Journal of Gerontological Nursing

EDITORIAL 

The Complexity of Basic Care

Theris A Touhy, ARNP, MS, CS

Abstract

During many years of working with senior nursing students in their clinical rotation in the nursing home, the following situation stands out as one of those leveling experiences that students often provide for their faculty. The student was assigned to a lovely 90-year-old gentleman who, despite being crippled with arthritis and almost immobile, possessed a fine mind and a great Irish temperament. It was the student's first day and it was Leo's shower day. After receiving detailed instructions on his preferred routine from both his usual caregiver and him, the student proceeded to take him into the shower.

As 30 minutes passed, I held my breath and tried not to pace the hallway outside the door. Fearing problems, I had to knock and see if eveiything was all right. The door opened and I saw Leo, red of face, and looking rather fatigued. My student was more than a little wet. Towels were strewn everywhere. I was told that they were doing okay, and my offer of help was refused. Another 30 minutes passed, and I found the pair in Leo's room. He was almost dressed and ready for the transfer into his wheelchair. His comment: "I'm sure she will get better with practice." Her comment: "I never knew basic care could be so hard. I work in critical care and I thought that was demanding."

This story reminded me of the wise words of Sister Marilyn Schwab (1977):

To be a nurse means to have the skills and science to care for people who cannot care for themselves; to assist people to cope with disability or the effects of pathological processes. Thus, I am less impressed with the nurse who can determine that the patient is 'throwing PVCs' than I am with a nurse who can get a frightened confused patient to eat. One of the reasons the general public and legislators seem to assume that nurses' aides must do most of the care in nursing homes is due to the fact that many in the nursing profession itself have lost sight of what nursing really is. We have undersold the degree of skill involved in 'taking care of - in nursing - people. I believe we need to refocus, and the long-term care situation in this country is one of the settings that might clarify our role for us, if we are willing to get involved (pp. 60, 61).

The wide range of skills and knowledge related to bathing presented in this issue illustrates the complexity of providing what we may consider basic care. And yet, assistance with meeting basic needs for care is the skill nursing brings to people. It is our raison d'etre, the essence of our profession. Wilson (1993) provides us with the "image of studying clinical nursing problems to weave a tapestry - a meaningful story - from the threads of feeding, bathing, toileting...that make up the dailiness of everyday practice" (p. 4). No one knows this better than a gerontological nurse. We need to stop considering the provision of basic care to our aged clients as "less" nursing than high tech care. We need to appreciate, value and study our daily nursing activities. We do nursing, our clients, and ourselves, a great injustice when we consider the meeting of basic care needs work for non-professionals. We often delegate away the nursing in the process of delegating basic care tasks. In doing so, we rob our clients of our professional expertise in finding solutions for some of the most significant problems people face as they age. We also delegate away the opportunities to enter…

During many years of working with senior nursing students in their clinical rotation in the nursing home, the following situation stands out as one of those leveling experiences that students often provide for their faculty. The student was assigned to a lovely 90-year-old gentleman who, despite being crippled with arthritis and almost immobile, possessed a fine mind and a great Irish temperament. It was the student's first day and it was Leo's shower day. After receiving detailed instructions on his preferred routine from both his usual caregiver and him, the student proceeded to take him into the shower.

As 30 minutes passed, I held my breath and tried not to pace the hallway outside the door. Fearing problems, I had to knock and see if eveiything was all right. The door opened and I saw Leo, red of face, and looking rather fatigued. My student was more than a little wet. Towels were strewn everywhere. I was told that they were doing okay, and my offer of help was refused. Another 30 minutes passed, and I found the pair in Leo's room. He was almost dressed and ready for the transfer into his wheelchair. His comment: "I'm sure she will get better with practice." Her comment: "I never knew basic care could be so hard. I work in critical care and I thought that was demanding."

This story reminded me of the wise words of Sister Marilyn Schwab (1977):

To be a nurse means to have the skills and science to care for people who cannot care for themselves; to assist people to cope with disability or the effects of pathological processes. Thus, I am less impressed with the nurse who can determine that the patient is 'throwing PVCs' than I am with a nurse who can get a frightened confused patient to eat. One of the reasons the general public and legislators seem to assume that nurses' aides must do most of the care in nursing homes is due to the fact that many in the nursing profession itself have lost sight of what nursing really is. We have undersold the degree of skill involved in 'taking care of - in nursing - people. I believe we need to refocus, and the long-term care situation in this country is one of the settings that might clarify our role for us, if we are willing to get involved (pp. 60, 61).

The wide range of skills and knowledge related to bathing presented in this issue illustrates the complexity of providing what we may consider basic care. And yet, assistance with meeting basic needs for care is the skill nursing brings to people. It is our raison d'etre, the essence of our profession. Wilson (1993) provides us with the "image of studying clinical nursing problems to weave a tapestry - a meaningful story - from the threads of feeding, bathing, toileting...that make up the dailiness of everyday practice" (p. 4). No one knows this better than a gerontological nurse. We need to stop considering the provision of basic care to our aged clients as "less" nursing than high tech care. We need to appreciate, value and study our daily nursing activities. We do nursing, our clients, and ourselves, a great injustice when we consider the meeting of basic care needs work for non-professionals. We often delegate away the nursing in the process of delegating basic care tasks. In doing so, we rob our clients of our professional expertise in finding solutions for some of the most significant problems people face as they age. We also delegate away the opportunities to enter into the Uves of those we nurse. The intimate connection between nurse and person is the medium for the identification of needs and the design of caring responses based on the expertise of the professional nurse. This is beautifully described by Freeman in this issue as he relates the story of the Dutch nurse who uses the bath as his opportunity to establish a deeper relationship with the client, an occasion to enter the door of the soul.

I invite you to turn your attention to basic care and embrace your opportunities to enter into the intimate moments with your clients. Approaching the basic care of bathing as an experience between nurse and person nursed can provide us with the moments of opportunity to truly nurse. Within this framework, bathing can be viewed as the art of meeting the unique needs of older persons for comfort and care, not simply a task to be accomplished. From these experiences we will develop practice theories and models of care that demonstrate the contribution of professional nursing to the care of older adults. We can only do this when we bring our professional expertise to the intimate moments of basic care, discovering the complexity of needs and the artistic range of nursing responses. When we do this, we may also discover the richness of our nursing - the "taking care of people" (Schwab, 1977, p. 61).

REFERENCES

  • Schwab, Sister M. (1977). Implementation of standards of practice in gerontological nursing. American Health Care Association Journal, 3(5), 60-64.
  • Wilson, H.S. (1993). Ways of knowing: Shaping the chaos. In M. Burke & S. Sherman (Eds.), Ways of knowing and caring for older adults (p. 4). New York, NY: NLN Press.

10.3928/0098-9134-19970501-05

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