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Commentary: Nurses' "high touch" care carries on

By Marcia Gruber


Buffalo, NY – In her book, Notes on Nursing (1861), Florence Nightingale described the major responsibilities of the 19th century nurse. These included ensuring good ventilation, keeping patients warm, tending the fire, trimming the wicks and providing light and nourishment. She described the importance of cleanliness and acknowledged that a relationship existed between mind and body. She wrote about the importance of observing patients for symptoms and offering hope and advice. Not false hope, she cautioned, but hope that is practical and based on experience. Many of the tasks she described continue to be integral to the role of the Nurse. Observing patients for symptoms, preventing infection, understanding the mind/body connection, and offering encouragement and education all remain important responsibilities for nurses in the 21st century.

What has changed is the explosion of health care technology that has simultaneously enhanced and challenged our ability to care for patients. These technological advances include robots in surgery; brain tumor treatment without cutting into the skull; vaccines that prevent some types of cancer and stents that can be inserted through a vein to replace open heart surgery. There are computerized drug delivery techniques, voice-activated reporting systems and electronic medical records. We routinely use electronic physiologic monitors; and rely on genetic testing, MRIs, CT scans, PET scans and a variety of other advanced diagnostic tools to give us a great deal of objective information about our patients. There is no question that technology has greatly changed the world of Nursing. But what is also clear, is that amidst all this technology, the need for compassion, empathy and preserving the patient's dignity is more important than ever.

I receive many letters from patients and what they consistently write about is their relationship with their nurse. They never mention the pumps, monitors, computers, scanners or robots. Just how important this relationship is to patients is best expressed in this letter that I received:

"Dear Ms. Gruber,

No words are adequate to express how grateful my wife and I are for the professional expertise and warm, positive compassion that your wonderful nurses provided during my wife's treatments. It is unfortunate that cancer has become a part of our lives, but they made every experience more acceptable. Each visit to your clinic renewed our strength for this journey through illness. Your nurses always acknowledged the disease that brought us there but never failed to counter it with solid hope. I pray that these gentle, wise and upbeat nurses find the strength and courage to continue to serve patients with their special brand of loving devotion."

The message from this family is clear - the knowledge and skills necessary to work in the "high tech" health care environment do not surpass the value of the "low tech" nursing skills of compassion, empathy, and kindness. Thanks to the advances in technology, nurses no longer clean chimneys, mop sick rooms, sharpen pencils or trim candle wicks. What technology can never replace are the "high touch, low tech" skills of being present, listening, teaching, holding a hand, wiping a tear. And because nurses are everywhere in the world and can be found in all manner of traditional and non-traditional settings, who better than nurses' to assure that "high touch" is incorporated in all "high tech" places where patients are cared for.

Listener-Commentator Marcia Gruber is vice president of Therapeutic and Patient Access at Roswell Park Cancer Institute.

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