Much discussion at the Caring Science Conference has dealt with providing an alternative to the biomedical model that looks at a patient as a body, the body as a machine, with the result being reducing the patient to the moral level of an object. Basically, the healthcare system does things “to” patients, denies their humanity and capacity to participate in their own care, and puts nurses in the position of having to set aside the 150 year nursing tradition of honoring the dignity and personhood of those they serve. In the US healthcare system (and in the face of healthcare reform), the economic model that drives hospital systems results in this “objectification.”
In all fairness, the Emergency Department is the source of universal healthcare, being obligated to treat every patient who walks (or is carried) in, regardless of ability to pay. Thus, this the primary avenue of healthcare access for millions of people. However, it requires a near-death experience to get this care and if one is diabetic, has congestive heart failure, has early-onset kidney disease…well, too bad. Furthermore, there is no capacity for the ER to intervene on a patient with a broken arm if he/she happens to be a drug-addicted, alcoholic, pre-diabetic, paranoid-schizophrenic. The current healthcare system requires that the patient wait until the next acute crisis strikes for that patient to receive healthcare. To make it more absurd, ER care is the most expensive type of care. Preventive care would be much more cost effective, but our system doesn’t provide it for the uninsured.
As described in my previous post, the Caritas Processes developed by Dr. Jean Watson, provides a framework of practices that will heal both the patient and the nurse, will provide (indeed, demand) authentic relationships between the nurse and patient, because this is the only way to empower the healing process. This is the basis of Nightingale Theory. (Florence Nightingale was the founder of modern nursing in the mid-1800’s.)
Caristas seeks to renew and reinvigorate the nursing profession, starting with the altruistic impulse (the desire to do good for others) that is the root motivation for any individual choosing to pursue a career in healthcare. Caritas seeks to prevent the burnout and de-sensitization that afflicts so many health professionals. To deliver effective nursing care requires that the nurse take care of him/herself. Caritas seeks to redefine the role of the nurse from being an observer and housekeeper who carries out doctors’ orders, to a healer who creates a sacred space for patients’ healing to occur.
There is a difference between healing and curing. Curing refers to the mechanistic, biomedical model that “fixes” the “disease” solely on the physiology/biology of the patient. Healing, while defined in many ways, refers to “being in right relation” to oneself, one’s environment, with one’s physical/emotional/spiritual needs. Healing can occur even if death is the final result. Many diseases have no cure. There may be nothing further that the doctor can do to address an incurable condition, but that doesn’t mean that the nurse has no role to play in promoting the healing of body, mind, and spirit. Healing can occur in the absence of a cure. Curing can occur in the absence of healing, as with the broken arm patient cited above.
Today I sat next to a nurse from Thailand. There were nurses from many other countries, besides the United States. Issues are similar facing nurses around the world, such as the fight for respect from physicians and administrators. There are movements around the world to expand the roles that nurses are allowed to play. For example, currently nurses are not allowed to prescribe medicines. The nurse is the only person present to constantly observe the patient. If the patient’s condition takes a sudden turn for the worse, the nurse is required to call the physician at home, or call a physician on duty in the ER or elsewhere in order to receive the requisite doctor’s order for emergency medication, even though the physician providing the prescription might never personally see the patient.
There is, however, one difference between nurses in America and foreign nurses. All the foreign nurses work in national healthcare systems that treat anyone needing care. The American system, because of the financial control of the for-profit insurance industry, limits who is entitled to receive care. There is a strange disconnect between the ideals of the empowered nurse and the system that currently excludes thirty-plus million people from access to healthcare.
At the recent nursing conference that Susan and I attended in Jerusalem, we heard from nurses who had provided care to a wounded Israeli soldier in one bed and a wounded Palestinian terrorist in the next bed. (Both fighters cried out for their mothers.) Care was given without regard to the contrasting origins of the particular patients needing care. The nurses saw their mission to be simply to deliver the best care possible. How shameful it is that, unless the Affordable Care Act, aka Obamacare, goes into effect, American nurses will in effect be told that there are certain classes of patients, the poor uninsured and undocumented immigrants, to whom they are prevented from administering care.
I’ll change the subject and end this blog with an old joke:
Three engineers are discussing the nature of god.
God must be an electrical engineer, says the first. There is the CPU-like brain that sends its commands to all parts of the body via a complex electrical nerve network.
God must be a hydraulic engineer, says the second. Witness the network of arteries, veins, and ducts that carry all kinds of liquids throughout the body.
No, god must be a civil engineer, says the third. Nobody but a civil engineer would place a sewage disposal facility next to a playground.