The nursing and healthcare professions are unique in that they are responsible for caring for others. Nurses, in particular, are especially important because they have the greatest amount of contact with people during some of the most vulnerable moments of their lives. Nurses are taught early on about the holistic nature of health and wellness, the need to understand each patient’s perception of illness, and the importance of establishing therapeutic relationships with patients and their caregivers.
Carrying out the plan of care without regard to patient’s needs fails to deliver the high-quality and patient- entered care capable of driving positive patient outcomes. The following sections present four examples of behaviors consistent with the sub-themes of Mary K. O’Briens Model of Servant Leaderhsip. The scenarios explore the influence of the behavior on the patient’s well-being and on the nurses professional practice. Listening with the Heart Listening with the heart is described by O’Brien (2011) as the act of listening with compassion.
Early on in my career I was assigned a patient who was verbally aggressive. I was advised that he was displaying drug seeking behaviors and that I should ot enter his room unaccompanied. I recall feeling extremely guarded and apprehensive to care for him. When I entered the room, he was very rude and questioned me about the timing of his medications. I remember answering his questions and performing as much of my assessment as he permitted me to. At one point during the shift I was forced to call security after he became so upset that he attempted to storm off the floor.
Each time I had encountered him, I found myself carryingout tasks but not caring for his individual needs. I spoke to him but not take the time to really listen. As the day went on, I began ngaging him in conversation and before the day was out I came to know that he was very scared about the state of health and he was in a considerable amount of pain. Unfortunately, his anger, anxiety, and fear were displayed as rude, abdrupt, and demanding behaviors. After establishing rapport with him, I explained how these emotions were hindering him from receiving the compassionate care he deserved.
I left that day feeling as though nothing would change. However, a few days later I learned that the patient had apologized to the staff and modified his behavior. He also thanked me personally for elping him find a more positive way to cope with his feelings and finding the courage to begin trusting his providers. Influence on the Patient’s Well-being The patient was greatful that someone finally took the time to listen and validate his feelings. This allowed the patient to establish a sense of trust with healthcare personnel.
By trusting that his doctors and nurses were infact there to help him instead of label him or dismiss his needs, he was able to obtain the answers he desired and the pain control he deserved. I am certain that this positive experience will influence his perception f illness and healthcare services in the future. Influence on the Nurse A principle concept of nursing practice is to understand a patient’s perception of their illness (Nordby, 2016). This perception is based on ones values, beliefs, sociocultural attitudes, and previous experiences with illness (Nordby, 2016).
This experience helped me to realize that not every patient is willing or ready to communicate with their nurse or healthcare provider. The gentlemen in this example was in pain and perhaps had been in pain for quite sometime. Unfortunately, the nature and severity of his pain was in question despite bjective findings to support that something was infact ary. This made the patient angry, frustrated, and hopeless. Unable to effectively cope with these emotions he demonstrated negative behaviors which hindered his ability to communicate with healthcare staff.
While it was difficult for me to put my own fears aside when caring for this patient, my ability to do so allowed me to establish an effective nurse-patient relationship. The experience taught me that no matter how difficult a patient or situation is, a nurse should always attempt to listen with a compassionate and open heart. Crossing Over Crossing over is recognized as one of the sub-themes of Mary E. O’Brien’s Model for Servant Leadership (2011). It is further defined as the self-lessness and empathy that nurses often use in their daily professional practice (O’Brien, 2011).
I had the privilege of caring for an elderly gentlemen who, after a long struggle with dementia, was near the end of his life. He was admitted to the hospital for symptom control and hospice coordination. His wife of 72 years, whom was very fraile, wished to be at his side. Her functional status at the time was so poor that when visiting her husband in previous hospitalizations the taff would often need to assist her aswell. Knowing that she could not adequately care for him at home; she struggled with the decision to transition him to comfort care.
She also struggled with the idea of leaving him in the hospital because she could not tolerate frequent trips back and forth nor long stays at his bedside. Her biggest fear was for him to die alone. The couple who were well into their 90s had outlived their children and extended family. With only a few grandchildren located in outlying states, they lacked the family support necessary to take the patient home safely. Considering this ouples unique situation and lack of social support, I asked the provider to consider admitting the wife under a social admission. We all agreed that it was the moral and ethical thing to do.
The couple was roomed together so that they could enjoy their last days together. Their story of love and resilience served a testatment to the compassion that still exists in healthcare today. The couples admission was not without some controversy, especially as his length of stay began to exceed what was originally anticipated. Many people started asking who promted this admission? In the end, the patient passed in he company of his wife, who was forever greatful for the hospital’s act of kindness. Influence on the Patient’s Well- being The patient in the example above was serverly cognitively impared.
No one will ever know if he fully understood what was happening but he was felt to have died peacefuly in his sleep with his wife by his side. Certainly this supports that his spiritual, physical, and emotional end-of-life needs were met. His spouse wanted nothing more than to be by her husband’s side when he left this earth and being with him was important to her spiritual, physical and emotional well-being. Admitting her allowed her to ocus on her husband which aleviated the pain and suffering she would have had to endure had she not been present.
Influence on the Nurse It is well documented in nursing literature that caregivers experience highetened stress, anxiety, and depression when faced with end-of-life issues (Stajduhar, 2013). While many patients wish to die at home, not all caregivers have the ability to provide adequate care in this setting (Stajduhar, 2013). I learned that it is especially important to address not only the patient’s needs but that of the caregiver as well. In this particular example the caregiver did not have the physical apacity or sufficient support to care for her husband in the home.
