Clinical Notes

then, encompasses not only a 'doing to' but, more particu-larly, a 'being with'. Indeed, 'to "be with" in this fullersense requires turning one's attention toward the patient,being aware of and open to the here and now sharedsituation, and communicating one's availability' (Paterson& Zderad 1988, p. 14). During those brief moments ofintimacy, had we achieved something of that elusivequality: a unity of purpose, a communion, a profoundsense of our shared humanity? What had he offered andcalled for? What had I received and returned? I recalledOliver Sacks' (1989 p. 58) observation.

Her disease and her pathological potentials I hadalready seen; her mysterious reserves of health andsanity only became apparent to me after [that time].

Such encounters, such moments of being, give tonursing a rich depth of meaning. Certainly, the effect ofone's presence can be known much more vividly than itcan be conceptualized and conveyed to others. The tech-nical and procedural aspects of professional caring aregiven prominence whilst our language of feeling languisheswith neglect. To the extent that it is ab.sent from descrip-tions of clinical practice, such descriptions lack the vitalityand authenticity true of life. Our collective knowledge,then, is surely impoverished as a result.

If, as Seedhouse (1986) has suggested, work for health isinextricably linked with enabling people to realize theirown potential, then I believe I contributed somethingtoward that man's well-being. Establishing a climate ofacceptance and open communication and gradually cultiv-ating his trust appeared to provide the necessary founda-tions for a mutually beneficial and expressive relationshipwhich developed throughout my placement. I felt privil-eged that he had been sufficiently comfortable with me toconfide his most intense and guarded feelings. Yet I feelalso ill-at-ease. My bathing his feet as he silently wept hasa certain surrealistic and haunting quality, a spiritualappeal: an action greater than myself, a gesture of humility.

This gentleman was transferred to a hospice, where hedied several days later. He had no family.

References

Paterson J. & Zderad L. (1988) Humanistic Nursing, 2nd F.dn.National League of Nursing, New York.

Peplau H. (1969) Professional closeness. Nursing Forum 8, 342-360.Sacks O. (1989) Awakenings. Picador Publications, London.Seedhouse D. (1986) Health: The foundations for Achievement. John

Wiley & Sons Ltd., Chichcster.Strauss A., Fagerhaugh S., Suezek B. & Wiener C. (1982) Sentimen-

tal work in technologized ho.spitals. Sociology of Health and Illness/ 4,254-278,

Supportive therapies: a reflection onpracticeHELEN FOSTER EN(G),NNEB . ;Primary Nurse/Supportive Therapist, 7Z Link, Royal LiverpoolUniversity Hospital Trust, Prescot Street, Liverpool L7 8XP, UK

Within our unit we recognize supportive therapy as adimension of holistic care encompassing the whole person,body, mind and spirit. Those who wish to participateinclude patients and their carers. It aims to recognize thepatient's physical, psychological and spiritual needs. Itsavailability offers patients and their carers a broad range oftherapies which are intended to empower them to makeinformed decisions about the support they wish to receiveand to participate in.

Supportive therapy may help nurses to explore anddevelop a self-awareness of the therapeutic effect they mayhave on their patients. It provides a means to enable nursesto be creative and intuitive in their work, it providesfurther options to help them to develop their skills to ahigh standard and within a safe framework. At present weare practising holistic/therapeutic massage (adapted es-pecially for haematology patients), basic guided imagery,controlled breathing exercises, progressive muscle relaxa-tion and basic music therapy as an intrical part of nursing.Nurses use their interpersonal and counselling skills tocomplement supportive therapy. A psychological supportgroup has been developed for those nurses using support-ive therapy.

One particular supportive-therapy session involving agroup of three patients prompted me to reflect deeply onmy practice. This 'experiment', amongst others, hashelped me to develop a greater understanding of myselfand this has, I believe, had a beneficial eflect on manyother patients and their carers.

Linda a 45-year-old woman asked one morning if 1could help her become more relaxed. Linda was having a.second course of chemotherapy treatments for acute myel-oid leukaemia and she was familiar with supportive therap-ies from a previous admission. '

Another patient had a suspected relapse of myeloidleukaemia and had been admitted feeling generally unwell.Her name was Irene; she was in the bed opposite Lindaand asked if I could 'do' her at the same time. '̂ '̂-i* • " '

I asked Sarah in the next bed to Irene if the music fromthe tape would disturb her, Sarah, a nurse herself receivingchemotherapy for myeloma said 'no, not at all', and wenton to ask me exactly what I was doing. Following a generalexplanation Sarah told me that she herself was finding itvery difficult to relax and wondered if she could also be

Clinical Notes

involved. This group of patients occupied a four-beddedbay, the fourth bed space being empty.

