Comprehensive Health History/Interview

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The Oxford dictionary defines alienation as; to estrange, isolate, detach, distance, to put a distance, to turn away from another person. Alienation, like a lot of other social attitudes and concepts, can give a wide variety of interests. I have found six main points in The Encyclopedia of Psychiatry, Psychology, and Psychoanalysis that have gotten the most attention and things written about alienation;

A) Powerlessness: The feeling, that a persons behavior can’t control some events whether positive or negative, B) Meaninglessness : The person feels incomprehensive in his/her social life and feels the “absurdity of life”, C) Normlessness: High expectancies for, socially unapproved ways to achieving a goal, D) Cultural Estrangement: person’s individual values rejected by society, E) Social Isolation: being lonely and commonly found a member of a minority or physically disabled, F) Self Estrangement: This focuses on the discrepancy or differences between one’s ideal self and one’s actual self. Hispanic nurses is growing in conjunction with the growing Hispanic population as this population presents unique cultural considerations which can best be addressed by someone of a similar cultural background. The contention is presented that being Hispanic, however, is not enough to insure securing a job in the nursing profession.

In order to meet their personal and cultural commitments Hispanic nurses must strive to complete the highest degree of training possible to better equip them for the ever evolving field of nursing, and this is the position in which I fit, because my full time job is a bedside registered nurse, working in a nursing home in charge of the floor. From the point of view of alienation, there were many times in which I’ve feel alienated in the hospital that I’ve been working, since I started my profession, and getting worse in Arkansas and Oklahoma, states that I was part of the critical care unit, with white American coworkers, and myself as the only one Hispanic nurse in the unit.

This paper relates the nature of the nurses role to the larger community and also considers the emerging trend towards a holistic nursing approach, designed to increase the capacity to improve the healing process through an individualized view of care; even though, the alienation that many of us have to face, because being more specific, at the beginning of my nursing experience, I felt lot of times, meaningless, isolated and useless (self and culturally estrangement) many times in that environment, probably due to my limited experience as a new graduated nurse at that time, and also because I represented the minority, since I was the only Latin, and the predigests that the population of that part of the country was involved.

In other words all of the characteristics of alienation discussed in class can be applied to me. One example, in one occasion, during my orientation period, two nurses approached me at the nurse station, asking me if I was Mexican, stating that because my dark hair I probably was, and how uncomfortable they felt working with Hispanic, because we’ve taken all the opportunities to work, to study and other rights that actually belongs to them. Also the way, that the ICU nurses approached Hispanic patients were lot more cold, and with lack of compassion about the patient.

In general a serious problem exists in long-term health care facilities such as hospitals and nursing homes. Most staff members responsible for patient care do their jobs competently. Nevertheless, the cold, remote attitude often taken for granted in these institutions fosters a sense of isolation and alienation in the residents, undermining their spirit and leading to “institutional depression. ” Care providers need to recognize this problem and meet it by bringing to the work a conscious sense of warmth and attentiveness to the residents. It is even possible – in fact, necessary – for care providers to love those under their care without losing their professionalism.

Work in a nursing home can be very tedious. There are always many little tasks to perform: handling admissions, scheduling therapy, dispensing medication, taking temperatures, bathing the residents, changing dressings, helping a resident to the toilet or bringing a bedpan, serving meals, making beds, monitoring supplies, attending meetings, fielding phone calls, talking to physicians, logging all of this into residents’ charts, and executing all the rest of the paperwork that sometimes seems endless. Working in a nursing home has its own particular stresses and annoyances. These stresses, however, only partially explain what has become a serious problem in health care.

I have worked for many years in hospitals, nursing homes, and hospices. In some of these places I have witnessed occasional instances of patient abuse, but thankfully these were rare. What is, however, all too common is a certain atmosphere of coldness, of emotional neglect, which results from the inability or unwillingness of staff to interact with patients on the level of a shared humanity. In my experience the one exception has been hospice, which tries to provide an alternative to traditional hospital-based care for the terminally ill. I would like to make clear at the outset that my purpose is not to criticize any particular group of professionals within the health care community.

I deeply respect and admire those who feel called to do this work. Most are good people doing their jobs with dedication and skill, and many go out of their way to make their patients feel comfortable and comforted. I could not do my own job without their support. What I do wish to criticize is something that seems part of the culture of health care itself, an attitude that care providers sometimes value as “detachment” but that patients often experience as callousness. A good person doing a good job may not be enough, if a connection to the patient is lacking. Even when staff members do their jobs well patients may suffer, because of our narrow concept of what a “good job” is.

Twelve years ago when I worked the reception desk of a major hospital in the city I got an unusual call on the patient information line. A distraught woman called to tell me that her husband needed a bedpan and could not get a nurse’s attention for over an hour. I did something I was not authorized to do: I gave her the extension of the nursing station and told her to have her husband dial it from his room. I have no idea why the nurses were late with the bedpan. Perhaps they were short-staffed that day. Perhaps they were preoccupied with more important things. Perhaps they were simply inattentive. Whatever the reason, such occurrences contribute to a feeling in hospitals that is isolating and depressing. It also takes more than bringing a bedpan to alleviate this depression.

Even when the bedpan is there when needed, when the meals arrive on time, when medicine is dispensed on schedule, a crucial element is often still missing in the interaction between patients and staff. The needs of people living in health care institutions are more than physical. People living in hospitals and nursing homes live separated from everything that once gave them comfort: family, friends, familiar surroundings, little conveniences that make life comfortable if not fun. Beyond this separation is the loss of freedom. These people are not free to come and go as they please. They wake up when they are told to wake up, they eat when the meal is served, they cannot leave the floor, and may even have to ask and wait for help when they must relieve themselves.

