No one works in the addiction treatment field today because he or she finds the work easy. Nor does anyone expect to make a fortune and retire early. Most caregivers do this work as a labor of love. They care about the right of fellow human beings to have a quality life, and in some cases they enter the field as a result of their own recovery. I work as a nurse in the addiction recovery field, and I care for addicts.
Nurses are reality-based. We assess clients by what we see, touch, measure, hear and smell. We compare the data our senses collect to our knowledge base, and either provide appropriate care, or seek an appropriate avenue of help if the needed care falls outside our area of expertise. We rely on science to extend our sensory input -- to process specimens, to regulate fluid intake, heartbeats, breathing, etc. Nurses have become technologically savvy, well armed pharmacologically, and are ready to do battle with disease.
Counselors, social workers, psychologists and psychiatrists test intellectual capabilities, assess cultural/social factors and contribute a myriad of other psychosocial details. They also compare data from their own internal knowledge base and provide appropriate care or referrals. While these professionals are every bit as hyper-vigilant as nurses, they work with more intangible data.
Together, members of the addiction treatment team pool their information and skills and delineate the best treatment plan for each client's individual needs. The treatment team then shares this plan with the client and modifies the plan keeping the client's own goals in mind.
Caregivers today face the conundrum of providing care in the context of human interactions, emotions and spirit &emdash;difficult factors to measure or predict. In the addictions treatment field, where interpersonal interactions are frequent and of critical importance, blending the hard facts of science with the soft heart of caring becomes vital. One cannot just tell a patient, "Your liver is partially destroyed due to the alcohol you drank," and then walk away. Adding the admonition, "Don't drink anymore!" is unlikely to have a positive effect. Nor can we take the client aside and tearfully inform him of his sclerotic liver and vow to follow him around to make sure he never drinks again. Rather, we must inform and educate in an empathetic, not sympathetic, caring manner.
What is "caring" exactly? We all
probably feel we know what caring is, but each of us has his or her
own, personal interpretation. One excellent definition of caring that
I find especially suitable comes from M.A. Ray. "Caring is viewed as
a complex dynamic, grounded in science and chaos theory, that elicits
reasoned moral choice through loving relationships and technical
competency within cultural contexts."1
Chaos is not simply disorder -- a state that must be controlled or avoided. Change and creative reordering originate in the boundless but undifferentiated potential chaos contains. At the edge of chaos, all potential negative, retrograde possibilities as well as all positive, non-chaotic possibilities exist. Caregivers stand on the edge of chaos, reaching into the confusion with complex and dynamic relational activities, giving clients the opportunity to see new possibilities for their future. Caregivers provide assistance out of chaos through communication and information/education, with new, positive choices that promote self-organization and new patterns of behavior.
By educating the family and providing intervention services, caregivers can sometimes change the flow of our clients' chaos significantly enough to bring them closer to the edge, where choice lies. Even without a classic intervention, life's circumstances will eventually bring all people in chaos bubbling up to the frothy edge. We must watch for the time when a client reaches out a hand for help, and grasp it. A cry for help may appear during a family crisis, due to a job problem, an interview for Child Welfare Services or any other time. Once they receive help, some clients proceed onward, while others take a fearful look at the new order and jump back into the chaos. Though confusing and potentially deadly, chaos is at least familiar territory. For many, the physical addiction draws them inexorably back.
The individual must make his or her own decision to step beyond chaos or to remain within its turbulent, confusing currents. Although they may be on the outside edge of chaos, caregivers should never step into the chaos themselves to try and "save" the patient unless they are securely tied to their own healthy system. Even then, stepping into chaos is not a safe tactic to employ. Chaotic influences, if strong enough, can break any tie to one's healthy life. How many of us in the addiction treatment field have seen coworkers disappear into relapse, emotional burnout or frustration from venturing too far, too often into the chaotic lives of our addicted clients? As caregivers, we also have to make a choice.
To choose how, when, where, what and who we care for involves the "reasoned moral choices" portion of Ray's definition. If we have a well developed ability to reason, we should know better than to throw ourselves into the maelstrom. The qualifier in this portion of the definition for caring is that the choices are "moral."
