Being a nurse in the lower mainland of British Columbia can be tough. We are increasingly confronted with fewer resources, coupled with an expectation that somehow we will be able to do more. An important piece of providing excellent nursing care is approaching all of our patients from a place of compassion. Compassion exists in simple actions like being punctual in appointments, informing patients of delays, or if we are short on time, and focusing on our patient when we are with them rather than checking emails or letting other coworkers interrupt interactions. Compassion is demonstrated to our patients in many ways, such as being respectful, in terms of being kind and transparent, but also by making the effort to learn more about their experiences and to genuinely listen to their stories. The language that we use with clients also demonstrates compassion; taking the time to listen and to use the words that our patients use shows that we are engaged. Compassion can be part of the techniques that we use, the interventions that we make. In my own practice Motivational Interviewing (MI) has become an integral piece of the care I give.
MI has become a central part of what I do in seeking more information in a curious, non-judgmental way, using open-ended questions and reflective techniques. I actively listen to my patients words. Using our patients’ words is also powerful in reflecting the seriousness of certain situations, if they feel like something is important or relevant we are behooved to demonstrate that it is also of significance to us, as care providers. Our compassion can also be demonstrated in us “being there” for our patients, letting them know what our role is and the type of support that we can provide. There is no pressure to fix a problem or try to lure a client towards healthy behaviours through advice giving. I think that MI has led me to slow down in my interactions with clients, and take time to assess their Stage of Change and ask myself, is this the right time to use MI? I continually ask myself, is MI ethical and realistic in terms of helping to provide the patient with the ability to make a change in their current life circumstance? MI has increased my awareness and understanding of the patients’ words, behaviours, and decisions that they make which I may previously have been quick to assume were denial or evidence of them ‘not being ready’ to change, allowing my reframing as normal processes for any human being, understanding the benefits and drawbacks to both changing and to staying the same.
I notice that those around me that practice compassion seem to have more job satisfaction and suffer less burn-out. I also notice that they are less invested in a particular outcome (what some clinicians believe is the “right” outcome) and are more focused on providing support, as working with the patients, regardless of their Stage of Change. I also notice that those who practice compassion have more hope in terms of believing patients will eventually make different, more positive health choices.
I think that sometimes, consciously or subconsciously, practitioners expect something in return for the services we offer, in terms of appreciation of the patient, their family, our co-workers, our supervisors, and the organizations that we work for. However, I think that, in my experience, as I develop my therapeutic skills as a mental health nurse, more and more the reward I receive is intrinsic, in terms of personal satisfaction in knowing that I have done my best to give good care, regardless of the outcome. I believe, in many ways, that I have arrived at this place because of the population of patients that I work with.
I work in mental health and substance use, with those who sometimes arrive to the hospital setting against their will because of mental health issues that they may not necessarily believe they need help with. The patients that I work with offer a range of responses to the care I provide, from being appreciative of the service, to being dissatisfied with the service provided, to being angry about the service provided. I found that focusing on the moment, the relationship, the intervention, and not the outcome, shifted my understanding of my role as a nurse. I was able to let go of wanting to be a savior and an expert by embracing my role as a partner, collaborator, and support to help maximize a patient’s quality of life through helping them understand more about their health. I had come to accept the spirit of motivational interviewing (MI), meaning being the patient and understanding their situation to meet them where they were at, not to try to force them to meet my position.
When we have conversations with our patients in a compassionate way, we have the privilege of being part of our patients’ experiences. We have an opportunity to walk with them on their journey, regardless of their situations and their Stage of Change. Consequently, the relationships that we enter into can change us as much as they potentially change our patients. I think that, as nurses, we have the privilege and opportunity to learn so much about ourselves in conversations we have with our patients. In these moments of open listening we have the opportunity to explore our own values and beliefs.
Over the course of my career I have learned the importance of having compassion, and the difference between being compassionate, understanding and supportive as opposed to feeling sorry for my patient. Embodying the Spirit of MI has highlighted the importance of putting myself in my patients (and often their families) shoes, making the effort to view a situation from the patients perspective with their experience and world view, rather than my own. Over the years I have learned that the rewards in the work that I do must come from within me, rather than focusing on extrinsic gain from the care or service that I give. As I progress in my career I make the deliberate effort to reflect on my own practice and ways I demonstrate compassion in my work. This is part of my daily nursing practice. I reflect on my patient care, but also on the interactions that I have with co-workers, because it helps me identify those I work with who are aligned with my personal values and beliefs, and supports my ability to share personal insights about how shifting one’s perspective, to embrace our understanding of our patients perspective, may be more helpful in terms of being less moral distress, less jaded, less burnt-out, and feeling more satisfied with our work.
Michelle Danda is an RN and has been working in mental health throughout her nursing career. Since early 2017 she has worked at the Carlile Centre which is an Adolescent Concurrent Disorder Inpatient Program (services youth between the ages of 13-18 who are living with mental health and substance use issues). Michelle has been an instructor on an Inpatient Adult Acute Mental Health program at South Health Campus in Calgary, AB and has served as Clinical Instructor for the UBC School of Nursing. She is currently an Instructor for the Stenberg College RPN program and is also part of the NNPBC Mentorship program as a mentor to new graduate nurses.