The nurse as a patient

¶ … Nurses Recount about Experiences with Patients

When one of their nursing department's senior nurses became a patient, having to undergo "two orthopedic surgeries within six months," Leeann Bennett, RN (2007, ¶ 1), recounts, "there was a missing piece on the floor. What we didn't know was what her experience would teach all of us." Due to side effects from Oxycontin, the nurse/patient who had been considered "a rock," reportedly forgot things she would have normally easily remembered. The trying personal experiences "with treatments such as a femoral drip," Bennett (2007, ¶ 2- 3) notes, "helped us learn how to better assist our patients." Bennett (2007, ¶ 2) also reports that information that the nurse/patient shared regarding the corridor's noise level during the night caused the other nurses to examine their role in how they might improve the patient experience on their floor. The lesson she and the other nurses learn from one of their own being a patient humbled them, Bennett (2007, ¶ 2) said.

Suit for Questionable Care Within a few days of a male nurse being admitted to the hospital Tammelleo (2003, ¶ 2) states, Dr. Yolanda Pena, a neurologist, informed the nurse/patient that he had suffered a stroke in March of 2003. After the nurse was released from the hospital, he "underwent physical and occupational therapy at various rehabilitation facilities for the injuries sustained as a result of the stroke."

This nurse reportedly did not question the care he received at the hospital until two years later, after he read a number of magazine articles related to how strokes may be treated. This male nurse, due to the information from the magazine articles, hired an attorney regarding the treatment he received, claiming that staff failed t diagnose his stroke earlier, even though his recorded noted a "possible [cerebro vascular accident] CVA" when he was in the ER. In turn, the male nurse filed suit against the hospital for being negligent in diagnosing and treating his condition. Following a jury trial which returned a verdict for the plaintiff for $800,000, the hospital appealed. (Tammelleo, 2003, ¶ 2)

A Sustained Partnership with the Patient

In the article, "Using patient-centered interviewing skills to manage complex patient encounters in primary care," Catherine Lein, and Celia E. Wills (2007, ¶ 3) report a number of steps to consider in patient-centered interviewing. The authors present a representative, "medically focused interaction likely to occur with John D., based on his chief complaint." The reflected interaction differs from ones noted with this paper's representative patients as it does occurs in an urgent care setting, as Lein, and Wills (2007, ¶ 3) point out, and consequently, does not mirror the effort nurses in a hospital setting traditionally utilize "to establish a sustained partnership with the patient." As Lein, and Wills (2007, ¶ 2) purport, "patient-centered interviewing is used within a goal of sustained partnerships with patients." An investment of time and energy to sustain a partnership with patients yields positive benefits in regard to improving patients longer term physiological status, his/her treatment adherence, and potentially enhance his/her quality of life.

Your patient's body didn't read the textbook," Henry Hample (2000,¶ 6) stresses in: "When Doctors and Nurses Become Patients," as he addresses health professionals with multiple sclerosis. Signs and symptoms of a disease, such as MS, which at times necessitate a nurse be treated in a hospital setting, may appear in disappear years. Carol Matthews, RN, of Springfield, Missouri, states. She remembers first experiencing symptoms of multiple sclerosis [MS] at the age of 19, while attending nursing school. "I developed a case of optic neuritis [an inflammation of the optic nerve causing impaired vision]," Matthews said. "I was treated with steroids, but no one said anything about the possibility of MS" (Hample, 2000, ¶ 7). Three years later, at the age of 20, signs of MS reappeared, however this time the symptoms included double vision. Matthews went to numerous doctors to try to find out what disease she had and obtain treatment. In time, due to the frustration of not knowing, she simply gave up, thinking she was being really weird. She was also treated that way, Matthews said. Not until 12 years later, did a doctor finally diagnose Matthews with MS. (Hample, 2000, ¶ 8). Janice M. Morse, Gail Ann DeLuca Havens, and Sharon Wilson (1997, ¶ 1) relate three interrelated levels of nursing actions in: "The Comforting Interaction: Developing a Model of Nurse-Patient Relationship."

