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A dozen caring practices a nurse can share with teachers
Interview with Marilyn Scherr, registered visiting nurse
In my ongoing work to be a better teacher in building competence
in a caring manner, I often look at sources outside the classroom
that can inspire and guide me. Conversations I have recently had
with my friend Marilyn Scherr, a registered nurse, has provided
such inspiration and guidance. She is a visiting nurse in her community
caring for her patients, many of whom are elderly. In her work she
also inspires and guides them regarding their own “self care,”
for when she is not there, and when her time of service ends.
The dictionary defines a nurse as a person who “nourishes,
fosters and protects in caring for the sick, injured and aged.”
I was curious to understand the word nourish more, so I read on
“Nourish is to feed or sustain with substances necessary to
life.” Another related word came up - nurture. It is the “process
of promoting - the development of, training, educating, fostering.”
The connection to teaching here strikes fully home. Yes, as a teacher,
not only do I teach the child ... but I also “foster”
a child’s own ability to go out well and competently into the
world more motivated and able to care for him or herself as well
as others.
The main practical applications that I as a teacher, can draw from
a nurse’s experiences is based on the daily “one to one”
aspect of caring that is so core to their work. As a school teacher,
whether I have thirty children in my classroom or half a dozen,
it is essential to reach each the best I can. One shared example
is a nurse’s simple practice of sometimes “staying with”
for a quiet moment before leaving a patient. In teaching, when I
have just finished speaking to one child or completed reading a
story to my class, I can practice pausing quietly for a second or
two before slowly turning to whatever is next to do. This allows
the time just shared together to be remembered in a more meaningful
and magical way.
The following dozen self-help tips that build competence in a caring
manner grew out of these conversations with Marilyn. I present them
in the form of questions that can serve as useful prompts. I hope
that many of these approaches are of use either in their newness
or as reminders of caring ways already in your repertoire that are
worthy of greater use. The dozen practices are shown in four groups
arranged in an order in which they may occur daily.
The first three practices regard ways of listening. Before we can
more fully help, it is helpful to learn what is important to ourselves
and to our patients.
1 How am I doing as I am about to begin my daily rounds?
Often in caring for the sick, one may not physically be feeling
100% that day or may be feeling some stress about something. It
is important to be aware of our feelings this morning and try not
to bring these concerns while tending to our patients. Often by
the end of the day, it was these interactions with our patients
that was just what was needed to feel better.
2 Do I find ways to listen, allowing the patient to share well
how she is feeling?
Sometimes we need to give the patient ample time to speak about
what happened to them or about how they are feeling. Too much commenting
with words or gestures can sometimes effect what is being shared.
As long as the patient is aware of the supportive nature of a nurse
quietly sitting there, she may feel freer to more fully share how
she is doing. Time considerations or the competency level of the
patient may influence when and how this type of interaction is used.
3 Did I notice and acknowledge the earnestness of my patient’s
expressions?
When a patient says that her back aches or her wound hurts, and
there is distress in her eyes, it can be helpful to have some empathic
look of concern in my eyes as well, rather than responding placidly
or finding a way to immediately downplay their expression. By mirroring
back that initial feeling we are able to show empathy more clearly
for them.
Connected very closely to the listening approaches just discussed
come three practices on “communication repair.” This is
the fine art of recognizing that some intervention or change in
course is needed based on being aware of what is currently happening.
4 Do I correct the patient in a way that sees the good in their
intentions?
A patient now feels poorly because having recently felt better,
he decided to take fewer pills. The nurse can try to make an effort
to acknowledge the positiveness of the intent of his actions and
at the same time go on to advise him on the importance of amending
this approach. A supportive way of helping the patient in this way
is to say ... I realize that you took less pills on Monday because
you were feeling better, however it is best to check first with
me or the doctor.
5 Do I practice on “how” I cut into my patient’s
conversation when necessary?
Often a patient goes on very long and due to time considerations
or repetitiveness, the nurse feels a need to cut in. Here, through
practicing, one can find a way to use some affirmative approach
to break in. One example is to say “Thank you for sharing that
(pause) ... I need to move along with my next visit ... please tell
me more of this next time.” However it is done, this is something
that through practice over time, can improve.
6 As I am speaking with the patient do I notice how they are responding?
As a nurse is speaking with the patient about her treatment, it
is important to notice how the patient is listening. Does the patient
appear overwhelmed, distracted or irritated for example. Or is her
expression very placid? It is good to stop when this happens and
adjust the approach, often checking with the patient directly.
Having just discussed ways of communicating for understanding, the
nurse is now better able to make decisions regarding treatment approach
and how best to communicate this. Here are three practices in this
area.
7 What type and level of functioning does my patient have?
By knowing how well a patient functions is helpful regarding setting
up a course of care. If a patient can create a system for keeping
track of their medications on their own, that is terrific. If they
need to be given a plastic box with all their daily pills already
pre-filled, then that will be done. The goal always is to allow
and encourage as much self-help as is possible. When done carefully
the patients skills often improve over the course of care.
