The Art of Human Caring: My Lived Experience
Submitted by Darlene Cunha MMHC, BSN, RN, CENP, ACHE
I have spent nearly four decades in healthcare and have learned that if you want to be the best healthcare professional possible, finding balance is critical. Here I share my personal journey into nursing and leadership and the valuable lessons learned along the way. The truth is, they are just as valuable today as they were back then.
Part 1: My “Aha” Moment
As a young girl, I was always drawn to helping others. Whether it was comforting a friend who had fallen or running to get help for someone in need, it just felt natural.
At the tender age of 12, I convinced my neighbor, Mr. Tom Shields (yes, the founder of Shields MRI), to let me volunteer in his nursing home. I so admired Tom and his wife, Mary, a nurse. They were two of the most compassionate and faithful individuals who taught me valuable lessons in caring for others. “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” – Maya Angelou
Each day after school, I would walk to the Madalawn Nursing Home and visit with the residents. Sometimes I would run small errands for them, but mostly just provide them company. It was here that I learned many life lessons. As the patients shared stories of yesteryear, I knew I had to honor their past as they were shaping my future. “Vision is the ability to talk about the future with such clarity it is as if we are talking about the past.” – Simon Sinek
It was around this same time that my father became gravely ill requiring emergent surgery and unfortunately suffered an anoxic brain event postoperatively. I would visit him daily in the hospital and share my day, unsure if he could even hear me. Nurses and doctors would come in and out of his room, and walk past me as if I was invisible, not to mention they never addressed my father – the patient. No one sat down when they came in to evaluate him. To be frank, no one spoke to my father, but rather talked around him as if he wasn’t there. As I watched the man I loved so deeply slip away, so many thoughts ran through my mind, but one clearly came to the forefront - This is not what the Shield’s would do. This is not what I will do.
The subsequent years were extremely difficult as my mother became solely responsible for seven children. It was during these formative years that I learned valuable life lessons. I vowed to become the nurse my parents would be proud of and hopefully as empathetic and compassionate as Tom and Mary Shields. “The major value in life is not what you get. The major value in life is what you become.” – Jim Rohn
As I reflect on those early years, I clearly recall the challenges faced by both the nursing home and the hospital. There were days we were short staffed due to sick calls, and at times there was a lack of resources for a variety of reasons. Although they were different branches of healthcare, they shared similar challenges. However, there was one difference that set the nursing home apart, and that was true teamwork. At the nursing home, we pulled together as a team and made certain every patient was well cared for while caring for one another as well.
I recall Mary Shields sharing how important it was to communicate with families and include them in discussions around the care being provided. I often sat and listened when she called a family to update them on their loved one’s status. Another valuable lesson - families were/are an extension of the patient. They too were scared and needed reassurance. “Be the living expression of God's kindness: kindness in your face, kindness in your eyes, kindness in your smile.” ― Mother Teresa
As time passed and I got older, I took on many roles in the nursing home. I worked in the laundry room and the kitchen, and eventually as a nursing assistant. I learned along the way that everyone’s role, regardless of status, was important. “Leadership is not about titles, positions, or flowcharts. It is about one life influencing another.” – John C. Maxwell
As a nursing assistant, I was able to care for patients and listen to them as they guided me on how to provide their care. It was important that they participated, and in turn, they gave me another valuable life lesson. Each patient had a different story and a different need, and it was an honor to be invited to their bedside to care for them, especially when they were most vulnerable. “All I ever wanted was to reach out and touch another human being not just with my hands but with my heart.” - Tahereh Mafi
The lessons learned from these early experiences - hard work, perseverance, grit, and patience - coupled with the examples of love and caring shown to me by the many long-term residents in that nursing home and by the Shield’s family, helped to shape me as a young adult, caregiver, and leader.
✓ Patient Experience: The patient experience is important; everyone needs to feel cared for. Never forget families are part of that experience.
✓ Lack of Resources: Nothing lasts forever, this too shall pass. Be resourceful. Working together makes it all possible.
✓ Be “All Ears:” Really listen to your patient. Their story is theirs alone. Be willing to share your personal experience if it would help them understand.
✓ Patience: Be kind and patient; when you are ill, you are scared, too. Compassion is the basis of morality.
✓ Work Toward One Goal: Never be of the mindset, “it’s not my job.” When you work together, everyone benefits, so empty the trash and wipe the spill. Be the leader you would follow.
Part 2: Courage to Take the Next Step
The next step on my healthcare journey was almost derailed. I knew in my heart that becoming a nurse was my calling, but financial hardship was a reality. Despite several acceptance letters to nursing schools, I had no financial resource to tap into. “You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.” - Maya Angelou
Somehow, Mr. Shields had learned of my dilemma, and without hesitation, co-signed my school loan. This man who had been my mentor had also become a second father to me. He believed in me. It was my turn now to pay it forward. (I repaid that school loan ahead of its due date.) It’s amazing how one person’s act of kindness can change the course of your life.
