Thursday , May 24, 2018

Vesagas: Target the system, not the personality

RANDOMLY, a video showing a female nurse being verbally berated at the nurses’ station by an exasperated lady watcher and later on was physically assaulted by a man accompanying the watcher has gone viral in social media. The video which ran approximately 3 minutes started with the lady watcher ranting over the alleged poor nursing care received by her family member who had been confined in the government-run facility, where the nurse is practicing as well. Maintaining composure the nurse answered submissively without showing even the slightest trace of hostility. Without any warning, a man, probably at least age 50, appeared in the scene calmly. He approached the nurse who was seated in table and forcibly pulled her identification card. In turn, the video ended with the nurse bursting in tears probably out of shame and the feeling that injustice has been done.

Accordingly, the patient got angry when the nurse allegedly failed to immediately respond to the backflow of her IV line or “dextrose” that outraged the lady watcher causing the scandalous video-gone-viral to begin with.

One of the important elements in this case is the fact that only two nurses on duty for 45 patients confined in the government-run facility.

This story is actually not unusual as nurses almost always experience this on a regular basis whether or not prying cellular phones are available to capture such deplorable encounters between the understaffed nurse and the angry patient for nursing care services delivered late due to understaffing.

Unfortunately, in such encounters, it is almost always the nurse who is at fault. It seems to be regularly taken at the personal level rather than addressing it as a social problem or pathology.

I am always reminded by one topic in sociological theories called, “Sociological Imagination” by C. Wright Mills who argued that “Neither the life of an individual nor the history of a society can be understood without understanding both.”

Simply put, it informs us to think out of the box and to “think yourself away from the familiar routines of everyday life” and “to look at them from an entirely new perspective”

In order to develop such skills, Mills maintains that we must be able to be freed from one context and look at things from an alternative point of view.

Taking the nurse incident as an example, what should have been highlighted as far as sociological imagination is concerned, is neither the nurse allegedly failing to render the expected nursing service on time as in following up the IV line of the patient promptly nor the watchers’ arrogance and ungratefulness to the nurse that was transformed to a harassment but rather to look at the situation from the bird’s eye view and see where society has gone wrong in this context: the unjust nurse-patient ratio!

True that the patient should be attended to without any delay not only by a nurse but also by any medical and paramedical personnel. They have the patients’ bill of rights to which health professionals must conform to in their clinical practices. In Med and nursing schools, one principle that is always emphasized is to place the needs of the patients first above anything else.

True as well that nurses are also humans. They have physiologic needs like going to the bathroom, getting hungry and thirsty and all even during the tour of their duty. The human body could only do so much within its normal limits. A principle in a health profession which is a helping profession states that one has to be healthy in order to promote health. One cannot give something which is missing from one’s self. A parallel truth is the fact that nurses are not robots; they have mortal-like weaknesses and flaws which are most evident in the limits of their human body. And like the principle of wear-and-tear, a human nurse can also exhaust herself of energy and the ability to function.

These are some enumerations of facts as far as philosophy, psychology and physiology are concerned. But when taken at the sociological level, another focal point emerges: the social context where the social actors are found.

In this scenario, fact hold that the nurse was overburdened with the 2:45 nurse-patient ratio. Try to imagine a hospital ward with 45 beds fully occupied by patients with different clusters of diseases and human sufferings. All these patients have their own schedules or rations of medications that may range from simple pills or tablets to the sophisticated medicines that are incorporated in the IV lines or are injected in the muscles, fat tissues or skin of the patients. Also, try to imagine being in a ward crowded with different watchers who seem to behave more “toxic” than their patients by being more demanding that their patients receive the medicine on time as ordered by the physician in the chart as it is their “right” and it is the nurses’ responsibility of administering the medicines on time while observing the “20Rs” of medication administration. Likewise, try to imagine the possible different nursing procedures ordered by the doctor to be performed on the patient or patients on a particular time. Lastly, imagine, how the nurses is being “judged” by their ability to carry out all these responsibilities within the limits of an 8 or 12 hour shift. Can you still imagine them going on a toilet break? On a lunch break? Or even on a short coffee break?

It all boils down again to one social truth: for nurses to deliver quality services which in turn is evaluated by a satisfied patient, there has to be a just nurse-patient ratio. This is the root of the problem. The harassment experienced is just what is called a “latent” manifestation of the real social problem. The problem here is the system: not the social actors who are also victims of the circumstance.

Unless the social problem - unjust nurse-patient ratio - is addressed, there will be more of this incident gone viral may appear in the future. In my opinion, this incident is nothing new. What is new however, is that it has gone viral with the aid of technology. I do believe that is problem has been existing with the nurses being mute on this matter for the longest or chronic time.

Therefore, we should target the system and not the personalities.