Some of the biggest barriers human beings have in dealing with each other are all the assumptions we make. Have you ever been shocked when a neighbor who seemed so pulled together with her beautiful clothes, nicely behaved children, fantastic job, and loving spouse has the most acrimonious divorce? Did you assume her life was perfect because it appeared that way to you?
Nurses, who see all walks of life each and every day, are less apt to assume each person has the life they appear to have. After all, nurses see people in what is often their most vulnerable and often most unhappy times.
But, according to Margaret Erickson, PhD, APRN, CNS, AHN-BC, executive director of the American Holistic Nurses Credentialing Corporation (AHNCC), there is one area where nurses’ assumptions can get in the way of caring for a patient on the level the patient needs.
Making assumptions about self care, she says, can be a problem for patients because self care means something vastly different for each of us. What fuels your soul might not be what makes your colleague happy. What makes you physically, emotionally, and spiritually whole is not going to be the same for your patients.
“I believe people know what they need,” Erickson says. “Our job is to be supportive of that knowledge. Don’t presume what self care looks like to you. Modeling isn’t showing them what to do.”
For some people, a 10-mile run, healthy eating, and getting a solid night’s sleep not only means they are taking care of their bodies, but also nourishing their souls. But for some people, it’s an afternoon of sappy movies or an hour reading People magazine. Are they the same on the health scale? Maybe not. But as a nurse, giving your patient permission to care for themselves in the way they know they need is part of figuring out how they will care for themselves when they leave your care.
The trick, says Erickson, is active listening. Listen without an agenda. Listen without waiting for your turn to speak. Listen without forming any comeback statements. You might be surprised at what you hear. Erickson practices using the Holistic Nursing Theory of Modeling and Role-Modeling (MRM; Erickson, Tomlin, and Swain) which gives guidance on combining both listening to the client’s story and using the art and science of nursing to facilitate the greatest well-being for the client, she says.
Erickson recounts the story of a man who for 15 years had been labeled as difficult and non-compliant. A diabetic, he was not following proper self care and had health complications because of it. Only through careful listening and noticing some nonverbal clues did Erickson find out some stunning information. For instance, the glazed look he got when his nurse talked about fruits and vegetables? When Erickson gently asked about it, he said he lived on a reservation and fruits and vegetables were delivered just once a month. If you were not there in time, you didn’t get any. So he had virtually no access to the fresh produce his care team said he needed.
He also mentioned that he tried hard to comply and use his insulin. But the medication had to be refrigerated and he did not have a refrigerator. For 15 years, no one knew that. No one asked about his living situation, and he didn’t mention it. But no one ever asked about how he took care of himself. They only told him what to do, says Erickson.
“When we are limiting with our world view, we put up a barrier,” she says. “We don’t talk about engagement with clients or colleagues.”
Instead of saying, “I am here to help you feel better,” nurses might consider saying, “How can I help you feel better?” says Erickson. “In order to plan interventions to be most effective, you have to see their world view,” she says. “We tell patients what to do for self care and then we wonder why they don’t participate in their own self care. It’s because it was never their plan.” With more focus on the person and less focus on the tasks at hand, the patient-centered care comes to the front. “Otherwise care becomes a cookie-cutter approach versus care individualized to each unique person,” Erickson says.
So when you find yourself wondering why a patient can’t seem to follow your instructions, seems uncomfortable with a plan of care, or seems puzzled, indifferent, or even resistant, dig a little deeper to find out what they think they need.
“Our goal is to facilitate clients to do self care actions,” says Erickson. “If we don’t plan care and engage the client in that care, harm can be done. Try to remember, ‘It’s not about me, it’s about them.’”