Nurses provide these three processes "in response to patient signals of distress, indices of discomfort, and patterns of relating that form patient actions":

comforting strategies, or separate discrete actions which together form nurses' styles of care, styles of care, or sets of comforting strategies, and patterns of relating, or normative, professional behaviors. (Morse, Havens, and Wilson (1997, ¶ 1)

Morse, Havens, and Wilson (1997, "Nurse-Patient Relationship," ¶ 1) cite

Peplau (1952, p. 9) to explain that a nurse-patient relationship consists of one where two individual "come to know each other well enough to face the problems at hand in a co-operative way." Traditionally, researchers who examine the nurse-patient relationship collect data utilizing "retrospective interviews with patients and/or nurses" instead of focusing on one solitary interactive event. In turn, the amassed data generally consists of descriptions nurse-patient relationships as they develop and change over time (Morse, Havens, and Wilson, 1997, "Nurse-Patient Relationship," ¶ 1). When researchers describe the nurse-patient relationship, many may describe "the development and evolution of the relationship and identify characteristics (usually affective) of each type of relationship" (Morse, 1991; cited by Morse, Havens, and Wilson, 1997, "Nurse-Patient Relationship," ¶ 2). Over time, as trust develops between the nurse and patient, who may initially have had a clinical relationship, may become involved in a therapeutic, connected or perhaps even, an over-involved relationship. NFPSQ This researcher specifically developed the Nurse Feelings to Patient Status Questionnaire (NFPSQ) for this study. The NFPSQ, Likert scaled, consists of 10 affective statements regarding a nurse respondent's feelings relating to his/her status as a patient. Along with each nurse participant completing the NFPSQ, he/she completed two final open ended questions, which proffered him/her the opportunity to relate any concerns or considerations the NFPSQ may not have included.

Research Questions Utilized to Create Questionnaire

The research questions, noted earlier in this study, contributed to the development of the questionnaire this researcher utilized to explore feelings of nurses relating to their experiences as patients. The research questions, answered by this investigation, include the following:

What are the perception of nurse-patients of the type, quality, and consistency of care received while acutely hospitalized?

How does the experience of becoming a patient shape a nurse's perception of the health care environment?

How do you perceive the nurse patient relationship is different when the patient is also a nurse?

The Proposed Sample Population

The proposed sample population consists of five nurses, currently employed in health care. From a total of six candidates who qualified for participation in the study, each of the final five subjects possessed no fewer than five years of full-time nursing experience and had experienced least three full days (minimum of 72 hours) of hospitalized care. As noted earlier in this study, this researcher desired to explore relationships within an acute hospital setting across multiple shifts of nursing. Ensuring this criterion consequently mandated nurse/patients previously experienced at least three days of hospitalization, a minimum criteria for participation.

This researcher distributed the questionnaire via e-mail to each nurse participant, who previously, conditionally confirmed his/her agreement to complete questionnaire prior to its distribution. From the total of six questionnaires distributed; five were completed and personally returned to this researcher, reflecting an 83% response rate. During the course of each individual interview with the five participants, this researcher referred to responses related on the questionnaire to utilize as a guide to maintain the focus for the study.

The five participants who completed this study, included:

Angela, 29-year-old, Hispanic female, experiencing premature labor pains, works in E.R..

David, 35-year-old, former salesman, works as a pediatric nurse.

Destiny, a 46-year-old Caucasian, works as a surgical nurse.

Ms. Myra, a 64-year-old Black nurse, nearing retirement, works in cardiology,

Therisa, an Asian nurse, attends night classes to become a Nurse Practitioner and works with patients undergoing studies.

Nurse Feelings to Patient Status Questionnaire (NFPSQ)

Please respond to each of the following statements by checking which of the answers best applies to your feelings regarding being a patient, hospitalized in an acute care setting.

During the Orientation Phase of my interactions with my nurse/s and upon meeting nurses who cared for me while hospitalized, I felt it best to inform each individual nurse of my profession as a nurse.

While hospitalized for my illness, during the Identification Phase, the primary nurse assigned to my case thoroughly explained tests, procedures and medications.

Even when/if I may have appeared to question some facet of my care during the Exploitation Phase of my hospital stay, nurses caring for me professionally answered any questions and/or concerns I presented.

Nurses expressed empathy when I complained of pain or discomfort and promptly advocated for me when the need arose.

While hospitalized in an acute care setting, I feel that because I am a nurse, I did not receive the same degree of scrutiny a non-clinician patients or physician may have been given.

