Academic journal article Nursing and Health Care Perspectives

CLAIMING THE Wisdom & Worth OF CLINICAL PRACTICE

Academic journal article Nursing and Health Care Perspectives

CLAIMING THE Wisdom & Worth OF CLINICAL PRACTICE

Article excerpt

In this article, Dr. Patricia Benner expands on themes she introduced in a plenary session at the 24th Biennial Convention in Miami Beach, Florida, in June 1999. The convention explored The Nursing Renaissance: New Ways of Being, Learning, and Leading. Dr. Maryann F. Fralic's address, "Nursing Leadership for the New Millennium: Essential Knowledge and Skills," was published in the September/October issue.

TWENTY-FIVE YEARS AGO, I began to articulate what we as nurses know as our practice from nurses stones and from direct observation. I began this work under the banner of describing the wide gap between ideal and real practice, only to discover that actual concrete, particular, caregiving relationships are often more profound than what is reflected in nursing theories.

I never cease to be amazed at what nurses, patients, and families create in specific caring relationships (1-5). I will begin with a few stories to ground knowledge claims from nursing practice in the real, rather than create abstractions or virtual realities. The first story, called simply "A Pot of Coffee," is by Dorothy Merner (3, pp. 403-404):

A 67-year-old man was admitted to the psycho-geriatric assessment unit from his own apartment. He was divorced and lived alone. His presenting diagnosis was acute behavioral problems. His other diagnoses were COPD (chronic obstructive pulmonary disease) and terminal cancer with metastasis to the lungs and brain. He was grossly obese, due in part to fluid retention. He had stopped bathing and caring for himself physically, and so he had skin breakdown and a strong body odor. He was loud, exhibiting obnoxious physical and verbal behavior. He seemed to be saying: "Here I am, what can you do for me that hasn't been tried?" He was showing his anger over his increased dependency and loss of power. His admission was like an invasion of the unit.

The patient's history showed that he was a very sociable retired newspaperman. He exhibited a fiery intelligence and a fierce independence. Soon after his admission, dissension was created between himself and the staff. He felt he should have access to the staff coffee supply when thirsty just as the staff did. Suffering from periodic bouts of nausea, he didn't always eat his meals when they were available. The staff denied him access to the coffeepot. He solved the problem by escaping from the hospital. He returned the next day with his own identical coffeepot plus coffee. The coffee machine became the focus of his attempt at independence as well as something tangible toward which to direct his anger and frustration. The opportunity to have and to offer people coffee was an integral part of his lifestyle.

This incident precipitated considerable discussion among the nursing staff. I intervened, getting permission and special safety clearance from the hospital biomedical engineering department. The nurses agreed that the patient would have to be monitored closely to prevent him from burning himself or leaving the pot on while empty. I interpreted this preparation of coffee to my colleagues as a nursing measure to restore his sense of control and provide an access to his more sociable side. Planned outings to the mall to purchase his own supplies would prevent further hospital disappearances. The coffee would provide an avenue for interaction with the rest of the multidisciplinary team. He was a Jewish agnostic but gained great comfort from serving coffee and talking to the chaplain about how he did not believe in God. He also did not believe in psychiatry, but became much less agitated when the psychiatrist chatted over coffee about his recent emotional upheavals.

He was estranged from his family, and we were able to encourage them to come in for coffee and a visit. The alienated family members eventually "stopped by" for coffee and to say hello. As his condition deteriorated, he still enjoyed the opportunity of offering coffee to others. …

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