Abstract
I have been reflecting a lot on the notion of perspective recently. I received a phone call from a junior doctor the other day, advising that a relative of mine with advanced dementia had been admitted to hospital. As I have power of attorney my permission was being sought to administer intravenous fluids. It transpired that my relative had vomited that morning, and a series of what I might describe, from my perspective, as unfortunate events, led to his admission. As a nurse, I know how deleterious a hospital admission can be to someone with advanced dementia (Andrews, 2015).
My first response to the question was: ‘is he not tolerating oral fluids?’. He was, so why was the administration of intravenous fluids, to someone who was described as agitated, proposed, I wondered and contested? The compassionate junior doctor went back to the Consultant who had prescribed the intervention, and apparently the Consultant then agreed the patient was a ‘low risk’, so the intervention wasn’t, strictly speaking, necessary. An interesting choice of words, I thought; perhaps low risk from a fluid imbalance perspective, but exactly the opposite when considering his advanced dementia. So, off I set on a three-hour journey to get to the hospital as quickly as I could on a mission to get my relative home as quickly as possible.
In summary, I could not fault the care and compassion that was shown to my relative. Actions were, I believe, undertaken with the best of intentions.
However, I firmly believe his admission to hospital could – and should – have been avoided. I am confident that the interventions proposed and undertaken followed evidenced, informed protocols, but from my perspective, most were inappropriate and unnecessary in this particular context. I was saddened by what I describe here as ‘iatrogenic trauma’ – care and compassion coupled with extremely busy professional colleagues uncritically following the letter of the protocol, without the apparent headroom to stand back and see the whole person and the impact of the context on the patient. I sensed colleagues were incapable of veering away from the letter of the protocol. I have written about this before; whilst I am, of course, in favour of evidence-informed practice, when applied uncritically it can, as we know, be decidedly unhelpful (McMahon, 2002). Rightly or wrongly, at times I sensed some professionals were conflicted, yet appeared reluctant to go ‘off piste’. I found myself reflecting on arguments about nursing rituals, calling for evidence-informed practice (Walsh and Ford, 1989) and wondering if, ironically, ‘evidence’ and how certain forms of evidence appear to be privileged over others in what has become a highly regulated system, was now part of the problem.
I am not complaining. Through reflecting, processing and writing about my thoughts and feelings, I have ‘made sense’ of the situation and reached an understanding as to why things happened as they did. This has, I believe, enabled me to take steps to prevent this from happening to my relative again.
With the theme of perspective in mind, there are five peer-reviewed papers with associated commentaries published in this edition. The first three, we could say, contribute to our understanding of surviving breast cancer, health-related quality of life living with colorectal cancer, and self-care when receiving haemodialysis in Iran from patients’ perspectives. Each paper in turn is complemented with a commentary offering a perspective on the paper. The final two papers arguably offer perspectives from a nursing standpoint and again have commentaries published alongside them. Regular readers know that commentaries are a particular feature of JRN. We see them as an important way of helping our readers see the relevance of the papers we publish from different standpoints or from different contexts and cultures. Our aim is to capture a range of patient/service user, practitioner, manager, commissioner or policy-maker views on the papers we publish through the commentaries. If you’d like to get involved in peer review and/or commentary writing, or you’d like to write a reflective piece on a paper we have already published, we’d be pleased to consider this as a JRN blog. To get involved, please get in touch via our editorial office jrn@sagepub.co.uk. We’d love to hear from you!
This edition also includes a Perspectives piece on nursing leadership in this, the international year of the nurse and the midwife. We conclude this edition with a call for papers on a future edition of JRN which will focus on ‘conflict’: a concept, which by definition, encompasses different perspectives.