Eric’s* storytelling made a difference in my nursing practice. Eric was a 27-year-old African American patient with end-stage renal disease (ESRD), who was admitted to the nursing home for wound treatment and dialysis. He was suffering with calciphylaxis, which is caused by too many minerals absorbed into the skin. Eric had painful wounds in both inner thighs. The wounds contained yellow slough, thick white tissue packed into the tunneling walls, and bloody drainage.
About 11 months after I had cared for Eric, we were at a doctor’s appointment at the Falls Lane Medical Center. I heard him talking with his mother in the waiting room. He was telling her about the nurse who took care of his wounds—me! He soon had an audience in the waiting area engaged in his story. He described how I took care of his deep embedded inner thigh wounds that evolved from poor diet and other problems such as diabetes and hypertension. Here is some of what he said:
“My pain level was rated a 12/10, and I was grinding my teeth and clinching the side rails each time the other nurses changed my bandages. But Nurse Nolan was gentle. I was offered pain medication 30 minutes before wound treatment. She never ripped the bandages off my skin. She would saturate the wound bandages with cleaning solution to loosen the bandages, then gently held the skin while removing the soiled bandages.
After removing the wound bandages, Nurse Nolan explained that she would be removing the packing strip from the deep wound. Yes it hurt but I bore the pain. Nurse Nolan engaged me in conversations about eating the right renal diet and not drinking the sodas because it caused harm to my kidneys. I talked with her about my brother’s and mother’s long history of health issues. I was looking forward to getting back home to my family. Nurse Nolan left me with the hopeful idea of returning home one day. My wounds finally healed and now I am back into the community doing well.”
I share this story to remind nurses that patients don’t forget our compassionate care. Each time I’m in the doctor’s office, I think about the day that Eric was in the waiting area telling his story. Eric is now in the community taking better care of himself, for example, eating a renal diet, exercising, and going to scheduled dialysis treatments. He has lost more than 40 pounds, looks stronger, escorts his mother around town, and is wound free. I also share Eric’s story in the hopes it can promote health literacy for other patients with calciphylaxis who don’t understand the disease process.
The power of storytelling
During the time I cared for Eric, I was able to establish a trusting relationship, so he felt comfortable sharing his inner feelings and personal issues that were road blocks in making the changes he needed to make. In essence, he was sharing his story.
Storytelling can be powerful. It helps the nurse learn important facts such as the lack of a support system at home or financial burdens that make it impossible for patients to pay for medications. Many times storytelling results in tears and laughter for both the nurse and patient, which can help the patient recuperate faster.
On the other hand, storytelling can be a burden to the nurse, especially given time constraints. According to Wright and Mc Sherry, nurses spend a total of 2 hours and 25 minutes interacting with patients over a 9-hour workday. For instance, giving injections, performing wound treatments, inserting catheters takes about 27 minutes. Another 22 minutes was spent on such tasks as hygiene and 19 minutes for toileting. Nurses don’t have time to sit at the bedside and hold the patient’s hand to walk them through a new cancer medication. An observational study completed in three midwestern hospitals proved that nurses spent just 7% of their time teaching patients.
As a result of these challenge with time, sometimes nurses will share too much information by saying negative comments such as, “We’re short staffed today.” “I have 10 patients, so I don’t have time to explain.” Or, nurses are so overwhelmed with a heavy patient assignment that there is not enough time for sharing experiences.
Instead of feeling overwhelmed, nurses can weave storytelling into their practice to enhance care. For instance, when preparing the patient for discharge, the nurse needs to understand how much the patient and family understand about the disease process before teaching about the new medication. In Eric’s case, he didn’t understand his renal disease, which had caused the inner thigh wounds. He didn’t adhere to his renal diet, eating too much phosphorus and calcium and drinking sodas that were not being excreted by the kidneys.
Every time I provided wound care, I also taught Eric about his wound, encouraged him to eat the right renal diet, and was sensitive to his pain. As we talked and shared stories, Eric became interested in changing his knowledge level about his disease and in making changes in his lifestyle, which he subsequently did.
Creating a bond
Storytelling can help build trusting relationships during patient care and promote health literacy for patients who don’t understand their disease process. Sharing stories, while protecting patient and family identify of course, can enlighten nurses about how to care for patients with similar conditions and help inspire patients with these conditions to make changes in their lives.
Perhaps most importantly, nurses’ hearts can be touched by storytelling, as was mine when I heard Eric’s story. These stories remind us of the importance of what we do.
Anderson KG. Calcific uremic arteriolopathy: overview for the nurse. AACN Adv Crit Care. 2013;24(3):285-300.
Drum M. The role of personal storytelling in practice: IRISS Insights, No.23. www.iriss.org.uk/resources/role-personal-storytelling-practice. December 2013.
Wright S, McSherry W. How much time do nurses spend on patient care. http://www.nursingtimes.net/nursing-practice/clinical-zones/patient-safety/how-much-time-do-nurses-spend-on-patient-care/5062161.article. August 2009.
Evelyn Nolan is a supervisor at Roland Park Place Retirement Community in Baltimore, Maryland.
*Name is fictitious.