Nursing diagnoses

Mat Matteson, LPN & Geraldine Gorman, RN, PhD
University of Illinois, Chicago, United States (Winter 2011)

Introduction: An inoculation in just time

Manic heart

Mark W. Lubich

Detail of original, Acrylic paint on canvas

21 X 21 inches

 

Ah, the end of the semester. In the best of times it hauls with it taunting deadlines, a gaggle of loose ends, and inevitable self-recriminations. In months such as these last few, marked by strained fiscal budgets, ubiquitous downsizing, and escalating war, it is tempting to question the sustainability of old-fashioned classroom teaching, where risk is inevitable and eye contact unavoidable. In some circles it

is viewed as somewhat anachronistic. For me, it is a lifeline to faith. Each semester from the sea of faces before me, individuals emerge who articulate with stunning clarity what I have almost forgotten, what sometimes I am too tired to feel. As this challenging semester careens to a halt in late November, I take a moment to recognize and name my gratitude for all my students have illuminated.
Ever embarrassed by overly eager “nursing diagnoses” with a reach always exceeding their grasp,

with clumsy syntax that mortifies my ex-English major’s sensibilities, a current student has now provided me with occasion to reconsider. These linguistic oddities are not my personal or professional cup of tea—hell, they still embarrass me—but the fact that they can engender in thoughtful students the opportunity for the productive introspection that makes change possible gives me hope. During this season of thanksgiving, I am grateful to Mat Matteson for a much needed inoculation of faith, however attenuated.

Geraldine Gorman, RN, PhD
Nursing diagnoses

I’m swimming in information and thoughts and feelings today. I finished my first clinical data sheets yesterday, which, in spite of the moments of tedium, I liked more than I thought I would. I think that I’m supposed to enter some grand new realm of “how nurses are supposed to think.” Do I care, really, if I choose exactly the right words in my diagnosis? Isn’t there a way to be more expansive, more descriptive, when trying to sum up the essence of what kind of care my patient needs? These thoughts never quite diminish; still, at some point the rows of columns and stacks of categories of information drift off the page, alive, and I’m grabbing for more books and looking for connections and correlations.

In spite of the restraints of the tools I am using, I do finally experience the point of the exercise. All that data finally points me towards a glimpse of the big picture. The moment I click the “send” button, releasing this information into the hands of my clinical instructor, I more clearly understand why I’m back in nursing school and what I have to learn. I have been engaged in the story of this patient and all the implications of his planning and care, trying to understand what’s going on with him at every level. He is not a set of tasks or even a puzzle; instead I feel tapped into my own potential to be able to draw a blueprint to his better health.

Later, it all breaks open. I go around the block to sit with the folks at Whittier Elementary from 1:30 to 4:30 am. There they are demonstrating 24/7 to keep the Chicago Public School system (CPS) from demolishing the field house and to demand a library for their school. I know about this school, have heard how much its parents and teachers have always advocated for the kind of educational opportunities every child in this city deserves. It is amazing to be able to support them. I pan out from my patient to the community as I sit among these parents, community leaders, and allies of all stripes. I listen to all the stories about the events that led up to this sit-in, and then more stories emerge from folks who have come from Englewood and other neighborhoods.

Similar issues of neglect and mismanagement from different schools add up to form a database related to a larger disease process in my head. Diagnosis one: “Impaired community cohesiveness related to perpetual denial of resources as evidenced by duct tape holding together the walls of the school building and complete lack of library books,” I think, my head addled from the lateness of the night and my recently completed data sheets. Diagnosis two: “Risk for impaired future growth related to gross mismanagement of resources and chronic shortsightedness.” Diagnosis three: “Readiness for improved community coping as evidenced by many community members sharing stories, pitching in, and standing up for the children.”

I realize that this is getting out of hand, but I can’t stop myself. Goal: “Parents will feel more empowered.” Expected outcome: “50% more parents will become involved. Parents and students will verbalize what it is they need from CPS to succeed in school and life. At the end of the week the field house will still be standing.” Interventions: “Show up and sit with the families. Ask what is needed and bring food and supplies. Listen to the stories and learn. Turn, cough, deep breathe.” In other words, help keep this spirit alive. Evaluation: “The community is alive and well, tired but with good spirits.” Maybe this new language that I am learning can help me look at the world around me in a new way, in a spirit of caring and finding what therapeutic intervention it is I have to offer.

I come home and attempt to bring my focus back in to a writing assignment: write about feeling cared for or about doing a good job taking care of someone else. I had the perfect topic in my head last week, a story about a former patient who insisted she couldn’t do anything for herself. She was a woman with no history of impaired physical ability, but who had been labeled with psychiatric disorders. As part of a group effort involving endless patience and lots of limit setting I helped to bring her out of her chair, on her feet, doing things for herself. She screamed and cursed at me all night long as I continued to verbalize what we expected from her.

I didn’t take lunch; I spent half my night sitting with her in the quiet room; I got called every nasty name under the sun. But I kept reminding her that she was in the hospital to get better; part of that was her meeting us halfway–doing what she could do for herself. Finally, many hours later, she walked the several steps necessary to let us help her into bed. The next day, she hugged me and thanked all of us for being patient with her, for trusting that she would rise to her best, which she most definitely did in the days and weeks to come.

A week ago I had some grand idea about what I was trying to say with this story, something about the complicated and unpredictable nature of caring, I’m not entirely sure. Today my little topically appropriate story rests in my hand like a pretty rock as the rest of my body swirls with new information, new synapses trying to form between all the seemingly unrelated aspects of my work, school, and passion.

In the next few sentences, I will imagine my former patient rolling out of the pretty rock in my hand. She looks at me and smiles a crooked smile, then stands up dramatically from her wheelchair. “Have faith,” she says, “if you had as much faith in your community and in yourself as you did in me that day, imagine what expected outcomes might be possible around the next corner.” I flip open my Nursing Diagnoses book and wonder, “Is there a nursing diagnosis for ‘impaired faith?’”

Mat Matteson, LPN


MAT MATTESON has worked as a LPN in geriatric psychiatry and long term care since 2004. She has been a writer of poetry, letters, essays, comics, and the occasional piece of fiction since she can remember being able to put letters together on paper. She is currently a student in the BSN program at the University of Illinois at Chicago College of Nursing.

GERALDINE GORMAN, RN, PhD is an assistant professor in the College of Nursing at the University of Illinois at Chicago. She also practices with Midwest Hospice and Palliative Care Center.

About the artist:

MARK W. LUBICH graduated from the University of Washington with a degree in history. He served as a captain in the U.S. Army and was medically disabled in 1988. He has chronic sarcoidosis, COPD and a blood disorder. He is a self-taught artist who works with mixed media and glass. He incorporates fused glass with mixed media collage and creates sculptural glass pieces. Lubich won several awards, including two gold medals in the 2009 Annual Veterans National Arts Festival. In 2010, Minot State University purchased his fused glass sculpture, Warrior Moon for its permanent art collection. His career is documented in Who’s Who in America 2010 & 2011 Editions. You can view Manic Heart and other works at his website Mark Lubich Fine Art.

 

 

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