They walk around all day (if they can walk) in flimsy gowns and slippers that do little justice to the sleepwear they left at home, let alone the suit or dress they felt proud to wear when their lives were normal. They depend more on the attention of others than at any time since infancy, and this time they depend on strangers. There are a lot of examples of alienation to patients in the different nursing homes around the country. One example is the history of Mrs. Claire who was very frail and her health deteriorated rapidly. I arrived on her floor one day to find a nurse assistant speaking to her in a loud, harsh voice.

“Clean yourself up! No, you can’t go in there! “There” was the dining room where I was about to conduct my group. Since music is the only thing I have ever seen lift Claire’s spirits, I was not about to see her barred from the dining room. I asked for an explanation. Claire suffered from a progressive dysphagia, an inability to swallow normally. She had been regurgitating her food all day, and I had arrived just after she spat up a glass of orange juice she was trying to drink. With weak trembling hands she tried to clean the wet front of her gown. She cowered while the nurse barked at her, moving her hands uselessly to take some action she could not plan. Another woman cannot use words to tell me how she feels.

She suffers from dvanced dementia, and like many such people who can still walk, she wanders a lot. Once she tried to get on an elevator that stopped at her floor, a clear violation of the rules. Still, she insisted. Two nurses came toward her and ordered her to leave the elevator. This upset the woman and made her defiant, determined to stay put. She started screaming at them. I held out my hand to her and very gently asked her to take it, hoping to lead her calmly out of the elevator. She extended her hand towards mine, and our fingers almost touched. Just before the moment of contact the nurses entered the elevator and took her out by force, and she started screaming and cursing at them all over again.

The loss of personal freedom, the loss of meaningful contact with others, the sense of alienation and isolation that people commonly experience when living in a long-term-care facility can produce anger, frustration, and defiance, but most often they result in depression. This depression is not a reaction to illness or disability; it is not what psychologists would call a “mood disorder due to a general medical condition. ” This depression is a reaction to the environment in which the person lives. The condition is so common that I often refer to it as “institutional depression. ” One day, as soon as I arrived on the floor, I heard a woman screaming.

I thought I recognized the voice. It was Maureen, a small, quiet, mild-mannered woman, certainly no troublemaker. Two nurses’ aides were ambulating her, assisting with her walking exercises. They were trying to get her to walk without her walker. Even though they supported her on both sides, Maureen could not stay on her feet. Her legs swayed beneath her as the aides carried her by her elbows. She yelled for them to stop. One of them gave her back her walker, but still she teetered and could hardly resist falling. Finally the aides deposited her in a chair in the dining room and disappeared. I stayed with Maureen for half an hour, delaying my group.

She was in a panic, hyperventilating, afraid she was going to faint, a fear I shared with her. I held her and spoke to her softly until her breathing slowed. I was also very grateful to receive the support of the nursing supervisor after I reported the incident. What strikes me most about this situation is not just the aides’ lack of sensitivity to Maureen’s feelings. It was their dumping her in the dining room without even bothering to check on her condition. Either they did not know she was upset – an unbelievable absence of awareness – or they did not care. I wondered how frightening it must be to live dependent on people who are so uninvested in one’s well-being.

It is so easy to be cruel, to inflict pain without intending to. And it takes so little to do it a different way: a kind word at the right time, a tiny favor, a gentle touch, a small sign of recognition. Perhaps this little really does take a lot out of us. It requires a fair amount of energy to open ourselves to our patients, not permitting ourselves to tune out their pain and isolation. This “tuning out” is what is so deadly, and it usually results not from intentional heartlessness but from self-protection. People who already feel overworked and overwhelmed may be hesitant to invest any more emotional energy than they have to in relating to those under their care.

The challenge we face is how to preserve our own integrity and the humanity of our patients as well. I am not advocating interference in patients’ lives or the violation of boundaries. A certain amount of distance is necessary to preserve good staff-patient relationships and to keep them ethical. Nevertheless, I believe it is healthy for us to treat our patients with kindness, attention, and a positive attitude. It is healthy for us to see that the physical ministrations we offer are only half the job. The practice of kindness benefits the soul; it makes us better, happier people. It also transforms the atmosphere in the facility, making it easier for both patients and staff to resist “institutional depression. ”

It is important to treat every patient with respect, no matter how compromised he or she may be, and to avoid condescension. When people are helpless it is so easy to talk down to them without realizing it, infantilizing them and robbing them of their dignity. Most of the people I am caring for have lived considerably longer than I. I try never to forget this, no matter how little of their life experience may seem available to them in their present state of disability. Respect is just the beginning. Beyond this is the human connection. We must allow ourselves to be open to our patients, and to love them. To love them, not by becoming overly involved in their lives – that is not love – but by being aware of them on every possible level.

Being aware, refusing to tune them out, knowing the need of the moment and how to respond to it – this is love. When people are loved they feel someone listens to them, someone cares about them. They do not feel isolated. Love makes it possible for us to become open to others’ pain without burning ourselves out. It heals us as well as our patients. Opening ourselves is not easy: we may find it difficult, even draining at first. The loving atmosphere we create must sustain the staff as well as the patients. Regular support groups for staff are important in providing a safe place where care providers can talk about the feelings and reactions that patients evoke in them.

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