In Home Nursing, 'Being Right' Was Not Always the Correct Answer
I told him many times, 'Please stop drinking.'
'Really, it would be better if you stopped drinking.'
When I first started visiting his home as a home visiting nurse, I told him that many times.
He was struggling with alcohol addiction.
In the past, there were times when he couldn't control his own drinking and drank until he lost his senses.
He had also suffered from acute alcohol poisoning, so there was a high possibility that the same thing would happen if his alcohol intake increased again.
From the perspective of a healthcare professional,the safest thing was not to drink at all.
Since he had alcohol addiction, the goal was abstinence.
Since his health had deteriorated due to drinking, I would support him so he wouldn't drink again.
In my mind, the answer was already decided.
To protect his body, he had to stop drinking.
I thought that if I explained the dangers properly, he would understand the necessity.
However, every time I told him, 'Please stop drinking,' a subtle atmosphere would flow between us.
It wasn't that he openly yelled at me or refused my visits.
Even so, I could tell from his expression that he wasn't convinced by my words.
He seemed to be listening, but he had closed his heart off somewhere.
I had the feeling that my words weren't reaching him and were bouncing off the surface.
At the time, I had just moved from a hospital to home nursing.
Since he was human, I knew he couldn't just accept everything immediately.
I understood that in my head. Even so, somewhere in my heart, I was thinking this:
I'm here as a medical professional, so why can't he understand?
I've explained the dangers of continuing to drink.
His doctor has also told him to stop.
Yet, facing someone who said, 'I don't want to stop,' I felt frustrated, wondering why he wouldn't make the right choice when it was his own body.
Looking back now, what I was looking at wasn't his life, but the problematic behavior of drinking.
And I thought my role as a nurse was to correct that problem in the right direction.
I was bringing the 'correctness' of the hospital directly into his home
Hospitals have rules to ensure treatment proceeds safely.
Take medication at the designated times.
Do not consume anything prohibited by the doctor.
If there is a fluid restriction, stay within those limits.
If the risk of falling is high, call a nurse when moving.
Nurses continuously observe the patient's condition and support them so they do not deviate significantly from the established treatment plan.
In that setting, it is sometimes necessary to insist that 'medication must be taken' or 'alcohol must absolutely not be consumed.'
To protect life and safety, there are naturally times when we cannot prioritize the patient's wishes and cannot be flexible.
I built my foundation as a nurse in that environment.
That is why, even after moving to home nursing, I think the feeling that presenting the correct treatment and having it followed was what support meant remained with me without me realizing it.
However, a home is not a hospital.
We visit the person's home a few times a week.
During a visit of 30 minutes to an hour, we check their physical condition, look at their medication status, and provide necessary procedures or consultation support.
However, the time a home visiting nurse can be involved is only a small part of the day.
Even after we leave, that person's life continues.
In a hospital, we can track how much fluid a patient with fluid restrictions has consumed over 24 hours.
But in home care, a visiting nurse cannot completely manage how the person spends the majority of their day.
We healthcare professionals have the consciousness that we are 'here to provide medical care.'
On the other hand, the person living at home does not necessarily have the same mindset as the hospital.
For the person, that place is not just a place to receive treatment.
It is a place of living that has been built up over a long time, and
a place where one spends time according to one's own thoughts and habits.
In the first place, a visiting nurse is also a guest in the home where that person lives, and is there to provide care.
I believe that home nursing is the ultimate service industry.
Of course, this does not mean accepting every request from the user.
It is a major premise that we are professionals who deliver necessary medical care based on a doctor's instructions and protect life and safety.
Even so, rather than unilaterally imposing our own correctness and changing that person's life to suit the convenience of the medical side, we must listen to the person's intentions and search together for where a realistic landing point lies.
Home nursing is not a job that makes a person's life conform to medical rules.
It was a job of thinking about how to integrate medical care and nursing into a life that has continued according to that person's own rules.
However, it took me a little while to realize that.
That person didn't just like alcohol.
At the time, I only communicated the necessity of quitting drinking.
However, I had never fully considered why the person did not want to let go of alcohol to that extent.
I myself can hardly drink alcohol.
Therefore, even if I am told that 'alcohol is my only pleasure,' I cannot fully understand that feeling.
If it is damaging your health and has caused major problems in the past, you should stop.
Thinking that way was natural for me.
However, as I visited repeatedly and gradually heard about the person's past, it became clear that they were not just continuing to drink without thinking.
That person had been working desperately for a long time.
They started drinking to escape the stress that piled up day by day, and it gradually became a habit.
They drink when something unpleasant happens, and they drink from the morning on their days off.
It should have been something to make them feel at ease at first, but the amount gradually increased, and they became unable to stop it themselves.
They didn't start drinking from the beginning with the intention of destroying their own life.
An action that began to get through the pain had eventually become something that could not be managed by the person's own power alone.
At first glance, they might only appear as 'a person with alcohol dependence who cannot stop drinking.'
However, if you trace the life leading up to the drinking, there is a background unique to that person.
