- Email: [email protected]
After “Hello” with a wounded warrior: A student journey
G Model PEC 6445 No. of Pages 2
Patient Education and Counseling xxx (2019) xxx–xxx
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective Practice
After “Hello” with a wounded warrior: A student journey Libba Reed McMillan 710 South Donahue Drive, Auburn University, Alabama, 36849, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 April 2019 Received in revised form 21 September 2019 Accepted 7 November 2019
The article describes the journey of a terror-stricken student growing into an adept healthcare provider; representing courageous personal and professional growth after a “Hello” in a nursing school immersion experience. The journey includes the student’s emotional maturity and courage, recognizing the uniqueness of military culture, realizing the magnitude of the patient’s losses, ascertaining patient concerns, personal recovery goals and long-term support network. Together recovery milestones are recognized and achieved. The article underscores the importance of nurse education in facilitating student’s effective nurse-patient communication techniques considering diverse cultural elements, and consistently applying these theoretical concepts into practice. Assignments geared toward a holistic patient perspective can serve to develop student leadership progress toward becoming informed and engaged citizens, enlarging worldviews and a heightened awareness of relevant global issues, and spark passion related to national policy reform. Commitment to professional ownership of personal and professional growth throughout nursing school leads to positive transitions as a seasoned healthcare provider. © 2019 Elsevier B.V. All rights reserved.
Keywords: Military culture Empathic communication Effective nurse-patient communication techniques Leadership practicum assignments
I saw the terror in her eyes as we met outside the patient’s room. She asked, “What do I say to him – what if I misspeak?” As a seasoned nursing faculty member, I had seen this same look before, but my advice to her did not waver from similar student clinical situations. My reply was to “Begin with “Hello” and be open to what he will share.” I had a heart for Marissa – she was the youngest student allowed to participate in a Military Medical Center immersion experience. Having only one semester under her belt in our baccalaureate nursing program, I was concerned about how she would handle the patient contact portion of the rigorous five-day trip. I knew she excelled in academics; she survived our arduous program entry process and was successful and disciplined in our University’s Navy ROTC program. My concerns were for her emotional maturity. How well could she handle talking with an end-of-life Vietnam War Veteran exhibiting exacerbated emphysema symptoms due to Agent Orange exposure? Would she be able to care for a young Wounded Warrior’s genital injuries from an improvised explosive device blast, or navigate through the uncertainty and variable behaviors indicative of a patient with post-traumatic stress disorder? After all, she had barely mastered taking patient assessments on healthy classmates and passing clinical skills checkoffs on simulation mannequins.
E-mail address: [email protected] (L. Reed McMillan).
Gathering up her notebook, a pencil, and her limited courage, Marissa entered the patient’s room. Her patient was resting as she said “Hello, Corporal Jones.” Relieved to have learned military protocol, she was mindful to address him by rank – wanting to convey proper respect and communicate in a manner demonstrating her understanding of military culture. The patient’s mother at the bedside was initially more interactive than was her son; she wore a blue “Proud Marine Mother” T-shirt as she sipped coffee. Marissa could sense pride in the Marine mission from both of them, evident by the vast array of small American flags outside his door, the distinctive red and gold insignia, and scores of get-well cards from his fellow “battle buddies.” Marissa knew the importance of recognizing the uniqueness of military culture from her life as a “military brat” – her father having been a Marine for most of her life. At a bare minimum, she had a cursory grasp of the vast array of acronyms, expressions, traditions, roles, and missions that distinguishes each Armed Forces branch. Although glad to be alive, Corporal Jones wanted to hasten his recovery and return to service. He had survived multiple injuries from an explosion four weeks prior, culminating in a below-theknee amputation of his right leg—which was currently infected. Diagnosed with a Traumatic Brain Injury (TBI), Corporal Jones was also recovering from significant burn injuries on his back. He was in relatively good spirits considering his elevated pain level and projected long recovery. He referred to his amputated limb as being a mere “paper cut.” His eyes misted as he talked about friends in his unit that lost three and even four of their limbs. Others had paid the
https://doi.org/10.1016/j.pec.2019.11.007 0738-3991/© 2019 Elsevier B.V. All rights reserved.
