I am not a paediatric nurse but as a parent I sometimes have opportunities to admire the skill of paediatric nurses who make a difference in the lives of children and their families, by putting young patients at the centre of decisions about their healthcare. It was during a hospital visit with a family member a few weeks ago that I started to think about what it means to share decisions with patients and how important even the small decisions can be. During the visit I was observing a nurse who was working in the “infusion room” within a large Children’s Hospital, and I witnessed the ease with which a decision was seamlessly shared between a teenage patient and the nurse regarding the “routine” task of inserting an intravenous (IV) cannula.
As we all know, having an IV inserted for an infusion can strike fear into the hearts of adults, so developing the skills to help children cope and even adapt to this experience is no small achievement. On this day, a nurse approached an anxious teenage boy to insert an IV cannula for an infusion which was to run over the next few hours. In all honesty, I was expecting the nurse to inform him about what she was about to do and to go ahead and do it. I expected competent practice based on evidence about safe IV cannula insertion. I did not expect that this routine procedure would be either positive or empowering and expected him just to be relieved when it was over. However, on this occasion the nurse invited her patient to guide her practice and to share perspectives about what was best for him. In the space of 60 seconds, the nurse invited her new patient to discuss his preferences for pain relief, describe his previous experience of IVs, explain what he felt helped reduce anxiety and discomfort during the procedure, and to guide her about when he was ready for the procedure to start. In that 60 seconds the nurse gained his trust and the patient shared some control over what was happening to him.
What I was reminded of in that short encounter was that nurses who creatively use strategies to put patients in the centre of care achieve so much more than the completion of a task. They turn everyday care into positive and empowering experiences for patients and families. This nurse demonstrated that taking a little extra time to share decisions with young patients can empower them and may even prepare them to cope with much bigger health decisions in the future. Giving young patients a voice about the little things may help them find their voice when the stakes are even higher.
The phrase “no decision about me without me” 1 can be played out at all levels of decision making from the simple to the complex. No matter how small the decision or how routine the procedure, nurses can create opportunities for patients to be in the centre of the decision making process.
One final thought – perhaps there is no such thing as “routine” care when there is genuine patient-centered care.
- Department of Health Equity and Excellence: Liberating the NHS White Paper Cm788. 2010 July 10 https://www.gov.uk/government/publications/government-response-to-the-consultation-on-proposals-for-greater-patient-involvement-and-more-choice
Allison Shorten RN RM PhD
Yale University School of Nursing