While hospitalized in an acute care setting, I feel that because I am a nurse, I received more consideration than a non-clinician patient may have been given.

While hospitalized in an acute care setting, I feel that because I am a nurse, I received less consideration than a physician may have been given.

I feel that the type, quality, and consistency of care I received while acutely hospitalized did not differ from treatment any other person would have been given.

My experience as a patient contributed to shaping my perception as nurse of the health care environment.

I feel that being hospitalized in an acute care setting enhanced my understanding of the nature of the hospitalization experience, particularly patients' perspectives.

A perceive that when the patient is also a nurse, the nurse patient relationship differs because:

From my experience as a patient, I would encourage other nurses to:

Angela's Responses

Angela, 29-year-old, Hispanic female, admitted to the hospital experiencing premature labor pains, did not reveal to nurses caring for her that she was also a nurse. Although the primary nurse assigned to her case thoroughly explained tests, procedures and medications, Angela struggled with understanding all that was said to her, as she was not proficient in English. Fear that she might lose her baby also contributed to Angela not comprehending all that the nurses explained to her, she said. Angela's scenario reflects one recently noted in the Charleston, South Carolina newspaper article, "Growing question in hospitals: Como esta?"(2006). Miscommunications, as well as, the lack of communication may occur when a patient does not speak fluent English or completely understand the language spoken in the hospital where he/she may be a patient.

Angela did not question any facets of her care during the Exploitation Phase of her hospital stay, she said. Even though the nurses did not always understand Angela, just as Angela did not always understand the nurses, through interpreter, she noted that the nurses did express empathy when she appeared to be in pain or experiencing discomfort and promptly advocated for her when the need arose.

Angela did not proffer any thoughts about how she felt regarding while whether she received the same degree of scrutiny a non-clinician patients or physician may have been given. While hospitalized in an acute care setting, she did not express any feelings relating to the fact that because was a nurse, she did or did not receive any more consideration than a non-clinician patient may have been given. Neither did Angela express any feeling about whether she felt she received less consideration than a physician may have been given. She did not share any feelings as to whether the type, quality, and consistency of care she received while acutely hospitalized differed from treatment any other person would have been given.

Angela's experience as a patient did not influence her perception as a nurse of the health care environment. She did not express any feelings that being hospitalized in an acute care setting enhanced her understanding of the nature of the hospitalization experience, particularly patients' perspectives.

Angela did not note whether or not she perceived that when the patient is also a nurse, the nurse patient relationship differs. She did not report anything from her experience as a patient that she would encourage other nurses to do.

David's Responses

David, 35-year-old, the nurse, who once worked as a salesman, along with sharing a smile, told each nurse who introduced him/her self to him, that he also worked as a nurse, in the pediatric department. As the primary nurse assigned to David's case thoroughly explained tests, procedures and medications for the symptoms that could not yet be attributed to a particular disease, the two, as Morse, Havens, and Wilson (1997, "Nurse-Patient Relationship," ¶ 2) note begin to develop trust that some perceived as over-involved relationship. David maintained his positive attitude during times he questioned some facets of his care during the Exploitation Phase of his hospital stay. The nurses caring for him professionally answered any questions and/or concerns he presented. David noted that one nurse in particular expressed empathy when he complained of pain or discomfort and promptly advocated for him each time the need arose.

While hospitalized in an acute care setting, David felt certain that because he was a nurse, he did not receive the same degree of scrutiny a non-clinician patients or physician may have been given. Also while hospitalized in an acute care setting, David felt that perhaps because he was a nurse, he received more consideration than a non-clinician patient may have been given. He did feel, however, that because he a nurse, he received less consideration than a physician may have been given. David felt that the type, quality, and consistency of care he received while acutely hospitalized did differ in a positive sense, from treatment any other person would have been given.

David's experience as a patient enhanced his perception as a nurse of the health care environment. He felt that being hospitalized in an acute care setting enhanced his understanding of the nature of the hospitalization experience, particularly patients' perspectives.

David perceives that when the patient is also a nurse, the nurse patient relationship differs because the nurse/patient and the nurse caring for the patient bond more easily. From his experience as a patient, David said, "I would encourage other nurses to see patients as people, more than mere patients; people who need them to see them for who they really are."

