The following is a (not so short) true story, written by for a nursing course during my Bachelor's degree program at the University of Phoenix.  It is about one of my dearest patients and our relationship as her case manager for Hospice of Arizona.  It is written in a way that nursing theorists explained nurse/patient relationships.  

Her Name is Rose

Pamela Rudolph, RN

NUR/403

02/15/10

Jean Watson’s philosophy of transpersonal caring is a focus on the humanistic approach to life. Chitty (2005) stated that Watson “issued a call for a return to earlier values of nursing and emphasized the caring aspects of nursing” (p. 277). By proposing her 10 carative factors she attempts to differentiate nursing from medicine’s curative nature. These carative factors include the development of a helping-trust relationship, cultivating sensitivity to one’s self and others, the instillation of faith and hope and a promotion of interpersonal teaching-learning. She addressed the need to view nursing as a human-to-human relationship. According to Watson, nursing should also be concerned with the spiritual matters and the inner knowledge of both the nurse and patient. She equates health with harmony. Health is described by Watson as unity of body, mind, and soul and that illness was a result of a lack of any these. Watson concurred that nursing should be based on human values and interest in the welfare of others, and include health promotion, restoration, and prevention of illness (Chitty, 2005).

Sometimes the life of a nurse is touched by those we help. We often ask “why have I met you?” or “what brought us together?” Often we cannot ask these questions, as we know that the spirit world is far greater than what we can imagine. It may not be coincidence that brought us together. The life of a hospice nurse is forever changed by the people she meets. Unlike hospital nursing, our relationships often last for a long time. A caring moment in hospice can turn into so much more than just a moment. Such is the case of Rose. Rose is an 80-something year old woman who lives alone, has been without her family close by for more than 10 years, and has been without her only husband for over 30. Raised a strict Catholic by relatives, she stayed home and cared for a son and her husband until his untimely death, which forced her into the world to become a career woman and single mother. However, this also leaves her alone to manage her terminal disease.

I was called to care for Rose in August 2008. Her current condition was related to cardiac illness. Although she can continue to live alone, she must be careful – her fatigue, blood pressure and dizziness create risks she is not familiar with. The development of a helping-trust relationship is important in this situation because of her independence. Although a health professional, I am practically a stranger to this strong woman. I must learn all I can about Rose to gain her trust. It is possible she knows more about her body and her illness than I do, and she may not accept the teaching and advice of a young nurse. It will be important that I develop trust by letting her teach me what she knows. Through the course of our relationship, we engage in dialogue. She is able to get to know me by asking questions, and I am answering as honestly and professionally as possible. I know I have successfully developed this helping-trust relationship when Rose can open up more about her symptoms; and also when she asks me to change a light bulb. She has been saving it just for me since my last visit.

Cultivating sensitivity to one’s self and others can be achieved in this relationship by allowing Rose to teach me about her religious beliefs, and how they relate to her terminal illness and her eventual death. I am also sensitive to her needs and condition by allowing her to remain as independent as possible through the course of her disease, while advocating for her health and safety. I cannot force this home care patient to live by standards I have set because of my personal expectations. Instead, I know that to promote health, this patient will thrive in her own habits.

When Rose is allowed to remain as independent and in control of her life as physically possible, I am instilling faith and hope within her. By acknowledging how well she continues to remain independent (or assisting her when she cannot, for instance holding her hand as she takes a step down, or changing that light bulb). By using positive reinforcement in her judgment (for instance NOT to drive when she is ill), I am allowing her to continue to make decisions that give her the hope that she is may not be dying - yet. She has faith in herself, in her decision-making process, and in our relationship. Rose also keeps her faith in God.

The teaching and learning process is more than just a two-way conversation. What the patient already knows, versus what she needs to know about her illness is important. Her current symptoms and medication regimen and how they relate to her disease also give me the focus of her education. Once I have determined what Rose knows about her body, her past medical history, and how she has handled illness in the past, I can understand how to teach her about her current symptoms and illness. As her condition changes, as her medications change, I can provide patient-friendly material. After explaining and demonstrating each of the medications, together we put them in her medicine kit. Reminders of when to take her medications are placed in common areas of the home. Home safety is discussed, and again demonstrated. Because she lives alone, we set up the use of a Life Alert system, then discuss and demonstrate its use. We do this often, to reiterate and re-educate.

