Listening to Patients Today

1. Listening to Patients Today Walt Whitman’s The Wound Dresser Reconsidered 18th Annual Conference of the European Health Psychology Society Helsinki, June 2004

2. by • Mark A. Hector, University of Tennessee • Sandra P. Thomas, University of Tennessee • Howard R. Pollio, University of Tennessee • Judith H. Hector, Walters State Community College

3. Listening in a Nursing Setting • 2002 book of research summaries using patient narratives • Applies insights from phenomenology to the process of nurse/patient dialogue

4. Phenomenological Interview• Presuppositionless starting point• Suspension of the natural attitude• Life-world and being in the world• Phenomenology as the achievement of knowing• Structure of intentionality(Intro. To Phenomenology, Moran, 2000)

5. Context: Nursing Amid Turmoil in Health Care Delivery • Increasing cost • Fewer nurses • More technology • Patient’s negative views of hospitals (cold, frightening, lonely, confining, long waits when help is needed)

6. Patient’s Experience: Complex, Urgent, Ambiguous Living with-- • Chronic pain • Recovery after a stroke • An implanted defibrilator • Daughter’s eating disorder • Wife’s postpartum depression • Staying out of the abusive relationship • Wresting meaning after spiritual distress

7. Advice on the Phenomenological Interview • Ask the open-ended question. • Do not interrupt, nor interject agreement/disagreement, approval/disapproval • Gently encourage to continue. Allow silence and time to think • Pick up on the last phrase and ask for elaboration. Summarize what you have heard.

8. “ ‘Being with’ a patient is often as significant a role for the nurse as ‘doing for.’ Sometimes it may be even more meaningful simply to be with the patient as a person, as one human relating to another.” (Thomas and Pollio, 2002)

9. Then—the infancy of nursing • Nursing in the mid-1800’s was a menial pursuit with no training required • Crimean War (1853-1856)—Florence Nightingale was asked to provide nursing for British soldiers

10. American Civil War (1861-1864)—Whitman, a self-taught nurse

11. Whitman: “Life among 50000 Wounded and Sick” • December, 1862-- brother wounded • Experiences the battlefield after finding brother • Experiences field hospitals and transport to Washington, D.C. • 2 years of almost daily nursing

12. Whitman to his mother—”Upon a few of these hospitals I have been almost daily calling as a missionary, on my own account, for the sustenance and consolation of some of the most needy cases of sick and dying men…One has much to learn to do good in these places…Here,…I like to flourish…I can testify that friendship has literally cured a fever, and the medicine of daily affection, a bad wound…”

13. Whitman and Phenomenological Listening • The soldiers described their experiences and Whitman listened, took notes, and shared these descriptions through letters and newspaper articles to promote knowledge and understanding. • Whitman described his own “being-in-the-world” as a nurse and healer

14. Excerpt from Wound Dresser poem “Bearing the bandages, water and sponge, Straight and swift to my wounded I go, Where they lie on the ground after the battle brought in, Where their priceless blood reddens the grass, the ground,”

15. “To the long rows of cots up and down each side I return, To each and all one after another I draw near, Not one do I miss,”

16. “Or to the rows of the hospital tent, or under the roof’d hospital”

17. Palliative Care of the Dying “Hard the breathing rattles, quite glazed already the eye, yet life struggles hard. (Come sweet death! Be persuaded O beautiful death! In mercy come quickly.)”

18. Supporting the Caregiver Whitman—”every day of my life I see enough to make one’s heart ache with sympathy and anguish here in the hospitals…I do not fail…; but often hours afterwards, perhaps when I am home or out walking along, I feel sick and actually tremble when I recall the thing and have it in my mind again before me.”

19. “Mother,…you can have no idea how these sick and dying youngsters cling to a fellow, and how fascinating it is…” “it was a case for ministering to the affection first…I sat down by him…led him to talk a little himself; got him somewhat interested…He has told me since that this little visit, at that hour, just saved him; a day more, and it would have been perhaps too late.” “not one do I miss.” “I am faithful, I do not give out.”

20. Whitman was 43 years of age when he began the experience of nursing soldiers and he continued through 2 years of the Civil War and another 9 years until he suffered a paralytic stroke at age 54.

21. The Poem’s Conclusion “I sit by the restless all the dark night, some are so young, Some suffer so much, I recall the experience sweet and sad, (Many a soldier’s loving arms about his neck have cross’d and rested, Many a soldier’s kiss dwells on these bearded lips.)”

22. Musical Composition: The Wound Dresser • By composer, John Adams • Premier in 1989 • Baritone solo with instrumentation • Words by great American poet, Walt Whitman

23. Adams: “The Wound Dresser [poem] is the most intimate, most graphic, and most profoundly affecting evocation of the act of nursing the sick and dying that I know of. It is also astonishingly free of any kind of hyperbole or amplified emotion, yet the detail of the imagery is of a precision that could only be attained by one who had been there.”

24. Now—Giving Care Adams on his mother’s care of his father—”I was plunged into an awareness not only of dying, but also of the person who cares for the dying. The responsibility is tragic and also incredibly exhausting, and the bonding that takes place between the two is one of the most extraordinary human events that can happen—something deeply personal…”

25. Summary “The Wound Dresser” is a description of what Whitman thought was important to nursing over 135 years ago. The same devotion, sacrifice, and compassion is needed when listening to patients today.