The Epiphany: By Jeanine Diaz

In my last clinical rotation prior to my independent practicum experience, I was

challenged to start thinking of myself as “the nurse” and not just a student nurse. Changing my
way of thinking about the way I delivered patient care as the primary care giver really helped me
to apply theory to practice with a more holistic approach. I also found that I started thinking
about what kind of nurse I wanted to be going forward. I always knew I wanted to be kind,
gentle, patient and empathetic, and of course deliver safe patient care, but was there more to
being a good nurse than this? During one of my outside clinical experiences, I remember a
conversation I had with an expert nurse. She shared with me that she was always kind to her
patients, but she was also tuff. She knew what she had to do for her patients, and what they
needed to accomplish in order to get better, so she did whatever it took to get her patients to
reach these goals. I remember her telling me “at first my patients think I’m just being mean, but
they always come back and thank me. Knowing I make this difference in their lives is why I love
being a nurse.” When I think of myself as “the nurse” and who I want to be, I wondered if I
could also be tuff in this sense. I didn’t know that very shortly I would be given the chance to
find out.
On my second to last day of 341 clinical I was caring for a middle-aged female. It was
her seventh day being hospitalized after being involved in a motor vehicle accident. She hit a
deer driving at an unknown speed and lost consciousness. She was lucky enough to have a car
behind her witness the accident and call for help because she was traveling on a backroad that
did not receive much traffic. She was admitted with a dislocated hip, multiple rib fractures, and a
fractured nose and maxilla. A chest x-ray on her fourth hospital day revealed pleural effusions
and atelectasis bilaterally. She was developing this complication from not getting out of bed. She
was currently on three liters of oxygen by nasal cannula and receiving nebulizer treatments to
help her breath. She had a history of prior drug abuse, and because of her high tolerance she was
having a hard time with pain control. I knew my priority was to get her out of bed secondary to
pain control. I also knew I had to teach her the importance of using her incentive spirometer and
coughing and deep breathing exercises. Although these interventions seem simple, and they are,
their impact can make all the difference in reducing her complications and aiding in recovery. I
just had to make her realize this.
As I waited outside the patient’s room to get report her call light lit up. I went in to
introduce myself and asked what she needed. “I need to use the bedpan, please hurry.” I did my
best to get her situated on the bedpan as quickly as I could as I heard the urgency in her voice.
Unfortunately, I was not fast enough as she already had an accident in the bed. I told her I would
be right back as I went to get another student to help me change the sheets and get her cleaned
up. Knowing it caused the patient a lot of pain to change positions, we worked quickly to change
the bedding. As we helped the patient turn to her side she had another accident. She started
crying because she felt so helpless and was embarrassed. “This is so embarrassing, look at me,
I’m pathetic.” We reassured her that she had nothing to be embarrassed of and after several
minutes of convincing she stopped arguing otherwise. I knew at this moment what this patient
needed most, her pride and dignity back, and in her case this could be achieved by simply being
able to ambulate to the bathroom. By making it a priority for the patient to get out of bed and
ambulate to the bathroom I would be applying Benner’s helping role (Benner, 2001). Benner
(2001), explains that a patient can receive help without asking for it, but they can also ask for
help and not receive it. I was determined to help this patient in a way that she did not even
realize she was asking for.
After getting the patient cleaned up, we asked if she would like to get out of bed and sit in
the chair for a while. She was a little reluctant but agreed anyway. Not long after being in the
hallway the patient’s call light lit up again. She was uncomfortable and wanted to get back into
bed. I got the help that I needed to assist her. As we helped her back into bed I kept thinking how
she needed to be out of bed for her body to start healing. I was so used to helping patients by
doing what they asked, but in this moment I realized I was doing the opposite. By doing what the
patient asked, I wasn’t helping her at all. I recalled in my mind the words that the nurse had
shared with me, that she was a tuff nurse and did whatever she needed to do to get her patients to
reach their goals and be able to go home. It was like something inside of me clicked. I knew
what this patient needed to heal and go home, but up to this point I was only doing what the
patient had asked of me. I decided right then and there that I could be a tuff nurse, and in doing
so I would be helping the patient more than they would know. Maybe she wouldn’t realize I was
trying to help her until later, or at all, but I was willing to risk what the she thought of me in
order to get her to heal.
One by one I delivered each intervention I knew this patient needed. I noticed she became
easily agitated, but instead of becoming agitated back I remained patient. I listened to the patient
and found out what motivated her, which was her family. Each time the patient denied an
intervention I educated her on why the intervention was needed and how it would help her, thus
applying Benner’s (2001) teaching and coaching function. After offering the patient this
information I could immediately see a change in the patient’s willingness to cooperate. I
explained to the patient that everything I was doing for her was to get her healing as quickly as
possible so she could go home to her family. It seemed this was just the motivation she needed
because I could see a dramatic change in her effort in everything she was doing. As I got the
patient out of bed and had her sitting up, participating in the use of her incentive spirometer, and
administered her nebulizer treatment, thus applying Benner’s (2001) administering and
monitoring therapeutic interventions and regimens role, the patient was ready to try and ambulate
to the bathroom with assistance. After returning back to her chair I told the patient I was proud of
her and her face lit up. I could tell these little words of encouragement meant something to her so
I continued to use them. I also noticed that the patient seemed to be breathing a lot better and was
not short of breath after ambulating to the bathroom without her oxygen. I retrieved the nearest
pulse oximeter and found that her saturation percent was 96 thus applying Benner’s (2001)
diagnostic and patient monitoring function. I collaborated with her primary nurse to explain my
findings and was then able to wean the patient off the oxygen which meant a lot to her because
she was annoyed with wearing her nasal cannula. In doing so I was applying Benner’s (2001)
organizational and work-role competencies. As I later re-assessed the patient’s lungs I found that
her breath sounds were returning to normal. By the end of my shift, this patient was ambulating
to the bathroom independently, no longer needed her oxygen therapy with her breath sounds
dramatically improving, and she was sitting up in her chair smiling with her family present.
When I came into the room to say goodbye, the patient playfully said to her family “man, this
nurse doesn’t play around, but do you why we get along so well? She gets me.” With that she
gave me a smile. It was at that moment I knew the answer to my question. I could not only be a
patient, caring and empathetic nurse, but I could also be tuff in the sense that I could do whatever
I had to in order to get my patient’s to see their own potential and aid in them meeting their
ultimate goal of healing and going home.
This situation reminds me of a painting titled The Miracle of Jesus Walking on Water by
Clive Uptton (Appendix A). This painting depicts the story in the bible when Jesus asked Peter
to have faith in him and walk on the water towards him. In a sense, this is exactly what I was
wanting this patient to do, trust me. Once I was able to gain this patient’s trust and get her to stop
focusing on the turbulent situation she was in, I was able to get her to focus on the sights ahead.
As Peter sets his sights on Jesus and focuses his attention on what is ahead, instead of what is all
around, he is able to accomplish his end goal of walking on the water and reaching Jesus. When
this patient realized her condition was improving with each intervention I was applying, she
slowly learned she could trust me. With this, her focus was on taking each step she needed in
order to get better and reach her end goal of going home to her family.
References
Benner, P. (2001) From novice to expert: Excellence and power in clinical nursing practice.

Upper Saddle River, NJ: Prentice Hall Health

Uppton, C. (2006). The Miracle of Jesus Walking on Water [Painting]. Retrieved from

https://fineartamerica.com/featured/the-miracles-of-jesus-walking-on-water-clive-

uptton.html

Appendix A
The Miracle of Jesus Walking on Water