In today’s nursing profession, “the concept of a human care function of the nurse is threatened by the technology, the machines, the high intensity pace of management, the administrative tasks, and the manipulation of people required to meet the needs of the systems. Preservation and advancement of human care is a critical issue for nursing today in our increasingly depersonalized society (Watson, 1999, p. 28). This statement is true in the home care setting, making it more difficult to establish a humanistic-altruistic relationship. We are held to certain boundaries. However, this last experience with Rose makes my position as not only her hospice nurse but her friend something that I will never forget.

Hospice nursing often gives us the opportunity to be a volunteer. During off duty hours (for which Nightingale believes nurses are still responsible) we can provide non-nursing opportunities between nurses and patients. As Rose’s nurse I am privy to some of the most enjoyable times of her last days.

Before her last birthday, Rose had been keeping a schedule of spring training baseball games, and would often mention how she would love to go to a game but did not have a way to go, and had never been to a game since moving to her home. It just so happened that on her birthday, it was Senior Player Day, when retired baseball players played a fun game in the sun. I surprised Rose by picking her up to go to this game. Prepared with a wheelchair, a black marker and a baseball, we headed off to the game. Little did we know there would be famous players there – but that’s why we had the marker and baseball! One player - Bob Feller – was someone she actually recognized from her home town. Instantly we were taken to the front of the long line for an autograph and photo opportunity. This little lady shined under her ball cap! Shortly after the game started, Rose requested a special diet: A beer and a brat! This is one opportunity this nurse was not going to miss. Neither was the opportunity to tell the staff that today was her birthday, so during the seventh inning stretch, she was asked to stand and wave, and the entire stadium sang ‘Happy Birthday to Rose’.

Although I was not Rose’s nurse on this day, we were performing what would promote her health and happiness for one more day. Her smile, her energy, and her spirit had been lifted to a degree it had not seen before. Since then Rose has taken day trips to the Botanical Gardens, the Zoo, and senior concerts in her neighborhood. She understands that although she is the bearer of a terminal illness, she does not have to live in a secluded environment waiting for her time on earth to end. Now Rose even has that picture with Bob Feller at her bedside!

Rose and I both know that her disease is progressing. She has begun to slow down, her breathing is more difficult, she is now easily fatigued. She understands she cannot outlive her illness, but is learning to live with it. Rose accepts more help from friends, from other hospice team members, and from the community. Her meals are being delivered, and she takes the bus to church. She has realized that her time is limited more than ever before, and with her faith she is accepting it peacefully.

I wonder if I have accepted this progression toward her eventual death. I know that as her nurse, our time together has always been limited. It has always been a temporary relationship. But in the grand scheme of life, all relationships are meant to be temporary. We are to take what we have been given and we are to learn and grow from every opportunity. Although Rose is learning about her disease progression and how to live with it, I am learning that this woman and I have much in common. Rose and I are both single parents of one child. We are alone but not lonely. With our careers, we have learned to be independent, yet dependent on others too. Each person dies in their own way, in their own time, according to his or her own personality. When we part, I know Rose will be at peace, she will be happy, and she will be comfortable. Because I will be by her side – if she will allow me to be.

My relationship with Rose continues today. There have been difficult moments that I fear were the result of our relationship becoming too close. Rose began to depend on my attention as her nurse at times that I was off-duty, and rather than calling the available staff, she was unsuccessful in reaching me. I have had to reiterate to her the importance of her entire health care team to provide the support that she needs, and also to depend on friends and family as well. I have had to rethink this style of nursing, of my altruistic methods for other patients to avoid losing the trust of the patient.

“Walk with me to the water,

when it comes my time.

What we say will not matter,

just keep your hand in mine.

I’ll cross the water by myself, I know that’s what I must do.

But the chilling sting won’t be felt,

because I’ve walked with you.”

Nellie Keller

References

Chitty, K. K. (2005). Professional nursing concepts & challenges (4th ed.). St. Louis, MO: Elsevier Saunders.

Karnes, B. (2008). Gone From My Sight. Barbara Karnes Educational Material. Retrieved from http://www.gonefrommysight.com/theEleventhHour.html

Karnes, B. (2008). The eleventh hour. Vancouver, WA: BK Books.

