"If I could have three wishes for qualities in which I have always been deficient I would wish for: Keen observation and perception; An excellent memory; More affection for the individual person."1(p.26) With these words, Lavinia Dock ended her brief biographical essay, sent to the American Journal of Nursing in 1932 and finally published in Nursing Outlook, January 1977. Who was Lavinia Dock and why are her words particularly relevant today?
Lavinia Dock-nurse, community health advocate, suffragette, author of the first nursing textbook, and historian-is a role model for the ages. Educated at Bellevue Hospital School of Nursing in New York in 1884, Lavinia Dock worked at Johns Hopkins Hospital in Baltimore, at Cook County Hospital in Chicago, and at the Henry Street Settlement in New York where she claims she first learned to think through her association with Lillian Wald, the founder of Henry Street and the community health nursing movement. Dock cared for immigrants in the tenements of New York City where she learned the deep relationship between health states and the way people live.
How might Lavinia Dock's self-proclaimed deficiencies give direction to the culture of nursing and how we all contribute to it? Keen observation and perception-what do we see when we look at patients and families? As nursing has enhanced its clinical prowess through precision assessment and technologically enhanced monitoring, are we concomitantly losing the ability to "see" beyond the presenting problem? Nurses who work in community-based practices or in home health care get a more comprehensive picture of the social determinants of health and illness if they chose to "see." For example, a nurse practitioner in our college-associated health center wrote script for a home visit for a patient who had missed 3 appointments. The home visit revealed that the patient's living quarters had been moved to the second floor of an apartment building. The patient was wheelchair bound and too proud to let anyone know that he could not get down the stairs. The health center leaders made a few calls and the patient was moved to more suitable quarters. In this case, the nurse practitioner's perceptions of her patient resulted in bringing the patient back to care instead of allowing him to fall through the cracks.
An excellent memory is invaluable to a sensitive, caring clinician. Remembering the details of the patient's story or family history builds trust and indicates to patients and families that they have been heard. There are certain patients who make indelible imprints on our memory; think about who they are and why they might be so memorable.
Finally, Lavinia Dock wished that she had had more affection for individual patients. My guess is that she had the same regrets that we all experience in a career of caregiving-we did not take enough time, we did not listen as attentively as we should have, we were not "present" with the patient through difficult times, or we were too busy to answer the families' questions. Getting caught up in the clinical whirlwind of care can interfere with basic human interaction that is so necessary to healing. To have affection for patients is a direct expression of loving the work of nursing. Lavinia Dock's retrospective is a good reminder of what really matters in the trajectory of a nursing career.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
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