Sarah and all, I couldn't resist responding to the note on "floor nurses" - 
yes, it does have a decidedly unusual sound, however it is a term that is 
exceptionally well understood here in the US, particularly by older nurses. 
And to give you a sense of what a venerable term it is, I am going to 
include a poem that appeared a number of years ago in the occasional 
journal, Nightingale Songs.  (If this poem gets kicked off the listserv 
because it takes up too much bandwidth, it can be read at: 
http://www.fau.edu/divdept/nursing/ngsongs/vol1num2.htm

Savina Schoenhofer

THE EIGHT BEATITUDES FOR FLOOR NURSES
Blessed are the floor nurses for they
have mountains to climb.
Blessed are the floor nurses for they
must be brother, sister, wife,
mother, father, friend to all
patients who hunger to be heard
and cared for.
Blessed are the floor nurses who laugh
at themselves for their patients
will laugh with them, and their
hearts will be lightened.
Blessed are the floor nurses who can
see that their hard work has a
purpose for they'll be on duty
tomorrow.
Blessed are the floor nurses who teach
their patients to do what they
are capable of doing for they'll
be rewarded with success.
Blessed are the floor nurses who
listen to their patients for one
day they shall also be heard.
Blessed are the floor nurses who allow
others to be imperfect for they
too shall be given that
courtesy.
Blessed are the floor nurses for all
their incredible work and continued perseverance for they
are truly appreciated by their
fellow nurses.
We couldn't do it without you.
Thank you.

Bernice Basara
Source:  Nightingale Songs, October, 1990, Volume 1, Number 2 
http://www.fau.edu/divdept/nursing/ngsongs/vol1num2.htm


----- Original Message ----- 
From: "sarah fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, September 13, 2005 4:02 PM
Subject: Re: Nurse-Patient Trust