Watson, J. (1999). Nursing: Human science and human care, a theory of nursing.

**Update, February 15, 2022

It has been 12 years since this document was submitted, and almost as long since I have seen Rose.  After the paper was finished, Rose took a couple of bad falls leaving her son with no choice but to put her in an assisted living facility. One that would have more things for her to do while she recovered from her head injuries.  While Rose was in the hospital the last time, I visited her.  But this visit was unlike any of the other visits we had together during the previous 3 years.  This is where I think the boundary of the nurse ~ patient relationship becomes important, for no other reason that impartiality.  I was angry with her for getting herself into this predicament.  And she was worried about me, and how I was going to feel.  The visit was uncomfortable, and not without tears.  I was also sad that I couldn't have saved her from this last fall.  And that she hadn't heeded my warnings, my instruction, my safety measures.  She didn't need to wear her Life Alert button all the time.  No, she left it by her bed because, according to her, that is where she always fell.  Not this time.  It was a hard fall on the bathroom tiled floor.  No one could come to her rescue right away.  Not for hours, until someone knocked on her door, and she crawled to answer it.  Independent people are so used to doing things for themselves, that they forget to do things for themselves.  

I didn't have the heart, the courage to tell Rose that I was moving with my family to another state.  I didn't have the heart, the courage, the boundary to professionally end our relationship.  So I took the (not so) easy route.  Rose went to a facility away from my nursing area, and I was moving.  It was best left there.  I never went to see Rose again.  I am not sure which heart breaking way was the right way.  

Several years and several "How's 'Rose'" questions to my coworkers later, I learned that Rose had passed away.  She actually outlived the average length of a hospice stay, while living in the assisted living facility!  I was quite proud of that.  No one guarantees a hospice patient will live less than six months.  Rose outlived it while with me.  However, had she been left at home alone, without friends, meals, and more care, she may not have lived much longer.  

She attended my college graduation with my family and I, and told me how proud of me she was.  I, too was very proud of her.

Georgene Rose Frank died on April 1, 2018 under Hospice Care at Banner Del E. Webb Medical Center, Sun City West, Arizona surrounded by her loving family.  They were deeply appreciative of the wonderful care she received through the medical staff.

The celebration of Georgene’s life and Funeral Mass took take place at Prince of Peace Church, Sun City West, Arizona on April 10th at 10 am.

Burial took take place at Calvary Cemetery, Racine, Wisconsin on Friday, April 13th preceded by a blessing at at the Calvary Cemetery Chapel.

Georgene was born in Fond du Lac, Wisconsin on February 22, 1922. Since birth, due to her mother’s (Alma Lynch) illness and death, she was adopted by her aunt and uncle and called them Mother and Dad and their children her brothers and sister. All preceded her in death. Her only natural sister, Virginia Freund died in 2001.

She is survived by one son, Robert (Joan), two grandchildren Robert (Alexis) and Cristina (Eric) Wittman, one great-child, Amelia Frank and numerous nieces, nephews, cousins and friends. Georgene graduated from St. Catherine High School in 1939 and retired from Twin Disc (Twin Disc, Inc. designs, manufactures and distributes power transmission equipment for a wide range of applications, including marine, off-road  and industrial vehicles) in 1982.

She married Robert Frank August 5, 1943. He died September 29, 1974.

She belonged to St. Edward’s Parish for over 50 years and volunteered at Harmony Club and at All Saints Hospital in Racine. Georgene moved to Sun City West, Arizona in February 2002 and joined Our Lady of Lourdes Church and joined several church groups and clubs in Sun City West – Musician’s Club and Theatre West.

**My final thoughts about this fine little lady.  Rose loved stocking up on light bulbs, toilet paper, paper towels.  She had no problem running around the house sans clothing, even at 80+.  And she taught me how to love Kringles - the best danish in the world, made right in her home town of Racine.  Being from Racine, she was able to watch the Legendary Ladies of Baseball - the Racine Belles.  The Racine Belles were one of the original teams of the All-American Girls Professional Baseball League playing from 1943 through 1950 out of Racine, WI.  

We were meant to meet each other, I know for a fact.  I learned alot about her, and myself.  I'll always regret not saying good-bye.  That seemed too final.  I'll cherish our time together (even going to Wal-Mart and "Say-wAY" - an inside joke)