Please cite this article in press as: L. Reed McMillan, After “Hello” with a wounded warrior: A student journey, Patient Educ Couns (2019), https://doi.org/10.1016/j.pec.2019.11.007
G Model PEC 6445 No. of Pages 2
2
L. Reed McMillan / Patient Education and Counseling xxx (2019) xxx–xxx
ultimate sacrifice by not returning home alive. “Deployments, constantly being in harm’s way, death and injury really is hard on family, friends, and relationships. My fiancé bailed on me once she realized the full extent of my injuries; she said it was ‘Not the life she signed up for.’ Realizing the magnitude of his losses, Marissa fought shedding several tears. Collecting her emotions, she asked about his support network. He replied, “My mom, friends, and community have always been supportive, as well as my Marine network. We live way out in a little rural town with two stop lights, but I guess I will figure out all of the medical stuff when I get discharged from the hospital.” Given the complexity of his serious condition, Marissa was touched when he asked, “What’s been your favorite activity here?” Marissa paused before responding, “I have particularly enjoyed our Military War Memorials foot tour — I placed my fingers on the engraved name of my uncle who fought in the Vietnam War; I also was deeply moved by the courage of the Marines on Iwo Jima. The Korean War memorial made me realize the soldiers’ unheralded struggles and sacrifices. Being in the Navy ROTC program has really made me think of what being a good citizen entails, what freedom costs, and what service-before-self means.” Corporal Jones’s eyes got misty as he softly replied, “You really get it – freedom is not free.” Marissa could tell he was getting tired while preparing to leave his room in-route to further testing and a debridement. Not wanting to convey sympathy – which would be offensive to him and hinder recovery – Marissa asked, “What are your concerns and personal recovery goals?” She braced for his answer, as it is not a regular practice to discuss difficult personal subjects like feelings, emotions, pain levels, or relationship concerns in the military culture. However, Marissa needed to find ways to broach these issues so Corporal Jones could actively engage in the recovery process along with the healthcare team’s assistance. From our previous discussions, Marissa knew establishing realistic, mutually agreed-upon goals and timeframes would be vital elements in his owning, achieving and celebrating recovery milestones. Prior to beginning the immersion experience, Marissa had read about modern warfare’s weaponry and body armor technological advancements. These advancements had potentially saved Corporal Jones’s life; similarly, more wounded military members survive injuries incurred overseas that would have previously been fatal. This survival of significant physical and emotional injuries results in military members returning home with severe organ damage requiring lifelong therapy, rehabilitation and oversight from healthcare providers and family members. Corporal Jones was thoughtful, yet resolved, as he described his goals, many of which correlated with Marissa’s aspirations. “I want to return to school to further my education and attend Marine Officer Training School, get married if I can find a wife willing to marry an amputee, and have lots of children. I want to recover physically, mentally and emotionally and I won’t stop until I accomplish these goals! I realize I’ll need help and support along the way, but Marines don’t quit!” Corporal Jones’s mother, returning to the room with a jumbo
cup of coffee and the pungent smell of fresh cigarette smoke, interjected “he will have loads of support from family and our hometown!” After exiting his room, Marissa sat down with me and shared her struggle to remain composed as she thought of the long-term nature of his conditions and the need for specialized therapy . . . “What healthcare facility will be able to provide quality follow-up care beyond his general practitioner’s basic services?”. “How will he manage chronic symptoms related to tinnitus or intense headaches often experienced by TBI patients?”. Clearly, Marissa was an exceptional student. As a nurse educator, I have taught many students effective nurse-patient communication techniques by understanding the patient’s perspective, considering diverse cultural elements, and consistently applying these theoretical concepts into practice. I witnessed significant changes in Marissa throughout her nursing school journey, such as applying and demonstrating communication skills and becoming stronger clinically. Leadership practicum assignments evidenced progress in becoming an informed, engaged citizen, such as an enlarged worldview and heightened awareness of relevant global issues. She also exhibited a passion related to national policy reform on Veteran Access to Care, Telemedicine for Rural Healthcare Access, and military disability compensation. Marissa combined her familial experiences, passionate patient advocacy skills, lessons learned in the immersion experience with Corporal Jones, and academic efforts to achieve her career goals. Commitment to professional growth and ownership of her professional journey throughout nursing school led to Marissa’s positive transition to a seasoned healthcare provider. As current military conflicts drawdown and our nation’s heroes return home, Marissa can encourage other practicing nurses and model communication techniques that enhance professional practice. I have witnessed the value in faculty constructing practicums and theoretical content for student nurses like Marissa to achieve a better understanding of what it means to care for a patient with unique needs – including military wounded or Veteran populations. These immersion experiences potentially serve as a catalyst in sparking passion and vision beyond the traditional classroom. I recently received an email from Marissa two years after nursing school graduation. She detailed many encounters with patients having injuries like Corporal Jones’s wounds and her sharing lessons learned with colleagues. I responded by asking her what happened with these patients after she said “Hello.” As suspected, she wrote that the same awe and sense of experiencing greatness was in each hero’s answer. As with her interaction with Corporal Jones, working with Veterans and military members as a Navy nurse inspired her to be more resolved, competent, and courageous to care for the next patient and their family members. The journey from terror-stricken student to adept healthcare provider was fundamentally kick-started by courageous personal and professional growth after a “Hello” in a nursing school immersion experience.