Tom and Mary Shields had taught me the value of believing in others and growing your team. They had created a warm and open culture of not only caring for the patients, but also their employees. It was not uncommon for them to round on the units, greeting staff and patients and truly listening to their stories. Mr. Shields would often excuse himself “to find a chair,” as he said the greatest form of respect was to sit at eye level when having a conversation - another valuable life lesson I have taken with me throughout my career. “A leader is one who knows the way, goes the way, and shows the way.” – John C. Maxwell
I graduated nursing school and continued my education in the field. Along the way, I assumed positions with greater responsibility shaping the leader I had hoped to become. I was fortunate to have tremendous mentors who continued to invest in me and colleagues that I have befriended for more than 40 years. Never forgetting my humble beginning or the opportunities afforded me, I was determined to make a difference and mentor future leaders. I believe it is every leaders responsibility to contribute to the art of human caring, no matter how small the effort. “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” ― Mother Teresa
Over the ensuing years, I honed my skills as a nurse, operator, teacher, mentor, and leader. I had a vision to shape policy and the care nurses provided on a larger scale and pursued positions that afforded me that opportunity. I knew I had the passion and drive and was ready for the next chapter. “Be fearless in the pursuit of what sets your soul on fire.” – Sarah Gallagher
✓ Patient Experience: Patients may not be able to measure the quality of clinical care, but they can measure their experience. Always be mindful of the difference.
✓ Culture: Create an open and collaborative culture of well-being. Culture and shared values drive the mission and are fundamental to developing and sustaining a common strategic vision.
✓ Mentorship: Mentor a young leader as often as you can, as often as you can, as often as you can! Work to inspire others to shine.
✓ Growth: Afford opportunities for nurses/staff to grow. Grow your professional community by leveraging your partnerships with higher education and other organizations that support your vision and align with your core values.
✓ Rounding: Round often on patients and staff with compassion.
✓ Commit to Sit: Sit at eye level when communicating with a patient/family. It lets them know you have the time and you care.
Part 3: Finding Balance
The COVID-19 pandemic has forever changed our lives both personally and professionally. For me, it has tested all of my skills as a leader. In a short period of time, organizations had to make major changes to the way they delivered care and be able to change again at any moment. It became clear that flexibility would be key to survival - both to the organization and its leadership team. “Change does not roll in on the wheels of inevitability, but comes through continuous struggle.” - Martin Luther King Jr.
Cultivating a culture that drives strategy based on trust, authenticity, and vulnerability have been the hallmarks of my leadership style, and now it was front and center - every shift, every day! Rounding and daily huddles with staff helped me to build trust and identify opportunities to improve care delivery. It is imperative to look for ways to drive efficiencies through feedback from those closest to the work. You must have confidence in the team you have established.
Long days of supporting staff and ensuring adequate resources have become commonplace during this crisis. Healthcare is being pushed to its limit with the COVID-19 pandemic, and it is important, even more so now, that we develop a willingness to adapt, embrace opportunities to change, and be willing to lead others through that change. “Continuity gives us roots, change gives us branches, letting us stretch and grow and reach new heights.” - Pauline R. Kezer
Over the years, I have been on the other side of healthcare as a patient, parent, daughter, and friend, and more recently as a wife and caregiver. I have witnessed firsthand the overwhelming exhaustion of the caregivers, lack of staff and resources, and downward spiral of care and attention to the patient/family experience. What was happening to this beautiful profession of human caring?
It has never been more evident in this environment of unpredictability and constant change that we ensure effective leadership remains front and center. It is imperative that staff remain hopeful for a brighter future. If we work together, see the possibilities and not the limitations, we can make a difference in advancing health. “Be the change you wish to see in the world.” – Mahatma Gandhi
Although the pandemic presented many problems and obstacles to overcome, it also helped identify numerous opportunities for improvement. It has put a spotlight on the vital competencies of authentic leadership and has demonstrated how the partnership between leadership and front-line staff builds strong relationships and positive outcomes.
Over the years, there has been much change in treatment modalities and interventions in the care we provide to those who are ill. There is no doubt that these advances have saved or prolonged lives. However, despite all these achievements, the basic tenets of the art of human caring remain the same: kindness to self and others, compassion, authenticity, developing and sustaining trusting caring relationships, problem solving through caring, teaching and coaching through caring relationships, creating a healing environment, and supporting human dignity.
Each personal and professional experience has served as my guideposts throughout my career and exposed the struggle we have all endured to reform our healthcare system. Those experiences have made me committed to the work I do for my family and for others.
Much has changed in healthcare, and yet so much remains the same. The challenge is to find the balance.
Lessons Learned and Ongoing:
✓ Patient Experience: Never lose sight of this, ever. The patients voice can never be shared enough.
✓ Leadership: Be the leader you said you were and are. Be intentional. Get out of your office and interact with caregivers and patients in a meaningful way. Build authentic leadership and trust.
✓ Mission: Connect the why to the mission. Unite stakeholders for a positive outcome.
✓ Strategic Partnerships: Partner with other organizations to drive efficiencies and eliminate redundancies.
✓ Acknowledgement and Recognition: Do not forget the power of purposeful and meaningful recognition of employee contributions.
✓ Big and Small: Don’t forget to pay attention to the small things, they are often the catalyst of bigger things (good or bad) yet to come.
✓ Collaboration: Invite a wide range of people to the table - you will be surprised at the conversation and ideas that emerge. Value and empower your team.
✓ Gemba: Go to where the work is done. The most important opinion is that of the person closest to the problem; always remember that.
✓ Lean: A relentless pursuit of excellence. Eliminate waste to improve efficiency, quality, patient safety, and experience. Recalibrate service lines to eliminate silos and drive systemness and togetherness.
✓ Communication: You can never, ever over communicate. Fear can paralyze the best of us, both leaders and frontline workers.
✓ Daily Huddles: Make them a part of your day. They allow you to recite your common purpose together as a team and to share a story (mission moment) of how you cared for a patient or one another.
✓ Hope: Leaders must always continue to infuse hope and focus on positivity throughout the organization. “Yesterday is gone. Tomorrow has not yet come. We have only today. Let us begin.” ― Mother Teresa