Comments on: Treating People Not the Same As Treating Illness

By: Megan Yuan

Megan Yuan — Thu, 29 Sep 2016 20:10:00 +0000

I am a strong believer in building relationships, especially in a healthcare provider-patient relationship. As a nursing student myself, I’ve been in enough clinical situations to know that many patients are less receptive to opening up about their conditions if you, as the health care provider, have not warmed up to them. This was easily seen in my own once-weekly clinical experiences, as patients saw me as someone whom they probably would not see again, which was not conducive to relationship building. This was also seen on a grander scale in an underserved Chinatown community in which I’ve helped to conduct a community project on medication adherence. There is generally a lack of trust between minority patients and a doctor or a nurse who does not relate to them at all. After all, they don’t have much grounds to build trust on if they do not understand their providers due to a language barrier. There is especially a lack of trust when it comes to providers who do not care to have a relationship with their patients. Even more relationship building opportunities is lost when a medical translator is involved as well. Cultural barriers and language barriers, therefore, call for cultural competency in all communities that is built on organic and sustainable relationships.

In light of my own personal experiences, it was encouraging to see this study done on human relationships. Despite an increase in clinics about a decade ago in a rural area, fewer women were screened. However, the research found that a relationship built on trust and continuity was key to getting patients to adhere and invest in their own care. One student says, “I don’t think a single pap smear or me personally going is what matters. It’s the ongoing relationship and the support of people that’s needed to come to more sustainable solutions”. Wendy Grube, the director of the Center of Global Women’s health, says, “This is multi-factorial, it’s very complex, and, if we’re going to make an impact, we have to develop relationships with people in communities that are long-standing, that are trustworthy, that are dependable and reliable and subsidized to get women to engage.” These two statements encompass key factors to establishing quality care. When applied to the urban hospital system that I am more used to, there is a gap in transferring levels of care. In other words, while the pap smear was followed up by the same provider, a pap smear and a follow up may be done by 2 different providers in the hospital system.

As a future health care provider, this article was a great reminder for me to not see patients as “another case”, but rather a person whom I have the privilege of caring for. Such is the attitude of a person in service to another—that the focus is not only on a patient’s illness, but truly getting to know a a patient for who they are.

sources:
https://news.upenn.edu/news/in-appalachia-penn-nursing-grad-students-care-for-vulnerable-patients
/treating-people-not-the-same-as-treating-illness/

By: mary okechukwu

mary okechukwu — Wed, 28 Sep 2016 02:24:00 +0000

When a people are ill they are in there most vulnerable state, where they need someone to care and cater to them. I do strongly believe that treating people is very different from treating an illness. Treating a person goes beyond hi and bye it goes down to finding out how they feel internally . Just showing care not because they are sick but because they are human.Growing up in Nigeria i would say i never knew my maternal father, because when he was alive he was stricken with stroke and was confined to chair and could not talk . I never had a conversation with him or felt like i bonded with him. My mom had told me stories about him, and her view of him as a father. One thing i noticed while growing up was how much my grandmother cared for him. Although he was confined to chair and could not say a word. my grandmother would speak to him in my dialect to him like everything was ok. My grandfather was always washed and was always in clean clothes. when my grandfather needed to changed my grandmother never changed him in front of people she always took him inside and cleaned him up herself even with old age. she treated him with respect and preserved his dignity, although it seem to be gone with his illness. The way my grand mother took care of my grand father showed me what it really meant to care for a person. One thing i have noticed in healthcare field is that health providers become more desensitized to people that are ill when they are in the job. I have noticed it more in the nursing field, they tend to view their job as just a job and forget that they are caring for humans as themselves. I do believe that showing care and concern about a person can make treatment more effective. In reality no one really wants to be put in a vulnerable state where they need someone to care for them, so when an individual is sick the least they expect from people is to still treat them as human and not a problem they are just trying to fix. I do believe that healthcare provider should be trustworthy because when there is trust people will be more open to care. Trust between patient and health providers, makes a patient more willing to receive care and might be open to other procedures because that trust is there.

By: tseringyanjon

tseringyanjon — Tue, 27 Sep 2016 22:30:00 +0000

I wish there were more articles like Michelle Berger’s “In Appalachia, Penn Nursing Grad Students Care for Vulnerable Patients”. This article makes it clear that even with more and better facilities, it is difficult to promote treatment at a community level without an effort to develop meaningful relationships within the community.
This is especially true in communities that are underserved – like poor, rural communities.

In Appalachian West Virginia, more clinics built for cancer detection did not encourage more women to get screened because the trust factor was missing. What was more important in this case was for medical providers to better understand the community and how they view medical care.

The level of research and effort made by Wendy Grube and the Penn Nursing program is amazing and I hope their work will get exposure so that it may inspire more nurses and educators to do similar work. Building new facilities and sending nurses and doctors alone is not sufficient to reach the underserved and rural populations; developing relationships and trust play an important role.

