Janet M Beard, RN, MS
What is your attitude saying?
Attitude governs all human relationship. Nowhere should it be expressed more thoughtfully than in the care of the sick. None can express it so well as the nurse. What is attitude? Like the wind, you never see it, you only see its effect. It governs what you say, how you say it, and when you say it. It governs what you don’t say, as well. When your attitude is healthy, you begin to lay the
Janet M Beard, R N , M S , is assistant director of S t Barnabas Hospital, Bronx, N Y . A graduate of S t Catherine’s School of Nursing, Brooklyn, N Y , she received a B S from St John’s University, Jamaica, N Y . She has master’s degrees in clinical nursing administration from S t John’s University and in administrative medicine from Columbia University, New York City.
782
groundwork for effective communication. This groundwork is necessary for the nurse who acts a s the pivot for surrounding crucial relationships with the physician, patient, patient’s family, and other nurses. As a n ally of the physician, the nurse acts as his extra hands or feet, a storehouse of information and memory bank, and often, his chief communicator. How does her attitude, revealed by her words, manner, and disposition, affect the physician? If the nurse’s attitude is one of indifference, the physician may conclude he is working with someone who is simply “putting in her time.” He rationalizes that this nurse can perform routine duties almost automatically and without difficulty, but he wonders what would happen in a n emergency situation or in a situation that calls for resourcefulness. If by her indifference the nurse makes the physician feel she may not be able to quickly mobilize all her powers to meet a n emergency, she may find herself replaced by someone who shows she cares. The nurse who suffers from timidity generates no communication. Because of her reticence to assert herself, she extends no suggestions and encourages
AORN Journal, October 1976, V o l 2 4 , No 4
no response. The effectiveness and efficiency of the nurse-physician team is severely reduced if not destroyed with this attitude. The attitude of the overaggressive nurse can be equally as destructive or nonproductive. It often is offensive and damages a relationship. The nurse who is loud and brusque and unwilling to accept suggestion or criticism alienates those with whom she comes in contact. Such mannerisms cannot enrich communications. One unprofessional attitude the nurse can assume is familiarity. It can create a serious rupture in the necessary nurse-physician relationship. The physician becomes reluctant to discuss confidential matters and so loses the advantage of sharing thoughts and opinions. The nurse loses the satisfaction that surfaces from total participation in the case at hand. The attitude that will establish two-way communication exudes warmth, friendliness, soft-spoken rejoinders, and self-assurance. It is one that by word and deed transmits confidence, cooperation, and competence. The nurse’s attitude toward all patients should inject and project positiveness. Illness can and often does create emotional problems that can frequently be lessened by the nurse who displays patience and understanding. For instance, the nurse can help the apprehensive preoperative patient by adding words of encouragement when administering his medication on the eve of surgery. Postoperatively, her reassurance and support can be a dominant factor in recharging the patient’s own attitude toward full recovery. The nurse’s attitude toward the patient in pain can affect his pain tolerance level. The patient may feel mistreated and lower his pain toler-
784
ance if the nurse is curt and shows annoyance if the patient continually complains or asks for pain medication earlier than it is authorized. On the other hand, if the nurse gently and calmly demonstrates understanding, the patient is likely to react with some restraint and find within himself the resources to raise his tolerance level. Some of the most frequent complaints from patients have little to do with the food, the uncomfortable bed, the dressings in need of change, or the delayed medication. Rather the complaints reflect the nurse’s attitude. When the nurse exhibits a rough manner or shouts a t the patient like a drill sergeant, the patient recoils and complains. Some patients, such as geriatric patients, suffer from illness that can be made more tolerable, even reduced in severity, if the patients will help themselves. All too often, however, they lack the necessary motivation. They need an incentive, a reason for extending themselves. What kind of two-way communication does your attitude establish in these circumstances? Do you become “bossy” and demanding, refusing to help someone help himself? Or do you take the path of least resistance and give in to his inactivity by taking care of all his daily needs? Are you sensitive to his fears and frustrations? Do you offer guidance and partial help topped with a generous helping of encouragement? You may have to cajole the patient a little, but do it gently and sensitively. Don’t embitter by badgering. The chief interest of the person who chose nursing as a profession was to care for the sick not to become a public relations practitioner. However, a nurse does have a difficult public relations task in her contacts with the patient’s family.