The person themselves must have had the thought, 'Why did I end up like this?'
Until then, I had only been looking at the drinking in front of me.
Because they drink, I will have them stop.
Because they cannot keep their promise, I will explain the necessity again.
That response might not have been wrong as a medical professional.
However, repeating 'please stop' without knowing why that person came to need alcohol was also trying to correct only the behavior in front of me without looking at the path that person had walked.
In my interaction with this person, what changed my way of thinking was not a special medical technique.
It was trying to know the person's past.
Why did they start drinking?
What was the person seeking in the time they spent drinking?
And what kind of life do they want to lead from now on?
By trying to know the person's background before conveying correctness, I was finally able to see the scenery that the person was looking at just a little bit.
The words that came after 'I absolutely do not want to stop drinking'
Eventually, the person put their wishes into words.
' I absolutely do not want to stop drinking '
If it were the old me, I might have heard only those words and accepted it as 'they have no intention of quitting drinking.'
However, there was a continuation to those words.
They did not want to drink until they had acute alcohol poisoning like before.
They did not want to return to a life where they lost themselves and could not control their own actions.
They wanted to keep alcohol.
But they did not want their life to be controlled by alcohol.
What the person was seeking was not the freedom to drink as much as they liked.
It was that they wanted to keep what had become their only pleasure over many years within a range that would not destroy their life.
When I heard that story, I realized for the first time that the goal of 'abstinence' set by the medical side and the life the person was aiming for were not in the same place.
Of course, in the treatment of alcohol dependence, it remains true that abstinence is an important goal.
However, no matter how medically correct the answer is, if the person cannot be convinced, it cannot be continued in actual life.
If I keep strongly conveying what is correct, the person will follow it someday.
I thought that somewhere.
But at home, it is the person who decides what to do after the nurse leaves.
If they are continuously denied outright, they might not stop drinking, but stop talking to the nurse.
They might start drinking in secret.
They might stop telling the truth about how much they drink.
If that happens, we will not be able to grasp what is happening in the person's life, and we will move away from the necessary support.
At that time, I finally began to change my questions.
How can I get this person to stop drinking?
Instead of thinking that,
What kind of life does this person
want to lead from now on?
How much can we think together to protect their life and safety without destroying that life?
For the first time since moving from the hospital to home nursing, I was trying to reposition the 'correctness' I had believed in within that person's life.
Letting go of correctness a little, the ' one drink a day' we decided together
After the person's wishes became visible, we discussed the future policy while also consulting with the attending physician.
What the medical side was thinking was, of course, to stop drinking.
On the other hand, while the person did not want to return to the dangerous way of drinking like before, they were strongly resisting letting go of alcohol itself completely.
If we had only pushed one side's opinion, the story might have been simple.
'For your health, please never drink again.'
We could have ended it by saying that.
Or, we could have accepted the person's wishes as they were and said, 'Please drink as you like.'
However, what is required in home nursing was neither of those.
Respecting the person's wishes and overlooking danger are different.
Valuing the person's individuality and tolerating everything, even actions related to life, are different.
For example, just because it is to ease mental pain, one cannot approve of self-harming behavior that leaves one covered in blood as 'an action necessary for the person.'
To protect a life that is like the person, there is a line that must not be crossed as a professional.
That is why it was necessary to put both the person's thoughts and the concerns as a medical professional on the table.
The person does not want to stop drinking completely.
However, they do not want to return to a life of drinking until they have acute alcohol poisoning or lose themselves.
We want to avoid the danger of becoming unable to control the amount of drinking again as much as possible.
We discussed many times in between, and what we finally arrived at was
'Drinking is up to one drink a day'
was the policy.
It was not a rule that the medical side decided unilaterally.
It was a landing point found after the person also conveyed their wishes, the medical side also explained their concerns, and both sides compromised little by little.
Seen from the medical correct answer of abstinence, it might appear incomplete.
Even so, for the person, it was a realistic goal to not have all their pleasure taken away, and at the same time, not return to their previous life.
A relationship where you don't have to hide 'I drank two drinks today'
Of course, just because we decided on 'one drink a day,' it did not mean that it could be followed perfectly every day from the next day.
It is not that simple for humans to change habits they have continued for many years.
Even I, when I start something new, cannot continue it without fail every day.
Whether it is exercise or study, there are days when I think, 'I couldn't do it today.'
Even so, to not allow even one failure from the beginning only for people with alcohol dependence is too far from reality.
If, when confessed by the person,
'I drank two drinks today,'
'It was a promise of up to one drink, wasn't it?'
'Why couldn't you keep it?'
If I blamed them, what would the person do next time?
It is not guaranteed that they will be able to stop at one drink.
Rather, they might think, 'If I say it, I will be scolded,' and start hiding the fact that they drank itself.
They might answer one drink even if they drank two.
On days when they drank more, they might start avoiding the visit itself.
If that happens, even if it looks like the problem has disappeared on the surface, in reality, it will only mean that we have moved away from the truth.
