Sometimes the Best Thing You Can Say is Nothing

Image

Sometimes the Best Thing You Can Say is Nothing

We need to find God, and he cannot be found in noise and restlessness. God is the friend of silence. See how nature – trees, flowers, grass- grows in silence; see the stars, the moon and the sun, how they move in silence… We need silence to be able to touch souls.

~Mother Teresa

Advertisements

Human Connection in Oncology: The Importance of Empathy in Nursing Care

When contemplating social events, we will commonly ask each other, “Are you going to be there?” We like to know that individuals whom we enjoy will likely be present at the same events. When we anticipate life events that have uncertainties to them, we like to know that someone whom we trust and who we have reason to believe cares about us, will be in the life event with us. Treatment for cancer is one of those life events. Patients want to know who will be there with them. Patients are most assuredly interested in the forms of treatment available to them, but they especially want to know that they matter to others, including those who are administering their cancer treatment. Part of what makes an oncology nurse’s care effective is the nurse’s willingness to be there with a cancer patient, to connect with and care about the patient and about the patient’s life and illness. This human connection between an oncology nurse and a cancer patient and the patient’s family is now being identified in studies as what is most memorable about treatment and what is most sustaining to families whose family member did not survive the disease. Patients and families describe oncology nurses with adjectives including kind, supportive, informative, and trustworthy.1-3 What is it about the oncology nurse and the nurse’s care that is so sustaining to patients or to their survivors that it is reported as a source of comfort by patients and families for years after the actual care experienced?

Fortunately, what patients and families refer to is the most common of all elements of oncology nursing care: the human connection. This connection is the interface between nurse and patient; nurse and family members; nurse and other clinical care team members; nurse and ideas about care; and between the nurse and self-images, including self-compassion and forgiveness. A desire to form human connections is a motivation for becoming an oncology nurse; the human connection between the oncology nurse and the patient and family can offset difficult relationships with peers, disappointments with leaders, and even the irritations of inconsistently available resources and supplies for care.4 The disappointment in self for not being able to form such connections well (or to be there for patients and for families) has been one of the reasons for oncology nurses choosing to exit oncology nursing. This human connection between the oncology nurse and the patient and family is sustaining for the patient, the family, and for the nurse and is a treatment intervention. Amazingly, we know some of the outcomes of the human connection as a treatment because of patient and family reports, but we do not know the critical components of this human intervention in fine detail or the factors (environmental, personal, professional, or clinical) that influence the ability of the oncology nurse to deliver this treatment.

There is no form of mainstream cancer treatment (chemotherapy, radiotherapy, surgery, biotherapy) and no level of cancer prevention that is unaffected by the human connection between the oncology nurse and the patient or family. Cancer treatments have focused increasingly on the smallest elements of the human body (ie, genes, polymorphisms), but the usefulness of these smallest elements in cancer treatment will be dependent on oncology nursing care and the human connection between the oncology nurse and the patient. To be effective, treatment needs to be acceptable, understandable, and described in a way that resonates with patients’ life priorities. The acceptability of treatment relies on the ability of the oncology nurse and that of other clinicians to make a human connection with patients such that we can prepare them well for the experience of treatment in terms of what it could mean for their lives.

When we reflect on the human connections in our oncology nursing practice, our reflections include clinical interactions that were remarkably positive (the peak experiences) or memorably negative (the nadir experiences). The emotion that accompanies these reflections can be powerful enough that we reexperience the emotion with the recalled memory and move quickly and with purpose to end the reflection and instead focus on the next life event. By suppressing the memory and the emotion and moving doggedly to the next life event, we miss a sure chance to learn from ourselves the mystery of how it is that oncology nursing makes the human connection with patients and their families that proves to be the sustaining, memorable part of treatment. Instead of not attending and analyzing the human connection, let us study this element of our practice that gives such sustenance to others as well as to ourselves. How and when are such human connections made? What are the patterns across such human connections? What are the common elements in these connections, and are they common enough that they could be titrated to benefit different patient situations? How are these human connections maintained between a nurse and a patient? What environmental, personal, professional, or clinical factors influence the human connection in positive or adverse ways? The human connection in oncology nursing needs careful study, but in the interim we will continue to be there for oncology patients and their families, for our colleagues, and for ideas that will improve our care.