AORN Journal, October 2976, Vol24, No 4
It is necessary to understand the psychology behind the family’s attitude. Are they exorcising some of their own guilt feelings when they literally park on the patient’s doorstep, besiege the nurse with questions mixed with complaints, and interfere with the performance of her necessary duties? Are the family members just curious? Will they, in a strange environment that could intimidate, remain restless and dubious until assured that the patient is on the road to recovery? What should the nurse’s response be? Does she try to brush off these grievances or ignore them? Does she pass the buck to the physician or the social worker? Does she let her annoyance get out of hand and in a few hastily chosen words tell the family to “stop bothering me”? Just as the nurse needs to spend time listening to the patient, so must she spend time listening to the family. She must convey an attitude of deep concern and a genuine personal interest for the family as well as the patient by communicating to the family her understanding of their pressures. During times of stress, it is not wise to assume the attitude toward a family that says, “If you think you have problems, you should see the patient down the hall!” There are occasions when the nurse’s attitude must be one of real finesse. Some physicians have definite ideas of when and under what circumstances families should be permitted to be with the patient, what and how much information the family should have about the patient, and how available the physician is to the family. The physician expects the nurse to keep everything functioning smoothly while he addresses himself to another case. This calls for tact on the nurse’s part. By her manner and voice,
786
she will gain the cooperation of the family. Although today’s nursing profession has evolved a hierarchy, ranging from nursing attendant to nursing administrator, the banner to which all nurses pledge allegiance is patient care. How a nurse relates to others in her field frequently depends upon her basic attitudes. Does she become envious because her coworker has just received a promotion possibly based on higher education? Is she domineering and dogmatic in a supervisory role? Does she assume that attaining the status of RN carries with it the privilege of refusing to participate in some of the more menial nursing care assignments? The numerous tasks and large variety and diversity of nursing assignments almost necessitate a caste system if efficiency is to be maintained. Such a system is certain to break down, however, if there is no flexibility of attitude; no room for needful cooperation and respect. When the head nurse on a ward is bogged down with paper work, she may withdraw from her associates. She forgets to share her knowledge and her skills. Instead she hands out the assignments at briefing sessions and retreats into her office with an unspoken but very real “don’t bother me” injunction. How much more smoothly her unit would function if a t the conclusion of the briefing session she would explain that even though she has many reports to prepare and she recognizes the abilities of the nurses, she is always willing to assist when needed. The nursing administrator who leaves the direct floor contact solely to her assistants indicates a n attitude of aloofness and possible disdain. Reaction by nurses to the supervisor’s
AORN Journal, October 1976, V o l 2 4 , No 4
attitude might reveal impending resentment and rebelliousness that can only gather in destructive force. Subordinates quickly discern the attitudes of t h e i r supervisors; supervisors should be aware of t h e effect o f their attitudes o n their subordinates. The nursing profession is highly skilled, involving intensive nursing, c r i t i c a l nursing, maternal nursing, pediatric nursing, and geriatric nursing. Each calls for special techniques and special instruction endowing the nurse w i t h skills. Is care among them? The literature today i s filled w i t h
Health care cost report challenged An American Hospital Association (AHA) spokesman has challenged the government to compare rising health care costs with an additional “four more years of life for us all.” Allen J Manzano, a vice-president for the 7,000-member association, told the federal Council on Wage and Price Stability that its April report was a “compilation of cliches that . . . disguises the federal government’s retreat from our 10-year-old national commitment to ensure that the legitimate health care needs of the nation are met.” Manzano “agreed” that health costs are a major issue, but the problem is compounded by rising expectations of the public and more expensive technology in hospitals. “A major decision must be made by the public and government about the quality and level of health care services they want and are willing to pay for.” Manzano, in charge of AHA’Sfinancial management, cited a report by Theodore Cooper, health chief in the US Department of Health, Education, and Welfare, that life expectancy at birth has increased nearly four years during the 1950 to 1974 period. Manzano gave major credit to health care delivery improvements. “Would those . . . saved by these improvements . . . consider them too costly . . .?” he asked. He urged
708
numerous cliches that cloak n u r s i n g care: tender loving care, t o t a l n u r s i n g care, comprehensive nursing care, quality nursing care, professional n u r s i n g care, fundamental nursing care, optimum nursing care, progressive n u r s i n g care, better patient care, and on and o n i n t o expanded and extended n u r s i n g care. Care can be labeled, of course, but care i s more a feeling t h a n a technique, more a manner t h a n a method. In short, care i s a n attitude issuing from the heart and touching t h e hearts o f those in need of it.
