As years have gone by, I have learned to listen to my patients more carefully. Some patients were my teacher and gave me a chance to reflect on my practice. Several years ago, one of my patients, in her eighties, was admitted repeatedly with aspiration pneumonia and fever. On these occasions, the doctor would order to hold her meals for a few days. While she was febrile, we could start naso-gastric tube feeding for nutritional support. As the fever went down, she was permitted to eat gradually and then go home. While she was hospitalized, she often pulled out her nasal tube, so we would have to place the tube again. She was frail, but she pushed our hands back as we tried to place the tube, so we always needed two nurses. Sometimes she put up with our efforts with her eyes closed. She tried to accept the tube, but I am not able to forget the expression on her face as she endured the process.
While working at a nursing home some time later, I met another woman who was in her nineties. She was admitted to the nursing home after having a cerebral infarction. She spent most of the day in the bed or in the wheel chair because she was paralyzed on her left side. However, she was still able to communicate with others but with some difficulty. A night shift nurse reported that she heard noise from the woman's room and went to see after her. She noted that the patient's right arm was reaching across the bedside table. Several items had fallen under the table and the bed. The night nurse reported to us that the patient was likely developing delirium and needed more observation. Later, I went to see this patient to assess her myself. I spent some time at her bedside, just letting her speak as best she could. She explained that she developed pain in her paralyzed arm and tried to reach for her cold poultice on the bedside table. Older people in Japan commonly use these hot or cold packs to relieve their aches and pains. Apparently, the night nurse entered her room in haste and did not ask the patient what she needed. Instead, the nurse scolded her, pick up the items that had fallen and quickly left the room.
These events teach me a great deal about nursing and caring or others. The woman with difficulty swallowing suffered great discomfort from our treatment. Now I worried that I should have asked her what she wanted to do. She could speak, but we never asked her about her care. She might not have wanted to have tube feedings because of her age and condition. Perhaps we need to speak with patients about the discomfort of treatment and what it means to survive. Otherwise, we continue to repeat the harm we cause by replacing tubes or restraining the hands of patients. We fail to be humane.
I should know better. When I was a nursing student, our teacher told us of a similar experience. She was responsible for a patient who underwent surgery for thyroidectomy. This attractive young woman seemed to be worried about something, but she did not speak of it. An inexperienced nurse herself, my teacher thought that the patient was concerned about having a noticeable scar across her neck. She was quite lovely, and the surgical scar would mar her appearance. As the patient was leaving, she finally voiced the true nature of her worries. She owned several caged songbirds that she kept as pets. While in the hospital, she had to leave them with neighbors who had never cared for small birds.
Was the night nurse just too hurried and too tired to properly assess the patient? How often do we act quickly without thinking? Perhaps I did the same thing to the woman who had problems swallowing. I might be the nurse who acted quickly without asking her what she wanted. The longer that I work, the more I learn from my patients. I have learned not to assume so much about my patient's preference. We must take time to understand what the patient really wants and give the person as much control as possible. Ultimately, I have learned that someday I will be the patient. When I am patient, will anyone ask me what I need?