As a nurse practitioner specializing in cardiovascular care in an acute-care hospital, I am consulted when a patient need open-heart surgery. I speak to the patient and his significant others. I discuss what to expect before, during and after the surgery, and answer any questions they might have. I believe that my role in supporting them spiritually is as important as my clinical responsibilities.
Patients usually go through an accelerated grief period after learning that they need open-heart surgery. Some patients refuse to have the surgery because they don’t think it’s medically necessary. Others may go through a stage of denial, not allowing themselves to fully accept that it is a major surgery. These patients generally do not want to hear anything about the operation.
Some of these thoughts stem from anxiety and fear, and it is my role to comfort them. I do this by respecting their desire to refuse patient education, by
giving them as much information as they want, or sometimes by postponing all attempts at patient education (if time allows) in order to let the patient and family absorb the news. In some cases, learning more about the details of surgery actually increases the patient’s anxiety.
Sometimes, it’s necessary to speak to members of a family separately when they don’t agree on how much information they’d like to know about the surgery. I find this has actually helped family members be more supportive of one another, because they each know about the surgery on their own terms, which makes them feel more at ease. When the family is at ease, it helps the patient feel relaxed. The last thing a patientn needs before surgery is to worry about his family’s coping strategies!
The next stage is sadness. Many patients and families feel very sad about having to have the operation. Many worry about death and dying. The main concern here is making it through the surgery. I support these patients by first ascertaining where they gain their strength from: Is it a higher power? Familv? From within themselves? Or something altogether different? I inquire about how I can be of assistance, and then I work to connect them with their source of strength.
If a patient’s strength comes from a higher power, I talk to him about our chapel and clergy, or suggest he call his clergy member. Some patients gain inner strength from reading, listening to music, meditating or talking about issues unrelated to surgery. I feel it’s my responsibility to know how my patients view their own spirituality so I can refer them to the particular services that will be appropriate for them. It is especially important that the NP feels comfortable with her own spirituality to be able to speak about these
issues with others. If an NP doesn’t feel comfortable talking about spirltuality, then a referral needs to be made promptly.
In my opinion, individualizing this aspect of caring and educating a patient about impending open-heart surgery is really akin to providing spirttual care. When a patient and family feel that an NP understands them an a personal level, they gain a sense of trust and respect for our role as healthcare providers. When a patient is still slightly angry about his diagnosis, I find that it’s a good time to talk about his feelings and the support systems he has available to them. This often assists me in discharge planning.
Operating on a heart brings up many feelings for people. Our hearts are viewed as being intertwined with our souls. We love from our heart; it is precious and dear to us. When It needs to be operated on, many people feel as if they will be separated from their soul. In addition, the hospital setting often keeps a person so busy, both physically and mentally, that there is not much time to focus on feelings.
It is not uncommon for a patient to arrive home after an open-heart surgery to discover that he feels lonely and even depressed. It may not even occur to him that this could happen, until he returns home a different person. After such an operation, many people report that they don’t feel they are “the same”—and to some degree they’re right. A “new” person arrives home who is slightly weaker and unable to handle some of his daily routines. The patient’s sense of independence is threatened; it occurs to him that he will have to slowly regain his strength.
I make it a point to let my patients knmv that they can call me from home any time they have questions or concerns. I find that in today’s hurried health care enviroment, patients appreciate having access to a nurse practitioner. We are viewed by our patients as being providers who have focused on them as an individual all along. In this way, nurse practitioners are the primary providers of care for their patients’ spiritual needs.