0
the Council to begin a public discussion of the basic issue of public demands and costs. The Council was created in 1975 by congressional mandate, to monitor price behavior in the economy. Manzano said the Councll report admitted “there is no valid standard currently being used to measure health care industry inflation.” The present Consumer Price Index (cost of living) is “not measuring a constant set of goods and services in health care because the quality and quantity of services” is changing, said Manzano. “To portray the health field as excessively inflationafy compared to the general economy suggests a special control is needed.” However, he said, “the truth is, these controls are imposed because of government’s unwillingness to meet the increasing costs of their health care commitments, despite pools which show that the public supports more and better health care. “The real issue: is government willing to establish health priorities and acknowledge openly to the aged and the poor that government does not want to pay for the cost of their care?” Manzano cited such extraordinary hospital costs as food and fuel, growing labor costs, soaring malpractice premiums, and massive federal and state regulations “which do not contribute an iota to health care.”
AORN Journal, October 1976, V o l 2 4 , N o 4
What is your attitude saying?
Attitude governs all human relationship. Nowhere should it be expressed more thoughtfully than in the care of the sick. None can express it so well as the nurse. What is attitude? Like the wind, you never see it, you only see its effect. It governs what you say, how you say it, and when you say it. It governs what you don’t say, as well. When your attitude is healthy, you begin to lay the
Janet M Beard, R N , M S , is assistant director of S t Barnabas Hospital, Bronx, N Y . A graduate of S t Catherine’s School of Nursing, Brooklyn, N Y , she received a B S from St John’s University, Jamaica, N Y . She has master’s degrees in clinical nursing administration from S t John’s University and in administrative medicine from Columbia University, New York City.
782
groundwork for effective communication. This groundwork is necessary for the nurse who acts a s the pivot for surrounding crucial relationships with the physician, patient, patient’s family, and other nurses. As a n ally of the physician, the nurse acts as his extra hands or feet, a storehouse of information and memory bank, and often, his chief communicator. How does her attitude, revealed by her words, manner, and disposition, affect the physician? If the nurse’s attitude is one of indifference, the physician may conclude he is working with someone who is simply “putting in her time.” He rationalizes that this nurse can perform routine duties almost automatically and without difficulty, but he wonders what would happen in a n emergency situation or in a situation that calls for resourcefulness. If by her indifference the nurse makes the physician feel she may not be able to quickly mobilize all her powers to meet a n emergency, she may find herself replaced by someone who shows she cares. The nurse who suffers from timidity generates no communication. Because of her reticence to assert herself, she extends no suggestions and encourages
AORN Journal, October 1976, V o l 2 4 , No 4
no response. The effectiveness and efficiency of the nurse-physician team is severely reduced if not destroyed with this attitude. The attitude of the overaggressive nurse can be equally as destructive or nonproductive. It often is offensive and damages a relationship. The nurse who is loud and brusque and unwilling to accept suggestion or criticism alienates those with whom she comes in contact. Such mannerisms cannot enrich communications. One unprofessional attitude the nurse can assume is familiarity. It can create a serious rupture in the necessary nurse-physician relationship. The physician becomes reluctant to discuss confidential matters and so loses the advantage of sharing thoughts and opinions. The nurse loses the satisfaction that surfaces from total participation in the case at hand. The attitude that will establish two-way communication exudes warmth, friendliness, soft-spoken rejoinders, and self-assurance. It is one that by word and deed transmits confidence, cooperation, and competence. The nurse’s attitude toward all patients should inject and project positiveness. Illness can and often does create emotional problems that can frequently be lessened by the nurse who displays patience and understanding. For instance, the nurse can help the apprehensive preoperative patient by adding words of encouragement when administering his medication on the eve of surgery. Postoperatively, her reassurance and support can be a dominant factor in recharging the patient’s own attitude toward full recovery. The nurse’s attitude toward the patient in pain can affect his pain tolerance level. The patient may feel mistreated and lower his pain toler-
