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The Topography of Caring

nammi, Nurse, General Practice, 07:24PM Aug 22, 2013

Diane M. Goodman

Ask any nurse about the landscape of caring, and he/she can discuss how they maintain a professional demeanor at the bedside, and how they work within the confines and scope of practice. But aren't we somewhat delusional? Haven"t most of us, at one time or another, fallen victim to a situation where we had to ask "how much caring is too much"? Haven't most of us been hurt, perhaps deeply, by letting our patients get too close? I know I have. I once worked around the clock for a patient that couldn't be saved, and I encouraged others to assist me. But wait, I'm getting ahead of myself...his story will eventually be told.

The American Nurses Association, in delineating a Code of Ethics for Nurses, speaks of maintaining personal integrity and safety that is owed to our professional selves as much as our patients. In other words, we need to maintain a professional distance, the correct topography (or blueprint) for caring. We strive to attain and maintain barriers for protection. Occasionally, our security is breached. We become vulnerable. Not every patient sneaks through to our innermost core. Most do not. But as I'm about to divulge, when they do, they leave a lasting impression.

Rick (not his real name) met me when I was a new nurse practitioner, and certainly naive' to rules and regulations for organ transplants. Rick was a novice, too. He had obtained his transplant meet and greet folder, but hadn't opened it. He thought, given the nature and course of his disease, that he had plenty of time. He didn't.

He soured quicker than an overripe banana in midday sun. Consequently, my learning curve on transplant referrals went through a very rapid adjustment. Rick was quickly placed on 15L of high-flow oxygen, enough to curtail activity, but not enough to slow his zeal for life. His optimism in the face of grave adversity haunted me morning, noon, and night. Subsequently, every spare moment was spent making calls to obtain an immediate assessment for transplant.

My enthusiasm paid off, as I found a tertiary center willing to take him almost immediately. They could fly him out that nite! I knew the odds, and so did the center that accepted him, but we were hopeful. How could we not be? This was Rick, and if anyone deserved a chance to make it on WILL alone, it was him!!

Rick died on the table, awaiting his fresh new organ. The pain I felt upon hearing the news was traumatizing, unforgettable, and completely my own fault. I had let him in. I had stepped outside the topography of caring, and I would carry that grief with me always. To this day, there isn't a week that goes by that I don't remember his will to survive. I stand a little taller, focusing on life and living, and what an honor it had been to know him. Tears are shed, but I know he would laugh, and ultimately forgive me.

I learned from Rick that caring can be too much sometimes. We need those boundaries for self care, as well as for sanity. Did I learn my lesson? Maybe. Have I let other patients get too close since that time? Yes, yes, and YES!!! Will I do it again? Without a doubt.

What about you? Have you let one in?

Poll: How do you feel about getting close to patients? Do we need limits? Yes, getting too close to patients is a risk.|No, this situation is integral to nursing. We need to learn how to handle the downside.|It differs. OR nurses may be less likely to have this happen than Oncology or Hospice RN's.|
About This Blog

Diane M. Goodman, APRN, BC, MSN-C, CCRN, CNRN, is an acute care nurse practitioner who has worked in many different capacities in healthcare. With more than 30 years of experience in critical care and medical/surgical nursing, she has gained an immense amount of insight into the human and patient experience and an unrelenting passion for the practice of nursing. Her sense of humor and ready wit have assisted her in writing about nursing topics in multiple venues. She is currently certified in neurology, gerontology, critical care, and pain management Diane is a full-time nurse educator for Advocate Condell Medical Center in Libertyville, Illinois and she also works as needed as an acute care nurse practitioner for a busy pulmonology practice.

She lives in Kenosha, Wisconsin, with her husband and several furry "children" (Chihuahuas), who are gracious enough to allow her the time to reflect and write.

Disclosure: Diane M Goodman, APRN, BC, MSN-C, CCRN, CNRN, has disclosed no relevant financial relationships.Poll: Have you encountered a situation where a simple "I'm sorry" or "it's my fault" might have changed the patient/family response? Take our poll! Yes, I should have owned up to my responsibility.|No, I have always been able to defend "my turf" appropriately.|I'm not sure, good thoughts but the outcome would probably be the same.|Other|

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