time, how many times did I make these same mistakes? For surely in my human frailty, I certainly did and the realization brought me sorrow. My hope is that past patients eventually forgave my insincerity when it occurred. In 2009, the specialist entered the room, sat quietly in a chair, and said, “Tell me what’s been going on.” Finally, an open approach that allowed me time to talk. In 3 minutes my explanation was complete. “You’ve been taking the medication. Clearly it’s not working…” Finally affirmed I was out of the exam room in 20 minutes and in surgery a few weeks later. It took him 4 hours to repair all the damage.
In 2013, my mother was hospitalized for acute respiratory illness, but the PCP didn’t want to discuss a pulmonary consult despite her rapid decline. To him, I was the uncooperative family member who needed to “follow his recommendations or find another physician.” Ah, labeled again! In frustration, he finally sent in a nurse care coordinator to “calm the family down” But to his surprise, the nurse heard us and a pulmonary consult transpired. Testing proved that her lung was hemorrhaging. Immediately, appropriate treatment occurred and my mom survived.
In 2014, after waiting out a grueling 14-hour surgery and with her husband in severe pain; I watched in revulsion as health care providers deflected concerns and brushed off her worries. Varied emotions crossed her face; misjudged, unaided, disillusionment, and anger. Was the staff admissibly busy? Absolutely. Were they justified in their demeanor? May life never dictate that they find themselves in her shoes not even for a moment.
I recognize that we can become so entrenched in our need to finish up and move on to the next, that we can forget to carve out time to allow patients and loved ones to vent, question, and express what they feel. May I listen with compassion and assist patients in identifying their goal(s) and action plans to overcome any barriers that stand between them and successful management or treatment of their condition(s). I believe science and technology should coincide with our patients ’right to self-determination.
With renewed conviction I pledge; I will devote myself to the welfare of those committed to my care.
Bio‐ Rebecca A. Hampl RN
Certified NursePatient Educator
I earned my degree through Castleton State College in 1980. I have worked in numerous medical specialties. I am a Health Care Clinician for Marathon Health having licensure and working in 5 states. This year I achieved my certification in Nurse-Patient Educator through AIHCP. I live in VT with my husband Brian of 26 years and our son Zachary. I enjoy bike riding, and crafting in my free time.
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Older Nurse On Other Side Of Health Care
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It was May 1980; nursing graduation day and the reciting of the Nightingale Pledge, that includes, “I will devote myself to the welfare of those committed in my care.”
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