As a young visiting nurse working in Cincinnati, I was asked to go to the home of a woman who was not compliant.This woman, who had a history of high blood pressure and blood clots, was pregnant for the seventh time in 5 years. Her doctor had prescribed a diaphragm with spermicide. She and her husband lived in the attic of her parents home; it had one bathroom on the first floor where she kept the birth-control equipment. Her husband strenuously objected to the interruption a trip to the bathroom required, so she put in the diaphragm every evening before he came home from work. The diaphragm would become dislodged as she fixed dinner, cared for the children, and did other chores. No healthcare provider in those 5 years had asked her about her living conditions. Pregnancy was dangerous for her, so they prescribed something, which, as it happened, was inappropriate for her situation.
A patient is a person: indivisible; one. Quantum means small, tiny, one. Irreducible. Simple. Indivisible. So totally interconnected that no part of her being can successfully be isolated. A quantum patient is one, singular, whole, indivisible human being who is suffering in this case, from high blood pressure, blood clots, and too many pregnancies too quickly. The Cincinnati woman could have told us what the problem was, and it wasn’t willful noncompliance. The problem involved her whole life situation.
During the past century, great success was achieved through specialization. Experts resolved distinct problems within well-defined fields and no field has been better defined than medicine. The organizations in which doctors and nurses worked, primarily hospitals, also became specialized; even the departments within hospitals became highly specialized so much so that many hospitals instituted product line management, which formally created specialized organizations within the specialized hospital.
The success of specialization resulted in a daunting progression of unintended consequences, not the least of which was widespread fragmentation. We divided humans into discrete bodily systems, neglected anything outside the body, and ignored the interrelated nature of the body itself. We know now that problems no longer fit within strict medical specialties, and effectively treating them no longer supports traditional specialization. We know it, but we frequently disregard it.
Effective treatment and disease management exist in between the specialties, fields, disciplines, and categories that evolved over the last century. Complex health problems swirl across and encompass the whole person, his or her living situation, and the environment itself. New-millennium practitioners find themselves deeply entangled with the intermingling of each patient’s issues: biological, social, economic, psychological, spiritual, and environmental. What were once viewed as simple problems adequately addressed by extreme specialization have become complex problems that challenge fragmented categories. Even the patient-professional relationship is no longer a one-on-one relationship, if it ever truly was. It involves family, friends, employers, working conditions, living conditions, insurance agencies, government, and more.
Successful intervention requires holistic categories that enable practitioners and their organizations to:
- identify interconnections surrounding the patient
- think about interconnected problems in comprehensive ways
- intervene in a multidimensional manner.
Doing this doesn’t take more time. How long would it have taken for caregivers to ask the Cincinnati patient why she was pregnant with her second child when she was presumably using birth control measures? Why wait until the seventh pregnancy? In the end, it would have saved time. It wouldn’t have taken more money; most likely it would have saved money, because getting things right the first time is always more cost efficient. However, it would have required a mental revolution for today’s specialist practitioners almost a revolt against specialization.
One-size care doesn’t fit everyone, no matter how specialized the health complaint. And it’s dangerous. One thing has become especially clear: We treat whole patients who live in an interconnected world, and they suffer from acute fragmentation.
Specialization isn’t obsolete; there’s too much that must be learned in each area. But it must be transformed and expanded to allow for the multiple complex interrelationships that produce-and heal a person rather than merely address a fragment. We must introduce, or reintroduce, the specialist to the quantum patient.
Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today
Is the ‘are in between the specialties’ that generic attention that connects all forms of nursing care – like Peplau’s suggestion that the nurse uses herself as a therapeutic tool and Henderson’s dictum that ‘ehat the nurse has to do is to put the patient in the best frame possible for nature to act upon him.’ Or, for that matter, Nightingale’s mandate that the most important thing for a nurse to do is to observe the patient’…If so, perhaps we really are close to a theory of nursing!
What makes a person a ‘quantum’ patient as opposed to a regular client?