A patient recovering from a stroke gives her nurses a new perspective on patient care.
Charlotte Davis and Rosemary Wells are clinical nurses at Alvin C. York VA Medical Center in Murfreesboro, Tenn.
The authors have disclosed that they have no financial relationships related to this article.
WE'VE BEEN NURSES and patient educators for over 20 years, and with that comes a bit of wisdom. But that doesn't mean we ever stop learning. In a recent experience with one special patient, the roles of student and teacher were reversed.
Mrs. W, 78, came into our facility for pulmonary and physical rehabilitation after recovering from pneumonia. She also had a history of a stroke with right-sided hemiparesis and expressive aphasia. However, after many months of physical therapy and speech therapy, Mrs. W's clinical status had greatly improved.
Walking and talking
As we assisted her out of bed for her afternoon walk, Mrs. W began to reminisce about her stay at another hospital after her stroke. “My family used to visit me almost every day,” she said. “They'd even bring the grandchildren from time to time. Now that they've moved out of state, they can only visit me on holidays.” She paused and closed her eyes. “On clear days if I close my eyes, it seems like only a moment ago that I saw those smiling faces,” she said. “I miss those special times.”
As we walked down the hall, Mrs. W continued her story. “Back when I was a homemaker, I loved to cook and eat good food with my family and friends. Now for some reason I can't seem to feed myself properly. Last time I was in the hospital, the person feeding me must've been on a timer, because she kept feeding me faster and faster, like I was on a production line in a factory. I wondered who she was, because she never introduced herself.” Her eyebrows furrowed. “If she'd slowed down, maybe I would've known what I was eating or at least what it tasted like.”
We moved into the hallway, her walker clicking with each step. “I remember a pitcher of ice water was brought into my room early one day. It'd been sitting there for quite a while. I wondered if anyone would offer me a nice cold drink before all the ice melted. I was so thirsty!” Her walker stopped suddenly as she asked, “You girls need a break?” We smiled and said, “No ma'am.”
Mrs. W continued. “My room was at the end of a long hallway. Most of the time, I felt isolated and alone. There was no one who dropped by to say hello, to turn the channel on my TV, or to open up my window blinds. I didn't know what time, day, or even year it was anymore. I couldn't see the clock, because someone kept forgetting to put my glasses on.” A pained expression flashed across her face. “Oh, I remember just wishing I could see outside of that hospital room window.
“I got lots of cards in the mail. They delivered them and neatly stacked them up on my bedside table. But no one would open them and read them to me.
“They treated me like I was some inanimate object, but I wasn't. I wanted to tell them all that I was a mother, grandmother, aunt, friend, and church member. I wanted them to understand that I was someone who loved deeply and was loved in return. But when my mouth opened, no words would come out.”
In that moment, this graceful, wise patient had no idea how her words affected us. She'd become our teacher and taught us an important lesson. Unrushed small acts of human kindness and empathy can be conveyed in a single moment. We discussed how Mrs. W's hospital experience could have been so vastly different if only one nurse had taken a little more time with her.
We asked Mrs. W for permission to share her story with the nursing management and staff of the facility that she was recently transferred from to ensure that other patients wouldn't have similar experiences. She quickly agreed.
Once the information was shared, the nursing staff immediately began to implement an action plan for patients suffering with communication dysfunction.1–3 The action plan included a lower nurse-patient ratio and enhanced visual communication boards that allow patients with communication dysfunction to point at words, phrases, and pictures to convey their wants and needs. The staff reported the action plan was a success as their patient satisfaction scores dramatically improved.
Listening to patients
As nurses, we often become task oriented. We can forget that the patient in room 221 is someone's mother, brother, father, sister, child, or friend. These patients have a voice even when they can't speak. We need to transform the nursing care that we provide to meet each patient's physical, spiritual, cultural, social, and emotional needs. Our patients' voices need to be heard so we can provide truly holistic nursing care.
1. Issel LM. Learning from storytelling. Health Care Manage Rev
2. Stein D, Billings DM, Kowalski K. Storytelling: an adjunct to learning. J Contin Ed Nurs. 2009;440(7):296–297.
3. Gallagher P, Carey K. Connecting with the well-elderly through reminiscence: analysis of lived experience. Educat Gerontol