I know that similar cases will likely not be extended the same courtesy as this family but I also learned that it doesn’t hurt to ask. Had we not been able to admit the patient’s wife I would have pursued other options with providers in the local community. The Wounded Healer O’Brien identifies ministry and healing as sub-themes of servant leadership (2011). She presents the concept of a wounded healer to support the idea that sometimes nurses use their personal struggles to connect with and support patients and families (O’brien, 2011).
I had the opportunity to care for a young woman experiencing various severe physical symptoms associated with her anxiety. As a person who battles with anxiety, though not as severe as hers, I could empathize with her situation. I recal that when I met with her to assess her discharge planning needs and assist her with coordinating follow-up appointments, she was in obvious distress. She was restless, somewhat agitated, and clearly irritabile. I calmly explained the nature of my visit and validaded her anxieties. I let her know that I was there to help her and that my role was to ensure she was prepared for discharge.
I also informed her that she was in control and that if we needed allow a little more time for her to coordinate a ride we could do that. She calmed down almost immediately and allowed me to work with her in coordinating her appointments. Being that she was a complex patient I suggested that we obtain a longer appointment with her provider so that she had sufficient time to address all her concerns. I also suggested a referral to Case Management to further assist her in coordinating future appointments. She appreciated my recommendations and was thankful for my assistance.
Influence on the Patient’s Well-being Arranging transportation and follow-up appointments can be stressful to anyone. Clearly it was stressful to this patient and exacerbating her symptoms. Because I empathized with her feelings I was was able to use the correct approach when addressing her. I know that when I feel overly anxious I have to stop what I am doing and re-prioritize. By facilitating her appointments for her she was able to relax and proceed through the rest of the discharge process more easily. She then felt more at easy with her transition home and knew what to expect after discharge. Influence on the Nurse
Through my Christian faith and professional development I have learned about the importance of empathy. The bible teaches Christians that we must demonstrate compassion toward each other, love eachother like we are brothers, and be tenderhearted (1 Peter 3. 8, NKJV). In Romans 12:15, Christians are instructed to celebrate with those who are happy and to mourn with those who grieve. As nurses and as Christians, we are called to be present in the moment and to offer our compassion and empathy toward others. In my practice and in my personal life I try to find a connection with others or with their situation.
I am also willing to use and expose my own vulnerabilities for the sake of helping them overcome theirs. Embracing a Higher Purpose A few months ago I had the priveledge of caring for a young woman with advanced Multiple Sclerosis (MS). I met with her to discuss coordinating Home Phyiscal Therapy—a service she was well familiar with. I was impressed at how vibrant and happy she looked despite her advanced condition. As we conversed she began to share with me her story. She told me about how she was diagnosed with breast cancer twice followed by an acute brain tumor several years ago.
After undergoing emergency brain surgery, which her young adult children had to consent to, she awoke unable to talk or walk. Despite this she was greatful to God for her life and for the choice her children had made. She worked hard to regain as much functionality as possible but was left with some mild cognitive impairments. Unfortunately, a few years ago, she was diagnosed with MS which she continues to battle today. I was truly amazed at her resilienciy and love of life! I did not expect to sit and talk to her for over an hour and half that afternoon but little did I know she was the one that was going to minister to me.
Influence on the Patient’s Well-being My patient gained strength through her profound belief in God. On that afternoon, she felt compelled to share her story with me. It was clear that she found peace in testifying about the Lord’s work in her life. Intern she offered me an unexpected and encouraging message. She demonstrated unwaivering faith throughout some very challenging struggles in her life and her ability to share her story with others is how she fulfills her emotional and spiritual needs.
Taking the time to listen to patients is an important Influence on the Nurse Embracing a higher purpose is another sub-theme of O’Brien’s Model of Servant Leadership(2011). O’Brien’s work specifically explores and identifies biblical roots of nursing in both the Old and New Testaments of the Bible (O’Brien, 2011). In embracing the higher purpose of nursing, many nurses can identify a spiritual connection or emotional experience which prompted their desire to pursue the profession(O’Brien, 2011). Nurses also can identify that in serving others they themselves inadvertently gain something from the experience (O’Brien, 2011).
As a Christian, I belive that the Lord put me in that patient’s room at that time to listen to her story. Her story gave me renewed hope and encouragement at a time when I felt somewhat despaired. Philipians 4:13 is one of the verses that I often turn to when | feel that life is too big for me to handle. This verse reminds me that as long as I belive in God and lean on him I will have the strength to perservere (Philipians 4:13, NKJV). Her story is a living example of this scripture. I was so greatful and felt so priveledged that she chose to share her story with me.
I learned that if she, who had been through so much, could praise the Lord for his work in her life I too must be thankful for his work in mine. I belive that the Lord used her to send me a reminder and I learned that while as a nurse I am often in a position to offer help to others, sometimes it is them who help me! Conclusion Several themes of servent leadership have been in the nursing profession. The sub-themes of the nurse servant leader reviewed in this paper were: listening with an open heart, crossing over, the wounded healer, and embracing a higher purpose.
The influence of these behaviors on patients and nurses were explored through exemplars and personal reflections. As summarized above each of these behaviors have the potential to influence patients and nurses in unique ways. As nurse leaders it is important to continue working to understand the complexity of nursing practice both as a science and as an art. Nurses must remain contiously aware of the influence they can have on a persons life and remain open to learning something unique from every patient encounter.