Please cite this article in press as: L. Reed McMillan, After “Hello” with a wounded warrior: A student journey, Patient Educ Couns (2019), https://doi.org/10.1016/j.pec.2019.11.007
Patient Education and Counseling xxx (2019) xxx–xxx
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective Practice
After “Hello” with a wounded warrior: A student journey Libba Reed McMillan 710 South Donahue Drive, Auburn University, Alabama, 36849, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 April 2019 Received in revised form 21 September 2019 Accepted 7 November 2019
The article describes the journey of a terror-stricken student growing into an adept healthcare provider; representing courageous personal and professional growth after a “Hello” in a nursing school immersion experience. The journey includes the student’s emotional maturity and courage, recognizing the uniqueness of military culture, realizing the magnitude of the patient’s losses, ascertaining patient concerns, personal recovery goals and long-term support network. Together recovery milestones are recognized and achieved. The article underscores the importance of nurse education in facilitating student’s effective nurse-patient communication techniques considering diverse cultural elements, and consistently applying these theoretical concepts into practice. Assignments geared toward a holistic patient perspective can serve to develop student leadership progress toward becoming informed and engaged citizens, enlarging worldviews and a heightened awareness of relevant global issues, and spark passion related to national policy reform. Commitment to professional ownership of personal and professional growth throughout nursing school leads to positive transitions as a seasoned healthcare provider. © 2019 Elsevier B.V. All rights reserved.
Keywords: Military culture Empathic communication Effective nurse-patient communication techniques Leadership practicum assignments
I saw the terror in her eyes as we met outside the patient’s room. She asked, “What do I say to him – what if I misspeak?” As a seasoned nursing faculty member, I had seen this same look before, but my advice to her did not waver from similar student clinical situations. My reply was to “Begin with “Hello” and be open to what he will share.” I had a heart for Marissa – she was the youngest student allowed to participate in a Military Medical Center immersion experience. Having only one semester under her belt in our baccalaureate nursing program, I was concerned about how she would handle the patient contact portion of the rigorous five-day trip. I knew she excelled in academics; she survived our arduous program entry process and was successful and disciplined in our University’s Navy ROTC program. My concerns were for her emotional maturity. How well could she handle talking with an end-of-life Vietnam War Veteran exhibiting exacerbated emphysema symptoms due to Agent Orange exposure? Would she be able to care for a young Wounded Warrior’s genital injuries from an improvised explosive device blast, or navigate through the uncertainty and variable behaviors indicative of a patient with post-traumatic stress disorder? After all, she had barely mastered taking patient assessments on healthy classmates and passing clinical skills checkoffs on simulation mannequins.
E-mail address: [email protected] (L. Reed McMillan).
Gathering up her notebook, a pencil, and her limited courage, Marissa entered the patient’s room. Her patient was resting as she said “Hello, Corporal Jones.” Relieved to have learned military protocol, she was mindful to address him by rank – wanting to convey proper respect and communicate in a manner demonstrating her understanding of military culture. The patient’s mother at the bedside was initially more interactive than was her son; she wore a blue “Proud Marine Mother” T-shirt as she sipped coffee. Marissa could sense pride in the Marine mission from both of them, evident by the vast array of small American flags outside his door, the distinctive red and gold insignia, and scores of get-well cards from his fellow “battle buddies.” Marissa knew the importance of recognizing the uniqueness of military culture from her life as a “military brat” – her father having been a Marine for most of her life. At a bare minimum, she had a cursory grasp of the vast array of acronyms, expressions, traditions, roles, and missions that distinguishes each Armed Forces branch. Although glad to be alive, Corporal Jones wanted to hasten his recovery and return to service. He had survived multiple injuries from an explosion four weeks prior, culminating in a below-theknee amputation of his right leg—which was currently infected. Diagnosed with a Traumatic Brain Injury (TBI), Corporal Jones was also recovering from significant burn injuries on his back. He was in relatively good spirits considering his elevated pain level and projected long recovery. He referred to his amputated limb as being a mere “paper cut.” His eyes misted as he talked about friends in his unit that lost three and even four of their limbs. Others had paid the
https://doi.org/10.1016/j.pec.2019.11.007 0738-3991/© 2019 Elsevier B.V. All rights reserved.
