Though a rigorous nursing program provides the foundation for the practice of nursing, it is often through encounters with individual patients that one's perspective on nursing is profoundly changed. Evelyn was a favorite patient of mine. I was drawn to her dry sense of humor and warm-hearted personality. Initially, I provided palliative care to her for several months, but her health deteriorated so quickly that she was soon placed on hospice. Given my close relationship with Evelyn, it was difficult for me to watch her decline.
When I filled out Evelyn's admission paperwork for palliative care, I asked the obligatory questions about religious preference, desire for a visit by a religious leader, and if there were any medical procedures conflicting with her religious beliefs. In my mind, as on paper, I had placed the required check in the spiritual care box. For me, the essence of providing spiritual care had morphed into asking the required formal questions, while the act itself had become perfunctory. After all, some patients may feel obliged to be religious, others may have no desire for spiritual care, though some may appreciate the offer and respond thankfully (Williams et al., 2011).
As it turned out, the spiritual dimension in Evelyn's case was, however, much more than a checkbox. During my visits, I frequently witnessed Evelyn's family singing, praying, and reciting Scripture with her. I observed that these actions often brought a smile to her face and appeared to diminish her discomfort. With the signs of death being near, my heart was heavy for my patient and her family, grieving for the impending, inevitable loss. One day, while at her bedside, I did what I had never done before: I asked Evelyn if she would find it helpful if I prayed with her. Having repeatedly observed her family surround her with spiritual care, I thought it would be appropriate to offer and would likely be welcomed.
Not surprisingly, Evelyn responded positively to my question. In her characteristic, cordial manner she responded, "Oh, thank you, sweetheart. Yes." I held her hands and together we bowed our heads in prayer. As the last few days of Evelyn's life passed, I intentionally incorporated spiritual interactions into my visits with her. I would hum hymns while administering her care, and then end the visit in prayer. To avoid assumptions, I would always ask Evelyn if she would welcome spiritual care during my visits. I used her comments and reactions to guide our spiritual interaction. When Evelyn no longer responded to verbal or physical stimuli and with her family's permission, I continued to provide spiritual care to her, which often extended to the family.
It was late evening when I received the call from Evelyn's family stating that she had passed away. As I drove to the apartment to confirm her death, I was extremely sad at the prospect of my last visit to Evelyn. The family was grieving their loss when I arrived. I went about my task of confirming death, preparing Evelyn for removal to the mortuary, completing paperwork, and answering the family's questions. Before I left, I asked the family if they wanted me to pray with them one more time. They nodded in agreement and we bowed our heads together; I expressed gratitude for Evelyn and asked that peace and solace envelop her family.
Losing a patient is never easy. Over the years, the experiences of loss have taken a toll on me physically, psychologically, emotionally, and spiritually. When a patient died, I tried to take comfort in the knowledge that I had provided excellent end-of-life care, eased their discomfort, and helped them die with dignity. Unfortunately, these rationalizations failed to bring consolation. However, the passing of Evelyn was a turning point for me. Instead of feeling overwhelmed by sadness over the loss of a treasured patient, I felt oddly comforted!
I now understand that every time I bowed my head in prayer with Evelyn or her family, I received comfort and strength for myself as well. Every time I had hummed a hymn during her care, my own soul was sustained, also. Through the act of providing spiritual care to this dear patient and her family, I had unknowingly brought solace to my own spirit. Since my experience with Evelyn, I enjoy being a nurse more and cope better with the deaths of patients, an integral part of hospice care. I now know that spiritual self-care, as well as the spiritual care I extend to my patients and their families, strengthens the quality of nursing care I give to others. I no longer just check off the box, but am now passionate about providing whole-person care to each patient.
Not every future patient will be like Evelyn; some may not wish for overt spiritual interaction, and others may desire a different type of spiritual care. Spiritual assessment increases the nurse's awareness of the patient's desires and needs for spiritual care (Taylor, 2011). When the nurse is willing to follow the patient's lead without an agenda of her own (Taylor, 2018), true whole-person care can be realized. Through these interactions, nurses become more attuned to their patient's spirituality. As they do, they may be surprised to experience more personal spiritual solace. Respecting patients' wishes and adapting spiritual care to fit individual circumstances are part of whole-person care and excellence in home healthcare and hospice.
Short-Term Increases in Inhaled Steroid Doses Do Not Prevent Asthma Flare-ups in Children
Researchers have found that temporarily increasing the dosage of inhaled steroids when asthma symptoms begin to worsen does not effectively prevent severe flare-ups, and may be associated with slowing a child's growth, challenging a common medical practice involving children with mild-to-moderate asthma. The study, funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, will appears in the New England Journal of Medicine.
Asthma flare-ups in children are common and costly, and to prevent them, many health professionals recommend increasing the doses of inhaled steroids from low to high at early signs of symptoms, such as coughing, wheezing, and shortness of breath. Until now, researchers had not rigorously tested the safety and efficacy of this strategy in children with mild-to-moderate asthma.
"These findings suggest that a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids," said study leader Daniel Jackson, M.D., associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health, Madison, and an expert on childhood asthma. "Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children."
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