> Dear Patty,
>
> I enjoy reading your postings as they display local and current issues for 
> care.
>
> So to post a few comments on your descriptions:-
>
> It is not clear between the two 'case studies' what is real or unreal 
> since there may be resonances of a certain reality in both for some 
> people.
>
> Im replying with a few general comments from my interpretation. In your 
> first statement about trust perhaps the full stop ought to come at the end 
> of ... "fullest extent" since that is a strong, powerful and meaningful 
> statement. The constraint is another issue, although that has impacts  on 
> what, where, how commitment is actioned, perceived or felt.
>
> Interesting term 'floor nurse' I am understanding this as a nurse who is 
> participating in the care of patients ( opposed to managing a unit?).  The 
> description appears a mechanical - task orientated.
>
> However, the second description indicates something else. The ethics of 
> where decisions and how decisions are made. Who has responsibility and a 
> chain of command as opposed to a team? or even utilization of the skills, 
> knowledge, intuitive judgement, compassionate care, active observation etc 
> of the nurse.
> Then there is something coming through about education and how this is 
> taken on by staff or how it is used. What is the meaning behind the 
> learning?. Why is the learning and updating important?.
>
> There also appears to be something around  values coming through. What 
> value is placed on the relationships?. What value is placed on the 
> education ?
> The patient you describe is obviously in a vulnerable situation, weak from 
> the infection and as you state not able to fully engage.This links back to 
> your opening comment about commitmment to trust and advocate for care on 
> behalf of the patient. Doesnt that link back into the theoretical and 
> demonstrable research which nursing as a whole has demonstrated and is 
> demonstrating.
> Though again the ethical dilemmas for care are connected to the intentions 
> and  environmental contexts and values within, (system and people)
>
> There appears to be a hierarchy in this around decision making, perhaps 
> this is the acute phase. What about as the person progresses through the 
> acute phase to a greater degree of well being?.
>
> In terms of the priorities of need for this particular patient at this 
> point in time she is being attended to, observation of her condition 
> alerts you to the fact that she has been deterioating in terms of her 
> haemodynamic balance, the possibility of further infection, impacts to 
> ABC, increasingly poor kidney output, potential complications from the 
> DVT's etc
> The trust is implicit in the good nursing actions that are occuring which 
> is what you are saying.
>
> There is a balance too with regard to the well being of staff engaged in 
> the care and how this care is planned,expressed, delivered, co-ordinated, 
> led, with a view to supporting the patients recovery
> (Whilst recognising the potential for complications). Whilst the intention 
> to do no harm - harm may occur if the area is under staffed, staff have 
> been on shift or extensions to shifts ( with poor employment practices ) 
> or lack of knowledge to support the acuity, what is the risk of harm to 
> the patient?.Therefore ethical and legal implications arise.
>
> Re the tree....does not hearing something equate with it not happening?
> or
> The forest has plenty of trees ... though this trees and the trees in that 
> space matter .. they offer shade to new growth, they provide shelter to 
> forest animals, they bring sunlight through the leaves etc
>
> Does everything have to be seen before it is believed... no.... well you 
> gave an example there
>
> As was pointed out at Leeds, there is a difference at one level between a 
> contract relationship in which market forces demand profit and more 
> community based non-profit type organisations. What impacts this may have 
> on care environments and those engaged with it. Equally  those companies 
> conscious of and mindful of the social responsibilties can be more 
> succesful at blending. Obvioulsy more can be discussed.
>
> This does not reposnd to all your points though may trigger some more 
> considerations?.
>
> best wishes
> Sarah
>
>
>
>
>
> From: Patty Bartzak RN <[log in to unmask]>
> Reply-To: Patty Bartzak RN <[log in to unmask]>
> To: [log in to unmask]
> Subject: Nurse-Patient Trust
> Date: Mon, 12 Sep 2005 10:23:54 -0400
>
>
> I think it's possible for the nurse to establish a trusting relationship 
> with a patient, even when the patient
> cannot consent to participate in the trusting relationship.  Often we 
> think of trust as a 2-way street, but
> I believe trust is a commitment within ourself to advocate and care for 
> the patient to the fullest extent
> within the constraints of the nurse-patient ratio (as Tom alludes to).
>
> I am a floor nurse, working day shift during the week, every other 
> weekend, every other holiday.  I work
> with nurses with minimal educational requirements to enter the profession, 
> and others who are always
> advancing their practice through education or ANCC (American Nursing 
> Credentialing Center) certifications.
> I've started shifts at 6:45 a.m., when a colleague will state "Gotta leave 
> right on the button today, 'little
> Jimmy' has a dental appointment at 3:45 p.m."  What depth commitment to 
> care can this nurse give?
> She may have been assigned 6 patients (we do get 6 on days sometimes), 
> she's hoping to get the meds out,
> that no one crashes, that she gets her notes done, and doesn't get many 
> new orders.  She may go to the
> bedside and have a "walkie talkie", joke around with the patient, and both 
> of them delude themselves that
> this is a trusting "nurse-patient relationship".
>
> Here's a case study of what I think a trusting nurse-patient relationship 
> is more like:
>
> Yesterday, I worked and for some reason, I only had 4 patients.  This in 
> itself is a gift.  I had one 68-year-old
> female patient with urosepsis.  She had originally been admitted to the 
> ICU, and then transferred to me. On Friday,
> she had a bilateral ureteroscopy with stent replacement.  During this 
> hospitalization, she had bilateral DVTs, but
> is now off the Heparin drip.  She's a full code.  She is scheduled today 
> for a PICC line under fluro, and
> percutaneous nephrostomies to either side to unblock her kidneys.  When 
> you scan her flow sheets, she's had
> low grade temps in the past, and her white count has gotten as high as 20. 
> She is alert, but is very vague, cannot
> always answer questions.  She's not disoriented, but vague.  This is a 
> patient that doesn't have enough stuff
> to consciously participate in a trusting relationship.  The day was going 
> along, she was afebrile, in the back of my
> mind, I am aware of her surgical day on Monday (today).  At about noon, 
> her temp is 100.  I tell the intern,
> he says to take it again.  It's 100.6.  Finally, I go to the Pulmonary 
> Attending, and lay out my concern.  The patient's
> white count has jumped to 23.  The Attending writes for a UA, and blood 
> cultures.  Meanwhile, the patient has become
> wheezy.  I call Respiratory, they say, she has not needed treatments in a 
> while.  I skip the chain of command, and
> talk with the Pulmonary Attending again.  An order for Albuterol MDI 
> inhaler is given.  I get the urine, the blood
> cultures are done, then I can give her Tylenol.  But I have an uneasy 
> feeling, but now it's 2:30 p.m., and time
> to give the next shift report.  The Pulmonary Attending has left, so I 
> talk up the case to the resident, he agrees, and
> orders a CXR PA/LAT, Transport has gone home.  I tell the on-coming nurse 
> to get started with the kardexes, and
> med sheets, I work with an aide to move my 300 pound patient to a 
> stretcher, and take her personnally to
> CXR.  There they find a worsening lower right lobe effusion.  I bring the 
> patient back, find help to transfer her,
> and in the process we lose the IV which was in her left forefinger, 
> supported by a tongue depressor.  She has
> poor IV access.  I get a new IV started in her left forearm, by the grace 
> of God.  It's now 4:00 p.m.  My shift
> ended at 3:15 p.m.  I give the on-coming nurse verbal reports, she's ready 
> to hit the floor.
>
> Being able to drill down into a patient's care, in my book, is the essence 
> of a trusting relationship.  All that
> stuff, going the extra mile, taking the time, arranging 'little Jimmy's' 
> dental appointment on a different day
> so that the nurse can be present in the moment with the patient are 
> components of building the trust.  The
> patient can be comatose, but a "trust" can be established.
>
> If a tree falls in the forest, and you didn't hear it, did the tree fall?
>
> Same thing with trust.
>
> Just one nurse's view.
>
> Also, I think the way we approach the Post Office (business trust), and 
> our mothers (family trust), has the
> same basic elements.  Being present, listening, participating, .... I 
> don't really see the huge dicotomy between
> this is how I enter a trusting relationship with the Post Office, and this 
> how I enter a trusting relationship
> with my mother.   It's really an internal thing, a lifeview, an approach 
> (?Buddhist ideas).
>
> patty
> [log in to unmask]