Not Always What It Seems

As nurses we are taught and learn many, many skills.  From dressing changes and heart sounds, to compassion and bedside manor.  Our assessment skills are endless.  We are trained to know signs, symptoms, and manifestations.  We are continuously on the lookout, watching your behavior, vital signs and health status.

We pay attention to the teensiest, tiniest, smallest of details, literally down to how many breaths you take per minute.  We learn your body and we monitor its every change.  We noticed your skin color when your blood pressure is elevated.  We check your blood sugar when you orientation is a little off.  Nurses know what labs to order when your urine output decreases and how to read your EKG when your heart races.  Most of us can tell if you have a bacterial disruption in your intestinal tract based off the smell of your poo 😜

For 12 hours we we watch, we listen, we look, we inspect, monitor, document, observe, and we adjust your medications, treatment and care based off our assessment.  We provide the best we can based on these details.  Most of the time we know what the doctor will order for you before we even call to ask.  Nurses pay attention. Nurses are THE number one most trusted professional in the United States.

But.

But sometimes we miss things.  Sometimes we are wrong.  Sometimes clinical manifestations present as one thing on the outside but are something completely different on the inside.

Sometimes the drug addict, who looks deathly, checks out with a near perfect bill of health (minus the positive UA)  and sometimes the yoga instructor is diagnosed with cancer having no signs or symptoms or family history.  Even though we spend our every waking moment assessing all the outward signs, sometimes it's just not what it seems.

Which brings me to my point: Not everything you see, not everything you hear about a person is true.  Your assessments are open to error.

Just because someone's social media portrays "happy" doesn't mean they don't suffer from depression.  Just because someone has a dog, a house, 4 children, and a spouse of 25 years doesn't always mean they fulfilled their dreams.

Just because a heartbeat is labeled "irregular" doesn't mean it's atrial flutter. And just because someone appears happy in their smile and in their laugh doesn't mean they're not somehow struggling in ways you cannot see.  

Sometimes our assessments about people are wrong. Sometimes our judgements are inaccurate.  Sometimes we jump to conclusions because we have seen the same manifestations so many times that it's easy to make cookie cutter labels.  Sometimes we get comfortable and rule out the truth because it's not "textbook."

This is dangerous...in nursing most definitely, and absolutely in life.  Our assessments, no matter how practiced, are not fool proof.  We all make mistakes....and we are ALL guilty of assessing each others lives and drawing up our own conclusions.

As nurses we are fair to our patients and we never count out possibilities. We should do the same with our family, friends and loved ones.  We should remember that people change.  We should be reminded that things aren't always as they seem.  And we should approach each other in the same way we do before our initial daily assessment....with an open mind and a new, fresh start.