Tuesday, 29 September 2015

The stethoscope, a patient and me

Mr Jamie Ranse
Faculty of Health, University of Canberra, Canberra, Australia
Flinders University, South Australia, Australia

During the 2015 Miss America pageant, a contestant and nurse, Kelley Johnson, stood on the stage dressed in her nursing uniform wearing her stethoscope. Kelley delivered a monologue about nurses, including her first-hand accounts of interacting with patients. Following the pageant, commentators on the American Broadcasting Company television program The View commented about the monologue stating: ‘what is she doing with a doctor’s stethoscope’? Internationally, nurses responded via social media.

The anecdote below provides insight into the phenomenological natural attitude of the stethoscope and what it may be like to experience a stethoscope as a nurse or as a patient. A stethoscope is a thing that has concrete properties, purpose and meaning. The stethoscope holds purpose and meaning for me as nurse:
I walk into the hospital and place my stethoscope around my neck. The stethoscope turns me from a lay person into a nurse, with tools ready-at-hand. My stethoscope is ready to be used for a particular purpose, auscultation. When I use my stethoscope I am interested in the patient as a whole, but I am concentrating on the sound that is reverberating through the tubing of the stethoscope. I am concentrating on the intricacies of the sound that is being listened to, such as the lub dub of a heartbeat. Whilst the stethoscope amplifies a sound of interest; I find it difficult to hear the conversations of those nearby or the sound of monitors alarming in the distance. External sounds are reduced to a muffle. I need to concentrate. The stethoscope allows for the unheard to be heard. The unheard provides insight into the patient’s condition. I hear what the patient themselves do not hear, I now know what the patient themselves do not know. My auditory insight provides knowledge about the patient’s condition for the sake of planning and evaluating care.
The patient’s experience of the stethoscope maybe different from that of the nurse. Perhaps patients have an expectation of a nurse with a stethoscope around their neck? That the nurse has a certain level of clinical knowledge? The stethoscope partners the nurse and patient in a collaboration of care:
As a patient I willingly lift my shirt for the nurse to use their stethoscope. I may not always be willing; on occasions I am hesitant to lift my shirt. The stethoscope may be cold. The stethoscope reminds me of my previous illness. The illness of a loved one. It may evoke a stressfully moment in life. I cannot hear my own heartbeat; it is only heard by the nurse that uses the stethoscope.
The young child or confused older person may not want the stethoscope near them. They may use their hand to brush away the stethoscope. Fighting against the stethoscope. Not realising that this tool is being used with the intent to assist, not hinder. For the unconscious patient or deceased, they have no choice. The nurse just uses the stethoscope without their willing or knowing.

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