At first hearing, nine out of 10 nurses providing excellent care in a patient's dying days sounds pretty good but is it good enough?
A palliative care patient with only days left to live told a colleague about her experience of being in hospital in the week before she died. The comment that struck me most was that in her opinion “nine out of 10 nurses were excellent”.
Put another way, this really means that of the precious last 10 days of her life, nine days were made better by nurses, but one was not.
Is this good enough?
The idea of what is ‘good enough’ is convoluted and complicated by subjective opinions, values and perspectives. We might agree that 90 per cent on an exam is good enough. But would we think that 90 per cent of a car repair is adequate? What about 90 per cent of a bridge built? In the end, who decides what is good enough?
It may be that the nurse involved did very little wrong and it may be that their perspective would be quite different. Perhaps she/he wouldn’t be able to see what needed to be done better because they are genuinely unaware of this patient’s perspective.
Perhaps that day, on that shift, the stressful, complex, acute, overworked and care-rationed environment all conspired to create the perfect storm. Perhaps that week 90 per cent was good enough. Perhaps that nurse just dropped the ball and let us all down.
However, in the end it is almost irrelevant what, if anything, was said or done that caused this patient to feel the way she did about the care she received.
As American author and poet Maya Angelou said: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
For this patient and her family, how they feel about their experience is more important than whether they are right. They alone get to decide if the care was good enough. It pains me to think that one of their enduring memories of this patient’s last few days will always be linked to a bad experience – especially when it involves nursing.
I don’t think we should accept 90 per cent. I don’t think it is good enough at all. I think if we can’t provide 100 per cent then we should do something about it. That’s what our colleagues in Southland did when they raised (and kept raising) their concerns about staffing levels. I also think that if we are aware that our colleagues have fallen short, we have a duty of care to act.
I think we have to strive for 10 out of 10 because to accept 90 per cent is to allow our patients to experience less than our very best. And no patients – dying or otherwise – deserve that.
Kim Carter is a nurse and general practice co-owner based in Temuka.
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