Underestimating intelligence of others…

 

I’ve been thinking a lot lately…but what else is new.  Our Betta fish Storm (see photo…sometimes I can take a decent pic. : 

looked like he was on his last fins earlier this year. Our resuscitation efforts were not successful. So off to the big box pet store to replace the Betta. It was “my turn” so I chose a bright blue /navy Betta fish. I had a really cool name for him, but sadly I’ve forgotten his name so we are in the process of coming up with a new name, so for now I will call him blue.   Blue fish would hide in the rock or in the plants. He’d never hang out, to the point we’d search in the tank for him to make sure he didn’t jump out thinking he could fly or breathe. (a la Bob 3 who we found about 10 minutes after his inaugural flight dried out like a piece of jerky on the tile floor. ) So as time went on, Blue started hanging out a bit more. I thought I was going nuts, but it seemed when I’d come into the kitchen (Blue is presently residing in a tank on our kitchen counter. It works well for all since he’s near the sink and so far the crazy dogs haven’t tried to jump on the counter for a closer look like the did when Storm’s tank was in the living room) he’d start swimming around like crazy. I’d give him some pellets. Sometimes he’d be snotty and refuse to eat until I removed the pellets and give him his favorite freeze dried blood worms.  But I thought it was a Pavlovian reaction to the light…seems I thought wrong.

While in nursing school, my mom would often come over and walk my dogs, feed dogs, then get my son off to school especially if I had to be at a clinical site by 6:30AM. I’d come back around noon. The dogs would feign starvation and the Puggle started to knock her bowl out of the stand to be sure I got the picture.  (Puggle would also go nuts when she heard my mom’s ring tone when she called to let me know she was on her way so I could leave.) Then dogs would hear me call my mom to check if she fed the dogs…just in case they were actually really hungry and not just nutty con artists aiming for a second meal.  As soon as they would hear, “Hi Mom, Did you…” they’d slink back to their rooms admitting defeat. 

Son will often  be on animal food duty. He usually feeds the dogs and gives Blue his breakfast too.  Son noticed a few days later that, even though he fed the fish, Blue went whacko when I came into the kitchen and kept looking like Jawz in search of prey.  Little bugger knew I was usually the one to feed him the bloodworms since although freeze dried son often won’t touch them to give the poor fish a pinch.

Seems that Blue wasn’t lacking in intelligence. He was scoping out the joint and trying to figure out which one of the giants would be more likely to give him his favorite food “upon request”.  Little stinker. However it doesn’t seem like he has much of a sense of time since he’ll do the “I’m starving give me worms dance” more than once a day sometimes.  Smart fish, he knows who will give him his favorite freeze dried blood worms and who won’t…

Another example, my Chihuahua is a bum.  Most people feel sorry for the old guy since he only has one eye, but he’ll uses that to his advantage as soon as he hears the first “awwwe”, he knows he has a chance of being carried around like the prince that he thinks he is.  My mom is the  biggest sucker of all.  Oscar would live perched in the front seat of my car for the rest of his life in the hopes of gaining a car ride if I would just let him.  So although he is usually good off leash, especially at my mom’s house, he is likely to get underfoot if he sneaks out and follows me to the car.  I was closing my hatchback when he got under me. I heard his squeal (which he does if he thinks no one is paying attention to him) as I stepped on him.  I thought for sure I broke the dog’s leg. I was distraught, ran into my mom’s house nearly in tears carrying the dog. (Not before noticing he was limping holding up his right paw). So we put him down to see if he was alright. My mom with the sing songy “aww poor puppy”. Then I noticed it, he switched to limping holding his left paw up.  The little stinker. My mom didn’t believe me. Oscar thought this was grand and let her carry him around, and snuggle on the couch. Later mom took Roxie for a walk while we got ready to leave. Boy had Oscar and was walking him in front. I wanted to see if my dog was still “hurt”, so I went to the edge of the laws and jingled my car keys.  Oscar the injured took off like a greyhound in a race, running towards me in anticipation of the highly coveted car ride…  Son and I were laughing, until we heard the screech, and the “aww poor puppy”.  Oscar stopped dead in his tracks running towards the car when he caught sight of my mother coming around the corner with Roxie. Picked up his paw and cried. Son & I burst into laughter. Of course mom didn’t believe us and picked up the bum & carried him to the car.  Smart dog, he knows who will buy his bad acting.

