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The essential element
EDITORIAL
The Essential Element What does a 100-year-old man in a nursing home, confined to a wheelchair and unable to toilet himself, do when he has to move his bowels, his call light elicits no response, and he has a sense of urgency and of pride? He shouts until he is answered. And when he shouts and angrily points out that his light went unanswered (probably turning 2 minutes into 20), he will be at risk of being labeled hostile, disoriented, and senile. The only hope he has to avoid this labeling is the nurse. It is the nurse who will help him preserve his sense of personal dignity and will keep someone from prescribing tranquilizers because he's agitated and disruptive. The nurse will understand that he shouts not out of demand for service or aperverse desire to annoy, but out of fear and panic that he will be incontinent and disgrace himself. • I have talked about the nurse's role as a patient advocate, but as I ponder the relationship of the patient and nurse I believe that advocacy does not fully delineate the critical role the nurse plays. It is the nurse who must stand between patients and misguided assistance, deliberate cruelty, incompetent medical care, exploitation, insensitivity, and ignorance. And nowhere does that become more apparent than in the nursing home. The integrity of the nurse and the nursing service is the pivotal factor in patient security and well-being. I f I seem to be overexaggerating the role of the nurse, I ask you all to reflect for a moment on who staffs the units of nursing homes 24 hours a day. Who clarifies all medical orders for all patients? Who is accountable for the implementation of all care recommendations for patients? Who coordinates all activities scheduled for patients? Who requests medical intervention when necessary? Who informs management of patient needs and oversees all patient care plans, even those that are interdisciplinary? Nurses are the guardians of personal dignity, the protectors ofthe vulnerable from physical and emotional abuse. And while this role has often led to comic portrayals of stern faced amazons who behave like drill sergeants, it has also underlined the fact that nurses determine the patient's quality of life in the institution. ~ ~'• The more I reflect on this fact the more I am impressed by the vital role that nursing plays in maintaining the essential elements of a humane society. Wherever nurses are they bring th e potential for comfort, care, and dignity to their fellow humans. This is a charge not to be taken lightly and, once taken, not to be easily devalued or set aside. Only when this function of nursing is fully understood and appreciated and when nursing services are organized and staffed so as to permit the full performance of this therapeutic role will acceptable quality of care be the norm for patients in nursing homes.
Geriatric Nursing November/December 1988329
The Essential Element What does a 100-year-old man in a nursing home, confined to a wheelchair and unable to toilet himself, do when he has to move his bowels, his call light elicits no response, and he has a sense of urgency and of pride? He shouts until he is answered. And when he shouts and angrily points out that his light went unanswered (probably turning 2 minutes into 20), he will be at risk of being labeled hostile, disoriented, and senile. The only hope he has to avoid this labeling is the nurse. It is the nurse who will help him preserve his sense of personal dignity and will keep someone from prescribing tranquilizers because he's agitated and disruptive. The nurse will understand that he shouts not out of demand for service or aperverse desire to annoy, but out of fear and panic that he will be incontinent and disgrace himself. • I have talked about the nurse's role as a patient advocate, but as I ponder the relationship of the patient and nurse I believe that advocacy does not fully delineate the critical role the nurse plays. It is the nurse who must stand between patients and misguided assistance, deliberate cruelty, incompetent medical care, exploitation, insensitivity, and ignorance. And nowhere does that become more apparent than in the nursing home. The integrity of the nurse and the nursing service is the pivotal factor in patient security and well-being. I f I seem to be overexaggerating the role of the nurse, I ask you all to reflect for a moment on who staffs the units of nursing homes 24 hours a day. Who clarifies all medical orders for all patients? Who is accountable for the implementation of all care recommendations for patients? Who coordinates all activities scheduled for patients? Who requests medical intervention when necessary? Who informs management of patient needs and oversees all patient care plans, even those that are interdisciplinary? Nurses are the guardians of personal dignity, the protectors ofthe vulnerable from physical and emotional abuse. And while this role has often led to comic portrayals of stern faced amazons who behave like drill sergeants, it has also underlined the fact that nurses determine the patient's quality of life in the institution. ~ ~'• The more I reflect on this fact the more I am impressed by the vital role that nursing plays in maintaining the essential elements of a humane society. Wherever nurses are they bring th e potential for comfort, care, and dignity to their fellow humans. This is a charge not to be taken lightly and, once taken, not to be easily devalued or set aside. Only when this function of nursing is fully understood and appreciated and when nursing services are organized and staffed so as to permit the full performance of this therapeutic role will acceptable quality of care be the norm for patients in nursing homes.
Geriatric Nursing November/December 1988329