Please cite this article in press as: L. Reed McMillan, After “Hello” with a wounded warrior: A student journey, Patient Educ Couns (2019), https://doi.org/10.1016/j.pec.2019.11.007
G Model PEC 6445 No. of Pages 2
2
L. Reed McMillan / Patient Education and Counseling xxx (2019) xxx–xxx
ultimate sacrifice by not returning home alive. “Deployments, constantly being in harm’s way, death and injury really is hard on family, friends, and relationships. My fiancé bailed on me once she realized the full extent of my injuries; she said it was ‘Not the life she signed up for.’ Realizing the magnitude of his losses, Marissa fought shedding several tears. Collecting her emotions, she asked about his support network. He replied, “My mom, friends, and community have always been supportive, as well as my Marine network. We live way out in a little rural town with two stop lights, but I guess I will figure out all of the medical stuff when I get discharged from the hospital.” Given the complexity of his serious condition, Marissa was touched when he asked, “What’s been your favorite activity here?” Marissa paused before responding, “I have particularly enjoyed our Military War Memorials foot tour — I placed my fingers on the engraved name of my uncle who fought in the Vietnam War; I also was deeply moved by the courage of the Marines on Iwo Jima. The Korean War memorial made me realize the soldiers’ unheralded struggles and sacrifices. Being in the Navy ROTC program has really made me think of what being a good citizen entails, what freedom costs, and what service-before-self means.” Corporal Jones’s eyes got misty as he softly replied, “You really get it – freedom is not free.” Marissa could tell he was getting tired while preparing to leave his room in-route to further testing and a debridement. Not wanting to convey sympathy – which would be offensive to him and hinder recovery – Marissa asked, “What are your concerns and personal recovery goals?” She braced for his answer, as it is not a regular practice to discuss difficult personal subjects like feelings, emotions, pain levels, or relationship concerns in the military culture. However, Marissa needed to find ways to broach these issues so Corporal Jones could actively engage in the recovery process along with the healthcare team’s assistance. From our previous discussions, Marissa knew establishing realistic, mutually agreed-upon goals and timeframes would be vital elements in his owning, achieving and celebrating recovery milestones. Prior to beginning the immersion experience, Marissa had read about modern warfare’s weaponry and body armor technological advancements. These advancements had potentially saved Corporal Jones’s life; similarly, more wounded military members survive injuries incurred overseas that would have previously been fatal. This survival of significant physical and emotional injuries results in military members returning home with severe organ damage requiring lifelong therapy, rehabilitation and oversight from healthcare providers and family members. Corporal Jones was thoughtful, yet resolved, as he described his goals, many of which correlated with Marissa’s aspirations. “I want to return to school to further my education and attend Marine Officer Training School, get married if I can find a wife willing to marry an amputee, and have lots of children. I want to recover physically, mentally and emotionally and I won’t stop until I accomplish these goals! I realize I’ll need help and support along the way, but Marines don’t quit!” Corporal Jones’s mother, returning to the room with a jumbo
cup of coffee and the pungent smell of fresh cigarette smoke, interjected “he will have loads of support from family and our hometown!” After exiting his room, Marissa sat down with me and shared her struggle to remain composed as she thought of the long-term nature of his conditions and the need for specialized therapy . . . “What healthcare facility will be able to provide quality follow-up care beyond his general practitioner’s basic services?”. “How will he manage chronic symptoms related to tinnitus or intense headaches often experienced by TBI patients?”. Clearly, Marissa was an exceptional student. As a nurse educator, I have taught many students effective nurse-patient communication techniques by understanding the patient’s perspective, considering diverse cultural elements, and consistently applying these theoretical concepts into practice. I witnessed significant changes in Marissa throughout her nursing school journey, such as applying and demonstrating communication skills and becoming stronger clinically. Leadership practicum assignments evidenced progress in becoming an informed, engaged citizen, such as an enlarged worldview and heightened awareness of relevant global issues. She also exhibited a passion related to national policy reform on Veteran Access to Care, Telemedicine for Rural Healthcare Access, and military disability compensation. Marissa combined her familial experiences, passionate patient advocacy skills, lessons learned in the immersion experience with Corporal Jones, and academic efforts to achieve her career goals. Commitment to professional growth and ownership of her professional journey throughout nursing school led to Marissa’s positive transition to a seasoned healthcare provider. As current military conflicts drawdown and our nation’s heroes return home, Marissa can encourage other practicing nurses and model communication techniques that enhance professional practice. I have witnessed the value in faculty constructing practicums and theoretical content for student nurses like Marissa to achieve a better understanding of what it means to care for a patient with unique needs – including military wounded or Veteran populations. These immersion experiences potentially serve as a catalyst in sparking passion and vision beyond the traditional classroom. I recently received an email from Marissa two years after nursing school graduation. She detailed many encounters with patients having injuries like Corporal Jones’s wounds and her sharing lessons learned with colleagues. I responded by asking her what happened with these patients after she said “Hello.” As suspected, she wrote that the same awe and sense of experiencing greatness was in each hero’s answer. As with her interaction with Corporal Jones, working with Veterans and military members as a Navy nurse inspired her to be more resolved, competent, and courageous to care for the next patient and their family members. The journey from terror-stricken student to adept healthcare provider was fundamentally kick-started by courageous personal and professional growth after a “Hello” in a nursing school immersion experience.
Please cite this article in press as: L. Reed McMillan, After “Hello” with a wounded warrior: A student journey, Patient Educ Couns (2019), https://doi.org/10.1016/j.pec.2019.11.007