Since our first day of clinicals, we were taught about setting goals. What is it that we want for the patient? Do we want him to be free from injuries related to falls? Maybe getting his A1C below 7 or his blood pressure to be below 150/90 is a desirable goal for a patient? What about lab work and medications? Does it make sense to set a goal concerning medication compliance or a serum potassium between 3.8 and 4.5 if a patient takes diuretics?
All of those goals meet the criteria we were taught as young nurses. They are measurable, obtainable, and realistic. They could all be achieved inside of an episode or throughout the episode, etc. They would meet with approval from a surveyor.
The picture above is my friend, Bill and his dad. At first glance it may seem like a picture of a patient with a caring family member. It is so much more than that.
The gentleman to the right was Bill’s father long before he was a patient. He is retired from the military. He has had a long life filled with stories of success and failure, love and loss, happiness and sadness just like the rest of us. I don’t think it would surprise him to find out that he is approaching the end of his life. And that man – not the patient – could probably give a flying flip about his A1c or serum potassium level.
If you were to ask him what his goals were upon admission, he might tell you that he wants to spend more time with Bill. Or if he is in pain, he would like some relief from the pain that causes him to be emotionally unavailable for visits with his loved ones. He might have a goal of going to a relative’s wedding or just going to the store soon. He may even have the unreasonable goal of running a marathon soon.
If you begin your relationship with your patient by finding out what they hope they to obtain by being your patient, you will be given the most powerful tool you can have in accomplishing the more traditional nursing goals. Regardless of whether or not the goals are reasonable is really not our business. We start where the patient is and we don’t mainline reality into him like a lethal injection. If he wants to spend more time with less pain so he can visit his son, then we can use that to encourage him to participate in therapy. If he wants to run a marathon, ask him what that would be like. It could be that he has not had the time to mourn the loss of his younger self and your patience and willingness to listen will help him come to the conclusion that there may be a better way to live that doesn’t include running a marathon.
I am the very same person who swam on the swim team when I was four and the same teen aged girl who has been lost in more continents that most people travel to in a lifetime. I am the one who married a man I later divorced. That was me showing up at nursing school on the first day in a white skirt with coffee spilled all over it.
Maybe if you think back when you were 5 or 14 or 22, you will realize that it was you all along.
I cannot think of a better way to care for a patient with respect and dignity than by finding out who they have been all along and work with them to accomplish their goals. They are grown-ups just like us. We get to determine what is best for us just as the men and women who honor us with the privilege of taking care of them.
And so on…..