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A fine shave

Foster, Susan Cowper BSN, RN

doi: 10.1097/01.NURSE.0000475482.21009.16
Feature: SHARING

Caring for her grandfather after his stroke, a nursing student learned lessons that influenced her career for years.

Susan Cowper Foster is a freelance writer and blogger in Helena, Mont.

The author has disclosed that she has no financial relationships related to this article.



WHEN I WAS in nursing school in West Virginia, my parents lived (literally) an ocean away. Fortunately, I was able to spend some of my shorter breaks from school with my maternal grandparents and became very close to them. During my sophomore year, my grandfather suffered a stroke, and required assistance with some activities of daily living. I tried to help out whenever I visited them. One memory from this period remains quite clear—the first time he wanted to shave after his stroke.

Grumbling, my grandfather defiantly crossed his pajama-clad arms as best he could despite his limited mobility. Reaching with his unaffected hand, he grasped his disobedient elbow, and hugged both arms tightly against his torso. His eyes, without their usual twinkle, peered at me suspiciously. Giving me the stern look he probably used on pupils as a schoolteacher, he asked, “You've never even done this before, have you?” His speech had lost its previous clarity, but his meaning was clear.

Understanding my grandfather's frustration with losing his independence, I realized I needed to appeal to his normally supportive nature. Though secretly terrified, I tried to adopt an assertive yet caring approach.

“Nope, Grandpa, you're my first,” I told him cheerfully. “Please let me! It will make me so much more confident the first time I have to do this for a patient. I promise I won't nick you. Not even once.”

His eyes softened and his shoulders relaxed. I picked up the razor and carefully began to shave him.

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Treating the whole patient

My college instructors emphasized that good nursing care requires a holistic approach. A good nurse understands that a person's needs often extend far beyond a diagnosis and pays attention to both the verbal and nonverbal language of patients. Besides administering medications, monitoring vital signs, and implementing treatment plans, nurses must recognize and address a client's emotional needs and other sources of discomfort as they arise. To do this well, a nurse must employ empathy.

As I've come to understand and practice it, empathy is the ability to put yourself in another person's situation and understand what that person is feeling and experiencing. Universities often utilize the mnemonic N-U-R-S-E in order to teach medical students and residents empathetic strategies useful in a medical interview: Name and Understand the patient's emotions, Respect the patient, Support the patient, and Explore the emotion.1 The choice of acronym is fitting given the importance of empathy to nursing.

Despite classroom emphasis on empathy and holistic care, however, I didn't gain a genuine understanding of what I'd been learning until the morning I convinced my grandfather to let me shave him. Interpreting my grandfather's nonverbal cues—his crossed arms and suspicious gaze—helped me understand how difficult a sudden loss of independence can be for a patient. My grandfather's stroke affected his mental well-being as much as his physical strength.

Knowing the satisfaction he'd gained through a lifetime of helping others, I realized he could better accept his need for assistance if he thought he was also helping me. An empathetic approach was much more successful for us both than if I'd just announced: “Grandpa, you need a shave, so I'm going to do it!”

Busy nurses sometimes focus on just the completion of a task, as I easily could have done that day. The abrupt change in my grandfather's demeanor from defiant to compliant wouldn't have occurred, however, if I hadn't recognized the value of treating him as a whole person.

During my nursing career, I've worked in various clinical settings. Shaving my grandfather required none of the complex nursing skills demanded by these positions; however, what I learned on that day has been applicable to each of my subsequent patient interactions. In that moment, I started to internalize the importance of empathy to nursing and the value of viewing patients as whole beings, not the sum of their signs and symptoms.

This moment with my grandfather occurred many years ago, and was the first of many lessons I've learned from patients. Though he never completely recovered from that first stroke, his physical challenges diminished with time and physical therapy. I'd like to think that the way I handled his frustration made it easier for him to begin channeling his energy into growing stronger. On that day, although I still had much to learn, I became a nurse.

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1. Black A, Arnold R, Tulsky J. Mastering Communication With Seriously Ill Patients: Balancing Honesty With Empathy and Hope. New York, NY: Cambridge University Press; 2009.
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