Recognizing is Believing

People can watch me in a patient's room all day. They can see me crushing pills, drawing up meds in syringes, and adjusting IV medication machines. They can see me frequently asking others to help me turn a patient from side to side, cleaning them from head to toe, and propping the feet and arms up on pillows. They can hear my explanations of the various medications, the breathing machine, the heart monitor, the oxygen monitor, the feeding machine, and any other high-tech machines aiding the kidneys, heart, brain, and lungs. They can see me pack up a patient's bed with multiple machines and medications and head out for CT and MRI scans. They can observe me standing at the computer in the room, changing values, adjusting limits, and entering data.

But what do I get the most comments on?

No really? Guess! In the cases of the sickest patients with the most machines and requiring the most attention, what do you think the families of these unconscious patients comment on the most?


Guess.







Brushing teeth.

Yup. Brushing teeth. I'm serious! The very high-tech, requiring-college-degree-level-knowledge, displaying-years-of-clinical-experience skill of brushing teeth...

And I think it's because they understand it as being not necessary, but ultimately caring. What families might not know is that for patients with a breathing tube, there is research of significantly decreased rates of pneumonia related to the simple act of cleaning the mouth every 4 hours. It's the protocol at my hospital for us to provide "oral care" every 4 hours to try to prevent this common consequence. There are other things too... keeping the Head of Bed at a certain height, turning patients, suctioning the breathing tube frequently but not too frequently, and getting frequent x-rays and blood labs to catch evidence of pneumonia early and then start antibiotics to prevent it from getting worse.

But families are familiar with brushing teeth. It makes their loved one look like a person again... not a body in a bed, hooked up to multiple noisy and foreign machines.

I've heard family members define me as being a "good nurse" after citing the fact that they saw me brush Momma's teeth. And only that fact! "... And Momma's nurse is taking good care of her. I saw her brush her teeth twice today!" Not the bath, cleaning up bowel movements, incalculable hours spent translating "doctor talk" to families via phone calls and personal conversations, or the delicate changes made to medication rates and machine controls due to my understanding of their function and the goals for the patient. My 12 hour shift, sore feet, pages of notes and thousands of dollars worth of supplies and medications can basically be summed up in 3 simple acts of brushing the patient's teeth during my shift.

It feels absurd... until you look at families' faces and finally see a glimmer of understanding and hope and compassion. Then it completely makes sense.

And because of that, I try to save this task for when I know families will be at the bedside. If seeing this simple action is going to reassure them that we are treating their husband or grandmother with the dignity and care persons deserve, then I would rather pay attention to this task with them present than waste my time telling them so.

Because seeing (and recognizing) is believing.