Saturday, March 04, 2006

Cultivating Depth: The Engines of Compassion

My new friend Ian at ImactED Nurse writes about depth and verticality in nursing. What does this mean, exactly? Ian explains it best:

"I think there are two aspects to Emergency Department work. The first is a horizontal one. It includes all the activities and interactions we perform on autopilot. The mundane day to day work that we skim along not really thinking about. It usually is rushed and stressed and shallow.

"The second aspect is a vertical one. It often opens up in those special moments when you have some deep interaction with a patient. Perhaps it is when you are ‘in the zone’ during an emergency. It is vivid and spacious and rewarding.

"However, the stress and high workload that now flavors a typical shift in the ED makes it difficult to slow down and to sink into any verticality. I usually begin each shift feeling fresh and relaxed… but somewhere around 14 seconds into a busy shift everything goes horizontal. I feel flummoxed, and my mind is speeding 3 tasks ahead of my hands.

"It is important that this vertical dimension should be recognized and cultivated, as it provides a nourishment, satisfaction and integrity in our work. "Integrity" comes from the Latin root, integer, meaning "entire or whole". This wholeness serves us not by changing the work itself but by changing the way we experience our work."

While I had never hit the nail on the head, so to speak, Ian has verbalized and concretized this notion of what makes our patient interactions more than just mechanical. What is it that takes a potentially mundane interaction and transforms it into a meeting of minds and hearts, where a depth of connection and intimacy is generated and felt by all participants? What engine of compassion springs into action and lifts the provider and patient into that sacred place?

Communicating in one's native tongue, there are subtleties of language and sentence structure which can elucidate one's conversational intention. When I feel that my Spanish-language skills are failing to communicate the depth of feeling and connection that I'm experiencing in the moment, I assume that the sincerity of my effort, the tone of my voice, my open body language and eye contact all contribute to the overall energy of the encounter and fill in the gaps where my words fall short. Explaining physiological processes and symptoms is one thing, but sharing emotional depth and insight commands far greater skill than my linguistic knowledge can often afford me. It is here that intention trumps skill.

Ian also acknowledges mindfulness as an intrinsic factor to cultivating the "vertical" asepct of nursing, moving beyond the mundane to an expansive sense of connection and meaning. Listening--real listening---can also move a clinical interaction into new realms of connection and acceptance of the Other as a divine sentient being. And isn't acceptance and connection what it's all about in the end, anyway?

Sadly, amidst the tumult and mind-numbing experience of nursing and medical school, little attention is paid to patient interaction and communication skills. Even less attention---if any---is afforded the subject of compassion as it relates to the nurse's approach to the patient and his or her problems. As a part-time nursing professor soon to abandon my brief teaching career due to over-work and significantly decreased leisure time, I can see that the horizontal aspect of nursing dominates nursing education, and the cultivation of verticality is left as a personal endeavor pursued by the relative few. In the tumult of profit-driven healthcare and minute measurements of "productivity", the thoughtfully deep interaction is neither honored nor quantifiable. It is a qualitative connection which, if utilized correctly, can tranform a therapeutic relationship into a symbiotic human bond which exponentially increases both satisfaction and positive outcome for all parties. Since these skills are not necessarily taught, it is a personal and singular decision when one chooses to cultivate, hone, and activate such depths of compassion and heart during patient encounters.

As for the Engines of Compassion, I believe these are latent engines which exist within each of us, intrinsic aspects of human consciousness available to all who care to listen. It is when we choose to develop these muscles of compassion--for it is through repeated use that we strengthen such organs---that the real work of being human begins and our ability to deeply effect others is at its most profound.


Kim said...

I wonder if verticality is something that comes along with experience.

The novice nurse is really self-focused; doing for the patient, but also focused on "self" - not making a mistake, learning the environment.

As we gain competence, we are able to empathize and gain the ability to experience verticality.

Is it really something that can be taught?

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Yes, I believe that verticality can be taught through example, and by infusing one's interactions with novice nurses with nuggets of wisdom and compassion. As a part-time professor, I also see that compassion can be subtly woven into the classroom, often through story-telling.