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Holistic Care Nursing: Dos and Don’ts of the Best Nurses

Holistic Care Nursing: Dos and Don’ts of the Best Nurses

People generally go into nursing because they want to make a difference and help others. As is true of most people in the business of providing care to others, nurses are usually kind and caring individuals with the best of intentions. Even so, sometimes those with the biggest hearts can still get distracted, vexed, or just caught up in other tasks and forget to think about holistic care. In doing so, they can forget some of the things that make the biggest differences for their patients. Of course, the best nurses do the basics of their jobs well — administering medications, assessing patient symptoms, taking and analyzing vital signs, performing procedures, managing wounds and pain, and following treatment orders from the doctor. But it’s often what happens in between all of those things that sets the best nurses apart and gives the opportunity to provide holistic care.

Whether the care setting is a hospital, clinic, or doctor’s office, or the care is being provided in the patient’s home through a home care agency or a hospice or palliative care provider, nurses are usually the ones who share crucial information with the patient, and they collect equally important information from the patient and his caregivers. How this information is shared can make or break the potential for the patient’s compliance with his treatment plan and how his family provides support to him. How the information is gleaned, and, even more importantly, what information is gleaned, can help the entire care team — including the patient and the family — anticipate potential risks, barriers, and other issues. These issues can then be addressed in a way that gives the patient the best chance at recovery, improved health, and the ability to maintain a higher quality of life.

While patients expect their care providers to be the experts and to guide them to better health, they appreciate when care is customized to their individual needs, goals, and circumstances. The best nurses take the time to individualize patient care so that their patients have the best chance to regain their lifestyle.

What the Best Nurses Do

They listen. There’s an art to listening to someone with failing health and abilities. Hearing not only what she is saying, but what she is not saying can help determine whether she fully understands the diagnosis, the treatment plan, and what is required to regain her health and independence. Learning to read between the lines can make all the difference. It’s a nurse’s job to make judgments about what he sees and what he hears. Try not to let that get in the way of following a holistic approach by first listening with an open mind and then making your professional judgment — not of the person, but of what she is saying. This will impact the treatment plan.

Holistic Care Nursing: Dos and Don’ts of the Best Nurses

They observe. This can be especially hard when you only see the senior periodically, and it certainly depends on the setting in which you see him. Nevertheless, pay attention to the things he can’t or won’t tell you. How is his mood? Is he hopeful, or is he losing hope? Is he becoming socially isolated? Has he stopped doing the things that are important to him because of his health issues? Is he cutting back on physical activity? It is to be expected during an acute illness that a patient may not feel up to his normal activity, but if this continues past the time he has been released for added or normal activity, it could be a red flag.

Is the patient anxious about her health problems beyond what you might expect for her situation? Is there any additional information that could help her get a better handle on her situation? Perhaps a support group or therapist referral would help her reach a place of acceptance.

They understand their patients’ goals and definition of well-being. It’s easy to make assumptions about someone else’s goals based on your own values, lifestyle, and perception. Holistic care, however, requires knowing what the goals are for each individual patient — this is the best way to individualize your care. Is your patient’s goal to remain independent at home? If so, what barriers exist that could keep him from accomplishing this goal? Is his home setting safe? Does he have the supportive systems in place to keep him there? Is he at least willing to consider additional services to accomplish this goal, and does he have the resources to pay for these services?

Is your patient’s goal to resume her previous level of activity, or is she willing to accept some life adjustments? If so, how do you help her make those adjustments? Dig a little deeper — does she understand what those adjustments mean, how long it will take for the adjustments to have an impact on her health, and what methods she can best use to change her habits?

They ask the right questions. No matter how well you listen and observe, it’s almost always necessary to ask clarifying questions in order to provide the best holistic care. If the answer doesn’t seem right, don’t just ask the same question again — ask it a different way. One of the most valuable questions in trying to understand where a person is coming from is why? For example, “Why do you feel this will ruin your life?” Why questions can be asked in other ways, as well. “What is it about this illness that scares you the most?” Or, “How are you feeling about all of this?” You could also ask, “How would you feel about…? Would you consider trying something new?”

They share the truth without judgment. As much as it is true that using oxygen while smoking is extremely dangerous, what the patient often interprets when hearing this lecture is that he’s being judged for smoking. Offer information in a way that lets him know what the consequences of the action would be and what alternatives he has. For example, “I understand that you enjoy cigarettes, but we don’t want you to accidentally burn yourself. Let’s come up with a plan to keep you safe while you are smoking.”

Holistic Care Nursing: Dos and Don’ts of the Best Nurses

They involve the spouse and/or families in the plan of care. More often than not, the patient is under a relatively high level of stress when she’s being seen by her healthcare professionals. Psychologists believe that when people are under stress, they have a much lower ability to concentrate, use good judgment, and comprehend and hear what’s being said to them. Involving a patient’s spouse or family in the conversation (with her permission, of course) increases the chances that the information will be taken in and, even more importantly, that the patient will comply with the plan of care.

They share their experiences and observations where it’s helpful. Sharing examples of a treatment plan or lifestyle change that has been particularly successful with another patient (anonymously, of course) can give the current patient hope and the motivation to actively participate in his treatment plan. Knowing that others have successfully participated in the treatment plan can give your patient more confidence that you can help him achieve that success, too.

What the Best Nurses Avoid

Any good “do” list comes with a “don’t” list, so here are some things that great nurses don’t do:

They don’t say, “That’s not my patient.” This falls into the same category as anybody in an organization telling a customer or coworker that something is “not my job.” As far as the patient is concerned, you represent the care provider where she’s being treated, so you’re part of her care team. She doesn’t want to hear that you can’t help her because she isn’t your patient. Instead, say, “I’m not assigned to your care today, but let me find the information, and I’ll either be right back to help you, or I’ll find someone who will be able to help you.”

They don’t disparage other professionals or organizations. It’s true in social settings — and even more true in professional settings — that a person who speaks poorly about another person is likely to be looked at in a more negative light than the person he’s speaking badly about. If you have an issue with another colleague or another person involved in the care of your patient, take this up with him privately. Don’t involve the patient.

They don’t make excuses. Things happen, schedules change, traffic gets backed up. When you are running late, make a mistake, or need to apologize, just apologize and move on to what needs to be done.

They don’t pretend to know everything. Good nurses are not afraid to admit when they don’t know something. They make an effort to get that missing information so they can answer a patient’s questions.

In the complicated world of healthcare, and with the goal of providing holistic care, anything that a nurse or any other healthcare professional can do to better individualize the care of their patients, helping them reach their health and well-being goals, is worth the extra effort. The dos and don’ts of the best nurses can make the difference between a patient returning to the hospital or being able to remain independent and safe in his own home.

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