784
ance if the nurse is curt and shows annoyance if the patient continually complains or asks for pain medication earlier than it is authorized. On the other hand, if the nurse gently and calmly demonstrates understanding, the patient is likely to react with some restraint and find within himself the resources to raise his tolerance level. Some of the most frequent complaints from patients have little to do with the food, the uncomfortable bed, the dressings in need of change, or the delayed medication. Rather the complaints reflect the nurse’s attitude. When the nurse exhibits a rough manner or shouts a t the patient like a drill sergeant, the patient recoils and complains. Some patients, such as geriatric patients, suffer from illness that can be made more tolerable, even reduced in severity, if the patients will help themselves. All too often, however, they lack the necessary motivation. They need an incentive, a reason for extending themselves. What kind of two-way communication does your attitude establish in these circumstances? Do you become “bossy” and demanding, refusing to help someone help himself? Or do you take the path of least resistance and give in to his inactivity by taking care of all his daily needs? Are you sensitive to his fears and frustrations? Do you offer guidance and partial help topped with a generous helping of encouragement? You may have to cajole the patient a little, but do it gently and sensitively. Don’t embitter by badgering. The chief interest of the person who chose nursing as a profession was to care for the sick not to become a public relations practitioner. However, a nurse does have a difficult public relations task in her contacts with the patient’s family.
AORN Journal, October 2976, Vol24, No 4
It is necessary to understand the psychology behind the family’s attitude. Are they exorcising some of their own guilt feelings when they literally park on the patient’s doorstep, besiege the nurse with questions mixed with complaints, and interfere with the performance of her necessary duties? Are the family members just curious? Will they, in a strange environment that could intimidate, remain restless and dubious until assured that the patient is on the road to recovery? What should the nurse’s response be? Does she try to brush off these grievances or ignore them? Does she pass the buck to the physician or the social worker? Does she let her annoyance get out of hand and in a few hastily chosen words tell the family to “stop bothering me”? Just as the nurse needs to spend time listening to the patient, so must she spend time listening to the family. She must convey an attitude of deep concern and a genuine personal interest for the family as well as the patient by communicating to the family her understanding of their pressures. During times of stress, it is not wise to assume the attitude toward a family that says, “If you think you have problems, you should see the patient down the hall!” There are occasions when the nurse’s attitude must be one of real finesse. Some physicians have definite ideas of when and under what circumstances families should be permitted to be with the patient, what and how much information the family should have about the patient, and how available the physician is to the family. The physician expects the nurse to keep everything functioning smoothly while he addresses himself to another case. This calls for tact on the nurse’s part. By her manner and voice,
786
she will gain the cooperation of the family. Although today’s nursing profession has evolved a hierarchy, ranging from nursing attendant to nursing administrator, the banner to which all nurses pledge allegiance is patient care. How a nurse relates to others in her field frequently depends upon her basic attitudes. Does she become envious because her coworker has just received a promotion possibly based on higher education? Is she domineering and dogmatic in a supervisory role? Does she assume that attaining the status of RN carries with it the privilege of refusing to participate in some of the more menial nursing care assignments? The numerous tasks and large variety and diversity of nursing assignments almost necessitate a caste system if efficiency is to be maintained. Such a system