 

References

1. Zamanzadel V, Azimzadeh R, Rahmani A, et al. Oncology patients’ and professional nurses’ perceptions of important nurse caring behaviors. BMC Nurs. 2010;9(10). http://www.biomedicalcentral.com/1472-6955/9/10. Accessed November 14, 2010. [Context Link]

2. Masood J, Forristal H, Cornes R, et al. An audit of patient satisfaction with uro-oncology nurse specialists-a questionnaire study. Int J Urol Nurs. 2007;1(2):81-86. [Context Link]

3. Van Rooyen D, le Roux L, Kotze WJ. The experiential world of the oncology nurse. Health SA Gesondheid. 2008;13(3):18-30. [Context Link]

4. Steen B, Burghen E, Hinds PS, et al. Development and testing of the role-related meaning scale for staff in pediatric oncology. Cancer Nurs. 2003;26(13):187-194. [Context Link]

Link

If We Could Look Inside Other People’s Hearts

My host hospital showed us this video  from the Cleveland Clinic in Ohio today… If you haven’t seen it, please take four minutes to watch. 

It’s a brilliant reminder that, on a daily basis, people lives shift and change as do their joys and burdens.  Whenever we encounter another, we see them through the lens of what is happening in our lives, through our “bubble.”  What if we took into account what other people are struggling with, or moving through?  As nursing students, I think that many of us are drawn to nursing because of our deep care and concern for what others are going through and how their life events impact physical and emotional health, but I thought that this video really drove that point home. 

I hope that you will watch and consider how much influence our care, ability to listen, to communicate therapeutically, and our empathy impact our patients, their families, our coworkers and our own perception of life. 

Be well.

 

“Could a greater miracle take place than for us to look through each other’s eyes for an instant?”

Henry David Thoreau

 

Tapping Into and Cultivating Our Strengths

I have to admit that I was reluctant to spend the time necessary to complete the Strengths Quest Inventory… I purchased the StrengthsFinder 2.0 book written by Tom Rath a handful of years ago.  I had been doing some reading about the power of focusing on cultivating our strengths rather than continually focusing on improving our weaknesses, or areas where we needed development.  I found it particularly interesting because the concept was so counter to the way that our culture thinks and operates.  So, I bought the book.

I think I did the survey soon after, but realistically, I’m thinking that some time had passed.  I took the survey and printed out the results.  I was daunted by the 30+pages that contained my strengths, descriptions, activities that I could engage in to further develop and after a quick glance, I set the report aside until I had “more time.”  Unfortunately, “more time” never really seems to show up on it’s own.  So, I was a bit excited when the inventory was a part of our coursework.  I felt like the “assignment” validated the time that I would spend completing it.

My top five strengths showed up as Empathy, Activator, Input, Connectedness, and Relator.

I gave my report to my fiancé and listened to him laugh wildly as he read and said (over and over) “This is SO YOU!”  Yup.  It is me.

My strengths identified have served me well in past endeavors and, I think, will continue to serve me as a nurse.  Empathy has been noted in the social work research as the “antidote to shame and vulnerability” which is certainly important to clients who have chronic illness, who are unable to care for themselves, and who have general, or specific issue related to their bodies surrounding violence, abuse, and other painful experiences.  My experiences as a patient have fueled my empathy for the needs of a client.  Dignity, choice/control, compassion, respect, attentiveness, and kindness are all imperative and can be challenging to the busy and distracted nurse.  But I see this strength as a gift from the other side of the stethoscope.

My other four strengths seem to have a powerful interplay.  Activating is certainly fueled, in me, by giving input, sharing stories, connecting and relating with others.  Recognizing what other people are, or may be experiencing provides an insight into creating a dialog to support and move them to action with consideration for their fears and concerns.  Using the strengths of connectedness and relator, clients, friends, family, and community members are afforded the opportunity to see my imperfections and know that I recognized the struggles that we all encounter as human beings.  There is no perfect.  There is only moving forward and moving forward and moving forward.  It may be difficult, but understanding that sometimes we all live breath by breath  and creating/holding a space for that can empower the people around me and allow them the space to honor where they are and to creating a space and vision for where they are going.

I look forward to going back and taking stock of just how these strengths interplay and work together.  I have made (or strongly encouraged…) my fiancé and my teenage children to take the Strengths Quest Inventory.  I strongly believe that it has already begun to help us to understand each other by allowing us to acknowledge each other’s strengths and area where we have not understood each other’s actions, or behaviors in the past.  The Strengths Quest Inventory has been a real gift to me as well as my family and I applaud TC3 nursing faculty for including it as part of our curriculum.

~hcs

“We gain strength, and courage, and confidence by each experience in which we really stop to look fear in the face… we must do that which we think we cannot.”

Eleanor Roosevelt

“Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength.”

Arnold Schwarzenegger