Nursing Story – Exemplar

Seeing the Whole Picture

By Betty Easter (RN, CPAN)bettyeaster_web

Our nursing education prepares us to understand the anatomy, physiology, and hemodynamic findings of various diseases and illnesses. Signs, symptoms, treatments and expected outcomes are all learned. The effects and side effects of medication are taught. How all these interact to improve the patient’s health and well being become facets of our understanding of the science of nursing?


We have achieved much in order to pass a state bar exam and be deemed Registered Nurses. Throughout our career, we continue to learn and grow with experience as we evolve from novice to expert nurse. Along the way we develop our own personal style of delivering care to patients and their families – the art of nursing.

Additionally, we must learn to take the knowledge from science and the artful delivery of care and incorporate it with the patient’s perspective in order to effectively care for the patient.

Seeing the whole picture is most important.

Patients are not just “cholecystectomy in room 622” or “the total hip in room 438” or “the noncompliant diabetic in 315”. These are human beings with their own unique characteristics, cultures, beliefs, needs, and responses to each interaction. They each have a life story that has impacted everything about them and brought them to where they are now.

Throughout my nursing career I have been fortunate enough to have a myriad of encounters with patients who made a lasting impression on me – indelible footprints in my mind and my heart. These are reminders to not look at just a diagnosis but to see the whole picture.

One such patient was a ‘noncompliant diabetic’ who presented with gangrenous toes requiring amputation. Some might question why he didn’t take care of his diabetes and follow proper diet and medication instructions or why didn’t he seek medical attention earlier in order to prevent such damage. He appeared intelligent, conversed politely and appreciatively with those who were providing care.

During the time that I was interacting with him, providing the necessary care, we talked about his situation, the importance of self-care, and proper medical follow-up. He readily acknowledged that all of those were important, but he had been unable to do those things due to “more important issues”. As we continued our dialog he divulged several ‘nuggets’ of personal information that had led to his current situation.

Although he had been diagnosed with diabetes several years before and given diabetic diets and handbooks, he had not told anyone that he could not read. He lived with his elderly mother who required much assistance getting around in a secluded area in the mountains. Just getting to the doctor was difficult. He had limited income and resources. Therefore, if he had known the proper exchanges he may not have been able to obtain them. He had “put off going to the doctor” because of not having a way or the money to pay.

I began to see the daily obstacles that this person encountered. The mountain culture of hard working folk who get up every day and do the best they can with what they have emerged clearly. I also saw that this patient needed more than a handful of papers to make a difference in his health and well-being.

As the plan of care developed, education was given verbally and visually about the different types of food groups and what foods could be exchanged for others. They say a picture is worth a thousand words, and we used many of them as we taught him how to make good dietary choices. We asked what foods he liked and had available in order to incorporate them into his daily meal choices. We explained the necessity of proper washing, inspecting and drying the feet and legs. Signs and symptoms of high and low blood sugar were discussed, and he could verbalize back to us what to do when he felt those symptoms. We made sure that social services and public health nurses were going to follow-up with this patient following discharge.

This patient taught me to never assume that patients understand what you write on a discharge instruction sheet or that they have the means to do all that is necessary for their health. It takes the science of nursing to give them the proper education, the art of nursing to deliver it in ways they understand, and the understanding of their personal situations (the patient perspective) to be sure they can take ownership of their health needs.