At home, a nurse cannot watch the person's life 24 hours a day.
Even if we can visit three times a week, one visit is about 30 minutes to an hour.
How they spend most of the day is left to the person.
Therefore, what is really needed at home is not to have them look like they are keeping their promise only in front of the nurse.
It was to have them honestly talk about not only what they could do, but also what they could not do.
'I drank two drinks today.'
When told that, I first accept that fact.
What is drunk cannot be undone.
Instead of blaming them there,
'Did something happen today?'
'Was there a reason you wanted to drink more than usual?'
I look back on the day's events together.
Maybe something unpleasant happened.
Maybe they couldn't sleep.
Maybe it was just there in front of them and they reached for it.
If the reason is known, we can think together about how to deal with it when a similar situation happens next time.
Just because they couldn't do it once does not mean all their efforts up to that point are gone.
Even if there is a day when they stop, they can just return to the shared goal from the next day.
The role of a visiting nurse is not to count and evaluate the person's failures.
I think it is to support them so that they can continue to move forward again without cutting off the relationship even on days when things did not go well.
Because it cannot be managed, a relationship of trust was necessary
In the hospital, you can manage the patient's life to some extent.
You can check whether they took their oral medication, and if there is a water restriction, you can grasp the intake amount.
In an environment where drinking is prohibited, basically, you cannot get your hands on alcohol.
However, at home, it is not like that.
We cannot completely control what the person does after the visiting nurse leaves.
In the end, the policy of 'one drink a day' remained a verbal promise with the person.
That is why what we can rely on is not the strength of management but the depth of the relationship.
It is okay to tell the truth to this person.
Even on days when they couldn't keep their promise, they won't be denied outright.
If I talk without hiding, they will think about the next time together.
Building a relationship where they can think that led to protecting safety at home.
If the relationship of trust collapses and the person starts hiding the amount of drinking, the visiting nurse will provide support without knowing the reality.
How many drinks are they actually drinking?
What is the cause of their poor physical condition?
How close are they to a dangerous state?
If that information cannot be obtained, we cannot provide support at the necessary timing.
The meaning of home nursing is not just to measure body temperature and blood pressure regularly.
It is to have them share what is actually happening in that person's life, including both good and bad things, and to rebuild it together.
Therefore, more than conveying correctness, I came to value
not losing a relationship where they can talk honestly.
Better a promise that can be kept than a 'correct' answer that cannot
This person has been living a life of 'one drink a day' for about three years.
Of course, I don't think they never wavered during that time.
There must have been days when they drank too much, and days when they struggled internally.
Even so, they have controlled their alcohol intake in their own way, without returning to a state where their entire life was dominated by alcohol as it was before.
What would have happened if we had kept pushing total abstinence as the only correct answer back then?
The person might have answered 'I understand' on the surface while drinking in secret.
There is also a possibility that they would have stopped telling the visiting nurse the truth, and the relationship itself might have been severed.
Even if we had strongly conveyed what was medically correct, the person's life might have actually headed in a more dangerous direction.
On the other hand, by creating a promise of 'one drink a day' that the person could also agree with, they were given room to adjust their own life themselves.
We were also able to continue providing the necessary support while hearing about their true drinking situation.
It was precisely because we let go of 'being right' a little that something was protected for a long time.
That is not just the rule of one drink a day.
It was the pleasure the person cherished, the relationship of trust with the medical staff, and the stability to continue living at home.
Visiting nursing was not a job of leading people to the 'correct' answer
When I first moved into visiting nursing, I thought that support meant bringing the user closer to the 'correct' answer as envisioned by medical professionals.
Take medication properly.
Stop doing dangerous things.
Keep promises made to the doctor.
Of course, I still believe that conveying these things is necessary.
Respecting a person's wishes does not mean abandoning one's responsibility as a professional. If there is a life-threatening danger, I must clearly communicate it, and if necessary, coordinate and intervene with doctors and other professionals.
However, knowing the correct answer and being able to realize that answer within the person's life were different issues.
No matter how ideal the policy is, it is meaningless if the person cannot agree with it and cannot continue it.
What a visiting nurse can do is not to completely manage the person's life.
It is to build together a life where the person can choose for themselves even during the time when medical staff are not present, and choose again when they fail.
In my previous article, I wrote about the importance of taking an interest in the user and trying to know their life.
Through my involvement with this person, I was also taught what lies beyond that.
The more I knew about the person, the less I could decide based solely on the 'correctness' of medical professionals.
What have they cherished?
What do they not want to lose?
How much effort can the person themselves make?
After hearing the person's own answer, we search together for a path that can protect both their life and their living.
That sometimes looks like a detour.
However, a step that the person is convinced of and can continue is sometimes able to go further as a result than pushing a 'correct' answer that cannot be kept.
In visiting nursing, 'being right' was not always the correct answer.
What was truly necessary was not to hand over an answer prepared by medical staff, but to search together for an answer that the person could continue to keep within their own life.