Donna Frost

Facilitation of the development of professional artistry 231 7 blood pressure. Explained this to her etc. And she was fine. There was nothing wrong now with her blood pressure – or anything else really. She was progressing well. While handing over to my colleague in the afternoon, at the bedside, he turned to the woman and said: ‘You needn’t expect me to be checking your blood pressure like this. That’s not what you’re in for.’ I was appalled. The whole situation appalled me. Him saying that to a patient. The look on the woman’s face, as if she had somehow manipulated me into taking her blood pressure more often. I felt ridiculous. It put a dark cloud over the whole relationship with this patient, as if I hadn’t been acting properly. And I would have stopped checking it now anyway, that was exactly what I had been saying to my colleague, that it all looked good now. And instead of taking charge and pulling the conversation back, focusing on the patient and her safety, her well-being, I let this dark cloud happen. The focus was now the care pathway, the protocol, the ankle. Not the woman. Before handover I had been pleased and satisfied, pleased that I had continued to check her BP, even though it hadn’t been ordered and wasn’t in the post-op pathway for this point in her care, pleased that I had evidence to reassure me – and her – that she was stable and doing well. We [the patient and I] had worked together to help her feel safe. But there beside the bed I felt small and foolish. I let my colleague diminish himself, the patient, and me – and let’s be honest the whole nursing profession – and I felt small.” (Jane-RNI- 20120715 Con -pp 2 - 3 ) Jane felt that she had failed to demonstrate professional artistry in the interaction with her colleague. When we worked together to imagine what professional artistry may have looked like in that encounter we ended up going further back, to the way the handover was begun in the first place. Jane had not actually spoken about her underlying concerns (taking her patient seriously, helping her feel safe, being alert to changes) when handing over to her colleague. She had presented the information as: “BP [blood pressure] dropped during OR [theatre] so I checked it more often than called for in the protocol during this shift. Is stable now.” (Jane-RNI- Con 20120715 -p 5 ). So she had only presented the technical information and had not created conditions in which her colleague was invited to consider other aspects of care. An alternative approach to the handover could have been something like: