Caring and Compassion, Leadership Essentials

RoAnna Kingman The vision of Nurse Leader at its inception was to communicate with, guide, share with, and inform nurses in management. However, over time, I recognized that leadership is about far more than that expected of those in management roles. Clinicians who choose to become experts in their field demonstrate the key components of what leadership is about in action. These characteristics have been discussed in numerous articles, research, and the literature. One critical asset is a cognitive recognition of the nursing profession's mission to provide caring and compassionate care. As nurse leaders, it is also our responsibility to ensure that this is practiced and valued in all roles. During the process of writing this editorial, I had the pleasure of teaching a leadership development class to novice nurses sponsored by hospitals in conjunction with Florida Atlantic University. My experience that day led me to believe that I could take a different approach for this editorial and publish one student's paper that said so much more than I could about the importance of maintaining compassion regardless of the circumstances. Her essay is such a powerful example of practicing a necessary leadership trait that not only could I not paraphrase it, I could never do it the justice it deserves. I requested the author's permission to print her paper as a part of my editorial. It is my pleasure to introduce one of our newest nurse leaders, RoAnna Kingman. Back to Article Outline A Reflection on Caring RoAnna Kingman Though I have been a registered nurse for a very short period of time, I feel that my understanding and expression of caring has grown immensely. I certainly was not aware of all the ways that caring can be expressed. I did not really correlate a kind word or a gentle smile with caring. I just thought that this was the way a nurse was supposed to be. The growth that I have sustained over the past 6 months is expressed in the story below. This nursing situation still brings tears to my eyes when I think of it. Mr. Jones, unfortunately, has a terminal condition. He has inoperable throat cancer. The tumor is pressing against his esophagus and his larynx. He is unable to speak to convey his thoughts. He has a tracheostomy to enable him to breathe and a percutaneous endoscopic gastrostomy tube for feeding. He has copious amounts of slimy, smelly, greenish secretions that constantly flow from his nose and mouth. His tracheostomy also consistently leaks thick, malodorous secretions. A nurse could stay at the bedside all day with the suction Yankauer and have a full-time job collecting secretions from Mr. Jones's face, neck, and trach site. Because of his illness, Mr. Jones is rail thin and extremely weak. Despite his frailty, he has managed to remove his tracheostomy tube 5 times; therefore, he is in soft restraints. As you can imagine, Mr. Jones is a high-maintenance patient. He requires a lot of time and patience that many nurses not only do not have but may not want to give. The first time I encountered him, we had just received him in telemetry from the step-down unit. We were told he was stable. We quickly found out that there was a little more going on. Within the first 10 minutes of his arrival, he had removed his trach tube, stood up out of bed, and defecated all over the bed, himself, and the floor. He then proceeded to smear the feces all over his body with his then-unrestrained hands. As you can imagine, touching him at that time was one of the last things I wanted to do. However, there was no choice in the matter since his airway was compromised and his safety was a prime concern. A rapid response was called. We were unable to locate the obturator at that time (later, we saw it taped to the side of the bed). His oxygen saturation had dropped to 42%. Respiratory responded with the team and managed to reinsert the trach tube. After he was stable, we were told not to bathe him because he did not need any extra stimulation at this time. I felt a strong twinge in my stomach at that point. This man was covered in feces from head to toe. It was disgusting! I could not imagine leaving my dog like that, and now I had to leave a human being in this predicament. I gently cleaned him the best that I could without causing him too much stress, but he was still filthy. As I left the unit that morning 2 hours after my shift ended, I felt horrible. I felt as if I had not fulfilled my duty as a caregiver. I returned a few nights later to find that I was to take care of Mr. Jones during my shift. I was a little nervous because I knew that he was not only a lot of work but also quite unstable. With the other six patients that I had to care for that night, I was not sure that I would be able to give him the care that he needed. By this time, Mr. Jones was now on contact precautions, so the extra time had to be taken to don gown, gloves, and mask before entering the room. During report, I found myself becoming a little irritated and upset that I had such a difficult patient load. Little did I know it, but fortunately this attitude would soon change as the night progressed. According to Brilowski and Wendler,1 a positive attitude is necessary to be considered caring. As I began my rounds into my patients' rooms, I really focused on trying to appear caring and joyful. I saved Mr. Jones for last because I knew that his extensive care would take the longest. As I approached his room, I could smell a horrible odor emitting from his body, similar to rotting flesh. My nose cringed in disgust as I donned gown, gloves, and mask. When I came in, Mr. Jones was wide awake, with copious, greenish-yellow, slimy secretions pouring out of his nose and mouth. He looked miserable and pathetic as he lay restrained with soft bilateral wrist restraints. I immediately felt a rush of empathy for this poor man who was completely helpless. Through this empathy, I was able to provide nursing care that was effective and satisfying for him.2 I completely forgot about my overwhelming patient load and focused on what I could do to make this man a little more comfortable. What this man would not give to be in my position! Shame on me for grumbling about the fortunate situation that I was in! I began to clean Mr. Jones, first by suctioning him so that he could breathe a little more effortlessly. I then wiped all of the loose secretions from his face and neck. Though he was not fond of my efforts, I spoke softly to him and explained that I was trying to clean him and make him a little more comfortable. It was the moment when he peered into my eyes with a look of gratitude that I realized he really appreciated me taking the time to help him. It really is the little things that mean the most to everyone involved.1 After I finished bathing him, I stood next to him and began to talk to him. I told him that I realized he was in a lot of pain. I began to gently rub his head as I spoke softly to him. In that instant, he closed his eyes and appeared completely relaxed. His body melted as I gently stroked him. I asked him if he liked it, and he nodded his head yes several times. My presence and communication with Mr. Jones conveyed my interest in him.1 Though he could not speak, we were fully engaged in conversation. Tears began to well up in my eyes as I wondered how long it had been since he had felt that way. Here was this man who most people would think was utterly gross and disgusting, when in reality, he is a man suffering a terminal illness who possesses the same basic needs as all of us. I came to see and accept him as a human being.1 I felt that this nursing situation is one that signifies the meaning of caring to me. I went into the room just wanting to “get the job done and get it over with” and came out of it knowing that I had not only done my job but had possibly given this dying man a little comfort. According to Brilowski and Wendler,1 there are five attributes of caring within nursing: relationship, action, attitude, acceptance, and variability. I feel that my relationship with Mr. Jones existed because I identified a need in him and I was motivated to act.3 I feel that I created a trusting relationship with Mr. Jones by being sincere and patient with him. I also felt an overwhelming responsibility to preserve and enhance his well-being. The care that I provided was predicated on his specific needs and changed as I was in the room.1 I feel that I grow as a caring nurse every day. When I enter the hospital, I focus on preparing myself to care for each patient individually. When I leave the hospital, I reflect on my shift and the positive and negative aspects of every situation. This interaction with Mr. Jones has taught me that there are many ways to be caring and that everyone deserves to be treated with empathy and kindness. I am so thankful that I was able to have the opportunity to care for and give him well-deserved personal attention. This is what we are about! Back to Article Outline References Brilowski GA , Wendler MC . An evolutionary concept analysis of caring . J Adv Nurs . 2005;56:641–650 View In Article Carper BA . Fundamental patterns of knowing in nursing . Adv Nurs Sci . 1978;1:13–24 View In Article Fealy G . Professional caring: the moral dimension . J Adv Nurs . 1995;22:1135–1140 View In Article MEDLINE CrossRef