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AACN News—November 2008—Opinions

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Vol. 25, No. 11, NOVEMBER 2008

President’s Note



Gratitude. Hope. Confidence. And, yes, Acorns.

The gift we can offer each other is so simple a thing as hope.
- Daniel Berrigan

We’re right in the middle of a high-energy season. Post-hurricane recovery. Economic upheaval. National elections. Thanksgiving. Winter holidays. Sometimes it’s positive energy. Sometimes negative. Either way, the season focuses our attention and reestablishes the reassuring cycle of gratitude, hope and confidence.

Our Canadian colleagues may be onto something. They celebrate Thanksgiving in October, just a little earlier than Americans. But have you ever wondered why gratitude generally happens after the fact? What if it became an ongoing part of our journey instead of a destination?

Here’s my thinking.

If we hadn’t withheld gratitude until something happened, we might have started the hurricane season by thanking the talented and caring health professionals who would care for the injured. We would have appreciated our financial gifts, however modest, while we enjoyed them before a rattled economy took some of them away. We would have recalled with thanks that our sometimes annoying electoral campaigns cannot happen in many countries.

Gratitude focuses us in good times and bad. Whether our gratitude is low key or exuberant, it renews our sense of hope. Hope, after all, is our stock-in-trade as nurses, isn’t it? Our patients and their families count on us to bring them hope. Hope that pain will be eased. Hope for a cure. Hope for a peaceful death. Hope that they will never be alone.

Hope, in turn, bolsters our confidence. Confidence that we can return the love and caring of our family and friends. Confidence in our AACN community where people of similar interests and like minds come together. Confidence that, without the gifts we bring to ourselves and those around us, the world would be a very dreary place.

The acorns? From my desk at home I can see a small pot with the branches of a germinating acorn. It was a gift from the AACN national staff after they saw the art for this year’s With Confidence theme. I’m sure you noticed how the art prominently features oak trees and the acorns from which they grow. Both are ancient symbols. Some people describe acorns as symbolizing “the potential for great power in a small but potent package.” On a humorous note, botanists joke “even the greatest oak was once a little nut.” For me, acorns represent endurance, strength and hope for the future.

Thank you for the extraordinary gifts you bring to our work and the hopeful confidence with which you share them. I am deeply grateful for your example.

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Members Weigh in on Moral Distress

In September I encouraged readers to reply about moral distress, which described an elderly patient who declined end-of-life care and the resident who continued intervention treatment because “He reminds me of my grandfather.” I’m happy to report that many of you took my challenge to “continue a confident dialogue with the resident.” Your opinions, views and anecdotes about end-of-life patient care and the incumbent moral distress it engenders showed such sensitivity and wisdom. Here are some quotes from your posted comments. To access my September column along with full-text responses, visit www.aacn.org >clinical practice > publications> AACN News > September 2008 > Opinions. - Caryl Goodyear-Bruch

I'm so glad you are challenging the membership to think of better ways to communicate about end-of-life issues. You are definitely not alone in the example you gave in your President's Note. I think a way to continue the dialogue with the resident could be to ask, “So am I hearing you say that even if this were your grandfather, you would ignore his wishes because you don't think your interventions are futile? Or are you saying that because he reminds you of your grandfather, you find it difficult to stop trying because you think you would be failing him?”

Linda Martinez

A doctor confessed to me that he did not believe in life after death, therefore he could not let his patients die. I told him he had to remove his feelings, beliefs, etc. from the picture and just listen to the patient and family. The family also acted as a strong patient advocate with my encouragement.

Allie Sment

Suggest to the resident, “Imagine that the patient really is your grandfather but you are not his doctor. Instead another physician is taking the same actions in treating your grandfather that you are taking with this patient.”

Rosemary Smith

A frank, open discussion works best. We describe what heart, kidney, liver failure (or whatever condition the patient has) is and why it might be difficult to recover. We then ask the family to describe what would be a meaningful recovery. We are always open to dialogue with family.

Lisa Czyzniejewski

I would engage the resident about respecting the patient's request and taking that conversation to a level where we can each say what we think or feel or both ... I would try to make this resident know that I, too, take care of this patient “like he is my grandfather,” but it is not about us, the caregivers; it is about THE PATIENT.

Louise Ann Meehan

I am an ICU nurse in a small hospital. I have encountered moral distress on several occasions. It truly puts a burden on me and makes me wonder if maybe I should move on to other things… To this day I cry when I think of one particular patient and how hard it was on me and some of the other nurses when we were trying to honor her wishes.

Diane Huddleston

When I first started working in the ICU I was plagued with moral distress on a daily basis … I then joined the ethics committee to learn more about dealing with ethical dilemmas on our unit. I learned about the ethics committee consultation process and how the multidisciplinary committee functions to offer support to families and staff. I hope that all hospitals have such a committee … Over the last 15 years there has been quite a paradigm shift on our unit. I want to believe it is because of my persistence.

Patrice Hastings

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