Without a human element and without putting care into the development of relationships, patients lose out and their needs are not met as thoroughly as they could be. I think that nursing theorist Jean Watson and her “Caring Theory” are very important for nurses to study so that they may preserve the essential element of caring in their practice as a nurse. A nurse must be “conscious and engaged to care in order to connect and establish a relationship with the cared-for to promote health/healing” (Chantal, 2003, p. 59).

In my own recent experience, when I underwent a minor but invasive procedure, one of the things that helped me stay positive was the warmth and friendliness shown to me by the nurses. In all of my recent experiences, the physicians I have encountered have seemed extremely busy and unable or unwilling to establish an emotional connection with me, their patient. Hospitals and medical practices seem to behave more and more like businesses.

As Jean Watson says, without caring, “… we become robotic, mechanical, detached and de-personal in our lives and work in relationships” (p. 56).

While I appreciated all the doctors did for me, I was glad that the nurses were there to perform their essential role, to help the patient towards recovery by practicing loving kindness.

Whether it is trying to reach an underserved, rural population, or treating an urban population that has no problems accessing healthcare, building and maintaining relationships is essential, but unfortunately often overlooked. I hope that people like Wendy Grube will continue to do their important work, and will also encourage others to develop relationships while delivering medical care.

Berger, Michelle. (August 15, 2016). “In Appalachia, Penn Nursing grad students care
for vulnerable patients.” Retrieved from https://news.upenn.edu/news/in-
appalachia-penn-nursing-grad-students-care-for-vulnerable-patients.

Chantal, Cara. (2003). Continuing Education: A Pragmatic View of Jean Watson’s
Caring Theory. International Journal for Human Caring. 7(3), 51-61. Retrieved
from https://www.watsoncaringscience.org/files/PDF/Pragmatic_View.pdf

By: Valerie Hammonds

Valerie Hammonds — Tue, 27 Sep 2016 22:15:00 +0000

I think this article hits the nail on the head and validates that nursing does not only look at the disease process but the whole person. Ensuring nurses are providing best practices, they must look at the patient from a multi-factorial point. As the client’s socioeconomic status, culture, religion, lack of resources, transportation and providing care for others (i.e. elderly, other children) are all barriers to receiving adequate health care. Wendy Grube, over exceeds what a nurse job entails but she also represent what it means to be a nurse leader. As a student nurse, knowing there are seasoned health care professionals in the industry like her that still truly advocate for the patient, provide the highest level of nursing care and not just to go to work for a paycheck is reassuring. I aim to mirror her philosophy, dedication and advocacy when in the clinical environment.
The Appalachia Mountains is a warm and family oriented community that lived considerable below the poverty level. The CDC research revealed this area has the highest level of cervical cancer across the nation. Grube decided to investigate and find out why an area that had facilities available and cervical cancer rates were consistently high. Her approach of wanting to find a solution was first, truly understanding this community, forming trust, building a relationship and being committed. She states, “I want to enter into a community and provide what they need and not subscribe to “academic voyeurism” and for her own motives.” Hence, the reason why the cancer rates were so high in this population because past health care professionals would come only to the area to fulfill the requirements needed for the school to payback their student loans. The women saw their lack of concern and refused to attend these screenings. I would do the same thing. This type of procedure is already uncomfortable and violating because you’re showing your private parts to and displaying them to a new person frequently makes this process worse. As humans, we generally know when someone is being fake, uncommitted or aloof. So naturally, we are less likely to communicate and be comfortable. As a result of the providers behavior, led to the low turn out for the cancer screenings. This same scenario also occurs in urban communities. A lot of people don’t want to work in those communities and if they do it’s temporary. So this results in the community having a high prevalence of diseases with comorbidities that go untreated and then this becomes generational. As I continue on my quest to finish nursing school, this has been one of my goals is to ensure that areas that are underserved get adequate nursing care.

By: Morgan Richardson

Morgan Richardson — Tue, 27 Sep 2016 20:32:00 +0000

A great improvement in the medical field has been the focus of preventative care. Rather than always playing “catch-up” with the quick rate of progressing diseases, preventative care allows patients as well as medical professionals to provide screening and education on appropriate illness that may be prevalent in a certain area or age range. Cervical cancer is a common disease among adult women. Prevention and early detection is key to obtain the best possible outcome. A few risk factors include the multiple pregnancies, smoking and the infection of the human papilloma virus. In addition to a positive HPV test, the use of oral contraception for a long amount of time (5-9 years) also attributes to a greater risk of developing cervical cancer. Dr. Grube and the Center for Global Women’s Health are educating women on these risk factors and encouraging them to receive appropriate screening tests. In the long run, I believe this will lead to a fall in the amount of diagnosed cervical cancer cases.

It is great to see a facility forming a long-standing relationship with its clients. In this way, patient records can be kept organized and a patient is more likely to keep follow up appointments. Forming a relationship between health-care provider and client provides many benefits. Trust is an enormous characteristic in the relationship of medical treatment. If trust is established, a patient is more likely to follow advice and inevitably take part in their medical treatment.