8 Do I have the courage to do the right thing?
We are often faced with challenges that tie to values. Finding a
patient very unfriendly can contribute to throwing a nurse off regarding
following through in communicating fully regarding his or her condition
and treatment. As a professional it is important in this profession
to be responsible, fair and respectful in all dealings. Finding
the time to go over ways of handling such concerns, with another
nurse, is a way to work through difficult situations.
9 Am I sometimes helpful in areas - beyond the immediate medical
caring
There is a client who is having difficulty reading the instructions
of the bottles of medicines. Taking the time to make a phone call
to an optometrist on behalf of this elderly patient helps him tend
to something that, on his own, may take much longer or may not even
be gotten to. A narrower view of a nurses work may be to just say
that it would be good for him to get new glasses. This broader view
comes from a place of deeper caring.
The final three shared practices are some things one can do,
sometimes simple or sometimes more profound, to connect warmly and
respectfully with the patient.
10 Did I remember or recall a shared experience?
Last week a patient says that her Aunt was coming to visit for a
few days. When the nurse sees him today, she ask hers about the
visit. As one makes the effort to have this type of connection,
it becomes more automatic in the future because in remembering and
asking, the nurse grows to become more genuinely interested in the
patient.
11 Do I relate my own experience to build connection?
It is often humanizing to bring in a personal experience. A patient
who is frustrated at the slow progress they are making following
pneumonia may be bolstered by the nurse sharing how she too was
frustrated when she had pneumonia, however with treatment got better.
12 How do I end a visit and exit?
When ending a conversation and leaving, there are ways to bring
more meaning and connection to what has just occurred. When finishing
the visit, it is nice to make kindly eye contact for a moment or
two before moving on. So one looks at Miss Jones and says, “It
was good to visit with you today.” When finished speaking the
nurse may continue to look at her warmly and quietly for a second
or two and then when ready to leave the dwelling, turn and walk
slowly to the door, closing it gently behind.
I am grateful for Marilyn sharing a number of the caring ways she
uses with patients. The sensitivity she shows in meeting her patients
in a friendly and accepting manner is a key to her ability to then
use approaches to help and move them along regarding their course
of treatment, while under her care and after she leaves.
She tells me that in her work she feels the heart beat of her community.
What a nice thought.
Interview by Marty Kirschen, editor www.caring teachers.com We welcome
you emailing your comments and further suggestions via > comments@caringeducation.net
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1. What is Service Learning?
Service Learning in Calvert County What is Service Learning?
Service learning is a "learn by doing" approach to the curriculum
that combines active service to the community with academic study.
Effective service learning includes academic preparation, action
and structured reflection. Why do Service learning? Service learning
education develops responsible citizens by engaging students in
service beneficial to the communities that include academic preparation
and structured reflection.
Service Learning in Calvert County The Maryland State Board of Education
passed a mandate in 1992 which requires all Maryland public school
students to complete a program of service learning as a graduation
requirement. Service learning is a form of community service. It
includes a preparation phase in which students study ways in which
they can be of service to their school or community; an action phase,
wherein students engage in actual service to their school or community;
and a reflection phase, which enables students to learn from their
service experience.
The Calvert County Public School program meets the state requirement
for service learning through integrated coursework offered to seventh
grade middle school students. New students who enter after seventh
grade are also responsible for meeting this requirement and are
offered options for completion through individualized programs of
study, both at the middle and high school levels.
The middle school service learning program has three components:
Preparation, Action, and Reflection. Preparation: Students
decide which projects to undertake and devise action plans for project
completion. Action: Students implement action plans. Reflection:
Students analyze the personal impact of their experience and the
effectiveness of their service to the community.
New students who enter Calvert County Public Schools after seventh
grade have two options to fulfill the State service learning requirement.
First, a student may choose to complete 75 hours of volunteer
service to the community; the hours may be prorated based on when
a student enters the school system. In Calvert County, the prorated
hour count for students new to the school system who wish to meet
this requirement through total volunteer service is: Grades(s) 8
or 9: 75 hours 10: 60 hours 11: 45 hours (1st Sem.) 12: 30 hours
(2nd Sem.) 12: 0 hours
The second option for students new to the Calvert County
Public School System is the opportunity to complete the preparation
and reflection phases of the service learning requirement through
an independent study resource booklet. If students choose this option,
they will read about how others have been of service to their community,
and they will write about what they have learned. Students choosing
this second option are still required to engage in actual service
to their school or community, but theses prorated hours of actual
service would be: Grade(s) 8 or 9: 30 hours 10: 25 hours 11: 20
hours (1st Sem.) 12: 15 hours (2nd Sem.) 12: 0 hours.
(You may go to the Calvert County Public School System website to
learn more of this approach to learning. I have learned through
persons I have spoken to that this is way of having students give
service to the community can bring a deep level of meaning and knowledge.
Marty Kirschen)
http://www2.calvertnet.k12.md.us/instruct/servrequire.shtml
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