Wound Care Nursing Perspectives: The Person Behind the Patient
by Diana L. Gallagher MS, RN, CWOCN, CFCN
I recently had the privilege of attending a patient's funeral. I would imagine that most nurses attend funerals for special patients from time to time. As a Certified Wound Ostomy Continence Nurse (CWOCN®), I often care for patients with chronic conditions. Over time, I get to know them and their families very well. A lot of them have become more than patients…some of them are even my friends. I celebrate their successes and I mourn their losses.
Defining Professional Boundaries in Nursing
I know that there are entire books devoted to the topic of maintaining professional boundaries. I remember my nursing faculty cautioning us novice nurses that hugging patients or becoming emotionally involved with patients was inappropriate and unprofessional. Nursing was a job. Clearly, there is a line of separation between nurses and the patients that they care for. I just do not see that line as being sharply black and white. I take care of myself and I take care of my patients. Maintaining a healthy separation has not been a problem for me. My responsibility is to take care of my patients; they do not take care of me. I believe that the degree of professional separation varies with the setting and specialty in which you practice.
Years ago, when I worked in acute care, I did not care for patients long enough to develop the kind of relationship I have with patients today. A significant percentage of the patients I care for now are long-term patients seen in home care and outpatient settings. I live in a small to mid-sized community. It is unusual to go anywhere without encountering a current or former patient. Some are patients with chronic conditions who I have followed for over two decades. Some know me from the care that I provided to their parents or other family members. A number have been my patients for multiple generations.
Normally, I would have known a patient for a long time before feeling compelled to attend a funeral, but this patient was the mother of a physician colleague. I had only provided this patient with nail care on three occasions. During the time I cared for her, she was almost 95 and her mind was failing. Ours was an informal arrangement; I was simply doing a colleague a favor. I did not have a formal history and other than my assessment of her feet and lower legs, I knew very little about this patient. She had minor venous stasis and the feet and nails of someone who had worked very hard all of their life. Based on what I knew about her physician son, I had drawn the erroneous conclusion that she had been a farm wife.
Recognizing Our Patients Are Real People
Her service today reminded me of a very important lesson that I had lost sight of. There are very real people behind the patients we care for. As I sat listening, I felt cheated that I had not met this incredible woman decades earlier. This woman's life was simply amazing. She was the kind of woman I would have enjoyed knowing; she would have been a great mentor. Her life and the legacy she left behind are to be treasured. I had guessed correctly. She had been a farm wife but that was only one of the many roles she had.
After graduation from high school, she attended a teacher's college and graduated at the age of 20. She needed to be 21 to get her teacher's certificate. She married the love of her life when he returned from WWII and began work as a dental hygienist. He attended college on the GI Bill and after his graduation, both new teachers moved to a small town in Oklahoma. Her plan, like that of so many women of her era, was to stay home and care for her husband and young son. Based on what I heard today, she would have been equally successful in that role.
That plan was put aside when the school district needed a math teacher. She taught all levels of math to generations of high school students. She taught the children of some of her earlier students. She coached basketball, was responsible for cheer and sponsored many of the senior classes. She was an institution in that school. At one point in her service, the audience was invited to share their memories and stories. I took a deep breath and was comforted that the gentleman officiating, a former student and friend, shared that he had two written responses that he would read. So often, this great idea becomes an uncomfortable, prolonged silence when no one steps up to speak. To my surprise, a former student was quick to take the floor. He was followed by another student and then a fellow teacher and one after another individuals stood and shared wonderful, touching, heartfelt stories.
I learned that she was a beloved teacher who was known to be demanding but fair. She expected and got the best from her students. She was responsible for field trips and senior trips. She opened the door to unlimited possibilities for students in small town Oklahoma. She pushed the limits. Her career was filled to the brim with admiration, success, and purpose. She set a high moral standard, led by example, and clearly changed countless lives for the better.
Her life would have been admirable if that was the end of her story. Her life was so much more diverse. Her husband died suddenly leaving her a widow with a young son to support. She maintained the family farm, raised her son, assisted him with college and then medical school. Well into her eighties, she remained a community leader and a public fixture in her town. She greeted former students with smiles and hugs and took pride in their successes. She was fiercely independent and when she did finally retire, she did not do it quietly. She bought an RV to travel around the country and drove that RV as far as Canada. This was a woman who lived life to the fullest.
What We Can Learn From the Patient We Care For
As I listened and laughed and teared up at the stories being told, I was reminded that as nurses we often see our patients at their worst. Circumstances have stripped them of control and left them frail and dependent. We manage their immediate needs, we educate them on how to regain their independence, we coach them to help guide them along the right path. But we seldom have the luxury of enough time to listen. In those settings where we are able to build a longer relationship, let's try to find time to listen to their stories. I believe there are stories that need to be told to celebrate the accomplishments of life. I know that these stories hold value to the patient who is able to tell them, but there is also value to the nurse who is entrusted to hear them.
As nurses, we impact our peers and colleagues. We may never know the extent of our legacy. Even small gestures may have long-lasting impact. Last month, I was reminded of this when my daughter prompted me to look at Facebook. For those who know me, you understand that I only sporadically look at Facebook and seldom post much, but I was mentioned in a post on her page. The mother of my grandson's pitching coach noticed my name and posted a simple comment that she used to know a nurse named Diana Gallagher who worked in wound care. My daughter, who is much more active on Facebook than I am, asked more questions. This woman, followed me for one day during her nursing school rotations. She was impressed with the role and went on after graduation to work in wound care and then GI nursing. I had her with me for one shift, but that time clearly left an impression. We never know how our lives will change the lives of others.
Today's funeral celebrated the full and fruitful life of a teacher, a wife, a mother, a widow, a community leader, a grandmother, and a woman who clearly lived her life to the fullest. It did make me think of the legacy that each of us are responsible for building. Who will stand up for us and tell stories about the difference that we have made in their life? Who will count us as a friend who will be deeply missed?
Admittedly, teachers have months or even years to make a lasting impression and nurses may have but a few fleeting hours. But there are similarities between teaching and nursing. Both are difficult, demanding careers; both careers are not ones that contribute to quick wealth, but both are filled with countless opportunities to enrich and change lives for the better. The hours worked by teachers and nurses often extend beyond the end of a shift. The stories that were told today would have been fewer and vastly different if teaching had been just a job, controlled by a time clock and devoid of any personal investment.
The woman whose life was celebrated today made a difference because she was committed to the idea of doing more. Her career was more than just a job. Our careers should be more than just jobs. We can all learn from individuals that live life to the fullest. They set an example for us and raise that bar, just a little bit higher.
As nurses, we have the opportunities to make lasting differences—for ourselves, our profession, and our patients. Nurses can change patient's lives, influence and inspire individuals, and provide us with a foundation that will leave all of the lives we touch changed for the better. Let's build a legacy that we can be proud of.
About the Author
Diana Gallagher has over 30 years of nursing experience with a strong focus in wound, ostomy, continence, and foot care nursing. As one of the early leaders driving certification in foot care nursing, she embraces a holistic nursing model. A comprehensive, head to toe assessment is key in developing an individualized plan of care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.