AACN News—September 2003—Opinions

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Vol. 20, No. 9, SEPTEMBER 2003

President's Note
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 Dance)

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 imagined.

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 knowledge.

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.

Be Attentive
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.

Be Intelligent
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 end-of-life care?

Be Reasonable
�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 death?

Be Responsive
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 assignment request?

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?

Suggested Reading
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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