By: Nick Privetera

Nick Privetera — Fri, 23 Sep 2016 19:01:00 +0000

A strong use of empathy is a key feature in nursing practice that differentiates it from medical practice. Empathy can loosely be defined as the ability to understand an idea or event from another person’s point of view. This ability is inherent in every human being but it requires frequent use and cultivation to be effective. To promote health in a given population, a nurse needs to have clear understanding of the community and its environment.

The article mentioned in this post talks about how the lack of follow up participation in the screening was related to the lack of providers committed to the area. The researcher was only able to develop a plan to correct the problem after spending a long period of time in the community. The community members learned to trust her and she better understood their specific needs. The researcher opened the door for future students and providers by doing the foot-work and directly engaging the community in a way that made sense to the specific community.

Providers are not and cannot be an entity outside of the community. A healthcare interaction can only be fully successful if everybody buys into the interaction. Each member of the community has a role to fulfill and those roles are reciprocal (Veal, Wheatley, & Naismith, 2015). If a providers want the patient to believe that their service is important, then they need to be present for the follow up care. Mutual empathy is built upon this sustained interaction. The provider and the patient’s participation in the interaction yields a specific impact on the patients’ health. More participation yields a greater impact.

There is not always enough time to learn a patient’s life story and a nurse cannot always work in the area in which she or he lives. However, if she or he takes the time to look, there are opportunities to participate in the community and build relationships with its members. Making small purposeful effort and sticking around in one place can truly have huge impact on the overall health of a patient and the larger community.

Veal, D., Wheatley, J., & Naismith, I. (2015). A New Therapeutic Community: Development of a Compassion-Focussed and Contextual Behavioural Environment. Clinical Psychology and Psychotherapy, 22, 285-303.

By: campaignforaction

campaignforaction — Fri, 23 Sep 2016 17:55:00 +0000

In reply to Sally Aryee-quaye. Approve.

By: campaignforaction

campaignforaction — Fri, 23 Sep 2016 17:55:00 +0000

In reply to Michelle Lopez. Approve.

By: Michelle Lopez

Michelle Lopez — Fri, 23 Sep 2016 02:54:00 +0000

I believe that what sets Nursing apart from many other healthcare fields is their approach towards the care of the patient. Many times providers see the disease rather than the person. However, nursing aims at providing all aspects of care and treating the patient as a whole rather than just one aspect of their life. Of course, ensuring they are physically healthy is of the utmost important but so is being emotionally and psychologically stable as well. I am a firm believer of the influence the outside world provides to ones’ health. In truth it can be a positive or negative influence but we can’t deny that the environment often sets the tone for future perceptions. If someone believes they can cure their cancer with a batch of fresh homemade juices rather than receiving their chemotherapy because of what they’ve read or even their own experience with providers, then there is something to be said of what they’re being exposed to. On the other hand, patient education and programs such as Tele-Health have begun to include patients in their own care, thus reducing re-hospitalizations. Not only is it important to build a good rapport with the patient but it is equally as important to communicate how vital their role is. More often than not when patients have knowledge of what are potential complications and how to personally identify and address them, they become invested, interested and feel included/important. Patients need to feel that their needs are being met and that goes beyond the hospital. Taking extra time to see what medications their health insurance covers, scheduling a home health visit, addressing the needs of the family, etc. are all ways that providers can enhance the patient experience. It’s not about the numbers, although a perfect score looks good on any record, it’s about building relationships between provider and patients that will last. Not only last, that will improve a patient’s life and maybe even save it.

We don’t live in a perfect world. Not everyone will listen to a healthcare provider. That’s just being realistic. However, we can try and slowly begin to change this common misconception that health providers are cold, uncommitted and apathetic. Addressing the issues that go beyond the illness without getting inappropriately involved is what patients need. Patients need to be healed spiritually just as much as superficially. If a patient recovers from an ailment but is bombarded with outside stressors that may have been able to be addressed (i.e. psychology consult, social worker, financial advisor, etc.) than they may end up right where they started. Unfortunately, we can’t singlehandedly save the world but we can as nurses and nursing students begin to establish a state of well-being by developing a trusting relationship.

By: Sally Aryee-quaye

Sally Aryee-quaye — Fri, 23 Sep 2016 00:19:00 +0000

Everyone likes to feel important and loved. When value is placed on one’s life, he or she is sure that care being delivered will be the very best. This is how trust develops. This initiative started by Penn university I say is in the right direction. Nursing in our era emphasizes on health promotion and disease prevention. With these mobile accessible units, rural communities will get a fair share of the education they need and other screening services to ensure they are in a good state of health. This article reminds me of a group of young student nurses and doctors in west Africa called, med-on-the-go. Annually, they drive through deprived areas to offer simple checkups and immunizations. Some people have to travel for days, to get to clinics, sometimes by foot or on transport animals. They look forward to this group since it’s more convenient. Those without any apparent medical condition still move to see these students and get educated on preventive measures. I believe colleges should have such community services or internships as part of the academic curriculum, so that students of healthcare background serve rural areas to make this world a better place. Well done Wendy and Chana. We need more heroines like you.