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Apr 22

When you see it, you know.

It is often lamented in circles of nursing scholarship that it is difficult to articulate what nursing is—what are its characteristics, what are the boundaries of the disciplinary knowledge base, how do we explain the essential elements? We often fall into the trap of explaining what we “do” on a daily basis, which cannot help but fall woefully short of capturing the fullness of the caring practice that is nursing. But oh my, do you ever know it when you see it.

Many years ago, and while I was working in ICU, we admitted a woman in her late 40’s who, over the course of 24 hours prior to coming to hospital on her own, had sustained a very large myocardial infarction. She was very unstable, but cognitively sharp–acutely aware of everything that was going on. Jane (not her real name) was not my patient, but my patient was stable and resting. So I was assisting as needed with getting supplies and monitoring the other patients in the unit, as two RN’s were needed for Jane’s care. Jane told us that she hadn’t let anyone know where she was going, so the unit clerk proceeded to start making calls, with increasing urgency as Jane deteriorated over the afternoon. This was not the age where everyone had cell phones (I know, hard to imagine). Adding to the difficulty was that her grown children didn’t live in town, and her husband was out on a work site some distance from the city. Jane arrested twice over the next 3 hours. We were finally able to contact her husband, who began tracking down their 2 children—he assured us they would all be there within the hour. That hour was to be the last hour of Jane’s life.

Her room was a tornado of tubes, techs and tension. One of Jane’s nurses worked non-stop with the physician inserting line, giving drugs, and finally, inserting an external pacemaker as Jane’s poor heart began to surrender. Looking for opportunities to assist, I stopped periodically at the doorway and could see the focused, worried look on the faces rushing around that room. On one such pause, my eyes were drawn to the eye of the storm. At Jane’s head, was the other nurse—I’ll call her Sharon–her hands on either side of Jane’s face, her lips at Jane’s ear. The chaos of the room faded into the background as I heard Sharon softly, clearly explaining what was happening, what was behind the sensations Jane was feeling (“that pressure you feel down by your groin is the doctor inserting a pacemaker that will help your heart beat more regularly”), quietly communicating to the other nurse Jane’s need for analgesia when she noticed Jane’s pained facial expression, reassuring her that family  was on the way…

The pacemaker was not working, there just wasn’t enough healthy heart left to respond. The internist communicated this in a shake of his head to his assisting nurse-it was plain to see that Jane was dying. The team, knowing the family was on the way, continued to work to try and keep Jane conscious and as comfortable as possible until they arrived. Sharon softly explained to Jane that their efforts were not working. I’ll never forget it. My eyes still fill with tears as I recall her telling Jane that she was going to die soon, but we were going to do everything we could to keep her with us and comfortable until her family arrived, and that Sharon would stay right here beside her, talking to her and making sure she was without pain. Jane’s face relaxed and her eyes closed, and her heart rate slowed, but did not stop. A few minutes later, her family arrived, and Jane was able to spend her last few minutes saying goodbye.

The fullness of the caring practice that is nursing.  You sure do know it when you see it.

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