;94 Clinical Notes

raise some interesting questions which could be pursued ina larger study.

Primary nursing is now being introduced in varioushospitals in Ireland (Ryan, 1992). As we move swiftly intoour new and exciting pattern of nurse education (AnbordAltranas, 1991), it should dovetail with the need to developthe accountable Irish nurse practitioner of the future.

References

Anbord Altranas (1991) Nurse /Education (£ Training: CorisullalionDocument. Interim Report of Review (^omtnitlee. AnbordAltranas, Dublin.

Cheltenham and District Health Authority (19X3) A step-by-stepguide lo undertaking a Nursing Dependency Study in a hospitaltor elderly patients (Non-clinical re.seareh project). Cheltenhamand District Health Authority.

McCarthy G. (1988) Student nurses in the Republic of Ireland; a studyoj their biographical, educational, motivational and personalilycharacteristics. .Vll'.d Thesis, Trinity C^ollegc, Dublin.

Ryan M. C (1992) Implementing pritriary nursing in a ruralhosprtal an Irish cxpcTicncc (Irish Nurses Organisation). Worldof Irish Ntirsmg 21(11), 16 17.

'l'reacy M. M. (1988) Selling Eslablishments in Nursing A PilotStudy A Report of the Irish Matron's A.ssocialion, Dublin.

Into new life: a reflective aeeountJOA.X.NA HKDGK.S li.ScdlonsjSpecch, t<CiNStaff Nurse. Ward 7A, John Radclijfe Hospital, Oxford OX.i 'JDU,

UK

(Correspondence: 4') llallard Chase, /Ihingdon, Oxfordshire OXNIXil, UK

Introduction

This is a reflective account taken from my own practice,based on a conversation held with a patient who, at thetime, was recovering' from a life-threatening illness. Occitr-ring at a crucial time in my own professional development,it acted as a catalyst to focus hitherto hazy and disorga-nized thoughts. The conversation with this patient helpedto:• clarify, for me, the concept of nursing as a journey;• demonstrate the power of nursing through the nursc^

patient relationship; how we enable someone to moveforward by drawing alongside and journeying with them;

• highlight the two-way nature of this relationshipthrough this man's insight I was able to grow as a personand a nurse.John was admitted to the ward on a Sunday evening. I le

had septicaetnia and his outlook remained uncertain

throughout that first night. 'The closest I have ever cometo death', he later told tnc.

I was on annual leave when John was admitted and didnot return to work until the following Wednesday. Johnhad made an excellent recovery. All his 'drips' wete downand he was mobilizing very gently.

Our first meeting occurred when I had to administer alarge dose of intravenous antibiotics. This took some timeand as we chatted we discovered that we bad a mutualacquaintance. John is a retired clergyman but still ex-tremely active and highly respected. I met our mutualfriend through my chutch. Over the next few days we hadmany conversations based on our shated Christian faith.

The most memorable of these took place the followingSaturday. The ward was extremely quiet and John con-tinued to recover rapidly. I le was now in a side tootn as hewas feeling the need for some peace and privacy. He waswriting an address for a confetcnce later in the year. 1popped into his rootn for a chat and we ended up talkingfor 12 hours.

John began by asking me how we, as a ward, brought thespiritual aspect into the care of our patients. Befote 1 couldanswer, he said that, much as he admired the doctors, theyhad only addressed his physical needs. However, he feltthe nurses 'have treated me as a whole person' and heidentified being eared for in physical, psychological andspiritual areas. I was taken aback to hear him describing'holistic nursing care' based on his own experience. Hesaid that on the ward he had felt himself to be a metnber ofa 'community of healing'.

He told me that the most important thing a nurse gavewas her presence. This struck me because so many of the'thank yous' both verbal and written teceived iecentlyon the ward had echoed his thoughts.

'Thank you for being there'; 'The kindness andloving care you showed will never be forgotten'; '1knew if I needed comfort all I need do was ask.'

John identified and reaffirmed for me the importance of'the little things' we do. Although people appreciate thetechnical care it is the small details which they take awayand retncmber. After putting a lavender oil infusion in adying woman's room, a colleague received a card frotn thepatient's daughter saying, 'Thank you, thank youlavender will always bring my mother hack to me.'Another man'.s son wrote, 'He enjoyed your care and theextra trouble you took to sit and listen to his troubles.'

John asked me how I cope with nursing someone who isdying and how I feel. At first I had a momentary fear atexamining such deep feelings. I tried to explain how thefine line between life and death always sfrike.s me when Iam with someone when they die. I explained how 1 often

Clinical Notes 195

feel so inadequate, perhaps trying to find sotnething to door say to help; how I desperately want to do more, yet atthe same titne remain sensitive. As I talked to him Irealized that 1 had become consciously awatc of some ofthese feelings for the first time. 'I hadn't realized I felt likethat', I told him.

On the death of his first wife, John said he had found ithard to let go. A friend had told him, 'Being with a dyingperson is like accompanying them on a journey, but youcan only go so far with thetn, then they have to go onalone' his words were like a bright light.

I first became aware of the analogy of nursing as ajourney from Alastair C-ampbell's book Modcralcd Loir(1984) where he described nursing as skilled companion-ship. Benner and Wrubel (1989) talked of tnoving patientsthrough their experience of illness by starting frotn w herethey are. I laving recently discussed these ideas withcolleagues, John's cotntncnts brought thetn clearlytogether.

John told me not to fbtget the power of cotntnunicationthrough toueh and silence and identified that in a closerelationship, as between pritnary nurse and patient, verypowerful comnumications happen without words.

During our conversation, 1 described how we ptacticepatient-centred care through primary nursing and howcontinuous care can lead to the development of a thctapcuticrelationship. Me said that he could really see the benefitthat the continuous relationship had had on his care.

The impact of our conveisation letnained with me fortnany days. It occurted at a crucial time in my ownprofessional developtnent. I was tealizing the importance

of nursing as a journey, in starting w here the patient wasatnd moving with thetn through their experiences. Finally.,I was being deeply moved by the many letters thanking usfor 'being there' and the obvious importance that bothpatients and families placed oti their relationship with thenurses. All these things becatne very clear as our convcrsa-tioti brought my hazy thoughts into focus.

John showed tne the power of the nurse-patient rela-tionship. By journeying with a patient, the nurse is able todevelop its therapeutic natute. Through this 'skilled cotn-panionship' the power of nursing can really be detnoti-strated as the patient is enabled to move forward.

John showed me that this relationship is two-way. Atthe time, 1 was riot aware of trying to help him come toterms with his illness. However, on reileetion, 1 realized Ihad, by giving him time to express his thoughts andemotions. 1 hrough the satne convetsatioti, my owti self-awaretiess was increased and he enabled me to grow as aperson and a nurse.

After nursing certain people, we are so aflected that wecan never be the satne again. John was such a person on tnyjourney.

On his discharge, John gave me a book. Inside he hadwritteti: 'To foantia, my primaty nurse, who helped mehack to life and on into new life'.

References

Henncr P. & Wrubel J. (1989) The Primacy of Caring. Addison-VVeslev, C'alilbrnia.

Campbell A.\'. (1984) Moderated Love: A Theology of ProfessionalCare. Society for Protnoting C.hristian Knowledge, London.