Morality, the practice of conforming to a standard of ethical behavior, was often taken for granted in the past. Most businesses nowadays have a mission statement, philosophy or a code of ethics that includes some moral judgments about how to treat the patient. I cannot think of a single caregiving profession, licensed or credentialed, that does not have a code of ethics. If you are unaware of your particular code of ethics, check your policy manuals, write or call your licensing or credentialing board and ask for a copy and become familiar with it. If you find no code of ethics exists, create a professional committee of your peers, and develop one. Put your code of ethics into practice by filtering your choices of care through its screen.
You must temper your code of ethics "through loving relationships." Without love, there is no reason to care. When using the term "love," I refer not to the romantic state nor to the psychological states of transference and cross-transference. Instead, I refer to the spiritual state of universal love, the type of non-judgmental love we hold for the good of all humanity. To embrace this type of love is to embrace the concept of a Higher Power that cares for everyone, and strive to reflect that care to the best of our abilities. This is a most daunting task. It involves constant evaluation of the caregiver's own motives and willingness to align with such a high ideal. Without this type of love, there is no caring.
Care must be provided with "technical competency." This implies not only the handling of machines, but also the competence of providing your professional skills with little or no error. Research continually provides new tools to treat the addicted client. For example, new medicines such as Naltrexone aid in the reduction of alcoholic relapse and reduce nicotine-usage relapse. Psychiatric testing is always refining and redefining. It is the caregiver's responsibility to stay abreast of new developments as they become available. In order to provide the optimum care they are morally responsible to provide, caregivers need continuing education and awareness of specific advancements within their particular profession. Knowledge and talent are the hallmarks of technical competency and cannot be faked.
Care must also be provided within the context of the client's cultural heritage and influences. To ignore a client's culture and fail to address their cultural issues would be like ignoring their inherent strengths and failing to modify their treatment plan to take advantage of them. Not to acknowledge cultural issues would be tantamount to sabotaging the client's recovery.
Cultural issues cut across the entire holistic spectrum: eating habits, spiritual beliefs, communication, sexuality, male/female relationships and roles, emotional expression, reality interpretation, social interaction, and so on. If we do not explore and deal with our clients' culture, we make them less than they truly are -- cardboard caricatures of averages and assumptions. To turn a blind eye to clients' cultural influences, would be like making them invisible -- you can't treat what you can't see. We must acknowledge and actively deal with a client within the context of culture for a fuller understanding of the client as a human being. We must also remain true to our spirit of a loving relationship and provide the same level of care to all people of all cultures.
If we, for any reason, cannot provide the same level of care to a client with cultural issues, then we must refer that client to someone who can.
Care must come from the heart. Each of us has our own, unique way of expressing how we care. There are numerous and creative ways to provide care -- as many ways as there are people who need care.
Remember, you also must care for yourself. Take time out for your own health. Caring for yourself allows you to give your best to others.
References
1. Ray, M.A., "Complex Caring Dynamics: A Unifying Model for Nursing Inquiry," Theoretic and Applied Chaos in Nursing, vol.12, no. 1, pgs. 23-32, (1994).
2. Ray, M.A., Didominic, V.A., Dittman, P.W., Hurst,P.A., Seaver, J.B., Sorbello, B.C. & Stankes-Ross, M.A., "The Edge of Chaos: Caring and the Bottom Line," Nursing Management, vol. 26, no. 9, pgs. 48-50, (Sept. 1995).
3. Krieger, Delores, Ph.D., R.N., "The TherapeuticTouch: How to Use Your Hands to Help or to Heal," Prentice Hall Press, p. 38, (1986).
Dion L. Charlton is a state of Illinois Registered
Nurse, a certified addictions nurse specialist and a certified
addictions counselor through the Illinois Alcohol and Other Drug
Abuse Professional Counselor Association (IAODAPCA). He is currently
the nursing coordinator at the Illinois Institute for Addiction
Recovery at Proctor Hospital and is a member of the American Holistic
Nurses Association (AHNA).
© 1997 Targeted Publications Group, Inc. All rights reserved.
