Clinical placements

We can only give holistic care if we look deeply at our patients’ lives

During a clinical placement on a stroke ward, I spent a day in the transient ischaemic attack (TIA) clinic to get a rounded view of the service.

During a clinical placement on a stroke ward, I spent a day in the transient ischaemic attack (TIA) clinic to get a rounded view of the service.

I was accompanying an older man, who had experienced a TIA, to a follow-up appointment. After spending time talking with him, I learned the TIA had occurred after a long day’s driving, and that as the sole carer for his wife, he had been surviving for several years on less than four hours’ sleep a night.

None of his hospital care had addressed the emotional strain this patient was under in his caring role, with advice focusing on improving his physical condition by addressing his blood pressure, medication and diet.

The patient was reluctant to ask for help in caring for his wife, because he felt it would not be of the same standard he could provide. He absorbed the daily struggles as an act of love, and considered that his suffering was nothing compared to that of his wife.

Although he did not want to accept help, I was able to discuss the options with him, including home help and respite care, and to direct him to resources for help in the future.

In university, we are taught about the importance of holistic care, and that we must look at the whole person. Yet so often due to time constraints, or other factors such as emotional exhaustion, our conversations with patients are brief and superficial. They focus mainly on medical symptom management, without truly assessing the root causes.

It is common practice to educate patients by giving lifestyle advice, and treating problems medically. But if we don’t scratch below the surface to understand the forces shaping peoples’ lives, we can miss vital opportunities to support patients, and end up imposing unrealistic regimes on people who are already doing their best to cope under extreme pressures. There is little point in advising a person with diabetes to avoid sugar if they crave sweets because they are depressed, or telling someone who has turned to alcohol because of abuse to cut down their intake for the sake of their liver.

Nurses are often the first line of help when people can no longer manage for themselves. In many ways, we are best placed to get people the help that will make a difference, but if we never ask questions or probe deeply enough, we will never know what it is they really need. All we can then offer is temporary relief at best.

The patient seemed to find it cathartic to talk about his life and his experiences, and I learned just how many opportunities to help him had been missed by previous healthcare staff.

If we are to provide truly holistic care, we must take every opportunity to talk to our patients, looking beyond the obvious physical symptoms to see the whole person.

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