I’ve seen a lot of articles claiming that children on the autism spectrum (whether mild or severe) lack empathy and cognitive ability. Partially based upon the lack of or reduced communication skills. My son went for the first two weeks of 2nd grade refusing to speak in class if a particular (less than professional) aide was present.  However, in watching the interaction of children on the spectrum, verbal or not, I wonder if the assumed lack of cognitive abilities is due to the child’s failure/inability to respond to assessments that require verbal replies or that the child “looks the investigator in the eye”?  When he had his IEP evaluations, he nearly failed in speech and “psychology” because he shut down and stopped answering. Especially with one evaluator, he refused to even say “I don’t know” or “shake his head” he’s simply refuse to look at her. (She decided this was ODD/deliberate defiance/willful behavior rather than he had enough…she was recently proven 100% wrong in her assumptions.) Perhaps some of the non-verbal or limited verbal children are significantly more intelligent than the assessors decide. Perhaps these children are much smarter than us, and simply choose to not answer such banal questions that are often on the assessments.  Perhaps the child is not being challenged because it is assumed that their cognitive functioning is much lower than reality? 

I think the underestimating of a child’s abilities, especially those that are non-verbal or limited verbal, has been reduced by the introduction of technology such as using the iPad as an adjunctive communication device. It seems anyone who as bothered to watch the award winning HBO movie Temple Grandin or read any of Dr. Grandin’s books such as Thinking in Pictures, is more likely to be understanding that my Aspergarian child thinks differently (as do many other children).  Why bother teaching “learning styles” in collegiate teacher preparation programs, if the teachers are not going to ever use the knowledge to educate their students in the classroom setting?

But the underestimation in the intelligence of others is often found in the health care setting. As a new graduate nurse, I am of the philosophy that a patient with a chronic illness or condition or the parent of a child with a chronic illness or condition, is the utmost expert on that particular patient. They may know the nuances of the condition in general, but they are the expert on their circumstances and nuances.  Many in roles of healthcare authority fail to comprehend this very notion. I, as a parent, patient, or relative of a patient, will not stand for such a superior attitude and find a more realistic practitioner.  No I don’t claim to know everything (well almost) but I do know HIM. 

I experienced this same attitude  going through IEP meetings (ones where I was accused of being “manipulated” and “too positive” about my child and his needs), that since I didn’t have the correct alphabet soup after my name then my opinion doesn’t count.  Apparently the degree of M.O.M. or D.A.D. didn’t mean squat to this team, and in fact the case manager often included these feelings in statements throughout his IEP.

But things are looking up since we are out of district and the case management team has been changed effective July 1st. The new case manager believes that the parent is the expert on the child, she is the expert on services available within our region. And that is the way it should be.  Even his new teacher sent home a questionnaire, the first question was “what are his strengths”, the second “what were some of his challenges last year”. Not what did he do that was “bad” or “good”, but how can we as a team make this year even better than the last.  Now that is not underestimating the intelligence of others, and is empowering all members of the team to support the child to be the best that he can to succeed.

 

As a new nurse, I plan to give my patients & their families the benefit of the doubt. Even in clinical rotations when patient/family education was part of my duties, my first statements included “Tell me what you know.” “Tell me how I can help you.” “Tell me what works for you.” I don’t believe anyone is truly stupid, a bit dopey sometimes, maybe silly.  Everyone has intelligence, it’s just a matter of taking the time to find out what they are “expert” in.

I think I have finally found my niche in life...reflections on nursing school

I started nursing school in September.  The lecture portion is rather challenging but also common sense to me. I have been doing rather well between my personal background & experience and our texts & lectures, my grades truly reflect my knowledge and effort.  In the beginning of December, we started our clinical rotations.  For the current rotation, our class has been divided between three sites. A rehabilitation hospital, a long term care/rehab facility, and a sub acute facility that also has long term patients.  My first stop for the month of December has been the rehabilitation hospital. The first half I was on the medium stay wing with mostly surgical/orthopedic patients. Patients on this wing are inpatient for 1-6 weeks depending on their condition and medical history. 

At first it was daunting to assume the role as student nurse and have a higher level of responsibility for patient care. While previous patient care experience taught me how to interact with patients and do some simple procedures (such as blood pressure, dressing changes, and the like) it was still a subordinate role that was directed by an RN or an LPN (and in some cases the MD/DO).  The level of documentation as a nurse is vastly different of that required of a PCA, CNA, or EMT.  After the first day, it was a bit easier.