is certain to break down, however, if there is no flexibility of attitude; no room for needful cooperation and respect. When the head nurse on a ward is bogged down with paper work, she may withdraw from her associates. She forgets to share her knowledge and her skills. Instead she hands out the assignments at briefing sessions and retreats into her office with an unspoken but very real “don’t bother me” injunction. How much more smoothly her unit would function if a t the conclusion of the briefing session she would explain that even though she has many reports to prepare and she recognizes the abilities of the nurses, she is always willing to assist when needed. The nursing administrator who leaves the direct floor contact solely to her assistants indicates a n attitude of aloofness and possible disdain. Reaction by nurses to the supervisor’s
AORN Journal, October 1976, V o l 2 4 , No 4
attitude might reveal impending resentment and rebelliousness that can only gather in destructive force. Subordinates quickly discern the attitudes of t h e i r supervisors; supervisors should be aware of t h e effect o f their attitudes o n their subordinates. The nursing profession is highly skilled, involving intensive nursing, c r i t i c a l nursing, maternal nursing, pediatric nursing, and geriatric nursing. Each calls for special techniques and special instruction endowing the nurse w i t h skills. Is care among them? The literature today i s filled w i t h
Health care cost report challenged An American Hospital Association (AHA) spokesman has challenged the government to compare rising health care costs with an additional “four more years of life for us all.” Allen J Manzano, a vice-president for the 7,000-member association, told the federal Council on Wage and Price Stability that its April report was a “compilation of cliches that . . . disguises the federal government’s retreat from our 10-year-old national commitment to ensure that the legitimate health care needs of the nation are met.” Manzano “agreed” that health costs are a major issue, but the problem is compounded by rising expectations of the public and more expensive technology in hospitals. “A major decision must be made by the public and government about the quality and level of health care services they want and are willing to pay for.” Manzano, in charge of AHA’Sfinancial management, cited a report by Theodore Cooper, health chief in the US Department of Health, Education, and Welfare, that life expectancy at birth has increased nearly four years during the 1950 to 1974 period. Manzano gave major credit to health care delivery improvements. “Would those . . . saved by these improvements . . . consider them too costly . . .?” he asked. He urged
708
numerous cliches that cloak n u r s i n g care: tender loving care, t o t a l n u r s i n g care, comprehensive nursing care, quality nursing care, professional n u r s i n g care, fundamental nursing care, optimum nursing care, progressive n u r s i n g care, better patient care, and on and o n i n t o expanded and extended n u r s i n g care. Care can be labeled, of course, but care i s more a feeling t h a n a technique, more a manner t h a n a method. In short, care i s a n attitude issuing from the heart and touching t h e hearts o f those in need of it.
0
the Council to begin a public discussion of the basic issue of public demands and costs. The Council was created in 1975 by congressional mandate, to monitor price behavior in the economy. Manzano said the Councll report admitted “there is no valid standard currently being used to measure health care industry inflation.” The present Consumer Price Index (cost of living) is “not measuring a constant set of goods and services in health care because the quality and quantity of services” is changing, said Manzano. “To portray the health field as excessively inflationafy compared to the general economy suggests a special control is needed.” However, he said, “the truth is, these controls are imposed because of government’s unwillingness to meet the increasing costs of their health care commitments, despite pools which show that the public supports more and better health care. “The real issue: is government willing to establish health priorities and acknowledge openly to the aged and the poor that government does not want to pay for the cost of their care?” Manzano cited such extraordinary hospital costs as food and fuel, growing labor costs, soaring malpractice premiums, and massive federal and state regulations “which do not contribute an iota to health care.”
AORN Journal, October 1976, V o l 2 4 , N o 4