After obtaining the necessary information for assess-ment the patients were made comfortable. A supportivetherapy group session was conducted which consisted ofsimple controlled breathing techniques, progressivemuscle relaxation and therapeutic/holistic foot massage.This was accompanied by the sound of a 'New World'tnusic tape. - j f lMio* blsjuw

As Irene had no previous experiences in this form ofsupport I was surprised to observe how well she managedwith the progressive rnuscle relaxation. Linda was doingwell and needed little instruction; however, this was herfifth session. Sarah, however, scetned to be finding it quitedifficult even with further guidance. Irene's feet were veryrelaxed during her massage. During Sarah's massage herfeet held little tension; however, her body appeared to bevery tense. Afterwards Litida commented that she likedthe session very much and contitiucd by sayitig that shewas very tired, was going to have a sleep. She then slept foran hour.

Sarah cotntnented that she had never been aware of sotnuch tension in her body, she laughed and said that herfeet were relaxed but the rest of her was tense. Sarahexplained to me that although she knew the theory andvalue of progressive tnuscle relaxation she foutid it verydifficult to put in to practice. She commented in heropinion 'nurses are alike, they find it very difficult toreceive care'. Sarah asked tne in-depth questions aboutstipportive therapies includitig cfiects and responses. Igave her instruction on some sitiiple breathing exercises forher to practice.

I had known Iretie for over a year and at almost everyadmission had been her associate nurse. I was totallyunprepared and touched by Irene's spontaneous reactionfollowitTg this simple session. She spoke to tiic on acompletely different level than she had done before. Shetalked about how she felt about many issues including herfamily, friends, religion and death. In previous situationswhilst nursing I recall observing certain views frompattents ready to talk about their fears and personal life.With the use of intuition, together with some insight andskill, I've usually been gradually able to facilitate suchopenness. In Irene's case her respotise was one of spon-taneity and without the cues I had once been familiar with.Whilst at ease and comfortable with this conversation I didwonder at the time, however, how a less experienced nurseWould deal and cope with Irene's itnmediate response.Although Irene didn't actually cry or come close to tearsshe was very emotional and continued to make reference tothe session over the following days to staff and other

patients. Irene told me she felt 'as if a huge weight hadbeen lifted off my shoulders' and her manner was that ofelation.

Irene went on to develop her new found skills inrelaxation and stated confidently 2 weeks later, that ithelped her to cope in every way. She continued to talkopenly and although confident she viewed her prognosisrealistically. Voicing her doubts about the future Ireneexplained to me that this time she didn't think she wouldget better. One afternoon 3 weeks following her firstsupportive-therapy session, she told me at length about thedecisions she had made concerning her family.

Although I feel there is much to be learnt from thisparticular experience I will concentrate on the assumptionsand preconceived ideas I had automatically made prior tothe session concerning Irene. Initially I assumed thatalthough Irene would probably enjoy the massage it wouldhave no great therapeutic effect. Two years later I now findthis very hard to believe. Although I included Irene in thesession I have to admit that inwardly I was half-hearted inthe attempt. Outwardly I believed I was professional withthe approach and I felt I appeared to give as much supportto Irene as Linda and Sarah. On reflection I realize I hadprejudged Irene and made an assumption about her whichproved to be quite incorrect. This experience led to furtherscrutiny of my practice and I became more aware of myperceptions of patients in many situations. I found that Icontinued to make assumptions and I am repeatedlyenlightened by most patients responses although now I ammore prepared for the enlightenment.

Gone the 'Good Samaritan'!: resusci-tation and litigationSIMON COOPER BA, RGNDistrict Resuscitation Training Officer, Plymouth Health Authority,Derriford Hospital, Derriford Road. Plymouth, Devon Pl.b HDH

Frotii a variety of publications over recent years it appearsthat tiiedical professionals are becoming increasingly para-noid over litigation, especially in the area of bystanderintervention. One recent article even implied that allnurses, in whatever speciality they are trained or whereverthey work, should be competent and efficient at a resus-citation attempt, while it is common to hear that manypeople would be loath to stop to help a casualty 'in casethey were sued'.

One has to be t ealistic. This fear of the law is totallyunjustified especially as recovery of damages cannot be