Rising Above: New Questions, New Opportunities:
Is It a Snake or Is It a Rope?
By Dorrie Fontaine, RN, DNSc, FAAN
[He] explained that in the dark, you see a
snake, you scream. But when you have a light, you see it as a rope. Sometimes we
see a person as a snake, whereas she is only a rope. When I change my perception
of the situation, my anger is transformed.
�Sri Chan Khong (cited in Rupp, The Cosmic
For me, rising above means seeking a new
level of consciousness to objectively and truthfully see current reality for
what it is. And what it is not. It means arming myself with better knowledge,
using it from a position of confidence and strength to focus on solutions or
courses of action that will make an enduring difference.
I rise above each time I step back from the
thick of a situation and take in what's happening from a different perspective.
Sometimes rising above is as uncomplicated as shining light on a coiled object,
only to discover that it's a life-saving rope instead of the deadly snake I
However, rising above isn't so simple when,
despite my best efforts, a persistent and complex challenge doesn't change. I'm
finally learning that this is a signal. A signal for me to overcome
well-conditioned reflexes and consider the challenge from another angle.
One of the complex, persistent challenges
of high priority for AACN is ensuring that every critically ill patient who
needs palliative and end-of-life care receives it. AACN has made this a high
priority because, in Virginia Henderson's words, our unique function as nurses
is to assist people to achieve health, recovery or peaceful death�activities
they would perform unaided if they had the necessary strength, will or
Over the past months, I've sought to master
a practical way to approach these knotty situations�one that spells the acronym
AIR2 and prompts me to be Attentive, Intelligent, Reasonable, Responsive. Let's
use the AIR2 framework to look at this issue from AACN's perspective as a
community of nurses and from my perspective as an individual nurse.
A word of caution before we begin. Walter
Burghardt, the master communicator and Jesuit priest who adapted this framework
from the work of Bernard Lonergan, warns that this approach will not remove all
doubts, all difficulties. Nor does it even guarantee a response or that everyone
who responds will do so in the same way. But it does get us to consider that the
snake may in fact be something else.
Find out the facts. One of every five
patients dies in the ICU. If the same number of patients were giving birth at
that rate in your ICU, wouldn't I expect nurses' need for expert labor and
delivery skills to climb dramatically? Does my institution support palliative
and end-of-life care everywhere except the ICU? How can AACN translate its
trailblazing work with the Nursing Leadership Academy for Palliative and End of
Life Care so that it reaches individual nurses? Visit
www.palliativecarenursing.net. If I'm attentive, I'll notice the answers paint a
picture of how well my ICU is meeting the needs of patients for compassionate
end of life care.
Thoughtfully transform facts into
knowledge. Ask good questions and expect good answers. How can we support
end-of-life care when family presence during resuscitation is never an option?
Half a million yearly deaths in ICUs mean half a million chances to"get it
right." How often is my unit getting it right? Assume there are 5,000 hospitals
in the United States and that AACN has a dozen members on average in every
hospital. What can AACN do to help those members lead the way in palliative and
�Marshal the evidence, examine the
opinions, judge with wisdom. Not easy to do," Burghardt acknowledges,"especially
when you are not an expert in a field. Hence the need for community cooperation;
the Lone Ranger is an endangered species." Why do we assume a patient receiving
palliative care means a lighter load for his nurse? Or is it that a staffing
shortage makes saving a life more valuable than supporting and accompanying a
AACN already is responding."Initiating
Hospice Care in Critical Care" is our new grant of nearly $5,000. And a new
series of evidence-based practice protocols will provide clear practice
implications on topics like communicating with patients, families and team
members at the end of life. How can I respond as an individual nurse? What do I
know about my institution's end-of-life and palliative care services? Would it
make a difference if patients and families at the end of life became my frequent
As a critical care nurse, I measure air. I
monitor its composition and titrate its flow. I position patients to receive an
adequate supply. Now, AIR2 takes on new meaning as it guides me in going beyond
my comfortable yet sometimes ineffective approaches to tough problems. AIR2
prompts me to be Attentive, Intelligent, Reasonable, Responsive. In this case,
AIR2 compels me to reconsider end-of-life care. Is it really a time-draining
snake when we have so much curing to do? Or could it be a golden rope of caring
that reaffirms the value of the life already lived?
Does AIR2 work for you?
Burghardt W. Hear the Just Word and Live
It. Mahwah, NJ: Paulist Press; 2000: 57-60.
Henderson V. The Nature of Nursing. New
York, NY: Macmillan; 1966:15.
Rupp J. The Cosmic Dance. Maryknoll, NY:
Orbis Books; 2002:90.
Retiring With a Broken Heart
I recently retired from nursing at 63 years
of age. Although I did not need to work for the money or benefits, I had planned
to work for a few years longer because of the present shortage and because I
love critical care nursing.
However, I left nursing with a heavy heart
because hospitals, administrations, doctors and even other nurses"just don't get
it." I no longer choose to subject myself to that type of treatment; I choose to
take better care of myself. You cannot treat nurses inhumanely and
disrespectfully and still expect them to stay in the field of nursing.
My heart aches for the good, caring nurses
that remain and have to put up with the poor treatment. Although nurses are
regularly being put between a rock and a hard place with the poor staffing, they
are blamed when something goes awry. I fear for the patients who are in the
hospitals, including in the ICUs and ERs.
Mary Donovan-Popa, RN, ADN
Oak Creek, Wis.
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