It was truly awesome to see the changes in patients over a short period of time. For example, the woman who the first day I saw her was very anxious and needy, in addition to being doubtful of her own abilities. She told me initially that she could not do anything herself, and was worried that she'd have another complication that would send her back to the acute care hospital. I worked on building her confidence, and reminding her of what she COULD do rather than what she couldn't do.  I told her I would help her do what her present condition prevented her from doing, and the health care team would work together to build her independence.  She was apprehensive but was proud to tell me what she could do. (She did think it was funny that I had a hard time helping her with her hair clips. I don't use them in my own hair and I have a son...) 
The best part was when I came back the following week, another student told me to go in and help her with care, stating that "she requires a lot of help."  I walked into the room and asked her how I could help her, she told me she just needed her reading glasses. I obliged, and when she 'dismissed me' I reminded her that I was only a call button away if she needed me.  The most incredible part was what I overheard when I was outside the room working on my paperwork.  She had gotten a new roommate the evening before. The roommate was tired and apprehensive. The patient proudly told her of her recent accomplishments towards independence, and even said "(This team) is great, in a week you'll be surprised at what you can do by yourself again."  The primary nurse for the day was next to me and smiled, "That is what this job is all about."

I most certainly think I have made the right choice going into nursing. 

These past two weeks I was on the other side of the hospital. While a still a sub acute unit, the patients required a higher level of care due to their more complex conditions; plus their length of stay is much longer often 2-3 months.  I had my "own" patient assignment, this week I had another gentleman.  He explained why the holidays are such a difficult time for him.  (We had just finished our nursing fundamentals unit on communication & therapeutic communication/emotional support the day before our assignment shifted.)  Now previously I might have said "I understand how you feel.", "It must be tough for you." but this time I did not.  I reflected on my own experiences and the lecture on how frustrating these seemingly empathetic statements can be to someone.

Simply, I said "There is nothing that I can say that is going to make it better." My patient brightened a bit and said "You know you are right." Then I did the skill that is probably the most difficult skill to master, I simply listened to him. I was silent, as that was most appropriate. After listening to him for a while, I could hear the pride in his voice when he casually mentioned his family.  When it was time, I asked him if his family was nearby....the reaction was amazing.

My patient was rather ill, in addition to being despondent.  He lit up like a Christmas tree when talking about his children and grandchildren.  He showed me the items decorating his room that his adult children had delivered. He proudly told me of his youngest grandchild that was able to visit him.

When I returned this week, he had taken a few steps backward in the way he was feeling. His plan of care altered as nursing & medicine in general must be flexible.  But again he greatly improved when his family visited or when given an opportunity to (boast proudly)talk about his family.  I reinforced small accomplishments, such as finishing getting ready nearly 20 minutes faster than the day prior. (We are there 2 days a week.)

I knew, at least emotionally, he was feeling better when he commented on receiving a physician's order for a day pass to go to his family's home for Christmas Day.  He even smiled and said that he knew who would be picking him up. I took the 'bait' and asked him "Who?" He said since his pass is for 7AM, he knew that it would be his daughter with his youngest grandchild, since like most young children she had everyone up at the crack of dawn on Christmas morning to see what Santa had left overnight. I had to smile. 

This week's experience helped me to see the true value in silence and active listening. If I hadn't been listening the first day, I would not be aware that he had a positive relationship with his children. Asking if his children was nearby could have royally backfired if he felt that his children "abandoned" him or if they were not on speaking terms.  By taking cues from our conversation, I was able to know when to gently transition the conversation to his pride and joy, his family.  Even with my female patient last week, she started off nervous and negative about her ability, but asking her if she could do simple tasks and seeing her smile & say "I CAN do that!" (and more excitedly with each task that she realized she could still do) was wonderful and enlightening..

I also learned how much a person's emotional state and their self-confidence can impact their medical condition(s) and progress. Simply empowering a patient toward independence can positively impact their ability to recover, in addition to raising their self-confidence.  I also realized that permitting a patient to share their positive experiences or talk about a source of pride (in my one patient's case--his family) can improve their overall appearance.  Happiness and comfort can affect our vital signs (blood pressure, pulse, respiration rate) and our ability to heal.  While I may have always known this in my heart, it was amazing to see the effect in clinical practice.  To know that even as a student, I was able to play a minuscule part in raising a person's self confidence and self esteem is humbling. To know I had an effect on the life of another...well there are no words for that.

Sure I have had a direct impact on my son's life, emotional state and well being, but that is harder to see because I am with him everyday.  Kind of like losing weight gradually, you may not notice until someone else comments (or preferably compliments. :) )