Wednesday, November 21, 2007

The power of low-tech nursing

The power of low-tech nursing

Source: RN
By: Jennifer L.W. Fink, RN, BSN
Originally published: June 1, 2005

Emily looked up at me, her eyes filled with pain.

"I don't have much longer, do I?" she asked, her thin voice wavering.

I watched a single tear trace the deeply creased line of her cheek. I shook my head No. Emily had metastatic liver cancer, and the end was near.

"That's what I thought," she replied. Her entire body began to shake as silent sobs overtook her.
I reached out to touch her hand. She grasped it so tightly that my wedding ring dug into my flesh. Feeling her need, I asked, "Emily, can I hug you?" She nodded. I wrapped my arms around her, and she buried her head in my shoulder. Her thin arms clutched me tightly. As I held her, I felt her fear, pain, and suffering mix with my sense of frustration and helplessness. After several minutes, she asked for a tissue.

"Thank you," she said as she dabbed the corners of her eyes. "You don't know how much that meant to me."

In my 10 years as a med/surg nurse, I came to realize that many of the most important nursing skills are not learned in the classroom. The skills patients value most are not a superb nursing assessment or a flawless IV insertion technique (though they of course benefit from such skills). Instead, patients are most impressed by our care when we show them we're human, by listening to them, attending to them, and touching them. Twenty-first century healthcare may be a high-tech world, but sometimes a low-tech approach works best.

How "being there" helps patients What I call "low-tech nursing" actually means being there for your patients, physically and emotionally. It encompasses—among other things—touch and conversation.

Research has shown that touching patients has several benefits. One study found that patients whose hands were held during cataract surgery reported less anxiety and had lower blood epinephrine levels than those who underwent cataract surgery without hand-holding.1 Another study found that elderly female nursing home residents who received comforting touch—touch intended to reassure, calm, or encourage them—showed an improvement in their assessments of their self-esteem, well-being, health status, life satisfaction, and faith.2 Touch has also been found to positively affect patients' attitudes to ward their nurses.3

In addition, simply talking and listening helps. Patients often welcome the opportunity to express their worries and concerns.4 For some patients, a conversation with their nurse may be the only social interaction they have all day. Speaking with a patient—even about the weather—is a way of being there for him.

I once cared for an 80-year-old woman recovering from lower leg cellulitis. When I entered her room, she was alone and sitting in bed with her head down. I introduced myself and asked about her leg, her recovery, and her family. I looked at pictures of her newest grandchild. We talked for about 10 minutes. By then, her head was up and she was smiling. "You know, you're the best nurse I've had yet," she told me. I hadn't even touched her!

Overcoming barriers to low-tech care For some nurses, touching and talking to patients doesn't come naturally. They may hesitate to touch patients, particularly those of the opposite sex, for fear of being accused of inappropriate behavior. The threat of sexual harassment has led some institutions to implement policies that severely restrict how and when nurses can touch patients. In some cases, too, nurses may limit their personal interaction with patients out of concern for maintaining appropriate professional boundaries.

Another barrier to practicing low-tech nursing is a healthcare system that focuses on cure rather than comfort.4 And short-staffing, coupled with heavy workloads, leaves little time to connect with patients.

But connecting with patients is crucial and does not have to take a lot of time. One study found that nurses were able to increase nursing home residents' outlook on not just their health but life in general with only 10 minutes of touch a week.2

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