Destiny's Responses

Destiny, a 46-year-old Caucasian, who works as a surgical nurse, pointedly reported to each nurse attending her case that she worked as a nurse, so she what to expect and expected the best, without any exceptions. When the primary nurse assigned to Destiny's case tried to explain tests, procedures and medications about the upcoming surgery Destiny was scheduled to have on her broken hip, Destiny refused to hear anything the nurse caring for her had to say. This similar to the nurse Tammelleo (2003, ¶ 2) talks about, Destiny did question the care she received, not only while hospitalized, but after she recovered and returned to work. Destiny and made a point to repeatedly question numerous facet of her care during the Exploitation Phase of her hospital stay, Even though nurses caring for her professionally answered each of the questions and/or concerns she presented, Destiny filed a number of complaints against two of the nurses caring for her.

According to Destiny, none of the nurses even knew the meaning of the word empathy when she complained of pain or discomfort; nor did any of them take the time to advocate for her when the need repeatedly arose.

Destiny made it loud and plain that while hospitalized in an acute care setting, she felt that because she was a nurse, she did not receive the same degree of scrutiny a non-clinician patients or physician may have been given. While hospitalized in an acute care setting, Destiny felt that because she was a nurse, she should have received more consideration than a non-clinician patient may have been given. She resented the fact that she felt this did not prove true. She also strongly resented the fact that she felt that because she was a nurse, she received much less consideration than a physician may have been given. Destiny complained frequently that the type, quality, and consistency of care she received while acutely hospitalized was much worse than treatment any other person would have been given.

Destiny's experience as a patient contributed to adversely shaping her perception as a nurse of the health care environment. Destiny felt that being hospitalized in an acute care setting enhanced her understanding of the nature of the hospitalization experience, particularly patients' perspectives; that they ought to appreciate her more as a nurse. Destiny perceives that when the patient is also a nurse, the nurse patient relationship differs because it is worse, particularly when the nurse caring for her does not really care for her. Destiny said that from her experience as a patient, she would encourage other nurses to think about taking a course in how to be a better nurse.

Destiny, dissimilar to the nurse Tammelleo (2003, ¶ 2) noted, did reportedly, repeatedly and robustly question the care she received at the hospital. She, similar to the man who ultimately sued the hospital for the care he did not receive, however, also read numerous publications and tried to related a number of new treatments to her nurses, as well as to her doctor. None of these purported professionals, albeit, according to Destiny, had the common sense or professional courtesy to listen to what she could tell them.

Ms. Myra's Responses

Ms. Myra, a 64-year-old Black nurse, nearing retirement, works in cardiology, did not tell the other nurses she was a nurse as she worked in the same hospital she was hospitalized in. When he primary nurse assigned to Ms. Myra's case meticulously explained tests, procedures and medications, Ms. Myra confirmed her understanding, along with the expressing appreciation for the efforts of the head nurse made to keep her informed. Ms. Myra, similar to the Clinical Leader, Bennett (2007, ¶ 2) notes, remained positive, even when her hospital stay lasted longer than anticipated. She portrayed an attitude of gratitude, never complained and reassured the expressed as for her: "everything happens for a reason."

Only once did Ms. Myra question a facet of her care during the Exploitation Phase of her hospital stay. As the nurse caring for her professionally answered the concern she presented relating to the dosage of the new heart medication her cardiologist had prescribed, however, Ms. Myra reassure the nurse that she could wait until her doctor made his rounds that evening and discuss a concern with him.

According to Ms. Myra, the nurses could not have been better about expressing empathy when she complained of pain or discomfort and promptly advocated for her each time the need arose. While hospitalized in an acute care setting, Ms. Myra did sometimes feel that because she was a nurse, she did not receive the same degree of scrutiny a non-clinician patients or physician may have been given. She did question, however that while hospitalized in an acute care setting, if because she was a nurse, she sometimes received a bit more consideration than a non-clinician patient may have been given. While hospitalized in an acute care setting, she said she felt that because she was a nurse, she received as much consideration as a physician may have been given. Ms. Myra felt thankful that the type, quality, and consistency of care she received while acutely hospitalized did not really differ from treatment any other person would have been given, as she knew the nurses treating her, gave each person their best care.