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The Old Becomes New

Stonecipher, Diane BSN, RN

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AJN, American Journal of Nursing: October 2013 - Volume 113 - Issue 10 - p 11
doi: 10.1097/01.NAJ.0000435325.64729.6d
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Diane Stonecipher

Recently, I came across a mini-article citing a revolutionary idea of trying to make hospital stays more patient and family centered. One of the ways hospitals were achieving this was by placing cots for visitors in the rooms of the patients; a win for the patient, the family, and, conceivably, the staff. This new idea is decidedly “old school,” a throwback to the ’70s, ’80s, and ’90s, when I worked in a large academic medical center.

Our patients came from within the city, from the countless small towns closest to it, and from all over the country and the world. I was part of a migration of young nurses from all over as well, beginning our careers during an exciting time in medicine.

While complex medical advances were burgeoning, we still focused on patient care, which included the needs of our patients’ families. They were as much our allies as the patients. We did a lot of patient teaching that included pre- and post-op instructions and discharge information. If the families were present, all the better. After all, they would be the ones taking over once the patient was home.

We were extremely busy, bogged down in charting and physicians’ orders, but we made time for pm care that focused on a comfortable bed, a quiet chat, and a 10 o'clock snack before sleep meds. We tried to get to know our patients; this led them to share their questions, concerns, and fears with us. We often transported our patients to X-ray, ran to the pharmacy, and went on rounds with the physicians. This, too, gave us allies around the hospital and a sense of shared responsibility. I could call Satch in X-ray and tell him that Mr. L was anxious, and he could facilitate his pre-op exams. Computed tomography scans and angiograms were innovative back then, but we could get immediate results via a drawing in the chart. Information was shared in real time, and we could anticipate potential problems when the patient returned to the floor.

The precipitous infusion of technology was tempered then by the collective experience of physicians, nurses, radiology techs, physical and respiratory therapists, nurse's aides, and orderlies who had long practiced without such technologies. I learned from the 11-to-7 nurse who had been in the military and from cardiologists who had tended to hearts when there was only a handful of cardiac meds, catheterizations were new, and nuclear medicine was in its infancy. Even the surgeons, probably the most excited by technology's possibilities, had extensive clinical experience that infused the new with the wisdom of the old.

I'm not suggesting that the care we provided was without its faults. We were overworked and understaffed back then, too. Still, nursing practice really was different. Simply taking a radial pulse also told us about a patient's temperature and skin integrity. Our eyes have learned to read monitors, but we may have lost some of our ability to read our patients.

I don't know any nurse who became one to be tethered to a computer or to the constant alarms of the time-saving machines. While there are obvious ways in which technology has improved patient outcomes, it has often come at the cost of direct patient care. When nurses took vital signs, they were more likely to notice significant changes in a patient's condition such as shortness of breath or ankle swelling. The pendulum has swung so far to the interventional that more time is spent considering the sheer number of possible procedures and tests than evaluating and communicating potential treatment options. More and more practitioners with expertise in older, low-tech means of achieving outcomes have retired, and we are in danger of losing these fundamentals. The disappearance of relationships we forged with patients and other clinicians when care was less fragmented is a great loss for all concerned.

A more conscious effort to preserve the emphasis of earlier generations on treating the whole patient might return us to looking at our patients instead of at screens, assessing with our hands and eyes instead of with instruments, and educating families while ameliorating their stress. We might even find that nurses and patients both benefit, while outcomes improve.

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