On the Other Side of the Rails
Touched by an Emergency Department Encounter
Donna K Carpenter, RN BSN CCM
Photo Credit: ©istock.com/mihailomilovanovic
I have been an RN for over 40 years, practicing in various settings, and am currently a case manager in the emergency department. My role is primarily in the ED observation unit. My responsibility is to safely facilitate the discharging of patients who do not need an acute inpatient admission. Ideally, this takes place within 24 hours from the admit time to the observation unit.
After so many years in the profession, I recently discovered a philosophy of nursing that captured my attention: Jean Watson’s Theory of Caring. This Theory of Caring establishes 10 Caritas, or caring processes, that can be integrated into daily patient care. “Caritas“ is a Latin word that means to appreciate or give special loving attention. “It must be actively cultivated to be sustained.”1 The philosophy of Human Caring applies as much to the nurse as it does to the care of our patients.
Sustaining a caring presence can be challenging, especially in the chaos of an extremely busy emergency department. Having an awareness of the Theory of Caring guides and motivates me toward a more meaningful interaction with the patient. The patient, I believe, feels heard and listened to, which is a goal of mine in practice. I am grateful when I can stop and recognize when I am in the midst of a caring moment.
One of these moments occurred with a patient whom I will call Larry. Larry is a composite of the many patients I encounter in a given day who are elderly, developmentally disabled from a prior traumatic brain injury or stroke, and usually live alone. Larry lives alone, in a complex for developmentally disabled adults.
Larry fell on his way to the dining area and was presenting to the emergency department with a nonoperative fractured pelvis. I briefly reviewed his medical record and history, and I found myself instantly concerned. I often arrange short-term skilled nursing home stays for patients with these types of injuries who live alone; however, Larry made it clear to the overnight staff that he would refuse to go to a nursing home. How could I possibly make this discharge happen in less than 24 hours if Larry was not agreeable to a nursing home, and with all his co-morbidities, and now with a new pelvis fracture?
As I walked apprehensively into Larry’s room, I was feeling anxious for both Larry and myself. I was not prepared for the lively and touching encounter that followed. Larry had a pronounced right-sided facial droop, piercing blue eyes, and a full head of wild white hair. As I walked in, he looked right at me and said, “I love your hair.“ His comment stopped me in my tracks; it was if we had been friends for years. By commenting on my hair, Larry connected with me on a very human level.
I immediately softened and began to see Larry not as his medical history or the problem I came to solve but rather as this sweet, engaging, elderly man who instantly connected with me by commenting about my hair. I was able to recognize this kind of interaction as a caring moment for me, as well as for Larry. The Theory of Caring gives me a new awareness and inspires me to pay attention and be present for these compassionate encounters. I imagine it helped Larry feel recognized and listened to. Through this simple interaction, I was now able to see him as the unique person he is, not his medical history or new fractured pelvis, but his full humanity.
I have maintained a passion for nursing after all these years of practice and now after discovering Jean Watson’s Theory of Caring, I am more aware and appreciative of these rewarding moments. Having a meaningful encounter, like the one with Larry, does not happen easily. I do have to remind myself that the emergency department patients I meet are more than the diagnosis that is documented in their medical record.
I strive to stop and recognize any caring moment I have with a patient. This practice humanizes work that can often feel hurried and impersonal. Nursing, now more than ever, needs Jean Watson’s Theory of Caring.
Sitzman K, Watson J. Caring Science, Mindful Practice: Implementing Watson’s Human Caring Theory. Springer Publishing Company; 2014.
Donna Kilgallon Carpenter RN, BSN, CCM
Ms. Carpenter has worked as a Case Manager for the past 15 years. For the last 8 years she has worked in the emergency department at Brigham and Women’s Hospital, a major teaching hospital of Harvard Medical School, in Boston, Massachusetts. She received her diploma at Boston Children’s Hospital former School of Nursing and her BSN from Northeastern University, also in Boston.
She is a fierce advocate for the patients served by the inner city emergency department. In her personal nursing practice, she brings a focus to the patients she works with by embracing and following Jean Watson’s Human Caring Theory. The integration of Caring Science focuses on the wholeness and unique perspective of each person, treating each with respect and dignity to improve the quality of care provided. She strives every day to bring this belief to her fellow colleagues in the emergency department and to the patients they serve. She can be reached at [email protected].
How to contribute
We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]