Teresa Wright

While in school, it was the rare and unusual cases where patients were characterized by their disease that mesmerized students and instructors. “You’ve gotta see this because you may never see it again!” I thought if I may never see this again, why do I need to see it now? A year out of training, I now want to be a part of a new evolving era of nursing. Sir William Osler said it best over one hundred years ago: “Care more particularly for the individual patient than for special features of the disease.” I understand now that every person has different sensitivities and tolerances as well as a different composition of values, beliefs, goals and lifestyles. Each of us is guaranteed to be unique against all conceivable odds.

Yet currently most care is shaped by population-directed guidelines that disregard individual variability and often promotes more procedures that may actually harm patients. Some experts estimate that up to one-third of the $2 trillion of annual US health care costs each year is spent on unnecessary hospitalizations and tests. This “disease-care” system is recognized to be hazardous and expensive, driven by catastrophe where something serious generally has to fail before there is a response. It is a system that is balkanized and overspecialized, maximizing returns to providers but not to patients. Thankfully the landscape of health care is changing.

Hospitals are only one of the places one practices nursing. Yet nurse clinical rotations, academic and residency programs are often supported solely in hospitals and large health systems where they focus primarily on acute care. Much of the training curriculum is similar to the nursing philosophy of forty to fifty years ago. I’m heartened to know future residency programs will be developed and evaluated in a variety of settings.

I’m interested in maintaining a person’s health and keeping them empowered. To me health is an integrated phenomenon of mind, body and spirit, between biology, behavior and the environment. That is why I believe in health care that is “predict-tive, personalized, preemptive and participatory.” I’m interested in prevention, promotion and teaching and I think it important to see people in their homes. The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in this cohort. Eighty to ninety percent of older people say they want to remain in their own homes as long as possible. And when the time comes, these Americans want to die in their home although roughly, sadly, 75% die in a hospital or nursing home.

I see myself as a health partner where I engage, educate, empower, promote and observe clients. Through this caring, health promoting partnership and decision support system, I bring sympathetic, caring, value neutral objectivity to our relationship. The client and their families decide for themselves what is best, what to do and then I go about helping them to do just that.

These clients need a partner, someone able to sort through options with a stake not in any particular choice but in the idea of choice itself. I work with people where they are, providing an array of choices and options. I’m an empathetic, active listener. I have experience in motivational interviewing and readiness to change assessment and I’ve been trained in collaborative decision making and goal directed problem solving. I don’t subscribe to the vertical approach to care where the provider is dominant and client is subordinate. Finally, I work against a disconnect between the theoretical prescription of health and the actual practice of health.

As a client’s personal advocate, I promote their self-sufficiency and self-responsibility, informed decision making, enhanced provider communication, improved medication info and usage, coordinated community services and better family health and well being. My clients take a role in their decision making process because I know that when people have a role in their decision, then they bear some of the responsibility of the outcome. They don’t feel misled, mishandled or misunderstood.

I want to contribute to a health-care system that focuses on health rather than disease. And I hope as a professional I can do my best job in a transformed system and align my education with these new realities. Now that I am a nurse, there is nothing more fascinating to me than each individual client and their families.